“In the vast majority of states the ObamaCare exchanges will offer less, not more, insurer competition than the state’s current individual market [and the plans are] something akin to Medicaid managed care for the middle class.”
“Hospitals Prescribe Big Data to Track Doctors at Work,” a July 12, 2013, article in The Wall Street Journal, describes a California health system that monitors physicians and grades them on the basis of what percentage of their patients meet certain metrics, such as a blood glucose level (as measured by HbA1C) of less than 8 percent.
But if some diabetes patients refuse to come in for visits, physicians can’t track their progress. If their blood sugar is elevated when they do come in, the measurement system gives the physician a black mark.
Dr. Keith Lee has found a solution to this problem. He refuses to give such patients long-term prescriptions. This forces them to come in for checkups in order to get new prescriptions. “I cut them short, and then they get the message,” he reportedly said.
According to the July 11, 2013 issue of The New England Journal of Medicine, the Look AHEAD trial has been canceled on the “basis of a futility analysis” after 9.6 years of follow-up. It was designed to study whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among overweight or obese patients with Type 2 diabetes. Short of interning people in exercise camps, it is hard to imagine a more intensive intervention.
The 5,145 participants were randomly assigned to either a control group or an intensive lifestyle intervention group. The control group received the usual information about behavioral strategies for adopting standard recommendations about how to eat right and exercise.
…even after some 400 completed clinical trials in various cancers, it’s not clear why Avastin works (or doesn’t work) in any single patient. “Despite looking at hundreds of potential predictive biomarkers, we do not currently have a way to predict who is most likely to respond to Avastin and who is not,” says a spokesperson for Genentech, a division of the Swiss pharmaceutical giant Roche, which makes the drug.
That we could be this uncertain about any medicine with $6 billion in annual global sales — and after 16 years of human trials involving tens of thousands of patients — is remarkable in itself. And yet this is the norm, not the exception. We are just as confused about a host of other long-tested therapies: neuroprotective drugs for stroke, erythropoiesis-stimulating agents for anemia, the antiviral drug Tamiflu — and, as recent headlines have shown, rosiglitazone (Avandia) for diabetes, a controversy that has now embroiled a related class of molecules. Which brings us to perhaps a more fundamental question, one that few people really want to ask: do clinical trials even work? Or are the diseases of individuals so particular that testing experimental medicines in broad groups is doomed to create more frustration than knowledge?
Researchers are coming to understand just how individualized human physiology and human pathology really are. On a genetic level, the tumors in one person with pancreatic cancer almost surely won’t be identical to those of any other. Even in a more widespread condition like high cholesterol, the variability between individuals can be great, meaning that any two patients may have starkly different reactions to a drug.
More at the NYT.
The 2010 Dietary Guidelines for Americans was developed by the Department of Health and Human Services and the Department of Agriculture. They say that dietary sodium intake should be reduced to less than 2,300 milligrams per day for the general population, and to less than 1,500 milligrams per day for African Americans, people over 50, and people who have hypertension, diabetes, or chronic kidney disease. This blog has been critical of that determination since early 2009, with posts on the Salt Police, Rejoinder on Salt, The Other Side of the Salt Debate, and The Uneasy Case Against Salt.
The Centers for Disease Control asked the Institute of Medicine (IOM) to examine the literature on dietary sodium intake and its effect on health outcomes in the general U.S. population. The May 14, 2013, summary of the IOM consensus report concludes that there is no evidentiary basis for the conclusion that sodium intakes below 2,300 milligrams per day either “increase or decrease the risk of heart disease, stroke, or all-cause mortality in the general U.S. population.”
The committee did find some evidence suggesting that sodium intake levels in ranges from 1,500 to 2,300 mg/day may have adverse health consequences for those with diabetes, kidney disease, or cardiovascular disease.
Noting that there is evidence to support a “positive relationship between higher levels of sodium intake and risk of CVD” via the effect of salt intake on the blood pressure of people who have high blood pressure, the IOM calls for “more randomized controlled trials.” The press release for the report says that the report does not establish a health intake range for salt because “variability in the methodologies used among the studies would have precluded it.”
In the past 30 years, the percentage of American adults who are obese has doubled, driving a sharp rise in such chronic conditions as diabetes, heart disease and hypertension.
The ramifications for health spending are significant. Annual health costs for obese individuals are more than $2,700 higher than for non-obese people. That adds up to about $190 billion every year. And many of these costs are borne by Medicare, which will spend a half-trillion dollars over the next decade on preventable hospital readmissions alone.
Ken Thorpe and Tommy Thompson in USA Today.
It’s not just sore throats and flu shots anymore. Walgreens today became the first retail store chain to expand its health care services to include diagnosing and treating patients for chronic conditions such as asthma, diabetes and high cholesterol…
Retail clinics generally appeal to consumers looking for convenience and cost savings. Costs are roughly 30 percent to 40 percent less than similar care at doctor’s offices and 80 percent cheaper than at an emergency room, according to a 2011 study published in the American Journal of Managed Care.
This is from Kaiser Health News.