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Creative thinking about the CER agenda

Picture 13This week the Institute of Medicine (IOM) released its list of the top 100 topics that should be addressed in  comparative effectiveness research (CER) now — thanks to $1.1 billion in the American Recovery & Reinvestment Act
— that the federal government actually has the resources to do
substantial CER. IOM has prioritized the list by creating four
quartiles, noting that the first quartile is the highest priority
group, etc.

In order for the federal government to make good use of the huge pot of CER money, there are at least five things that they need to do to ensure its value and actually change care delivery.
I’m all for trying to find out whether me-too drugs add any significant
value. However, the greatest opportunities for implementing delivery
system change that improves care effectiveness and efficiency relate to
innovations in how care is organized and delivered, and how insights
are communicated to the broad range of health care actors — most
notably consumers.

That’s why I was heartened by the IOM’s top 100 list — though
certainly I’d move a few up a quartile or two. The list has many
projects that fit my priorities, including a strong emphasis on CER to
reduce health disparities.

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Drug Suspected in Michael Jackson Death Subject of Recall

Ritalin-SR-20mg-1000x1000 Results of Michael Jackson’s toxicology tests have not yet been released, but suspicions have centered on the powerful anesthetic and sedative drug propofol, also known by the brand name Diprivan. It was reportedly found in Jackson’s house, and a nurse who worked with him said he begged for propofol to help him sleep. 

Now, some lots of propofol are being recalled for contamination.

Last night, the Centers for Disease Control and the Food and Drug
Administration advised clinicians immediately to stop using propofol
from two lots found to be tainted with elevated levels of endotoxin, a
toxin made by bacteria. Regulators said Teva Pharmaceuticals, the
manufacturer, had begun a voluntary recall of the lots.

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Preventing Extortion

Roosevelt signs the Tennessee Valley Authority Act The debate about a public health insurance option mirrors the debate
about public power in the 1920’s and 30’s. The arguments then were very
similar to the arguments we hear today.

The principal issue then was whether the federal government should
enter the public power business by investing taxpayers’ money to build
the Tennessee Valley Authority and to harness the Columbia and other
rivers for electrical energy, or whether the sites should be transferred to the
private sector. A second issue was who should build transmission lines
and set wholesale prices when the Federal government built dams.

The answer to the second question was first enunciated on the Senate
floor in the fight over the Wilson Dam in 1920 by Senator John Sharp
Williams of Tennessee. He said, “The government should have somewhere a
producer of these things that should furnish a productive element to
stop and check private profiteering.” Thus was born the yardstick
federal policy which later found its way into TVA legislation through
the efforts of Nebraska’s Senator George Norris. In a 1932 campaign
speech in Portland, Oregon, Franklin Roosevelt referred to his TVA and
other regional proposals as “yardsticks to prevent extortion against
the public.”

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Data to the People

I have been a strong proponent of the creation of a National Health Record (NHR), but will it increase the quality of care for each citizen? Without 100 percent compliance by all healthcare providers the establishment of the NHR will bear little fruit for its expense. Proponents of a NHR site the achievements of the VHA. VHA patients include highly mobile active and inactive soldiers. Ubiquitous methods for viewing clinical data are critical, however Joe Outpatient doesn’t move around in this manner nor does he stray far from the facilities where he receives care.

 

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It’s Not Just Doctors in Short Supply

Policy-makers involved in healthcare reform are making a mistake in disproportionately emphasizing ourWartman current doctor shortage while neglecting serious shortages of care providers in other fields of health.  Rather than continuing a failed, piecemeal approach, the nation needs to establish a multi-professional, multi-disciplinary, national planning body charged with carrying out a comprehensive and coordinated national health workforce policy.  National healthcare reform cannot be realized without effective national health workforce reform.

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Time to Revisit Wyden-Bennett?

Roger collier

With the Washington insiders at politico.com
reporting this weekend that health care reform appears to be in “real
jeopardy,” and the Senate Finance Committee so uneasy that they have
decided to delay reform bill markup until after the July Fourth recess,
it’s increasingly clear that an approach of layering more and more
fixes onto the present system isn’t going to work. 

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