The Health Care Blog – Page 243 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Mrs. Verma Goes to Washington

Nov 15, 2018• 13

By ANISH KOKA MD

Seema Verma, the Trump appointee who runs Medicare, has had an active week. The problem facing much-beloved Medicare is one that faces every other government-funded healthcare extravaganza: it’s always projected to be running out of money. Medicare makes up 15% of the total federal budget. That’s almost $600 billion dollars out of a total federal outlay of $4 Trillion dollars. The only problem here is that revenues are around $3.6 trillion. We are spending money we don’t have, and thus there there is constant pressure to reduce federal outlays.

This is a feat that appears to be legislatively impossible. The country barely is able to defund bridges to nowhere let alone try to reduce health care spending because, as everyone knows, any reduction in health care spending will spawn a death toll that would shame the black plague. The prior administration’s health policy wonk certified approach was to change the equation in health care from paying for volume to paying for value. This, we were assured, would allow us to get better healthcare for cheaper! And so we got MACRA, The Medicare Access and CHIP Reauthorization Act, that introduced penalties for doctors unable to provide ‘good’ care. Never mind that in some years good care means you treat everyone with a statin, and in others it means treat no one with a statin. When in Rome, live like the Romans. In 2018 parlance, that roughly translates to “check every box you can and everything will be all right.”Continue reading…

Health in 2 Point 00 Episode 58

Nov 14, 2018• 1

Today on Episode 58 of Health in 2 Point 00, Jess and I have more to share from Exponential Medicine, but this time we’re at the Health Innovation Lab checking out all of the startups. In this episode, Jess and I talk to Meghan Conroy from CaptureProof about decoupling medical care from time and location, Care Angel‘s Wolf Shlagman about the world’s first AI and voice powered virtual nursing assistant, and highlight Humm’s brain band which improves working memory, concentration, and visual attention. We leave you with some parting words from Godfrey Nazareth: “Let’s set the world on fire. Let’s change the world, with love.” -Matthew Holt

Health Plan Innovation Gets a ‘New Look’ | AHIP’s CEO Matt Eyles

Nov 14, 2018• 2

By JESSICA DaMASSA, WTF Health

“I don’t know that what they’re doing is going to be as transformative as maybe the potential of it is – and it’s going to take time. I don’t know that they’re going to ‘all-of-a-sudden’ leap frog over all the things that health plans have been doing for decades. I think they’re going to learn that this is really complicated stuff…”

Health plan innovation got a makeover this year. What used to look like value-based care models and telehealth visits has transformed. Health plan innovation is sexier – with big-dollar M&A deals like CVS-Aetna and Cigna-ExpressScripts looking to flatten the industry. Meanwhile, brand name collaborations like Amazon-Berkshire Hathaway-JP Morgan may prove that payment model innovation is unexpectedly ‘label-conscious.’

So, how are health plans dealing with this startling new look? And what should health tech startups who want their innovation investment dollars do now??

A Conversation About the Dangers of Overhydration with Professor Timothy Noakes

Nov 13, 2018• 2

By SAURABH JHA MD

Professor Timothy Noakes, a South African exercise scientist and emeritus professor at the University of Cape Town who has run over 70 ultramarathons, speaks to me about the dangers of overhydration in endurance sports.

Listen to our conversation at Radiology Firing Line Podcast.

Saurabh Jha is a contributing editor to THCB and host of Radiology Firing Line Podcast of the Journal of American College of Radiology, sponsored by Healthcare Administrative Partner

The Internet of Medical Things Gold Rush (And My Grandfather’s Wooden Leg)

Nov 12, 2018• 5

By MICHAEL MILLENSON

The most intriguing aspect of the recent Connected Health Conference was the eclectic mix of corporations claiming cutting-edge expertise in the Internet of Medical Things (IoMT).

HP, a legend in computer hardware, was touting a service that scoops data from Web-enabled home devices such as bathroom scales up into the cloud and then manages the information on behalf of your doctor. This presumably fulfills their corporate vow to “engineer experiences that amaze.”

Verizon, not content with deploying its cable TV clout to “deliver the promise of the digital world,” is connecting to a chip on the lid of your pill container that can monitor whether you’re taking your medications.

Even Deloitte, rooted in corporate auditing, has translated its anodyne assertion that “we are continuously evolving how we work” into a partnership with Google. DeloitteASSIST uses machine learning to translate verbal requests from hospital patients into triaged messages for nurses.
Continue reading…

Looking Back at the RWJF Challenges

Nov 9, 2018

Last Month in Oncology with Dr. Bishal Gyawali

Nov 8, 2018• 8

By BISHAL GYAWALI MD

Me-too deja vu

I read the report of a phase 3 RCT of a “new” breast cancer drug but I had the feeling that I had already read this before. Later I realized that this was indeed a new trial of a new drug, but that I had read a very similar report of a very similar drug with very similar results and conclusions. This new drug is a PARP inhibitor called talazoparib and the deja vu was related to another PARP inhibitor drug called olaparib tested in the same patient population of advanced breast cancer patients with a BRCA mutation. The control arms were the same: physician choice of drug, except that physicians couldn’t choose the one drug that is probably most effective in this patient population (carboplatin). The results were nearly the same: these drugs improved progression-free survival, but didn’t improve overall survival. In another commentary, I had raised some questions on the choice of control arm, endpoint and quality of data about the olaparib trial when it was published last year. This current talazoparib trial is so similar to the olaparib trial that you can literally replace the word “olaparib” with “talazoparib” in that commentary and all statements will stay valid.

The oncology version of half-full, half-empty glass

The PARP inhibitors olaparib and niraparib are also approved in ovarian cancer based on improvement in progression-free survival (PFS), without improving overall survival (OS). If a drug doesn’t improve OS but improves only PFS, it should also improve quality of life to justify its use. According to two new reports, these drugs do not appear to improve quality of life. The niraparib trial reported that the patients were able to “maintain” their quality of life during treatment while the olaparib trial reported that olaparib did not have a “significant detrimental effect” on quality of life. I find it remarkable that a drug that isn’t proven to improve survival is lauded for not significantly worsening quality of life … at $10,000 a month!

It is also important to recognize that these drugs were tested as maintenance therapy against placebos. For “maintenance therapies,” as explained in this paper, improving PFS alone is not an important endpoint. That’s why I am also not excited about this new trial of sorafenib maintenance in ovarian cancer. A drug has to be very ineffective to fail to improve even PFS as a maintenance therapy against placebo.
Continue reading…

Health in 2 Point 00 Episode 57

Nov 7, 2018

On Episode 57 of Health in 2 Point 00, Jess and I report from Exponential Medicine. In this episode, Jess and I talk about digital surgery and how Shafi Ahmed and Stefano Bini are transforming surgical training. She also asks me about my favorite session, one by Anita Ravi on health care for those who have been sex trafficked. Other highlights include ePatient Dave’s talk about access to data for patients and letting patients help, and Leerom Segal’s overview of why voice matters- Matthew Holt

The IPCC Confirms Life As We Know It Will Soon Cease to Exist

Nov 6, 2018• 7

By DAVID INTROCASO PhD

THCB readers may recall last year in early June when the Trump administration announced it would withdraw from the 2015 Paris climate accord and earlier this January when the World Economic Forum met to discuss its global risk report that included the chapter, “Our Planet on the Brink,” I discussed in part (here and here) the health care industry’s indifference to global warming (See also my related 3 Quarks Daily essay.) Now comes the United Nation’s Intergovernmental Panel on Climate and Change’s (IPCC’s ) latest report. Once again overwhelming scientific evidence that confirms life as we know it on this planet will soon cease to exist is received with apathetic insouciance.

Created in 1988 the IPCC is considered the world’s definitive scientific body on climate change and co-winner with Al Gore of the 2007 Nobel Peace Prize, finalized in early October its report, “Global Warming of 1.5°C.” The 2015 Paris accord called for the report. It was prepared by nearly one hundred scientists who analyzed thousands of the most recent scientific evidence. The report’s summary was accepted by over 180 countries including the American and Saudi Arabia delegation during the IPCC’s meeting recently concluded in South Korea.

What is newsworthy about the IPCC report is its conclusion that keeping or holding temperature increases below 2°C, the goal of the Paris agreement, would not avoid the catastrophic effects of global warming. At 1.5°C life on this planet would suffer serious or dire harm, at 2°C catastrophic harm. Specifically, the report compared the impact between a 1.5°C (2.7°F) increase in temperature with a 2°C (3.6°F) increase (The earth has already warmed by 1°C since the pre-industrial era). Among numerous other findings, should temperatures increase to 1.5°C, the report found of 105,000 species studied, four percent of vertebrates (that include us), eight percent of plants and six percent of insects would lose half of their climatically-determined geographic range. At 2°C, the percents double to triple. Global crop yields will decline significantly. At 1.5°C we will lose 70 to 90 percent of coral reefs, at 2°C there will be a 99 percent loss. At 1.5°C Marine fishery losses or the global annual catch loss would be 1.5 million tons, at 2°C they double.

2018 Midterms: The Year of the Female Physician

Nov 5, 2018• 9

By NIRAN AL-AGBA MD

While women make up more than half of the U.S. population, an imbalance remains between who we are as a nation and who represents us in Congress. The gender disparity is no different for physicians: more than one third of doctors in the U.S. are women, yet 100 percent of physicians in Congress are men. To date, there have only been two female physicians elected to Congress.

However, in the coming midterm election, there are six races with a chance at making history. It’s these battles which could make 2018 “The Year of the Female Physician.”

I remember being a first-time voter in 1992, labeled at the time “The Year of the Woman.” I was a sophomore at Michigan State University and turned 18 just three days before the election. Following the contentious Supreme Court hearings involving Clarence Thomas and Anita Hill, an unprecedented number of female candidates were vying for office that election year.

President George H. W. Bush was vilified for an appalling answer to the question of when his party might nominate a woman for President. “This is supposed to be the year of the women in the Senate,” he quipped. “Let’s see how they do. I hope a lot of them lose.” Frustrated about the state of gender inequality in politics, a little-known “mom in tennis shoes,” Patty Murray, decided to run for the U.S. Senate to represent Washington. She won, paving the way for an unprecedented number of women to enter national politics over the next 30 years. Still, very few of them have come with a background in medicine.