By HENRY J. AARON

The Supreme Court yesterday decided that Congress meant what it said when it enacted the Affordable Care Act (ACA). The ACA requires people in all 50 states to carry health insurance and provided tax credits to help them afford it. To have offered such credits only in the dozen states that set up their own exchanges would have been cruel and unsustainable because premiums for many people would have been unaffordable.

But the law said that such credits could be paid in exchanges ‘established by a state,’ which led some to claim that the credits could not be paid to people enrolled by the federally operated exchange. In his opinion, Chief Justice Roberts euphemistically calls that wording ‘inartful.’ Six Supreme Court justices decided that, read in its entirety, the law provides tax credits in every state, whether the state manages the exchange itself or lets the federal government do it for them.

That decision is unsurprising. More surprising is that the Court agreed to hear the case. When it did so, cases on the same issue were making their ways through four federal circuits. In only one of the four circuits was there a standing decision, and it found that tax credits were available everywhere.

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By BRIAN C. QUINN

Historically, placebos have been defined as a sugar pill or inert substance used as a control variable in experimental studies. Placebo effects were considered a nuisance. Researchers and clinicians have paid little attention to the fact that placebos seem to produce their own health impacts.

But in a July 2 New England Journal of Medicine Perspectives piece , Ted Kaptchuk of Harvard Medical School and Franklin G. Miller from the Department of Bioethics at the National Institutes of Health, show us that there’s more to placebos than we originally thought.

For example, in a study of patients with irritable bowel syndrome, patients experienced adequate symptom relief when given a placebo, compared to those who didn’t receive a placebo. That’s a common enough finding. But what’s most interesting is that relief was even greater when the placebo was coupled with more engaged positive interactions with a provider, such as attentive listening and thoughtful conversation. In another study, when given morphine directly by a doctor or nurse through a syringe, patients experienced more pain relief than when it was administered through an IV. Seeing it administered increased the effectiveness of the medication.

This evidence leads the authors to argue that placebo effects are not the products of dummy treatments but actually the effects of immersion in a health care environment with all its cues and signals. Continue reading…

By CINDY NAYER

As an innovator, restless entrepreneur, and national award winner for consumer engagement, I was intrigued with the stories I was reading about accessing the patient portal for data, basically the looking glass into “my data.” For those who are not familiar with health data, here’s a quick history.

As part of the Great Transformation in health care, HHS, CMS, and ONC (which is the Office of the National Coordinator for Health Information Technology), and others regularly update rules on health data, privacy, HIPAA and meaningful use. Meaningful use—otherwise known as MU—is a term that describes how the stakeholders, starting with the patient, provider (doc, hospital, etc.) and plan can and should be using the data, because it provides historical and patient-centric context. Meaningful use as a measure of quality improvement was launched to describe the kinds of health IT [HIT] improvements that would be developed over the course of several years.

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By DARRELL WEST and JACK KARSTEN

By MARGALIT GUR-ARIE

The latest salvo in the interoperability and information-blocking debate comes from two academic experts in the field of informatics, and was recently published in JAMIA. In the brief article, Sittig and Wright are endeavoring to describe the prerequisites for classifying an EHR as “open” or interoperable. I believe the term “open” is a much better fit here, and if the EHR software happens to come from a business dependent on revenues, as opposed to grant funding from the government, bankrupt may be a more accurate description. Since innovation in the EHR market seems to lack any disruptive effects, perhaps a bit of disruptive regulation would help push everything over the edge.

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