Implausibility of radical life extension in humans in the twenty-first century

“In 1990, it was hypothesized that humanity was approaching an upper limit to life expectancy (the limited lifespan hypothesis) in long-lived populations, as early gains from improved public health and medical care had largely been accomplished, leaving biological aging as the primary risk factor for disease and death; the rate of improvement in life expectancy was projected to decelerate in the twenty-first century; and e(0) [life expectancy at birth] for national populations would not likely exceed approximately 85 years (88 for females and 82 for males) unless an intervention in biological aging was discovered, tested for safety and efficacy and broadly … Read More

State Medical Boards and Interstate Telemedicine in the Courtroom

“Despite the convenience and value of telehealth, many states have rolled back COVID-19 pandemic–era flexibilities and reimposed strict licensure requirements for telemedicine. Thus, as it was prepandemic, so it is again that a physician, duly licensed in their home state, is prohibited from consulting or following up with an out-of-state patient via video or phone unless they are also licensed in the patient’s state. Penalties for doing so without that license can amount to tens of thousands of dollars in fines and potential imprisonment. Despite growing pressure to respond to patient preferences and widespread evidence of the benefits of interstate … Read More

Value-Based Payment and Vanishing Small Independent Practices

“An estimated 80% of physicians are now employed by hospitals, health systems, and corporations. Many factors have contributed to this shift away from independent practices, including rising administrative burdens, changing employment preferences, greater capital demands for health information technology, and favorable financial incentives (eg, site-differential payments). However, underappreciated among these factors is another important accelerant of corporate consolidation: the shift from fee-for-service to value-based payment models. [..] Evidence suggests that, on average, they [independent practices directly owned by clinicians] exhibit lower per-patient spending, fewer preventable admissions, and lower readmissions compared with their hospital-owned counterparts. [..] However, independent practices are often … Read More

How Psychedelic Research Got High On Its Own Supply

“First synthesized by the drug company Merck in 1912, MDMA, also known as the party drug Ecstasy or molly, has both stimulant and hallucinogenic properties. It also has the ability to foster feelings of connectedness and to seemingly dissolve a person’s mental boundaries, which advocates say can help patients revisit their trauma more comfortably during psychotherapy sessions in order to heal from it. Lykos has spent years conducting clinical trials testing whether MDMA-assisted psychotherapy could alleviate the symptoms of PTSD. Its most recent drug trial showed that more than 86 percent of people treated had a measurable reduction in symptom … Read More

The Future of Medicare and the Role of Traditional Medicare as Competitor

“The basic benefits package of Medicare — replete with deductibles and coinsurance — long ago began falling short of the promise of financial protection as articulated by President Lyndon Johnson in 1965. In 2019, out-of-pocket spending in traditional Medicare averaged $7,053 among all seniors and $12,315 in the top decile, which was equal to 25% of seniors’ mean after-tax income and to 69% of retirees’ mean Social Security income. [..] Over time, Medicare Advantage has evolved into a conduit for financing coverage expansion that is arguably overdue. Enrollees enjoy substantially lower premiums for supplemental and prescription drug coverage than they … Read More

Doing more cancer screening won’t reduce Black-white health disparities

“Why would more screening in both Black and white Americans reduce the mortality disparity between the two groups? What’s more, cancer screening actually stands out for its lack of racial disparity. The proportion of Black and white women having mammograms has been virtually identical for the past three decades (in fact, Black women currently have the test at slightly higher rates). Yet deaths from breast cancer are about one-third higher in Black women. For the past two decades, a similar pattern has been seen in colorectal cancer screening — equal rates among Black and white Americans — yet colorectal cancer … Read More

Different reasonable methodological choices can lead to vastly different estimates of the economic burden of diseases

“Landeiro and colleagues computed the economic burden of four diseases (cancer, coronary heart disease [CHD], dementia, and stroke) in England using consistent methodology and a broad definition of disease burden. This analysis is an important advance that will allow policy makers, researchers, and other stakeholders to assess the absolute and relative burden of these diseases in a meaningful way. The Global Burden of Disease also uses a consistent methodology for estimating the burden of many diseases across countries. However, its methodology focuses only on mortality and morbidity, which are evaluated comprehensively, but does not account for many other costs included … Read More

Medical Expertise — Balancing Science, Values, and Trust

“over the past half-century, as was made especially clear by the Covid pandemic, patients have increasingly challenged their physicians’ expertise. Merely providing patients with data and advice has become an inadequate way to disseminate information and promote informed consent. [The author goes on to describe medicine’s historical failures with patients, including Tuskegee, childbirth practices in the 1970s, harvesting cancer cells from Henrietta Lacks, physicians paid by tobacco companies to “manufacture doubt,” the slow response to the AIDS epidemic and 2024 medical article retractions from researchers at the Dana-Farber Cancer Institute.] To some degree, the AIDS model — in which patients … Read More

Optimizing Employer-Sponsored Health Insurance in the Face of Increasing Cost Pressures

“[Data analytics company Embold Health chief executive officer Daniel Stein:] In the larger health care policy discussions, Medicare and Medicaid and other government programs get a lot of attention. But as you noted, most working Americans get their coverage through their employer. All in, about 165 million Americans are getting coverage through their employer. It’s a tough job to provide health coverage for your employees. Not only do you have to worry about things like cost and quality, the usual types of pressures that a purchaser has, but coming through this global [Covid-19] pandemic, employers were focused for a long … Read More

Toward a Comprehensive Measure of Drug-Attributable Harm

“While overdose deaths and related outcomes, such as the prevalence of substance use disorders (SUDs), are helpful indices, they fail to capture the broader dimensions of drug-attributable harm, including non-overdose deaths, chronic disease morbidity, and other conditions that cause people who use drugs to live in a state of less than full health. [..] The DALY [disability-adjusted life-years, the sum of years lived with disability and the years of life lost due to premature death] index captures the health burden beyond overdose deaths and SUDs, to encompass other morbidity and mortality attributable to substance use. Such outcomes could include conditions … Read More