“The idea of medical transparency undergirding provisions in the 2016 Cures Act is broadly supported. But implementation of the regulations expanding access to medical records, which took effect in 2021, has been more divisive. Congress has taken little interest in this issue, and federal health officials have stood by the rules, arguing that concerns will be resolved as technology improves and as medical practices adjust how they prepare patients for results. “There is just a moral imperative here, which is for patients, this is their information. They ought to be able to access it whenever they want,” said Micky Tripathi, … Read More
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“Obesity spans a spectrum of health states, from an asymptomatic predisease risk factor—where excess adiposity (however defined) has yet to manifest overt signs or symptoms—to advanced disease stages complicated by downstream comorbid conditions, including diabetes, heart disease, and cancer. Obesity causes health effects and poses risks on a continuum; greater excess adiposity leads to higher health risk. In this way, obesity is analogous to many cardiometabolic risk factors, such as elevated blood pressure, dyslipidemia, and hyperglycemia. The location of adipose tissue also matters for some metabolic effects, whereas for others (for example, obesity’s mechanical effects), total adipose tissue affects functional … Read More
“The use of BMI has long been criticized as fundamentally flawed because it does not distinguish fat mass from lean mass. Despite this limitation, one nationally representative analysis found that BMI is strongly correlated (Pearson correlation coefficient of approximately 0.9) with fat mass adjusted for height as measured by dual x-ray absorptiometry (DXA), which is considered a gold standard. Moreover, BMI is strongly associated with indicators of cardiovascular risk, such as blood pressure and blood lipid levels, and is similar to DXA as a predictor of these risk factors and metabolic syndrome. The correlation between BMI and fat mass measured … Read More
“A daily dose of a widely used antibiotic can prevent some infections with syphilis, gonorrhea and chlamydia, potentially a new solution to the escalating crisis of sexually transmitted infections, scientists reported on Thursday. Their study was small and must be confirmed by more research. Scientists still have to resolve significant questions, including whether S.T.I.s might become resistant to the antibiotic and what effect it could have on healthy gut bacteria in people taking it every day. [..] Previous studies have shown that the antibiotic doxycycline substantially cuts the risk of new infections if taken within 72 hours after unprotected sex. … Read More
“Although this new frontier of [vertical] consolidation has the potential to generate efficiencies [UnitedHealthcare’s ownership of Optum Health (providers), Change Healthcare (analytics), a pharmacy benefits manager, pharmacies and a bank], there are also risks: vertically integrated conglomerates can deploy a range of financial tactics and engage in market abuses that raise costs, undermine fair competition, and erode the quality of patient care and physician morale. Driving this vertical consolidation has been the tidal shift from fee for service toward “capitation based” financing in public programs. Under these financing models, the federal government and state governments delegate the management of a … Read More
Excerpt – For a growing number of doctors, A.I. chatbots — which can draft letters to insurers in seconds — are opening up a new front in the battle to approve costly claims, accomplishing in minutes what years of advocacy and attempts at health care reform have not. [..] Doctors are turning to the technology even as some of the country’s largest insurance companies face class-action lawsuits alleging that they used their own technology to swiftly deny large batches of claims and cut off seriously ill patients from rehabilitation treatment. Some experts fear that the prior-authorization process will soon devolve … Read More
Excerpt – In 2022, my investigation in Science showed evidence that the famous 2006 experiment that helped push forward the amyloid hypothesis [for Alzheimer’s Disease] used falsified data. On June 24, after most of its authors conceded technical images were doctored, the paper was finally retracted. Days later, a City University of New York scientist behind a well-financed, controversial Alzheimer’s drug was indicted on charges alleging research fraud. Such cases are extreme. Yet few of the multitude of honest Alzheimer’s papers offer much hope to patients. In reporting for my forthcoming book about the disturbing state of play in Alzheimer’s … Read More
“[Introduction] Nearly 10% of cardiovascular events are attributed to type 2 diabetes (T2D). [..] Prior large RCTs [randomized controlled trials], including Look AHEAD (Action for Health in Diabetes), DIRECT, and the Diabetes Prevention Program, attempted to investigate the cardiovascular benefits of weight loss and increased PA [physical activity] volume among individuals with prediabetes or T2D, but no relationship between lifestyle-induced weight loss and cardiovascular benefits has been reported. [..] this study evaluates the interactions of weight loss and PA volumes in association with the risk of cardiovascular events by conducting a post hoc secondary analysis of the Look AHEAD trial … Read More
“In January 2024, the pharmaceutical company Eli Lilly launched LillyDirect, a service that includes a direct-to-consumer pharmacy and a referral network of in-person and telehealth clinicians. These tools are intended to add new options for patients to access the company’s drugs, including its newly approved antiobesity drug tirzepatide (Zepbound). [..] LillyDirect is similar to several pharmacies that cut out insurers and PBMs [pharmacy benefit managers] and allow patients to purchase drugs at discounted cash prices. These include pharmacies introduced by major retail companies like Walmart, Costco, and Amazon, and independent pharmacies like the one named for its billionaire cofounder Mark … Read More
Excerpt – Consulting medical teams nearly always follow my antibiotic recommendations, no matter how idiosyncratic they may seem, but recommending that they stop checking white-cell counts on stable inpatients seems to strike them as beyond the pale. Much of this trend is driven, I believe, by the quantitative fallacy: the human tendency to attach too much weight to factors that are easy to measure, and not enough weight to more complex, hard-to-quantify variables. This inclination induces doctors and patients alike to obsess over the crisp, objective, but highly nonspecific assessment of leukocytosis, while eschewing the seemingly squishy but highly informative … Read More