“Transparency has always been seen as a hallmark of honesty and integrity. The logic is familiar: democracies aspire to be transparent, but dictatorships are opaque; faithful spouses are guileless, while philanderers lie; reputable businesses operate in the open, but shady operations literally draw the shades. Collectively, we’ve embraced Louis Brandeis’s dictum that sunlight is the best disinfectant. We demand transparency in government, charitable institutions, nutrition labels, and middle-school grading rubrics. The medical record should be no different. [..] In 2008, Ethan Bernstein, an associate professor at Harvard Business School, travelled with a team of students to a vast mobile-phone-manufacturing plant … Read More
All posts by Anupam
Excerpt – The three biggest PBMs [pharmacy benefit managers] — OptumRx, CVS Caremark, and Express Scripts — control about 80% of prescription drug sales in America and are the most profitable parts of the health conglomerates in which they’re nestled. CVS Health, the fourth-largest U.S. corporation by revenue on Fortune’s list, owns CVS Caremark and the insurer Aetna; UnitedHealth Group, a close fifth, owns Optum; and Cigna, ranking 12th, owns Express Scripts. While serving as middlemen among drugmakers, insurers, and pharmacies, the three corporations also own the highest-grossing specialty drug and mail-order pharmacies. [..] Drug manufacturers claim that exorbitant PBM demands … Read More
“Many countries and organizations are taking stock of what can be learned from the Covid experience. In Singapore, the office of the prime minister recently issued an assessment of that country’s response to determine what worked and what didn’t. Such honest reflection is essential to ensure that the response to the next pandemic is better. Unfortunately, efforts stalled in Congress to create a national commission to render a nonpartisan assessment of how the country responded to a contagion that so far has killed some 1.1 million people. [..] we offer 13 lessons, many of which are not yet fully appreciated or integrated … Read More
Excerpt – In this issue of JAMA Cardiology, Cohen and colleagues have performed a formal cost-effectiveness analysis of SGLT2 [sodium-glucose cotransporter-2] inhibitors for patients with heart failure and an ejection fraction more than 40%. They developed a computer-simulation model to project the long-term clinical benefits and costs for patients with HFpEF [heart failure with preserved ejection fraction] with and without SGLT2 inhibition. Their model was based on pooled estimates of baseline risk and effectiveness of SGLT2 inhibitors derived from the EMPEROR-PRESERVED and DELIVER trials. Because these trials followed up patients for a median of only 2.3 years, the authors extrapolated … Read More
“When Roe v. Wade was decided in 1973, a group of 100 U.S. professors of obstetrics and gynecology predicted that teaching hospitals would emerge as leaders in compassionate abortion care, creating outpatient clinics to meet the demand for legalized abortion. But most hospitals did not embrace abortion provision; many of them in fact adopted policies that were more restrictive than was legally required. Freestanding clinics instead emerged as the primary provider of abortion care, and this siloing was further reinforced by stigma, threats of violence, and the exclusion of abortion coverage by major health care payers. In 2020, hospitals accounted … Read More
“we believe the quality bonus program (QBP), which offers incentives for providing high-quality care in Medicare Advantage, needs critical review and strengthening to improve accountability — steps that will be particularly important to support enrollees with serious illness. The foundation of the QBP is a five-star rating system in which plans are scored on the basis of claims-based performance measures and patient surveys. [..] A decade after the QBP’s implementation in 2012, however, concerns about its accuracy in measuring quality and its ability to drive quality improvement have been persistently documented in academic research and MedPAC reports. The inaccurate reflection … Read More
“Exposure to firearm violence is associated with lasting consequences for youth and their loved ones. Indirect exposure (eg, witnessing violence) and direct exposure (eg, surviving an assault) can influence mental and physical health outcomes over the life course. In a subset of individuals, exposure is associated with the future enactment of firearm violence, feeding cycles of firearm violence at the community level. [..] At the same time, efforts must directly target the systemic inequities that concentrate firearm violence exposure among Black and Hispanic youth. Racial and ethnic disparities in these outcomes are profound and longstanding. In the study by Lanfear … Read More
“Three years into the Covid pandemic, SARS-CoV-2 is still with us. As the virus evolves, it continues to pose a health threat in terms of both acute infections (or reinfections) and postacute sequelae. In regard to the former, there is evidence that several pharmacologic interventions reduce the severity of infections, lessen morbidity, and lower mortality. Prevention programs have also been successful in reducing overall infection rates. These efforts can be traced in part to colossal federal support for work ranging from vaccine development to clinical trials to nationwide educational endeavors. Such impressive support is all the more striking in contrast … Read More
An excerpt: Introduction [..] Although an increasing number of studies have focused on the impact of single cardiometabolic diseases on cognitive aging, only a few have considered the associations between their frequent co-occurrence and the loss of cognitive health. Additionally, previous studies of cardiometabolic multimorbidity and cognitive ageing have been limited to only examining individuals from European regions. These countries have a lower prevalence of individuals with cardiometabolic diseases than some countries in Asia, which could potentially lead to different effect estimations regarding the associations between these types of disease and cognitive ageing. [..] Methods This pooled multicohort study utilised data … Read More
“For fifty years, Roe protected providers from legal risks like the ones taken on by the Jane Collective, an underground network of women in Chicago. Collective members arranged more than eleven thousand illegal abortions in the late nineteen-sixties and early seventies, until a team of detectives raided their makeshift clinic and charged them with multiple counts of “conspiracy to commit abortion.” (Just before their cases went to trial, the Supreme Court legalized abortion.) Arguably, providers face greater legal dangers now than they did before Roe. Carole Joffe, a sociologist who has written about the history of abortion, told me that … Read More