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
“Population genomic screening, which was envisioned almost 20 years ago with the publication of the draft human genome sequence, is recognized by the Centers for Disease Control and Prevention (CDC) as having notable potential to improve public health. In 2014, the CDC’s Office of Public Health Genomics designated Tier 1 genomic applications as those with evidence-based guidelines and recommendations to prevent morbidity and mortality associated with genetic risk. The initial 3 autosomal dominant conditions assigned to Tier 1—Lynch syndrome (LS) (high risk for colorectal cancer [CRC]), hereditary breast and ovarian cancer syndrome (HBOC), and familial hypercholesterolemia (FH)—cause a high lifetime … Read More
Excerpt – “When we started in 2010, we were appropriately concerned that genetic engineering would create so-called Frankenstein cells that would be uncontrollable,” [professor at the University of Pennsylvania and a CAR-T pioneer Carl] June said. “There were lots of regulatory issues put in that has slowed research. But 11 to 12 years in, more than 20,000 people treated, and it’s never happened — the Frankenstein cell turned into a CAR-T tumor hasn’t happened. Autologous cells are safe, they don’t need to be regulated as in experimental, early stage by the FDA.” [..] Innovation is needed in the CAR-T field, … Read More
“Commensurate with the rise in telehealth has been a proliferation in publications assessing the cost, experience, efficiency, safety, and unintended consequences of telehealth. Many publications aim to answer the “Goldilocks question”: what is the right amount of telehealth that optimizes its benefits while minimizing potential problems? The right dose of telehealth needs to balance (1) concerns by payers and policy makers that it will increase cost and cause unintended consequences (eg, misdiagnosis or duplicative care) and (2) the desire of its proponents who want to allow clinicians to use it as they see fit, with few restrictions. [..] To date, … Read More