“The lack of palliative care resources and shifting patient needs due to improvements in cancer therapeutics highlight the need for less resource-intensive and more patient-centered palliative care models. Moreover, the historical model of a referral system that relies on oncologists to identify patients with cancer who may benefit from early palliative care remains inadequate. [..] In stepped care, all patients receive care for their condition, but with a minimum of required contact with a specialty-trained clinician. More intensive treatment with the clinician is reserved for patients who do not benefit sufficiently from the less intensive therapies. A key element of … Read More
“As artificial intelligence (AI) tools become more consistently used in health care, federal agencies, health care facilities, medical societies, and other stakeholders are grappling with how to ensure they do not introduce unintended patient harm. [..] Regardless of approach, a well-designed one could improve safety, promote patient and health care professional confidence in AI use, and incentivize developers and users to focus on these important issues. Developing a testing and certification approach that is effective, rigorous, and rapid and that is a shared responsibility of both developers and users is necessary to meet the needs of multiple stakeholders. The Office … Read More
“Colonoscopy is the dominant approach to colorectal cancer screening in the United States. Among people who are screened, two thirds get a colonoscopy. This fact is easy to miss in Halpern and colleagues’ 2021 data, which included 9.2 million people reporting colonoscopy and 9.8 million reporting fecal immunochemical testing (FIT). That ambiguity is explained by the distinct screening intervals (every 10 years for colonoscopy and annually for FIT), whereas there is no ambiguity about the difference in the resources required each year: $24 billion for colonoscopy versus $0.6 billion for FIT. Colonoscopy is clearly overused in the United States. It … Read More
“The number of people living with dementia worldwide in 2019 was estimated at 57 million and is projected to increase to 153 million by 2050. The proportion of people with dementia has increased over time in lower-income countries due to a greater percentage increase in longevity than in high-income countries. [..] There has been a rapid expansion in the volume of work on dementia prevention and risk reduction related to the 12 risk factors that were identified from the existing research literature and discussed in our earlier Lancet Commission reports in 2017 and 2020. The risk factors identified in our … Read More
“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
“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