A Moment with Gina Merchant: On Shiny Objects and Technology’s Path to Meaningful Behavior Change

“[Question] What’s the biggest barrier to getting things done in your line of work? [Merchant] The biggest barrier I face, and observe others facing, is being asked to play by a set of rules and a culture handed down by the tech industry, which does not transfer well to the health tech industry. For example, product timelines are often too short to bring an effective product to market (and despite lip service to iteration, products often remain unchanged year over year). Also, the right combination of experts and leaders are often missing seats at the table; there isn’t enough investment … Read More

Gilead’s Covid-19 Drug Is Mediocre. It Will Be a Blockbuster Anyway.

“the F.D.A.’s decision to grant the drug full approval — which means the company can now begin broadly marketing it to doctors and patients — has puzzled several outside experts, who say that it may not deserve the agency’s stamp of approval because it is, at best, a mediocre treatment for Covid-19 [remdesivir..]. “I think most people think that because a drug is F.D.A. approved, that means it must work,” said Dr. Aaron S. Kesselheim, a professor of medicine at Harvard Medical School who studies the drug industry. He and other researchers recently found that less than one-third of new … Read More

Comparison of Community-Level and Patient-Level Social Risk Data in a Network of Community Health Centers

“no clear standard has emerged on how to implement social risk screening, nor how clinicians can or should use social risk information to adjust patient care or make referrals to community resources. Moreover, some have questioned the benefit of integrating social risk screening into primary care, raising concerns about the additional burden of adding more required data collection to already busy primary care practices and the limited resources available to address identified social risk factors. [..] relying solely on community-level data to understand the social context of an individual patient and/or to guide patient-level interventions poses a risk of ecological … Read More

Where Health Improvement Lags in Recent Decades—Pain and Mental Health

“The health of the US population has improved enormously in many areas but been stagnant in others. The biggest success may have been improvements for people with cardiovascular disease. Major cardiovascular events are declining in incidence, and cardiovascular disease risk factors are better controlled than they used to be. There are many elements behind this good news, the 2 most important being pharmaceuticals to treat cardiovascular disease and public health efforts to reduce smoking. Other areas of health in which there have been major improvements include lung cancer (associated with reduced smoking), breast cancer (stemming from improved treatment), and colorectal … Read More

No-Fault Compensation for Vaccine Injury — The Other Side of Equitable Access to Covid-19 Vaccines

“Wealthy governments that have invested in vaccine candidates have made bilateral agreements with developers that could result in vaccine doses being reserved for the highest-income countries — a phenomenon known as “vaccine nationalism” — potentially leaving people in poor countries vulnerable to Covid-19. The response to vaccine nationalism has been the creation of the COVAX Facility, an international partnership that aims to financially support leading vaccine candidates and ensure access to vaccines for lower-income countries. Seventy-nine higher-income countries are COVAX members. Their governments will help support 92 countries that couldn’t otherwise afford Covid-19 vaccines. [..] Equally important is offering companies … Read More

Constructing the Modern American Midwife: White Supremacy and White Feminism Collide

“US exceptionalism in maternity care is marked by the lack of midwives as primary providers. Out of 100 births, only 10 to 12 will be attended by a midwife – and 9 out of 10 of these midwives are white. Yet globally, most childbearing women are attended to by midwives, only turning to an obstetrician if serious complications arise. According to WHO and The Lancet, midwives could help avert roughly two-thirds of all maternal and newborn deaths, while providing 87% of all essential sexual, reproductive, and maternal health services. Midwifery is one of the most ancient of traditions and professions … Read More

Effective interventions for potentially modifiable risk factors for late-onset dementia: a costs and cost-effectiveness modelling study

“[Abstract methods] we searched PubMed and Web of Science from inception to March 12, 2020, and included interventions that: successfully targeted any of nine prespecified potentially modifiable risk factors (hypertension, diabetes, hearing loss, obesity, physical inactivity, social isolation, depression, cigarette smoking, and less childhood education); had robust evidence that the intervention improved risk or risk behaviour; and are feasible to enact in an adult population. We established when in the life course each intervention would be delivered. We calculated dementia incidence reduction from annual incidence of dementia in people with each risk factor, and population attributable fraction for each risk, … Read More

Evaluation of Risk-Adjusted Home Time After Hospitalization for Heart Failure as a Potential Hospital Performance Metric

“Although the implementation of HRRP [Hospital Readmission Reduction Program] has been associated with significant reductions in readmission rates for HF [heart failure], it remains unclear whether current health policies have contributed to improvement in patients’ overall experience or quality of life. Although there has been an increasing emphasis on use of patient-oriented outcomes in evaluation of therapeutic benefits of newer HF therapies in clinical trials, the role of patient-oriented outcomes in defining hospital-level care quality for patients with HF is limited. [..] we assessed home time after hospitalization for HF through Medicare administrative claims data and its association with currently … Read More

Reducing Common Mental Disorder Prevalence in Populations

“The burden of common mental disorders (CMDs), including major depressive and anxiety disorders, is substantial. CMDs contribute to lowered work productivity, family dysfunction, substance misuse, suicide, and reduced life expectancy. The point prevalence of CMDs has been stable since the 1980s, although expenditures on mental health care and drug therapy have increased dramatically. Given failure of increased treatment to lower CMD prevalence, some have called for reconceptualizing the diagnosis of CMDs and investing in new research to improve treatment. [..] We need to consider organizational reforms in treatment delivery for the subset of patients at highest risk of relapse and … Read More

Coronary Artery Calcium for Personalized Risk Management—A Second Chance for Aspirin in Primary Prevention?

“Over the last 2 years, use of low-dose aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) has become one of the most debated topics in cardiology. Initial trials conducted between the 1980s and early 2000s suggested a significant benefit in a primary prevention population at high risk. However, with expanded use of statins and declining ASCVD rates in Western countries in the last 2 decades, the benefit of prophylactic aspirin became progressively less certain among individuals without established ASCVD. Three trials published in 2018 found no benefit or modest benefit with aspirin and raised concerns about the potential … Read More