“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
“I had to learn over and over again that extreme conviction requires extraordinary evidence, and the evidence we have is usually far from extraordinary. For instance, our frontline anti-depression drugs are supposed to work by changing serotonin levels in the brain, but a review published last year found that there’s no consistent evidence that serotonin has much to do with depression at all. (Maybe that’s why antidepressants don’t seem to work that well, especially in the long term.) It seems obvious that sunscreen should protect you from skin cancer, but a 2018 meta-analysis could not confirm that this is true … Read More
[NYT’s David Wallace-Wells]: [..] The way most people think about a virus like, say, RSV, or chickenpox, is that a single exposure, while potentially worrisome, does deliver lifelong protection. Is it really the case that, as babies, we are fighting off those viruses hundreds of times? [Immunologist and epidemiologist Michael Mina]:The short answer is yeah. We start seeing viruses when we’re 2 months old, when we’re a month old. And a lot of these viruses we’ve seen literally tens, if not hundreds of times for some people by the time we’re adults. People tend to think that immunity is binary … Read More
“Some meatfluencers stress that human beings are animals and maintain that, if allowed to eat according to our animal instincts, we will favor a meaty menu. But the biologists David Raubenheimer and Stephen J. Simpson have been investigating animal alimentation for more than thirty years, and their new book, “Eat Like the Animals,” suggests that the meatfluencers have it all wrong. The authors started collaborating at Oxford, studying the eating preferences of locusts (grasshoppers, basically). First, they found that locusts preferred a certain ratio of carbohydrates to protein. When forced to live on foods higher in carbs and lower in … Read More
“Recently, the U.S. Preventive Services Task Force (USPSTF) changed its recommendation for the starting age for mammography screening from 50 to 40 years. Previously, the Task Force deemed screening in 40-to-50-year-old women a personal choice. Because USPSTF recommendations are so influential, mammography screening for women in their 40s will probably become a health care performance measure; if so, it will effectively become a public health imperative with which primary care practitioners must comply. Such a change will affect more than 20 million U.S. women, and it raises some important questions. First, is there new evidence that mortality from breast cancer … Read More