Too often, doctors pursue ‘normal’ numbers instead of looking closely at the patient “Once we base our definition of disease on numerical abnormalities, we can change the numbers in a way that expands those who have the disease. This has been occurring in dramatic fashion the past 20 years, especially since Medicare (by congressional decree) relinquished the task of defining normal numbers to specialty medical societies. Hence the American College of Cardiology can change the definition of an abnormal cholesterol reading or abnormal blood pressure reading such that more people will be labeled with a diagnosed disease related to these … Read More
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“The largest health care companies in the US are no longer just health insurers, pharmacy benefit managers (PBMs), physician practices, home health agencies, hospices, data warehouses, data analytics firms, or hospitals. They are increasingly all of the above. A small number of unavoidable health care intermediaries are incorporating these services into essential platforms that simultaneously serve as payers, providers, and everything in between. While these companies claim to rationalize health care and realize the promise of coordinated, integrated care, the reality may be quite different. The creation of “big health care” platforms risks worsening the already serious problem of monopoly … Read More
A new book reveals how Big Pharma’s brazen behavior fueled medical mistrust. “Five years before Purdue Pharma received FDA approval to begin selling OxyContin, an oxycodone pill that Purdue claimed was less prone to abuse, J&J [Johnson & Johnson] received the agency’s sign-off on its own opioid-based painkiller. Duragesic was a fentanyl patch that was initially given primarily to cancer patients who struggled with swallowing—a relatively limited market. As [investigative journalist and author of “No More Tears” Gardiner] Harris writes, doctors already knew that opioids were highly addictive; few of them “were willing to prescribe them in anything but the … Read More
“Objective: To compare screening costs per relevant target finding of CRC [colorectal cancer] screening (that is, CRC, advanced adenoma, or sessile serrated polyp ≥1 cm) for FIT [fecal immunochemical tests], MSDT [multitarget stool DNA tests (e.g., Cologard [Exact Sciences])], and N-G [next-generation] MSDT. Methods and Findings: [..] We summed the test costs for all participants, including costs for follow-up colonoscopies, and we divided those costs by number of participants with detected CRC or any advanced neoplasia (CRC, advanced adenoma, or sessile serrated polyp ≥1 cm). Furthermore, we calculated costs per additional early-detected CRC case or any advanced neoplasia with MSDT-based and … Read More
“The theoretical case for routine cancer surveillance is strong. Tumor burden is expected to be lower before signs and symptoms of a recurrence develop; treatment is therefore expected to be more effective when a recurrence is identified by means of routine surveillance. [..] The empirical case for routine cancer surveillance is weak. None of the 12 RCTs assessing imaging-based surveillance that were included in a 2021 systematic review revealed a statistically significant reduction in mortality associated with surveillance. [..] These findings suggest that detection and treatment of asymptomatic cancer recurrences offers no advantage over initiation of treatment only after symptoms … Read More
“Health care spending as a proportion of total national spending has been flat, at approximately 17%, since the late 2000s, meaning that health care cost growth hasn’t exceeded growth in the gross domestic product, on average. Per-beneficiary Medicare spending grew at an average rate of 6.6% per year between 1987 and 2005, but by 2.2% per year between 2013 and 2019. [..] low growth has persisted well beyond the Great Recession for all types of insurance. Putting aside the spike in health care spending that occurred during the Covid-19 pandemic, growth in per-capita national health expenditures has been low by … Read More
“Although many health care clinicians have been fired by a patient or family, palliative care clinicians may be at increased risk for dismissal. We invite difficult conversations, confront people with news they prefer to avoid, and encourage otherwise taboo topics such as human frailty and death. Our focus on what may go wrong differs from other clinicians’ optimism and may be unwelcome to patients and health care teams alike. We acknowledge emotional vulnerability, explore uncertainty, uncover fears, and describe a future in which patients make difficult choices about how they live and how they die. When we do our jobs … Read More
“CT utilization in the United States in 2023 was estimated to result in 102 700 (90% UL, 96 400-109 500) projected lifetime cancers, including 93 000 (90% UL, 86 900-99 600) in adults and 9700 (90% UL, 8100-11 600) in children. The leading cancers in adults were lung cancer (21 400 [90% UL, 19 200-24 000]), colon cancer (8400 [90% UL, 7500-9400]), and leukemia (7400 [90% UL, 6100-8900]), whereas the most frequent projected cancers in children were thyroid (3500 [90% UL, 2300-5500]), lung (990 [90% UL, 870-1100]), and breast (630 [90% UL, 550-730]) cancer. Lung and thyroid cancer incidence were higher in female patients, whereas incidence of most other cancers … Read More
“The COLONPREV trial—published online in The Lancet—is, therefore, a landmark study. It is the first randomised controlled trial to compare colorectal cancer deaths in people screened with the two most commonly used methods: colonoscopy and faecal immunochemical test (FIT), an antibody-based test for haemoglobin, indicative of blood in the stool. The study finds that invitation to biennial FIT-based screening is non-inferior to invitation to one-time colonoscopy in terms of colorectal cancer mortality at 10 years. These results build on the NordICC trial, published in The New England Journal of Medicine, which showed that invitation to colonoscopy reduced colorectal cancer risk … Read More
“An estimated 80% of physicians are now employed by hospitals, health systems, and corporations. Many factors have contributed to this shift away from independent practices, including rising administrative burdens, changing employment preferences, greater capital demands for health information technology, and favorable financial incentives (eg, site-differential payments). However, underappreciated among these factors is another important accelerant of corporate consolidation: the shift from fee-for-service to value-based payment models. [..] Evidence suggests that, on average, they [independent practices directly owned by clinicians] exhibit lower per-patient spending, fewer preventable admissions, and lower readmissions compared with their hospital-owned counterparts. [..] However, independent practices are often … Read More