“A French team of investigators studied the question of whether a protocol-driven strategy of progressive reduction of blood pressure lowering drugs would alter a primary outcome of death rates in elderly frail patients who were residing in a nursing home. The authors also measured many relevant secondary endpoints. Just over 1000 patients underwent randomization to either the so-called step-down approach or usual care. The hypothesis was that reducing BP meds, and allowing BP to rise a bit would improve mortality. Inclusion in the trial required patients to be older than 80 years, be on more than one BP-lowering drug and … Read More
All posts in High-value Care
“Patients arriving with researched information is not new. They have long brought newspaper clippings, internet search results, or notes from conversations with family. Potential solutions passed along in WhatsApp threads have at times been an integral part of my clinical conversations. Information seeking outside the health care setting has always been part of the landscape of care. But something about this moment feels different. Generative artificial intelligence (AI), with tools like ChatGPT, offers information in ways that feel uniquely conversational and tailored. Their tone invites dialogue. Their confidence implies competence. Increasingly, patients are bringing AI-generated insights into my clinic and … Read More
“Long-term routine laboratory toxicity monitoring (lt-RLTM) is used for management of patients with rheumatoid arthritis (RA) who are being treated with disease-modifying antirheumatic drugs (DMARDs). Intensive monitoring is recommended during the first 6 months due to higher risks for adverse reactions, followed by less frequent monitoring for the duration of DMARD use, which can last for decades. Laboratory parameters used for lt-RLTM typically include liver, renal, and hematologic toxicity markers. Despite high consistency in the types of tests ordered, the frequency of testing and responses to abnormal results vary widely across practices. [..] Typically, lt-RLTM is performed every 3 months … Read More
More than a thousand dentists have set up shop in Los Algodones. Their patients are mostly Americans who can’t afford the U.S.’s dental care. “According to Roberto Díaz and Paula Hahn, who run a website about medical tourism called Border CRxing, Los Algodones now has the highest per-capita concentration of dentists in the world: well over a thousand in a population of fifty-five hundred. It’s known as Molar City. [..] technology has its downsides. The more advanced the imaging system, the more expensive the visit, and the more problems it can find with your teeth. Last year, at a routine … Read More
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
“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