But My White Count…

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

Misdiagnoses cost the U.S. 800,000 deaths and serious disabilities every year, study finds

“Analyzing the nature of misdiagnoses also provides significant opportunities for solutions: The errors are many, but they are quite concentrated. According to the study, 15 diseases account for about half the misdiagnoses, and five diseases alone — stroke, sepsis, pneumonia, venous thromboembolism, and lung cancer — caused 300,000 serious harms, or almost 40% of the total, because clinicians failed to identify them in patients. “That’s a lot that you could accomplish if you cut those harms by 50% for just those five diseases — that would be 150,000 prevented serious permanent disabilities or death,” said [lead author of the BMJ … Read More

Providing Birth Control Over the Counter Should Be Just the Beginning

“At a 1992 conference on birth control, an official on the F.D.A.’s fertility and maternal health drugs advisory committee, Philip Corfman, noted that the birth control pill is safer than aspirin, which is available over the counter. The F.D.A. subsequently announced plans to convene a hearing to consider moving oral contraceptives over-the-counter. It was believed that this would greatly expand access to birth control by bypassing doctors, to whom millions of Americans then — as still now — had little access. But, as the historian Heather Munro Prescott has recounted, the hearing was canceled at least partly because of criticism from … Read More

Using Publicly Available Health Plan Pricing Data For Research And App Development

“We used Elevance Health’s in-network pricing data and medical claims data. We focused on in-network prices because these are the prices negotiated by the payer, and out-of-network providers represent a small percentage of use for planned procedures. The formatting of the released data files follows the specifications provided by CMS. We limited our analysis to one state, Colorado, and one month, August 2022, to illustrate the concepts. [..] We split the prices into two components, the professional price and the facility price. Notably, these two components may not be the only costs associated with a procedure as there are often other … Read More

CMS’s Universal Foundation Measures Are Not Universally Good For Primary Care

“Primary care is where most people have relationships with a health professional, where more than one-third of all health care visits happen, and the only part of the health system that demonstrably produces longer lives and more equity. However, primary care is experiencing widespread and longstanding shortages and skyrocketing rates of burnout and moral injury. Primary care physician turnover, often associated with burnout, is estimated to cost CMS nearly one billion dollars annually. Before the COVID-19 pandemic, more than one-third of family physicians reported frequent burnout. Since the pandemic, primary care physicians are stepping up to meet patient needs even … Read More

Cost-effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors for Patients With Heart Failure and Preserved Ejection Fraction—Living on the Edge

Excerpt – In this issue of JAMA Cardiology, Cohen and colleagues have performed a formal cost-effectiveness analysis of SGLT2 [sodium-glucose cotransporter-2] inhibitors for patients with heart failure and an ejection fraction more than 40%. They developed a computer-simulation model to project the long-term clinical benefits and costs for patients with HFpEF [heart failure with preserved ejection fraction] with and without SGLT2 inhibition. Their model was based on pooled estimates of baseline risk and effectiveness of SGLT2 inhibitors derived from the EMPEROR-PRESERVED and DELIVER trials. Because these trials followed up patients for a median of only 2.3 years, the authors extrapolated … Read More

Current concepts in coronary artery revascularisation

“More than five decades after the introduction of CABG and four decades after the introduction of PCI into clinical practice, the procedural and long-term outcomes of the two revascularisation methods are now well characterised. Although technological improvements will continue to increase their safety and efficacy, the relative advantages and disadvantages of the two interventions will probably remain substantially unchanged. A limitation of available data is that they are from prevalently young, White, male, HIC [high-income countries] populations. The results of coronary revascularisation in women, non-White racial and ethnic groups, older adults, and LMICs [low- and middle-income countries] require further and … Read More

Can We Avoid The Impending Healthcare Workforce Labor Shortage?

“I’ll propose in a moment what I believe are some achievable, common-sense solutions to the labor-shortage problem. But first, it helps to quickly understand why policymakers and industry leaders believe a crisis will come. It boils down to three elements. First, the number of older Americans is growing and will continue to grow – peaking in 2030 at roughly 56 million adults – and the impact on our health system will be enormous. A typical senior’s health is arguably more complicated than at any point in history, with many managing two or more chronic illnesses, and thanks to treatment advances … Read More

We’ve Had a Cheaper, More Potent Ozempic Alternative for Decades: New weight-loss drugs are getting all the hype, but bariatric surgery is still the “gold standard” for treating obesity.

“Ozempic itself is technically a diabetes drug, but its active ingredient, semaglutide, has been approved by the FDA for weight loss under the brand name Wegovy, and can reduce a person’s body weight by up to 20 percent through a weekly injection. An even more powerful drug, known as tirzepatide, or Mounjaro, may soon be approved for weight loss, and a host of new medications are coming down the pipeline. All signs suggest that America is on the verge of a weight-loss revolution. But for people with obesity, semaglutide isn’t even the most effective weight-loss treatment around—not even close. Bariatric … Read More

Study: Single dose of HPV vaccine up to 98% effective

“A new study from researchers at the Kenya Medical Research Institute (KEMRI) and Massachusetts General Hospital (MGH) showed a single dose of human papillomavirus virus (HPV) vaccine was highly efficacious in preventing HPV, the virus that causes cervical cancer, in girls and women ages 15 to 20. The study results were announced at the 35th International Papillomavirus Conference in Washington, DC, this week. Researchers described the findings from their randomized, multicenter, double-blind, controlled trial, which included 2,275 participants in Kenya between the ages of 15 and 20. The women were randomly assigned to receive either a single dose of the bivalent … Read More