DCMedical News: Tuesday, November 15, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS Tuesday, November 15, 2022
What’s The Evidence?
A paper (here) in the Journal of Clinical Epidemiology found that nine out of ten medical interventions are undertaken without “high quality” evidence of their effectiveness. In a sample of 1,567 interventions studied with Cochrane reviews, 94% of interventions were not supported by high-quality evidence, and potential harms of the healthcare interventions were measured more rarely than were benefits. “Patients, doctors, and policy makers should consider the lack of high-quality evidence supporting the benefits and harms of many interventions in their decision-making.”
“AI in Medicine is Overhyped”
An opinion piece on artificial intelligence in Scientific American (here) with that title notes that “As researchers feed data into AI models, the models are expected to become more accurate, or at least not get worse. However, our work and the work of others has identified the opposite, where the reported accuracy in published models decreases with increasing data set size.” The authors note “While [these] overoptimistic estimates of accuracy get published in the scientific literature, the lower-performing models are stuffed in the proverbial ‘file drawer,’ never to be seen by other researchers; or, if they are submitted for publication, they are less likely to be accepted. The impacts of data leakage and publication bias are exceptionally large for models trained and evaluated on small data sets. That is, models trained with small data sets are more likely to report inflated estimates of accuracy.”
STAT+ reports (here) on EPIC’s overhaul of its flawed sepsis algorithm. “Epic is not the only company moving aggressively to sell AI tools to health systems. But the precarious roll out of its popular sepsis algorithm has become a case study in the challenges of ensuring such algorithms are used safely and effectively at the bedside. It also underscores shortcomings in procedures for evaluating and regulating AI products, which risk giving faulty advice to doctors and nurses trying to make time-sensitive decisions about very sick people.”
VA Publishes Systematic Review of Long COVID
The Department of Veterans Affairs (VA) has published a guidebook on caring for veterans with long COVID, the Whole Health System Approach to Long COVID (here).
The guidebook provides information on signs, symptoms, treatments and measures for success or concern. From the publication, “At the time of this writing, it is estimated that 4-7% of those diagnosed with COVID-19, or 2% of the U.S. population, will develop Long COVID (Xie Y, 2021). Based on approximately 600,000 known Veterans with a diagnosis of COVID-19, this equates to 24,000-42,000 Veterans. However, these numbers have the potential to be much higher, as the VA has more than 6 million Veterans in care.”
Industry Payments to Advanced Practice Clinicians Compared to Payments to Physicians
A report in JAMA (here) notes that “In 2021, more than one-third of physicians and APCs received non research industry payments. APC payments consisted largely of food and beverage payments related to drug products, whereas physician payments included a wider variety of products and greater payments for consulting and commercial activities.”
The study noted “Because industry payments have been associated with prescribing behavior, they raise concerns regarding industry influence on medical care. . . In contrast to the scrutiny cast on physician-industry relationships, industry interactions with APCs remain relatively unexplored. Because APCs compose a growing proportion of the health care workforce and their scope of practice is expanding, policies to ensure transparency and evaluation of payment effects are imperative.”
“Open Payments” reports on industry payments to physicians began in 2013.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Pricing: Hospital Markup in Head and Neck Surgery
A study of hospital price markup for head and neck cancer surgery published in the journal JAMA-Otolaryngology-Head & Neck Surgery (here) found that “Extreme markup hospitals were more often large, private for-profit hospitals, and were less likely to be high-volume [for these procedures] hospitals or in competitive markets.”
In addition, “Postoperative complications occurred more often in extreme markup hospitals.”
DRUGS & DEVICES
Uh-Oh: Author Says, “After 30 years of 340B, it’s time for data and an honest conversation.”
Writing in STAT (here), researcher John O’Brien says “The 340B Drug Discount Program turns 30 on Nov. 4. This once-obscure drug access program began modestly, but has grown to be the second-largest federal prescription drug program, behind Medicare Part D. It’s time, past time, really, for an honest conversation about it.”
He notes, “Research on 340B suggests a complicated story, with the program’s growth in spending boosting hospitals’ bottom lines. Press accounts have highlighted the importance that 340B profits play in health center acquisitions, rather than providing care to underserved communities. More recent articles have pointed out that some highly profitable hospital systems are using poor neighborhoods to generate 340B revenue while investing profits into hospitals in affluent communities.”
He adds, “The 340B program lacks even the simplest of transparency requirements. The federally funded health clinics, nonprofit hospitals, contract pharmacies, and third-party administrators that are part of the 340B pipeline don’t disclose how many patients receive 340B drugs and whether or not they received the 340B discount, leaving researchers to come up with inventive methods to peer into this box of mysteries . . . I was delighted to see IQVIA shed some light on 340B with a new report [here, funded by Bristol Myers] that pointed out, among other things, that just 1.4% of 340B-eligible claims show that discounts were actually given to patients.”
Cancer Drug Prices Based on What the Market Will Bear, Not on Effectiveness
A research letter in JAMA Internal Medicine (here) finds that “The US has worse cancer-related outcomes than other high income countries while bearing the highest cost of cancer care in the world. A reason for increasing cost may be improved efficacy of expensive novel agents.”
What benefit (efficacy) comes with higher prices for novel cancer drugs? The researchers reported that “We did not detect a meaningful association between cancer drug prices and the magnitude of benefit for any of the end points . . . This suggests that cancer drugs are priced based predominantly on what the market will bear.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
November 16, 17, 18, 29, 30
December 1, 2, 5, 6, 7, 8, 12, 13, 14, 15
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org