DCMedical News: Tuesday, March 3, 2020
DCMedical News-DCMN
Washington, D.C.
Tuesday, March 3, 2020
DCMedical News is published every day both the House and the Senate are in session.
THE BIG STORY IN HEALTH CARE
Coronavirus News
Tracking by Johns Hopkins shows on 3-2 at 8:00 p.m. EST worldwide 90,912 confirmed cases, 3,117 deaths, 47,977 patients recovered.
Public Health Resource Pages: AMA resource page for physicians here. CDC information page here. NIH information page here. National Library of Medicine Coronavirus page here, New England Journal of Medicine update page here.
Commerce: according to the Boston Globe, “Stocks rose sharply on Wall Street Monday, with the Dow surging nearly 1,300 points, or more than 5 percent, on hopes that central banks will act to shelter the global economy from the effects of the coronavirus outbreak.”
Supreme Court to Review Obamacare, Again
The Supreme Court has agreed to review the constitutionality of the Patient Protection and Affordable Care Act (PPACA). According to Amy Howe in SCOTUSBlog (here), “The justices announced today that they had granted two petitions involving the ACA . . . The justices will hear oral argument in the case next fall, with a decision likely to follow sometime in 2021. . . Today the Supreme Court granted California’s petition for review, which asks the justices to weigh in on three questions: whether the challengers have a legal right to sue at all; whether the mandate is now unconstitutional; and whether, if the mandate is unconstitutional, it can be separated from the rest of the ACA. The justices also granted a cross-petition filed by Texas, which asks the court to decide whether the district court was correct in deeming the entire ACA invalid.” More background by Dylan Scott at Vox, here.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Progress in Primary Care Under PPACA One Decade In: Not Much
A Mathematica group summarizes progress on primary care after a decade of PPACA: in Health Affairs (here) they report, “Considerable progress has been made in understanding how to implement and support different approaches to improving primary care delivery in that decade, though evaluations showed little progress in spending or quality outcomes. This may be because none of the models was able to test substantial increases in primary care payment or strong incentives for other providers to coordinate with primary care to reduce costs and improve quality.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
HIMSS to Hear From POTUS
The 50,000-member Health Information and Management Systems Society will hear from President Trump next Monday during their convention in Orlando.
Screening for Hernia: Risks and Benefits Not Clear
Surgeons from the University of Michigan discuss hernia screening in JAMA Surgery (here) in light of potentially misleading advertising (for example, from the 13,900 returns on an internet search for “hernia screening.”) They report, “With increasing screening detection, physicians are challenged with whether to expose a patient to the risks of treatment with unclear clinical benefits. While most patients want to know about the harms of unnecessary screening and treatment, most physicians do not discuss this . . . Consider the risks and benefits of detecting an asymptomatic or even minimally symptomatic groin hernia: fewer than 0.1% of patients who do not pursue treatment will go on to require immediate intervention, whereas up to 16% of patients who undergo operative repair go on to develop debilitating chronic pain. Virtually all advertisements for hernia screening highlight the ‘severe complications’ that can result from an untreated hernia; however, the fact that this applies to fewer than 1 in 1000 patients is missing.”
DRUGS AND DEVICES
More Effective Medical Equipment Device Surveillance
Salazar and Redberg report in JAMA Internal Medicine (here) on examples of effective medical device safety surveillance. The nationwide experience of Iceland with the Riata defibrillator lead (St Jude Medical), recalled in 2011 because of the risk of serious injury or death, demonstrates the importance of record keeping; all adverse event data were captured and are available in a national registry in Iceland. A second case study characterized the high burden of serious adverse events (including death) with another cardiac device, the InSync III model 8042 heart failure pacemaker (Medtronic). The report demonstrates “considerable deficits in both the swiftness (19 months from first notice of pacemaker failure to recall) and the appropriateness of the response (the US Food and Drug Administration [FDA] classifying the recall as class II—a low probability of serious adverse events). This long unexplained delay before the recall and the inappropriate recall classification raised concerns about patient harms that could have been prevented by speedier and stronger regulatory actions.”
Litigation and Secrecy Concerning Defective Drugs and Devices
Krumholz and colleagues report (here) in JAMA Internal Medicine on another aspect of medical device (and drug) safety surveillance and reports, namely secret and confidential agreements reached in the settlement of litigation. They write, “in practice, courts and litigants commonly use overly broad or unwarranted confidentiality orders, which can prevent the public from accessing important public health information that emerges during litigation.” Their article reviews “the rules governing confidentiality orders and discusses the tension between these rules and prevailing legal practices relating to court secrecy in medical product litigation, including competing interests among manufacturers, plaintiffs, and courts.”
READINGS AND REFERENCES
Research Methods Homework
JAMA Surgery publishes a series of short essays with examples and references on research methods. Today (here) a practical guide to survey research. From the report, “Dismissing surveys is a mistake, as there are many questions that are only answered using this research approach. Questions about knowledge, attitudes, and beliefs are best answered in useful ways through surveys. Surveys can also be useful to gather information on behaviors and practices, although this is dependent on the type of behavior or practice. Surveys are commonly used in medical education research, as approximately 50% of original medical education research is survey based.”
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Committees and Members at https://www.senate.gov/committees
CQ 2020 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March 4, 5, 9, 10, 11, 12, 23, 24, 25, 26, 27, 30, 31
April 1, 2, 3, 20, 21, 22, 27, 28, 29, 30
May 12, 13, 14, 15, 18, 19, 20, 21
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.