Posted in Access to healthcare, CDC, Disease Prevention, Education, Evidence-based Medicine, FDA, News From Washington, outcomes, outcomes measurement, Patient Choice, Patient Safety, Uncategorized, Unsettled Science

FDA to Study Hydroxychloroquine for COVID-19 | MedPage Today

The drug is currently approved for malaria and also for rheumatoid arthritis and systemic lupus erythematosus, which is its main use in the U.S. It’s therefore available to be prescribed off-label, and some clinicians have already said they’re using it on COVID-19 patients. But neither Hahn nor other task force members addressed whether enough hydroxychloroquine is on hand to treat large numbers of coronavirus cases. Convalescent plasma is another treatment the FDA is considering for COVID-19, said FDA Commissioner Stephen Hahn, MD.

Convalescent plasma and the immune globulin that it contains is another possible treatment the agency is considering, Hahn added. “FDA’s been working for some time on this,” he said. “If you’ve been exposed to coronavirus and you’re better — you don’t have the virus in your blood — we could collect the blood, concentrate that and have the ability, once it’s pathogen-free, to give that to other patients, and the immune response could potentially provide a benefit to patients. That’s another thing we’re looking at; over the next couple of weeks, we’ll have information and we’re really pushing hard to try to accelerate that.” Such treatments have been effective in Ebola, for example.

Source: FDA to Study Hydroxychloroquine for COVID-19 | MedPage Today

Posted in Education, outcomes, outcomes measurement, Patient Safety, Policy Issues, Prevention, Protocols, Uncategorized

Are medical errors really the third most common cause of death in the U.S.? (2019 edition) – Science-Based Medicine

The claim that medical errors are the third leading cause of death in the US has always rested on very shaky evidence; yet it’s become common wisdom that is cited as though everyone accepts it. But if estimates of 250,000 to 400,000 deaths due to medical error are way too high, what is the real number? A study published last month suggests that it’s almost certainly a lot lower and has been modestly decreasing since 1990.

https://sciencebasedmedicine.org/are-medical-errors-really-the-third-most-common-cause-of-death-in-the-u-s-2019-edition/

Posted in Dependency, Economic Issues, Education, Free Society, Liberty, outcomes, outcomes measurement, Philosophy, Policy Issues, Uncategorized

If Only Economics Was as Easy as Rocket Science – Foundation for Economic Education

Gary M. Galles is a professor of economics at Pepperdine University. His recent books include Faulty Premises, Faulty Policies (2014) and Apostle of Peace (2013). He is a member of the FEE Faculty Network.

However, as America’s founders attested so vehemently, rights are at the core of social interactions and government, violations of which can justify revolution. And unlike the physical sciences, where the goal of language is precision, in the social sciences, the language (and thus analysis) is often quite vague and inconsistent (e.g., current versions of “social justice” are inconsistent with the traditional meaning of “justice”), making clear communication, much less clear analysis, far harder.

What is the upshot of all this? Economics is not like physical sciences, and reasoning and analogies based on them are often misleading in economics. Further, they can be dangerous to society, particularly in the mouths of those who wish to subject others to their command and control. That is why Friedrich Hayek wrote,

“The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design.”

In other words, economics is a science whose principles and logic tell us why we cannot know enough to control people, even if we do know enough to control rockets.

https://fee.org/articles/if-only-economics-was-as-easy-as-rocket-science/

Posted in Economic Issues, Education, emotional intelligence, Organizational structure, outcomes, outcomes measurement, Philosophy, Uncategorized

Watch “Why Did I Say “Yes” to Speak Here? | Malcolm Gladwell | Google Zeitgeist” on YouTube

Fascinating research reveals a phenomenon of Elite Institution Cognitive Dissonance (EICD).

The data demonstrates that the effects of Relative Deprivation, as predictors of success, applies predictably to students at elite and non-elite institutions.

Take-home: Your place within your immediate hierarchy matters more than your place within the universal hierarchy of rank order.

Posted in Access to healthcare, Economic Issues, Education, Evidence-based Medicine, Health Insurance, Medicaid, Medical Costs, outcomes, outcomes measurement, Patient Safety, Philosophy, Poverty, Prevention, primary care, Protocols, Uncategorized, Unemployment

Bridging the Gap Between Where the Quality Metric Ends and Real Life Begins—A Trusting Relationship |JAMA NETWORK

Jennifer E. DeVoe, MD, DPhil

JAMA Intern Med. 2020;180(2):177-178. doi:10.1001/jamainternmed.2019.5132

My teaching session with the medical student at the end of the day included a discussion about patient care decisions and recommendations that go beyond ticking quality boxes and following the latest guidelines. Initially, I felt as if I was rationalizing my delivery of suboptimal care and began to doubt myself. 

However, the quality reports I receive each month do not capture the complexity of many patients’ lives.4 These reports fail to reflect the individualized and shared decisions made between a patient and her physician who have known each other for 15 years; the proprietary quality score calculation formulas do not adjust for the healing power of relationships.5 Amid the mounting evidence that primary care saves lives,6 our health care system does not (yet) have a population health analytics tool that captures and tracks the progress that she and I have made together in more than a decade. When will we create better systems with capabilities to measure the emergency department visits that were prevented, the stable housing that was obtained, the increased resiliency she has built into her life, her feelings of empowerment to be a better parent, the reduction in her self-destructive behaviors, and the trusting relationship we have built over time?

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2757531?guestAccessKey=15c869b5-37d4-42f4-9feb-12bdc314dbe6&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=etoc&utm_term=020320&appId=scweb

Posted in Disease Prevention, Nutrition, outcomes, outcomes measurement, Prevention, Uncategorized, Unsettled Science

Filter Coffee Tied to Lower Diabetes Risk in Metabolomics Study

Adults who drank two to three cups of filtered coffee a day (the highest quartile of filtered coffee–metabolite score) had a 58% lower risk of developing type 2 diabetes within 10 years than those who drank fewer than one cup of filtered coffee a day (lowest quartile) after adjusting for multiple confounders (odds ratio, 0.42; 95% confidence interval, 0.23 – 0.75).

The protective effect of drinking this high amount on the risk of developing type 2 diabetes was not seen with boiled coffee.

https://www.medscape.com/viewarticle/923238

Posted in British National Health Service, Economic Issues, FDA, Health Insurance, Healthcare financing, outcomes, outcomes measurement, Patient Choice, Patient Safety, Policy Issues, Protocols, Quality, Technology, Uncategorized

Should access to life-saving medicines be determined by economic evaluations? | TheHill

“My opportunity finally came. In April 2018, I was one of a few hundred cystic fibrosis patients to dose in a pivotal phase III clinical trial to evaluate a new drug designed to correct CFTR, the dysfunctional protein responsible for CF. The medication, two pills in the morning, and one at night worked almost immediately.

Within a few hours, the viscosity of my usually thick, sticky mucus changed; within a week, the constant cough I had lived with for my entire life nearly vanished, and within a month, my pulmonary function tests skyrocketed. I could finally breathe.

Instead of heading towards end-stage illness, disability income, and an end to my fight with cystic fibrosis, Trikafta, as the drug came to be named, saved my life.

A disturbing trend is washing over the United States, though. Insurers are using economic analyses based on a discriminatory cost-effectiveness metric called Quality-Adjusted Life Years (QALY) as negotiating leverage to limit access to life-changing medications.

A 2018 article in Health Affairs said, “QALY calculations inherently privilege treatments that extend the lives of those who can be restored to perfect health, and disadvantage the many who seek life-extending treatments despite having a disability or chronic condition that is not curable.”

But, QALY is not adequately able to quantify what happened in my own life — my journey from near end-stage illness and no hope for a future to correctly managed CF and entrance into an elite graduate program. Living in a world where I would not have had the chance to dose Trikafta sends a shiver down my spine.

That world, however, has existed in countries where QALY has been used to justify not covering CFTR modulators for people with CF. In the United Kingdom, the National Institute for Health and Care Excellence (NICE) makes QALY calculations to determine which medications are covered by the nation’s National Healthcare Service. In 2016, NICE decided that Orkambi, a previous CFTR modulator iteration, was not cost-effective for its citizens.”

https://thehill.com/opinion/healthcare/477547-should-access-to-life-saving-medicines-be-determined-by-economic