Viewpoints: High Court’s Opinion On Health Care Fraud Creates Uncertainty; Updated Thinking About Addiction
A selection of opinions on health care from around the country.
U.S. Health-Care Law Just Got Even More Confusing
The Supreme Court is supposed to take appellate cases to make the law clearer. Today's opinion on health-care fraud had the opposite effect. Instead of spelling out exactly when a misrepresentation in health-care billing counts as a legal violation, the court said that sometimes it is and sometimes it isn't. The result introduces new uncertainty in the law instead of greater clarity. (Noah Feldman, 6/16)
The Wall Street Journal:
Rehabbing Our Ideas About Addiction
In 1980, our roads were seven times deadlier than our drugs. But in 2008, drug overdoses surpassed car crashes to become the No. 1 cause of accidental death in the U.S., killing almost 50,000 Americans in 2014, the latest year on record. This epidemic is due almost entirely to the alarming rise of one class of drugs: Opioids, which include prescription painkillers and heroin, killed nearly 30,000 Americans in 2014, up from just under 10,000 in 2001. Once considered a relic of the 1970s, heroin in particular has seen a peculiar and deadly resurgence, as more patients become dependent on prescription opioid painkillers and switch to heroin when their prescriptions run out. Between 2010 and 2014, heroin overdoses tripled. (David M. Cordani, 6/16)
No Takeover Premium, No Problem
When news broke last week about a possible merger of AmSurg and Envision Healthcare, investors were betting that the deal between the two big U.S. hospital-services providers would be arranged as a typical takeover, with at least some sort of stock price bump for Envision. That sent Envision's shares surging more than 8 percent to their highest levels of the year. (Brooke Sutherland, 6/16)
Is The United States Prepared For A Major Zika Virus Outbreak?
From its initial discovery in Ugandan forests nearly 70 years ago, Zika virus has emerged as a worldwide public health crisis, with active transmission in more than 40 countries in the Americas and Caribbean. On February 1, 2016, the World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC), concerned about clusters of microcephaly and Guillain-Barré syndrome (GBS). A week later, the Centers for Disease Control and Prevention (CDC) triggered the highest “level 1” activation of its emergency operations center, and President Obama requested $1.86 billion in emergency funding.1 On April 7, the WHO reported there is scientific consensus that Zika is a cause of microcephaly and GBS. (Lawrence O. Gostin and James G. Hodge Jr., 6/14)
The Washington Post:
Mosquitoes Don’t Just Spread The Zika Virus. They May Be Helping An Older Killer Reemerge.
Yellow fever is a virus spread by Aedes mosquitos (which also spread Zika, dengue and chikungunya). Although most cases are mild, about 15 percent of patients progress to a more serious stage marked by jaundice, from which yellow fever takes its name. Until the 20th century, yellow fever was one of the world’s most feared diseases — a major killer and threat to commerce. Historical efforts to fight yellow fever laid the groundwork for our current public-health policies and disease-control strategies, both nationally and internationally. (Mara Pillinger, 6/16)
Hedge-Fund Consultant Bantered For Insider Information
Today's murk is a criminal and civil insider trading case against Sanjay Valvani, a portfolio manager at Visium Asset Management, and Gordon Johnston, a former FDA official (from 1987 through 1999) who, at the time of the alleged insider trading (2010 to 2011), was vice president of the Generic Drug Trade Association. He was also working as a consultant for Visium, on a retainer of $5,000 a month. Johnston, who has pleaded guilty to the charges, called up an official in the FDA's Office of Generic Drugs and asked him if it was going to approve some drugs. The official told him, and then he allegedly told Valvani. Then Valvani traded in the stocks of companies that made those drugs, or their brand-name competitors. (Matt Levine, 6/16)
Using Intermediaries To Improve Health
As we explore the social determinants of health, we are discovering some very important things. One is that compared with other developed countries, the United States spends a much higher proportion of resources on medical services to treat people than on social services that improve the prospects for good health. Research shows that countries placing a greater emphasis on social services rather than medical care have better health outcomes. Recent research comparing spending on health and social services among US states also found that spending relatively more on social services is significantly related to better health outcomes. (Stuart Butler, 6/15)
The Wall Street Journal:
‘A Swimming Pool In The ICU?’
“A swimming pool in the ICU? You must be nuts.” The nurse’s voice was almost lost amid the whooshing ventilator and infusion pumps. Five days earlier, we had admitted Bennie, a Vietnam veteran, to the intensive care unit of our VA hospital in Nashville, Tenn. Frail and wrinkled, he had a look of utter confusion and a furrowed brow that would pluck the heartstrings of even the most calloused physician. Decades spent in Southern tobacco fields left him looking old enough to remember Hoover’s presidency. Double pneumonia and too much sedation made him delirious. (E. Wesley Ely, 6/16)
Implementing MACRA Implications For Physicians And For Physician Leadership
On April 27, the Centers for Medicare & Medicaid Services (CMS) released the highly anticipated 962-page proposed rule1 for implementing the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA will overhaul Medicare’s physician payment system starting in 2019, placing most physicians in the Merit-Based Incentive Payment System (MIPS), a pay-for-performance system that adjusts payments based on measures derived from prior care. Physicians can be exempt from MIPS and receive bonus payments by demonstrating sufficient participation in advanced alternative payment models (APMs), which are intended to support greater flexibility in care delivery alongside greater accountability for efficiency and care improvement. (Jeffrey D. Clough and Mark McClellan, 6/14)
The New England Journal Of Medicine:
State Initiatives To Control Medication Costs — Can Transparency Legislation Help?
Spending on prescription drugs has risen sharply in the United States over the past 2 years.1 Although thousandfold price increases for a few generic products in limited use have attracted much attention, overall spending growth has been driven more by the widespread use of costly new agents such as sofosbuvir (Sovaldi) and cumulative markups in prices of common brand-name drugs such as rosuvastatin (Crestor), imatinib (Gleevec), and etanercept (Enbrel). Coverage of these products has strained payers’ budgets, forcing difficult funding choices. (Ameet Sarpatwari, Jerry Avorn and Aaron S. Kesselheim, 6/16)
The New England Journal Of Medicine:
Beyond Bathrooms — Meeting The Health Needs Of Transgender People
One might have to go back to the era of racial desegregation of U.S. bathrooms to find a time when toilets received so much attention. Recently, several states have debated or passed legislation requiring people to use the public bathroom corresponding to their sex as “identified at birth” or “stated on a person’s birth certificate.”1,2 Some supporters of these laws have focused on the fear that male stalkers will claim to be transgender women in order to victimize girls and women in restrooms. Others have expressed vitriol and revulsion toward transgender people, describing them as “sexual predators,” “voyeurs,” and “pedophiles.” Although transgender people have been characterized as dangerous, it is transgender people who have generally been the victims of verbal harassment and physical assaults when trying to use public bathrooms. (Mark A. Schuster, Sari L. Reisner and Sarah E. Onorato, 6/15)
Transgender People Face Challenges For Adequate Health Care: Study
Millions of transgender people around the world face major challenges in getting adequate medical care despite multiple health issues, from depression to high rates of HIV, researchers say. (Lih Yi, 7/17)
The New England Journal Of Medicine:
Wollschlaeger V. Governor Of Florida — The First Amendment, Physician Speech, And Firearm Safety
On June 21, 2016, the full 11th Circuit Court of Appeals will hear arguments in Wollschlaeger v. Governor of Florida, which challenges a Florida law regulating physicians’ speech related to patients’ gun ownership. A decision by the court on the merits will most likely have broad implications both for states’ ability to regulate physicians’ speech and physicians’ efforts to protect patients from firearm-related injuries, which in 2014 in the United States, included more than 33,000 deaths, most of which (21,334) were suicides. (Wendy E. Parmet, Jason A. Smith and Matthew J. Miller, 6/16)
We Are Not Viruses: Don’t Limit Gay Men From Donating Blood
Don’t get me wrong. We should be concerned about the human immunodeficiency virus (HIV) and AIDS, its deadly consequence if left untreated. But we should not be fearful of acquiring HIV through a blood transfusion. Thanks to highly sensitive blood tests, conservative estimates place the risk of acquiring HIV through a transfusion as at most 1 in 1,000,000. (Benjamin Mazer, 6/16)
St. Louis Post-Dispatch:
Congress Passes A Not-Very-Good Toxic Chemical Bill
Just when you're fed up with the United States Congress (approval rating: 11 percent) comes word that it has passed and sent to the president an overhaul of the 1976 Toxic Chemicals and Substances Act, generally regarded as the weakest environmental law on the books. And it only took 10 years. The Environmental Protection Agency is now free to begin testing 64,000 household chemicals to determine how dangerous some of them are. But lest the EPA get carried away with its new powers, the new law restricts the agency to testing only 20 chemicals at a time, with a maximum testing period of seven years. (6/16)
Bad Ruling On Reproductive Rights In Ky.
A Court of Appeals ruling allowing the Bevin administration to shut down one of only two abortion providers in Kentucky misses the constitutional forest for the regulatory trees. Fayette Circuit Judge Ernesto Scorsone ruled in March that closing the EMW Women’s Clinic in Lexington even temporarily would “have a severe, adverse impact on the women in the Eastern part of the state.” In overruling Scorsone, a three-judge panel discounted the impact on Kentucky women, then went on to conclude preposterously that “this is not about a woman’s right to an abortion” and “the Cabinet is not seeking to prevent women from obtaining abortions.” (6/16)
San Jose Mercury News:
Cresanti: Drug Cost Transparency Will Kill Patients, Jobs
American research firms develop dozens of such advanced, targeted drugs each year. But that flow of lifesaving discoveries could soon cease if some short-sighted lawmakers continue their opportunistic and uninformed crusade against the U.S. pharmaceutical industry. California lawmakers, for instance, are considering a bill -- SB 1010, introduced by Sen. Ed Hernandez (D-West Covina) -- that would require pharmaceutical companies to disclose marketing budgets, public research funding grants, and reams of other information related to their development and sales of prescription medicines. ... The laws, if passed, will hinder research and discourage developers from creating the kinds of cutting-edge drugs that saved Wood's life. (Robert Cresanti, 6/16)
Planning In Case A Loved One Develops Alzheimer's
The situation is bad. So families should start planning for what to do if a family member develops Alzheimer ’s disease. The incidence of the disease has become devastating, and the numbers are projected to grow. Estimates are only 25 percent of those with the condition have been diagnosed. (J. Brendan Ryan, 6/16)
The New York Times:
Soda Tax Passes In Philadelphia. Advocates Ask: Who’s Next?
Forty times, city or state governments had proposed taxes on sugary soft drinks, failing each time. Then, in 2014, liberal Berkeley, Calif., passed such a tax, but most people saw it as an aberration. Several measures, including one in New York, never won much support. But on Thursday, a measure to tax sweetened drinks passed in Philadelphia, one of the country’s largest cities — and also one of its poorest. Indeed, raising revenue was the winning argument in Philadelphia. (Margot Sanger-Katz, 6/16)