Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Brookings Conference] Exploring Implications of the Nonprescription Drug Safe Use Regulatory Expansion (NSURE) Initiative on Reimbursement and Access

 

Check back after the conference, audio and/or video of the conference should then “be up”

From the Brookings Institute Web page

On November 4, the Engelberg Center for Health Care Reform convened an expert workshop “Exploring Implications of the Nonprescription Drug Safe Use Regulatory Expansion (NSURE) Initiative on Reimbursement and Access.”

In an effort to address the undertreatment of common diseases and conditions, the U.S. Food and Drug Administration is exploring how a regulatory expansion of the nonprescription drug class might increase access to medications. This initiative, known as the Nonprescription Safe Use Regulatory Expansion (NSURE), is exploring how health care professionals and innovative technologies can serve as a condition to the safe use of drugs in a nonprescription setting.

Understanding the impact of NSURE on reimbursement and patient access to medication will be critical to the initiative’s success in addressing medical undertreatment. At this expert workshop, a wide range of experts and stakeholders explored previous effects from prescription-to-nonprescription medication switches, identified potential incentives for coverage of nonprescription drugs with Conditions of Safe Use, and investigated potential mechanisms for reimbursement.

This expert workshop was the third in a series of meetings that explored the NSURE initiative. To explore previous discussions regarding the potential role of health care professionals as a Condition of Safe Use within the NSURE initiative, please visit our expert workshop, “Nonprescription Medications with Conditions of Safe Use as a Novel Solution for Undertreated Diseases or Conditions”. To explore previous discussion regarding the role of technology in supporting the safe and effective use of nonprescription products, please visit our expert workshop, “Innovative Technologies and Nonprescription Medications: Addressing Undertreated Diseases and Conditions through Technology Enabled Self-Care”.

 

November 7, 2013 Posted by | Consumer Health, health care | , , , | Leave a comment

Addicts May Be Seeking Relief from Emotional Lows More Than Euphoric Highs

From the 6 November 2013 ScienceDaily Report

Cocaine addicts may become trapped in drug binges — not because of the euphoric highs they are chasing but rather the unbearable emotional lows they desperately want to avoid.

In a study published today online inPsychopharmacology, Rutgers University Behavioral and Systems Neuroscience Professor Mark West, and doctoral student David Barker in the Department of Psychology, in the School of Arts and Sciences, challenge the commonly held view that drug addiction occurs because users are always going after the high. Based on new animal studies, they discovered that the initial positive feelings of intoxication are short lived — quickly replaced by negative emotional responses whenever drug levels begin to fall.

If these animal models are a mirror into human addiction, Rutgers researchers say that addicts who learned to use drugs to either achieve a positive emotional state or to relieve a negative one are vulnerable to situations that trigger either behavior.

“Our results suggest that once the animals started a binge, they may have felt trapped and didn’t like it,” said West. “This showed us that negative emotions play an equal, if not more important role in regulating cocaine abuse.”

Read the entire article here

 

November 7, 2013 Posted by | Psychiatry, Psychology | , , , , , , | Leave a comment

Ethics Abandoned: Medical Professionalism and Detainee Abuse in the ‘War on Terror’

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From the summary at Full Text Reports (November 6, 2013)

Source: Institute on Medicine as a Profession and Open Society Institute (via Harvard Law School)

the task Force has determined that actions taken by the U.s. government immediately following 9/11 included three key elements affecting the role of health professionals in detention centers:

1. The declaration that as part of a “war on terror,” individuals captured and detained in Afghanistan, Pakistan, and elsewhere were “unlawful combatants” who did not qualify as prisoners of war under the geneva conventions. Additionally, the U.S. Department of Justice approved of interrogation methods recognized domestically and internationally as constituting torture or cruel, inhuman, or degrading treatment.

2. The DoD and CIA’s development of internal mechanisms to direct the participation of military and intelligence-agency physicians and psychologists in abusive interrogation and breaking of hunger strikes. Although the involvement of health professionals in human rights violations against detainees progressed differently in the military and the CIA, both facilitated that involvement in similar ways, including undermining health professionals’ allegiances to established principles of professional ethics and conduct through reinterpretation of those principles.
[my emphasis – Janice]

3. The secrecy surrounding detention policies that prevailed until 2004– 2005, when leaked documents began to reveal those policies. secrecy allowed the unlawful and unethical interrogation and mistreatment of detainees to proceed unfettered by established ethical principles and standards of conduct as well as societal, professional, and nongovernmental commentary and legal review.

These key elements, as well as the task Force’s recommendations for remediating the participation of health professionals in detainee torture or cruel, inhuman, or degrading treatment, are summarized below and addressed in detail in the body of this report.

November 7, 2013 Posted by | health care, Psychiatry | , , , , , , | 2 Comments

[Reblog from KevinMD.com] Insurers should stop paying for robotic hysterectomies

Those of you who follow me know I do not usually post items on specific procedures.
However, I frequently repost items which point out contributions to rising health care costs.
Thus this entry.

From the 21 October 2013 post by Jennifer Gunter MD at KevinMD.com

A new study confirms what previous studies tell us. That a robotic hysterectomy is not a safer or a more efficient way to remove a uterus for non-cancerous (benign) surgery than a traditional laparoscopic approach. This study indicates that there is little difference between the two types of surgery with one glaring exception, a robotic hysterectomy was $2,489 more expensive than a laparoscopic hysterectomy.

 

Several months ago the American Congress of Obstetricians and Gynecologists (ACOG) issued these statements:

Robotic surgery is not the only or the best minimally invasive approach for hysterectomy. Nor is it the most cost-efficient. It is important to separate the marketing hype from the reality when considering the best surgical approach for hysterectomies.

And,

there is no good data proving that robotic hysterectomy is even as good as—let alone better—than existing, and far less costly, minimally invasive alternatives.

Robotic hysterectomies for benign disease provide nothing additional from a medical perspective although they are a welcome marketing ploy for doctors and hospitals (Hey, we have a robot! Come see us! That’s so cool!). Some hospitals and GYN practices have literally built their marketing around the robot. And obviously the more robotic hysterectomies performed the greater the profits for the makers of the da Vinci robot.

There is enough data for insurance companies to say, “We won’t pay the price difference.” If insurance companies capped hysterectomy fees at the cost of a laparoscopic procedure then if hospitals and doctors wanted to eat the price difference or pass that price difference along to their patients, so be it.

Wasting money on a procedure that offers nothing over a less expensive alternative is an outrage. As an aside, this is the biggest issue I have with Obamacare. We should all be insured, but doctors, hospitals, and medical device companies should not be allowed to take advantage of that. The need to curtail egregious expenses is urgent. A robotic hysterectomy does offer advantageous for cancer surgery, so I’m all over that, but isn’t it better to channel the money to where it can actually improve outcomes?

And so my plea is to insurance companies. Whether procedures and drugs are covered or not depends in a large part on the body of medical literature and recommendations by professional organizations (like ACOG). There is not one study that shows the benefit of robotic hysterectomy over a traditional laparoscopic approach. Since the doctors and hospitals that push robotic hysterectomies don’t have the ethics to police themselves, insurance companies must step in and stop the madness. Insurance companies can either flat-out deny robotic hysterectomies or simply cap what they will pay at the cost of a traditional laparoscopic procedure. If there were a $2,489 co-payment for a robotic hysterectomy versus a $200 co-payment for a laparoscopic hysterectomy, given they have similar outcomes, which do you think would be more popular?

It is wrong to pass the additional cost of a more expensive and non medically advantageous procedure along to other purchasers of the same insurance. I don’t want my premiums to go for medically unindicated expenses and I certainly don’t want my premiums paying for corporate perks at Intuitive Surgical (makers of the da Vinci, and who are, by the way, laughing all the way to the bank).

Given that we are all curators of the health care system it is unethical to recommend robotic hysterectomies for benign disease. If doctors and hospitals refuse to read the literature (never mind reducing the waste in the system) then they should not be surprised at all when a third party steps in to do it for them.

Someone has to help stop the madness.

Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.

 

Excerpts

“The study, published in the Journal for Healthcare Quality earlier this year, focused on incidents involving Intuitive Surgical’s da Vinci Robotic Surgical System over nearly 12 years, scrubbing through several data bases to find troubled outcomes. Researchers found 245 incidents reported to the FDA, including 71 deaths and 174 nonfatal injuries. But they also found eight cases in which reporting fell short, including five cases in which no FDA report was filed at all.”

“James F. Blumstein, director of the Vanderbilt Health Policy Center and Professor of Constitutional Law and Health Law & Policy, said with robotic surgery, for patients it’s not necessarily about knowing which procedure would be best but being fully informed of their options. He said that if there are known injuries and routine problems, health care providers need to disclose that information to patients.

“If you as a patient are going to a doctor, and they’re using a robot, it’s a question of who’s in charge,” Blumstein said. “If it’s a mechanical malfunction, would the professional standard of care apply to a robot?”

If problems occur during robotic surgery and subsequent litigation, a question might arise about whether the doctor, the hospital or the manufacturer was responsible, introducing the potential issue of product liability. But there may be protection for doctors performing robotic surgery in disclosing the risks, Blumstein said.

“If a doctor discloses to a patient there’s a comparative risk (between regular surgery and robotic surgery) and that disclosed risk materializes, I would have a hard time thinking the doctor would be considered negligent,” he said.”

November 7, 2013 Posted by | health care | , , , , , , | Leave a comment

   

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