New York, NY, January 26, 2015 — A multi-institution team of sleep researchers recently found that workers who participated in an intervention aimed at reducing conflict between work and familial responsibilities slept an hour more each week and reported greater sleep sufficiency than those who did not participate in the intervention. Their study is published inSleep Health, Journal of the National Sleep Foundation.
“Increasing family-supportive supervision and employee control over work time benefited the sleep of hundreds of employees, and even greater effects may be possible if sleep is overtly addressed in workplace interventions,” explained lead author Ryan Olson, PhD, of Oregon Health & Science University. “The Work, Family, and Health Network Study intervention was designed to reduce work-family conflict. It did not directly address sleep, yet sleep benefits were observed.”
The invention focused on the U.S. employees of an information technology firm. Groups of randomly selected managers and employees participated in a three-month, social and organizational change process that included interactive sessions with facilitated discussions, role-playing, and games. Managers were also trained in family supportive supervision and self-monitored how they applied the training on the job. Data were collected through qualitative interviews 12 months after the intervention was introduced and by actigraphy, the measurement of individuals’ sleeping and waking patterns using a monitor attached to participants’ wrists. Actigraphy measures of sleep quality and quantity were taken at the beginning of the intervention, to establish baseline measures for participants, and 12 months after the intervention. Each of the 474 participants’ activity recordings were evaluated by two scorers, who identified periods of sleep relative to each participant’s waking activities.
“I applaud the methodological rigor of Olson and colleagues’ approach to assessing the Work, Family, and Health Network Study’s effect on the sleep duration and quality of a real world population,” commented Dr. Lauren Hale, Editor-in-Chief of Sleep Health. “This study demonstrates that interventions unrelated to sleep can improve sleep in the population. Furthermore, these findings serve as a reminder that there are opportunities to deploy innovative interventions to improve sleep.”
The authors had hypothesized that both sleep duration and insomnia would be improved in the study’s twelfth month; secondarily, they hypothesized that any improvement in sleep quality and duration would be mediated by employees’ enhanced control over their work time and reduced work-family conflict assessed at the sixth month after baseline. Researchers created a statistical mediation model that accounted for the multiple temporal aspects of actigraphic sleep data and participant characteristics.
“Here we showed that an intervention focused on changing the workplace culture could increase the measured amount of sleep employees obtain, as well as their perception that their sleep was more sufficient,” noted lead investigator Orfeu M. Buxton, PhD, Pennsylvania State University (with secondary appointments at Harvard and Brigham and Women’s Hospital). “Work can be a calling and inspirational, as well as a paycheck, but work should not be detrimental to health. It is possible to mitigate some of the deleterious effects of work by reducing work-family conflict, and improving sleep.”
Giving employees more control over their work schedules may help curb sleep deficiency, according to health researchers.
“In the absence of sufficient sleep, we are not as attentive or alert, we process information more slowly, miss or misinterpret social and emotional cues and decision making is impaired,” said Orfeu M. Buxton, associate professor of biobehavioral health, Penn State. “For example, we may misjudge risks by undervaluing negative consequences and overvaluing potential rewards.”
About 30 percent of U.S. adults reported not regularly getting a sufficient amount of sleep, a 2012 Centers for Disease Control survey found. Sleep deficiency has been linked to increased risk of automobile crashes, chronic disease and early mortality. Improving adequate sleep within the population is a goal of Healthy People 2020, a federal initiative that sets national objectives and monitors progress concerning the health of the nation.
Buxton and colleagues looked to see if a workplace intervention, designed to increase family-supportive supervision and give employees more control over their work time, improved sleep quantity and quality. They report their results in an article published online today (Jan. 21) in the journal Sleep Health.
The researchers followed 474 employees as part of a Work, Family and Health Network study conducted at an information technology company, with about half of the employees serving as the control while the other half experienced the study intervention. Both employees and their supervisors participated.
The intervention was designed to reduce conflicts between work and personal life, and focused on two main cultural shifts: allowing employees to decide on when and where they worked and training supervisors to support their employees’ personal lives. Those who were assigned to the intervention were encouraged to be completely flexible about when and where they would work — at the office, from home or elsewhere — while still working the same number of hours as the control group. All of the participants wore a sleep-monitoring watch, a device that tracks movement to monitor periods of sleep.
People who dismiss their symptoms as trivial or worry about wasting the doctor’s time may decide against going to their GP with red-flag cancer warning symptoms, according to a Cancer Research UK study* published in the British Journal of General Practice(link is external)today.
“Many of the people we interviewed had red flag symptoms but felt that these were trivial and didn’t need medical attention, particularly if they were painless or intermittent.” – Dr Katriina Whitaker
Others might decide not to get possible cancer symptoms checked out because they fear a cancer diagnosis, they adopt a stiff upper lip, they lack confidence in the healthcare system, or they think their problem is down to ageing.
Researchers in London and Hull** looked at how people who experience possible cancer symptoms decide whether or not to seek medical help. They sent out a health survey that was completed by more than 1,700 people, aged 50 and over, from three London GP practices.
The survey specifically did not mention cancer, but incorporated a list of 17 symptoms including 10 cancer ‘alarm’ warning signs, such as persistent cough or hoarseness, unexplained lump, persistent change in bowel or bladder habits, and a sore that does not heal.***
More than 900 people reported having at least one alarm symptom during the past three months. Researchers carried out in-depth interviews with almost 50 of them, almost half (45 per cent) of whom had not seen their GP about their symptoms. ****
One woman with persistent abdominal pain did not go for a recommended test. She said: “At times I thought it was bad … but when it kind of fades away, you know, it doesn’t seem worth pursuing really.” A man, who experienced a persistent change in bladder habits, said: “You’ve just got to get on with it. And if you go to the doctor too much, it’s seen as a sign of weakness or that you are not strong enough to manage things on your own.”
Dr Katriina Whitaker, a senior research fellow at University College London during the study, said: “Many of the people we interviewed had red flag symptoms but felt that these were trivial and didn’t need medical attention, particularly if they were painless or intermittent.
“Others felt that they shouldn’t make a fuss or waste valuable NHS resources. The stiff-upper-lip stoicism of some who decided not to go to their doctor was alarming because they put up with often debilitating symptoms. Some people made the decision to get symptoms checked out after seeing a cancer awareness campaign or being encouraged to do so by family or friends – this seemed to almost legitimise their symptoms as important.”
Reasons people gave for deciding to seek help included symptoms not going away, instinct that something was not right, and awareness or fear that they might have cancer. A man with an unexplained throat lump said: “But always at the back of your mind you’ve always got the fear of cancer …….. well it’s best to check just in case.” However, fear also made some people decide not to check out symptoms, or if symptoms did persist some people began to think they were normal for them.
Some people waited for another reason to visit their GP and mentioned the cancer alarm symptom then. Others said they would rather use an emergency route, such as going straight to A and E, than wait to see a specialist after being referred by their GP.
Dr Richard Roope, Cancer Research UK’s GP expert, said: “The advice we give is: if in doubt, check it out – this would not be wasting your GP’s time. Often your symptoms won’t be caused by cancer, but if they are, the quicker the diagnosis, the better the outcome. Seeking prompt advice from your GP about symptoms, either on the phone or during an appointment, could be a life-saver, whatever your age. And the good news is that more than half of all patients diagnosed with cancer now survive for more than 10 years.”
Young lovers walking down the aisle may dream of long and healthy lives together, but close friends in the wedding party may have a better sense of whether those wishes will come true, suggests new research on personality and longevity from Washington University in St. Louis.“You expect your friends to be inclined to see you in a positive manner, but they also are keen observers of the personality traits that could send you to an early grave,” said Joshua Jackson, PhD, assistant professor of psychology in Arts & Sciences.
Jackson
Published Jan. 12 in an advance online issue of the journal Psychological Science, the study demonstrates that your personality at an early age (20s) can predict how long you will live across 75 years and that close friends are usually better than you at recognizing these traits.Male participants seen by their friends as more open and conscientious ended up living longer. Female participants whose friends rated them as high on emotional stability and agreeableness also enjoyed longer lifespans, the study found.
“Our study shows that people are able to observe and rate a friend’s personality accurately enough to predict early mortality decades down the road,” Jackson said. “It suggests that people are able to see important characteristics related to health even when their friends were, for the most part, healthy and many years from death.”
It’s no secret that a person’s personality traits can have an impact on health. Traits such as depression and anger have been linked to an increased risk of various diseases and health concerns, including an early death.
Men who are conscientious are more likely to eat right, stick with an exercise routine and avoid risks, such as driving without a seat belt. Women who are emotionally stable may be better at fighting off anger, anxiety and depression, Jackson suggests.
While other studies have shown that a person’s view of his or her own personality can be helpful in gauging mortality risk, there has been little research on whether a close friend’s personality assessment might also predict the odds of a long life.
To explore this question, Jackson and colleagues analyzed data from a longitudinal study that in the 1930s began following a group of young people in their mid-20s, most of whom were engaged to be married.
The longitudinal study included extensive data on participant personality traits, both self-reported and as reported by close friends, including bridesmaids and groomsmen in the study participants’ wedding parties.
Using information from previous follow-up studies and searches of death certificates, Jackson and colleagues were able to document dates of death for all but a few study participants. Peer ratings of personality were stronger predictors of mortality risk than were self-ratings of personality.
“There are two potential reasons for the superiority of peer ratings over self ratings,” Jackson said.
“First, friends may see something that you miss; they may have some insight that you do not. Second, because people have multiple friends, we are able to average the idiosyncrasies of any one friend to obtain a more reliable assessment of personality. With self reports, people may be biased or miss certain aspects of themselves and we are not able to counteract that because there is only one you, only one self-report.”
The study also revealed some gender differences in self-assessment: Men’s self-ratings of personality traits were somewhat useful in predicting their lifespans, whereas the self-reports of women had little predictive value.
Jackson suggests this gender difference in self-reporting may be a function of the era in which the study began, since societal expectations were different then and fewer women worked outside the home.
Young women seen as highly agreeable and emotionally stable may have increased odds for a long and happy life since their personalities were well suited for the role of a supportive and easy-going wife, which would have been the norm in the 1930s. It is likely that fewer gender differences would arise in more modern samples if we were able to wait 75 years to replicate the study, he said.
“This is one of the longest studies in psychology,” Jackson said. “It shows how important personality is in influencing significant life outcomes like health and demonstrates that information from friends and other observers can play a critical role in understanding a person’s health issues. For example, it suggests that family members and even physician ratings could be used to personalize medical treatments or identify who is at risk for certain health ailments.”
The study is co-authored by James J. Connolly, PhD, and Madeleine M. Leveille, PhD, of Connolly Consulting, Waterford, Connecticut; S. Mason Garrison of the Department of Psychology and Human Development, Vanderbilt University; and Seamus L. Connolly of College of Medicine, Touro University, California.
Of the many hidden gems in the Affordable Care Act, one of my favorites is Physician Compare. This website could end up being a game changer—holding doctors accountable for their care and giving consumers a new way to compare and choose doctors. Or it could end up a dud.
The outcome depends on how brave and resolute the Centers for Medicare and Medicaid Services (CMS) is over the next few years. That’s because the physician lobby has been less than thrilled with Physician Compare, and, for that matter, with every other effort to publically report measures of physician performance and quality.
I’d give CMS a C+ to date. Not bad considering it’s the tough task. The agency has been cautious and deliberate. But after the many problems with Hospital Compare, Nursing Home Compare, Home Health Compare, and Dialysis Facility Compare—not to mention the shadow of healthcare.gov’s initial rollout—that’s understandable. They want, I hope, to get this one right from the get-go. And competition from the private sector looms.
Congress mandated that CMS establish Physician Compare by Jan. 1, 2011 and that an initial content plan be submitted by Jan. 1, 2013. CMS met those deadlines, albeit with a rudimentary site that launched in late December 2010. The agency updated its plans in 2013 and 2014, even as it added more content and functionality to the site.
The law requires the site to have “information on physician performance that provides comparable information on quality and patient experience measures.” That’s to include measures collected under the Medicare Physician Quality Reporting System (PQRS), Medicare’s main quality reporting vehicle, and assessments of:
patient health outcomes and the functional status of patients
continuity and coordination of care and care transitions, including episodes of care and risk-adjusted resource use
the efficiency of care
patient experience and patient, caregiver, and family engagement
the safety, effectiveness, and timeliness of care
Notably, Congress set no deadline for the site to meet those specifications or be fully operational.
So what’s posted so far? The centerpiece of the site is a searchable directory of some 850,000 Medicare providers. That includes most of the practicing doctors in the U.S. with the exception of pediatricians and other physicians who don’t treat Medicare patients. This database predates the ACA and Physician Compare but its functionality, reliability and accuracy (a big complaint from physician groups) is being gradually enhanced.
Each doctor has his or her own profile page—a significant foundation that could accommodate quality and patient experience data in the future.
Consumers can also search three additional databases on the site. They identify doctors and other clinicians who participate in (a) PQRS; (b) the Electronic Prescribing Incentive Program; and (c) the electronic health record (EHR) incentive program (also called the meaningful-use program). About 350,000 physicians and other clinicians participate in the latter.
The bad news: these databases are separate and their content is not integrated. That makes searching for information on a particular group practice or individual doctor cumbersome and time consuming. And the databases aren’t user-friendly. On the plus side, for researchers and health administrators, the databases are downloadable.
To control one’s dreams and to live out there what is impossible in real life – a truly tempting idea. Some persons – so-called lucid dreamers –can do this. Researchers from the Max Planck Institute for Human Development in Berlin and the Max Planck Institute of Psychiatry in Munich have discovered that the brain area which enables self-reflection is larger in lucid dreamers. Thus, lucid dreamers are possibly also more self-reflecting when being awake.
Sagittal human brain with cortical regions delineated. (Photo credit: Wikipedia)
Lucid dreamers are aware of dreaming while dreaming. Sometimes, they can even play an active role in their dreams. Most of them, however, have this experience only several times a year and just very few almost every night. Internet forums and blogs are full of instructions and tips on lucid dreaming. Possibly, lucid dreaming is closely related to the human capability of self-reflection – the so-called metacognition.
Neuroscientists from the Max Planck Institute for Human Development and the Max Planck Institute of Psychiatry have compared brain structures of frequent lucid dreamers and participants who never or only rarely have lucid dreams. Accordingly, the anterior prefrontal cortex, i.e., the brain area controlling conscious cognitive processes and playing an important role in the capability of self-reflection, is larger in lucid dreamers.
The differences in volumes in the anterior prefrontal cortex between lucid dreamers and non-lucid dreamers suggest that lucid dreaming and metacognition are indeed closely connected. This theory is supported by brain images taken when test persons were solving metacognitive tests while being awake. Those images show that the brain activity in the prefrontal cortex was higher in lucid dreamers. “Our results indicate that self-reflection in everyday life is more pronounced in persons who can easily control their dreams,” states Elisa Filevich, post-doc in the Center for Lifespan Psychology at the Max Planck Institute for Human Development.
The researchers further want to know whether metacognitive skills can be trained. In a follow-up study, they intend to train volunteers in lucid dreaming to examine whether this improves the capability of self-reflection.
When cancer patients take part in a clinical trial to develop new therapies, they and their physicians want to know how they will feel and function during treatment. A new collaboration between Bayer and The University of Texas MD Anderson Cancer Center will go straight to the patients to learn how certain investigational new drugs affect them. The project will involve the use of questionnaires to assess how a drug may impact a patient’s disease-related symptoms.
“Fit-for-purpose patient-reported-outcome (PRO) measures are an invaluable resource for helping us to better understand how patients are actually being affected by new therapies,” said Charles Cleeland, Ph.D., chair of symptom research at MD Anderson. “This will be especially important in the developmental pathway of new drugs, given that these PRO measures will enhance information about treatment tolerability and potential symptom-reduction benefit earlier in the drug development process.”
Charles Cleeland, Ph.D.
The information will be beneficial in further evaluating the drug if it progresses to later stages of clinical development and is tested in larger numbers of patients. The importance of having data on the symptom burden or benefit conferred by therapy is often not recognized until late in that process.
“For patients and their physicians, knowing the probable effects of a treatment can help with decisions among treatment options when therapeutic outcomes are similar but symptomatic effects are not,” said Cleeland.
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Related Resources
ClinicalTrials.gov
registry and results database of publicly and privately supported clinical studies of human participants conducted around the world
Each ClinicalTrials.gov record presents summary information about a study protocol and includes the following:
Disease or condition
Intervention (for example, the medical product, behavior, or procedure being studied)
Title, description, and design of the study
Requirements for participation (eligibility criteria)
Locations where the study is being conducted
Contact information for the study locations
Links to relevant information on other health Web sites, such as NLM’s MedlinePlus® for patient health information and PubMed® for citations and abstracts for scholarly articles in the field of medicine.
Some records also include information on the results of the study, such as:
Description of study participants (the number of participants starting and completing the study and their demographic data)
Outcomes of the study
Summary of adverse events experienced by study participants
University of Pennsylvania researchers have found that the words people use on Twitter can help predict the rate of heart disease deaths in the counties where they live. Places where people tweet happier language about happier topics show lower rates of heart disease death when compared with Centers for Disease Control statistics, while places with angry language about negative topics show higher rates.
The findings of this study, which was published in the journal Psychological Science, cut across fields such as medicine, psychology, public health and possibly even civil planning. It’s yet another affirmation that Twitter, despite any inherent demographic biases, is a good source of relatively unfiltered data about people’s thoughts and feelings,well beyond the scale and depth of traditional polls or surveys. In this case, the researchers used approximately 148 million geo-tagged tweets from 2009 and 2010 from more than 1,300 counties that contain 88 percent of the U.S. population.
(How to take full advantage of this glut of data, especially for business and governments, is something we’ll cover at our Structure Data conference with Twitter’s Seth McGuire and Dataminr’s Ted Bailey.)
What’s more, at the county level, the Penn study’s findings about language sentiment turn out to be more predictive of heart disease than any other individual factor — including income, smoking and hypertension. A predictive model combining language with those other factors was the most accurate of all.
That’s a result similar to recent research comparing Google Flu Trends with CDC data. Although it’s worth noting that Flu Trends is an ongoing project that has already been collecting data for years, and that the search queries it’s collecting are much more directly related to influenza than the Penn study’s tweets are to heart disease.
The last of four Florida insurers blasted by AIDS activists for the high cost of their HIV drugs relented last week, saying it would cap what patients pay every month for four types of medication.
“We will voluntarily agree to set an out-of-pocket limitation of $200 per month on each of the following drugs: Atripla, Complera, Stribild, and Fuzeon,” Preferred Medical Plan CEO Tamara Meyerson wrote to Kevin McCarty, commissioner of the Florida Office of Insurance Regulation, in a Jan. 14 letter.
The other three companies — Coventry Health Care, Humana and Cigna — had earlier reached formal agreements with state regulators to lower their prices and to fill prescriptions without prior authorization for 2015.
Preferred did not violate Florida’s anti-discrimination laws, said Amy Bogner, a spokeswoman for the state’s insurance office.
This copyrighted story comes from the Miami Herald, produced in partnership with KHN. All rights reserved.
An estimated 120,000 Floridians have HIV, and nearly half of them live in South Florida, according to state data.
First Amendment jurisprudence frequently pits societal ideals against free speech. A recent conference at Yale Law Schoolshowed that this is no less the case when commercial free speech protections conflict with public health regulatory objectives.
The conference, Public Health in the Shadow of the First Amendment, was co-sponsored by the Information Society Project, the Yale Global Health Justice Partnership, and the Yale Health Law and Policy Society on October 17 and 18, 2014. The event brought together public health advocates, medical professionals and First Amendment scholars to discuss the implications of recent controversial First Amendment case law. The panels highlighted several areas where courts have protected commercial speech in spite of unpopular consequences for public health policy. Hilary Richardson attended the conference on behalf of the Wikimedia Foundation legal team, given its interest in free speech law.
Professor Post provided insight into how we theorize the First Amendment and why we understand it to protect commercial speech at all. According to Post, the primary distinction between speech that is covered by the First Amendment and speech that is not comes down to our democratic value of self-governance: speech triggers First Amendment coverage when it participates in the formation of public opinion because we want the government to be responsive to public opinion. Generally, this creates a First Amendment right which is speaker-oriented. However, this changed when the Supreme Court invented the commercial speech doctrine. In Virginia Pharmacy,[3] the Court gave two rationales: we need efficient distribution of information in order to have efficient markets, and we protect commercial speech because it distributes information which is necessary for citizens to participate in public opinion formation. Post argued that in this sense, Virginia Pharmacy created a First Amendment right of the receiver to hear information rather than speak it. In the context of commercial speech, the Supreme Court conceives of the public as people capable of processing information. This suggests that it is up to the people to decide what information they need.
Professor Volokh echoed Post and Bambauer in his agreement that First Amendment protections are about protecting a free market, so that it is better for people to have more information when making decisions. Volokh stressed that the logic behind the commercial speech doctrine is that even though we may think that patients and doctors may make bad decisions, it is possible that government regulators might as well: “the First Amendment directs us to be especially skeptical of regulations that seek to keep people in the dark for what the government perceives to be their own good.”
Recently the FDA has approved the first “biosimilars” to be available in the United States. In order for a drug to be considered biosimilar, the law requires that the copycat drug is “highly similar” to the reference drug, and does not have “clinically meaningful” differences. Biosimilar drugs will offer lower-cost competition as they tend to cost between 20 – 30 % less than the original branded drug. According to the Federal Trade Comission, Biosimilar products are estimated to take 8 to 10 years to develop and will cost the manufacturers up to $200 million to produce.With this new class of drugs, patients will be able to save thousands on their medications. Has your company/employer began exploring the budgetary effects of biosimilars? How will this new class of biosimilars affect health care spending in the US?
Want to ace that test tomorrow? Here’s a tip: Put down the coffee and hit the sack.
Scientists have long known that sleep, memory and learning are deeply connected. Most animals, from flies to humans, have trouble remembering when sleep deprived, and studies have shown that sleep is critical in converting short-term into long-term memory, a process known as memory consolidation.
But just how that process works has remained a mystery.
The question is, does the mechanism that promotes sleep also consolidate memory, or do two distinct processes work together? In other words, is memory consolidated during sleep because the brain is quiet, allowing memory neurons to go to work, or are memory neurons actually putting us to sleep?
In a recent paper in the journal eLife, graduate students Paula Haynes and Bethany Christmann in the Griffith Lab make a case for the latter.
Haynes and Christmann focused their research on dorsal paired medial (DPM) neurons, well-known memory consolidators inDrosophila. They observed, for the first time, that when DPM neurons are activated, the flies slept more; when deactivated, the flies kept buzzing.
These memory consolidators inhibit wakefulness as they start converting short-term to long-term memory. All this takes place in a section of the Drosophila brain called the mushroom body, similar to the hippocampus, where our memories are stored. As it turns out, the parts of the mushroom body responsible for memory and learning also help keep the Drosophila awake.
“It’s almost as if that section of the mushroom body were saying ‘hey, stay awake and learn this,’” says Christmann. “Then, after a while, the DPM neurons start signaling to suppress that section, as if to say ‘you’re going to need sleep if you want to remember this later.’”
Understanding how sleep and memory are connected in a simple system, like Drosophila, can help scientists unravel the secrets of the human brain.
“Knowing that sleep and memory overlap in the fly brain can allow researchers to narrow their search in humans,” Christmann says. “Eventually, it could help us figure out how sleep or memory is affected when things go wrong, as in the case of insomnia or memory disorders.”
To learn more about this and other fly research, check out Christmann’s blog, Fly on the Wall.
English: An elderly patient at St. Elizabeths Hospital in Washington, D.C. (Photo credit: Wikipedia)
Excerpt
Date:January 22, 2015
Source:BMJ-British Medical Journal
Summary:A checklist has been designed to spot elderly hospital patients likely to die within the next three months, a new article outlines. The researchers emphasize that the checklist is not intended to substitute healthcare for the elderly who are terminally ill. Instead, it is meant to “provide an objective assessment and definition of the dying patient as a starting point for honest communication with patients and families about recognizing that dying is part of the life cycle.”
Source:University of California, Los Angeles (UCLA), Health Sciences
Summary:Researchers have proposed a system for off-label drug prescriptions combining reporting, testing and enforcement regulations, and allowing interim periods of off-label use. This would give patients more treatment options while providing regulators with evidence of the drugs’ safety and efficacy.
Medicine drugs (Photo credit: Wikipedia)
Off-label use of drugs and medical devices — using approved remedies in unapproved ways — has long been a part of medicine. The practice provides public health benefits but also presents some risks.
For the most part, the U.S. Food and Drug Administration allows physicians to prescribe drugs and devices off-label in the same way they are prescribed for their approved uses. The FDA couldn’t require approval for each off-label use because the burden for approval would be so high that few off-label uses would be approved, which would deprive patients of effective treatments for which the drugs weren’t originally intended.
As a result, health care providers have had to make their own decisions about using drugs off-label, often in the face of uncertain evidence.
To address that issue, researchers from the David Geffen School of Medicine at UCLA have proposed a system combining reporting, testing and enforcement regulations, and allowing interim periods of off-label drug prescription. Their recommendations, published in the Duke Law Journal, would give patients more treatment options while providing regulators with evidence of the drugs’ safety and efficacy.
….
The authors’ proposal comprises three elements:
• Improved reporting of off-label use through disclosure of diagnostic codes in reports to the FDA, in detailing data that pharmaceutical companies obtain on physicians’ prescribing habits, and in reports to the FDA and Medicare/Medicaid reimbursement requests. This information, which would omit details that could identify individual patients, could then be shared with academics and pharmaceutical companies for use in research. • Expansion of post-market testing requirements for off-label use of drugs and medical devices. • A tiered labeling system for drugs consisting of “red box” warnings that prohibit certain off-label uses; informed consent from patients receiving prescriptions for off-label use of some drugs that currently carry “black box” warnings, which identify drugs that pose a significant risk of serious or life-threatening adverse effects; and the creation of a new “grey box” warning that blocks Medicare Part D and Medicaid reimbursements by the Centers for Medicare and Medicaid Services.
“The improved reporting, testing and enforcement regulation would work together to produce a more layered range of regulatory responses,” the authors write. “The FDA, armed with better information about the extent of off-label use and adverse effects, would be in a better position to require post-market testing and to discourage off-label use with new types of warnings if manufacturers fail to provide sufficient, timely evidence of safety and efficacy in that particular extrapolation.”
It’s time to toss the whole business-as-usual model — for your own good and the good of your customers.
The emerging Default Model of health care — the “consumer-directed” insured fee-for-service model in which health plans compete to lower premiums by bargaining providers into narrow networks — not only does not work for health care’s customers, it cannot work. This is not because we are doing it wrong or being sloppy. By its very nature the Default Model must continually fail to bring our customers what they want and desperately need. Ultimately it cannot bring you, the providers, what you want and need.
Take a dive with me into the real-world game-theory mechanics of the health care economy, and you will see why. It’s time to rebuild the fundamental business models of health care.
The Default Model Health Care Game
It’s a little easier to find our way around an economic model by picturing it as a game and asking: “What defines winning for each player? What does each player need to do to win?”
Health plans: For health plans, winning means surviving, succeeding and growing as a business. But there are a couple of rule changes now. Health plans used to be able to stay more profitable by pushing down their medical loss ratio (MLR — the percentage of premiums actually paid out for medical care), by “rescinding” the plans of people who cost too much, and by refusing to cover anyone with pre-existing conditions.
Now they have to take everybody, can’t toss them out, and their MLR has to be at least 80 percent (or 85 percent for large customers). So their administrative expenses, advertising, executive salaries (and the profits and stock price of the for-profits) are all tied to a percentage of the actual costs of health care. Hmmm. If they were confronted with a way to make health care cost half as much, would they be interested? Would they make it a top priority? No. They have no incentive to actually drop the real costs of health care.
….
Related articles
While I agree with the author of the above article, the selected related articles do include other viewpoints.
CAPTION Journal of Medicinal Food is an authoritative, peer-reviewed, multidisciplinary journal published monthly in print and online. Led by Editors-in-Chief Sampath Parthasarathy, MBA, PhD, and Young-Eun Lee, PhD, Wonkwang University, Jeonbuk, Korea, this scientific journal publishes original scientific research on the bioactive substances of functional and medicinal foods, nutraceuticals, herbal substances, and other natural products. The Journal explores the chemistry and biochemistry of these substances, as well as the methods for their extraction and analysis, the use of biomarkers and other methods to assay their biological roles, and the development of bioactive substances for commercial use. Tables of content and a sample issue may be viewed on the Journal of Medicinal Food website.
New Rochelle, NY, January 21, 2015–The hundred trillion bacteria living in an adult human–mostly in the intestines, making up the gut microbiome–have a significant impact on behavior and brain health. The many ways gut bacteria can impact normal brain activity and development, affect sleep and stress responses, play a role in a variety of diseases, and be modified through diet for therapeutic use are described in a comprehensive Review article in Journal of Medicinal Food, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The paper is available free on the Journal of Medicinal Food website until February 21, 2015.
In “The Gut Microbiome and the Brain”, Leo Galland, Foundation for Integrated Medicine (New York, NY), presents the most up-to-date understanding of the relationship between the proteins produced by intestinal bacteria and the human central nervous system. The author explores the various mechanisms through which the microbiome can influence the brain: by stimulating and over-stimulating the immune system, producing neurotoxic agents, releasing hormones or neurotransmitters identical to those made by the human body, or through direct neuronal stimulation that sends signals to the brain.
“The microbiome has become a hot topic in many branches of medicine, from immune and inflammatory diseases, such as Crohn’s and IBD to cardiovascular diseases,” says Co-Editor-in-Chief Sampath Parthasarathy, MBA, PhD, Florida Hospital Chair in Cardiovascular Sciences, University of Central Florida, Orlando. “Scientists are not only aware of the ‘good’ and the ‘bad’ microbes in the gut but are becoming increasingly aware of how they could alter the metabolism beyond gut.”
From the January/February 2015 journal article abstract
If there is one thing that health care experts seem to agree on, it is the importance of preventive care. Anything that can help the American public to do a better job of understanding, accessing, and affording effective preventive care and thereby helping them to avoid potential threats to their health should be indisputably a good thing for individuals, families, and society.
Recommendations for the public about what preventive care services an individual might need at different points in his or her life can be one important tool in this tool box, and that goes double for recommendations that speak with the imprimatur of the U.S. Department of Health and Human Services (DHHS). So, a series of fact sheets on “staying healthy” from the Agency for Healthcare Research and Quality (AHRQ)—a branch of DHHS devoted to evidence-based improvements to the provision of U.S. health care—should be a welcome and valued resource (Agency for Healthcare Research and Quality (AHRQ), 2014a, Agency for Healthcare Research and Quality (AHRQ), 2014b).
In this light, it is disappointing to find the AHRQ fact sheets falling short of the mark in some critical ways related to their recommendations on sexual and reproductive health care. The four fact sheets—for women of all ages, women at age 50 and older, men of all ages, and men at age 50 and older—contain a wealth of good advice about screenings and preventive medicine that a patient might need. However, they leave out many effective sexual and reproductive health-related preventive services—perhaps most notably any mention of contraceptive services and supplies—that have been endorsed by other agencies in the DHHS and by the medical establishment more broadly, and that have been promoted through the Affordable Care Act’s (ACA) requirements for private health plans to cover preventive services without patient out-of-pocket costs (HealthCare.gov, 2014, Sonfield, 2012). The AHRQ fact sheets compound those oversights by seeming to imply that they embody the sum total of DHHS’s preventive care recommendations, when in reality they seem to be based almost exclusively on the recommendations of a single body, the U.S. Preventive Services Task Force.
From the January 2015 NCHS Data Brief (US Centers for Disease Control and Prevention)
Key findings Data from the National Hospital Discharge Survey
In 2010, adults aged 85 and over accounted for only 2% of the U.S. population but 9% of hospital discharges.
From 2000 through 2010, the rate of hospitalizations for adults aged 85 and over declined from 605 to 553 hospitalizations per 1,000 population, a 9% decrease.
The rate of fractures and other injuries was higher for adults aged 85 and over (51 per 1,000 population) than for adults aged 65–74 (9 per 1,000 population) and 75–84 (23 per 1,000 population).
Adults aged 85 and over were less likely than those aged 65–74 and 75–84 to be discharged home and more likely to die in the hospital.
From 2000 through 2010, the number of adults aged 85 and over in the United States rose 31%, from 4.2 million to 5.5 million, and in 2010, this age group represented almost 14% of the population aged 65 and over (1). It is estimated that by 2050, more than 21% of adults over age 65 will be aged 85 and over (2). Given this increase, adults aged 85 and over are likely to account for an increasing share of hospital utilization and costs in the coming years (3). This report describes hospitalizations for adults aged 85 and over with comparisons to adults aged 65–74 and 75–84.
What percentage of hospital care was provided to adults aged 85 and over?
In 2000, adults aged 85 and over accounted for only 2% of the U.S. population but 8% of hospital discharges. In 2010, adults aged 85 and over still accounted for 2% of the U.S. population but accounted for 9% of hospital discharges (Figure 1).
Figure 1. Population, discharges, and days of care, by age: United States, 2000 and 2010
NOTE: Population is the U.S. civilian noninstitutionalized population.
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000–2010.
In 2000 and 2010, adults aged 85 and over accounted for 12% and 14%, respectively, of those aged 65 and over. However, adults aged 85 and over accounted for more than 20% of hospital discharges for those aged 65 and over for both years.
Adults aged 85 and over accounted for a disproportionate share of the total days of care, 10% in 2000 and 11% in 2010.
Figure 2. Hospitalizations, by age: United States, 2000–2010
1Rate of hospitalization exceeds the rate for younger age groups for every year from 2000 through 2010 (p < 0.05).
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000–2010.
From 2000 through 2010, the hospitalization rate for adults aged 85 and over remained significantly higher than the rates for adults under age 65, aged 65–74, and aged 75–84.
In 2010, the hospitalization rate for adults aged 85 and over (553 per 1,000 population) was more than five times higher than the rate for adults under 65 (80 per 1,000 population).
What were common causes of hospitalization for adults aged 85 and over?
In 2010, congestive heart failure (43 per 1,000 population) was the most frequent first-listed diagnosis for adults aged 85 and over, but in 2000 and 2005, pneumonia (51 and 52 per 1,000 population, respectively) was the most common first-listed diagnosis for adults aged 85 and over (Table).
Hospitalization rates for congestive heart failure, pneumonia, stroke, and hip fracture decreased from 2000 through 2010 for adults aged 85 and over, and the rates for urinary tract infections and septicemia increased from 2000 through 2010.
Table. Common causes of hospitalization for adults aged 85 and over: United States, 2010
First-listed diagnosis
2000
2005
2010
Percent change1 (2000 to 2010)
Rate of hospitalization per 1,000 population
Congestive heart failure
48
47
43
–9.5
Pneumonia
51
52
34
–32.8
Urinary tract infection
19
24
30
+55.9
Septicemia
15
18
28
+84.8
Stroke
37
27
28
–25.0
Hip fracture
28
23
21
–25.4
1Percent change for each diagnosis is significant from 2000 through 2010 (p < 0.05).
NOTE: First-listed diagnosis is considered to be the main cause or reason for the hospitalization. The diagnoses were chosen because they were the top six first-listed diagnoses in 2010.
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000–2010.
How likely were adults aged 85 and over to be hospitalized for injury?
The rate of all injuries for adults aged 85 and over (51 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (9 and 23 per 1,000 population, respectively) (Figure 3).
The rate of hip fractures for adults aged 85 and over (21 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (2 and 8 per 1,000 population, respectively).
The rate of other fractures for adults aged 85 and over (18 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (4 and 10 per 1,000 population, respectively).
The rate of other injuries for adults aged 85 and over (12 per 1,000 population) was higher than the rates for adults aged 65–74 and 75–84 (3 and 6 per 1,000 population, respectively).
Last month I unfriended (FB) Huffington Post. The postings were increasingly not only sexual in nature, but outright base. Came across this one via a FB friend, and am grateful. While I believe the jury is still out, it does highlight a factor that probably has been overlooked. Caring compassionate communities do make a difference. Reminds me of a story about an inmate. He was very angry with another inmate, so much so he was contemplating murder. He told this to other members of his prayer group. He also related that he did not murder because he didn’t want to let the prayer group members down.
It is now one hundred years since drugs were first banned — and all through this long century of waging war on drugs, we have been told a story about addiction by our teachers and by our governments. This story is so deeply ingrained in our minds that we take it for granted. It seems obvious. It seems manifestly true. Until I set off three and a half years ago on a 30,000-mile journey for my new book, Chasing The Scream: The First And Last Days of the War on Drugs, to figure out what is really driving the drug war, I believed it too. But what I learned on the road is that almost everything we have been told about addiction is wrong — and there is a very different story waiting for us, if only we are ready to hear it.
If we truly absorb this new story, we will have to change a lot more than the drug war. We will have to change ourselves.
…
The rats with good lives didn’t like the drugged water. They mostly shunned it, consuming less than a quarter of the drugs the isolated rats used. None of them died. While all the rats who were alone and unhappy became heavy users, none of the rats who had a happy environment did.
At first, I thought this was merely a quirk of rats, until I discovered that there was — at the same time as the Rat Park experiment — a helpful human equivalent taking place. It was called the Vietnam War. Time magazine reported using heroin was “as common as chewing gum” among U.S. soldiers, and there is solid evidence to back this up: some 20 percent of U.S. soldiers had become addicted to heroin there, according to a study published in the Archives of General Psychiatry. Many people were understandably terrified; they believed a huge number of addicts were about to head home when the war ended.
But in fact some 95 percent of the addicted soldiers — according to the same study — simply stopped. Very few had rehab. They shifted from a terrifying cage back to a pleasant one, so didn’t want the drug any more.
Professor Alexander argues this discovery is a profound challenge both to the right-wing view that addiction is a moral failing caused by too much hedonistic partying, and the liberal view that addiction is a disease taking place in a chemically hijacked brain. In fact, he argues, addiction is an adaptation. It’s not you. It’s your cage.
….
There just might be something to this. Can only speak for myself. There’s a bottle in the house with about 10 oxycodone pills left over from my husband’s hospital admission. Been there from about a year. I’ve taken three when I thought they were needed. Could be argued I’m not physiologically wired for them. But I think I have a relatively stable life and good support…
This blog presents a sampling of health and medical news and resources for all. Selected articles and resources will hopefully be of general interest but will also encourage further reading through posted references and other links. Currently I am focusing on public health, basic and applied research and very broadly on disease and healthy lifestyle topics.
Several times a month I will post items on international and global health issues. My Peace Corps Liberia experience (1980-81) has formed me as a global citizen in many ways and has challenged me to think of health and other topics in a more holistic manner.
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