Lately, Doctor Pundit has been reporting some tidbits from the arena of medical research. Here are a few more to make the wires for 9/1.

• Is it really possible? For now you’ll just have to ask the mice taking it. Metformin, the country’s most widely used antidiabetic agent, could lead to the prevention of lung, breast, and prostate malignancies. | LINK
• Speaking of cancers, are certain heritable forms of breast cancer prevented by a certain surgical technique? | LINK
• Again, on the topic of cancer: an anti-tumor drug may be altered to serve as the basis for a novel agent to prevent the formation of senile plaques seen in the central nervous system in virtually all Alzheimer patients. | LINK
• Finally, on the lighter side of things — the all-star line-up for the “Stand Up to Cancer” telethon is almost finalized. | LINK

The huge drive to immunize the masses against threat of H1N1 in the 2009/10 influenza season (which the WHO has officially declared concluded) has created more than a watershed moment in 21st century public health response to a potential biological catastrophe, it has also touched off a political debate that’s just getting started. And it all has to do with authoritarian mandate of the vaccine for healthcare workers.

Contrary to popular thought, many healthcare workers do not receive the vaccine; in fact, approximately 40 percent of said workers actively refused [PDF link] the vaccine last year — during infection’s peak. This notion does not sit well with a couple of policy organizations — one academic and one medical. Both groups say mandatory influenza vaccine should be a condition of employment. The groups stress increased availability of the vaccine, a steadier supply of healthy workers to administer care in times of a crisis, and an overall decrease in the incidence of influenza-related deaths in already compromised inpatients with other medical problems.

Already, the state of New York is hard at work in developing regulatory actions for its public healthcare workers. | LINK

The massive increase in procedures over the past 20 years has added to the cost of providing care, to no one’s surprise. A study in the recent Radiology journal acknowledges this.

Part of the explosion in medical imaging over the past two decades may be attributable to overutilization, and steps need to be taken to cut back … Imaging services and their costs have grown at about twice the rate of other technologies in healthcare including lab procedures and pharmaceuticals…

Part of the problem fueling this growth has been the inclusion of many non-invasive standard imaging techniques as being procedure based — lumping the costs associated with uncomplicated, unenhanced CT imaging with, say, CT-guided renal biopsy — for example. Of course, bordering on the unethical side are the practices of self-referral within large imaging groups in many healthcare markets. | LINK

The application of the philosophy that is at the core of medicine: first do no harm — is a little at play in an article in the NYT. The rise of so-called concierge practices in the wake of healthcare reform has touched off a debate of sorts on the ethics of delivering such care. That is, you essentially pay for what you get — nothing more, nothing less. Perhaps its the myriad names by which its central workings are known that give it some ethical cover: membership medicine, concierge health care, cash only practice, direct care, boutique medicine. These terms convey one basic fact — the patient pays an annual fee (with other possible charges). In exchange for the retainer, doctors provide enhanced care.

[I]t’s hard not to wonder whether it is possible to practice in a way that reconciles concierge medicine with all the ethical concerns. One group of doctors in Boston believes it is possible. [...] But unlike other boutique practices, the retainer fee of $1,800 per year that these patients pay does not go directly to the doctors’ coffers. Instead, it is used to support the traditional general medical practice, the teaching of medical students and trainees and free care to impoverished patients.

Thinking of the delivery of this type of “specialized” primary care in which fees go to the process of delivery itself before direct provider revenue is another way some primary care practices hope to regain some lost footing in practices on the brink of dissolution or acquisition under the brave new world of reform. For some of these practices, for now, arrangements seem to be paying off — ethically, if not fiscally. | LINK

Just how effective are vaccines at keeping mass pandemics of infectious disease abated? Well, it may not be so easy to estimate.

[T]he number of annual flu-related deaths in the United States has ranged from a low of about 3,300 to a high of about 49,000. This is a revision of the static estimate of 36,000 annual deaths that has been reported consistently for years by the U.S. Centers for Disease Control and Prevention.

The CDC has revised its projections on the preventive care of the seasonal influenza vaccine, moving from statistical dead targets to ranges of mortality among influenza outbreak figures. Its projections cover most of the past 30 years (up to 2007, and not inclusive of last year’s H1N1 pandemic). | PDF  LINK to latest issue of CDC’s Morbidity & Mortality Weekly

The retooled GAMC health plan initiated due to the budget crisis in this state earlier this year appears to be at a crossroads of sorts — and it involves payments to the participating safety-net hospitals.

The discussions began because Hennepin County Medical Center (HCMC) in Minneapolis has had a smaller percentage of potential patients enroll than the other three participating hospitals and, as a result, is getting paid more than twice the amount per patient.

The capitated-type payments to the hospitals which have the resources to participate in the GAMC overhaul was introduced as a way to complement patient enrollment caps to each of those participating hospitals. However, it appears that there is a breakdown in access-to-care and cost-per-patient parity, with HCMC getting the lions’ share of patients outside of the scope of its available general assistance medical funds. | LINK

I have always viewed as circumspect the interest of certain medical specialty societies which take stands that could be viewed by some as political. The need for these groups to make some sort of societal statement applied to medical corollary without the acknowledgement of the majority of its members implies ever so slightly of a kind of elitism better served by organizations more overtly deemed “political”.

Consider the statement by the APA on the recent effects of the oil spill on the incidence of mental illness diagnoses and subsequent insurance claims for treatment.

Mental illnesses brought on by difficult situations surrounding the BP oil spill may be less visible than other injuries, but they are real. An entire way of life has been destroyed, and this is causing anxiety, depression, [PTSD], substance use disorders, thoughts of suicide and other problems,” said APA President Carol A Bernstein, M.D.

The position –  the result of a response to BP’s chief claims administrator essentially denying payment equity with physical ailments payable with the government’s escrow relief funds — sounds more like a pitch to the feds and Big Insurance for more action guaranteeing accessible mental health care under reform. Since the biggest oil fiasco in this country’s history won’t be fading in importance anytime soon, the drive is on for greater awareness of the need for improved access to mental healthcare services.

While there is nothing wrong in actively lobbying the federal government for goals like this — the timing of this announcement, the association with a prominent DC-area mental health lobby, and the strong interest in this particular tragedy (as opposed to other numerous, less newsworthy ones) — should remind healthcare providers of the blurred line between political activism and healthcare advocacy.

The initial impact of the new healthcare reform law won’t begin until late September/early October. But how much do Americans really know about the legislation’s benefits and changes? President Obama has embarked on some PR jaunts to remind the public of the virtues of reform, but is the White House’s awareness campaign really enough to get the word out that reform is actually imminent? Apparently not.

Many key parts of the new law, signed by President Obama in March, take effect in several stages beginning next month and continuing through 2015. Because it’s so complex, consumer advocates worry that people won’t take advantage of its benefits, so they have embarked on a nationwide education campaign. [..]

“People are still afraid that there are death panels . . . or that Medicare is going to go away,” says Cheryl Matheis of AARP, the nation’s largest seniors organization. “We have an obligation to get the information out there…”

It’s the new reality. Focus groups, polls, lobbies. To bad reform won’t cover the cost of these mechanisms of information dissemination. | LINK

The push for widespread adoption of the electronic medical record has been viewed as an attractive by-product of health reform — a rather sexy “distraction” amid the legislative haranguing that has slowed the ongoing acceptance of reform as law. Perhaps our president is to blame. The electronic health record has an aura about it that sounds compelling at first, but its allure to many organizations considering its incorporation morphs into increasing trepidation as that day draws nearer.

For the Obama administration — assuming reelection — that “day” is the year 2014. The lofty goal of the creation of an e-record for every American by that time doesn’t seem to be taking into account the costs inherent in its smooth transition. That transition includes everything from logistical commitments to hidden costs that have yet to be accounted for, usually because of poor planning in the race to the early adoption for many health systems. For many of those systems, the reality of medical errors as a result of snafus in massive roll-outs is setting in. | LINK

In addition to re-evaluating its pharmacotherapeutic review process against the backdrop of reform, the FDA is proposing changes to its medical device review process. Essentially, it’s focusing on the scheme in which medical device makers have to prove their product is similar to one already in the marketplace before launching it commercially. This proposal may be in response to critics of the present process, which bypasses clinical trial rigor — potentially releasing an unsafe device to public. Other points the FDA is considering:

• Making the approval process smoother for so-called medical devices brand-new to the market (novel), as those would not be similar to a product currently on the market but are still relatively low-risk.
• Issuing guidelines on when a device on the market shouldn’t be used as the basis for approval of a new device; so that approvals cannot be based on an unsafe product.
• Issuing alerts/bulletins to medical device makers to better communicate changes in preapproval expectations.

LINK

Confirming what many, if not all providers in healthcare delivery already know, a study in the Annals of Int. Med. confirms the rampant favorability of results in pharma industry sponsored trials. In the meta analysis of over 500 trials, researchers found that industry-funded trials received positive outcomes approx. 80 percent of the time, compared to positive outcomes in just 50 percent of government-funded ones. Also, results of industry-funded studies were published within two years of study completion 32 percent of the time compared with 54 percent for government trials — suggesting not only certain bias in reporting in heavily invested outcomes, but also that government funding occurs sooner in trails when results may not seem as certain to produce a favorable outcome. The government’s registry of trials in development provides excellent information on study quality of over 90,000 investigations for those interested in getting at the true purpose of a proposed clinical trial. | LINK

Health care coordination seems to the mechanism by which many healthcare pundits on either side of the the debate agree on how significant waste in spending can be cut. North Carolina’s Medicaid program is utilizing the medical home model as an example of that type of care coordination.

Moving beyond Medicaid FFS and traditional managed care partnerships, the delivery of care in this context identifies the appropriate patient populations based upon services meeting certain primary care needs. Physicians are paid higher reimbursements and a specialized “care-coordination” fee as incentive to continue participation. Community care networks made up of primary care teams in multiple locations serving Medicaid enrollees are headed by physicians and serve as the de facto health plan for those patients.

This model is another example of putting state healthcare spending to practical use, empowering physicians who manage it not only to have a stake in its success but also to remain intimately involved in quality healthcare delivery at the state level. | LINK

Republicans and Dems are waiting to see just exactly how public opinion continues to be shaped on the issue of healthcare reform in this country in the run-up to the 2010 mid terms. If the results of a new tracking poll [PDF] are any indication, there is comfort for the latter party.

The July Health Tracking Poll indicates overall public support for the health reform law is steady from June, while unfavorable views of the law have trended downward.  Half the public (50%) now expresses a favorable view of the law, while 35 percent say they have an unfavorable opinion (down from 41% in June).

The results don’t exactly show that misconceptions do exist, however.

[L]arge shares of seniors mistakenly believe the law includes provisions that cut some previously universal Medicare benefits and creates “death panels.”

Results are over at the Kaiser (kff.org) website, a link from this blog in the Blogroll.