Genes seem to play a role in causing disease, but perhaps not in the way you may think. The current thinking around genes is that one bad or missing gene isn’t going to be the sole cause of most diseases. Rather, it seems that multiple genetic factors mix together to increase risk. Dr. Sekar Kathiresan came up with a way to assess how many genes are causing those risks in a patient, called a polygenic risk score. The score could help identify ‘hidden’ at-risk patients—AKA patients at-risk for a condition that weren’t tipped off by current assessment tools. Also, Kathiresan wants to offer the assessment for free. But there’s some skepticism that an extra diagnostic tool could cause patients to seek unnecessary treatment. Still, something to keep tabs on.
We’re used to vulnerabilities in data systems leading to massive personal data breaches (cool visualization of those here.) But there’s an even darker side to hacking that can put peoples’ lives directly at risk. We’re talking medical device hacks. Two “white-hat” (good) hackers identified vulnerabilities in pacemakers and insulin pumps which “black-hat” (bad) hackers could use to injure patients. One scenario put forth is a pacemaker being manipulated to deliver too many or too few electric shocks, which obviously could lead to negative patient outcomes. The researchers shared their findings with the device manufacturer and relevant regulatory bodies, but they say these authorities are playing down the risks. They apparently considered bringing in a pig they could kill with an app to make their point, so we should probably take them seriously.
American Patients First. Catchy title. Unless you’ve been under a rock, you’ve likely heard of President Trump’s “sweeping” drug pricing proposals. While it’s way too complicated a topic to cover in our typical article length, we’re going to provide some of the better summaries. First is a nice summary about how this could impact the drug distribution system. Second is about how PhRMA increased its lobbying by 30% in 2017. Third is how Wall St. reacted in a positive manner on Friday, signaling Wall St. isn’t scared of the Trump plan for drug makers. Our last point is how Health & Human Services (HHS) Secretary Alex Azar said pharmacy benefit managers (PBMs) are a prime target in the effort. There will be lots more to digest in the future as the plan is unraveled. As the Brits say, keep calm and carry on.
That’s really the name of a 2003 paper that explains health care spending is so high in the US because the prices for health care are so high, stupid. 14 years later the story still rings true—the per unit cost of health services hasn’t shifted much. Vox, in an effort to get a scope of these prices across the nation, is asking readers to send in their emergency facility fee (think: what the hospital charges to keep their lights on waiting for you to break your toe) to crowdsource the cost of that specific unit price. It’s an interesting idea since hospitals don’t advertise their ED admission fees. Telling patients they have to pay at least $500 beforehand typically isn’t the best look after all.
Patients with atrial fibrillation do! According to a new study, hundreds of thousands of patients aren’t receiving them each year. Folks with AFib are at a very high risk for stroke, and guess what? Oral anticoagulants—a.k.a. blood thinners—can reduce the risk by two-thirds and direct oral anticoagulants (DOACs) are proven to be just as effective, if not more so. No, this isn’t a groundbreaking new therapy. Quite the opposite. DOACs have been available since 2010. 655,000 patients were evaluated in the study and the data show that over a seven-year period, only 6 out of 10 patients with high stroke risk were prescribed these potentially life-saving meds. This guy sums it up best.
If you have an upcoming surgery, you might just get a sneak peek at your innards. Surgery performed on awake patients is on the upswing. InsightCity staff are split on whether this trend is terrifying or awesome (tell us your thoughts in this week’s FastPoll™). This technique is being used primarily in orthopedics but other specialties are moving in this direction. Benefits include reduced cost (no anesthesiologist necessary), faster recovery, patient feeling increased control, and curiosity satisfaction. I mean, who doesn’t want to see their colon up close and personal? Surgeons are going to have to work on their (operating) table manners… cursing when something goes awry or re-hashing last night’s partying will no longer be kosher. InsightCity assumes patients would rather not think of their surgeon binge-drinking like she’s on Grey’s Anatomy.
Doctor: Unfortunately, you’ve been diagnosed with [insert scary disease here]. Call this number to schedule your procedure. See you in a month.
Patient: Huh? (shuffles out, looking bewildered)
New research is telling us that the above doctor-patient interaction is not what’s best for patients. Wuuuuuuut? No way. We’ll wait while you pick your jaws up from the floor… Data show that the more involved patients are in their health care decisions, the better. Presenting clear options, simplifying information, and making EMR data available to patients are ways physicians can involve patients in treatment decisions. Sounds to InsightCity like that leaves the ball mostly in the doctors’ court. Here’s hoping a little doctor-patient teamwork will leave patients feeling less like this.
Recent power plays in the prescription drug industry make J.R. Ewing’s actions seem like child’s play. If you don’t track the specialty pharmacy market, you should. This is a $100B industry that is growing rapidly. Think high-priced drugs used to treat Hep C and Cystic Fibrosis. According to the New York Times, large PBMs might be trying to force out independent specialty pharmacies. In Alabama, BCBS recently told patients that they cannot have their prescriptions filled at CVS. This is a big deal. It means patients have to sever long-standing relationships with pharmacists, especially difficult with specialty indications. This is all part of an emerging trend to narrow networks. Look it up. You will be glad you did and you’ll be smarter.