Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis

E-cigarettes deliver an aerosol of nicotine by heating a liquid and are promoted as an alternative to combustible tobacco. This study determines the longitudinal associations between e-cigarette use and respiratory disease controlling for combustible tobacco use.

This was a longitudinal analysis of the adult Population Assessment of Tobacco and Health Waves 1, 2, and 3. Multivariable logistic regression was performed to determine the associations between e-cigarette use and respiratory disease, controlling for combustible tobacco smoking, demographic, and clinical variables. Data were collected in 2013−2016 and analyzed in 2018−2019.

Among people who did not report respiratory disease (chronic obstructive pulmonary disease, chronic bronchitis, emphysema, or asthma) at Wave 1, the longitudinal analysis revealed statistically significant associations between former e-cigarette use (AOR=1.31, 95% CI=1.07, 1.60) and current e-cigarette use (AOR=1.29, 95% CI=1.03, 1.61) at Wave 1 and having incident respiratory disease at Waves 2 or 3, controlling for combustible tobacco smoking, demographic, and clinical variables. Current combustible tobacco smoking (AOR=2.56, 95% CI=1.92, 3.41) was also significantly associated with having respiratory disease at Waves 2 or 3. Odds of developing respiratory disease for a current dual user (e-cigarette and all combustible tobacco) were 3.30 compared with a never smoker who never used e-cigarettes. Analysis controlling for cigarette smoking alone yielded similar results.

Use of e-cigarettes is an independent risk factor for respiratory disease in addition to combustible tobacco smoking. Dual use, the most common use pattern, is riskier than using either product alone.

The full article can be downloaded below.  

An $800 Head Cold? Time to Fight for Price Transparency in American Healthcare

Jay Singh had a nasty head cold. Not a “will-I-survive-this-plague” kind of infection, but also not one he thought, if left to its own devices, would blow over in a day or two. So he went to the primary care clinic near his exurban New York City home. The doctor spent ten minutes examining and talking to Singh (a pseudonym), a quick look at his throat, a cursory listen to his lungs. The doctor ordered a routine “respiratory viral panel” and prescribed a cough suppressant. Singh had already anted up a co-pay for the office visit, but a few weeks later he received a bill for the services rendered: $800 to cover his doctor’s time and the cost of the viral panel.

I spoke to Singh several months after his appointment, and he was still determined to leverage his experience into political action: he thinks it’s time for the state of New York, perhaps the whole U.S., to bring healthcare prices out of the dark so patients like him can make informed decisions about their medical care.

The full Forbes article can be viewed at this link.  

Applications of Blockchain Technology for Data-Sharing in Oncology: Results from a Systematic Literature Review

Timely sharing of electronic health records across providers, while ensuring data security and privacy, is essential for prompt care of cancer patients, as well as for the development of medical research and the enhancement of personalized medicine. Yet, it is not trivial to achieve efficient consent management, data exchange, and access-control policy enforcement, in particular, in decentralized settings, and given the gravity of the condition such as cancer. Using blockchain technology (BCT) has been recently advocated by research communities and gained momentum from the industry perspective. However, most of the proposed solutions are at the level of a prototype, and blockchain-based healthcare data management systems are not in place yet.

This paper presents a systematic literature review, aiming to analyze the motivations, advantages, and limitations, as well as barriers and future challenges faced when applying the state-of-the-art distributed ledger technology in oncology. We then discuss its outcomes and propose the direction of the future research that can help to attain integration and adoption of the BCT for data-sharing, medical research, and the pharmaceutical supply chain in oncology, as well as in healthcare in general.

BCT has the potential to enhance data-sharing (for primary care and medical research), as well as to attain optimization of the pharmaceutical supply chain by bringing properties such as transparency, traceability, and immutability to the applications. However, BCT itself cannot guarantee data privacy and security. Thus, it is never proposed as a stand-alone technology, but as a combined technology with cryptographic techniques. Regardless of the number of existing prototypes of blockchain-based healthcare systems, due to the existing barriers of the adoption (e.g., legal, social, and technological limitations), there is a lack of evaluation in real-world settings. Aiming to overcome these limitations, we propose future research directions that include design of the privacy-preserving hybrid data storage, interoperable infrastructures and architecture, and are compliant with the international laws and regulations.

The full article can be downloaded below.  

Billionaire Electronic Health Records Pioneer Judy Faulkner Warns Of Cambridge Analytica-Type Data Risk

Judy Faulkner, founder of Epic, one of the largest providers of electronic medical health records, warned that a proposed rule on information sharing could create a Cambridge Analytica-type situation, where the data of a patients’ friends and family is shared without their consent. 

A federal rule on digital health-sharing now under review “has good things to it but there are some bad things that have to be fixed, in my opinion,” Faulkner, 76, told NYU Langone Health CEO Robert Grossman at the Forbes Healthcare Summit in New York City on December 5. 

“It’s a bit like Facebook in that—the friends of the users who gave permission to Cambridge Analytica to use the system—the friends’ data got pulled out with the users who had authorized Cambridge Analytica,” she said.

The full Forbes article can be viewed at this link.  

Anthem Will Use Blockchain To Secure Medical Data For Its 40 Million Members In Three Years

Anthem, the second-largest health insurance company in the U.S, has started to use blockchain technology to help patients securely access and share their medical data. The company plans to roll out the feature, which is in pilot testing now, to groups of members in the next few months. All 40 million members will have access to it in the next two to three years, according to company officials.   

“What blockchain potentially gives us the opportunity to do is not worry about those trust issues,” said Anthem CEO Gail Boudreaux at the 8th Annual Forbes Healthcare Summit in New York last week. “We have an opportunity now to share data that people can make their own decisions on.

The full Forbes article can be viewed at this link.  

2019 IMPACT REPORT: PRESCRIPTION PRICE TRANSPARENCY

Prescription price transparency offers patients and prescribers the power of informed decision-making at the point of care. It improves outcomes, reduces costs, increases medication adherence and enhances the care experience between doctor and patient. The data we present in this report reflects a strong and growing demand for prescription price transparency at the point of care. For example, the number of prescribers leveraging patient-specific information on drug costs and therapeutic alternatives in their electronic health record (EHR) more than doubled in 2019, from roughly 100,000 in January to nearly 250,000 in November.

The full Surescripts report can be viewed at this link.  

Resolving Tension Between Cost-Effectiveness Analysis And Patient Centricity

There appears to be an inherent tension between cost-effectiveness analysis that informs allocative efficiency at the population level, and patient centricity. Here, patient centricity can be defined as incorporation of patient-centric outcomes in value calculations and inclusion of patient input in clinical and economic decisions.

Ideally, precision medicine resolves this tension, as by definition it’s patient-centric, and when done right, cost-effective. But, there’s still a long way to go before precision medicine’s promise becomes widespread reality.

Through intermediaries, such as payers, cost-effectiveness analysis informs treatment choices made by physicians and patients. For patients and their healthcare providers, issues can arise when reimbursement protocols (e.g., formularies) derived from population-based cost-effectiveness analysis impact (often limit) the choices patients and physicians can make.

The full Forbes article can be viewed at this link.  

Congress’s new plan to end surprise medical bills, explained

Just as the prospects of a congressional deal to stop surprise medical bills seemed to be dimming, lawmakers had a breakthrough. On Sunday evening, the leaders of several key health care committees announced they had come to an agreement.

Sen. Lamar Alexander, the top Republican on the Senate health committee, announced the news alongside Reps. Frank Pallone (D-NJ) and Greg Walden (R-OR), the top Democrat and Republican on an important House committee. (Sen. Patty Murray, the ranking Democrat on Alexander’s committee, did not join the trio; her spokesperson told Axios some Senate Democrats still have unspecified concerns but she still welcomed the development.)

”I do not think it is possible to write a bill that has broader agreement than this one does among Senate and House Democrats and Republicans on Americans’ number one financial concern: what they pay out of their own pockets for health care,” Alexander said on Sunday night.

They got there by compromising on what has been the most contentious issue in the surprise billing legislation: how much doctors will get paid when they provide emergency out-of-network care to patients.

The full Vox article can be viewed at this link.  

Unpacking the Black Box in Artificial Intelligence for Medicine

In clinics around the world, a type of artificial intelligence called deep learning is starting to supplement or replace humans in common tasks such as analyzing medical images. Already, at Massachusetts General Hospital in Boston, “every one of the 50,000 screening mammograms we do every year is processed through our deep learning model, and that information is provided to the radiologist,” says Constance Lehman, chief of the hospital’s breast imaging division.

In deep learning, a subset of a type of artificial intelligence called machine learning, computer models essentially teach themselves to make predictions from large sets of data. The raw power of the technology has improved dramatically in recent years, and it’s now used in everything from medical diagnostics to online shopping to autonomous vehicles.

But deep learning tools also raise worrying questions because they solve problems in ways that humans can’t always follow. If the connection between the data you feed into the model and the output it delivers is inscrutable — hidden inside a so-called black box — how can it be trusted? Among researchers, there’s a growing call to clarify how deep learning tools make decisions — and a debate over what such interpretability might demand and when it’s truly needed. The stakes are particularly high in medicine, where lives will be on the line.

The full Undark article can be viewed at this link.  

Here’s How Health Data Can Help Stem the Opioid Crisis

The number of people losing their lives each day to prescription or illicit opioid-related overdoses is staggering. According to the Centers for Disease Control and Prevention, more than 47,000 Americans died in 2017 — 130 fatalities each day — due to opioid overdoses, making it the deadliest year on record. 

You don’t have to be personally touched by the opioid crisis to understand the gravity of the statistics, let alone the immeasurable and lasting impact it is having on society. This can be addressed by better harnessing the power of data to stem this crisis. 

The full Morning Consult article can be viewed at this link.