The Devastating Allure of Medical Miracles

Transplants that improved lives rather than saved them posed a serious new ethical problem. Even today’s transplant drugs cause side effects ranging from passing nausea, dizziness, and weight loss to life-threatening conditions such as diabetes, infection, cancer, and kidney failure. In a 2003 study, up to 21 percent of transplant recipients experienced total renal failure within five years, forcing patients to have dialysis or a kidney transplant.

Most people readily accept such risks to get a new heart, lung, or liver: When the benefit is life itself, most find almost any cost bearable. But a hand transplant sharply changes this calculus. Is taking dangerous drugs for the rest of one’s life worth the satisfaction of tying a shoelace or moving a strand of hair from a child’s face? Such deeply personal questions test the boundaries of medical ethics.

The full Wired article can be viewed at this link.  

Top-Funded Digital Health Companies And Their Impact On High-Burden, High-Cost Conditions

Digital health companies hold promise to address major health care challenges, though little has been published on their impact. We identified the twenty top-funded private US-based digital health companies to analyze their products and services, related peer-reviewed evidence, and the potential for impact on patients with high-burden conditions. Data analytics (including artificial intelligence and big data) was the most common company type. Companies producing biosensors had the greatest funding. Publications were concentrated among a small number of companies. Healthy volunteers were most commonly studied. Few studies enrolled high-burden populations, and few measured their impact in terms of outcomes, cost, or access to care. These data suggest that leading digital health companies have not yet demonstrated substantial impact on disease burden or cost in the US health care system. Our findings indicate the importance of fostering an environment, with regard to policy and the consumer market, that encourages the development of evidence-based, high-impact products.

The full article can be downloaded below.  

Why health orgs are embracing cloud to improve physician and patient experience

Experience. Whether it’s about patients or clinicians, one thing that’s clear is that health insurers and providers, from solo practices to large systems, must improve the experience they deliver or risk losing consumers and employees.

Leading organizations are already headed in that direction and many of them are harnessing cloud apps or services to make it happen.

At its most elemental, the cloud can be used to “re-humanize rather than de-humanize healthcare,” said David Vawdrey, vice president for analytics and clinical systems at NewYork-Presbyterian.

That’s because the cloud model by its very nature can “drive simplicity to front-stage actions and complexity behind the line of invisibility,” according to Antonio Melo, director of Humana’s digital experience center. 

“We’re interested in providing care where people spend the majority or a lot of their time. How do we reinvent who is improving care in the home? How do we create contextually relevant experiences for what might be considered low-level care?” Melo continued. “You’re seeing a shift from an institution-first model to a person-first model.”

The full Healthcare IT News article can be viewed at this link.  

Mayo Clinic, MIT, Harvard join forces on Medical Genome Initiative

A consortium of eight health care and research organizations in the U.S. and Canada, including the Mayo Clinic and the Broad Institute of MIT and Harvard announced the launch of the Medical Genome Initiative.

The initiative will work to expand access to clinical whole genome sequencing (cWGS) for the diagnosis of genetic diseases, with a focus on the publication of common laboratory and clinical best practices for the application of cWGS.

Clinical whole genome sequencing is the laboratory process of sequencing all 3 billion base pairs in the human genome to identify a disease-causing mutation, and has the potential to reduce the number of unresolved pediatric rare genetic disease cases--especially when utilized as a first-tier clinical test.

Evidence indicates early utilization of cWGS could deliver precise molecular diagnosis to enable change in medical management, thus reducing the number of unresolved, complex, costly and chronic genetic disease cases, especially for newborns and children.

The full Healthcare IT News article can be viewed at this link.  

Eric Topol On Deep Medicine, AI’s Healing Hands, And The Future Of Healthcare

Artificial intelligence is the single most important opportunity to address all the major things wrong with healthcare today, according to Dr. Eric Topol, a world-renowned cardiologist, geneticist, digital medicine researcher, and author.

At NVIDIA’s GPU Technology Conference (GTC) on March 17-21, 2019 in Silicon Valley, Dr. Topol will present a talk on how AI and deep learning are beginning to affect medicine at three levels: clinicians, health systems and patients.

Dr. Topol, founder and director of the Scripps Translational Science Institute, answered a few of our questions on his upcoming book, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again and discussed his perspective on the future of healthcare.

The full Forbes article can be viewed at this link.  

The Contemporary American Drug Overdose Epidemic in International Perspective

Will the contemporary American drug overdose epidemic prove a case of American exceptionalism, a cautionary tale, or the US as vanguard nation? In many respects, the American epidemic is distinctive—it is clear from the results of this analysis that the US is experiencing a drug overdose epidemic of unprecedented magnitude, not only judging by its own historical experience, but also compared to other high-income countries. No other country has exhibited anything close to the levels of or increases in drug overdose mortality observed in the US. However, the potential remains for drug over-dose mortality to increase in other countries in the near future. Similar and troubling signs are already discernible in the countries which are closest to the US, namely the Anglophone countries (Australia, Canada, and the United Kingdom), and some of the similarities among this subset of countries have been highlighted in the Discussion.

Furthermore, cross-national convergence of the substances driving drug overdose mortality is already occurring. While the current American epidemic started with prescription opioids, it is now rapidly transitioning to heroin and fentanyl (Jones et al. 2018). European countries may be moving in the opposite direction—much of their drug overdose mortality is driven by heroin, but the use of prescription opioids and synthetic drugs like fentanyl are becoming increasingly common in many high-income countries and constitute a common challenge to be confronted by these countries in the near future (EMCDDA 2017a).

Finally, this paper compared the US to other high-income countries partly because of data quality and availability considerations, but also be-cause access to painkillers is very limited outside these countries (Berterameet al. 2016; INCB 2015). However, this situation may change imminently.  Mundipharma—a network of international companies owned by the same family as Purdue Pharma—is expanding rapidly into Latin America, Asia,the Middle East, and Africa (Ryan, Girion, and Glover 2016). Its efforts to generate demand for painkillers mirror practices used in the US, including sponsoring physician training seminars and campaigns to medicalize and increase public awareness of chronic pain. Mundipharma’s marketing campaigns involve the use of celebrities urging people to stop thinking of pain as a normal part of daily life: “Don’t resign yourself” and “Chronic pain is an illness in and of itself,” say these advertisements (ibid.). Comparisons are being drawn between opioid painkillers and cigarettes; in the latter case, multinational tobacco companies moved aggressively into developing-country markets when they started losing revenue in developed countries,and it proved a highly successful strategy. If OxyContin follows the same route, it will pose a major concern because regulatory structures, healthcare systems, and surveillance systems are much less developed in low-income countries, rendering them more vulnerable to aggressive marketing by pharmaceutical companies, and there is a strong possibility that serious drug overdose epidemics could develop with very little warning in these countries.

The full article can be downloaded below.  

The Alluring Mirage Of Digital Health

Improving our population health and reducing our healthcare spending requires that we make hard political and personal choices. Historically, we have not been receptive to doing either. We should employ and leverage information technology tools. But digital health is not a panacea. We should be leery of placing too much faith on government edicts, data analytics and logarithms to avoid doing the hard work and making the hard choices necessary to improve the health of all Americans.

The full Forbes article can be viewed at this link.  

Systematic Review and Meta-Analysis of the Magnitude of Structural, Clinical, and Physician and Patient Barriers to Cancer Clinical Trial Participation

Barriers to cancer clinical trial participation have been the subject of frequent study, but the rate of trial participation has not changed substantially over time. Studies often emphasize patient-related barriers, but other types of barriers may have greater impact on trial participation. Our goal was to examine the magnitude of different domains of trial barriers by synthesizing prior research.

We conducted a systematic review and meta-analysis of studies that examined the trial decision-making pathway using a uniform framework to characterize and quantify structural (trial availability), clinical (eligibility), and patient/physician barrier domains. The systematic review utilized the PubMed, Google Scholar, Web of Science, and Ovid Medline search engines. We used random effects to estimate rates of different domains across studies, adjusting for academic vs community care settings.

We identified 13 studies (nine in academic and four in community settings) with 8883 patients. A trial was unavailable for patients at their institution 55.6% of the time (95% confidence interval [CI] ¼ 43.7% to 67.3%). Further, 21.5% (95% CI ¼ 10.9% to 34.6%) of patients were ineligible for an available trial, 14.8% (95% CI ¼ 9.0% to 21.7%) did not enroll, and 8.1% (95% CI ¼ 6.3% to 10.0%) enrolled. Rates of trial enrollment in academic (15.9% [95% CI ¼ 13.8% to 18.2%]) vs community (7.0% [95% CI ¼ 5.1% to 9.1%]) settings differed, but not rates of trial unavailability, ineligibility, or non-enrollment.

These findings emphasize the enormous need to address structural and clinical barriers to trial participation, which combined make trial participation unachievable for more than three of four cancer patients.

The full article can be downloaded below.  

Machine Learning in Relation to Emergency Medicine Clinical and Operational Scenarios: An Overview

We described two important health informatics-related topics that are relevant to emergency care and research: machine learning and natural language processing (NLP). Traditionally, the machine-learning model in healthcare has suffered from low external validity or poor portability between sites, but this seems to be changing with active employment of creative solutions. NLP is highly problem-specific, and the tools available are intended for use by programmers rather than end-users, except for speech recognition and machine translation (the use of software to translate text or speech from one language to another). NLP is being used more for research purposes, but there is no general purpose information-extraction tool because what one chooses to extract depends on the problem one is trying to solve. Computational artifacts are complex and hinder our ability to predict the performance of these tools. It is important to carefully evaluate these tools using both subjective and objective approaches. It is prime time for clinicians and researchers in emergency medicine to take full advantage of health informatics to improve patient care.

The full article can be downloaded below.  

Generic Drug Price Hikes And Out-Of-Pocket Spending For Medicare Beneficiaries

Recent increases in prices of longtime generic drugs have focused attention on competition in generic markets. We used Medicare Part D data for the period 2006–15 to examine sudden large price increases in generic drugs in the context of their base prices, duration, and accompanying changes in patients’ out-of-pocket spending. The fraction of drugs that at least doubled in price increased from 1.00 percent of generic products in 2007 to 4.39 percent in 2013. Almost all were initially low- or medium-price medications and not among the most widely used generics. Changes in out-of-pocket spending for these drugs were modest. However, the elevated prices persisted for two to five years. Data for 2011–15 showed similar trends. Potential steps to ensure that generic markets remain strong include fast-tracking new generic drug applications when competition is limited, allowing temporary importation of off-patent drugs, and implementing greater oversight of drug company mergers and takeovers.

The full article can be downloaded below.