Vital Signs

January 27, 2014

Testing… testing…

The UK’s Parliamentary Science and Technology Committee recently announced the start of a comprehensive review of the scientific evidence supporting the value of preventative health screening. Health screening, the testing for conditions that patients show no symptom of having, is near universally recommended. Many of these tests aim to catch asymptomatic cancer before it becomes a major health issue for the patient; think mammograms and prostate exams. Testing also exists to detect early heart disease, signs of stroke damage, diabetes, and various forms of cancer.

But although these tests are pushed by doctors and health care organizations as a crucial first line of defense, the evidence supporting their effectiveness is not so black and white. Mammograms, for many the public image of preventative health screenings, are thought to be an essential tool in the fight against breast cancer. Catch the cancer early, the argument goes, and you wipe it out before it has a chance to spread.

mammograms by raceGraphic: Percent of women aged 50–74 years who reported having a mammogram within the past 2 years, by race and ethnicity, in 2010.

But what if screening leads to over-diagnosis and unnecessary treatments? A 2012 review of UK breast cancer screening outcomes found that for every 10,000 women tested for breast cancer, 43 deaths would be prevented. Unfortunately, an additional 129  women will be diagnosed and treated for cancers that would have remained benign and asymptomatic had they gone undetected.

This is exactly why more research has to be done on these tests. Untold numbers of lives are saved from them, there’s no doubt about that. But it isn’t always clear if the benefits of early diagnosis outweigh the risks of unnecessary treatment. Treatments for breast cancer range from full mastectomy to radiation therapy, and both come with risks.

Making the distinction between a relatively harmless lump and a lethal cancer can be a time intensive task, something that many doctors just don’t have the resources to do. With an average doctor visit lasting anywhere from 5-15 minutes, it’s easier to go with the “safe” choice and push  for treatment. As more research is funded to compare the risks and benefits of health screenings, we can only hope that doctors keep this information in mind when seeing patients.

The UK’s Parliamentary Science and Technology Committee recently announced the start of a comprehensive review of the scientific evidence supporting the value of preventative health screening. Health screening, the testing for conditions that patients show no symptom of having, is near universally recommended. Many of these tests aim to catch asymptomatic cancer before it becomes a major health issue for the patient; think mammograms and prostate exams. Testing also exists to detect early heart disease, signs of stroke damage, diabetes, and various forms of cancer.

But although these tests are pushed by doctors and health care organizations as a crucial first line of defense, the evidence supporting their effectiveness is not so black and white. Mammograms, for many the public image of preventative health screenings, are thought to be an essential tool in the fight against breast cancer. Catch the cancer early, the argument goes, and you wipe it out before it has a chance to spread.

mammograms by raceGraphic: Percent of women aged 50–74 years who reported having a mammogram within the past 2 years, by race and ethnicity, in 2010.

But what if screening leads to over-diagnosis and unnecessary treatments? A 2012 review of UK breast cancer screening outcomes found that for every 10,000 women tested for breast cancer, 43 deaths would be prevented. Unfortunately, an additional 129  women will be diagnosed and treated for cancers that would have remained benign and asymptomatic had they gone undetected.

This is exactly why more research has to be done on these tests. Untold numbers of lives are saved from them, there’s no doubt about that. But it isn’t always clear if the benefits of early diagnosis outweigh the risks of unnecessary treatment. Treatments for breast cancer range from full mastectomy to radiation therapy, and both come with risks.

Making the distinction between a relatively harmless lump and a lethal cancer can be a time intensive task, something that many doctors just don’t have the resources to do. With an average doctor visit lasting anywhere from 5-15 minutes, it’s easier to go with the “safe” choice and push  for treatment. As more research is funded to compare the risks and benefits of health screenings, we can only hope that doctors keep this information in mind when seeing patients.

January 24, 2014

Healthcare on the World Stage

Every year at this time, a cadre of movers and shakers—from government officials to non-profit leaders, from celebrities to CEOs—descends upon the sleepy Swiss city of Davos for the World Economic Forum (WEF).

But don’t let the name fool you. The thought leaders attending this exclusive event are typically wealthy and influential, but they don’t spend all four days just dishing about dollars. Other key issues like the environment, education, and yes, our collective health are discussed at length, in the hopes of finding innovative solutions to some of the world’s most bedeviling problems.

One reason the WEF is worth following is that it lends us a broader perspective on health and healthcare. At a time when most of our attention is focused on policy (the ACA) and government’s role in healthcare, the Forum reminds us that innovation comes from all directions, not least of which are corporations. In one example discussed at Davos, the Gavi Alliance shows how a non-profit can connect global companies to immunize children against common diseases. Mere “charitable giving” or traditional corporate “philanthropy” almost seems passive and quaint in view of this sort of deliberate partnership that ostensibly has saved 6 million lives in the last dozen years.

Another WEF attendee highlights the importance of addressing social needs in providing optimal patient care. In one survey, about 80% of primary care physicians said that the personal social needs of a patient can be just as important as the patient’s medical condition. Or, to put it another way, the effectiveness of all the prescriptions, surgeries, and other treatments a patient receives may be limited if other life factors aren’t addressed, like access to healthy foods, clean air and water, and a stable home life. The next discussion, then, is what amount of social factors and behavior change can or should medical professionals incorporate into their repertoire to improve patient care?

What’s the role of corporations in worldwide public health, or a patient’s home and social life in improving quality of care? Well, at least for this week, that’s for the experts at Davos to sort out. Keep up with these and the many other health happenings coming out of the WEF here.

Every year at this time, a cadre of movers and shakers—from government officials to non-profit leaders, from celebrities to CEOs—descends upon the sleepy Swiss city of Davos for the World Economic Forum (WEF).

But don’t let the name fool you. The thought leaders attending this exclusive event are typically wealthy and influential, but they don’t spend all four days just dishing about dollars. Other key issues like the environment, education, and yes, our collective health are discussed at length, in the hopes of finding innovative solutions to some of the world’s most bedeviling problems.

One reason the WEF is worth following is that it lends us a broader perspective on health and healthcare. At a time when most of our attention is focused on policy (the ACA) and government’s role in healthcare, the Forum reminds us that innovation comes from all directions, not least of which are corporations. In one example discussed at Davos, the Gavi Alliance shows how a non-profit can connect global companies to immunize children against common diseases. Mere “charitable giving” or traditional corporate “philanthropy” almost seems passive and quaint in view of this sort of deliberate partnership that ostensibly has saved 6 million lives in the last dozen years.

Another WEF attendee highlights the importance of addressing social needs in providing optimal patient care. In one survey, about 80% of primary care physicians said that the personal social needs of a patient can be just as important as the patient’s medical condition. Or, to put it another way, the effectiveness of all the prescriptions, surgeries, and other treatments a patient receives may be limited if other life factors aren’t addressed, like access to healthy foods, clean air and water, and a stable home life. The next discussion, then, is what amount of social factors and behavior change can or should medical professionals incorporate into their repertoire to improve patient care?

What’s the role of corporations in worldwide public health, or a patient’s home and social life in improving quality of care? Well, at least for this week, that’s for the experts at Davos to sort out. Keep up with these and the many other health happenings coming out of the WEF here.

January 22, 2014

Forever Young: A Look at ACA Enrollment to Date

Despite a rocky launch, nearly 2.2 million people have enrolled in health insurance under the Affordable Care Act (ACA). But a segment of the population crucial to the success of the ACA are showing underwhelming enrollment rates. Although adults ages 18-34 make up an estimated 40% of the under or uninsured US population, less than one in four new ACA enrollees are under the age of 35. This is a potentially massive problem for the fledgling ACA.

slide12

Younger, healthier enrollees are needed to offset the cost burden of older and sicker members. According to the Kaiser Family Foundation, “on average, older adults will be paying premiums that do not fully cover their expected medical expenses, while younger adults will be paying premiums that more than cover their expenses. For this system to work, young people need to enroll in sufficient numbers to produce a surplus in premium revenues.” The Obama administration estimated that to balance costs, around 40% of new enrollees under the ACA need to be under the age of 35.

But all hope is not lost for the ACA. Enrollment rates for young adults have been steadily increasing since the start, and the trend is expected to continue. A similar pattern was seen when healthcare reform was rolled out in Massachusetts, with low early enrollment rates for younger people eventually filling out as time went on.This problem is exacerbated further by the fact that insurance rates are set on a state by state basis. So while the District of Columbia has no worries with young adult enrollment hovering around 44%, states like Arizona face fiscal uncertainty with low rates of around 17%. If similar enrollment patterns continue, insurers will be forced to raise premiums to cover their increasing costs. As premiums rise, the “Affordable” part of the Affordable Care Act could come under fire from critics on both sides of the political spectrum.

And it is always possible that older enrollees will turn out to have less complex medical conditions than expected. Though the future success of the ACA is unclear, the need to make healthcare affordable and effective for all remains a pressing issue.

Read more here:

http://www.medpagetoday.com/Washington-Watch/Washington-Watch/43790

http://kff.org/health-reform/perspective/the-numbers-behind-young-invincibles-and-the-affordable-care-act/

*Info compiled by Alex Pelley

yong-adults-trend

Despite a rocky launch, nearly 2.2 million people have enrolled in health insurance under the Affordable Care Act (ACA). But a segment of the population crucial to the success of the ACA are showing underwhelming enrollment rates. Although adults ages 18-34 make up an estimated 40% of the under or uninsured US population, less than one in four new ACA enrollees are under the age of 35. This is a potentially massive problem for the fledgling ACA.

slide12

Younger, healthier enrollees are needed to offset the cost burden of older and sicker members. According to the Kaiser Family Foundation, “on average, older adults will be paying premiums that do not fully cover their expected medical expenses, while younger adults will be paying premiums that more than cover their expenses. For this system to work, young people need to enroll in sufficient numbers to produce a surplus in premium revenues.” The Obama administration estimated that to balance costs, around 40% of new enrollees under the ACA need to be under the age of 35.

But all hope is not lost for the ACA. Enrollment rates for young adults have been steadily increasing since the start, and the trend is expected to continue. A similar pattern was seen when healthcare reform was rolled out in Massachusetts, with low early enrollment rates for younger people eventually filling out as time went on.This problem is exacerbated further by the fact that insurance rates are set on a state by state basis. So while the District of Columbia has no worries with young adult enrollment hovering around 44%, states like Arizona face fiscal uncertainty with low rates of around 17%. If similar enrollment patterns continue, insurers will be forced to raise premiums to cover their increasing costs. As premiums rise, the “Affordable” part of the Affordable Care Act could come under fire from critics on both sides of the political spectrum.

And it is always possible that older enrollees will turn out to have less complex medical conditions than expected. Though the future success of the ACA is unclear, the need to make healthcare affordable and effective for all remains a pressing issue.

Read more here:

http://www.medpagetoday.com/Washington-Watch/Washington-Watch/43790

http://kff.org/health-reform/perspective/the-numbers-behind-young-invincibles-and-the-affordable-care-act/

*Info compiled by Alex Pelley

yong-adults-trend

January 17, 2014

Healthcare Happenings this Week

In case you missed them, here’s a rundown of some of the many new developments in healthcare over the past week.

As might be expected, developments around the Affordable Care Act dominated many aspects of health news. Several outlets reported that the back-end payment system for Healthcare.gov is still being built. This infrastructure, which is necessary for processing payment to insurers, was expected to be finished soon, though no firm date is currently set. Meanwhile, prominent voices in the cybersecurity community warn that the site has some significant vulnerabilities still to be addressed.

best doctors eyeThe prospects for gene therapy got a boost this week based on published results of a study on patients suffering an uncommon and incurable eye disease. While only 1 in 50,000 people may be afflicted with the disease (choroideremia), scientists were encouraged by the significant improvement observed after replacing a defective gene with a healthy one.

Also this week, the firm BCC Research predicted that when the dust settles for 2013, the Electronic Health Records (EHR) market would be worth $11.2 billion. But not so fast—that number is expected to more than double to $23.5 billion within four years. We’ll just have to wait and see.

And finally, for those who really want to geek out over questions of health policy and ethics, the Presidential Commission for the Study of Bioethical Issues this week highlighted the four principles that provide guidance for many clinical, research, and direct-to-consumer relationships. They are: respect for persons; beneficence; justice and fairness; and intellectual freedom and responsibility. Proof positive that there are non-political (and reasonable) messages coming from our agencies of government this week.

In case you missed them, here’s a rundown of some of the many new developments in healthcare over the past week.

As might be expected, developments around the Affordable Care Act dominated many aspects of health news. Several outlets reported that the back-end payment system for Healthcare.gov is still being built. This infrastructure, which is necessary for processing payment to insurers, was expected to be finished soon, though no firm date is currently set. Meanwhile, prominent voices in the cybersecurity community warn that the site has some significant vulnerabilities still to be addressed.

best doctors eyeThe prospects for gene therapy got a boost this week based on published results of a study on patients suffering an uncommon and incurable eye disease. While only 1 in 50,000 people may be afflicted with the disease (choroideremia), scientists were encouraged by the significant improvement observed after replacing a defective gene with a healthy one.

Also this week, the firm BCC Research predicted that when the dust settles for 2013, the Electronic Health Records (EHR) market would be worth $11.2 billion. But not so fast—that number is expected to more than double to $23.5 billion within four years. We’ll just have to wait and see.

And finally, for those who really want to geek out over questions of health policy and ethics, the Presidential Commission for the Study of Bioethical Issues this week highlighted the four principles that provide guidance for many clinical, research, and direct-to-consumer relationships. They are: respect for persons; beneficence; justice and fairness; and intellectual freedom and responsibility. Proof positive that there are non-political (and reasonable) messages coming from our agencies of government this week.

January 14, 2014

TED Talks and Healthcare

In a recent video that’s making the rounds online, Professor Benjamin Bratton does something unexpected. During his talk at TEDx San Diego he gives a takedown of, well, TED talks. (Unsuspecting audience members may have felt a smidge awkward for this one.)

TED stands for (T)echnology, (E)ntertainment, (D)esign. And those who have seen some of the hundreds of free online videos know that TED is all about spreading innovative and inspiring ideas on all manner of topics, including health and medicine.

So what’s Bratton’s beef with TED? A brief summary of the video wouldn’t do justice to his talk, largely because he introduces so many themes into his 12-minute discussion. The main criticisms are that TED stands for oversimplification, that it’s cynical, and that its many inspiring pronouncements simply don’t work. He asserts that presenters are taken to “dancing about like infomercial hosts,” and assures us that simply talking a lot about the world’s problems is no way to solve them.

But let’s think about it another way. TED talks are like fashion shows from top designers—they often feature outlandish concepts that push boundaries and are completely impractical for the mass market at the present time. But their bold statements will eventually trickle down and inform the tastes of, well, just about anybody who wears clothes. TED is the same way in its own realm.

Bratton also paints with a very broad brush, lumping all TED talks together. But in truth they tend to run the gamut from grounded to hyperbolic. Some promise future innovations that would make even the most ardent sci-fi fanboy blush; others talk about the present and explain, for example, how physicians can use checklists and follow the basic rules of hygiene to improve patient care and outcomes. What could be more reasonable and mundane?

Best Doctors recently held an event featuring Dr. Daniel Kraft, an inspiring individual (and TED speaker) who can discuss many existing innovations you may never have heard of, along with the blue-sky medical innovations of tomorrow. Some will come to pass, and others won’t. And some will just take a lot longer and come in different forms than originally conceived. That’s just the nature of TED talks. Anyone who’s seen more than a few knows that they’re not meant to be swallowed hook, line, and sinker. They’re an idea mill, a jumping-off point, a futuristic fashion show. They don’t have all the practical answers for health, medicine, or any other pressing concern, but they’re a great place to start the conversation.

In a recent video that’s making the rounds online, Professor Benjamin Bratton does something unexpected. During his talk at TEDx San Diego he gives a takedown of, well, TED talks. (Unsuspecting audience members may have felt a smidge awkward for this one.)

TED stands for (T)echnology, (E)ntertainment, (D)esign. And those who have seen some of the hundreds of free online videos know that TED is all about spreading innovative and inspiring ideas on all manner of topics, including health and medicine.

So what’s Bratton’s beef with TED? A brief summary of the video wouldn’t do justice to his talk, largely because he introduces so many themes into his 12-minute discussion. The main criticisms are that TED stands for oversimplification, that it’s cynical, and that its many inspiring pronouncements simply don’t work. He asserts that presenters are taken to “dancing about like infomercial hosts,” and assures us that simply talking a lot about the world’s problems is no way to solve them.

But let’s think about it another way. TED talks are like fashion shows from top designers—they often feature outlandish concepts that push boundaries and are completely impractical for the mass market at the present time. But their bold statements will eventually trickle down and inform the tastes of, well, just about anybody who wears clothes. TED is the same way in its own realm.

Bratton also paints with a very broad brush, lumping all TED talks together. But in truth they tend to run the gamut from grounded to hyperbolic. Some promise future innovations that would make even the most ardent sci-fi fanboy blush; others talk about the present and explain, for example, how physicians can use checklists and follow the basic rules of hygiene to improve patient care and outcomes. What could be more reasonable and mundane?

Best Doctors recently held an event featuring Dr. Daniel Kraft, an inspiring individual (and TED speaker) who can discuss many existing innovations you may never have heard of, along with the blue-sky medical innovations of tomorrow. Some will come to pass, and others won’t. And some will just take a lot longer and come in different forms than originally conceived. That’s just the nature of TED talks. Anyone who’s seen more than a few knows that they’re not meant to be swallowed hook, line, and sinker. They’re an idea mill, a jumping-off point, a futuristic fashion show. They don’t have all the practical answers for health, medicine, or any other pressing concern, but they’re a great place to start the conversation.

January 09, 2014

Report: 40% of Health Care Spending in Massachusetts Could be Considered Wasted

The Massachusetts Health Policy Commission today released results on the state’s ballooning wasted health care spending numbers. Brace yourself for this: Massachusetts wastes nearly 40% of total health expenditures. That rounds out to between $14.7 and $26.9 billion! It should trouble us all that wasted spending is so prevalent. Published numbers indicate that over $750 billion is wasted each year throughout the US, and so much of this waste can be tied back to incomplete diagnoses which lead to incorrect treatment plans. What else can we expect from a system that often values speed over accuracy?

file0001300605042

Some of the fixes may be simpler. The report found that huge percentages are wasted on hospital readmissions, preventable ER visits, hospital-acquired infections, and unnecessary tests for low back pain. However, the larger problem will require some serious thought and action. The report found that 5% of patients accounted for nearly half of all medical spending among those covered by Medicare and commercial insurance. These patients tend to be chronically ill, which in turn leads to more issues with misdiagnoses, medication management, and long-term positive results. If 5% are accounting for the largest amount of health care spending, maybe our focus needs to shift toward what we can do to better address that population, while reducing the numbers added to it.

The sad reality becomes even more disappointing when we stop to think what good could have been done with that $27 billion.

The Massachusetts Health Policy Commission today released results on the state’s ballooning wasted health care spending numbers. Brace yourself for this: Massachusetts wastes nearly 40% of total health expenditures. That rounds out to between $14.7 and $26.9 billion! It should trouble us all that wasted spending is so prevalent. Published numbers indicate that over $750 billion is wasted each year throughout the US, and so much of this waste can be tied back to incomplete diagnoses which lead to incorrect treatment plans. What else can we expect from a system that often values speed over accuracy?

file0001300605042

Some of the fixes may be simpler. The report found that huge percentages are wasted on hospital readmissions, preventable ER visits, hospital-acquired infections, and unnecessary tests for low back pain. However, the larger problem will require some serious thought and action. The report found that 5% of patients accounted for nearly half of all medical spending among those covered by Medicare and commercial insurance. These patients tend to be chronically ill, which in turn leads to more issues with misdiagnoses, medication management, and long-term positive results. If 5% are accounting for the largest amount of health care spending, maybe our focus needs to shift toward what we can do to better address that population, while reducing the numbers added to it.

The sad reality becomes even more disappointing when we stop to think what good could have been done with that $27 billion.

January 06, 2014

Hunting for Zebras

A recent article on the front page of the Boston Globe about different opinions on a child’s medical care caught my eye. It follows the story of one family to illustrate the complicated emotions and legal maneuvers that can take place when doctors disagree on a diagnosis and treatment plan, and when those doctors disagree with family members. Really powerful stuff.

As the writers point out, doctors disagree all the time on the definitive diagnosis and the best way forward for the patient. The more rare and complex a case is, the more likely it is to be misdiagnosed (or go undiagnosed), and that puts the patient further from the care they need.

zebra casesThere’s a phrase that some folks in the healthcare community use to describe those rare medical occurrences: “zebra cases.” The term comes from the notion that when medical professionals learn about diagnosing patients, they’re generally taught that when you see hoof prints and hear clopping on the ground, you’re supposed to think horses, not zebras. But once in a while, it turns out to be a zebra, and that changes things quite a bit.

Best Doctors encounters these zebra cases with some frequency. One in particular came from a woman named Evelyn, who came to us with what she thought was lung cancer, but upon closer review, turned out to be a recurrence of thyroid cancer that she had had more than 30 years ago. Her doctors thought, what sounds like a horse must be a horse (cancer in the lungs means lung cancer), but it turned out to be a zebra (a different type of cancer), and that means Evelyn likely avoided the wrong kind of treatment, which would have been both costly and dangerous.

These are precisely the cases that are extremely unlikely to be sorted out during a 15 minute office visit or by following a certain pathway for a particular complaint or symptom. These are the cases that confound many providers and cause families unnecessary worry. Fortunately, it doesn’t have to be this way. Evelyn got the right answers because her case went to an expert in her particular condition, who took a fresh look at her records and spent the time that was necessary with the case to come to the right diagnosis.

It may not always be good news, but the right answers the first time means better care every time, whether it’s an everyday horse or a more exotic zebra.

A recent article on the front page of the Boston Globe about different opinions on a child’s medical care caught my eye. It follows the story of one family to illustrate the complicated emotions and legal maneuvers that can take place when doctors disagree on a diagnosis and treatment plan, and when those doctors disagree with family members. Really powerful stuff.

As the writers point out, doctors disagree all the time on the definitive diagnosis and the best way forward for the patient. The more rare and complex a case is, the more likely it is to be misdiagnosed (or go undiagnosed), and that puts the patient further from the care they need.

zebra casesThere’s a phrase that some folks in the healthcare community use to describe those rare medical occurrences: “zebra cases.” The term comes from the notion that when medical professionals learn about diagnosing patients, they’re generally taught that when you see hoof prints and hear clopping on the ground, you’re supposed to think horses, not zebras. But once in a while, it turns out to be a zebra, and that changes things quite a bit.

Best Doctors encounters these zebra cases with some frequency. One in particular came from a woman named Evelyn, who came to us with what she thought was lung cancer, but upon closer review, turned out to be a recurrence of thyroid cancer that she had had more than 30 years ago. Her doctors thought, what sounds like a horse must be a horse (cancer in the lungs means lung cancer), but it turned out to be a zebra (a different type of cancer), and that means Evelyn likely avoided the wrong kind of treatment, which would have been both costly and dangerous.

These are precisely the cases that are extremely unlikely to be sorted out during a 15 minute office visit or by following a certain pathway for a particular complaint or symptom. These are the cases that confound many providers and cause families unnecessary worry. Fortunately, it doesn’t have to be this way. Evelyn got the right answers because her case went to an expert in her particular condition, who took a fresh look at her records and spent the time that was necessary with the case to come to the right diagnosis.

It may not always be good news, but the right answers the first time means better care every time, whether it’s an everyday horse or a more exotic zebra.

December 27, 2013

New Blood Pressure Guidelines

Strong debate is still on-going over the newest blood pressure guidelines recommended by a panel of experts last week. The Boston Globe‘s Deborah Kotz summarizes the findings nicely, and boils them down to five major points:

1. The threshold for treating high blood pressure has been raised for older Americans.

2. Drugs should no longer be used in older Americans to drive down their systolic pressure to below 150.

3. Adults under age 60 should aim to have their blood pressure below 140/90.

4. Lifestyle changes to lower blood pressure should be emphasized along with medications.

5. Expanded array of drugs recommended as a first line of treatment.

The American Heart Association, and others, have approached the new recommendations with some hesitance. There is a genuine concern for the unintended consequence of telling people they can let their blood pressure go up more without taking medication. The debate is a good one, and one that we should be having. Most importantly, it reminds us that health care is ultimately about getting the diagnosis and treatment right. That won’t always be a black or white issue, but it is one that requires regular review of the way things have always been done. Just because blood pressure guidelines have always been X, and medication has always been prescribed at X, does not mean that practice must continue, especially if the evidence shows otherwise.

If these new recommendations do take hold, there is the potential to reduce the effects of unnecessary medication while reducing huge amounts of wasted health care spending. However, because it forces us to get it right, the conversation is still the most important part.

 

 

Strong debate is still on-going over the newest blood pressure guidelines recommended by a panel of experts last week. The Boston Globe‘s Deborah Kotz summarizes the findings nicely, and boils them down to five major points:

1. The threshold for treating high blood pressure has been raised for older Americans.

2. Drugs should no longer be used in older Americans to drive down their systolic pressure to below 150.

3. Adults under age 60 should aim to have their blood pressure below 140/90.

4. Lifestyle changes to lower blood pressure should be emphasized along with medications.

5. Expanded array of drugs recommended as a first line of treatment.

The American Heart Association, and others, have approached the new recommendations with some hesitance. There is a genuine concern for the unintended consequence of telling people they can let their blood pressure go up more without taking medication. The debate is a good one, and one that we should be having. Most importantly, it reminds us that health care is ultimately about getting the diagnosis and treatment right. That won’t always be a black or white issue, but it is one that requires regular review of the way things have always been done. Just because blood pressure guidelines have always been X, and medication has always been prescribed at X, does not mean that practice must continue, especially if the evidence shows otherwise.

If these new recommendations do take hold, there is the potential to reduce the effects of unnecessary medication while reducing huge amounts of wasted health care spending. However, because it forces us to get it right, the conversation is still the most important part.

 

 

December 23, 2013

“Over-diagnosis”

What if 20% of lung tumors are growing so slowly that they would never cause a threat, yet we still addressed them with aggressive treatment options?

Doctors Examining an Xray

This is what a new study, published in JAMA Internal Medicine, claims. It leads to the under-asked question: “Is over-diagnosis getting the attention it deserves?”

The available statistics about misdiagnosis in general (occurring in about 15-28% of all medical cases) is slowly gaining more attention, but this new research should make us sit up and take notice of misdiagnosis’ ugly cousin, over-diagnosis. If the number one cause of world cancer deaths requires a more detailed look at what we treat, and how we treat it, then maybe we need to apply similar logic to other conditions.

This past summer, the National Cancer Institute recommended changing the definition of cancer to help alter the way we approach everything from detection to treatment. Much of the motivation came from patients seeking the most aggressive treatments when the word “cancer” was used.

Let’s assume one in five patients who heard about their lung tumors immediately received painful, expensive, and side-effect riddled treatments; treatments that they probably did not need. Doesn’t that deserve a more broad discussion? What can be done to help coach patients on treatment decisions?

Sometimes the life we save is the one that isn’t treated.

What if 20% of lung tumors are growing so slowly that they would never cause a threat, yet we still addressed them with aggressive treatment options?

Doctors Examining an Xray

This is what a new study, published in JAMA Internal Medicine, claims. It leads to the under-asked question: “Is over-diagnosis getting the attention it deserves?”

The available statistics about misdiagnosis in general (occurring in about 15-28% of all medical cases) is slowly gaining more attention, but this new research should make us sit up and take notice of misdiagnosis’ ugly cousin, over-diagnosis. If the number one cause of world cancer deaths requires a more detailed look at what we treat, and how we treat it, then maybe we need to apply similar logic to other conditions.

This past summer, the National Cancer Institute recommended changing the definition of cancer to help alter the way we approach everything from detection to treatment. Much of the motivation came from patients seeking the most aggressive treatments when the word “cancer” was used.

Let’s assume one in five patients who heard about their lung tumors immediately received painful, expensive, and side-effect riddled treatments; treatments that they probably did not need. Doesn’t that deserve a more broad discussion? What can be done to help coach patients on treatment decisions?

Sometimes the life we save is the one that isn’t treated.

December 20, 2013

Welcome to Vital Signs

Welcome to Vital Signs, a new blog about some of the most important news and trends in the practice of health care. We hope you’ll make frequent stops at this site to stay informed and share your opinions on a wide range of topics about diagnoses, treatments, and how we can make sure we’re getting them both right.

“We bring together the best minds in medicine to help people get the right diagnosis and treatment.” It’s a simple approach that Best Doctors has been using to transform lives for nearly 25 years. Vital Signs hopes to take a page out of the Best Doctors playbook and bring together minds, yours included, to begin discussion and potentially solve some of the issues that have plagued health care for far too long.

With an endless supply of discussion about how we pay for health care, Vital Signs hopes to take a look at the care itself. If we could start from scratch, what would we do differently? What would we prioritize?

The contributors to this blog are naturally curious, and have turned this curiosity into a platform to encourage discussion. Why is it that despite the incredible advances we make in medical technology and medicine, the number of misdiagnosed patients does not decrease (and in many cases, has increased)? What will health care look like in 10 years, and are we prepared for it? If patients are expected to be their own best advocates, should they be trained to maximize the patient/doctor relationship? What role should policymakers play in discussions about improving health results?

So many questions, yet so many minds to help us navigate the discussion. We look forward to working together with you.

Welcome to Vital Signs, a new blog about some of the most important news and trends in the practice of health care. We hope you’ll make frequent stops at this site to stay informed and share your opinions on a wide range of topics about diagnoses, treatments, and how we can make sure we’re getting them both right.

“We bring together the best minds in medicine to help people get the right diagnosis and treatment.” It’s a simple approach that Best Doctors has been using to transform lives for nearly 25 years. Vital Signs hopes to take a page out of the Best Doctors playbook and bring together minds, yours included, to begin discussion and potentially solve some of the issues that have plagued health care for far too long.

With an endless supply of discussion about how we pay for health care, Vital Signs hopes to take a look at the care itself. If we could start from scratch, what would we do differently? What would we prioritize?

The contributors to this blog are naturally curious, and have turned this curiosity into a platform to encourage discussion. Why is it that despite the incredible advances we make in medical technology and medicine, the number of misdiagnosed patients does not decrease (and in many cases, has increased)? What will health care look like in 10 years, and are we prepared for it? If patients are expected to be their own best advocates, should they be trained to maximize the patient/doctor relationship? What role should policymakers play in discussions about improving health results?

So many questions, yet so many minds to help us navigate the discussion. We look forward to working together with you.