Friday, June 2, 2023
Delayed several times in 2010, most recently on December 9 until January 2012, the Medicare pay cut would be triggered by the sustainable growth rate formula used for setting physicians' pay. It could force many physicians to stop seeing new Medicare patients or to drop out of the Medicare program entirely, which would send shockwaves throughout the system. For 70% of physicians, Medicare patients make up about a third of their practices.
For more information: Healthcare Reform News & Perspectives
The most comprehensive overhaul of the nation's healthcare system at least since Medicare, the Affordable Care Act (ACA) seeks to dramatically expand the number of people who can afford healthcare. It does that by subsidizing the cost for those who can't afford it, penalizing those who refuse to buy it, and limiting the cases in which insurers can deny coverage. Among scores of other provisions, it boosts pay for primary care physicians, encourages compensation based on quality of care, and bars copayments for most preventive services. Ongoing lawsuits about the individual mandate to buy health insurance mean the ACA will likely end up before the Supreme Court.
For more information: Healthcare Reform News & Perspectives
The advent of better tests — such as prostate-specific antigen (PSA) screening — can in some cases save lives with early treatment. However, these tests can also pose new dilemmas, as the American Cancer Society (ACS) emphasized on March 3 when it updated its prostate cancer screening guidelines. The test picks up benign disease in addition to cancer, and it can't distinguish between aggressive and mild forms of the disease, the ACS pointed out. In some cases, PSA screening has led to expensive and invasive treatments in patients who might never have experienced symptoms. So the ACS is calling on physicians to spend more time counseling patients about their options (despite the difficulty of billing for such counseling).
In November, the US Food and Drug Administration (FDA) pulled propoxyphene, sold under the brand names Darvon and Darvocet by Xanodyne Pharmaceuticals, from the US market. The decision also affected generic manufacturers and the makers of propoxyphene-containing products. New clinical data showed that the drug puts patients at risk for potentially serious or even fatal heart rhythm abnormalities. An estimated 10 million patients have used these products.
Two nurses reported Rolando Arafiles Jr, MD, at Winkler County Memorial Hospital in Kermit, Texas, to the Texas Medical Board for low quality of care. As it turned out, Dr. Arafiles was friends with the local sheriff, who arrested Anne Mitchell, RN, and Vickilyn Galle, RN, for misuse of official information — a third-degree felony. Prosecutors dropped charges against Galle, and a jury quickly acquitted Mitchell, but the hospital fired both of them. Subsequently the medical board charged Dr. Arafiles with 9 instances of substandard care. The nurses sued Dr. Arafiles and the hospital in federal court for, among other things, violating their freedom of speech, but dropped the suit after the defendants agreed to pay them $750,000 as part of a settlement.
When an earthquake devastated Haiti on January 12, thousands of physicians and other healthcare professionals started packing their black bags and booking airplane tickets. Experts at a webinar held by the American Medical Association warned against a rush, pointing out that volunteers without the proper preparation could hinder relief efforts. During the next 10 days, however, the need for specialists in emergency medicine, orthopaedic surgery, and neurology became increasingly clear. By the end of the month, more than 600 relief organizations were working in Haiti, and the American Medical Association established a physician registry for volunteers.
When President Obama nominated Donald Berwick, MD, administrator of the Centers for Medicare and Medicaid Services, critics pointed to admiring comments Dr. Berwick had made about Britain's National Health Service and that he called for the redistribution of wealth "from the richer among us to the poorer and less fortunate." However, Dr. Berwick has a track record of success in helping many organizations to solve practical healthcare problems, which earned him support among groups of physicians, consumers, businesses, and insurers, including the American Medical Association. Facing opposition in the Senate, Obama took advantage of a loophole allowing him to appoint Dr. Berwick without the need for confirmation while the Senate was in recess.
Although the American Diabetes Association published new clinical practice recommendations in December 2009, the news story quickly became one of the most-read articles on Medscape. The guidelines promote the use of the hemoglobin A1c (A1c) as a faster, easier diagnostic test that could help reduce the number of undiagnosed patients and better identify patients with prediabetes. A1c measures average blood glucose levels for a period of up to 3 months. Previously it was used only to evaluate diabetes control with time, but because it doesn't require fasting, A1c testing will encourage more people to get tested, leading to treatments and lifestyle changes that could prevent the worst effects of the disease, the American Diabetes Association said.
A large study found that calcium supplements taken without vitamin D may increase the risk for heart attack by as much as 30%. Researchers reported the finding online July 29 in the BMJ, based on their meta-analysis of 15 randomized trials with up to 11,921 participants. Most guidelines for osteoporosis currently recommend the supplements, despite relatively small benefits in bone health, but senior author Dr. Ian R. Reid, from the University of Auckland in New Zealand, said that in most cases, "discontinuation of calcium would seem appropriate." The study raised many questions, such as why calcium could have this effect during a relatively short period of time. Pending further research, some experts advised eating foods high in calcium rather than taking supplements.
Drug warnings dominated the news in 2010. The most popular news of the year among drug warnings was a repeat FDA warning that off-label use of quinine for leg cramps may result in serious and life-threatening hematologic adverse effects.
Among other drug alerts, the FDA warned against taking long-acting beta agonists by themselves; that the 80-mg dose of simvastatin is associated with an increased risk for myopathy, including rhabdomyolysis; opioid tramadol is linked to increased suicide risk; bisphosphonates used to treat osteoporosis have a possible increased risk for atypical femur fractures; rosiglitazone was allowed to remain available under a stringent restricted-access program, despite adverse cardiovascular effects; and tigecycline was linked to an increased risk for death in patients with certain severe infections.
On January 6, 2010, the American College of Radiology and the Society of Breast Imaging directly contradicted 2009 recommendations from the USPSTF calling for an end to routine mammography in women younger than 50 years.
For more information: Breast Cancer News & Perspectives
Abbott Laboratories pulled the obesity drug sibutramine from the market in October in light of clinical trial data pointing to an increased risk for stroke and myocardial infarction. Roughly 100,000 people in the United States were taking sibutramine at the time.
Preexposure chemoprophylaxis (PrEP)using the combination oral antiretroviral therapy emtricitabine/tenofovir (Truvada) demonstrated significant effectiveness against HIV infection in a major, multicontinent clinical trial. The HIV infection rate was 44% lower for those in the PrEP treatment group than for those in the placebo group. For individuals who took their pills on 90% or more of the days in the study, the risk for infection decreased by more than 70%. Experts called the trial results "game-changing" and said it was "a landmark study."
A systematic review from Canadian researchers suggests higher chocolate consumption may be associated with a lower risk for incident stroke and stroke-related mortality. The results were released in February in advance of their presentation at the American Academy of Neurology 62nd Annual Meeting in April.
The huge randomized National Lung Screening Trial (NLST) in the United States was stopped in November after 8-year results showed that screening heavy smokers with low-dose helical computed tomography (CT) significantly reduced deaths from lung cancer, compared with screening with chest x-rays. This was the first time clear evidence of a significant reduction in lung cancer mortality with a screening test in a randomized controlled clinical trial has been seen, said Christine Berg, MD, NLST project officer for the Lung Screening Study at the National Cancer Institute, which funded the trial. This finding will "have implications for the screening and management of lung cancer for many years to come," Dr. Berg predicted.
The long-awaited draft of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released by the American Psychiatric Association in February. After a 2-month period of public review and commentary, which garnered "unprecedented" response, standardized field trials began in October. Experts heading up the development of the DSM-5 say the manual is important not only to psychiatry but all medical specialties. One of the primary goals of developing the new manual is to make it more useful in all clinical practice, including primary care, they say.
Workers involved in clean-up of the Gulf oil spill may be at risk of being exposed to the volatile organic compounds present in crude oil. Burning oil may result in particulate matter that can be deposited in the lungs, which poses a greater risk to people with underlying health conditions, such as asthma, chronic obstructive pulmonary disease, or heart disease. Psychosocial effects were also important consequences of the Gulf oil spill, according to experts from the Institute of Medicine and the Centers for Disease Control and Prevention.
Scientists at the Venter Institute reported the creation of the first "synthetic cell" — Mycoplasma capricolum cells that received and are controlled by a laboratory-assembled genome of Mycoplasma mycoides.
The Centers for Disease Control and Prevention in September updated guidelines for use of the 23-valent pneumococcal polysaccharide vaccine in adults. Changes include the recommendation that all persons aged 19 to 64 years with chronic or immunosuppressive medical conditions, including asthma, should receive the vaccine.
NDM, a gene that makes bacteria impervious to many antibiotics, is spreading worldwide. The gene evolved in India but is widespread in Pakistan and Bangladesh as well. It's been isolated all across the United Kingdom, prompting a national alert. It's also popped up in the United States, Canada, Sweden, Australia, and the Netherlands. A Swedish patient of Indian origin who got a urinary tract infection while visiting New Delhi was found to be infected with NDM-carrying bacteria. Reseachers dubbed the new bug NDM-1.
Robert Edwards, PhD, was awarded the 2010 Nobel Prize in medicine or physiology, for his work in developing vitro fertilization (IVF). About 4 million people were born over the past 32 years using IVF.
Fingolimod is the first of the long-anticipated oral treatments to receive approval for multiple sclerosis (MS). The drug is approved to reduce relapses and delay disability progression in patients with relapsing forms of MS.
New research provides the first direct evidence that attention-deficit/hyperactivity disorder (ADHD) is genetic. In a study published online September 30 in The Lancet, investigators from the University of Cardiff, United Kingdom, say their findings suggest ADHD should be classified as a neurodevelopmental and not a behavioral disorder.
