Please confirm that you would like to log out of Medscape.
If you log out, you will be required to enter your username and password the next time you visit.
Log outCancel
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017
| Contributor Information
Swipe to advance
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Image from Joe Raedle/Getty Images
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Record Year for Natural Disasters
In 2017, three major hurricanes hit the United States, Puerto Rico, and the US Virgin Islands, straining hospitals and healthcare systems and prompting the Centers for Disease Control and Prevention to issue guidance for clinicians treating patients from hard-hit areas.[1] Hurricane Harvey ravaged parts of Texas and Louisiana in late August, flooding thousands of homes and businesses and shutting down services.[2] In early September, Hurricane Irma caused catastrophic damage in parts of the northeastern Caribbean and the Florida Keys and widespread power outages.[3] Ten residents of a Miami-area nursing home died after days of exposure to sweltering heat in the aftermath of Irma, prompting a criminal probe.[4] Hurricane Maria hit Puerto Rico in mid-September, knocking out power to much of the island and fueling a major humanitarian crisis.[5] In October, the deadliest wildfires in California history swept through the state's wine country.[6] On November 13, at least 452 people were killed when a powerful 7.3-magnitude earthquake struck near the border of Iran and Iraq. It was the deadliest in 2017, surpassing the 7.1-magnitude earthquake that hit near Mexico City in September.
Image from Evan Vucci/AP
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
GOP Fails to Repeal and Replace Obamacare
When Donald Trump swept into the White House in January, his first order of business was to repeal and replace the Affordable Care Act (ACA). He immediately issued an executive order to "ease the burden of Obamacare," sending a strong signal that he intended to follow through on his campaign promise to abolish the ACA.[7] In March, the Republican-controlled House released a bill to replace the ACA[8] but then pulled it because of lack of support.[9] In May, the House finally passed "repeal and replace" legislation known as the American Health Care Act (AHCA).[10] In June, a Senate Republican bill to replace the ACA was introduced, called the Better Care Reconciliation Act (BCRA), but the Congressional Budget Office said it would leave 22 million more Americans uninsured.[11] In July, the Senate rejected a Republican "repeal-only" bill known as the Obamacare Repeal Reconciliation Act (ORRA).[12] Failure to repeal and replace the ACA was cited as the most significant policy news of 2017 in Medscape's reader survey.[13]
Image from Dreamstime
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Opioid Crisis Declared Public Health Emergency
In late October, President Trump declared the opioid epidemic a national public health emergency, nearly 3 months after the President's Commission on Combating Drug Addiction and the Opioid Crisis recommended Trump immediately declare a national emergency.[14] The Commission also called for incentives that steer prescribers toward nonopioid alternatives.[15] The US Food and Drug Administration (FDA) also said it's looking for ways to limit both the number of opioid prescriptions and the duration of those prescriptions and is asking healthcare providers to step up and support this effort.[16] It seems the message is getting through, according to a study that found a reduction in prescriptions for opioid pain medicines.[17] Seventy-three percent of physicians and 82% of pharmacists responding to a recent Medscape poll said that the opioid epidemic has changed their habits around prescribing or filling prescriptions for opioids.[18] Still, opioid prescribing remains high and varies widely from county to county. The Appalachian region of the United States remains hard hit, but no part of the country is spared.[19] Opioid manufacturers came under fire in 2017 with several lawsuits filed and a congressional inquiry into whether manufacturers' business practices — such as aggressive marketing, sales quotas, and sponsoring CME and advocacy groups — have contributed to overprescribing and overuse of the drugs.[20]
Images from Getty Images, AP
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Trump Fills Key Healthcare Posts
In February, the Senate narrowly confirmed Rep. Tom Price, MD (R-GA), an orthopedic surgeon, as secretary of the US Department of Health and Human Services (HHS).[21] But less than 8 months later, engulfed by controversy over expensive government trips aboard charter and military aircraft, Dr Price resigned from his post.[22] President Trump has nominated former pharmaceutical executive Alex Azar to lead HHS.[23] In March, the Senate confirmed healthcare consultant Seema Verma as administrator of the Centers for Medicare & Medicaid Services (CMS).[24] Verma has said she is open to any Medicaid reforms that would improve health outcomes for beneficiaries. "The status quo is not acceptable," Verma said. "This is the United States of America. We can do better for these vulnerable populations." Other key appointments included Scott Gottlieb, MD, to lead the FDA;[25] David Shulkin, MD, as Veterans Affairs secretary;[26] and Jerome Adams, MD, as surgeon general.[27]
Image from Dreamstime
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
CMS Exempts Some Clinicians From MIPS
This past spring, CMS exempted about two thirds of physicians and other clinicians who provide care to Medicare beneficiaries from the Merit-based Incentive Payment System (MIPS), a pay-for-performance scheme that will determine part of physicians' Medicare payments, starting in 2019. CMS said it notified 418,849 providers that they are participating in MIPS and 806,879 that they are not participating in MIPS.[28] In the final regulations for the Medicare Access and CHIP Reauthorization Act (MACRA) issued in October 2016, CMS predicted that 53% to 57% of Medicare providers would be exempt from MIPS. But when the letters went out to practices in May, CMS excluded 65% of them. CMS also introduced an online lookup tool that enables clinicians to determine whether they have to participate in MIPS.[29]
Image from Fredy Perojo/Medscape
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Physicians Make Themselves Heard at the March for Science
On April 22 in cities across the United States, physicians added their voices, presence, and passion to thousands of other people in support of the principles and practice of science.[30] The March for Science, held in conjunction with Earth Day in Washington, DC, and an estimated 600 satellite marches worldwide, is "the first step of a global movement to defend the vital role science plays in our health, safety, economies, and governments," according to the event's website. In a rally held prior to the DC march, more than 50 speakers representing all realms of science — from climate to space to science education to nature conservancy to biological and chemical science — exhorted the crowd to continue to press for science funding and against the antiscience attitudes and "alternative facts" some have said are coming from the Trump administration. Speaking at the event, Georges Benjamin, MD, executive director of the American Public Health Association, said, "A nation that ignores science, that denies science, that underfunds science, does so at its own peril. We cannot allow this to happen. We need to ensure that data and evidence drive policy-making, not uninformed ideology."
Image from Dreamstime
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Maintenance of Certification Debate Continues
Fierce debate over maintenance of certification (MOC) continued in 2017. Proponents claim that it is necessary and demonstrates a commitment to lifelong learning. Critics claim that MOC is an expensive, burdensome, and clinically irrelevant process. In August, JAMA published a study suggesting that costs to physicians for board certification and MOC are substantial and that American Board of Medical Specialties (ABMS) member boards may be benefiting financially from them.[31] In September, amidst continuing pushback from physicians on MOC requirements, the American Board of Internal Medicine (ABIM) announced an agreement with three medical societies to explore alternatives to the current process.[32] The American College of Cardiology (ACC), the American College of Physicians, and the American Society of Clinical Oncology have agreed to work with ABIM to explore "collaborative maintenance pathways" through which physicians can maintain board certification. In October, the ABMS announced that MOC requirements would undergo yet another overhaul.[33] The umbrella group for 24 specialty boards formed a commission to "ensure a continuing board certification program that remains relevant and meaningful to physicians and the patients they serve," said John Moorhead, MD, who chairs the ABMS board of directors.
Image from iStock
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Mid-Level Providers Practicing Without MD Supervision
Debate over whether nurse practitioners and other mid-level providers should be allowed to practice medicine unsupervised by physicians continued this year. Several states have granted full independence to nurse practitioners. Recently, in a move decried by organized medicine, the Department of Veterans Affairs (VA) decided to allow advanced practice registered nurses to work independently without physician supervision in its far-flung healthcare network and regardless of individual state law.[34] The AMA was disappointed with the VA's decision, saying it will rewind the clock to an outdated model of care delivery that is not consistent with the current direction of the healthcare system. The AMA also said the action runs counter to physician-led, team-based care, which it called the best approach to improving quality.[35]
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Physician Dragged Off United Flight
In April, disturbing video surfaced of a 69-year-old physician being dragged off an overbooked United Airlines flight because he refused to surrender his seat, which raised the question: As long as airlines continue to overbook flights, should they automatically exempt physicians from getting bumped because of their profession? Ethicists interviewed by Medscape tended to think not, even though they sympathized with the battered passenger, who said he was a physician with patients to see the next day.[36] "I do think that physicians have pulled rank, and there has been a culture of pulling rank on a regular basis, just in the everyday routine of making patients wait, for example," said Linda Emanuel, MD, PhD, a medical ethicist at Northwestern University in Evanston, Illinois. "None of that is really necessary and it is arrogant." Medscape's story on the incident drew more than 540 comments from readers. The physician who was dragged off the flight later reached a settlement with United Airlines.[37] The much-maligned and repentant airline also unveiled new policies to ensure that no more passengers are removed by force from overbooked or fully booked flights.
Image from Salt Lake City Police Department/AP
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Nurse Arrested for Doing Her Job
In August, another disturbing video was released. It showed nurse Alex Wubbels, who was protecting her unconscious patient from a blood draw by police, handcuffed, arrested, and forcibly moved from the University of Utah hospital's burn unit into a patrol car by a Salt Lake City detective.[38] The nurse tried to explain to the officer that he needed a warrant or consent from the patient or had to put the patient under arrest before she could allow a blood draw, per hospital policy. As a result of the incident, the hospital now requires police officers to interact directly with the hospital supervisor.[39] The American Nurses Association (ANA) released a statement expressing outrage and called for the Salt Lake City Police Department to conduct a full investigation, make amends to the nurse, and take action to prevent future abuses. "It is outrageous and unacceptable that a nurse should be treated in this way for following her professional duty to advocate on behalf of the patient as well as following the policies of her employer and the law," said ANA President Pam Cipriano, PhD, RN. The Salt Lake City police fired one police officer and disciplined another over the incident.[40] The nurse later reached a settlement of $500,000 with all the parties involved.[41]
Image from iStock
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
New Hypertension Guidelines Make 130 the New 140
The ACC and the American Heart Association (AHA) in November released a highly anticipated new guideline on the prevention, detection, evaluation, and management of hypertension with a new definition that considers stage 1 hypertension to be a blood pressure 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic.[42] The guideline was released at the AHA 2017 Annual Scientific Sessions, held in Anaheim, California, and published simultaneously in the Journal of the American College of Cardiology and in the AHA journal Hypertension . It emphasizes blood pressure measurement, both the accuracy of the measurements and using the average of measures taken over several visits, as well as out-of-office measurements, "which is relatively new for a blood pressure guideline," said guideline chair Paul Whelton, MD, from Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
Image from Alamy
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
House Passes VA Telehealth Bill
In November, the House of Representatives passed a bill that would allow VA doctors to treat patients remotely across state lines using telehealth technology. A similar measure is pending in the Senate.[43] The VA has proposed a new regulation that would accomplish the same goal.[44] However, congressional action is required to authorize the department to issue that regulation. A 30-day comment period on the VA proposal recently expired, but no final rule has been released. The House bill, the Veterans E-Health and Telemedicine Support Act of 2017, would create a VA state licensure exemption to allow VA-credentialed healthcare professionals to work across state borders to perform telemedicine without having to obtain a new license in that state. Like the proposed VA regulation, the House legislation would not allow VA-contracted private physicians to treat patients remotely in states where they are not licensed. A number of veterans associations and patients' rights organizations have endorsed the bill, as have the AMA, the American Psychological Association, the American Psychiatric Association, and the American College of Radiology.
Image from iStock
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Appeals Court Overturns Florida’s Physician “Gun-Gag” Law
In February, in a decision that may be contested in the Supreme Court, a federal appeals court overturned a Florida law that prohibits physicians from asking patients if they own a gun unless the question is medically relevant.[45] The AMA, the American Academy of Pediatrics, and other major medical societies have opposed the so-called gun-gag law, saying it infringes on the First Amendment right of physicians to discuss gun safety, especially with parents of young children. They liken questions about gun ownership — always relevant, in their view — to those about unfenced swimming pools and other household hazards. Florida lawmakers, along with the National Rifle Association, counter that the law prevents physicians, some with an antigun bias, from harassing gun owners. Besides banning the ownership questions except when clinically necessary, the law forbids physicians from recording in the medical chart that a patient owns a gun, "unnecessarily harassing" gun owners, or otherwise discriminating against them. The law, called the Firearm Owners' Privacy Act (FOPA), has been on a judicial rollercoaster since its passage in 2011.
Image from Steven Senne/AP
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Foreign-Born Physicians and Travel Ban
In January, President Donald Trump signed an executive order limiting travel into the United States. This move affected thousands of medical professionals[46] and prompted leaders of some major medical conferences to issue strong opposition statements and some physicians and scientists to cancel plans to present their work.[47] The action may ultimately threaten medical progress and patient care, clinicians from several large academic institutions wrote in the New England Journal of Medicine (NEJM).[48] Organized medicine, including the AMA, banded together to voice confusion, worry, and, in some cases, outright opposition to the travel ban.[49] The travel ban confusion also complicated Match Day decisions for some international students.[50]
Image courtesy of Novartis
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Approval of First CAR T-Cell Therapies to Treat Cancer
In August, the FDA approved the first T-cell therapy that uses chimeric antigen receptor (CAR) technology.[51] The product, tisagenlecleucel-T (Kymriah, Novartis), is for patients with relapsed or refractory acute lymphoblastic leukemia. Novartis priced Kymriah at $475,000, which caused some sharp intakes of breath across the oncology community, but it has also been pointed out that this is a 'one-off' therapy that is potentially curative. In successful cases, the one-time treatment eradicates the leukemia. In October, the FDA approved a second CAR T-cell therapy.[52] Axicabtagene ciloleucel (Yescarta, Kite Pharma) is for patients with relapsed/refractory aggressive B-cell non-Hodgkin lymphoma who are ineligible for autologous stem cell transplant. The therapy involves engineering a patient's T cells to express a CAR that will then target the antigen CD19, a protein expressed on the cell surface of B-cell lymphomas and leukemias. The cells are then redirected to kill the cancer cells. "We're entering a new frontier in medical innovation with the ability to reprogram a patient's own cells to attack a deadly cancer," said FDA Commissioner Scott Gottlieb, MD.
Image courtesy of Wikimedia
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Global EpiPen Recall Amidst Firestorm Over Price
On March 18, more than 80,000 EpiPen auto-injectors for anaphylactic shock were recalled in several countries overseas because they may fail to inject their potentially life-saving dose of epinephrine, Mylan, the company that markets the devices, announced. The recall applied to devices distributed in Australia, Europe, Japan, and New Zealand. Mylan reported two instances of the device failing to deliver its dose.[53] On March 31, the United States joined the list of countries covered by the voluntary recall of EpiPen auto-injectors.[54] In June, the Department of Health and Human Services announced that the US government may have overpaid Mylan by as much as $1.27 billion between 2006 and 2016 for its EpiPen emergency allergy treatment.[55] In August, Mylan finalized a $465 million settlement with the US Justice Department.[56]
Image from iStock
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Longer Shifts for First-Year Residents
In March, the Accreditation Council for Graduate Medical Education (ACGME) announced that residency programs could increase shift hours for first-year trainees beginning in July from 16 to 24, with an extra 4 hours to manage patient hand-offs.[57] As a result, first-year residents can have shifts as long as those of more senior residents. However, the maximum number of hours that any resident can log per week remains at 80. The ACGME stated that the new standard, in the making since 2015, will improve continuity of care for patients, clinical teamwork, and the learning experience for residents. However, critics of the policy, which include the American Medical Student Association and the consumer watchdog group Public Citizen, contend that longer shifts for rookie residents increase the odds of sleep deprivation and accidents, putting patients as well as physicians in harm's way. The decision by the ACGME to relax limits on shifts for first-year residents comes at a time when the problem of physician burnout and suicide is gripping the profession. This story garnered 300 comments from Medscape readers.
Image courtesy of Marathon Pharmaceuticals LLC
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
FDA Clears Deflazacort (Emflaza) for DMD
In February, the FDA approved the corticosteroid deflazacort (Emflaza, Marathon Pharmaceuticals) to treat patients aged 5 years and older with Duchenne muscular dystrophy (DMD).[58] The deflazacort approval was the first FDA approval of any corticosteroid to treat DMD and the first approval of deflazacort for any use in the United States. The drug was given fast-track designation and priority review by the FDA. The drug also received orphan drug designation, which provides incentives to assist and encourage the development of drugs for rare diseases. "This is the first treatment approved for a wide range of patients with Duchenne muscular dystrophy," Billy Dunn, MD, director, Division of Neurology Products, FDA Center for Drug Evaluation and Research, said in a news release. "We hope that this treatment option will benefit many patients with DMD."
Image from iStock
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Insufficient Evidence for Pelvic Exams in Asymptomatic Women
In March, the US Preventive Services Task Force (USPSTF) issued a final recommendation on pelvic exams to screen for gynecologic conditions in nonpregnant asymptomatic women in primary care.[59] It concluded that the available evidence is insufficient to assess the harms and benefits in this population, and the decision to undergo the procedure should be shared between a woman and her physician. The task force said evidence is lacking, of poor quality, or conflicting, and hence the harms–benefits balance cannot be determined. Therefore, "Screening for Gynecologic Conditions With Pelvic Examination" is an I (insufficient) statement. The authors, led by Kirsten Bibbins-Domingo, MD, PhD, from the University of California, San Francisco, stressed that the I statement does not apply to cervical cancer, gonorrhea, and chlamydia, for which the USPSTF already recommends screening. "This is not a recommendation against performing pelvic exams," said Dr Bibbins-Domingo in a USPSTF statement. "At this time, there simply is not enough evidence to determine the benefits and harms of using pelvic exams to screen for conditions other than cervical cancer, chlamydia, and gonorrhea."
Image from iStock
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Stem Cell Therapy Blinds Three Patients at Florida Clinic
The risks of stem cell tourism made headlines this year, including a report in the NEJM describing three women with non-neovascular ("dry") age-related macular degeneration (AMD) who sustained profound visual loss after receiving bilateral intravitreal injections of autologous adipose tissue–derived stem cells at a Florida clinic.[60] "This report joins a small but growing medical literature highlighting the risks of such wanton misapplication of cellular therapy," wrote George Daley, MD, PhD, in an NEJM editorial. He led development of the International Society for Stem Cell Research's guidelines for clinical use of stem cells. "The guidelines highlight the stark distinction between the innovative treatments that are founded on methodical preclinical evidence, proven in rigorous clinical trials, and approved for marketing after regulatory review and the unproven interventions that are offered by practitioners who are naive regarding the biologic complexities of stem cells or by charlatans peddling the modern equivalent of snake oil," wrote Dr Daley.
Image from Science Source
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Even Short-term Oral Steroids Carry Serious Risk
A cohort study of more than 1.5 million adults suggests that the millions of Americans prescribed short-term oral corticosteroids are taking a dose of risk along with their medication. Within 30 days of initiating these drugs, even at relatively low doses, users had a nearly twofold increased risk for fracture, a threefold increased risk for venous thromboembolism, and a fivefold increased risk for sepsis, reported Akbar K. Waljee, MD, from the University of Michigan in Ann Arbor, and colleagues in the BMJ in April.[61] They found that more than one in five adults included in a large national database of commercial insurance claims received prescriptions for short-term oral corticosteroids during the 3-year study. "Although physicians focus on the long-term consequences of steroids, they don't tend to think about potential risks from short-term use," said Dr Waljee. "We see a clear signal of higher rates of these three serious events within 30 days of filling a prescription. We need to understand that steroids do have a real risk and that we may use them more than we really need to. This is so important because of how often these drugs are used."
Image from iStock
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Do Latest US Guidelines Bypass, or Spare, Millions From Statins?
A study published in April, showing that about 9.3 million fewer Americans would be recommended for primary-prevention statin therapy if physicians followed 2016 recommendations based largely on low-density lipoprotein cholesterol targets rather than competing 2013 guidelines based more on risk, prompted debate and concern.[62] The study estimated that 15.8% of US adults aged 40 to 75 years without prior cardiovascular disease would be started on statins if the 2016 USPSTF recommendations were fully implemented vs 24.3% if the 2013 ACC/AHA guidelines were followed. This is on top of the 21.5% of adults already taking lipid-lowering therapy and translates into an estimated 17.1 million vs 26.4 million Americans, respectively, with a new recommendation for statins. Steven E. Nissen, MD, from the Cleveland Clinic in Ohio, stressed that having multiple guidelines is very confusing to the public and to physicians. He noted that neither guideline is ideal and that he has been openly critical of the ACC/AHA guidelines because it uses a risk calculator that had never been previously published. "It just wasn't a sensible thing to do, and I hope it's corrected in the next iteration of the guideline," he said.
Image from Dreamstime
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
All NSAIDs Linked to Increased MI Risk
A patient-level meta-analysis published in May found a significantly increased risk for myocardial infarction (MI) with use of nonsteroidal anti-inflammatory drugs (NSAIDs), including naproxen, considered by some as one of the safest drugs in this class.[63] The heightened MI risk occurred as early as the first week of use, and the risk was greater with higher doses. But for most patients, the risk is very small, noted Michèle Bally, PhD, from Centre hospitalier de l'Université de Montréal, Quebec, Canada. "If you average people with different baseline heart risks, the risk specifically due to an NSAID is only about 1% per year, so out of 100 people treated continuously for a year, there will be one extra heart attack." Nonetheless, Dr Bally said, "This new research on NSAIDs reinforces what physicians know already: that patients should use the smallest possible dose for the shortest possible time." Even though the research suggests the increased MI risk lessened over time, "the findings were not conclusive enough about longer duration," said Dr Bally.
Image from Dreamstime
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Mortality Higher Among Inpatients Treated by Older Physicians
A study published in May found that inpatients treated by older physicians have a higher 30-day mortality than those cared for by younger physicians.[64] The increased risk, however, did not apply to older physicians who treated high volumes of patients, and the researchers cautioned the results are "exploratory." However, if confirmed, the findings would mean that for every 77 patients treated by physicians aged 60 years or older, one fewer patient would die if cared for by physicians younger than 40 years. The findings suggest that within the same hospital, patients treated by physicians younger than 40 have 0.85 times the odds of dying or an 11% lower probability of dying compared with patients cared for by physicians aged 60 years or older, they reported in the BMJ. "This difference in mortality is comparable with the impact of statins for the primary prevention of cardiovascular mortality on all-cause mortality (odds ratio of 0.86) or the impact of β blockers on mortality among patients with myocardial infarction (incidence rate ratio of 0.86), indicating that our observed difference in mortality is not only statistically significant but arguably clinically significant," they wrote. The researchers called for additional studies to understand exactly why low- to medium-volume older physicians have worse outcomes, and how to solve this problem.
Image from iStock
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Landmark Trials Deliver Evidence to Rethink Saline Use
Two landmark studies released in October found that hospitalized patients who receive balanced crystalloid fluids, whether they are critically ill or not, are about 1% less likely to need renal replacement therapy, have persistent renal dysfunction, or die in the hospital than patients who receive saline.[65] The studies were presented at CHEST 2017, the American College of Chest Physicians annual meeting. The findings have "population-wide implications," said Matthew Semler, MD, from Vanderbilt University Medical Center in Nashville, Tennessee, who led one of the studies. "These fluids are administered to more than 5 million ICU patients, so a difference of 1% translates to thousands of new renal replacement therapies, persistent renal dysfunction, and deaths," he said. "There has been a hypothesis that balanced crystalloids are more aligned with human blood, and there were theories about why that might be better for use in humans. Now we can support those."
Image from Dreamstime
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Diabetes Drug a “Landmark Change” for Intracranial Pressure
Exendin-4, a commonly used diabetes drug, has shown promise in reducing intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH) and other conditions associated with elevated brain pressure.[66] Researchers at the University of Birmingham, United Kingdom, studied the effect of exendin-4, a glucagon-like peptide-1 (GLP-1) receptor agonist, in rats with elevated ICP.
They found that it reduced ICP by 44% within 10 minutes of dosing. Moreover, the treatment effects lasted at least 24 hours. These findings could have clinical applicability to several neurologic conditions associated with elevated ICP, including hydrocephalus, IIH, stroke, and traumatic brain injury. "This is a real breakthrough because it is a completely different way of reducing brain pressure. What we have shown is that this GLP-1 receptor agonist can actually reduce the amount of CSF [cerebrospinal fluid] production, thereby reducing brain pressure," said study investigator Alexandra Sinclair, MBChB, MCRP, PhD. The study appeared in Science Translational Medicine.
Image courtesy of Otsuka Pharmaceutical Co
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
FDA Clears Drug With Ingestible Digital Tracker
In November, the FDA approved aripiprazole pills that have an ingestible sensor embedded in them that digitally records whether and when the medication is taken. Abilify MyCite (Otsuka Pharmaceutical Co/Proteus Digital Health) became the first digital medicine system to be cleared by the FDA.[67] The product is approved for the treatment of schizophrenia, the acute treatment of manic episodes, the treatment of mixed episodes associated with bipolar I disorder, and adjunctive treatment for major depressive disorder in adults. The system works by sending a message from the pill's sensor to a wearable patch, which transmits the information to a mobile application, allowing patients to record their daily medication intake on their smartphone. Patients can allow their healthcare provider to access the information through a web-based dashboard. Jeffrey Lieberman, MD, chair of psychiatry at Columbia University in New York City, said it remains to be seen whether patients with schizophrenia will accept digital pill tracking. "When you think the treatment is indicated for people who have psychotic symptoms, like paranoid delusions, questions may be introduced that it is intrusive or that it sounds kind of like overbearing government, Big Brother intrusion into my personal autonomy," he said.
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Most Significant Medical or Healthcare Policy News of 2017
In a Medscape reader survey, 47% of respondents said failure to repeal or replace the ACA was the most significant medical or healthcare policy news of 2017. Twenty-two percent of respondents picked the travel ban and its effects on access to care as the top medical or healthcare policy news; 8% picked declaring the opioid epidemic a public health emergency; 4% picked approval of the first two CAR T-cell therapies for cancer; 3% picked the FDA's approval of a noninvasive device for intractable pain; and 1% picked longer shifts for first-year residents. Sixteen percent of readers picked the "other" (write-in) response category. By far the most common write-in response for top medical or healthcare news of 2017 was nurse practitioners and other mid-level providers seeking to practice medicine unsupervised.
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Most Exciting News to Affect Clinical Practice of 2017
Overhaul of the MOC process by the ABMS topped the list in Medscape's reader survey as the most exciting news to clinicians in 2017 that could impact practice or healthcare policy, cited by 35% of respondents. Failure to repeal or replace the ACA was a close second, with 33% of respondents picking this topic, followed by the amount of attention given to the opioid epidemic (30%), first and second approvals of CAR T-cell therapy for cancer (16%), CMS exempting two thirds of clinicians from the MIPS (12%), progress on getting reimbursed for telemedicine visits (12%), and President Trump signing the executive order about the ACA on his first day in office (11%).
The Year in Medicine 2017: News That Made a Difference
Megan Brooks; Fredy Perojo; Darbe Rotach | December 6, 2017 | Contributor Information
Most Frustrating Medical News of 2017
For about one third (32%) of respondents to our reader poll, failure to repeal or replace the ACA was the year's most frustrating medical news to clinicians. Thirty percent of respondents said the most frustrating news was the Utah nurse who was arrested for protecting her patient from a blood draw. Other top frustrating events were the travel ban on foreign-born doctors (27%), the physician who was dragged off the United Airlines flight (22%), the amount of attention given to the opioid epidemic (15%), protestors urging the removal of a statue of a controversial physician in New York City's Central Park (12%), and longer shifts for new medical residents (10%). Common responses for most frustrating events from the "other" write-in category were the election of Donald Trump as president and mid-level providers practicing without MD supervision.
For more medical and healthcare policy news all year round, join us on Facebook and Twitter
The Year in Medicine 2018: News That Made a Difference
Read the news that got the most attention this year in medicine, including the severe flu season, record high STD incidence, gun violence, and more.Medscape News Slideshows, December 2018
Commenting is limited to medical professionals. To comment please Log-in.
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Please do not use this form to submit personal or patient medical information or to report adverse drug events. You are encouraged to report adverse drug event information to the FDA.
Comments