News That Excited, Shocked, Frustrated Docs in 2019: Survey

This year in medicine will be remembered — among many other things — as the year vaping-related lung disease deaths began to mount as frustrated physicians and scientists searched for what was making the practice so potentially toxic, according to Medscape Medical News' year-end survey.

The 749 physicians who responded to the survey chose from lists of news topics that had the biggest impact this year and identified what they found most exciting, frustrating, and shocking.

Dozens of Vaping Deaths

As reported by Medscape Medical News, the number of vaping-related deaths rose to 52 this month, most of them in people under age 35. The number hospitalized rose to 2409.

Nearly 60% (59.2%) of respondents said that development will be the most remembered for 2019. Meanwhile, the Centers for Disease Control and Prevention identified vitamin E acetate as a "chemical of concern."

Next most memorable was the measles outbreak in 31 US states, chosen by 42.9% of physicians. There were 1261 cases this year — 342 new cases in April alone — compared with 372 cases in 2018 and 120 cases in 2017. It was the worst outbreak since 1992 and most cases occurred in people who were not vaccinated.

Almost 41% of physicians ranked the "Medicare for All" debate third most memorable. The issue joined the single-payer healthcare debate as the proposal had its first hearings this year. Discussions of its feasibility have raged as some Democratic presidential candidates have made it a core campaign issue.

ISCHEMIA Results Most Exciting

When asked what news or event was most exciting personally, 42.9% of physicians put results from the ISCHEMIA trial at the top.

Medscape Medical News reported from the American Heart Association (AHA) Scientific Sessions 2019 in November that the $100 million trial involving more than 5000 participants "failed to show fewer major cardiovascular events with an early invasive strategy than optimal medical therapy."

The trial was seen as the definitive word on the true value of revascularization for those with stable ischemic heart disease.

"This study changes cardiology practice and provides society an important new way to understand atherosclerotic heart disease," John M. Mandrola, MD, wrote in a Medscape commentary.

Physicians ranked the debate surrounding Medicare for All second in the excitement category (chosen by 39.7%), followed by the first approval for gene therapy for spinal muscular atrophy by the US Food and Drug Administration (FDA).

A one-time infusion of onasemnogene abeparvovec-xioi (Zolgensma, AveXis, a Novartis company) for children younger than 2 years costs more than $2 million, Medscape Medical News reported, making it the world's most expensive drug.

However, 3 months after approving the drug, the FDA has accused the manufacturer of manipulating data and is investigating.

Approval of esketamine nasal spray for treatment-resistant depression was found to be most exciting by 18.2% of respondents.

Frustrations Ran High

Several topics frustrated physicians this year, and just more than half (51.5%) put the measles outbreak at the top.

Next was the Medicare for All debate (41.4% ranked it most frustrating), followed by vaping-related lung disease injury and deaths (37.1%).

Ranked fourth (31.9%) were recalls of the popular generic and branded heartburn drug Zantac because of contamination with a carcinogen.

Generic Zantac was recalled in September and branded Zantac was taken off the market in October in the United States and Canada.

Opioid Fraud Was the Top Shocker

Almost half (47.0%) of physicians who responded to the survey said the most shocking subject of the year was the dozens of doctors in seven states (West Virginia, Tennessee, Ohio, Alabama, Kentucky, Louisiana, and Pennsylvania) charged in an opioid fraud bust.

According to the story, as reported by Medscape Medical News, "60 people, including 31 doctors, were accused of illegally prescribing opioid drugs in exchange for cash and sexual favors."

Several physicians were accused of prewriting prescriptions for controlled substances without examining the patients who received them.

Fraud was also at the root of the second most-shocking development when multiple hospitals closed this year in the wake of multistate fraud allegations (44.0% of physicians said it was the most shocking story).

As reported in that Kaiser Health News story, entrepreneur Jorge Perez, who, along with his Miami-based management company EmpowerHMS, oversaw 18 rural hospitals across eight states, allegedly involved the hospitals in a scheme around falsified lab fees.

Health insurance and government agencies began to ask questions including, "How could Unionville, Missouri — a town of 1790 — generate $92 million in hospital lab fees for blood and urine samples in just 6 months?" And, "Why had lab billings at a 25-bed hospital in Plymouth, North Carolina, nearly tripled to $32 million in the year after Perez's company took control?"

Insurers started filing lawsuits and stopped reimbursements, and 12 hospitals entered bankruptcy and eight closed, devastating communities.

The story highlighted legal gaps in the fragmented US health system, as noted in the story.

"How companies run by this Miami businessman and his associates were able to drive so many hospitals into the ground so quickly, devastating their communities, is a story about the fragility of healthcare in rural America and the types of money-making ventures that have flourished in legal gray areas of America's complicated medical system," the reporter wrote.

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