Health care

Beverly Merz

Precision medicine is coming, but not anytime soon

Beverly Merz, Executive Editor, Harvard Women's Health Watch

President Obama’s announcement of a Precision Medicine Initiative was one of the few items in this year’s State of the Union address to garner bipartisan support. And for good reason. Precision medicine, also known as personalized medicine, offers the promise of health care based on your unique DNA profile and the profiles of a million other individuals. Getting to precision care will require new diagnostic tests. It will also need a new regulatory framework to make sure that technologies aren’t launched before they’ve been proven to be safe and effective, according to a Perspective article in The New England Journal of Medicine. It may take a few years to design this new vetting system and put it in place. In other words, precision medicine is on the horizon, but it isn’t around the corner.

Will the Supreme Court send Obamacare into a death spiral?

Gregory Curfman, MD, Editor in Chief, Harvard Health Publications

The Supreme Court heard arguments this morning in a case that could threaten the viability of the Affordable Care Act, President Obama’s signature health care law. The law, also known as Obamacare, survived a previous Supreme Court challenge in 2012. But this new case, called King vs. Burwell, has many people worried, and rightfully so. At issue in the case are the financial subsidies provided to millions of Americans to buy health insurance through the insurance marketplaces, called exchanges. Without these subsidies, many people of lower income would not be able to afford coverage. Stopping these subsidies would put a big dent in the “affordable” part of the law’s name. The plaintiffs argue that the Affordable Care Act allows for subsidies to be provided when insurance is purchased on exchanges “established by the State” (there are 17 of these), but not on the exchange established by the federal government for the other states. The outcome of the case may hinge on how the justices interpret those four words in the health law.

Howard LeWine, M.D.

Better use of medicines could save billions

Howard LeWine, M.D., Chief Medical Editor
Internet Publishing, Harvard Health Publications

Wiser use of prescription medications by everyone—doctors and their patients—could save the U.S. health care system more than $200 billion a year. That’s the conclusion of a new report, Avoidable Costs in U.S. Healthcare, from the IMS Institute for Healthcare Informatics. Inefficient or ineffective use of medications lead to six million hospitalizations, four million trips to the emergency room and 78 million visits to doctors and other care providers each year, according to the report. Those are huge numbers. Although $213 billion represents less than 8% of what Americans spend on health care each year, it’s still a staggering sum. It also exacts human costs that aren’t reflected in the estimates. The report identifies 6 things that can be improved to address the problem: 1) not taking medications as directed, 2) taking too many medications, 3) delayed treatment, 4) overuse of antibiotics, 5) medication errors, and 6) underuse of generic medications.

Daniel DeNoon

Cities can learn lessons about diabetes from rural areas

Daniel DeNoon, Executive Editor, Harvard Heart Letter

City dwellers often think of rural America as a throwback to past “good old days.” But when it comes to obesity and diabetes, people living outside urban areas offer a frightening glimpse of the future. While more than 8% of Americans now have diabetes, in some rural counties 20% of the residents have diabetes. Those counties also tend to have high rates of obesity. Barriers to healthy living contribute to both obesity and diabetes. So does lack of primary care physicians. One answer may be greater reliance on community health workers—lay people trained to provide diabetes education and outreach. In Birmingham, Alabama, the Cities for Life program has doctors refer people with diabetes to “patient navigators” who help them find local resources such as nearby exercise classes or mobile farmers’ markets.

Patrick J. Skerrett

Ask questions to get the most out of a health care visit

Patrick J. Skerrett, Executive Editor, Harvard Health

During visits with your doctors or other health care providers, do you speak up and ask questions? If the answer is “yes,” congratulations. You’ve taken an important step to getting the most out of your health care visits. You’re also in the minority. Most people have trouble asking their doctors questions. It can be even harder to disagree with your doctor, or make known your preferences for care and even your worries. There are many reasons for poor patient-doctor communication. One is what Timothy J. Judson and colleagues call the asymmetry of power. Medical lingo is another key barrier. The federal Agency for Healthcare Research and Quality’s “Questions to Ask Your Doctor” campaign and the Joint Commission’s “Speak Up Initiatives” offer free information to help people ask the sometimes difficult questions needed for good health care.

Howard LeWine, M.D.

Base shared decision making on good information, personal preferences

Howard LeWine, M.D., Chief Medical Editor
Internet Publishing, Harvard Health Publications

We are taught to share at an early age, and sharing is encouraged and praised across the life span. One area in which there has been a lack of sharing is medicine. Doctors have traditionally made decisions for their patients with little or no discussion about the preferences of the person who will ultimately have to live with the decision. That’s changing. More and more, doctors are trying to implement a model known as shared decision making or informed decision making. These terms refer to a process that includes a thoughtful, informed conversation between you and your doctor aimed at making a decision that’s right for you. Shared decision making is gaining acceptance as a medical “best practice.” Many studies suggest that it improves health outcomes, taking medications as directed and following other instructions, and satisfaction with a treatment or course of action.

Stephanie Watson

More Americans using retail health clinics

As wait times to see a doctor for simple problems like sinusitis and urinary tract infection lengthen, more and more Americans are turning to retail health clinics—walk-in medical facilities located in pharmacies, grocery stores, and retailers such as Wal-Mart and Target. The number of visits to such clinics quadrupled from 1.48 million in 2007 to 5.97 million in 2009, according to a study published in the journal Health Affairs, and topped 10 million last year. Convenience is driving this migration to retail health clinics, since you can walk into a retail health clinic without an appointment, and many are open nights and weekends. Although most retail clinics focus on immunizations and common ailments such as strep throat and sinus infections, some are beginning to manage chronic conditions such as high blood pressure, diabetes, high cholesterol, and asthma.

Patrick J. Skerrett

New public database shows hospital billing charges all over the map

Patrick J. Skerrett, Executive Editor, Harvard Health

Most reputable companies that provide services tell you what you’ll get for your money. Hospitals are an exception. They haven’t traditionally made public the cost of operations and other procedures. This secrecy has let hospitals set widely different prices for the same procedure. It’s also made it impossible to do any comparison shopping. Yesterday’s release to the public of a once very private database shows just how big the differences can be from hospital to hospital. The database, released by the Centers for Medicare and Medicaid Services, details what 3,300 hospitals charged for the 100 most common treatments and procedures in 2011. It data reinforce the big differences in charges from one part of the U.S. to another. What’s new and surprising are the huge differences sometimes seen between hospitals in the same city, or even the same neighborhood.

Mary Pickett, M.D.

Few plan for long-term care though most will need it

Mary Pickett, M.D., Faculty Editor, Harvard Health Publications

Two of every three Americans who reach age 65 will at some point need long-term care for up to three years. Yet the majority of those age 40 and older have done “little or no planning” for how they might pay for long-term care when they get older. That’s a key finding from a new survey of 1,019 Americans over age 40 on the topic of long-term care. The survey was done by the Associated Press and NORC at the University of Chicago. Most people underestimate the cost of nursing home care (it averages $6,700 a month) and overestimate what Medicare will cover. And few people are setting aside money for long-term care even as most worry about key issues of aging such as memory loss or being a burden to family members. Without a crystal ball, it’s tricky to plan for the future. It’s easy to convince yourself that you or a partner won’t need long-term care. But the statistics suggest you should start planning now, even if your plan isn’t perfect.

Patrick J. Skerrett

Panel cites top 10 strategies for improving patient safety

Patrick J. Skerrett, Executive Editor, Harvard Health

The toll taken by medical mistakes burst into public attention with a 1999 report called To Err Is Human from the U.S. Institute of Medicine. The report estimated that between 44,000 and 98,000 people die each year as a result of preventable medical errors. Such errors can be headline grabbers, like the death of Boston Globe columnist Betsy Lehman from an overdose during chemotherapy. The safety of hospital stays and encounters with health-care providers got a boost today with the publication of 22 evidence-based “patient safety strategies.” Although most focus on care that takes place in hospitals, they extend to almost all interactions between individuals and their doctors, nurses, and other care providers. Very few of the safety practices are expensive, high-tech interventions. Instead, they are almost old-fashioned efforts that aim to improve communication between health-care providers and their patients, and to improve the practice of medicine rather than the art of medicine. The theme of all of these interventions is to create systems that help caregivers follow every step that is known to improve patient care, and to avoid relying on fallible human memory. To err may be human, but it is also often preventable.