Viewpoints: When a doctor should keep quiet; 2 views of hospital pricing; Stem cell 'snake oil'

May 17 2013

Los Angeles Times: For A Dying Patient, A Prescription Of Silence
In medical school, we were taught not to withhold information from our patients or to be "paternal" in making decisions for them. We internalized the idea that fully informed patients are better equipped to make treatment decisions. And with patients likely to die of their diseases, discussing the prognosis frankly would allow them to say goodbyes, get things in order and prepare advanced directives for what kind of interventions they did and didn't want. But Pedro's wife was adamant. "He will lose his will to live if he knows he has cancer. And he will then die even sooner" (Susan Partovi, 5/16).

USA Today: Hospital Pricing Gouges Patients: Our View
Shouldn't you be able to see the price of something before you buy it, so you can shop for value or simply figure out whether you can afford it? Before you roll your eyes and say, "Of course," think about the last time you bought medical care, especially in a hospital. See any price lists on the wall? Probably not. And, if you had, you might have fainted on the spot (5/15).

USA Today: Hospital Billing Too Complex: Another View
Many parts of America's health care delivery and financing systems urgently need updating, and the matter of "charges" ranks high on the list. Today's hospital bill is a symptom of a broken payment system. Hospitals deal with more than 1,300 insurers, each having different plans with multiple requirements for hospital bills. Decades of federal regulations have made a complex billing system even more complex and frustrating for everyone involved (Rich Umbdenstock, 5/15).

USA Today: Beware Of Stem Cell Therapy Claims
A stem cell transplant can help cure patients with acute myeloid leukemia, and research has shown incredible potential, from growing teeth to mending "unhealable" bone fractures. Still, stem cells are poorly understood. Despite this, as (Ferris) Jabr writes, many cosmeticians continue to claim that stem cells are a cure-all for "everything from wrinkles to joint pain to autism." Until we understand them better, stem cells are the new snake oil peddled by 21st century charlatans. Thankfully, the Food and Drug Administration is cracking down (Alex Berezow, 5/15).

JAMA: Accountable Care Organizations: Accountable For What?
Dr Robert Potenza and Dominica Potenza, partners in life and in work, are, respectively, a cardiologist and a registered nurse who have a cardiology/internal medicine practice in the Bronx. … In theory, continuity of care should be improving at Montefiore, one of 32 Pioneer Accountable Care Organizations (ACOs) that aim to become models for improving population health while lowering costs. Montefiore has been acquiring physicians' practices to expand its primary care capacity, but the Potenzas are reluctant to join, fearing they'll lose what control they have over the personalized care they give their patients (Diana Mason, 5/15). 

Columbus Dispatch: Expanding Medicaid Would Help In Fight Against Breast Cancer
As a seven-year breast-cancer survivor, I know how important annual screening can be. I was diagnosed with Stage IIa breast cancer on a routine mammogram. ... I was lucky and had very adequate health insurance, yet my personal cost remained over $6,000. While expanding Medicaid in Ohio would seem counterintuitive as a cost-saving measure, we must sometimes view Medicaid dollars spent as a long-term investment in Ohio and enable Ohioans to realize the savings. Screening to capture cancer at the earliest possible stage reduces the costs of treatment and improves mortality (Tammy Weis, 5/16).

Bloomberg: U.S. Must Fight Harder Against TB
While USAID's TB budget is being slashed, public-health spending on tuberculosis in the U.S. is also being cut. On top of belt tightening from sequestration, the administration of Barack Obama has been pillaging money from the U.S. Department of Health and Human Services' Prevention and Public Health Fund, which goes to efforts such as immunizations, health screenings and smoking prevention. ... Almost all TB specialists in the U.S. work in public clinics and hospitals. Many patients, being either uninsured or underinsured, have nowhere else to go for their treatment. Even after the Affordable Care Act is fully in place, public TB clinics will remain important safety nets for undocumented immigrants and legal immigrants who don't yet qualify for public services. It's safe to assume that cuts in public health funding will have the same effect we saw in the early 1990s after earlier reductions: Many patients will be inadequately treated, allowing greater transmission of TB and the emergence of multidrug-resistant strains (Celine Gounder, 5/15).

Tampa Bay Times: Fight On Prescription Drug Abuse Not Over
Once local law enforcement and the Florida Legislature finally committed to addressing prescription drug abuse, it made a difference. The welcome news that prescription drug deaths in the Tampa Bay area are down 30 percent since 2010 is surely a result of a focus on unscrupulous pain clinics and easy access to pills. But there is more work to be done, and boosting the state's still-tepid commitment to a prescription drug database is the place to start (5/14).

New England Journal Of Medicine: The Role Of The NIH In Nurturing Clinician-Scientists
The awarding of the 2012 Nobel Prize in Chemistry to Robert Lefkowitz and Brian Kobilka, both M.D.s trained in cardiology, for their work on characterizing the structure and function of beta-adrenergic receptors, should remind us of the critical role that clinician-scientists have played in formulating the seminal concepts that govern modern biomedical science. Much has been written since the 1970s about the demise of the physician-scientist -- as evidenced by the declining share of RO1 grants that the National Institutes of Health (NIH) awards to physicians -- and the economic factors that have driven physicians away from the laboratory and research clinic into more remunerative clinical practice (Dr. Michael Gottesman, 5/15).