Longer looks: the economics of infertility; placebos as treatment raises ethical dilemmas

Jul 25 2014

Every week KHN reporter Marissa Evans finds interesting reads from around the Web.

Vox: States That Deny Anti-Psychotics To The Poor Have Lots Of Mentally Ill People Behind Bars
About a decade ago, Medicaid programs were struggling to keep up with skyrocketing prescription drug costs. Between 1997 and 2002, drug spending in the program for low-income Americans grew by about 20 percent annually. ... Medicaid directors began looking for ways to tamp down on those costs. One of the most popular policies was something called "prior authorization" for a new wave of more expensive, anti-psychotic drugs ,... These policies, in a sense, worked: they helped rein in how much Medicaid spent filling prescriptions. But in another sense, they may not have worked at all: a growing body of research has begun questioning whether restricting drug spending may have just shifted costs elsewhere -; particularly, into the prison system (Sarah Kliff, 7/22). 

The Washington Post: They Want A Baby. The Economy Won't Play Along.
The languishing economy has caused people to doubt if they can afford to be parents. The barriers are even higher for Melissa and Rick [Myrick], among the 6 percent of U.S. married couples facing infertility. Living in Missouri, one of 35 states that doesn't mandate insurance coverage for infertility, they are on the hook for related doctor's visits or drugs. They face a huge upfront price tag -; a cost that can't be pushed down the road, when their economic outlook might be brighter. That's frustrating to them. "Why should the economy play into my family planning?" Melissa asks (Todd C. Frankel, 7/21). 

The Pacific Standard: People Are Clueless About Placebos
Most people have a basic understanding of placebos and why they're necessary in scientific experiments. However, placebos are also viable options for treating patients in clinical settings. ... Despite their healing effects, the premise of prescribing placebos is ethically ambiguous. In some cases (but not all), patients can't know that they're taking a dummy drug, otherwise the placebo will have no effect. This deception means that both doctors and patients can feel uncomfortable with the idea of placebos as medical treatment (Bettina Chang, 7/21). 

The New York Times: Is Truvada, The Pill To Prevent H.I.V., 99 Percent Effective? Don't Be So Sure
Truvada, the once-a-day pill to help keep people from contracting H.I.V., is on the cover of this week's New York magazine, and Tim Murphy's cover story focuses on how the pill is changing sex by drastically reducing gay men's fear of infection. It's not hard to see why: Mr. Murphy writes, "When taken every day, it's been shown in a major study to be up to 99 percent effective." This is a claim I hear thrown around a lot among gay men in New York. And it's wrong. The 99 percent figure isn't a study finding; it's a statistical estimate, based on a number of assumptions that are reasonable, but debatable (Josh Barro, 7/16).

New York Magazine: Sex Without Fear
This summer-;on social media, on Fire Island, at the Christopher Street pier, and in certain cohorts around the ¬country-;what many gay men are talking about among themselves is Truvada. And what's surprising them is how fraught the conversation can be. For some, like Jacobs, the advent of this drug is nothing short of miraculous, freeing bodies and minds. For doctors, public-health officials, and politicians, it is a highly promising tool for stopping the spread of HIV. But for others, a drug that can alleviate so much anxiety around sex is itself a source of concern. They worry that Truvada will invite men to have as much condom¬less sex as they want, which could lead to a rise in diseases like syphilis. Or they fret that not everyone will take it as religiously as they ought to, reducing its effectiveness and maybe even creating resistance to the drug if those users later become HIV-positive and need it for treatment (Tim Murphy, 7/13). 

The Boston Globe: Honoring A Once-Scorned Voice For Medical Openness
Dr. Ernest Amory Codman was in his mid-40s when his golden career as a sought-after Harvard surgeon began to unravel. He had quit in exasperation from Massachusetts General Hospital, and when he took his dispute with hospital leaders public, colleagues turned against him. Many stopped sending him patients. It was the early 1900s, and Codman was impatiently pushing hospitals and doctors to adopt a practice many considered heretical at the time: Record the "end results'" for every patient -; including harm caused by physicians' errors -; and make them public. A century later, many of Codman's ideas are the bedrock of modern medicine (Liz Kowalczyk, 7/21).

NPR: A YouTube Video Is Doctor's Secret Weapon Against Back Pain
In my patient's case, I was confident that her back pain wasn't serious. A minor injury was the clear cause. And nearly all back pain like hers from a simple mechanical strain gets better on its own. I wanted to reassure her. I told her to go about her daily life. Keep exercising, but try to take it just a little bit easy until she felt better. At a minimum, I said, she should be walking 30 minutes a day. Also, try some ibuprofen, which helps with inflammation and doesn't require a prescription. But she wasn't buying it (Dr. John Henning Schumann, 7/20).