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Thursday, October 29, 2015
Wednesday, October 28, 2015
Premiums for Health Insurance Bought on Exchanges to Climb in 2016 - WSJ
Consumer Power Report #479:
More than 500,000 Could Lose
Obamacare Subsidies
Premiums for Health Insurance Bought on Exchanges to Climb in 2016 - WSJ
Tuesday, October 27, 2015
Costs for Dementia Care Far Exceeding Other Diseases, Study Finds - The New York Times
Three diseases, leading killers of Americans, often involve long periods of decline before death. Two of them — heart disease and cancer — usually require expensive drugs, surgeries and hospitalizations. The third, dementia, has no effective treatments to slow its course.
So when a group of researchers asked which of these diseases involved the greatest health care costs in the last five years of life, the answer they found might seem surprising. The most expensive, by far, was dementia.
The study looked at patients on Medicare. The average total cost of care for a person with dementia over those five years was $287,038. For a patient who died of heart disease it was $175,136. For a cancer patient it was $173,383. Medicare paid almost the same amount for patients with each of those diseases — close to $100,000 — but dementia patients had many more expenses that were not covered.
On average, the out-of-pocket cost for a patient with dementia was $61,522 — more than 80 percent higher than the cost for someone with heart disease or cancer. The reason is that dementia patients need caregivers to watch them, help with basic activities like eating, dressing and bathing, and provide constant supervision to make sure they do not wander off or harm themselves. None of those costs were covered by Medicare.
For many families, the cost of caring for a dementia patient often “consumed almost their entire household wealth,” said Dr. Amy S. Kelley, a geriatrician at Icahn School of Medicine at Mt. Sinai in New York and the lead author of the paper published on Monday in the Annals of Internal Medicine.
“It’s stunning that people who start out with the least end up with even less,” said Dr. Kenneth Covinsky, a geriatrician at the University of California in San Francisco. “It’s scary. And they haven’t even counted some of the costs, like the daughter who gave up time from work and is losing part of her retirement and her children’s college fund.”
Dr. Diane E. Meier, a professor of geriatrics and palliative care at Mount Sinai Hospital, said most families are unprepared for the financial burden of dementia, assuming Medicare will pick up most costs.
“What patients and their families don’t realize is that they are on their own,” Dr. Meier said.
Everything gets complicated when a person has dementia, noted Dr. Christine K. Cassel, a geriatrician and chief executive of the National Quality Forum.
She described a familiar situation: If a dementia patient in a nursing home gets a fever, the staff members say, “I can’t handle it” and call 911, she said. The patient lands in the hospital. There, patients with dementia tend to have complications — they get delirious and confused, fall out of bed and break a bone, or they choke on their food. Medical costs soar.
Costs for Dementia Care Far Exceeding Other Diseases, Study Finds - The New York Times
Behavioral Medicine in your Community
If you are interested in improving care for homeless individuals or reducing the number of incarcerated people, watch these outstanding presentations
Assisted Outpatient Treatment: The Nevada County Experience from Treatment Advocacy Center on Vimeo.
How can you help in making this a reality ?
Assisted Outpatient Treatment: The Nevada County Experience from Treatment Advocacy Center on Vimeo.
How can you help in making this a reality ?
Monday, October 26, 2015
Friday, October 23, 2015
Judge Bars DOJ From Interfering With Calif. Medical Marijuana Laws - California Healthline
On Monday, a federal court in California ruled that federal authorities cannot close medical marijuana dispensaries that operate within the boundaries of state law, Time reports (White, Time, 10/20).
Details of Case
At issue in the case was the Drug Enforcement Administration's interpretation of the Rohrabacher-Farr amendment to last year's federal government spending bill.
Under the amendment, which lists the states with medical marijuana laws, the Department of Justice cannot use federal funds to stop such states from implementing their own laws to "authorize the use, distribution, possession or cultivation of medical marijuana" (Ingraham, "Wonkblog,"Washington Post, 10/20). However, DOJ interpreted the amendment to mean they were only barred from taking action against the state, not medical marijuana-related businesses and individuals who deal with the implementation of such laws, according to a leaked memo.
According to Time, DEA's enforcement resulted in the closure of many California dispensaries.
Details of Ruling
In his decision, U.S. District Judge Charles Breyer ruled that DOJ cannot use federal money to interfere with state medical marijuana laws and practices (Time, 10/20).
Breyer said the federal government's interpretation of the amendment "defies language and logic" and was "at odds with fundamental notions of the rule of law."
The decision could affect DEA's ability to prosecute future federal medical marijuana cases ("Wonkblog," Washington Post, 10/20).
Judge Bars DOJ From Interfering With Calif. Medical Marijuana Laws - California Healthline
Thursday, October 22, 2015
Fear itself | The Economist
PTSD A term which has become common amongst military and veterans returning from Middle East assignment and former Vietnames and Korean War Veterans.
PTSD, originally recognized during and after WWII as 'battle fatigue" It labels a constellation of signs and symptoms which have been studied with modern neuroscience.
Fear itself | The Economist
A mental illness caused by trauma may be one of the first to be understood in physical terms
PTSD, originally recognized during and after WWII as 'battle fatigue" It labels a constellation of signs and symptoms which have been studied with modern neuroscience.
Accounts of debilitating fear after trauma date back to the Trojan wars. In the 19th century survivors of train crashes were diagnosed with “railway spine” because doctors thought their hysteria was caused by compression of the backbone. In the first world war it was known as shell shock, soldier’s heart or battle fatigue. Not until soldiers returned from the Vietnam war with the same symptoms of hyper-vigilance, flashbacks and nightmares was the disorder truly taken seriously. In 1980 an umbrella term was coined: post-traumatic stress disorder (PTSD).
Attitudes are now quite different from those that prevailed during the second world war, when George Patton, an American general, threatened to court-martial men with battle fatigue. And research is progressing swiftly. A remarkable amount has been discovered about the causes of PTSD and how to treat it—which is welcome, because another discovery is how common it is.
According to Charles Marmar, a psychiatrist at New York University’s medical centre, it may be the first psychiatric disorder “where we crack the mind-brain connections”.
Neural research is helping to reveal how people get stuck in a state of fear. The amygdalae, a pair of almond-sized regions deep in the brain, are the main orchestrators of fear, reading incoming signals such as smells and sounds and sending messages to other bits of the brain, which filter the signals before reacting. In someone with PTSD the filters struggle to distinguish between real threats and those that can safely be ignored.
The brain of a healthy person given cause to panic will tell the body to activate various reactions, including releasing adrenalin. A person’s heart rate will increase and they will have a strong urge to fight or flee. Once back to safety, symptoms subside and all that remains is a bad memory. A woman assaulted in a noisy bar may react fearfully to the sound of clinking glasses for a few weeks, but over time, in what is called “fear extinction”, the positive association of celebrating with friends will outweigh negative ones. The more often people receive such reminders without suffering a disaster, the more likely the fear is to dissipate—which is why it is important not to hide away after a trauma.
Retraining the brain
When this mechanism fails, the result is PTSD. A soldier returning from war may continue to freeze and have debilitating flashbacks when anything reminds him of combat. One ex-soldier tells of “freaking out” every time his wife baked: it turned out that the smell of almonds evoked Semtex, an explosive. People who were abused as children may suffer when it is dark, because such abuse often happens at night.
Studies of twins suggest that susceptibility to PTSD is about 30% genetic. Researchers in the new field of epigenetics—the study of how external factors influence the way the instructions written in genes are expressed in organisms—have produced some evidence to suggest that stress might be passed on to offspring.
An exciting recent development is the discovery of markers that show differences between the brains, genes and even blood of people with and without PTSD. When a sufferer sees a picture of a frightened face, the amygdala shows a heightened response. At the same time the prefrontal cortex, which regulates fear, is suppressed. Researchers are hot on the trail of chemicals that could indicate PTSD in a blood test, says Kerry Ressler, a molecular scientist and psychiatrist at McLean Hospital of Harvard Medical School.
Treatments mostly aim to retrain the brain’s fear response. Many patients are given cognitive therapy, which teaches them to think differently about what happened and trains them to cope with triggers. Debra Kaysen of the University of Washington says severe symptoms recede in about four out of five patients following a dozen or so sessions. Other patients are given exposure therapy, in which they are confronted with the feared stimuli. Adults may be asked to describe a traumatic event in excruciating detail until it loses its potency; young children might play out what happened with toys. Virtual-reality simulations have been used on soldiers. One therapist compares the work to treating a burn victim: layer after layer.
Amit Etkin and colleagues at Stanford University are studying how the brain circuits that control fear can be tweaked with the aid of SSRIs (a class of drugs, some of which are used to treat depression or anxiety) and transcranial magnetic stimulation, in which an electromagnet held close to the scalp transmits magnetic pulses to the brain. They found that stimulating a part of the frontal lobe can reduce activity in the amygdalae, which could lessen the symptoms of PTSD. Within five years, thinks Dr Etkin, new therapies will be available, including applying brain stimulation or using drugs to enhance the effects of talk therapy. Better treatments for other anxiety disorders, which afflict a third of Americans, could follow.
Even if new treatments for PTSD take longer to develop than hoped, acceptance of PTSD’s inherently physical nature could encourage sufferers to seek help earlier. Rape victims in Dr Kaysen’s practice typically waited 20 years before turning to her; Dr Marmar has treated veterans of the second world war who had tried to cope with their nightmares for as long as 40 years.
In a freezer in Boston are 50 samples of brain tissue donated to the world’s first brain bank dedicated to the study of PTSD, set up by the Department of Veterans Affairs. More veterans and civilians, with and without the disorder, are filling in health questionnaires and pledging to donate brain tissue after death. Those who could not be healed themselves might help arm future generations against the same suffering, or perhaps, one day, help prevent it altogether.
Fear itself | The Economist
23andMe Launches New Health Tests, Navigates FDA Regulations - iHealthBeat
Consumer driven genomic testing joins consumer driven laboratory testing.
Both promise to reduce health care costs. But, will established laboratories oppose these efforts. The disruption will be massive. The key issue is FDA approval and reliability of results.
The development pipeline may be altererd forever.
Elizabeth Holmes, CEO and owner of Theranos states that publishing basic research in peer reviewed journals takes too much time and expensive delays. She prefers subitting to the FDA directly. But does the FDA have the manpower to establish reliability and repeatability of that data ?
Background on 23andMe
23andMe Launches New Health Tests, Navigates FDA Regulations - iHealthBeat
Both promise to reduce health care costs. But, will established laboratories oppose these efforts. The disruption will be massive. The key issue is FDA approval and reliability of results.
The development pipeline may be altererd forever.
Elizabeth Holmes, CEO and owner of Theranos states that publishing basic research in peer reviewed journals takes too much time and expensive delays. She prefers subitting to the FDA directly. But does the FDA have the manpower to establish reliability and repeatability of that data ?
Background on 23andMe
On Wednesday, genetic testing company 23andMe announced that it will provide customers with health information again, but in a more limited capacity because of continuing regulatory involvement from FDA, the New York Times reports.
23andMe Co-Founder and CEO Anne Wojcicki launched the company with investments from her then-husband Google Co-Founder Sergey Brin (Pollack,New York Times, 10/21). 23andMe launched its first genetic test, the Personal Genome Service, in 2007 (Humer/Steenhuysen, Reuters, 10/21). The company said its original $99 test could predict a likelihood of developing conditions such as:
However, FDA in 2013 ordered 23andMe to halt sales of the service because the tests had not received FDA approval (Reuters, 10/21). Since then, the company has used the genetic data it collected to fuel drug research and has focused on analyzing family history and ancestry, which is not FDA-regulated. More than one million people have used 23andMe's saliva-based test to learn about their genetic code (AP/Sacramento Bee, 10/21).
Details of 23andMe's New Testing Service
About eight months ago, FDA approved 23andMe's carrier screening test for Bloom Syndrome, a disorder that causes short stature and a predisposition to cancer. FDA then reclassified such carrier screening tests as Class II medical devices, meaning they no longer require premarket approval, which involves clinical trials.
On Wednesday, 23andMe debuted a new $199 carrier screening test that can predict whether a person will pass on one of 36 conditions to a child, including:
In addition, the test can predict non-medical traits, including:
In addition, 23andMe still is working toward gaining FDA approval for personal tests predicting an individual's likelihood of developing specific diseases and how that individual might respond to specific drugs
23andMe Launches New Health Tests, Navigates FDA Regulations - iHealthBeat
Friday, October 16, 2015
Theranos, one of the hottest new biotech startups, has a huge credibility problem - Vox
The Wall Street Journal and VOX Updated by Julia Belluz
According to Theranos founder Elizabeth Holmes, her technology amounts to nothing less than a health-care revolution: a disruptive and lifesaving innovation that delivers cheaper, earlier, and less painful results.
According to Theranos founder Elizabeth Holmes, her technology amounts to nothing less than a health-care revolution: a disruptive and lifesaving innovation that delivers cheaper, earlier, and less painful results.
But Theranos, and Holmes, has also been surrounded by a dark cloud of suspicion. Critics have asked for proof that the company's technology actually works, and that its results are accurate. Holmes — the world's youngest self-made woman billionaire at 31 — and her PR team have mainly responded by citing intellectual property concerns and suggesting that the seeds of doubt have been sown by incumbent laboratory companies such as Quest and Laboratory Corporation.
Elizabeth Holmes talks with Matthew Herper at the
2015 Forbes Under 30 Summit. (Image: Glenn Davis)
Some are questioning the accuracy and reliability of the results of their testing. Theranos offer a menu of tests, however only one test, HIV, has been approved by the FDA. And there have been some 'insider' employees who question the accuracy of the "Edison machine". These claims are refuted by it's founder, Elizabeth Holmes in a one thousand page rebuttal presented those claims to investigative reporter Matthew Herper of Forbes magazine
In a series of tweets Elizabeth Holmes also counters Mr Herper's report.
There were other bizarre revelations in the Journal piece. Some parts of the Theranos website, which carried claims Carreyrou was probing, disappeared during his investigation. One former employee, Dr. Ian Gibbons, killed himself, and after the reporter spoke to his widow, "a lawyer representing Theranos sent her a letter threatening to sue her if she continued to make 'false statements' about Ms. Holmes and disclose confidential information."
The story goes on like this: Theranos repeatedly swings back at the Journal, even sending representatives to the homes of some of Carreyrou's sources to ask them to sign statements saying the newspaper "mischaracterized their comments."
Unsurprisingly, almost as soon as the story went up, the company published a statement denying many of the facts in the piece: Theranos' website elaborated their rebuttal statements.
Elizabeth Homes states;
“We’re under real attack from the lab industry which is seeding all sorts of stuff about us into the press,” Holmes told me, as you can see in the video above. Wait, I said to her. A lot of the people with questions Theranos are good, thoughtful people who are not in anybody’s pocket. She doubled down: “To be clear, the commentary in the press is 100% instigated by the lab industry and it showed up in the press about us last year and it’s just been repeated. What I would say is that we’re the only laboratory company that is really focused on transparency.”
According to Wikipedia, Elizabeth Holmes excelled early in life and later at Stanford University, where her original idea was developed.
Holmes proposed establishing a company to Professor Robertson in the fall of 2003, while she was a 19-year-old sophomore at Stanford. She used money that her parents had saved for her education to establish Real-Time Cures in Palo Alto. Later, she changed the company's name to Theranos (an amalgam of "therapy" and "diagnosis"),[9] because she believed that many people had a cynical reaction to the word "cure."[6] Holmes initially worked out of a basement of a group college house.[3] She dropped out a semester later to pursue her business career full-time. Professor Robertson served as a director of the company.
The company grew gradually over the next decade, raising $400 million from Draper Fisher Jurvetson, Larry Ellison, and others. Theranos operated in "stealth mode" during this period, remaining highly secretive to avoid potential competitors and investors who could fund a competitor. The company took three former employees to court in 2007, accusing them of misappropriating trade secrets.[12]
By 2014 the company offered 200 tests and was licensed to run in every state of the US.[6] It had 500 employees and was valued at more than $9 billion. Holmes retained control of more than 50% of the company's equity.[13]
As of 2014 Holmes has 18 US patents and 66 non-US patents in her name and is listed as a co-inventor on over one hundred patent applications.[6] Holmes is the youngest self-made female billionaire on the Forbes 400 list at #111, with an estimated net worth of $4.6 billion.[2]
Arguments that dominant laboratory companies such as Quest and Labcorp have much to lose if Holmes innovative testing proves reliable and accurate. She argues they are behind much of the controversy.
Elizabeth Holmes idea is to allow patients to order their own laborataory blood tests, walking into a Walgreens and ordering the test for themselves.
One other component for success will be if health plans will reimburse for a Theranos test ordered by a patient or a physician. Bloomberg reports a Theranos-- Capital Blue Cross agreement for reimbursements.
Theranos may be a disruptive technology for the clinical laboratory world. It's progress will be measured ultimately by individual decisions regarding specific test by FDA and/or CLIA wavers. Ultimately consumer acceptance as well as physician endorsement will predict success or failure for Holmes.
Health Train Express supports her efforts despite doubts by her competitors and others. Large and established companies have much to lose and/or learn from her creative efforts.
Theranos, one of the hottest new biotech startups, has a huge credibility problem - Vox
Thursday, October 15, 2015
This study is forcing economists to rethink high-deductible health insurance - Vox
Americans aren't used to shopping for health care — and maybe we don't want to start
In 2006, about one in 10 employees had a health insurance deductible over $1,000. Today? About half do.
To health economists, this sounded like good news; they've long theorized that higher deductibles would force down health-care costs. The idea was that higher deductibles would make patients become smarter shoppers: If they had to pay more of the cost, they'd likely choose something closer to the $1,529 appendectomy than the $186,955 appendectomy (yes, some hospitals really do charge that much). This would push the really expensive doctors to lower their prices so cheaper physicians didn't steal their business.
This was, however, just a theory. And a massive new study suggests it might have been all wrong.
Economists Zarek Brot-Goldberg, Amitabh Chandra, Benjamin Handel, and Jonathan Kolstad studied a firm that, in 2013, shifted tens of thousands of workers into high-deductible insurance plans. This was a perfect moment to look at how their patterns of care changed — whether they did, in fact, use the new shopping tools their employer gave them to compare prices.
Turns out they didn't. The new paper shows that when faced with a higher deductible, patients did not price shop for a better deal. Instead, both healthy and sick patients simply used way less health care.
"I am a little bit surprised at just how poorly patients were able to do when looking at very similar products, like MRI scans, and with a shopping tool," says Kolstad, an economist at University of California Berkeley and one of the study's co-author. "Two years in, and there's still no evidence they're price shopping."
This raises a scary possibility: Perhaps higher deductibles don't lead to smarter shoppers but rather, in the long run, sicker patients.
This study is forcing economists to rethink high-deductible health insurance - Vox
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