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from my Newsblur RSS feeds and Twitter, mostly
Clinical Implications of SPRINT
“…benefits of a lower blood pressure target in high-risk nondiabetic people do not outweigh harms.”Most of the editorials and commentaries about the SPRINT trial have given it a positive spin and recommended that target BPs should be lower as a result of this trial. These commentaries have ignored the finding that individuals experiencing at least one serious adverse event were numerically increased in the low BP target group. ¶ [98] Does SPRINT change our approach to blood pressure targets? | Therapeutics Initiative Ronald H Estey, www.ti.ubc.ca
Ray Collinsyesterday
Golden State Warriors Coaching Staff Takes Uber Driver for a Ride
In early January, Kerr took the staff out to Caffe Mingo, one of his favorite restaurants in Portland. They all piled into an Uber car…together. ¶ “The driver started saying it was bullcrap that I wasn’t getting the wins,” Walton recalls. “He didn’t know Steve was in the back, or he didn’t recognize Steve yet. So Steve was like, ‘Yeah, that head coach of theirs is a real a — hole. He’s only thinking about himself.’ Then we all started jumping in. I said, ‘Yeah, I think Steve even called the NBA to make sure he got those wins.’ The Uber driver was like, ‘God, he sounds like a jerk.’”Ray Collins3 days ago
Really Bad Headline
“Bleary-eyed doctors may be better for patients”This newspaper report has a headline that displays exceptional ignorance. When reporting the result of a non-inferiority trial, “better” is a word that can NEVER be used. Depending on the trial and the result, it might be possible to say “no worse than.” A more technical term would be “non-inferior.” ¶ Bleary-eyed doctors may be better for patients ¶ Bleary-eyed doctors may be better for patients mobile.philly.comRay CollinsFeb 19
Uber representative in Tampa tells a big one.
The workforce control inherent in hourly guarantees supports the argument that Uber drivers are employees.For some Januaries past, Uber has cut rates with the claim that increased market share will result in higher income for drivers. Not true, never has been, but the new statement below is an even bigger lie. ¶ “As we have always said, price cuts need to work for drivers. If they do not, we will roll them back.” ¶ Uber’s actual response has been “hourly guarantees.” You can read about those in this post by Christian Perea on The Rideshare Guy blog, but I find more interesting the section on…Ray CollinsFeb 19
An Astounding Lede
Why medical education continues after granting some person a license to practice.The content of this lede is true. What is astounding to me is that I have never before seen anyone put this all together in a lede. ¶ There is a bit of an axiom that circulates in medical school: “Half of what you’re learning is wrong, but we don’t yet know which half.” This has borne out observationally simply by examining the frequency of reversed medical practices in the major medical journals.1Ray CollinsFeb 15
Compulsory Licensing of Drugs
The FDA has never granted a march-in petition. NIH has never submitted one.Texas Congressman Doggett was one of the legislators who asked the NIH to consider submitting so-called “march-in” petitions to the FDA, and has followed up with HHS Secretary Burwell. Individual patients and patient groups have submitted march-in petitions, which the FDA has never granted. The NIH has never submitted a march-in petition. ¶ I have followed compulsory licensing in India for years with great interest as a model for the US and other nations whose governments and citizens are…Ray CollinsFeb 12
The Times They Are A’Changin’?
Triplet of Austin PD court losses over police abuse may signal trendFor some years now, many advocates including your correspondent have considered civil courts a non-viable avenue for police reform in Texas because of qualified immunity, a culture of tort-reform among state judges, and the prosecutor-friendly 5th Circuit waiting to reduce or overturn any verdict that might be achieved at trial. ¶ Grits for Breakfast gritsforbreakfast.blogspot.comRay CollinsFeb 9
The Patient Experience
Patient-Physician Relationship and CommunicationThree different doctors present the same test results to a hospitalized patient. Follow the link below and see which message you would prefer to hear. ¶ Not only did various physicians present information with different degrees of optimism, but individual doctors presented things differently on different days … depending on (I guess) how tired/hurried they were. Consider these different messages with the same ejection fraction (EF — a measure of heart pump strength) and angiogram (heart vessel…Ray CollinsFeb 3
Jamie Love
Sorry to say he is of no known relation to us.Fifteen years on, it is no longer just the poor who cannot afford the drugs they need. New medicines for lethal diseases such as hepatitis C and cancer have been launched on the global market at such high prices that the richest countries in the world are having to find ways to ration them. And Jamie Love is back in the fray. ¶ Big Pharma’s worst nightmare | Sarah Boseley Sarah Boseley, www.theguardian.comRay CollinsJan 26
A patient-centered electronic health record
New Open Source Health charting system (NOSH)I didn’t care to start out with a 55 minute YouTube video, so I put the links to the 3-min preview video and a slide set below. ¶ The current EHR model is that each office or institution owns and manages an electronic record that contains information about the patients in that system. Despite the obvious need and lots of talk, there has been little actual progress towards making these separate and mostly proprietary systems ‘interoperable’ and therefore able to share information.Ray CollinsJan 23
Don’t Be an Early Adopter
FDA approval for marketing means a drug isn’t likely to kill you outright.Don’t be an early adopter. ¶ This is why many doctors and some healthcare organizations recommend waiting 5–7 years after a FDA-approved drug enters the US market before prescribing it. ¶ “The GAO report confirms my greatest fear — that FDA lacks fundamental resources and leadership in ensuring that drugs brought quickly to market are truly safe and effective,” Rep. Rosa DeLauro (D-CT), who asked for the study, told Bloomberg.Ray CollinsJan 19
What he’s about.
Dr. Nardo pauses in a series of posts to explain himself.In a way, what I’m trying to do here is at cross purposes with some of my own beliefs. Short term Randomized Clinical Trials [RCTs] can tell us whether a drug has the desired medicinal properties; something about the strength of those properties; the incidence of early adverse effects; and can identify some but certainly not all serious toxicity. Long term trials, the experience of practicing clinicians, and the reports of patients taking these drugs are a much more important source of ongoing…Ray CollinsJan 9
The threat to your personal finances
US Congressional dystopia and poor voter turnoutThe fear-mongering headlines journalists write every day concern a US financial sector remote from almost all citizens. Worry instead about your dysfunctional US Congress and then go vote in the upcoming primaries. ¶ But there is one big thing to be worried about, one that never really makes the headlines: the capacity for the United States to respond to the turmoil ahead. Companies might be in decent shape to weather a slowdown or a mild recession, what with the giant piles of cash they have…Ray CollinsJan 7
Robert Spitzer, RIP
Psychiatrists joined with Pharma for personal and institutional gain, exploiting Spitzer’s work.When I posted my recent review of Neurotribes, by Steve Silberman, I was unaware that Robert Spitzer, who I mentioned in passing, had died Christmas Day. ¶ Mickey Nardo’s retrospective, excerpted below, is worth reading in its entirety. ¶ Looking back on those days, I don’t think psychiatry changed just because of Robert Spitzer. Robert Spitzer’s DSM-III was the more public face of a broader effort with strong political and economic undercurrents that transcended the stated scientific agenda.Ray CollinsDec 29, 2015
Austin Hospitals Penalized
Three Austin hospitals will be penalized for lack of safety in 2016, and were penalized in 2015.Two of the three Austin hospitals penalized for 2015 and 2016 correspond to our personal experience and to anecdotal evidence from other people’s experiences. People who have worked at these hospitals have also spoken to me of their problems. ¶ SETON MEDICAL CENTER AUSTIN AUSTIN TX Y* ¶ ST DAVID’S SOUTH AUSTIN MEDICAL CENTER AUSTIN TX Y ¶ UNIVERSITY MEDICAL CENTER AT BRACKENRIDGE AUSTIN TX Y ¶ *Y = penalized in 2015 ¶ 758 Hospitals Penalized For Patient Safety In 2016: Data Table…Ray CollinsDec 19, 2015
Drug Bust
Especially if you are an elder, do not use the SPRINT blood pressure guidelines.Now you’re wondering, “Do I really need to get down to 120 over 80?” Certainly, for older people, the pay-off is in quality of life. Do you really want to spend the rest of your life dizzy, falling and suffering from the effects of kidney failure based on the results of the newest trial being hyped? Maybe you do. But if not, maybe you should repeat back to your doctor the words of retired pharmacologist Dr.Ray CollinsDec 19, 2015
When will we pay for outcomes?
No biomarkers or other proxies allowedThe one thing the medical profession is not rewarded for is providing better, higher-value care. We are financially rewarded either for doing more stuff or for securing monopoly power. ¶ Health Care’s Price Conundrum — The New Yorker Atul Gawande, www.newyorker.comRay CollinsDec 19, 2015
But, but, the label says its “natural.”
I hope you are aware that labeling a food product “natural” has no particular meaning in the US.I hope you are aware that labeling a food product “natural” has no particular meaning in the US, and certainly no legal definition as exists for other phrases found on labels. ¶ In response to petitions from quite a number of US citizens who want this marketing conundrum changed, the FDA is asking what the term “natural” means to you, or what you think it should mean. Here’s the link for your comments.Ray CollinsNov 13, 2015
Blame enough for all — systemic failure
This homeless, mentally ill veteran is in the demographic group for which death and illness have shown a sharp increase.Blame enough for all — systemic failure ¶ This homeless, mentally ill veteran is in the demographic group for which mortality and morbidity, death and sickness, have shown a sharp increase in contrast to all other downward trends for other groups in the US and in other developed countries. ¶ A lot of the trouble with Jerry I place at the door of our own psychiatrist. Instead of trying to find psych medicines that might work for him, even older medicines that the drug companies hate because…Ray CollinsNov 12, 2015
Silos
Readmissions PenaltiesMuch of the time when hospitals and doctors complain about readmissions penalties, what they are complaining about is the federal government’s increasing insistence that they reduce costs by taking into account whether all the healthcare dollars spent on a patient are going to be for naught shortly after that person is wheeled out the door. ¶ A common theme in these initiatives is cooperation across traditional health and social service silos.Ray CollinsNov 7, 2015
Treatment Burden
“What if every time we see a patient who is ‘non-compliant’, instead of blaming the patient, we looked at ourselves?” -Victor Montori, MDAs I’ve said many times in many places, thus far patient-centered care is a marketing term, not a reality. ¶ This philosophy of care [minimally disruptive medicine] requires healthcare providers to embrace…committing to work toward the patients’ goals, not…the physician’s goals. ¶ How Minimally Disruptive Medicine is happily disrupting health care Carolyn Thomas, myheartsisters.org ¶ “There is stuff that I am SUPPOSED to do, and stuff that I actually DO.Ray CollinsOct 17, 2015
Why I keep it short here in Links Links.
A sentence or two, a paragraph, links, judicious use of screen shots.Different types of linking present different copyright issues, and the law is not entirely settled here — so I’ll hit the two most important points that (for the most part) are settled. ¶ Can I use that? A legal primer for journalists Jonathan Peters, CJR, www.cjr.orgRay CollinsOct 3, 2015