Monday, 28 December 2015

The genome price plummets: Good news?

Peter Ubel is a researcher at Duke University in North Carolina and author of "Critical Decisions" book. We already had a post mentioning Dr Ubel: "Teaching patients to make the timely question." Now, along with that tweet, he sent us to a post written by himself on the Forbes magazine blog which analyzes the impact of plummeting prices for the genome test.

Monday, 21 December 2015

Meaningful use of electronic medical records

If you want to know if something is serious in health policy, check whether a budget allocation has been reserved for its implementation. Therefore I consider relevant that in 2011, the US federal government started a long term incentive program (until 2020) for the adoption of electronic medical records (EMR). The program is called "Meaningful use" which could be translated as meaningful use of medical records. That is, it encourages not the investment in information systems but its use and is measured by various indicators grouped into 3 stages.

Earlier this year Botta and Cutler published "Meaningful use: floor or ceiling?" an article where the process of encouragement was studied from expert interviews and from data from implementing a survey of American Hospital Association. Well, according to this analysis, the "Computerised Physicians Order Entry" (computerized physician orders) increased their deployment when they were encouraged by the "Meaningful use" program and even went ahead in the use of barcodes for drug delivery, action that was not encouraged by the government program (see figure).

Monday, 14 December 2015

Overscreening: new excess data

JAMA Internal Medicine has just published the results of a study from the National Health Interview Survey (NHIS) - US in the period 2000 to 2010. The study included 27,404 participants aged 65 years or more, and used a NHIS specific index to assess the risk of mortality to 9 years of life.

The conclusion is that a substantial proportion of US population with limited life expectations received screenings for prostate, breast and colorectal cancer. These results show that the overscreening is standard practice in the US. These practices, the study's authors relate, rarely produce any benefits to these population groups and instead, increase health spending and induce therapeutic overbearing from with complications arise.

This American study warns us that we need more professional and social debate, not only about the advantages and disadvantages of preventive practices in healthy people, but also about the limits of such practices in geriatric patients who already have their own clinical management difficulties.

Jordi Varela


Monday, 7 December 2015

Cancer: are the military metaphors appropriate?

Many people are convinced that when someone close has cancer, they ought to encourage them to fight, but this tweet by Dr. Margaret McCartney, author of "The patient paradox", refers to an article published in the BMJ, defending a critical attitude to this position. The reason is simple: the moral struggle is not associated with an improved survival rate (Petticrew 2002).