Local, state and national news of interest to the physician community

November 1, 2023

Election Day 2023

Tuesday, Nov. 7th

Election Day 2023 is almost upon us! In case you have yet to cast your ballot, here is a list of all Virginia candidates for House of Delegates and Senate. You can also locate candidates for your local offices on the Virginia Department of Elections site. If you need assistance determining your district or polling place, click here or here.

A new report by the Commonwealth Fund says that "the United States spends twice as much per person on health as the average of peer nations." Ask the lay person why health care costs are soaring and one of the answers you may hear is that "doctors and nurses are overpaid."

But is that the answer? Aiming to "identify and estimate components of excess U.S. health spending relative to peer nations," the report dives into data from numerous sources, analyzes the numbers, and arrives at a much different conclusion: Physician and registered nurse wages account for only about 10% and 5%, respectively, of that excess.

So where is the extra spending going? "More than half of excess U.S. health spending was associated with factors likely reflected in higher prices, including more spending on: administrative costs of insurance (~15% of the excess), administrative costs borne by providers (~15%), prescription drugs (~10%)...and medical machinery and equipment (less than 5%)."

The conclusion: "Reductions in administrative burdens and drug costs could substantially reduce the difference between U.S. and peer nation health spending."

IN RELATED NEWS... Unnecessary coronary stents cost taxpayers $800 million annually: Axios. See breakdowns of stats and hospitals with highest and lowest rates of overuse here.

Daylight Saving Time: Pros, Cons, and Future

Clocks will turn back one hour this Sunday, November 5, as daylight saving time ends that day at 2 a.m. But it's more than about just winding back a clock: The potentially negative impacts it has on health are well documented. Debates are swirling about DST's pros, cons, and future: Click here to learn how DST affects health and why many physicians support ending the practice. SEE ALSO: JCSM.

Following high-profile pharmacist walkouts at Kansas City CVS locations in September and various Walgreens earlier this month, a larger strike, dubbed "Pharmageddon" by organizers, drew support this week from as many as 4,500 pharmacists and pharmacy technicians, USA Today and Fox Business report.

Pharmacy staff called in sick this past Monday through today at large chains CVS, Rite Aid and Walgreens, Reuters reported. They're hoping for a nationwide movement "against what they call unsafe working conditions that put both employees and patients at risk," CNBC says. "Representatives from all three companies, however, told USA TODAY they are experiencing zero to minimal disruptions as a result of the effort."

Cost-cutting measures by the larger chains, including reduced technician hours and store closures, have resulted in burned-out technicians quitting and further pressures being placed upon pharmacists, who are now also burdened with vaccine season.

"CVS is in the middle of shuttering 900 locations in three years, while Walgreens said in June that it would close 150 U.S. locations. Rite Aid is closing at least 154 stores, and probably more, as it goes through Chapter 11 bankruptcy reorganization. That means there are fewer locations serving customers, which makes the remaining stores busier," NBC News says.

The latest strike "also drew support from the American Pharmacists Association, the industry’s largest professional organization, which said in a statement that it stands with every participant of the movement."

Florida community college instructor and mother Laura Bray was hit out of the blue four years ago when her 9-year-old daughter Abby missed a leukemia treatment due to her hospital running out of the $10.00 drug's supply.

Advocating for her child, Bray studied supply chain matters, compiled information, reached out to other health care providers, and discovered that the system was broken. She "worked the phones, in search of a hospital, researcher or cancer center with drug supply to spare," NPR reports. She then launched a nonprofit, Angels for Change, with hopes of changing an industry.

Now, she helps other families find lifesaving drugs. "She realized she could help more people by identifying a whole hospital's drug needs and then finding small amounts of supply to fill those gaps...If a factory shuts down production, her sources on the ground can help her estimate when the factory might restart. She then turns to alternative makers to see whether they can ramp up to meet the sudden increased need."

Bray's journey has put her in "regular conversations with drugmakers, hospital pharmacies and even factory floors," and she has become the "accidental expert" of the pharmaceutical industry.

Advanced artificial intelligence (AI) is being rapidly deployed to health care systems, garnering both accolades and criticisms from physicians, while the federal government appears stumped as to how it should be regulated.

"The Biden administration hasn't decided how to handle emerging tools like chatbots that interact with patients and answer doctors' questions," Politico reports. On Monday, President Biden issued an order that "directs the Department of Health and Human Services to establish a safety program to receive reports of AI-related harms and unsafe practices — and take actions to remedy them," Stat reports.

Several high-profile incidences of misdiagnoses and racial bias involving medical AI have underscored the medical field's dilemma with the technology. "Wary of such flaws, physicians have kept AI working on the sidelines: assisting as a scribe, as a casual second opinion and as a back-office organizer. But the field has gained investment and momentum for uses in medicine and beyond," The New York Times reports.

In the limited applications many doctors have allowed it, AI is showing promise helping to alleviate burdens on physicians and perhaps grant them more time with patients. Take, for example, Massachusetts General Hospital's Dr. Michael Mansour, who tells NPR that the technology has expedited his diagnosis times.

IN OTHER MEDICAL AI NEWS:

• World Health Organization (WHO) issues six important considerations for regulating AI in healthcare.
• North Carolina-based Atrium Health said almost 85% of its physicians reported an improved documentation experience with a new AI tool by Nuance.
• A 10-second smartphone voice clip is all one AI model needs to distinguish between people with and without type 2 diabetes: Mayo Clinical Proceedings.
• Study finds predictive AI models may lose accuracy over time due to issues with re-training that can create negative feedback loops: Annals of Internal Medicine.
• FDA adds more than 150 devices to its list of Artificial Intelligence and Machine Learning (AI/ML)-Enabled Medical Devices, expects to see a greater than 30% year-over-year increase. The majority of devices (79%) are in radiology.
• Only 10 of the 521 authorized devices on the FDA's AI/ML list as of 2022 were likely capable of informing critical decision-making on critically ill patients: JAMA.

Mescape released the findings of its 2023 Female Physician Compensation report recently, and the findings indicate that progress has been made towards fairer compensation.

According to the report, "average compensation rose about 6.4% last year to $300,000, incentive bonuses also climbed for those women who qualified, and the gender gaps vs male counterparts on both narrowed."

The gender gap remains, however: male doctors earned 29% more on average ($386,000), but women did close the gap from 34% in 2020.

Female physicians in the South Atlantic region (Virginia included) averaged $296,000 annually, $18,000 less than those in the Pacific states. There was a near even-split among them in their opinions on being fairly paid (48% said yes, 52% said no). Not surprisingly, the specialty with the highest percentage of female physicians is Ob/Gyn (62%) followed closely by Pediatrics (59%). For plenty more insights, check out MedScape's report here.

The RAM Board of Trustees serves staggered two-year terms. Each year, approximately one-half of our board completes their term in office. At the close of 2023, six Trustees' terms expire.

Please click here to learn more about each candidate. Online voting will close on November 14th at 6:00 p.m.

Although the technology has shown great promise in many trials, the CRISPR gene-editing tool has yet to be a part of any FDA-approved treatments. That could change by December 8, when the agency is expected to make a decision on whether to grant grantexagamglogene autotemcel (exa-cell) an indication to treat sickle cell disease.

Yesterday, an FDA advisory panel suggested that "the benefits of gene therapy outweigh risks of off-target editing," MedPageToday and NYT report. "If...the FDA's commissioner concurs with its assessment, it will be the first medicine to use the revolutionary tool, CRISPR, to snip out a piece of DNA. Other comparable treatments for sickle cell could follow," The New York Times reports.

"Reviewers expressed concern about whether the gene-editing therapy will make unwanted changes to patients' DNA," MedPageToday and USA Today say. Could it inadvertently be the genesis of a real-life comic book superhero...or a science fiction nightmare? Both could have been appropriate for a Halloween panel discussion. And, of course, the up to $2 million price tag has left some observers wondering who could actually benefit, NPR notes.

The therapy's efficacy was not in question, however: "29 of 30 evaluable patients (96.7%) achieved the primary efficacy endpoint of the absence of severe vaso-occlusive crises (VOCs) for at least 12 consecutive months. Of those 29 patients, 28 remained free of VOCs for a mean duration of 22.3 months, with a maximum of 45.5 months." Nothing short of "transformational," as treatment maker Vertex Pharmaceuticals described it.

The panel noted that Vertex and CRISPR will assess the safety risks of gene therapy in a follow-up study, Reuters says.

IN RELATED NEWS... FDA review of a second sickle cell gene therapy by bluebird bio will follow on the heals of Vertex's therapy: Reuters...Also in time for Halloween, FDA considers whether "candy-like" nonprescription drug products such as gummies, particularly for children who often cannot, or do not want to, swallow actual pills, are worth the risk of overdoses: Stat; NBC News.

"I am a physician who has served the Northern Virginia community for over 12 years, and I have seen many trends in health care that aren't in the best interest of our patients," says Dr. Rommaan Ahmad in a commentary recently published in the Virginia Mercury. Particularly egregious, she argues, is the increasing frequency of smaller, independent hospitals and practices being bought out by larger health care systems, fueling consolidations that result in "extra, unnecessary charges on patients' medical bills for providing exactly the same services." Read her editorial here.

RAM Events & News

Tuesday, November 14, Beginning @ 5:30 p.m.

Country Club of Virginia

Featuring Dr. Karen Rheuban

Medi¢: The Business of Medicine

Optimizing patient flow is a top priority for many hospitals, as current efforts are often disjointed. To shift to a proactive approach, hospitals need to centralize oversight of patient flow and move away from defaulting to hospital admission. Get Advisory Board's take on the future of patient flow and learn three ways your organization can transition to a coordinated, more proactive model.

Other Medical Business News:

• The federal government is rolling back a pandemic-era waiver that lowered the bar for 340B hospitals to dispense discounted drugs across additional outpatient sites: Fierce Healthcare.
• "A very ugly few years": Will hospital-insurer payment disputes such as the recently settled Bon Secours-Anthem tussle continue to leave patients out in the cold? USA Today says they very well could.
• How do health plan rates compare across regions of the country? Axios and a study reveal who pays more for the same services.
• "Some 500,000 clinicians and many hospitals could be subject to new payment reductions or 'disincentives' for violating the federal information blocking rule, which prohibits healthcare providers from preventing patients from accessing their electronic health information, if a new rule proposed by HHS is finalized": MedPageToday.
• An updated cybersecurity "toolkit" has been released by the Biden administration to strengthen defenses of health care infrastructure: Axios.
• Meta, parent company of social media platforms Instagram and Facebook, sued by several states for harming young users' mental health through "addictive" features: CBS News; CNN. Is social media addictive?: The New York Times.
• A judge rejected Home Depot's legal challenge to a $2.67 billion settlement that resolves civil antitrust claims against Blue Cross Blue Shield Association and member plans for conspiring to drive up health insurance costs: Reuters.
• Drugmaker Nostrum and its CEO have agreed to pay up to $50 million to settle claims for underpaying rebates owed under the Medicaid Drug Rebate Program, the Department of Justice announced.
• The impact of increasing syphilis cases is causing strain on state budgets: AP.

• "Abysmal": A month after federal officials recommended new versions of COVID-19 vaccines, 7% of U.S. adults and 2% of children have gotten a shot: AP; The New York Times.
• Experimental flu-COVID combo shot generates a strong immune response: Reuters.
• HV.1 has usurped EG.5 as the most dominant variant in the U.S. this week: NBC News; most U.S. markers down: CIDRAP.
• Transition of Paxlovid coverage from federal government to insurers begins today: Stat; Axios; The Hill.
• SARS-CoV-2 Omicron infections linked to more severe outcomes than flu, RSV: CIDRAP. Vitamin C had little positive effect vs. severe COVID: MedPageToday.
• Simvastatin improved outcomes for severely ill COVID patients by 96%, survival at 3 months by 92%: CIDRAP.
• No signs of ongoing infection or brain damage in long COVID patients: CIDRAP. Severe infections linked to greater risk of long COVID (CIDRAP), which did not improve in over 50% of patients 18 months after diagnosis (CIDRAP).
• Troublesome urinary problems due to an enlarged prostate gland may be more likely to develop, or get worse, after COVID infection: Reuters.
• Can milk cure COVID? No, but Lactovid can! The Hill.
• Those with severe mental illness had 50% higher risk of death following COVID infection: Cambridge; CIDRAP.
• Contract dispute shuts down a quarter of nation's wastewater surveillance sites, making COVID tracking difficult: Politico.
• CBS News interviewed Virginia Tech professor Linsey Marr on the latest scientific knowledge concerning the value of face masks vs. COVID. SEE ALSO: New study.

Quick Bites

Brief Useful & Intriguing Health News of Note:

National News

• Biden administration seeks $1.55 billion from Congress to address fentanyl crisis: NBC News.
• George W. Bush Institute presses Congress to continue funding billions of dollars for global HIV/Aids initiative: AP.
• Half of working-age Americans struggle to pay off medical debt, according to a new report from the Commonwealth Fund: Axios.
• Food insecurity rose for millions of Americans last year as compared to 2021: Reuters; NPR.
• HHS proposes new rules to fix controversial No Surprises Act dispute resolution process.
• Biden administration proposal to reduce out-of-pocket costs for mental-health care and substance-use-disorder treatment opposed by insurers: WSJ.
• FDA issues draft guidance reflecting its stance on how "companies can communicate scientific information to clinicians regarding unapproved uses of products already on the market": MedPageToday.
• Young woman with heart condition dies after drinking highly caffeinated Charged Lemonade at Panera Bread: NBC News.
• FDA warns against probiotics for preterm babies after infant death: AP.
• The only Native American training program affiliated with a tribal government, a Cherokee Reservation medical school works to expand the number of doctors serving rural or tribal communities: CBS News.
• American Heart Association announces full support for creation of a new American Board of Cardiovascular Medicine (ABCVM).
• In Memoriam: Dr. Donlin Long, 89, neurosurgeon and innovator who helped develop an insulin pump for diabetes patients and a device to relieve pain and joined Dr. Ben Carson in a historic operation on conjoined infants: NYT.

Drug, Tech & Vax News

• UPDATE: Pig heart transplant patient Lawrence Faucette dies six weeks after procedure: AP; CNN; NYT.
• No evidence GLP-1 drugs like Ozempic linked to thyroid cancer, says European Medicines Agency: Reuters.
• What is the true value of a $949 cancer-detecting blood test? The Wall Street Journal finds that opinions differ concerning the Galleri liquid biopsy.
• A subcutaneous version of Alzheimer's drug lecanemab (Leqembi) seems promising: MedPageToday.
• Mpox vaccinations should continue to be recommended to high-risk men even after the current outbreak ends: AP; CIDRAP.
• RSV vaccine Arexvy could protect higher-risk people as young as 50: CNN Health.
• A short course of inhaled antibiotic amikacin (Arikayce) reduced the rate of ventilator-associated pneumonia: MedPageToday.
• Minoxidil, treatment for male or female pattern hair loss, may be in short supply in Virginia pharmacies: NBC News; JDD.
• GSK's cancer drug Jemperli, combined with chemotherapy, met the primary goal of overall survival in patients with advanced or recurrent endometrial cancer: Reuters.
• Novartis' atrasentan had a positive effect on an indicator of kidney health in people suffering from IgA nephropathy: Reuters.
• Reviva Pharma's schizophrenia drug brilaroxazine reduced severity of symptoms: Reuters.

Thursday, November 30, 6-8 p.m.

RAM Offices

Featuring Sean Byrne, Byrne Canaan Law

FDA Approvals

• Abatacept (Orencia), indication expanded to include treatment of patients age 2 years and older with active psoriatic arthritis.
• Ivosidenib (Tibsovo), for rare form of blood cancers called myelodysplastic syndromes: FDA.
• Mirikizumab-mrkz (Omvoh), for moderately to severely active ulcerative colitis (UC) in adults: Eli Lilly; MedPageToday.
• Pembrolizumab (Keytruda) in combination with chemotherapy, initial therapy for locally advanced unresectable or metastatic biliary tract cancer: Merck.
• Secukinumab (Cosentyx), new indication for hidradenitis suppurativa: Novartis.
• Toripalimab (Loqtorzi), for adults with metastatic or recurrent nasopharyngeal carcinoma (NPC): MedPageToday.
• Vamorolone (Agamree), for Duchenne muscular dystrophy (DMD) in patients aged two years and older: Reuters; MedPageToday.
• Zilucoplan (Zilbrysq), for generalized myasthenia gravis: UCB.
• Amgen's biosimilar version of J&J's psoriasis treatment Stelara: Reuters.

Medical Miscellany

• Can merely the sight of a sick person trigger your immune system? A California professor says yes: The Mercury News.
• Heavy News for the Holidays: One-third of chocolate products contain concerning levels of lead or cadmium: Consumer Reports; Reuters. ALSO RECALLED for high levels of lead: WanaBana fruit pouches: USA Today.
• Excessive weight gain during pregnancy has been tied to increased risk for earlier death: MedPageToday.
• Infant mortality rose by 3% in U.S. this past year: WSJ; AP; CNN.
• Babies exposed to endocrine-disrupting PFAS and other chemicals in the womb may be at higher risk of rapid weight gain during early childhood: NBC News; EHP.
• High cell phone use tied to low sperm count in young men: CNN.
• About 22 minutes of moderate to vigorous physical activity per day is enough to counter harmful periods of sitting too long: British Journal of Sports Medicine.
• The value of intermittent fasting in managing type 2 diabetes has been documented in a recent study: NPR; CNN.
• Researchers believe they have an explanation for the connection between type 2 diabetes, obesity, and higher pancreatic cancer risk: Reuters.
• Loss of slow-wave sleep as you age may increase your risk of developing dementia, according to a new study: CNN; MedPageToday.

Pathogen Report

• Salmonella outbreak tied to diced onion products has so far caused at least 73 illnesses in 22 states, including 3 in Virginia: CDC; AP.
• International Salmonella outbreak linked to chickens sickens 335: CIDRAP.

FUN FACT OF THE WEEK

A recent study has baffled researchers while providing evidence to support a traditional Chinese medicine. Tongxinluo means "to open the network of the heart." Consisting of traditional Chinese herbs and insects, it is used to treat cardiovascular diseases, although Western medicine had yet to empirically test it...until now. Despite none of its ingredients possessing documented cardiac benefits, Tongxinluo shined in the study, lowering the odds of heart attack patients experiencing further events by 36% over a placebo. Researchers hope that isolating and testing specific active ingredients may "provide the world with the next advance in the treatment of acute STEMI."

Thanks for reading The Leg.Up!



I strive each week to bring you an informative and (occasionally) entertaining recap of news in the world of medicine and how it affects you. Please be sure to send me any feedback and news tips:

[email protected].

Click here for past editions of The Leg.Up.

Scott C. Matthew

RAM Director of Communications

Richmond Academy of Medicine

www.ramdocs.org

STAY CONNECTED