As I listened to Gerard Anderson, PhD at recent seminars at the Department of Anesthesiology and Critical Care and the Leonard Davis Institute, I reminisced about many hours sitting on the couch in his office at Johns Hopkins talking about my research career. One of the best pieces of advice he gave me was to always understand your audience.
Prisons and jails in this country are now serving as de facto mental health care institutions. We believe that this represents an ethical and social justice transgression and should be at the center of civic discourse—particularly during an election year. To bring this situation to light and elevate the conversation and debate, we are convening a diverse group of health care providers, law enforcement officials, mental health care advocates, academicians, and bioethicists in Philadelphia on Oct. 20 for “Recovering Inside: Ethical Challenges in Correctional Mental Health Care.”
While a tax on sugary drinks is grabbing the headlines in Philadelphia, several cities and states are exploring other interventions to curb the consumption of sugary drinks, and hopefully reap health benefits. One such proposal is to put warning labels on sugary drinks, or on the advertising for them, calling out adverse health effects, particularly obesity, diabetes and tooth decay. While we can’t yet evaluate the real-world impact of sugary drinks warning labels, recent work by Christina Roberto and colleagues tests the extent to which exposure to warning labels on beverages might influence beliefs and purchasing choices of adolescents and parents.
Richard "Buz" Cooper, MD, noted LDI researcher and health policy contrarian who died this year, played “hard ball” every day for decades, telling it like he saw it, making observations that made us pause, and questioning assumptions that did not jibe with his clinical experiences and common sense. Typical of his intensity and humor, he was known to say that if the association between the number of surgeons and the number of operations was due to surgeon-induced demand, what might obstetricians be up to that resulted in the birth of more babies in communities with more obstetricians? Eventually this line of thinking led him to wonder if the problem had little to do with the number of doctors and everything to do with the underlying demographics of communities, especially the uneven geographic distribution of the poor. Could their high illness burden, use of expensive healthcare, and poor outcomes be related to preexisting conditions and delayed access to healthcare?
September 16, 2016 [cross-posted from the Health Cents blog on philly.com]
Over the past month, the EpiPen controversy has triggered a national debate on what to do about high drug prices. The enormous public attention stems from a doubling of the price over a three-year period. Families with life-threatening allergies can now end up paying more than $600 for a prescription. Heather Bresch, CEO of the company (Mylan) that makes the EpiPen, blames insurance plans. She says it’s high deductibles that are the root of the problem. I disagree. High deductible health plans are not causing the price hikes – they are just making them visible to consumers and the public.
Sometimes you have to look back to see the path forward. As the Pennsylvania House of Representatives considers legislation to modernize Pennsylvania’s antiquated regulations for nurse practitioners, we might learn something by reviewing the history of the Rendell Administration’s similar battle to expand scope of practice nearly 10 years ago. And if history is a predictor, there is reason to be optimistic.
It seems that every time Obamacare gets a cold, experts call it pneumonia. The high profile withdrawals of a few national insurers from Obamacare exchanges have some experts wondering whether the exchanges are entering a death spiral. The companies’ reports of large losses have led to speculation that the exchanges are unsustainable. If more insurers decide to withdraw, competition will decline and prices could rise to unaffordable levels. So, is there hope that the exchanges will survive? For many reasons, there is.
Pennsylvania Governor Tom Wolf announced the launch of the PA Prescription Drug Monitoring Program (PDMP), PMP AWARxE. With one of the highest overdose rates in the country (3,500 drug overdose deaths in the state in 2015), Pennsylvania’s PDMP is a timely and critical tool to save lives and address this crisis.
In caring for hospitalized patients with serious illnesses, clinicians and researchers often focus on death as the primary outcome to be avoided, but tend to pay less attention to other outcomes that may be equally or more unacceptable to some patients. We asked 180 patients hospitalized with serious illnesses to rate a series of health states on a 5 point Likert scale with options of worse than death, neither better nor worse than death, a little bit better than death, somewhat better than death, or much better than death. We report our findings in a research letter to JAMA Internal Medicine.
In a new paper in the European Journal of Public Health, Harkness Fellow Claudia Maier, and LDI Senior Fellow and Director of Penn Nursing’s Center for Health Outcomes and Policy Research Linda Aiken document the shifting of tasks that reflect expansion of nurses’ scope-of-practice in 39 countries. Their work shows that the current debates on scope-of-practice laws across US states have analogues in Europe, Canada, Australia, and New Zealand, as many countries seek to meet the primary care needs of their populations.
Following approval by the US Food and Drug Administration (FDA), subdermal probuphine will become the latest medication-assisted treatment (MAT) option to treat opioid use disorders in the United States. There are many advantages to probuphine, such as reducing the risk of medication diversion and increased medication adherence, but more research is needed to understand its cost-effectiveness and comparative effectiveness.