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Health Costs, Health Policy, In the News, Media, Medicine and Society, NIH

#ACT4NIH campaign seeks stories to spur research investment

#ACT4NIH campaign seeks stories to spur research investment

ACT4NIH_Samples_FINAL

No ice buckets are involved in the latest push for investment in medical research. Instead Act for NIH: Advancing Cures Today, a Washington D.C.-based non-profit led by a former National Institutes of Health staffer, is a good ‘ol fashioned media campaign using data, stories and images, including a haunting photo of a presumably sick child captaining its home page.

The need is real. NIH funding has failed to keep pace with inflation or with investments by other nations including China. Now, only one in six research proposals, the lowest ever, are accepted, according to Act for NIH.

The campaign’s goal is simple: “We advocate an immediate, significant funding increase for the NIH, followed by steady, predictable budget growth in the future.”

Not so simple, of course, is the actual funding hike. That’s why the campaign is hunting for stories, as well as money. It urges supporters to photograph themselves besides a ACT for fill-in-the-blank poster. ACT for cancer, for hope, my grandfather, for AIDS – you name the reason to support research, action (and money) is needed.

Science released an interview with leader Patrick White today. White admitted the group lacks a formal plan, but it does have momentum, thanks to the backing by real estate developers Jed Manocherian.

It’s launch comes just in time for the 2015-16 federal budget cycle, which usually begins with the president’s budget proposal in February.

Becky Bach is a former park ranger who now spends her time writing about science and practicing yoga. She’s an intern with the Office of Communications and Public Affairs. 

Previously: How can health-care providers better leverage social media to improve patient care?, NIH network designed to diagnose, develop possible treatments for rare, unidentified diseases and Federal investments in research and higher education key to U.S. maintaining innovation edge
Photo by Act for NIH

Health Costs, Health Policy, In the News, NIH, Public Health, Science Policy

Research investment needed now, say top scientists

Top scientists made the case for continued investment in basic science and engineering earlier this week by unveiling a new report, “Restoring the Foundation: The Vital Role of Research in Preserving the American Dream” by the American Academy of Arts and Sciences.

Here’s why this is important: Federal investment is needed to power innovation engines like Stanford’s School of Medicine, and if that money gets funneled to roads, the military, Medicare, or any of a variety of other uses, fewer jobs, and fewer discoveries, could result. From the report:

Unless basic research becomes a higher government priority than it has been in recent decades, the potential for fundamental scientific breakthroughs and future technological advances will be severely constrained.

Compounding this problem, few mechanisms currently exist at the federal level to enable policy-makers and the research community to set long-term priorities in science and engi­neering research, bring about necessary reforms of policies that impede progress, or facilitate stronger cooperation among the many funders and performers of research…

Stanford President John Hennessy, PhD; biochemist Peter S. Kim, PhD; and physicist (and former U.S. Secretary of Energy) Steven Chu, PhD, are among the scientific rock-stars who co-authored the report.

For an excellent piece on the political debate surrounding the report’s release, check out the coverage in Science here. NPR also recently aired a series that colorfully illustrates the effects of research cutbacks, including a piece on a patient suffering from ALS, and a profile of several underemployed scientists.

Becky Bach is a former park ranger who now spends her time writing or practicing yoga. She’s a science writing intern in the Office of Communications and Public Affairs. 

Previously: More attention, funding needed for headache care, “Bold and game-changing” federal report calls for $4.5 billion in brain-research funding, Federal investments in research and higher education key to U.S. maintaining innovation edge

Health Costs, Research, Women's Health

Menopausal symptoms tied to lost work productivity, higher health-care costs

Menopausal symptoms tied to lost work productivity, higher health-care costs

Previous studies have shown that hormone therapy, a common treatment for menopausal symptoms such as hot flashes, can lead to a higher risk of breast cancer, heart disease, stroke and blood clots in some women. For that reason, many women no longer use the treatment for their symptoms.

Now, a study from Yale School of Medicine researchers has highlighted the economic consequences of this aspect of menopause, with hot flashes being tied to lost productivity at work and to increased health-care costs. Medical News Today reports on the findings (subscription required), which appear in the journal Menopause:

[The research team] used data on health insurance claims to compare over 500,000 women, half with and half without hot flashes. The team calculated the costs of health care and work loss over a 12-month period. Participants were all insured by Fortune 500 companies.

The team found that women who experienced hot flashes had 1.5 million more health care visits than women without hot flashes. Costs for the additional health care was $339,559,458. The cost of work lost was another $27,668,410 during the 12-month study period.”

“Not treating these common symptoms causes many women to drop out of the labor force at a time when their careers are on the upswing,” Philip Sarrel, MD, said in the piece, later adding that there are options for those suffering: “The symptoms can be easily treated in a variety of ways, such as with low-dose hormone patches, non-hormonal medications, and simple environmental adjustments such as cooling the workplace.”

Jen Baxter is a freelance writer and photographer. After spending eight years working for Kaiser Permanente Health plan she took a self-imposed sabbatical to travel around South East Asia and become a blogger. She enjoys writing about nutrition, meditation, and mental health, and finding personal stories that inspire people to take responsibility for their own well-being. Her website and blog can be found at www.jenbaxter.com.

Previously: Studying the link between post-menopausual hormones, cognition and moodAnxiety, poor sleep, and time can affect accuracy of women’s self-reports of menopause symptoms  and Most physicians not prescribing low-dose hormone therapy 

Cancer, Health Costs, In the News, Stanford News, Videos

TV spot features a more humane approach to late-stage cancer care

Updated 8-4-14: The video is no longer posted on the Al Jazzera website, but the online story is still available.

***

7-30-14: Is it possible to cut the costs of late-stage cancer care by 30 percent and provide a much better experience for patients?

That’s the question that recently brought an Al Jazzera America TV news crew out to the VA Palo Alto Health Care System, to interview patients enrolled in a new Stanford-designed pilot study on cancer care. You can watch their 9-minute video on this topic here.

The guiding principle behind this cancer-care program is this: Make sure that patients are fully informed about survival odds and treatment side effects well before they’re on the brink of death, when emotions overwhelm the decision-making skills of patients, their families and clinicians.

“Eighty percent of all cancer patients express a desire to die at home, yet only 10 percent do,” says Manali Patel, MD, the VA hospital oncologist running this study. “These end-of-life conversations, which typically take two hours in the beginning and require many follow-on conversations, are too hard, time-consuming and draining for a busy oncologist to do well.”

For these life-and-death discussions, patients are assigned personal care coaches who help them understand the big picture — treatment side effects, survival odds and pain-relief options. They also have access to a 24-hour symptom-management hotline and an option for in-home chemotherapy.

Architects of this new cancer care model, working with Arnold Milstein, MD, at Stanford’s Clinical Excellence Research Center, estimate that this program will lead to fewer unwanted treatments and expensive emergency room visits, saving the overall heath-care system money, while at the same time improving patient quality of life.

Previously: Communicating with terminally ill patients: A physician’s perspective, Identifying disparities in palliative care among cancer and non-cancer patients, Uncommon hero: A young oncologist fights for more humane cancer care, The money crunch: Stanford Medicine magazine’s new special report and New Stanford center to address inefficient health care

Chronic Disease, Health Costs, Health Policy, Nutrition, Obesity, Stanford News

Study shows banning soda purchases using food stamps would reduce obesity and type-2 diabetes

Study shows banning soda purchases using food stamps would reduce obesity and type-2 diabetes

soda

In the late 1800s and early 1900s, carbonated beverages such as Coca-Cola, Dr Pepper and 7UP were sold as nerve tonics and health drinks. But, we now know that sugary sodas contribute to obesity, type-2 diabetes and cavities. Still, most Americans drink more soda than they like to admit.

Even though sugar-laden soft drinks have no nutritional value, they are still eligible for food stamps. Nutrition researchers and some politicians have advocated for a ban on buying sugar-sweetened drinks with food stamps but the U.S. Department of Agriculture, which runs the program, is under tremendous pressure from beverage company lobbyists to keep the existing regulations.

Sugary drinks are especially concerning because too many liquid calories put consumers at a higher risk of developing type-2 diabetes. Some nutrition experts are concerned that taxpayers are subsidizing an unhealthy diet, which will result in higher medical costs for Medicare and Medicaid down the road, when food stamp recipients experience the health problems associated with obesity and diabetes.

In a new study (subscription required) published in this month’s Health Affairs, Sanjay Basu, MD, PhD, an assistant professor of medicine at the Stanford Prevention Research Center, and his colleagues created a computer model to simulate the effects of a soda ban on the health of food stamp recipients. They found that obesity would drop by 1.12 percent for adults, and by 0.41 percent for children, affecting about 281,000 adults and 141,000 children. Type-2 diabetes would also drop by 2.3 percent.

The researchers also calculated the effects of reimbursing participants 30-cents for each dollar spent on fruits and vegetables. The subsidy did not affect obesity or diabetes rates, but doubled the number of people who ate the recommended number of fruits and vegetables each day. A county in Massachusetts tried the same reimbursement system as part of the USDA’s Healthy Incentives pilot study, and saw a similar increase in the fruit and vegetable purchases of food stamp recipients.

“It’s really hard to get people to eat their broccoli,” said Basu in a press release. “You have to make it really cheap, and even then, sometimes people don’t know what to do with it.” But, with one in seven Americans receiving food stamps, he points out that these small changes can have wide-ranging effects.

“It’s very rare that we can reach that many people with one policy change and just one program.”

Patricia Waldron is a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Food stamps and sodas: Stanford pediatrician weighs inCan food stamps help lighten America’s obesity epidemic? and Stanford’s Sanjay Basu named a Top Global Thinker of 2013
Photo by Andy Schultz

Global Health, Health Costs, Infectious Disease, Public Health, Research, Stanford News

The earlier the better: Study makes vaccination recommendations for next flu pandemic

The earlier the better: Study makes vaccination recommendations for next flu pandemic

no fluIn 2009, the H1N1 flu virus circled the globe, sickening and killing thousands of people. Though the World Health Organization announced that the virus was a pandemic in June 2009, in the U.S., widespread vaccination campaigns didn’t occur until about nine months later. By that time, many people had already spent a week coughing on the couch, recovered, and developed immunity to the virus.

After observing these delays, Stanford researchers Nayer Khazeni, MD, and Douglas K. Owens, MD, wanted to know when is the best time to vaccinate to save lives, reduce infections and lower health-care costs. They used the U.S. response to the 2009 pandemic to create a computer model that simulated how a more deadly flu pandemic would move through a metropolis like New York City.

In their paper, which appears in Annals of Internal Medicine, the researchers found that if a city could vaccinate its residents six months after the start of an outbreak, instead of nine, it could stop more than 230,000 infections and prevent the deaths of 6,000 people. The city could also save $51 million in hospital bills for infected individuals.

It takes about six months for scientists, public health officials and vaccine companies to create and distribute a new flu vaccine. Most vaccines are still grown in chicken eggs! But newer technologies that use cell cultures or genetic engineering to create vaccines may soon shorten the wait to just four months. Shaving off those two months would almost double the savings, in terms of both lives and health-care dollars, they found.

Even if the city can’t vaccinate until nine months into an outbreak, residents can slow the virus’ spread by staying home when sick, wearing a face mask, hand washing, and in severe cases, even closing down schools and public transportation. These low-tech methods can buy the residents time while they are waiting for a vaccine to become available.

Patricia Waldron is a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Could self-administered flu vaccine patches replace injections? Text message reminders shown effective in boosting flu shot rates among pregnant women and Working to create a universal flu vaccine
Photo by itsv 

Chronic Disease, Health Costs, Health Policy, Research, Stanford News

Keeping kidney failure patients out of the hospital

Keeping kidney failure patients out of the hospital

Keeping kidney patients healthy enough to stay out of the hospital certainly sounds like a good thing – both for the patients and the economy. Now there’s scientific evidence to show how this can be done.

Reducing hospital readmissions was a focus of the the Affordable Care Act, and Kevin Erickson, MD, an instructor in nephrology at Stanford, decided to study a group of patients who are often hospitalized. He and his colleagues examined whether an additional doctor’s visit in the month after hospital discharge would help keep kidney-failure patients on dialysis from being readmitted. He and his colleagues analyzed data collected between 2004-2009 by the United States Renal Data System, a national registry of nearly all end-stage renal disease patients in the country.

It’s nice to find something that may generate both cost savings and better health outcomes

Results showed that there was a significant reduction in hospital readmissions with that extra doctor’s visit in the month after hospital discharge. And while the percentage doesn’t sound all that significant – 3.5 percent -  in real numbers that translates to 31,370 fewer hospitalizations and $240 million per year saved, according to the study published this month in the Journal of the American Society of Nephrology.

“It’s nice to find something that may generate both cost savings and better health outcomes,” Erickson told me. “Patients with end-stage renal disease suffer from poor quality of life. Some of that I suspect is related to multiple trips in and out of the hospital.”

Patients with kidney failure are at a particularly high risk of hospital readmission: In 2009 patients getting dialysis were admitted to the hospital nearly two times per year, 36 percent of whom were rehospitalized within 30 days, according to the study.

Previously: Study shows higher Medicaid coverage leads to lower kidney failure rates; Study shows higher rates of untreated kidney failure among older adults; Study shows daily dialysis may boost patients’ heart function, physical health.

Emergency Medicine, Health Costs, Health Disparities, Pediatrics, Research, Stanford News

ER visits for U.S. newborns show racial disparities

ER visits for U.S. newborns show racial disparities

Haiti Earthquake“Baby’s first trip to the ER” is probably one photo that no one ever wants to put in a baby book. But a surprising number of newborns – 320,000 each year – visit an emergency department within their first month of life. For reasons that are likely a complex mix of socioeconomic and biological factors, black newborns across the U.S. are more than twice as likely to make the trip.

Henry Lee, MD, an assistant professor of pediatrics at Stanford, broke down the stats of how often newborns end up in the emergency department and looked at race, age and insurance status. In collaboration with researchers at the University of California-San Francisco, Lee analyzed data from nationwide emergency room visits collected by the National Center for Health Statistics. The study appears in the May issue of the journal Pediatric Emergency Care.

The researchers found that 14.4 percent of black babies visited the emergency department, compared to 7.7 percent of Hispanic babies and 6.7 percent of white newborns. Some trips to the ER are unavoidable, such as when a baby has an infection or isn’t gaining weight. But it’s likely that some of these visits could have been prevented.

All babies must get a checkup within several days of being born. But if the delivering doctor failed to counsel the new parents about checkups – or if the doctor missed a common problem, such as jaundice – then the new family might end up in the ER instead of at a clinic. In addition to representing a lack of continuity of care for the newborns, these visits drive up health-care costs.

Additional studies may tease apart the factors that cause black newborns to end up in the emergency room more often than other groups, and to find ways to reduce spending on health care while providing better services.

“Improving the quality of care for this higher-risk group could also help to improve disparities and outcomes as well,” Lee said.

Patricia Waldron is a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Decreasing demand on emergency department resources with “ankle hotline” and Speed it up: Two programs help reduce length of stay for emergency-room visitors
Photo by Olav Saltbones / Norwegian Red Cross

Health Costs, Health Policy, Podcasts, Stanford News

Considering the costs of treatment while making clinical decisions

Considering the costs of treatment while making clinical decisions

The headline of the front page New York Times article caught my attention: “Cost of Treatment May Influence Doctors.” The piece read in part:

Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care.

The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how health care dollars are spent.

In reading further, I discovered that one of Stanford’s cardiologists, Paul Heidenreich, MD, was a c0-chair of the policy review that led to new guidelines from the American College of Cardiology and the American Heart Association. I thought it would be interesting to delve deeper in a 1:2:1 podcast with Heidenreich about why, as he told the Times, “we couldn’t go on just ignoring costs.” Did escalating health-care costs that are consuming GDP spur the action? Are these guidelines a threat to individual decision-making between a physician and patient? And, what role do patients have in these decisions? Shouldn’t they be included in potential key life-and-death verdicts?

I was also especially intrigued by a quote from the societies’ paper outlining the changes: “Protecting patients from financial ruin is fundamental to the precept of ‘do not harm.’ ” Hmm… a new take on the Hippocratic Oath that I’ve never considered.

Why the new guidelines?  Just consider for a moment the iconic rock lyrics of Bob Dylan. They say it all:

Come gather ’round people
Wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You’ll be drenched to the bone
If your time to you
Is worth savin’
Then you better start swimmin’
Or you’ll sink like a stone
For the times they are a-changin’

Previously: Personal essays highlight importance of cost-conscious medical decisions and Educating physicians on the cost of care

Dermatology, Health Costs, In the News, Research, Stanford News, Videos

Stanford dermatologist tackles free drug samples on NewsHour

Stanford dermatologist tackles free drug samples on NewsHour

Last week, my colleague reported on a new Stanford study showing that free drug samples lead to more expensive prescriptions. Over the weekend, dermatologist Al Lane, MD, senior author of the study, appeared on PBS NewsHour to discuss the implications of his findings. (He’s also quoted in a New York Times blog post on the research.) After mentioning that pharmaceutical companies spend more than $6 billion a year on sampling, he told NewsHour’s Hari Sreenivasan “that [this] cost eventually has to be paid by someone.” And he closes on a powerful note:

One of the focuses of our study was for the dermatologists to realize that although they think they’re helping the patients, they’re really being manipulated to write for more expensive medications with no proven benefit of those medications over the generic drugs.

Previously: Drug samples lead to more expensive prescriptions, Stanford study finds

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