Real World Health Care Blog

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Smoking Out Nicotine Addiction: What’s Working in the War on Cigarettes

With CVS Pharmacy’s recent announcement that cigarettes and other tobacco containing products will no longer be sold in its stores, Real World Health Care has been crunching the numbers on the success of anti-tobacco efforts and reviewing recent advances in smoking cessation. Here’s what we’ve found:

  • #1. Smoking still holds the unfortunate distinction of causing more preventable deaths than anything else.
  • 8 million. That’s how many lives have been saved by 50 years of anti-smoking efforts, according to a recent study by researchers from Yale University.

    Jamie Elizabeth Rosen

    Jamie Elizabeth Rosen

  • 19%. That’s the current smoking rate in the U.S., down from a whopping 42% five decades ago when U.S. Surgeon General Luther Terry published the first report on the negative health impacts of smoking.
  • 3,000. The number of young people who still try their first cigarette every day. Almost 700 become regular smokers.
  • 7,600. The number of store locations that will no longer sell tobacco products as a result of CVS’s decision. Under the Tobacco Control Act, the Food and Drug Administration cannot mandate what retailers sell, although interestingly it does have the power to mandate the amount of nicotine in cigarettes in addition to advertising restrictions and general standards for tobacco production

Public consciousness, regulation, and education on the harmful effects of tobacco are all factors in the tremendous progress that has been made in saving lives. The World Health Organization’s global recommendations for tobacco control are known as the MPOWER measures and include the following:

WHO_MPOWER

With the efforts of both public and private sector actors, 2014 could be a watershed year for tobacco control in the U.S. In addition to CVS’s tobacco ban, several new initiatives on the part of the government and private industry have already been announced this year that address components of MPOWER:

  • Earlier this month, the FDA launched a new media campaign targeting youth. “We are addressing one of the biggest public health problems in this country and in the world,” FDA Commissioner Margaret A. Hamburg said. “It’s something the FDA has not really done before in terms of a broad public health campaign of this magnitude but it’s something that we are so pleased to be doing because it matters for health.”
  • Walgreens and GlaxoSmithKline (GSK) Consumer Healthcare announced a smoking cessation initiative. Along with resources to help quit smoking, Walgreens’ new Sponsorship to Quit provides smokers with 24/7 tips and tools, celebrations for milestones, a free consultation and other valuable support systems for smokers in their journey to quit. MinuteClinic also provides online tips, tools and facts to help smokers kick their habits.

Have you or anyone you know succeeded in quitting smoking cigarettes or using other tobacco products? Have you seen an effective campaign against tobacco? Post to the comments section to share your impressions of what works.

Targeted Therapies Open Door to Improved Outcomes and Lower Costs to Treat HCV

As we were reminded on World Hepatitis Day, early detection is critical to turning the tide of this “silent epidemic” that impacts millions. However, strategies to end the deadly effects of viral hepatitis don’t stop there. Personalized treatment is another essential tool that fuels better outcomes for patients with hepatitis C (HCV) while saving money in the long term for the health care system too. 

Paul DeMiglio

Paul DeMiglio

The importance of finding effective therapies for HCV is underscored by the reality that the disease often goes undetected, with an estimated 80 percent of Americans with HCV unaware of their status. Many HCV-positive people show mild to no symptoms, making it more likely for the illness to progress and become more expensive to treat as a result. 

Although safe and effective vaccines are available for hepatitis A and B, none exist for HCV. To help answer this need, Abbott created the fully automated RealTime HCV Genotype II Test – the first FDA-approved genotyping test in the United States for HCV patients – to facilitate targeted diagnosis and treatment that boosts desired outcomes.

This treatment-defining genotyping test empowers physicians to better pinpoint specific strains of HCV, determine which treatment option is best for the patient, and make more informed recommendations about when it should be administered. Available to individuals with chronic HCV, the test is not meant to act as a means to screen the blood prior to diagnosis.

So how does finding the right HCV treatment save money?

Targeted therapies like these are important for diseases like HCV because they reduce the “trial and error” of having to use additional treatments when the initial ones don’t work, saving money and time for patients and providers. Early detection, combined with follow-up care, can prevent patients from developing later stages of hepatitis that can mean more serious long-term conditions that are harder and more expensive to treat.

Treating HCV patients with end-stage liver disease, for example, is 2.5 times higher than treating those with early stage liver disease. Advanced HCV can also escalate to chronic hepatitis infection, a side effect of this being cirrhosis (scarring of the liver and poor liver function) and liver cancer. Treatment for these two conditions (which can include a liver transplant) can cost more than $30,000. Liver cancer treatment can be more than $62,000 for the first year, while the first-year cost of a liver transplant can be more than $267,000.

As more and more patients find themselves unable to afford treatments, HCV is becoming an increasingly larger financial burden on the health care system.

The annual costs of treating HCV in the United States could be up to $9 billion, and over the course of a lifetime the collective cost associated with treatments for chronic HCV is estimated to total $360 billion.

“As we see patients with more advanced liver disease, we see significantly more costs to the system,” says Dr. Stuart Gordon, author of the Henry Ford Study. “The key, therefore, is to treat and cure the infection early to prevent the consequences of more advanced disease and the associated economic burden.”  

Targeted therapies show great promise to improve outcomes while saving time and money by linking patients to the specific treatments they need at earlier points of diagnosis. But what can health systems do to make innovations like the HCV Genotype II Test accessible to more patients and increase the cost-savings benefit on a larger scale?

World Hepatitis Day Spotlights Importance of Early Detection to Improve Prevention and Treatment Strategies

This Sunday, July 28, is World Hepatitis Day, an observance that reminds us that hepatitis (inflammation of the liver) remains largely unknown as a major health threat. Approximately half a billion people worldwide and 4.4 million people in the U.S. live with chronic viral hepatitis, with one million deaths resulting from the disease each year.

Linda Barlow

Linda Barlow

The goal of World Hepatitis Day is to move from awareness to action to address the “silent epidemic” of viral hepatitis – so named because most people don’t experience symptoms when they first become infected, often not until they develop chronic liver disease many years later.

Stakeholders in government and private industry are stepping up to answer the call, supporting early detection and medical intervention as key starting points to effectively address the epidemic.

Earlier this month, Quest Diagnostics announced a partnership with the CDC to improve public health analysis of hepatitis C screening, diagnosis and treatment for the 3.2 million Americans living with it. Under the collaboration, anonymous patient data will be evaluated to identify and track epidemiological trends in hepatitis C virus infection, testing and treatment and determine how those trends differ based on gender, age, geography and clinical management.

“Our collaboration with the CDC underscores the importance of using diagnostic information to derive useful insights enabling effective prevention, detection and management programs for diseases with significant impact on public health,” Jay Wohlgemuth, M.D., senior vice president, science and innovation, Quest Diagnostics, said in a statement.

Early detection was also the focus of a 2012 National Institutes of Health (NIH) study published in Proceedings of the National Academy of Sciences. In the study, researchers concluded that elevated blood levels of a specific enzyme and a specific protein early on in the course of hepatitis C infection were much more likely to develop into advanced fibrosis or cirrhosis. The study found:

  • The long-term course of chronic hepatitis C is determined early in infection.
  • Rapidly progressive disease correlated with persistent and significant elevations of alanine aminotransferase (ALT), an enzyme released when the liver is damaged or diseased.
  • Rapidly progressive disease correlated with persistent and significant elevations of the protein MCP-1 (CCL-2), a chemokine that is critical to the induction of progressive fibrogenesis and ultimately cirrhosis.

Armed with this information, clinicians are expected to make a fairly accurate assessment of which patients are likely to develop advanced disease rapidly. Instead of waiting for a new class of drugs to be approved, these patients are likely to be pressed to start treatment right away – with the goal of treating the virus before it causes cirrhosis of the liver.

Because hepatitis does not result in symptoms until serious liver damage occurs, getting tested is also crucial. In fact, the CDC recommends that everyone born from 1945-65 get a one-time test for hepatitis C because they are five times more likely than American adults in other age categories to be infected and face an increased risk of dying from hepatitis C-related illnesses.

The first FDA-approved hepatitis C genotype test is now available in the U.S. From Abbott, the fully automated Realtime HCV Genotype II test determines the specific type or strain of the HVC virus present in the blood of an HCV-infected individual.

To locate organizations where you can access services including Hepatitis testing, vaccines and treatment, click here. You can also take this 5-minute Hepatitis Risk Assessment to obtain a personalized report from the CDC.

Early awareness and prevention-based practices are crucial to avoiding hepatitis. But what else can be done to ensure access to and availability of reliable and cost-effective screening and diagnostics, in addition to safe and simple treatment regimens for people with the disease?

We hope this post serves as a resource for journalists covering or interested in writing stories about World Hepatitis Day and related issues. Also stay tuned for our follow-up post next week that will address the cost-savings implications of vaccination and early treatment of hepatitis.

Juvenile Arthritis Awareness Month Underscores Efforts to Identify Causes and Develop Treatments

That’s right. Children get arthritis too. In fact, according to the Arthritis National Research Foundation (ANRF), nearly 300,000 children in the U.S. have been diagnosed with juvenile arthritis (JA) – one of the most common childhood diseases in the country.

Linda Barlow

Linda Barlow 

When Juvenile Rheumatoid Arthritis (JRA) first shows its symptoms in a child’s body, many parents write off swollen joints and fever as the flu, or think a sudden rash might have occurred from an allergic reaction. The symptoms might even recede slightly before showing up again, sometimes delaying diagnosis. 

Because a child’s immune system is not fully formed until about age 18, JRA can be especially virulent, compromising the body’s ability to fight normal diseases and leaving children open to complications that can adversely affect their eyes, bone growth and more.

Both the Arthritis Foundation and the ANRF are on the forefront of combatting this disease by supporting research into causes and treatments.

The ANRF’s Kelly Award is one example of how the organization dedicates part of its research effort toward treatment of JRA. The $75,000 grant is given annually to a researcher focused solely on JRA treatment and cures. For the past two years, the award went to Dr. Altan Ercan at Brigham & Women’s Hospital in Boston, whose work has the potential to provide novel targets for new therapies.

Another example is the Arthritis Foundation’s partnership with the Childhood Arthritis and Rheumatology Research Alliance (CARRA). Through the partnership, the Foundation is working to create a network of pediatric rheumatologists and a registry of children with the disease, allowing researchers to identify and analyze differences and similarities between patients and their responses to treatment. Ultimately, the registry will help researchers cultivate personalized medicine, the ultimate weapon in battling the disease. The CARRA Registry has been launched at 60 clinical research sites and has enrolled 8,000 patients.

The Arthritis Foundation has also committed to providing more than $1.1 million in funding this year to researchers investigating a wide range of topics, including: 

  • Exploring how environmental and genomic factors might play a role in triggering juvenile arthritis; 
  • Collecting data and evaluating the efficacy of standardized treatment plans; and 
  • Developing and testing a smart phone app to help children cope with pain.

According to the Arthritis Foundation, there is no single test to diagnose JA. A diagnosis is based on a complete medical history and careful medical examination. Evaluation by a specialist and laboratory studies, including blood and urine tests, are often required. Imaging studies including X-rays or MRIs may also be needed to check for signs of joint or organ involvement.

“When joint pain, swelling or stiffness occurs in one or more of your child’s joints for at least six weeks, it’s important not to assume these symptoms are temporary, and to get a proper diagnosis from a pediatric arthritis specialist,” says Arthritis Foundation Vice President of Public Health Policy and Advocacy, Dr. Patience White. “Early medical treatment of juvenile arthritis can prevent serious, permanent damage to your child’s joints and enable her to live an active, full childhood.”  

Management of JA depends on the specific form of the disease but can include:

  • Care by a pediatric rheumatologist.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to control pain and swelling.
  • Corticosteroids such as prednisone to relieve inflammation, taken either orally or injected into inflamed joints.
  • Biologic Response Modifiers (BRMs), such as anti-TNF drugs to inhibit proteins called cytokines, which promote an inflammatory response. These are injected under the skin or given as an infusion into the vein.
  • Disease-modifying anti-rheumatic drugs such as methotrexate, often used in conjunction with NSAIDs to treat joint inflammation and reduce the risk of bone and cartilage damage.

One promising therapy in the fight against juvenile arthritis has been recently approved by the Food and Drug Administration – Actemra (tocilizumab) – from Roche. Used to treat polyarticular juvenile idiopathic arthritis (PJIA), the medicine can be used in children ages 2 and older. It is also approved for the treatment of active systemic juvenile idiopathic arthritis (SJIA).

How can organizations like the Arthritis Foundation and the ANRF increase awareness that arthritis happens to children, and build support to advance development of research and therapies?

More Patients DASH to New Solution to Reduce High Blood Pressure: Part I

Shawn_J_Green

Shawn J. Green

What’s the solution to reversing the tide of hypertension, the most commonly diagnosed condition in the United States?  More evidence indicates that the answer begins with the food choices we make every day.

An underlying cause of heart attacks, strokes and kidney disease, one in three American adults now experiences high blood pressure – the single-largest contributor to death worldwide. It is also becoming more resistant to the pharmaceutical drugs used to lower it. In fact, blood pressure remains elevated in nearly one-third of all treated hypertensive patients on pharmaceutical drugs.

Instead of relying on prescriptions, more patients are turning to a healthier eating approach: Keeping sodium intake low and making consumption of nitric oxide-rich vegetables and leafy greens high. This cardio-protective daily diet, known as the DASH (Dietary Approach to Stop Hypertension) Eating Plan, is emerging as an effective way to delay or prevent high blood pressure altogether.

The value of nitric oxide was spotlighted when the Nobel Prize was awarded in 1998 for discovery of this naturally produced cardio-protective factor. A string of clinical studies underscored that vegetables (like red beet roots) and leafy greens (such as spinach and arugula) are replete with nitric oxide.

Diets known for promoting heart health and lowering rates of diabetes and obesity – like Japanese diets, Mediterranean diets and plant-based diets, such as DASH, among others including TLC, Ornish, and Pritikin – incorporate these natural whole foods. The need to consume more nitric oxide-potent vegetables and leafy greens becomes even more critical as we age because our bodies are less able to synthesize this natural hypertensive-fighting factor.

Reducing hypertension would not only improve health outcomes for individual patients, but would also benefit the health system as a whole. Although the percentage of resistance to antihypertensive drugs is relatively lower in the U.S., elevated blood pressure among a rapidly growing number of baby boomers will mean more challenges for health care in the long run unless we identify tools that work and make them as accessible and user-friendly to the public as possible.

DASH holds great promise to fuel compliance – a critical driver to prevent elevated blood pressure – among those living with hypertension. But a healthful eating strategy alone will not mean better outcomes for patients without a model to help them break bad habits and support dietary changes on a personal level, one day at a time.

So how do we get there?

Join us here next Thursday for the second post in our two-part series. Discover what innovative tools can empower patients to make the DASH Diet a part of their arsenal in the fight against hypertension.

Keeping Boston Strong: How Disaster Training at Osteopathic Medical School Helped Save Lives

VCOM Image 2

The Bioterrorism and Disaster Response Program equips students at VCOM with critical skills through field exercises and more (photo courtesy of VCOM).

When Danielle Deines crossed the finish line of the Boston Marathon on April 15, she had no idea her unique medical training as Doctor of Osteopathic Medicine would make a real difference in the life-and-death events that would soon unfold.

A 2012 graduate of the Edward Via College of Osteopathic Medicine – Virginia Campus (VCOM), Dr. Deines immediately sprang into action after the explosions violently rocked the most prestigious race in the country. Triaging people in the medical tent to ensure they received the care they needed, she helped make room for victims on a moment’s notice:

“They asked all of the runners to move to the back of the tent,” Dr. Deines said. “Once there as the volunteer physicians headed to the explosion sites, I made an effort to get to my feet and informed the nurse near me that I wanted to help. I was asked to discharge runners who were able and interested in leaving to help make room for the victims who were starting to be brought in from the street. I cleared those wishing to leave and signed off on their discharge paperwork, then helped to get them out of an entrance that had been made in the side of the tent.  We then moved the freed up cots to form triage areas. The back corner became the most severe triage area, nearest the entrance where the ambulances were arriving. I saw victims with traumatic amputations of the lower extremities, legs that had partially severed or had shrapnel embedded, and clothing and shoes literally blown off of victims’ bodies.”

Dr. Deines’ ability to help at the time of urgent need did not come coincidentally. Her education at VCOM equipped her — and all other graduates of the Blacksburg, Virginia school — with the critical life-saving skills that are needed when attacks or other emergencies strike.

The Bioterrorism and Disaster Response Program, a two-day, mandatory training curriculum for all second-year osteopathic students at VCOM, has immersed students in real-life disaster training, field exercises and specialized courses since its inception in 2003. This comprehensive approach gives participants expertise in areas including terrorist and major disaster response, hospital planning, behavioral risk factors, psychological response to trauma, and media relations.

Students who have completed the program now serve as lifelines, having the ability to respond to catastrophes locally, nationally and internationally – from Hurricane Katrina to the Virginia Tech shootings, tsunamis and tornado damage in Virginia.

Now more than ever, a working knowledge of disaster response issues is central to providing quality patient care.

“All medical students and practicing physicians need to be able to respond to natural and manmade disasters.  With changing global weather patterns such as global warming and changing political climates, disasters are now a part of the framework,” said Dr. James Palmieri, Associate Professor and Dept. Chair at VCOM. “I always teach the students that no matter what kind of disaster takes place, both natural and manmade, it will always begin in someone’s neighborhood and the local medical community will be part of the initial response.  In light of today’s instant communication, if and when you respond, the world will see you as the local expert.  You had better know how to respond properly for both your benefit and that of your patients.”

How can VCOM’s leadership role in disaster response training be replicated by other medical training programs?  In what ways can more medical schools develop and leverage their curricula to prepare students for disaster response?

Today, more than one in five medical students in the United States are training to be osteopathic physicians, who can pursue any specialty, prescribe drugs, perform surgeries and practice medicine anywhere in the U.S. Osteopathic physicians bring the additional benefits of osteopathic manipulative techniques to diagnose and treat patients, helping patients achieve a high level of wellness by focusing on health education, injury prevention, and disease prevention.

For students who are interested in going into osteopathic medicine, visit the American Association of Colleges of Osteopathic Medicine, www.AACOM.org; and VCOM at http://www.vcom.vt.edu/.

Three Pillars of Health Care Success: Cost Savings, Prevention/Patient-Centered Care, and Access to Care

Welcome to www.RealWorldHealthCare.org, a blog dedicated to showing what’s working to  improve health care in the U.S.

Why are we talking about improving access to good medical care? Rising costs could bankrupt us, and most people need to do a better job of preventing illness. But digging deeper, you may be surprised to learn that almost 10 percent of the U.S. population (that’s 29 million Americans) can’t afford the health insurance copayments, coinsurances and deductibles required to cover out-of-pocket costs for necessary treatments of certain chronic and life-altering medical conditions. The situation is so dire that about 60 percent of the personal bankruptcies filed in the U.S. are due to medical expenses.

As we see every day in the news, patients are facing more obstacles in accessing affordable, quality care. As across-the-board cuts to health care programs are now taking effect with implementation of the sequester – along with projected layoffs to health providers across fields – available funds to cover the rising cost of care will be strained even further. Staying abreast of the latest proven solutions to the increasingly complex challenges of our health care system is more important than ever, for patients and providers alike.

We want our blog to be the go-to source for demonstrating what’s working in our health care system by focusing on three important pillars of health care success:  Cost Savings, Prevention/Patient-Centered Care, and Access to Care.

Cost Savings: No patient – adult or child – should go without health care because he or she cannot afford it. The first step to finding solutions to the increasing cost of care is enabling health care systems and health care professionals to share their practical knowledge with one another as well as the patients who often have to choose between paying their medical bills and putting food on the table. From paying for prescription drug copayments and deductibles to affording health insurance premiums, our Cost Savings posts will explore proven strategies to help patients and families reduce the financial strain associated with the rising price of care.

Prevention/Patient-Centered Care: What’s the first thing you think of when given the words “health care?” Most people think “trip to the doctor,” or “medication.” Our attention has to shift more aggressively to find ways to help people stay healthy. Seeing a dietitian could be vital for millions of Americans hoping to live healthier and longer. Annual lab work can find vitamin deficiencies. Sometimes very simple things, like removing carpeting from the home, can contribute to better cardiovascular health, resulting in increased life expectancy. It takes a village to care for a patient. Partnerships among practitioners, payers, patients and their families are crucial for ensuring that health care decisions are made in a way that respects patients’ needs and that patients have the knowledge and support they need to make reasoned decisions and participate in their own care. In our Prevention/Patient-Centered Care blog posts, we’ll focus on the many strategies available for staying healthy and recognize ways that patients are taking an active role in decision-making about treatment options.

Access to Care: We are so fortunate to live in a world where scientists are developing novel, breakthrough therapies. But those therapies can’t result in positive health outcomes if the patients who so desperately need them can’t access them. The evidence is clear: Proper medication compliance and adherence – consistently the right medication, at the right dosage, for the right patient – is essential to mitigating chronic disease. Continued and properly managed care and staying on treatment will be the focus of our Access to Care blog posts.

We’ll be sharing real-life examples of positive health outcomes in this space, and we encourage you to join in the dialogue. How would you tackle the problem of unaffordable health care? How can business and philanthropy work together to reduce the financial burden on patients? Have you or someone you know received help paying for needed therapies? Let us know in the comments section.

Categories: General