Wednesday, March 4, 2015

Physician Shortage Update

From the Washington Post: "U.S. faces 90,000 doctor shortage by 2025, medical school association warns".

Here is the opening:
The United States faces a shortage of as many as 90,000 physicians by 2025, including a critical need for specialists to treat an aging population that will increasingly live with chronic disease, the association that represents medical schools and teaching hospitals reported Tuesday.

The nation's shortage of primary care physicians has received considerable attention in recent years, but the Association of American Medical Colleges report predicts that the greatest shortfall, on a percentage basis, will be in the demand for surgeons — especially those who treat diseases more common to older people, such as cancer...
The shortage did not originate with ObamaCare, but the ObamaCare health law will make the shortage worse in two ways.  First, there will be an influx of new patients without a corresponding increase in the number of doctors. Second, many doctors are already demoralized by the pressures of the new health law -- and as they retire, we may not see the same caliber of new physicians entering the medical profession.

Some of this shortage can be addressed by having patients see non-physicians (such as nurse practitioners or physician assistants). But although the NPs and PAs can handle many medical issues, they can't completely perform at the level as a full-fledged physician -- nor should we expect them to.

Unfortunately, patients will pay the price in terms of longer waits for care.

Tuesday, March 3, 2015

Catron On King-v.-Burwell

David Catron explains why "King v. Burwell Is Much Bigger Than Obamacare".

Here's the opening to his piece:
The Court will hear oral arguments this Wednesday in King v. Burwell. The petitioners in this case want the justices to rule that the Obama administration must abide by the provisions of PPACA that govern insurance subsidies. The text of that law, better known as Obamacare, requires that all subsidies must flow through exchanges established by the states. But due to the refusal of 36 states to set up such “marketplaces,” the Obama administration cobbled together federal exchanges in those states through which it is now issuing illegal subsidies.

In other words, the President conducts himself in a manner utterly inconsistent with republican principles and his constitutional oath. Obama obviously believes the law is what he says it is, a delusion evidently shared by his party and the press. He behaves as if he possesses the power to unilaterally change laws and create new ones merely because the opposition party actually opposes his agenda. Adams characterized such behavior as that of “a despot, bound by no law or limitation but his own will; it is a stretch of tyranny beyond absolute monarchy.”

This is, at its core, what King v. Burwell is about. It has nothing do with any “plot to kill health care,” as the New York Times recently put it. Nor does it involve a surreptitious conspiracy to reinvigorate the “states’ rights” movement, as it was described last week in Politico. It isn’t even an attack on Obamacare, though a ruling in favor of David M. King and his fellow plaintiffs would obviously have a profound effect on the future of the “reform” law. It is rather an attempt to prevent the President from doing further violence to the Constitution...
Or as he notes, "The Supreme Court is about to decide whether we are a nation of laws or men."

For more, read the full text of "King v. Burwell Is Much Bigger Than Obamacare".

Monday, March 2, 2015

"Right To Try" Proposed In Oregon

Another good step in the right direction:
Diego Morris said he’s alive today because he used experimental drugs to treat his cancer even though they weren’t approved by the FDA.

In 2012, Morris was diagnosed with osteosarcoma. But because the medicine needed to treat it was not approved in the US, he traveled to Europe with his mother to get it.

Now he’s cancer-free and he flew to Oregon to join Rep. Knute Buehler to support the Right To Try bill...
Click through to see related video.

CO passed a similar law in 2014.  (Via Christina Sandefur.)

Tuesday, February 24, 2015

Catron: Still Not Working

David Catron discusses the latest snafus with ObamaCare in his latest AmSpec piece, "No, Mr. President, Obamacare Isn’t Working".

A couple of excerpts:
Last week, the White House took to Twitter for purposes of publicizing its latest Obamacare enrollment blarney. Far more informative than the tweet’s fictitious sign-up numbers was the schmaltzy video to which it was linked. Staged in the Oval Office, this one-act farce features a simpering HHS Secretary briefing our Thespian in Chief, who then delivers the following soliloquy: “The Affordable Care Act is working. It’s working better than we anticipated. It’s certainly working a lot better than many of the critics talked about early on.” In Obama’s 27-word script, “working” appears three times. The President doth protest too much, methinks.
Ask the folks who learned last Friday that Obama’s bureaucrats sent them erroneous tax information relating to PPACA. AP reports, “Officials said the government sent the wrong tax information to about 800,000 customers, and they’re asking those affected to delay filing their 2014 returns.” And, as with most government blunders, the price will be paid by those who can least afford it. Robert Pear points out in the New York Times, “[T]housands of lower-income Americans who qualified for subsidized insurance had hoped for tax refunds and now must wait for weeks to file their taxes.”
For more, read the full text of  "No, Mr. President, Obamacare Isn’t Working".

Monday, February 23, 2015

FDA Hindering Promising Therapies Derived From Patient's Own Cells

Interesting update from the Winter 2015 issue of City Journal: "Patient, Heal Thyself".

Their teaser line: "Treatments from our own cells could cure many diseases -- if Washington will only allow it to happen."

They discuss how the current FDA regulatory paradigm stifles this promising research:
Unlike conventional drugs, these cell therapies are created from scratch, one patient at a time, and many of the tools used to create them are simple, compact, and cheap enough to land in laboratories that serve hospitals, small clinics, and doctors in private practice. They have been landing there in growing numbers in the last decade, and Washington has been trying to keep pace.

The Food and Drug Administration (FDA) has taken the position—upheld in February 2014 by a federal appellate court—that a patient’s cells become a “drug” when extracted and manipulated in a laboratory, and may not be used to treat the patient without FDA approval. But it is far from clear how the agency should set about approving a custom-made drug that will be prescribed to only one patient, in whom its safety and efficacy will be largely determined by how the patient’s molecular biology interacts with itself....

[R]igidly scripted trials remain the norm at the FDA. Responding to the advent of drugs precisely designed to modulate specific molecular targets, the FDA has gradually come to accept that the drug-approval process must take into account the relevant patient-side molecular factors as well.

The FDA has, however, been slow to accept trial protocols that systematically investigate those factors and incorporate them into prescription protocols that increase the likelihood that the drug will be effective. With rare exceptions, the agency requires that the molecular factors that might affect a drug’s efficacy be identified by studying the disease before a clinical trial begins, or by analyzing the drug’s performance in short, early-phase trials that involve few patients—far too few to provide a full understanding of how variations in patient chemistry may affect a drug’s performance. This has already been recognized as a serious problem in the testing of certain categories of conventional drugs...
The scientific aspects are fascinating. And the regulatory aspects are infuriating.

For more details on both, see the full text of "Patient, Heal Thyself".

(Link via Instapundit.)

(Image from the article, captioned: "Emily Whitehead, a child given cell therapy for acute leukemia; her family says that she shows no sign of the cancer today. Ed Cunicelli, The Children's Hospital Of Philadelphia/AP photo.")

Saturday, February 21, 2015

BRI Debate at Georgetown

The Benjamin Rush Institute will be sponsoring a debate on 3/27/2015 at Georgetown University School of Medicine:

"Be It Resolved: Affordable, quality healthcare develops from maximizing freedom of choice – not government programs or mandates".

If you're in the Washington DC area, it looks like a great event!

From their announcement page:
When: March 27, 2015 @ 6:00 pm – 8:00 pm
Georgetown U. School of Medicine - New Research Building Auditorium
Georgetown University
3900 Reservoir Road Northwest, Washington, DC 20007
Free, but RSVPs requested.
John Grimsley
Please RSVP through the green “Tickets” link on the announcement page.

The event is free but we want to plan the right amount of food! There is a parking garage located under the Leavey Center accessible from Reservoir Road, or there is the Southwest Parking garage accessible from Canal Road.

Debate Venue Details:

Date: Friday, March 27, 2015

Time: [Eastern]
6:00 PM Reception with soft drinks and hors d’oeuvres; Registration and initial voting
6:30 Debate Begins
7:45 Debate Ends. Final voting, tally.
8:00 Announcement of results.

Place: Georgetown University School of Medicine
Room — New Research Building Auditorium
3900 Reservoir Road Northwest,Washington, DC 20007

Moderator: Michael Ramlet (Morning Consult)

Arguing the Affirmative:
Dr. Josh Umbehr MD (AtlasMD)
Dr. Lee Gross, MD (Epiphany Health, Inc.)

Arguing in Opposition:
Dr. Dennis McIntyre, MD
Dr. Adriane Fugh-Berman, MD

Friday, February 20, 2015

WSJ On Records and Regulators

Two quick links to recent Wall Street Journal pieces worth reading.

Singer: "ObamaCare's Electronic-Records Debacle".

He highlights both the obvious and hidden costs of mandated electronic medical records, and how they harm patients in the real world.

Huber and Howard: ''What Failed, the new Cancer Treatment or Regulators?"

They discuss how rigid FDA testing guidelines hinder the approval of drugs that might work well for one subpopulation of patients, even if they have minimal effect on the general population.  In essence, this means stifling the development of "personalized medicine" and "precision oncology" based on an individual's unique genetic traits.

(As always, if these direct links only show the preview page, you can often read the full text for free by typing the article title into a Google search box, and getting the "Free Day Pass" version of the article.)

Wednesday, February 18, 2015

ICD-10 Costs

From the Daily Signal: "How This New Regulation Will Drive Up Your Health Care Costs".

Our own medical practice is already undergoing ICD-10 training as well as upgrading our business office software.  I don't know how much money it is costing, but it sure is taking a lot of man-hours!

(Via Benjamin Rush Institute.)