Consulo Indicium - 8/17/18

Information for your Consideration…

Drug Overdose Deaths: Moving From Shrugging Shoulders To Action – The death toll from drug overdose – in particular, opioids – continues to climb, increasing to more than 72,000 Americans in 2017 or, about a 10% over the prior year. The deaths from drug overdoses even exceeds the highest recorded levels for car accidents and gun-related deaths and outpacing influenza, pneumonia and suicide – which makes the tragedy all that much worse.  So, the question is Why?  According to the CDC, the cause is because “…overdose deaths involving synthetic opioids rose sharply, while deaths from heroin, prescription opioid pills and methadone fell.”  Furthermore, certain areas of the country have been hit harder than others.  The New England states and Appalachia have been particularly hard hit with West Virginia at the top – tipping the scale at nearly 59 overdose deaths per 100,000 residents.  But, something can be done that’s not being done.  As Patrice A. Harris, M.D., chair of the AMA Opioid Task Force, noted, “We know what works. We can point to states where making access to medication assisted treatment (MAT) has been a priority, and the mortality rates are doing down.”  Such programs need to be uniformly available across the entire country.  The hold up is primarily with state legislatures making the investments. Now is the time for the medical community to step forward and aggressively push for programs at the state level. 

Meanwhile, at the state level, one example of state action is the lawsuit by New York state which was filed against Purdue Pharma.  The reason?  The state alleges that the pharma manufacturer of fentanyl misled physicians on the safety of the drug which has been linked to the addiction, overdose and deaths of many people throughout the nation.  In announcing the lawsuit, Governor Andrew Cuomo stated: “The opioid epidemic was manufactured by unscrupulous distributors who developed a $400 billion industry pumping human misery into our communities.”

In The Nick Of Time Or, So We Hope – The Alzheimer’s research world was abuzz recently when Eisai, a Japan-based drug company, and Biogen announced the results of BAN2401.  The drug was used in a trial involving 856 patients from across the USA, Europe and Japan who exhibited early signs and symptoms of cognitive decline with a diagnosis of either mild cognitive impairment or mild Alzheimer’s dementia.  The key issue is that all of the patients had significant accumulations of the amyloid protein, the clumps or plaques which are present in brain for those people with the disease.  The essence of their finding was that for the first time in a large clinical trial, a drug was able to both reduce the presence of plaques and slow the progression of dementia in patients with the disease.  In prior research with other drugs, amyloid levels have been reduced but the memory decline and other cognitive difficulties continued so there was, in essence, no relief.  However, for this study – at the high dose given – both amyloid levels and cognitive loss declined compared to patients who had received the placebo.  Now, to be cautious, this was a Phase 2 study and other drugs have shown promise at this stage only to fail at Phase 3 trials.  So, we shall wait and see – but, with anticipation!!  For those of us with Alzheimer’s in our family history (the cause is unknown), we are continuously vigilant and anxious about what comes next…

Believe It Or Not – A new study by the Brookings Institute revealed that ACA (= ObamaCare) “premiums would likely be decreasing next year if the Trump administration and congressional Republicans had left the law alone”.  The data from the study showed that the premiums would be 4.3% lower.  Why?  Because the healthier people leave the individual market which raises premiums for those who stay and keep their insurance in place because they are most likely at higher risk.  For those of us who are cynics – these are the “intended consequences” of dismantling the program.  But, I’m taking the long view.  My prediction: we will be back to something like ObamaCare in the not-too-distant future.  Remind me that I predicted this in case I forget (SEE prior note).

Shulkin’s Legacy Lives On At The VA – In a long awaited decision, the Department of Veterans Affairs finalized a new rule that will allow providers to treat patients across state lines using tele-technologies.  It’s part of the ongoing movement toward the use of virtual technologies for enhancing and delivering care.  The big obstacle to the advancement in use of virtual technologies has been state licensure laws which have required that anyone being treated at an in-state entity be licensed in the state.  The new rule finalizes a proposal from last year which laid out the approach for the VA to override state licensing restrictions so clinicians can treat veterans from anywhere in the country. It’s a legacy of David Shulkin, MD’s leadership when he announced about one year ago the VA’s Anywhere to Anywhere, telecare initiative. The VA’s leadership is a harbinger of what’s to come. 

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