Performance-Based Medicine

Novartis Approval for Gene Therapy Signals New Cancer Treatment Era

The U.S. Food and Drug Administration gave a green light to Novartis AG's leukemia treatment, marking the first time that a highly anticipated new type of potent gene-modifying immunotherapy has gained approval in the United States.

Medicine Still a Lucrative Profession

  • Medical specialists continue to be relatively highly paid.
  • Male specialists earn significantly more than do women specialists.
  • U.S. Physicians earn considerably more than physicians elsewhere in the developed world.
  • Medicine is not the most highly paid profession per year of required education.
  • Other professionals can earn more, sooner in a career, and with less training.

Surgery for Torn Meniscus in the Knee is Often Unnecessary, Ineffective, Misdirected

  • Surgical meniscus repair was not superior to sham surgery in a randomized, controlled trial.
  • Non-surgical care of meniscus-injury related pain, such as exercise, was equally or more effective than surgical interventions.
  • Approximately 700,000 arthroscopic partial meniscectomies are performed annually in the U.S.
  • Annual direct medical costs are estimated at $4 billion.
  • Physicians and patients should consider all non-surgical options before undertaking surgical intervention for knee pain related to meniscus injury.

Ablation in Patients with Atrial Fibrillation

According to the American College of Cardiology, ablation is the first-line treatment for atrial fibrillation. Dr. Oussama Wazni weighs the pros and cons of this treatment option.

American College of Cardiology Issues New Atrial Fibrillation Treatment Guidelines

  • Use the CHA2DS2-VASc score for determining which patients are at greatest risk of stroke.
  • Clinicians should take an individualized approach to antithrombotic therapy.
  • Strict rate control is preferred over lenient.
  • Catheter ablation is a first-line option.

This Procedure Is Now First-Line A-Fib Therapy: New ACC Guidelines

  • Recent guidelines from the American college of Cardiology offer important revisions regarding the management of atrial fibrillation.
  • Ablation is now a first-line therapy.
  • Cardiologists should now use the more precise risk stratification scoring system.
  • Tight heart rate control is preferred over lenient control.
  • Antithrombotic therapy is to be individualized based on shared decision-making between patient and physician.

Predicting Risk in AF: Which Stratification Scheme Performs Best?

  • The CHA2DS2-VASc is better at discriminating truly low-risk patients and finding those at high risk as well.
  • In the first validation study from the EuroHeart survey, CHA2DS2-VASc had a similar C statistic to CHADS2 but improved prediction in truly low-risk patients and classified only a small proportion into the intermediate-risk category.
  • the more precise the risk tool is to assess future risk of stroke, the better the chance that low-risk patients can avoid anticoagulation and that those who will benefit from anticoagulation will be identified accurately.
  • The major weakness of CHADS2 is that a substantial proportion of patients (approximately 60%) are assigned a score of 1, indicating an intermediate risk of stroke, and the benefit of application of anticoagulation to this subset is uncertain.

Studies Link Backpacks, Back Pain in Kids, Adults

  • Studies link heavy backpacks with low back pain in children.
  • Chronic low back pain in children is strongly linked to chronic low back pain in adulthood.
  • Low back pain is one of the most frequent causes of missed work days and long-term disability.
  • Backpack weight should not exceed 15% to 20% of child’s body weight.
  • Societies and associations have published backpack guidelines to reduce incidence of low back pain.
  • This cost-free healthcare could prevent extensive future medical interventions.

More than 15 Million Americans at Risk of Significant Kidney Damage

  • Proton pump inhibitors (PPIs) are among the most commonly used drugs worldwide.
  • H2 blockers are equally effective for acid control and pose significantly less risk.
  • Long-term PPI exposure is linked to significantly increased risk of chronic kidney disease (CKD), CKD progression, and end-stage renal disease.
  • The risk of developing these diseases correlated directly with the duration of therapy.
  • PPI use was associated with CKD in all analyses, including a time-varying new-user design.
  • Twice-daily PPI dosing was associated with a higher risk than once-daily dosing.

New Guidelines Endorse Daily Aspirin, Without a Doubt

  • Daily low-dose aspirin appears to be one of the most cost-effective disease, morbidity, and mortality preventatives available.
  • Updated guidelines from U.S. Preventive Services Task Force (USPSTF) call for the use of aspirin to prevent both cardiovascular disease and gastrointestinal cancers.
  • Major medical societies endorse daily aspirin.
  • Long-term use appears necessary; greatest benefit after 7.5 years of use.
  • Cancer and cardiovascular disease are two of the leading killers of Americans.
  • Vast literature now supports the use of daily aspirin to prevent disease.

Mobile Apps Found to Improve Management of Chronic Conditions

  • Systematic review of randomized, controlled trials finds that mobile apps can benefit patients with chronic diseases.
  • Review included 9 RCTs.
  • Disease states included diabetes mellitus, cardiovascular diseases, and chronic lung diseases.
  • Interventions ranged from automatic text messages to enhanced clinician contact.

Laparoendoscopic Single-Site Varicocelectomy Significantly Superior to Conventional Lap Approach

  • Laparoendoscopic single-site varicocelectomy found to be superior surgical approach for resolution of varicocele.
  • Cochrane meta-analysis included 6 trials
  • Laparoendoscopic single-site varicocelectomy was superior to conventional laparoscopic surgery with respect to postoperative pain scores, time to convalescence, cosmetic satisfaction, and other clinical variables.
  • Operative time was shorter with CTL-V versus LESS-V.
  • There were no differences between LESS-V and CTL-V in hospital stay and postoperative complications.

Cancer Outcomes Influenced by Health Insurance Status

  • Two studies published in Cancer reveal that uninsured and Medicaid-insured patients have worse outcomes than patients with private insurance.
  • In these 2 studies, patients with private insurance had a clear survival advantage
  • Based on SEER data on glioblastoma multiforme outcomes, researchers found that an uninsured patient was 14% more likely to have a shorter survival time than a patient who carried private insurance.
  • A patient insured through Medicaid was 10% more likely to have a shorter survival time.
  • In a study of the outcomes of men diagnosed with testicular cancer, compared with men with private insurance, uninsured men were 88% more likely to die.
  • Men insured through Medicaid were 51% more likely to die of the disease.

Sitting Is the New Smoking: Urge Patients to Stand, Walk, Turn Off TV

  • Prediabetes increasingly detected in middle-aged Americans with normal BMI.
  • All patients should be tested for diabetes and prediabetes.
  • Researchers attribute rise in pre-diabetes to sedentary lifestyle.
  • Studies have shown sitting and a sedentary lifestyle to be a significant health risk.
  • Sitting for more than 3 hours per day cuts life expectancy by at least 3 years.
  • Extended TV watching also tied to decreased lifespan.

Middle-Age Hearing Loss Results in 33% Higher Healthcare Costs

  • Individuals diagnosed with hearing loss had 33% higher healthcare payments.
  • Middle-aged individuals with hearing loss expended $14,165 per year in healthcare expenditures versus $10,629 for those with normal hearing over a 1.5-year period.
  • The onset of hearing loss has been found to be gradual, with prevalence tripling from the age of 50 years to 60 years.
  • Age-related hearing loss affects more than 60% of U.S. adults aged ≥70; has been linked to increased risk of hospitalization, decreased quality of life, and increased risk of functional and cognitive decline.
  • This cohort study included 561,764 individuals.