Essential Updates: Comp Medical News for October

Welcome to this month’s edition of Comp Medical News, an essential update series. Opioid guidance, the Johns Hopkins black lung controversy, and “diabetes nation” are your headlines.

First, two major public health issues and tech in surgery are in the spotlight:

CDC Announces Project to Draft Guidance on Opioids for Chronic Pain

The CDC announced last month that they are currently working on a set of guidelines for providers treating chronic pain, citing that “existing guidelines vary in recommendations” and that “primary care providers say they receive insufficient training in prescribing opioid pain relievers” as the primary problems necessitating the agency’s action. The CDC hosted a webinar, which was not later distributed, outlining the guidance. According to Pain News, the agency expects to finalize its guidelines in early November to submit to the Department of Health and Human Services, with the goal of publishing them in January 2016.

Read the CDC info page on the guidelines here. Read the Pain News Network coverage and outline of the proposal here.

Half of the Nation is Diabetic or Pre-diabetic

A paper published in the Journal of the American Medical Association (JAMA) in early September made waves for its claims that half of the American populace qualifies as either diabetic or pre-diabetic. However, experts in chronic disease and obesity medicine have cited the new statistics as a tally in the win column, noting that the authors found diabetes rates to have remained steady from 2008 to 2012. The study is based on data collected by the National Health and Nutrition Examination Survey. The researchers found that from 2011 to 2012 between 12 percent and 14 percent of Americans had diabetes, depending on what criteria were used to diagnose them. This percentage has remained stable since 2008. The research team also found that the proportion of people who had diabetes without knowing it decreased from 40.3 percent in 1988-1994 to 31 percent in 2011-2012.

Read more from the Los Angeles Times here. Access the JAMA paper here.

Telemedicine Visits Preferred By Patients Post-Surgery

A small study of U.S. veterans published in JAMA Surgery found that most patients can safely utilize telemedicine visits after surgery and are happier doing so. The authors explain that the “quality improvement” investigation sought to assess a chosen population’s satisfaction with in-person, phone or video assessments. Past research has found that telehealth visits may be useful in the treatment of chronic conditions and after surgery, but less is known about patient preferences for these types of visits. Researchers evaluated data collected over several months in 2014 from 23 veterans, all but one of them men, who were seen three times after a simple operation. One visit was via video, the second was via telephone and the third was an in-person office visit. The researchers found that no postoperative infections were missed during the video or telephone visits, and 69 percent of patients overall reported a preference for the telemed consult methods.

Read more from Reuters here. Access the JAMA Surgery article here.

Next, controversy over a high profile program and biometrics testing in the workplace drive ire:

Johns Hopkins Quietly Ends Black Lung Program After Review of 2013 Investigatory Findings

Johns Hopkins stated last week that its black lung program will be discontinued after a lengthy suspension stemming from claims made in a Center for Public Integrity-ABC News investigation. The Center and ABC publicized back in 2013 in their Pulitzer Prize winning series “Breathless and Burdened” that “coal companies routinely beat back sick coal miners’ disability claims with help from doctors at the nationally recognized hospital.” The university suspended the program on November 1st, 2013, two days after the story ran. In particular, the series accused Dr. Paul Wheeler, head of the Johns Hopkins program, of mishandling diagnoses. Wheeler did not find a single case of severe black lung in the more than 1,500 cases decided since 2000 in which he offered an opinion. Such a finding would allow a miner to access a federal benefits program. Last year, the Department of Labor told approximately 1,100 coal miners that their black lung benefit claims may have been wrongly denied as a result of Wheeler’s readings of their X rays.

Access the original series here. Read more about the discontinuation of the Johns Hopkins program here.

Workplace Wellness Programs May Contribute to “Over-testing” in the Healthcare System

Half of large employers offering health benefits have wellness programs that ask workers to submit to medical tests (sometimes called “biometrics”) that can involve a trip to a doctor’s office, lab or workplace health fair. While aimed at uncovering potential health risks early to head off serious and costly problems, the programs that involve those biometrics are also controversial, not just for privacy reasons, but also for their contribution to “over-testing” in the U.S. healthcare system – a major cost driver. As the cost-savings potential for these programs remains hazy, Kaiser Health News asked experts in both the workplace wellness industry and in primary care and cardiac medicine to weigh in on the issue.

Read the piece here.

Finally, an editorial in Aeon Magazine questions of value of testing and treating for risk factors:

Editorial: “Misunderstanding of risk factors has led to massive overtreatment of diseases people don’t have and probably never will”

Jeff Wheelright for Aeon explains the science (and statistical maneuvering) behind determining an individual patient’s risk factors. He explains the conundrum as, “Though we might feel fine now, our individual risk for (fill in the blank) tells us that our wellbeing might not last. That vague and remote prospect of a stroke or a tumour has taken on a sharply numerical precision, thanks to screening tests that expose and quantify our risk factors.”

Read his thoughts here.


Image Credit: Coal miners rally for black lung law reform on the steps of the U.S. Capitol in 1975, NPR Special Series “Black Lung Returns to Coal Country”

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