In a WTOP-FM interview, Health Affairs Editor-In-Chief Alan Weil assesses how consumers may (or may not) benefit from two long-anticipated rules, recently unveiled by the Trump Administration, that increase price transparency for both hospitals and insurers.
“Dysautonomia is probably significantly more common than we realize,” says Jeremy Cutsforth-Gregory, a neurologist at Mayo Clinic in Rochester, Minnesota. “I think it’s significantly underdiagnosed.” In about half of POTS cases, he adds, the patient’s disease grows out of the immune response to an infection.
Ryan Cooley, a doctor and co-director of the Dysautonomia Center at Aurora Medical Center in Grafton, says detecting the disorder is especially challenging because “typically there isn’t a dominant symptom or physical finding.”
Perhaps the most common clue to the disorder is that patients find that when they stand up from a chair their heart races and they feel light-headed.
Medicare negotiation of prescription-drug prices would bring U.S. government policies in line with those of other high-income countries, and the idea is popular with both the public and policy analysts. But it would represent a sea change for pharmaceutical firms, which will maintain that any threat to their pricing power will slow innovation.
Negotiating prices of 10 too-little drugs and 10 too-late drugs to levels currently paid in the United Kingdom would produce about $26.8 billion in savings in 2019 alone, most of which ($25.9 billion) would come from savings on drugs in the latter category. Over time, the drugs included could change. For instance, in 2020 this category might include Revlimid (lenalidomide), which generated $6.5 billion in 2018 U.S. sales; its price in the United Kingdom is 32% of that in the United States.
Americans all along the political spectrum favor allowing Medicare to negotiate the prices it pays for prescription drugs.1 In September, House Speaker Nancy Pelosi (D-CA) introduced what is now called the Elijah E. Cummings Lower Drug Costs Now Act of 2019 (H.R. 3), and the bill would have Medicare do just that.
Although there are draft pieces of legislation and regulation that take aim at the rising cost of drugs, H.R. 3 is the legislative tip of the spear for price negotiation. If it became law, Medicare would target drugs that claim the largest share of the health care budget and that face limited competition from generics or biosimilars. I propose an alternative set of drugs for price negotiation: those that have too little evidence to support full approval or are too late in their life cycle to justify continued high prices.
One of the immune system’s jobs is to protect us from harmful bacterial. And the beneficial organisms that we refer to as probiotics contribute to this effort in a number of ways. In the gut, a robust population of beneficial bacteria can help crowd out harmful bacteria, making it harder for them to thrive. In addition, probiotic bacteria can influence the activity of our own immune cells, regulating inflammation, barrier function, and cell-to-cell signaling.
One way to foster healthy intestinal bacteria is to eat more of the foods these bugs like to eat—namely, fiber. Increasing your intake of plant fibers from vegetables, fruits, legumes, whole grains, nuts, and seeds is like filling a bird-feeder with the kind of seeds that the beautiful songbirds you want attract like best. If you feed them, they will come!
And if we want to attract a lot of different types of songbirds—er, bacteria—then we want to put out a variety of foods. That means you don’t just want to get all your fiber from a single source, such as a fiber supplement. You want to get it fiber from lots of different kinds of vegetables, fruits, legumes, grains, nuts and seeds.
What does it mean for someone to flourish? Flourishing is more than just being happy—although that’s a part of it. But the idea of flourishing expands beyond happiness to look at a person’s overall well-being, taking into account things like life satisfaction or someone’s sense of purpose. That’s why studying flourishing is an interdisciplinary science drawing on public health, philosophy, psychology, and more.
In this week’s episode we’re talking to two researchers from Human Flourishing Program at Harvard University who are tackling big questions about flourishing: What does it mean for people to flourish? How do we measure it? And are there things that make people more or less likely to flourish?
Rieder likens his experiences trying to get off prescription pain meds to a game of hot potato. “The patient is the potato,” he says. “Everybody had a reason to send me to somebody else.”
Eventually Rieder was able to wean himself off the drugs, but not before receiving bad advice and going through intense periods of withdrawal. He shares his insights as both a patient and a bioethicist in a new book, In Pain: A Bioethicist’s Personal Struggle With Opioids.
Press play button above to hear interview.
In 2015, Travis Rieder, a medical bioethicist with Johns Hopkins University’s Berman Institute of Bioethics, was involved in a motorcycle accident that crushed his left foot. In the months that followed, he underwent six different surgeries as doctors struggled first to save his foot and then to reconstruct it.
Rieder says that each surgery brought a new wave of pain, sometimes “searing and electrical,” other times “fiery and shocking.” Doctors tried to mitigate the pain by prescribing large doses of opioids, including morphine, fentanyl, Dilaudid, oxycodone and OxyContin. But when it came time to taper off the drugs, Rieder found it nearly impossible to get good advice from any of the clinicians who had treated him.