Tuesday, November 15, 2016

On Call by Casey Ross

Good morning! Here's the latest in hospitals and health care news. Make sure to check out our list of who to follow to keep up with Trump's impact on medicine. And get updates from @statnews on Twitter or like us on Facebook.

Fresh take: Why doctors should drive drug policy

The worldwide epidemic of drug abuse needs a new solution.

And it must come from doctors, not law enforcement officials and politicians whose war on drugs is regarded as a worldwide failure.

That’s the argument proffered today in The BMJ, which says the drug war, like all wars, has caused “human rights violations” — in this case by disproportionately imprisoning minorities and poor people, and failing to treat non-medical use of narcotics as a health problem.

Its editorial makes the case that criminalization is the wrong answer, and that clinicians must be more involved in finding the right one.

In the US, attitudes are clearly shifting, with seven more states voting to legalize marijuana in some form on Election Day. But on that same day, the nation also elected Donald Trump, whose border wall argument is a distinctly law-and-order solution to the opioid epidemic.

It is within this context, The BMJ says, that doctors must step up.

“Doctors are trusted and influential,” its editorial says, “and can bring a rational and humane dimension to ideology and populist rhetoric about being tough on crime."

Seeking cancer’s cure in ‘Colontown’

Thousands of cancer patients who can’t wait for the moonshot are pinning their hopes on Facebook.

Colontown is a members-only page where patients are trying to chart their own course to a cure. STAT contributor David Steen Martin reports today about the activism that is driving the effort, as well as the concerns of physicians who worry that anecdotal evidence can easily lead desperate patients astray.

Read more.

New survey: Surgical residents want flexibility in working hours

Long hours can be crushingly hard for young surgeons.

But so can hard-and-fast rules that tell them they must stop caring for a patient even when the work is not done.

A new survey found that, when push comes to shove, a majority of surgical residents would prefer to work longer hours when the job demands it.

About 86 percent said they prefer flexible hours or had no preference; 14 percent said they prefer standard shifts, which max out between 16 and 28 hours, depending on a resident’s level of experience. The findings come after an influential accrediting body recommended that maximum shifts go back to 28 hours for even first-year residents.

Critics of longer shifts have argued that such hours undermine patient safety.

But the survey revealed a much different perception among residents: A greater percentage of those working standard hours reported concerns about patient safety — about 23 percent, compared to 11 percent among residents working flexible hours.

However, residents working flexible shifts were also more likely to report that their hours were negatively impacting their well-being. Those concerns diminished as they gained more experience.

Zag of the day: Improving chemo through real-time decision-making

Kenny Engels is launching his own fight against cancer, and it doesn’t involve a NASA-like quest to find a new cure.

Instead he is trying to make today’s cancer medicines work better, in real time. 

Engels, chief executive of WorkUp, is releasing new software aimed at improving medication adherence for users of oral chemotherapy drugs. The product connects patients to nurses and oncologists, so they can quickly address side effects and paperwork problems that interfere with treatment.

“You can pick up an app or your mobile phone and you conveniently say what you need to say, when you need to say it,” Engels said. “And someone gets back to you. You never have to re-articulate your issue.”

His company's revenue comes from pharma companies, which pay WorkUp to address supply-chain problems and provide de-identified data about how their drugs are working.

Amid a sea of apps and patient management software, the question facing WorkUp is whether it can get buy-in from clinicians.

Engels is betting that the more time clinicians spend struggling with their own electronic health records, the more likely they are to knock on his door.


  • The ethical questions swirling around device reps in your OR (Washington Post)
  • Should hospitals be preparing for a recession? (Fierce Healthcare)
  • Smoking is at an all-time low, but... (Medscape)
  • Another way to fix Obamacare? Take a look at Medicare (NY Times)

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