Morning Rounds Shraddha Chakradhar

Court documents reveal Amazon strategy for shaking up U.S. drug business

Amazon is looking to work directly with health plans and employers to sell prescription drugs, a move that could potentially shake up how medicines are sold and distributed in the U.S. The tech giant’s ambitions were revealed yesterday in newly surfaced court documents from a lawsuit filed by CVS to prevent one of its former executives from taking a job at PillPack, an Amazon subsidiary. According to the suit, Amazon-PillPack would essentially become its own pharmacy benefit manager, cutting out Express Scripts, CVS, and Optum, which currently control about 80% of the market. Though it remains to be seen how Amazon-PillPack will ultimately use its distribution reach and what types of deals it may strike with health plans and employers. More for STAT Plus subscribers here.

NEJM names a new editor-in-chief

Dr. Eric Rubin, an infectious disease specialist and public health researcher at the Harvard T.H. Chan School of Public Health, will be the new editor-in-chief of the New England Journal of Medicine. Rubin, whose research has focused on tuberculosis, has been serving as an associate editor for the journal since 2012. He has also been on the editorial board of other journals including PLoS Pathogens and mBio. Rubin will take over in September from Dr. Jeffrey Drazen, who has been serving as the journal’s top editor since 2000. He announced last year that he would be retiring within a year’s time.

Insurance spending on prescriptions expected to increase

A new report from PwC’s Health Research Institute predicts that insurance companies will be spending more to pay for prescription drugs starting next year, from around 3% to almost 6% by 2027. Here’s more forecasts on medical spending from the report:
  • Generics: Almost half of the estimated sales from the top 100 brand-name drugs won’t be affected by generic competition for another three years.

  • Specialty drugs: Spending on specialty drugs — such as biologics or rare disease treatments — has already been growing over the past five years, but by 2020 these drugs may make up more than half of all U.S. drug spending.

  • Chronic disease: 85% of all employer-provided insurance spending is on chronic conditions, and obesity and diabetes will be the two top conditions that will account for spending in 2020.

Inside STAT: Why two doctors trained in primary care are changing course

Despite warning signs about a looming national shortage of primary care physicians, burnout, and the burdens of paperwork, two doctors in training were still working toward becoming primary care specialists. Until they weren’t. In a new First Opinion for STAT, Richard Joseph and Sohan Japa outline why, despite being on track to finish up their residencies in less than two weeks, they will not be becoming primary care doctors. Among the many reasons they share is how primary care physicians are not compensated fairly — which can be detrimental after incurring substantial medical school debt — and how physician training tends to consider training for outpatient services an afterthought. Read more here.

Arkansas Medicaid work requirements led to fewer insured people 

Arkansas became the first state last year to require Medicaid recipients to work at least 80 hours per month and engage in some other community activity. A federal judge in March blocked the requirements from continuing, but a new study provides the first evidence to suggest that the rules led to a dip in Medicaid enrollment. As of late 2018, when the survey was conducted, there was a 12 percentage point reduction in Medicaid enrollment in Arkansas in those ages 30-49, but the same wasn’t true for people who were surveyed in three other states that didn’t have similar requirements at the time. The vast number of Arkansans were meeting the work requirements, but a third were unaware of the new rules, suggesting that many lost Medicaid coverage because they didn’t know they were supposed to report proof of employment. 

Vitamin D supplements do not reduce risk of cardiovascular complications

Taking vitamin D supplements does not reduce the risk of adverse cardiovascular events, according to a new review that analyzed the results from 21 clinical trials. Previous research has suggested that those with low vitamin D levels have a higher risk of heart attack and other cardiovascular problems, and researchers have been trying to figure out if boosting vitamin D levels can have a beneficial effect. The trials involved more than 83,000 people, half of whom took vitamin D supplements and half of whom were on placebo. Taking vitamin D supplements was not associated with a decrease in cardiovascular complications, including heart attack, stroke, or death. Many of the trials included in the study were not designed with a cardiovascular event as an endpoint, which could limit the findings of the study. 

How dust from World Trade Center on 9/11 could have caused cancer in first responders

Sept. 11 first responders at the World Trade Center seem to have an increased incidence of prostate cancer, and a new study suggests that dust from Ground Zero caused inflammatory changes that led to the development of cancer. Researchers compared tumors from responders with those from non-responders. More inflammatory cells were active in the tumors from responders than non-responders, and genes involved with cell death and immune modulation were also expressed more in the responders’ tumors. The scientists also exposed rats to dust from the WTC site — which contains asbestos, glass fibers, and other carcinogens — and found that within a month, the rats showed chemical changes that are known precursors to cancer. The study compared a small number of human tissue samples, and more work is needed to better understand the effects of WTC dust. 

What to read around the web today

  • Meet the New York couple donating millions to the anti-vax movement. The Washington Post
  • “We didn't cause the crisis”: David Sackler pleads his case on the opioid epidemic. Vanity Fair
  • When trying to save the world also trashes it. FiveThirtyEight
  • UN health agency to remove controversial opioid guidelines. Associated Press
  • Black leaders denounce Juul’s $7.5 million gift to medical school. The New York Times

Thanks for reading! I'm traveling to Aspen to attend the Aspen Ideas Health Festival over the next few days. My colleague Elizabeth Cooney will be bringing you most of the news tomorrow, but I'll fill you in on a thing or two from the conference! 


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Thursday, June 20, 2019


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