It’s enough to give you whiplash.

The Affordable Care Act ushered in big changes. Now, more than 65 percent of US health care professionals believe Trump’s plan to “repeal and replace” the law (which he has lately modified to “amend or replace”) will shake up their jobs yet again.

Many of the more than 2,100 respondents to the poll from our partner, Figure 1, shared concerns about patient access and Trump’s ability to guide change carefully. Comments came from all corners of the profession:

A pediatrician: “I practice in an area that is predominantly Medicaid and I know people will lose coverage under his plan, which means sicker children with less follow up.”

An orthopedic surgeon:  “Health care is truly the 3rd rail of politics...If he is interested in being a two term president (which itself is questionable) he will put the rhetoric aside and at least appear to approach change thoughtfully.”

A registered nurse: “What we are currently doing isn't working well, and we just elected someone who says they want to change it...Panic accomplishes nothing.”

Who will be the most powerful person in health policy next year?

The answer will tell us plenty about how Trump wants to change the funding and practice of health care — and more importantly, if he has a clear vision for accomplishing that.  

STAT’s Dylan Scott reports the list of contenders being circulated so far. The names include Newt Gingrich, who, among many other things, is a self-styled science nerd and big NIH supporter. Also, Dr. Ben Carson, whose reform plan leans very heavily on expanding access to health savings accounts. Read more.

To stay on top of all the health and science news coming out of the new administration, sign up for our daily roundup, Trump in 30 Seconds. 

The theory sounded eminently plausible: Opening retail health clinics near hospitals would reduce the unnecessary use of emergency rooms.

But a new study by Rand Corp. tosses ice water on that idea.

It shows that the recent explosion of retail health clinics — from 130 in 2006 to 1,400 in 2012 —  had little effect on ER use. Specifically, use of ERs for minor problems only decreased by about 17 visits per quarter over that period — and only among patients with private insurance.

That doesn’t mean retail clinics aren’t being used.  They are — just not as a substitute for the ER. So what’s the solution?

It’s not to “build more convenience settings,” said Dr. Jesse Pines, an emergency medicine doctor and professor at George Washington University, “but to improve the value of existing settings by increasing the connectivity among providers.”

Dr. Steve Nissen said it was the hardest thing he’s ever done in his career.

But after a decade, he and his colleagues at Cleveland Clinic finally have produced a finding that will shake up arthritis treatment for millions of Americans: Celebrex does not increase the risk of heart problems.

The newly-reported results of his PRECISION trial run counter to more than a decade of conventional wisdom that caused many doctors to prescribe other non-steroidal anti-inflammatories, such as ibuprofen (Advil) or naproxen (Aleve).

The study found that, over time, use of those drugs was associated with increased instances of cardiovascular events compared to Celebrex. It produced similar secondary findings with regard to gastrointestinal issues and kidney problems.

The findings only apply to people who are at risk for heart disease and who take anti-inflammatories for months or years at a time. They should not dissuade people from taking an occasional Advil or Aleve for pain. 

Nissen said the trial, which examined more than 24,000 patients, was particularly challenging because of high dropout rates. Patients who suffered pain as a result of the drugs prescribed did not want to keep going. The initial expectation was that about 40 percent would discontinue treatment; it ended up being 68 percent.

While that limits the conclusiveness of the trial, Nissen said, he is confident that he has come to an important finding. “Everybody got this wrong, and so did I,” said Nissen, the clinic’s chairman of cardiovascular medicine. “I’ve been telling patients for 10 years that if they have heart disease they should probably take naproxen. This shows that is not the case, and it’s going to have big implications.”  

Read more.

• New guidelines: Statins should be considered for everyone over 40 (Washington Post)
• Hepatitis C cure remains out of reach in Kentucky (STAT)
• DNA is not destiny when it comes to heart health (NPR)
• Obamacare sign-ups spike after election (Fierce Healthcare)