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Tuesday, March 7, 2017

Morning Rounds by Megan Thielking

Happy Tuesday! Here's what you need to know about health and medicine today. For more STAT stories, follow us on Twitter and like us on Facebook. 

Your rundown of Republicans' ACA replacement plan

House Republicans have released their long-awaited, official plan to repeal and replace much of the Affordable Care Act. Here's what you need to know about the proposal. 

  • The GOP bill would repeal the individual mandate, making it so Americans don't have to pay a penalty if they choose to forgo health insurance. Experts worry that doing away with the mandate will mean healthy people won't buy insurance, driving prices up for others who need it. 
  • Republicans are suggesting a dramatic shift in Medicaid coverage, which was expanded under Obamacare to cover 10 million more Americans. Right now, the insurance program is an open-ended entitlement. The new proposal would put a cap on spending. 
  • Several Senate Republicans are up in arms about potential Medicaid cuts. In response to drafts of the legislation, four Republican senators released a letter rejecting it because of cuts to federal funding that made it possible to expand Medicaid in their states. 
  • It would increase the amount people can put into their health savings accounts, a proposal President Trump tossed around on the campaign trail.
  • Young adults would still be able to stay on their parents' insurance until they reach age 26. The bill would also strip Planned Parenthood of federal funding for one year. 

Telemedicine doesn't lower costs as experts hoped

Direct-to-consumer telemedicine doesn’t trim medical spending like it’s been touted to do, according to a new study. The RAND Corporation examined the health care habits of more than 300,000 individuals with health insurance that covered direct-to-consumer telemedicine. The practice has been promoted as an easy, cheap way for patients to get quick consultations about minor medical issues. But the new analysis finds that just 12 percent of those telehealth appointments actually replaced visits to the doctor’s office or ER. Instead, 88 percent of the visits constituted new use of health services, meaning patients wouldn’t have otherwise sought any sort of care without the telemedicine option.

Doctors aim to fix incorrect penicillin allergy records

It’s estimated that up to 15 percent of hospitalized patients have a documented penicillin allergy in their medical record — but upwards of 95 percent of those individuals aren’t actually allergic to penicillin. Now, researchers have developed two tactics to boost use of penicillins and related antibiotics in patients thought to be allergic. They developed new protocols for skin allergy tests for penicillin and a tool for doctors to use in picking an antibiotic. The goal: Reduce the use of alternative antibiotics, some of which are less effective than penicillin and can increase antibiotic resistance.

Researchers tested those strategies among inpatients at Brigham and Women’s Hospital who needed antibiotics and had a penicillin allergy listed in their medical records. None of the 24 patients who received the skin test had an allergy, and because of that, those patients were twice as likely to be discharged with a penicillin or related antibiotic prescription than patients who were treated according to the current standard of care. 

Sponsor content by EMD Serono

Share stories and strength throughout MS Awareness Month

Diane has been living with multiple sclerosis (MS) for more than a decade. Throughout her journey her local community has supported her. “The community rallied around our family to help drive my kids to school and cook us meals, I was humbled.” Diane has her MS experience on My Story, a new platform that helps people impacted by MS share their experiences. During MS Awareness Month, join Diane and others and share your MS story.

Inside STAT: Top hospitals promote unproven therapies

(Molly ferguson for stat)

Top hospitals affiliated with Yale, Duke, Johns Hopkins, and other medical research centers might be on the leading edge of scientific research, but they also actively promote alternative therapies that have little or no scientific evidence. Some offer homeopathic bee venom for fibromyalgia; others offer “energy healing” to treat multiple sclerosis. The treatments are touted for conditions including depression, cancer, heart disease, and autism. STAT examined alternative medicine practices at 15 centers across the US and found they’ve become deeply embedded — read more.

Does living near a mine harm health? 

The National Academies will host the first meeting this morning to discuss the health effects of coal mining in Appalachia. Researchers suspect that people who live in close proximity to sites that are being mined for surface-level coal deposits might also be at an increased risk for health problems. They’ve set up a committee to examine the connection between the two. Today’s meeting will bring together state and federal health agencies involved in the issue, along with time for the public and stakeholders to weigh in on the issue. 

How gender bias impacts women physicians

Gender bias doesn’t only impact women who have established careers as physicians — a new study from JAMA Internal Medicine concluded that women who are doctors-in-training may also face bias in their residency evaluations. The authors analyzed two years' worth of evaluations on 359 residents across eight emergency medicine programs. Male and female residents began their training with similar scores in 23 skills. Women, in many cases, actually received slightly higher average scores.

But by the third year, average evaluations for women had fallen behind those of their male counterparts in every category. The difference is about equivalent to three or four months of training, the authors calculated. It’s not clear what’s behind the difference; unconscious biases among evaluators might be at play.

The evidence on treating high blood lead levels

Doctors often advise parents of kids with high blood lead levels to feed their kids diets chock-full of iron, calcium, and vitamin C. It’s a suggestion that’s made by the CDC, too, which says healthy foods “may help keep lead out of the body." That's a laudable goal, because even a low blood lead level is thought to impact a child’s attention and cognitive ability. But a new analysis suggests there’s little evidence to back up that recommendation. Epidemiologist Katarzyna Kordas of the University of Buffalo scanned the research and found no robust studies to show that those specific dietary recommendations do, in fact, lower blood lead levels. That’s not to say they’re right or wrong — Kordas said she’d like to see more research done on what interventions, including dietary recommendations, could be helpful.

What to read around the web today

  • Trump tells Planned Parenthood funding can stay if abortion goes. New York Times
  • Unscrambling the nutrition science on eggs. NPR
  • This Trojan horse app sneaks vital health info to women in Iran. Buzzfeed

More reads from STAT

Thanks for reading! More tomorrow,

Megan

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