Monday, July 10, 2023

Trends in opioid toxicity–related deaths in the US before, after the start of the pandemic

JAMA Network Open

Peer-Reviewed Publication

JAMA NETWORK




About The Study: Deaths due to opioid toxicity increased substantially during the COVID-19 pandemic. By 2021, 1 of every 22 deaths in the U.S. was attributable to unintentional opioid toxicity, underscoring the urgent need to support people at risk of substance-related harm, particularly men, younger adults, and adolescents. 

Authors: Tara Gomes, Ph.D., of the University of Toronto, is the corresponding author. 

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/ 

(doi:10.1001/jamanetworkopen.2023.22303)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Biden declares war on 'junk' health insurance: 

President tries to reverse dire approval ratings with crackdown on Trump-backed plans that last only three months and put 'stress' on families

President Joe Biden is going after 'junk' health insurance plans
 
The short-term plans were allowed to be used for three years under Trump
 
They don't follow Obamacare rules, so often leave people in medical debt


By NIKKI SCHWAB, SENIOR U.S. POLITICAL REPORTER FOR DAILYMAIL.COM

PUBLISHED: 7 July 2023 | 

President Joe Biden has declared war on 'junk' health insurance policies and will announce new rules he's proposing in a speech Friday afternoon in the East Room.

The White House is taking aim at short-term health insurance policies that former President Donald Trump touted as 'much less expensive health care at a much lower price.'

However, those plans often don't provide comprehensive coverage, won't cover pre-existing conditions, don't cover prescription drugs and have saddled patients with thousands of dollars in medical bills.

'We know healthcare costs can be a real economic stress for families,' White House Domestic Policy Adviser Neera Tanden told reporters on a call Thursday night.

The announcement is part of a broader plan to curb household costs, as inflation has taken a toll on Americans' pocketbooks - and on the president's poll numbers.

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President Joe Biden, photographed speaking in South Carolina Thursday, will deliver a speech Friday afternoon on how his administration is going after 'junk' short-term health insurance plans

The Biden White House has also gone after excess fees charged by airlines, hotels and banks.

The so-called 'junk' insurance rules changed under Trump, who had wanted Congress to repeal the Affordable Care Act - the 2010 watershed healthcare bill dubbed 'Obamacare' - but was thwarted by Republican Sen. John McCain in July 2017.

One of McCain's reasons for preserving Obamacare was that Republicans hadn't come up with a way to replace it.

Cut to 2018 and the Trump administration worked to change the rules so that Americans could buy cheaper, short-term plans - meant to last three months - and keep them longer.

The idea was that these plans were not bound to the strict rules of the ACA, so the move was a work-around since Trump didn't have the votes in Congress to repeal Obamacare.

'Short term plans are intended to provide temporary coverage as people transition from one source of coverage to another like when we're between jobs,' Tanden explained.
 
Former President Donald Trump, had wanted to repeal Obamacare but didn't have the votes in Congress, so made tweaks to short-term insurance plans

'Under the previous administration, however, companies were allowed to take advantage of loopholes and sell what we call junk insurance for much longer than intended - up to three years,' she noted.

White House officials said on the call that those who currently have short-term plans would be able to keep them - and that the rule would impact sales of new plans.

Patients would also be made aware that their insurance was considered a 'junk' plan.

The Biden administration is also going after third-party medical credit cards, launching an intragovernmental probe into the emerging practice, Tanden said.


Biden cracking down on "junk" health insurance plans


JULY 7, 2023 / 

President Biden on Friday rolled out a new set of initiatives to reduce health care costs: a crackdown on scam insurance plans, new guidance to prevent surprise medical bills and an effort to reduce medical debt tied to credit cards.

Mr. Biden's remarks will build on previous initiatives to limit health care costs, with the Department of Health and Human Services releasing new estimates showing 18.7 million older adults and other Medicare beneficiaries will save an estimated $400 per year in prescription drug costs in 2025 because of the president placing a cap on out-of-pocket spending as part of last year's Inflation Reduction Act.

Gearing up for his 2024 reelection campaign as inflation remains a dominant concern for voters, the Democratic president has emphasized his policies to help families manage their expenses, as well as a spate of government incentives to encourage private sector development of electric vehicles, clean energy and advanced computer chips.

Republican lawmakers have criticized Mr. Biden's policies by saying they have spurred higher prices that hurt the well-being of families.

The Biden administration plans to limit what it calls "junk" insurance plans, such as short-term policies that can deny basic coverage as people transition between employers and still need temporary health care coverage.The hospital bills didn't find her, but a lawsuit did — plus interest

Neera Tanden, director of the White House Domestic Policy Council, highlighted the case of a man in Montana who received a $43,000 health care bill because his insurer said his cancer was a pre-existing condition.

"That's not real insurance — that's junk insurance," Tanden told reporters on a phone call previewing the president's remarks. "We will propose a rule to crack down on these plans."

The president also announced new guidance on medical billing stemming from 2020's No Surprises Act. The guidance would limit the ability of insurers that contract with hospitals to claim provided care was not in network and have customers pay more money. Health plans also would need to disclose facility fees that are increasingly charged to patients and can surface as an unexpected cost in a medical bill.

"Frankly, what they are doing is gaming the system — this is not allowed," Tanden said.At least 1.7 million Americans use health care sharing plans, despite lack of protections

The Consumer Financial Protection Bureau and Treasury Department also are seeking information on third-party credit cards and loans that are specifically used to pay for health care. The higher costs and interest charges can discourage people in need of treatment from seeking care.

The president is expected to also highlight previous efforts to reduce health care costs, including a plan allowing Medicare to negotiate lower prices for prescription drugs and a $35 monthly price cap on insulin for people in Medicare Part B.



FOR PROFIT MEDICINE

Prostate cancer patients face financial toxicity: Who is affected and how do they cope?


New insights into financial impact on patients with advanced prostate cancer in The Journal of Urology®

Peer-Reviewed Publication

WOLTERS KLUWER HEALTH



July 7, 2023 – Fifty percent of patients with metastatic prostate cancer experience some level of financial hardship due to their treatment, according to a study in the August issue of The Journal of Urology®, an Official Journal of the American Urological Association (AUA). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Our findings help in understanding the rates of and risk factors for financial toxicity among patients with advanced prostate cancer, along with the coping mechanisms, including the impact on personal spending, experienced by those reporting higher levels of financial toxicity," comments senior author Stephen A. Boorjian, MD, of Mayo Clinic, Rochester, Minn.

"Our most significant finding may be that patients experience financial toxicity despite their ability to remain compliant with treatment," says lead author Daniel D. Joyce, MD. "Simply asking patients whether they are following their suggested treatments is not sufficient to screen for financial toxicity."

New data on financial toxicity rates, risk factors, and coping strategies

The researchers administered a validated questionnaire concerning financial toxicity to all patients seen at their advanced prostate cancer clinic over a three-month period. Financial toxicity – which has been defined as "the harm to patients that results from treatment costs" – has become recognized as important patient-centered outcome. Previous reports suggest that up to half of cancer survivors are affected by financial toxicity, which has been linked to increased rates of adverse treatment outcomes.

Drs. Joyce and Boorjian and colleagues assessed the rate of financial toxicity and the related patient characteristics and coping strategies among patients being treated for metastatic prostate cancer. The analysis included responses from 281 patients, median age 69 years.

Based on the study questionnaire, 79 patients were classified as having high financial toxicity. Overall, 54% of patients said they experienced at least some level of financial hardship related to their cancer treatment. The impact was "more profound" among patients with high financial toxicity, with 89% percent reporting financial hardship.

Patients may make 'profound personal sacrifices' to remain compliant with prostate cancer treatments

Several patient characteristics were associated with higher or lower risks of financial toxicity. Older patients had lower financial toxicity, as each additional year of age was associated with a 25% reduction in risk. For patients who were married (or had a non-married partner), financial toxicity risk was nearly four times lower than for those who were unmarried, widowed, or divorced. Not surprisingly, income was a significant factor: risk of financial toxicity was nine times lower for patients with annual incomes of $100,000, compared to incomes under $20,000.

Patients experiencing high financial toxicity coped in varied ways. They were more likely to decrease spending on basic goods and leisure activities, to use their savings to pay for medical care, to delay filling prescriptions, and to borrow money to pay for their care. "Notably, very few patients reported only partially filling medications or stopping medications altogether due to cost," the researchers write.

More than half of patients with high financial toxicity reported difficulty paying bills – and patients in this group were more likely to have delays in starting cancer treatment. Patients with high financial toxicity were also more likely to use financial assistance programs: 32%, compared to 12% of those with low financial toxicity. "Patients are often unable to meet the high treatment initiation costs without some type of financial assistance program or subsidy," the researchers write.

Dr. Joyce comments: "Some patients may be making profound personal sacrifices in order remain adherent with their prostate cancer treatment, which may have a significant impact on the quality of life that we hope to prolong with these treatments. Conversations about these issues are even more crucial given the observed improvement in financial toxicity among patients in our study who were able to access financial assistance programs."

The researchers highlight the need to identify factors that may mitigate the financial impact of treatments for metastatic prostate cancer. They conclude: "Such data are crucial to understand how to include financial toxicity in shared decision-making and to guide future interventions designed to reduce financial toxicity in this population."

Read [Coping Mechanisms for Financial Toxicity Among Patients With Metastatic Prostate Cancer: A Survey-based Assessment]

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

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About The Journal of Urology®

The Official Journal of the American Urological Association (AUA), and the most widely read and highly cited journal in the field, The Journal of Urology® brings solid coverage of the clinically relevant content needed to stay at the forefront of the dynamic field of urology. This premier journal presents investigative studies on critical areas of research and practice, survey articles providing brief editorial comments on the best and most important urology literature worldwide and practice-oriented reports on significant clinical observations. The Journal of Urology® covers the wide scope of urology, including pediatric urology, urologic cancers, renal transplantation, male infertility, urinary tract stones, female urology and neurourology.

About the American Urological Association

Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, and has more than 23,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health care policy. To learn more about the AUA visit: www.auanet.org

About Wolters Kluwer

Wolters Kluwer (EURONEXT: WKL) is a global leader in professional information, software solutions, and services for the healthcare, tax and accounting, financial and corporate compliance, legal and regulatory, and corporate performance and ESG sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

Wolters Kluwer reported 2022 annual revenues of €5.5 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

For more information, visit www.wolterskluwer.com, follow us on LinkedInTwitterFacebook, and YouTube.

The long-neglected ultraslow spreading Southwest Indian Ocean Ridge not only develops diverse types of hydrothermal systems but also has the potential to form large polymetallic deposits


Peer-Reviewed Publication

SCIENCE CHINA PRESS

Schematic diagram of eHeat-dFault sulfide metallogenic model for SWIR 

IMAGE: THE DIAGRAM ILLUSTRATES THE TWO MAIN TYPES (INTENSE MAGMA SUPPLY TYPE AND TECTONIC CONTROL TYPE) OF METALLOGENIC MODELS ALONG THE SPREADING AXIS OF A MID-OCEAN RIDGE, WITH THE TECTONIC CONTROL TYPE FURTHER DIVIDED INTO ONE-WAY DETACHMENT CONTROL AND FLIP-FLOP DETACHMENT CONTROL. view more 

CREDIT: ©SCIENCE CHINA PRESS


The research findings of Dr. Tao Chunhui, a senior researcher from the Second Institute of Oceanography, Ministry of Natural Resources, were published in Science China: Earth Sciences. Over a decade, Dr. Tao's research team conducted investigations into the distribution patterns and formation mechanisms of hydrothermal activities and associated polymetallic sulfides in the Southwest Indian Ridge (SWIR). They discovered a diverse range of hydrothermal activities with higher frequency and the potential for forming large-scale sulfide mineral deposits than what expected by previous theoretical model. The team also established a sulfide metallogenic model controlled by local enhanced heat supply and deep faults (eHeat-dFault model).

Submarine polymetallic sulfides have significant economic value and are primarily formed through hydrothermal circulation. The two key elements of hydrothermal circulation are the driving heat source and fluid circulation pathways. Through analysis of submarine seismic data, it was found that the driving heat source of the hydrothermal system in the SWIR exhibits local enhanced characteristics, and the depth of the heat source and circulation conduit structures are deeper compared to similar hydrothermal systems in other ridges. These characteristics are mainly manifested in deep magma chambers in the strong magmatic segment, deep detachment faults in the weak magmatic segment, and flip-flop detachment faults in the amagmatic segment. It is commonly believed that the spreading rate controls heat source, magma supply, and tectonic processes. However, this study suggests that the type of hydrothermal circulation system, circulation depth, frequency of hydrothermal activity along the axis, and the scale of sulfide mineralization may be the result of a balance between magma supply and tectonic activity.

For the ultraslow spreading SWIR, local enhanced heat supply and deep fault structures are more direct controlling factors for hydrothermal circulation and sulfide mineralization. The eHeat-dFault sulfide metallogenic model is expected to provide guidance for the exploration and mineralization research of polymetallic sulfides on the ultraslow spreading SWIR.

See the article:

Tao C, Guo Z, Liang J, Ding T, Yang W, Liao S, Chen M, Zhou F, Chen J, Wang N, Liu X, Zhou J. 2023. Sulfide metallogenic model on the ultraslowspreading Southwest Indian Ridge. Science China Earth Sciences, 66(6): 1212–1230, https://doi.org/10.1007/s11430-023-1108-7