Too many hospital mergers are ‘flying under the radar’ of FTC, says Harvard prof in NEJM Catalyst report

While the Federal Trade Commission has challenged some mergers and acquisitions of health care systems, it has more work to do — such as stepping up investigations of largely ignored “cross-market mergers,” which may constitute antitrust violations, says Harvard Business School Professor Leemore Dafny and colleagues in a study.

These mergers,  involving hospitals more than 30 minutes apart, have been relatively free of FTC scrutiny,  a study about “cross-market mergers,”  says in an article  I wrote for  the New England Journal of Medicine Catalyst

pexels-photo-hospital-239853“There is a whole set of potentially problematic mergers that flies under the radar,” Dafny says.  “Cross-market is a different frontier, and it is time to turn attention to it.”

Since its publication in March, the Dafny study “has made waves within antitrust circles,”the NEJM Catalyst report says.

A Young Entrepreneur Cracks the Code of Healthcare Inefficiency

Everybody is talking about value-based care, says Chris Bradley, CEO of Mana Health, referring to the term for new paths to treat patients with more efficiency across healthcare systems.

The move to value-based care, payment for procedures a patient wants and needs, has been a focus for hospital systems as they move from a traditional fee-for-service models, a kind of payment that is extremely variable, and not based on quality. Procedures, such as imaging and screening, can have great variations of cost regardless of the kind of care, according to Dartmouth-Hitchcock.

But value-based care has little value if the technology isn’t working, the electronic health records are slowed, and the cost of integrating a system is nearly half million dollars, never mind that doctors and administrators aren’t happy about it, Bradley says.

Yet that’s where a lot of hospital systems and health centers find themselves.  “Let’s be honest, it’s not where it could be,” Bradley says. “The EMRs (electronic medical records) themselves, they are not as useful as people had hoped, and for interoperability, many haven’t seen them take off as they thought.”

Interoperability is the extent into which systems and devices exchange and interpret data.

The immense possibilities – and sometimes improbabilities – of healthcare is what got Bradley into this business. He is the founder and co-owner of New York City -based Mana Health, a technology provider that focuses on healthcare data access solutions, with the idea of making them faster, and more cost-effective.

The idea of Mana Health – which means ‘flowing energy’ – is to streamline data access, interoperability, and innovation. The analogy makes sense for Bradley, who has a neuroscience background, who grew up in a family of doctors and initially thought he’d go into medicine. Instead, he found he could help more people on the technology end of things.

“We want to crack the code of having a sustainable and scalable network.”

The company touts its innovative key data access programs, including those named ManaCloud, ManaCreate and ManaPortal.  ManaCreate works, in part, to reduce the usually  time-consuming function of bringing IT systems to market, and the company has a specific focus on application program interface (API), the protocols and tools to building software applications.


Bradley says there is a growing movement to standardize the way applications can access data, through API, which has been “notoriously absent in health IT until very recently” in an article he wrote for  MedCity News.

Integrating and launching an application on top of medical data can be a nightmare, and getting the data into the application and hosting that data in a HIPAA (The Health Insurance Portability and Accountability Act of 1996) compliant service is where things slow down and cost begins to spin out of control, Bradley says.

Although Mana Health is only a few years old, Bradley says it is growing its clientele, and has recently completed a program for an as yet undisclosed upstate New York hospital system that may save them upwards of $1 million. In one plan, Mana Health is working on proposals to develop a chat room for patients and families, where they can create data “and everyone knows what’s going on,” Bradley says.

Bradley puts it this way in a statement: “A cardiologist envisions treating patients faster with the right data points and providing targeted content. She is certain that with this experience she can improve outcomes.” So, where does she go from there? Bradley says.

“With ManaCreate and an efficient development team, she can expedite the design process, integrate all the right data and move into deployment mode faster for the betterment of healthcare,” Bradley adds.

“Data and interoperability and API, that is now a hot area,” he tells me.

Bradley says he recently attended a CEO roundtable, and the discussion was supposed to be about “value-based care, and that’s what they wanted to talk about. It delved into a conversation about interoperability. You cannot have value-based care without it.”

But when the CEOs talk about what they want, or the problems they face, often the topics revolve around data: it can be applications they want to deployed faster, saving millions from an EPIC investment, or improve tracking of patients with EMRs. “The one thing they have in common is the data” question, he says.

“That’s the highest value problem to solve,” he says of the data.

“Sometimes (healthcare leaders) don’t know they need to solve it until they go down that rabbit hole and realize, ‘Wait a second, I’m being asked to implement a variety of population health measures to integrate an (Accountable Care Organization), and I can’t because these systems don’t work with each other.’ Then you say you have an API, and you can launch an application in weeks instead of six months, they say ‘that’s interesting.”

“That,” he adds, “is how we get into it.”

Will the anti-depressant you take work? Researchers looking for clues: smiles included

As more Americans take antidepressants, the feeling is that the already large numbers may grow considerably in the stress-filled world we are in. Look how turbulent the past 12 days have been in light of the elections.

What if we can predict what antidepressants would work for some patients, or not, based on their childhood stresses, and brain activity, and studying their facial expressions, such as smiles?

That could mean a big difference, not only for patients, but for healthcare, and its spending on medications.

A team from Stanford University led a study to do that very thing; they “created a model, based on brain activity and exposure to stress in childhood, that predicts the likelihood that antidepressants will benefit a patient,” according to a recent National Institutes of Health Research Matters story Predicting the Usefulness of Antidepressants. The model has a80 percent accuracy for prediction of antidepressants helping patients.

“Addressing this question could provide a new mechanistic understanding of why some individuals respond to antidepressant treatments and others do not, as well as offer new targets for intervention,” the researchers said in the study.

The study findings indicate that many patients who faced stressful situations should be considered for other therapy techniques before medication.

Certainly, however, many people are now taking the meds.

In 2013, Roni Caryn Rabin of The New York Times wrote that the use of antidepressants skyrocketed, with one of 10 Americans taking antidepressant medications. Last November, Justin Karter reported in Mad in America that from 1999 to 2012, the percentage of Americans on antidepressants increased from 6.8% to 13%, citing the Journal of American Medical Association.

Not only are the numbers increasing, but a report in the Medical Daily show that most people take some type of anti-depressants, even though they don’t need it.

Finding the keys to antidepressants

As Tianna Hicklin, a writer at the NIH who wrote about the federal agency sponsored study, notes, antidepressant medications usually are linked to the treatment of depression, but done so as a result of a “trial and error” process.

So researchers looked into the mechanism of depression, examining patients’ stressors at childhood, and the brain’s handling of emotions. They reviewed  data from 70 patients who had  major depressive disorders, and asked them how many life stressors they had experienced before age 18, Hincklin wrote. Those stressors could include abuse, neglect, family conflict, illness, or death and natural disasters, she said.

In the meantime, the  researchers evaluated the amygdala activity of the brain linked to depression. Amygdala is a mass of gray matter inside each cerebral hemisphere. The researchers found that amygdala circuitry and early life stress (ELS) are both “strongly and independently implicated in the neurology of depression,” the team, led by Leanne Williams and Andrea-Golstein-Piekarski said. Williams did not respond to questions from Health Data Buzz.

Impact of Smiles

Using an MRI, the researchers measured brain activity in patients  and  viewed pictures of “emotional faces,” including smiling,  Hicklin wrote. Brain scans were taken before and after patients started taking antidepressants.

Ironically, antidepressants were less likely to work for those patients considered in the high -stress category, but “these patients had a greater chance of benefiting from the medications if their brains were highly responsive to happy facial expressions,” Hicklin added.

Also, patients with low childhood stress were most likely to benefit from antidepressant treatment. Their chances increased if their brains were less sensitive to both happy and fearful stimuli,” according to Hicklin.

“These results suggest that, for some patients, it might help to first try therapy techniques that address the impact of trauma in a person’s life before considering medication,” she wrote.




Cancer Moonshot: Shared Hope, Yet Still Not Enough Cooperation

President Nixon announced the war on cancer in 1971, in which we as a society are still slogging through, this immense battlefield. Vice President Biden, who ends his term in January, says one of his regrets is that he wouldn’t have been the commander-in-chief to preside over the “end of cancer, as we know it.”

He knows the heartbreak that cancer could cause, with the loss of his eldest son, Beau, who died at age 46 in 2015.

Of the VP’s vision to end cancer, he noted, “I said it, because I believe it’s possible.”

Is it?

There’s much to be happy about the progress we’ve made, as Biden said delivering the Cancer Moonshot task force report, a strategic plan to transform cancer research and care, to President Obama, since its work began in January.

Some of the areas of innovation and hope are wrapped around coordination and cooperation, the possibility  for penultimate team approaches.

There is still much to be concerned about, however: because there is still not enough coordination and cooperation, holes significant enough to stymie progress. Moreover, there may be questions ahead about research funding, because without the money, no matter how big the dreams, research will only go so far.

There is a $1 billion plan, but there are questions now with the GOP- led Congress and an incoming Donald J. Trump administration, and  how much money will actually be pumped into research, in which the new president-elect has not tipped his hand, or has shown conflicted interest.

Sharing Information

Let’s start with the question of sharing information to get us moving along the best path of the Cancer Moonshot. In science and elsewhere, it’s not easy. Biden notes there has been much progress, but there are still outstanding issues to be resolved.

The existing obstacles cited by Biden, in the words of the report:

  • Rapidly and effectively poor retention and recruitment in cancer clinical research trials
  • An antiquated culture of research and funding
  • Failure of sharing of medical records
  • Insufficient collaboration, (and) slow dissemination of cancer center knowledge.

What Biden Sees Ahead

Biden said he was convinced that the obstacles are not insurmountable.

The vice president didn’t want to dwell on the pitfalls. He noted the tremendous progress that has been made in bringing together some teams in research. Inevitably, the idea is to have more people understand the impact of the data and help them control their own healthcare.

Five years ago, oncologists weren’t routinely working closely with immunologists, virologists, genetics, chemical engineers and others – now they are, Biden said.

It’s different today. There are at least 70 commitments of partnerships, public and private, under Cancer Moonshot. Among them: the National Cancer Institute, Amazon Web Services and Microsoft are announcing a collaboration to build a sustainable model for maintaining cancer genomic data in the cloud. In addition, the Department of Defense  is establishing a groundbreaking new study to transform an  understanding of the biological basis of cancer. The administration says researchers will have at their fingertips potentially 250,000 samples to uncover new connections between the earliest signs of cancer.

The Money Issue

What’s ahead next year is uncertain as the GOP swept the House and Senate as well as the White House. Some analysts believe that Trump isn’t inclined to be a large booster of research programs in science, but the verdict as of yet is pretty unclear.r

Some analysts believe that President-elect Trump is not inclined to be a large booster of research programs in science, while others do not. It’s a mixed forecast, according to the Verge.  The media outlet noted that Trump had told a conservative radio host the NIH was “terrible” but told  Scientific American “we must make the commitment to invest in science, engineering, healthcare and other areas that will make the lives of Americans better, safer and more prosperous.”

When the Obama administration launched the National Cancer Moonshot program, officials described it as a $1 billion initiative to provide funding for researchers to speed up development of new cancer detection and treatments the White House said. The initiative would begin immediately with $195 million slated for new cancer initiatives at the National Institutes of Health (NIH) in fiscal year 2016.

Recently, the American Association for Cancer Research has asked Congress in its “lame duck” session to support a $2 billion increase for the National Institutes of Health in a fiscal year 2017 appropriations bill. That includes $216 million for the National Cancer Institute.

The AACR  calls for “alternative funding stream for targeted multi-year initiatives” such as the National Cancer Moonshot Initiatives, and other programs.

Nearly everyone involved, as one official told me, “has their fingers crossed.”

“The mission of this Cancer Moonshot is not to start another war on cancer, but to win the one President Nixon declared in 1971,” Biden said.

To do so, the battles must be consistently – and cooperatively – fought.



Progress Against Tobacco Use. Yes. But…36 Million Smokers…Still

Lots of people are quitting cigarette smoking, current federal data  released  yesterday show, but there is a lot more to do to crash that fogged-up window of nasty tobacco use, with an uneven effort seen in too many states to enact tobacco prevention or control programs. Indeed, there are still 36 million smokers in this country, according to the Centers for Disease Control and Prevention.

“Sadly, nearly half (of the people) could die prematurely from tobacco-related illnesses, including 6 million from cancer, unless we implement the programs that will help smokers quit,” said CDC Director Tom Frieden in a statement.

Forty percent of cancers diagnosed in the U.S. may have a link to tobacco use, according to the CDC’s Vital Signs report.

Tobacco use is the leading preventable cause of cancer and cancer deaths. Each year, between 2009 and 2013, about 660,000 people in the U.S. were diagnosed with, and about 343,000 people died, from a type of cancer-related to tobacco use, according to the  CDC. Three in 10 cancer deaths are linked to cigarette smoking, but since 1990 about 1.3 million tobacco-related cancer deaths have been avoided, the agency said.

“When states invest in comprehensive cancer control programs – including tobacco control – we see greater benefits for everyone and fewer deaths from tobacco-related cancers,” said Lisa C. Richardson, director of CDC’s division of cancer prevention and control.

“We have made progress, but our work is not done,” Richardson said.

There has been progress indeed. Cigarette smoking among U.S. adults declined from 29.0 % (45.1 million) in 2005 to 15.1% (36.5 million) in 2015.

During 2014-2015 alone, there was a 1.7 percentage point decline, resulting in the lowest prevalence of adult cigarette smoking since the CDC’s National Health Interview Survey began collecting data in 1965.

The CDC has touted “comprehensive cancer control programs” that the agency says “focuses on reducing cancer risk, detecting cancer early and improving cancer treatments.” That helps more people survive cancer, or improve survivors’ quality of life.

But “not all states or all people have experienced the benefits of these efforts,” the CDC says, noting: “tobacco prevention and control resources, along with access to medical care and cancer treatment, vary widely across the U.S.”

The incidence and death rates were highest:

  • Among African-Americans compared with other races or ethnicities
  • People who live in counties with a low proportion of college graduates
  • People who live in counties with high poverty levels.

Tobacco use was highest in the Northeast (202 per 100,000 people) and lowest in the West, (17 per 100,000 people). Tobacco-related  cancers were higher among men (250 per 100,000 people) =then women (148 per 100,000 people).

It’s time for states, counties and local communities to help our neighbors stop smoking. Smokers can get free help by calling 1-800-QUIT-NOW. You can also get additional  resources from the CDC on the internet.





Sanders Burned Up In a Big Way Over Big Pharma: Will Trump Join the Fray?

Sen.  Bernie Sanders was torching the  Twitter lines in a big way over being fed up with pharmaceutical  price hikes, especially over the past month or so. Once the debris is cleared over the Democratic mess following Donald Trump’s surprise victory, Sanders is likely to raise the heat,  I’m sure. Will Trump join in?

Yes,  Sanders  has been on a rampage, decrying drug costs and Big Pharma, but there’s been more than talk: he’s also been seeking investigations into reasons behind some of these price hikes, such as the cost for insulin medication Humalog, which has  increased nearly 700% since 1996 (adjusted for inflation).  Last week, for instance, the Vermont Senator and Rep. Elijah Cummings of Maryland sent a letter to the Justice Department and the Federal Trade Commission to “investigate potential collusion among pharmaceutical companies that manufacture diabetes products.”

“Why has the price of Humalog insulin gone up 700% in 20 years,” Sanders said on Twitter. “It’s simple. The drug industry’s greed.”

In another tweet on drug pricing, he wrote: “The business model of the drug industry is a fraud.”

And another, “9 out of 10 Americans blame the pharmaceutical industry for the high cost of healthcare,” Sanders said.  “It’s time to end their greed and lower drug prices.”

How does the Sanders drum-beating sound to Trump? Trump hasn’t been shy about the pharmaceutical industry, but has not specifically complained about specific companies for over-pricing.  In a STAT article  “Say what you will about Donald Trump. He’s right about drug companies,” a Trump supporter physician said that Trump was “honestly and forthrightly calling Big Pharma on its Big Baloney.”

But John LaMattina in Forbes noted he wouldn’t be surprised to see legislation that allows Medicare to negotiate drug prices, but  “if anything the group NOT likely to support such legislation would be Republicans and not Democrats.”

When it comes to drug prices, Sanders is all over it.  He’s referred to news articles and reports about outrageous drug prices, and he’s jumped on them, including a comparison of U.S. drug costs and those in Europe.

“It makes no sense that the same drug that costs $70 in France  costs $450 in the U.S.,” he said. “We should reduce barriers to importation of drugs.”  Trump also has discussed allower less expensive drugs made abroad to be sold in the U.S.

“Americans shouldn’t pay higher prices than Canadians for the same drugs simply because Congress is bought by the pharmaceutical industry,” he said.

In August, Sanders also  blasted the pharmaceutical company Mylan, referring to its generic EpiPen that costs three times more than it cost in 2007.  He also stepped that argument  last month when Reuters reported that EpiPen price increases added millions of dollars to Pentagon expenses.

“The greed of Mylan and the entire pharmaceutical industry is out of control.”











Trump: Ditch Obamacare on Day One. Will He?


Donald Trump’s stunning victory early this morning as the 45th president of the U.S., coupled with the GOP takeover of the Senate and House, could mean trouble – or the end – of Obamacare.

Just ask President-elect Trump.

Trump said  Hillary Clinton called to concede, and that he  wanted to “bind the wounds of division.”  There may be many division ahead, not the least of which what may happen with Obamacare. Trump didn’t mention it but remember: “On day one of the Trump Administration, we will ask Congress to deliver a full repeal of Obamacare,” Trump says on his campaign website.

In the weeks before last night’s election, in which everything from FBI miscues to miscalculations by pundits was highlighted, Obamacare also played a role when it was announced recently some premiums would be increased by 25%.

While the defeated Hillary Clinton was ready to continue Obamacare, or the Affordable Care Act, Trump has been defiant anytime he discussed it.

“As it appears Obamacare is certain to collapse of its own weight, the damage done by the Democrats and President Obama, and abetted by the Supreme Court will be difficult to repair unless the next President and a Republican Congress lead the effort to bring much –needed free market reforms to the healthcare industry,” Trump said on his website.

“It is not enough to simply repeal this terrible legislation,” he said. “We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country.”

While Trump continually has pounded on the campaign trail about Obamacare, he specifically lambasted the administration for increased Obamacare premiums.

“On November 1, just before the election on November 8, new numbers are coming out which will show 40, 50, 60% increases,” CNN quoted Trump saying at a September 16 campaign rally in Miami. “They want to delay it until after the election because it’s … a disaster.”

As USA Today reported in October as federal exchange opened up, premiums would be increased 25% for plans for which the tax subsidies are calculated.