Viewpoints: Gottlieb At FDA — A Change Agent Or A ‘Man Who Knows Too Much’?; ‘Prime Time’ For Shared Decision Making

The Wall Street Journal: The Man Who Knows Too Much
Politicians aren’t always as dumb or cynical as they sound, but you wouldn’t know that from Wednesday’s confirmation hearing for Scott Gottlieb. Democrats criticized the nominee to run the Food and Drug Administration for the “conflict of interest” of knowing too much about the industries he’d regulate. (4/5)

The Washington Post: Trump’s Nominee For The FDA Could Be The Leader The Agency Needs
As an investor in early-stage life-science companies, Gottlieb has presumably developed a hard-won, highly valuable understanding of the nuance of product development. This will help him identify opportunities for accelerating the approval process, as well as to head off any nefarious attempts to game the system at the expense of patients. If Gottlieb can leverage his experience as a company builder (along with his experience as a doctor, policy wonk and cancer patient), he might be able to unleash the latent passion within the FDA and inspire its innate creativity. With the right leadership, the FDA — however improbably — might lead us out of our present health-care miasma. (David Shaywitz, 4/5)

The Wall Street Journal: How FDA Rules Made A $15 Drug Cost $400
The theory is that generic drugs should be less expensive than the original. By the time a generic hits the market, the drug’s patent has expired, allowing competition from companies that didn’t spend millions of dollars to develop it. As more options become available, prices are supposed to drop. But because of quirks in America’s regulatory system, it doesn’t always work out this way. (Mark L. Baum, 4/5)

JAMA: The Prescriptions I Write
I write prescriptions most days in my work as a family physician. These prescriptions are often for commonly used medications, such as antihypertensives, antibiotics, and antiglycemics. Writing the prescription is a small part of what happens between a physician and a patient. Recently, I have started to write a different type of prescription. In some situations, these unconventional prescriptions may be as important, if not more important, as traditional prescriptions. (Norah Neylon, 4/4)

JAMA: Prime Time For Shared Decision Making
The recognition that informed patients often choose more conservative and hence less expensive medical options has made shared decision making a focus of value-based care. In 2007, Washington State passed legislation incentivizing shared decision making as an alternative to traditional informed consent procedures and forms for preference-based treatment decisions that include an elective procedure, such as joint replacement for hip or knee osteoarthritis. (Erica S. Spatz, Harlan M. Krumholz and Benjamin W. Moulton, 4/4)

Stat: To Fight Physician Burnout, I'm Making A Binder Of Medical Successes
This doctor was once a student like me. Now she is using vulgar language to describe a patient and flying into a rage because a sub-intern called her. The interaction shook me, mostly because I knew I wasn’t immune to becoming a doctor like her. I started looking for answers about how or why this transformation takes place. An abundance of articles in medical journals made me realize that the health care system can be harmful to doctors’ mental health. Burnout affects all medical specialties, at rates climbing higher than 50 percent. Doctors get worn out by daily battles with insurance companies, cumbersome electronic medical records, and increased patient caseloads. The lack of job control coupled with low reward and high demands increase exhaustion. (Erin Barnes, 4/5)

Stat: Why President Trump Needs To Finally Name A Science Advisor
Insights from science and technology are relevant to many of the decisions about actions and policies that a president must make — whether they deal with the economy, public health, urban issues, transportation, agriculture, land use, the environment, or national security. What are the potential benefits of new gene-editing technologies, and what are the risks? What effect does hotter weather have on agricultural productivity? Could terrorists make an effective nuclear bomb if they were able to steal or buy plutonium or highly enriched uranium? While scientific insights won’t be the only factors the president considers in any given decision, it would be foolish for him to make policy or take action without having the relevant scientific facts. If access to those facts is to be timely, the president needs people close at hand, in the White House, who can find, vet, and explain them. (John P. Holdren, 4/5)

St. Louis Post-Dispatch: Children Are The Collateral Damage Of Nation's Opioid Epidemic
Foster care programs across the country are overwhelmed by an influx of children dubbed by health care officials as “opioid orphans,” collateral damage from the nation’s opioid-addiction epidemic. They are youngsters who have been literally orphaned or left in the care of aging grandparents or other young siblings because of parental drug abuse. Statistics are slim in Missouri, where state Department of Social Services officials have refused to acknowledge or speculate about whether drug abuse has caused the four-year uptick in foster care needs. The department’s latest annual report, with data from 2015, indicates the system is strained. It said more children were entering foster care than leaving, and that social workers need manageable caseloads to help find permanent homes for children. (4/5)

JAMA Forum: Safe Injection Facilities Reduce Individual And Societal Harms
Last winter, the mayor of Ithaca, New York, Svante Myrick, proposed to provide a safe and legal space in which people could inject heroin. It may sound like a radical and desperate way to reduce the harms of drug use. But its effectiveness — and cost-effectiveness — is well supported by research. Supervised injection facilities (SIFs) such as the one proposed by Mayor Myrick are a close cousin to syringe exchange programs (SEPs). The difference is that SIFs don’t just provide clean injection equipment, as SEPs do, but also medical staff for supervision of injection of preobtained drugs, which can prevent unsafe techniques and drug overdoses. (Austin Frakt, 4/5)