Viewpoints: Lessons Learned From Neighboring Countries On Abortion Bans; For Starters, Ask Americans How Much To Invest In Drug Innovation

The New York Times: What Happens When Abortion Is Banned?
Whether we’re marching with coat-hanger posters or passing laws that outlaw the procedure earlier and earlier, we fight over abortion in the United States as if we know what will happen if it’s banned. But as we inch closer to potentially allowing states to recriminalize the procedure — with laws that ban abortions after six weeks, in the case of Iowa, or in the case of Arkansas, even seek to ban the use of abortion-inducing drugs — we would do well to look past our southern border to consider what happens when abortion actually becomes illegal. It’s not the outcome anyone is looking for. (Michelle Oberman, 5/31)

The Wall Street Journal: Three Steps To Fix The Way We Develop New Drugs
In defending their pricing practices, pharmaceutical companies consistently point to one argument: High prices are necessary to support innovation, and innovation is the key to scientific breakthroughs that will save future lives. The argument is persuasive. Our nation’s investment in biomedical research and development (R&D)—the basis for innovation—has yielded huge advances that extend life and reduce suffering. But in pointing to R&D as a justification for high and rising drug prices, the pharmaceutical industry is raising a fundamental question: How should we, as a society, decide how much to spend on research and development, and what should we spend it on? (David Blumenthal, 5/31)

Bloomberg: A ‘Right To Try’ That Americans Didn’t Need
Now that President Donald Trump has signed his long-sought “right to try” law, Americans have a dubious new freedom to bypass the drug quality-control system and experiment with medicines of questionable safety that may or may not work.This solves no real problem. The Food and Drug Administration has long granted access to medicines that are only partway through the U.S. approval process for patients in extreme circumstances who might benefit. But a myth had spread throughout the land, promulgated by conservative groups, that dying patients were being refused permission to try experimental drugs. Congress responded with a feel-good law. (5/31)

Stat: Mergers Between Health Insurers, PBMs Could Be Bad For Your Health
But when a health insurer merges with a pharmacy benefit manager, who controls whom? If you’re an optimist, you’d say that such a union would allow the insurer to take control over drug purchases. The insurer would want to get the best deal for its subscribers to keep premiums down and attract the greatest market share for their insurance products, so it would buy drugs that are cost-effective and avoid lower-value drugs. The problem with this view is that it neglects the possibility that the pharmacy benefit manager might be the tail that wags the dog. (Barak Richman and Kevin Schulman, 6/1)

The Wall Street Journal: How Many Times Has Your Hospital Performed The Surgery You Need? Good Luck Finding Out.
The woman at the other end of the line was overcome with remorse about the hospital where her husband had esophageal surgery. Her voice cracked with strain. Might he still be alive, she asked me, if they had chosen a different hospital? As a physician and hospital administrator for over two decades, I heard stories like this more often than should ever be the case. And it boils down to one simple piece of information that too often isn’t available: How many times has the surgeon and hospital performed the type of surgery you need? (Peter Pronovost, 5/31)

The Wall Street Journal: Three Difficult Questions To Ask About Using AI In Medicine 
Recent demonstrations have illustrated how computers can match or outwit their human physician counterparts in interpreting X-rays, reading pathology specimens, diagnosing heart rhythms, and identifying troublesome moles. Last month the FDA approved the first AI system for diagnosing diabetic retinopathy. These breakthroughs have led to tremendous hope and hype about the potential for AI systems to diagnose alongside doctors–or even instead of them. Before we get ahead of ourselves however, there are a number of legal, ethical, and psychological issues that need to be worked out. (Gurpreet Dhaliwal, 5/31)

New England Journal of Medicine: Beyond Legalization — Dilemmas Physicians Confront Regarding Aid In Dying
“What do you think about physician aid in dying?” Because 18.2% of the U.S. population lives in jurisdictions where physician aid in dying (PAD) is now legal, physicians need to anticipate that patients may inquire about or request it. Two decades ago, when PAD was illegal throughout the United States, 18.3% of physicians reported ever having received a request for assisted suicide; inquiries are likely to be more frequent now. But physicians may feel unprepared, uncertain, and uncomfortable when confronting these conversations, even if they’ve thought through their own position on PAD legalization. (Bernard Lo, 5/31)

Stat: 'Angels In America' Again: It's Time To Humanize Addiction
One of the most sought-after tickets on Broadway these days is “Angels in America,” a revival of Tony Kushner’s seminal play about the AIDS crisis and its aftermath. While only a few of us will be fortunate enough to see the show in person, everyone can benefit from the following insight: When the play originally debuted in 1991, HIV/AIDS was considered a death sentence and slapped with a stigma that isolated and ostracized those with the disease and their families. The same type of stigma is happening now with substance abuse and the opioid epidemic. (Sandeep Kapoor, 6/1)

New England Journal of Medicine: The FDA And The Next Wave Of Drug Abuse — Proactive Pharmacovigilance
In response to the opioid crisis, the Food and Drug Administration (FDA) has taken action on multiple fronts. We have approved better measures for treating opioid use disorder and preventing deaths from overdose, have launched efforts to inform more appropriate prescribing as a way to limit clinical exposure to opioids, have taken actions to reduce the excess opioids available for abuse, and are working to facilitate development of new therapeutics that can effectively and safely help patients suffering from pain. Going forward, the FDA needs to remain vigilant to recognize shifting trends in the addiction landscape. Taking a systematic approach to monitoring such trends should allow us to intervene promptly and appropriately and protect the public from associated risks.Meanwhile, we must be aware that any decisive actions taken to reduce prescription opioid abuse and stem the tide of overdose and death can have unintended consequences, including prompting people to turn to alternative, potentially dangerous substances. (Douglas C. Throckmorton, Scott Gottlieb and Janet Woodcock, 5/31)

The New York Times: A More Egalitarian Hospital Culture Is Better For Everyone
Perched atop a hill overlooking a major thoroughfare, the massive brick tower was a holdout from decades earlier. With green tiles lining the walls, black and white linoleum flooring, and hallways redolent of an antiseptic whose recipe hadn’t changed since the 1950s, the hospital had a distinct postwar feel, and an unchanging culture to go along with it. For surgical trainees like me in the 1990s, the institution’s resistance to change was best embodied by a four-page, single-spaced document affectionately known as “The Hernia List.” (Pauline W. Chen, M.D., 5/31)

New England Journal of Medicine: Innovation For Pandemics
Over recent decades, the world has seen incredible progress in reducing child mortality and tackling infectious diseases. Thanks to better vaccines and other interventions, child mortality has decreased by more than 50% since 1990. We are on the verge of eradicating polio. HIV is no longer a certain death sentence. And half the world is now malaria-free. Yet there is one area where the world isn’t making much progress: pandemic preparedness. This failure should concern us all, because history has taught us there will be another deadly global pandemic. We can’t predict when, but given the continual emergence of new pathogens, the increasing risk of a bioterror attack, and the ever-increasing connectedness of our world, there is a significant probability that a large and lethal modern-day pandemic will occur in our lifetime. (Bill Gates, 5/31)

St. Louis Post Dispatch: Nearly 5,000 Untested Rape Kits Signals Ongoing Injustice To Missouri Victims
Missouri’s backlog of nearly 5,000 untested rape kits represents the failure of the criminal justice system to take sexual assault seriously. Shame on law enforcement and health care authorities who have not prioritized the testing of rape kits, protected survivors or gotten offenders off the streets. Each kit means there is a woman who has not received the justice she deserves and lives in fear that her attacker is free to strike again. Every woman who suffered sexual assault and went to a hospital or police station to be swabbed, scraped and photographed, expected her kit — with its potential wealth of DNA evidence — would be tested at a laboratory as a first step toward getting her attacker off the streets. It would be a gross understatement to say these women have been let down. (5/31)

Boston Globe: How Mass. Could Disrupt Lyme Disease Research
Sunny weather? It’s here. Crowded beaches? Check. Now, for what has lately become the third sure sign of New England summer: Killjoy warnings from health officials about the risk of Lyme disease, the tick-borne malady that may cause fatigue, headaches, joint pain, and other ailments. ...Researchers at UMass Medical School in Worcester have identified a human monoclonal antibody that could defend against Lyme disease with just one annual dose. The medicine, called Lyme PrEP, involves injection of a single protective antibody. It blocks the Lyme-causing bacteria in the tick after it bites — before it can get into the bloodstream. ...“There’s definitely a hunger for a medicine that is preventive,” says Dr. Mark Klempner, a professor of medicine at UMass Medical School in Worcester. (6/1)

Los Angeles Times: There Are Fewer Homeless People In L.A. County — But The Problem Remains Grim And Unacceptable
For the first time in four years, the number of homeless people in Los Angeles County has decreased. It went down by just a modest 3% (and 5% in just the city of L.A.), but that is still a significant reversal of the shocking double-digit increases of recent years.The dip, reported in the official 2018 “homeless count,” was welcome news. The Los Angeles Homeless Services Authority, which administers the count, says that about 16,500 homeless people were housed over the last year, which is the highest number ever. It’s a sign that city and county officials are finally treating homelessness as the crisis it is and directing more time, money and resources into housing, services and outreach. (6/1)