Drug pricing is the hottest topic in healthcare, and ICER founder Dr. Steve Pearson is the coolest person to discuss it with.
In this episode of the HealthBiz podcast, Steve describes how the Institute for Clinical and Economic Review (ICER) compiles and analyzes clinical evidence to estimate the fair value of treatments for cancer and other serious illnesses. ICER has been especially active during the pandemic, developing a pricing model for remdesivir and other COVID-19 therapies that’s being used in the United States and by health technology assessment agencies around the world.
Shahir Kassam-Adams is one of the most knowledgeable and outspoken people in healthcare. In this episode, Shahir shares his initially unsettling but ultimately reassuring view that “data will eat public health.” He opines on interoperability and explains how his company, Datavant has promoted data sharing on COVID-19, leading to a plethora of interesting and potentially useful projects, including one that models the tradeoffs for specific American cities to reopen.
Russia –yes the Russia that exerts special influence on our president– has done a poor job of keeping the COVID-19 virus in check. But now they claim to have a safe and effective vaccine that’s ready to go.
Some suggest that the vaccine may not be safe – or effective.
“It’s obvious that the Russians are rushing the vaccine to market without adequate testing,” David Eugene Williams, president at Health Business Group, told International Business Times in an email. “It’s possible that the vaccine will work, but there hasn’t been enough time to verify that it’s both safe and effective. The Russians haven’t released any data that would support their claims.”
“I don’t think people will travel to Russia to receive the vaccine because, 1) they won’t trust that it will work, 2) they could get COVID-19 on their travels to Russia, and 3) the Russians may allocate it to their own citizens,” he said.
It would be great if the Russian vaccine works. But we’ll have to wait and see –which is something the developers haven’t done.
Patients have been receiving a megadose of virtual care since March. How’s it going and what will it mean long-term? Provider search and scheduling company, Kyruus asked 1000 patients for their opinions and published the findings.
Kyruus Chief Medical Officer, Dr. Erin Jospe and I had a chance to catch up on the report and speculate about its implications in this podcast.
Here’s what we discussed:
(0:15) Key findings and surprises
(1:54) Baby Boomers’ affinity for virtual care
(3:40) Paradox that Baby Boomers are big utilizers of virtual care but not so likely to switch doctors to get it
(6:21) Downsides and limitations of virtual care
(10:55) Impact of virtual care on disparities
(13:47) Potential to launch a virtual-first practice
Purposeful –aiming to meet the objective of educating children in person while keeping them and staff members safe
Timely –coming at the end of the school year, with updates promised over the summer
Evidence based –relying on the latest medical and public health guidance and the experience of schools abroad
Appropriately detailed –with enough specifics to guide decisions that need to be made now without being overly prescriptive
Circumscribed –acknowledging and accounting for issues of racism and disparities without purporting to solve every problem
Balanced –recognizing that we are living in the real world (such as it is!) and that COVID-19 is part of it. None of the measures (hand washing, masks, staying home when sick, social distancing) on their own will prevent the spread, but taken together they have and will
I’m not an easy grader, so my A for this assignment is real. I have publicly criticized Massachusetts’ reopening plan and its testing plan for being vague, non-evidenced based, and irrational. Privately, I’ve admonished the local school system for its defeatist attitude toward COVID-19.
The plan doesn’t set a cap on the number of students in classrooms
COVID-19 testing is not mandated
Daily temperature checks are not required
It mandates only 3 feet of social distancing even though officials have been telling us 6 feet
Superintendents need to develop 3 sets of plans (in person, hybrid, virtual)
No clear guidance on whether state should go back to in-person classes when school reopens
Doesn’t adequately address challenges of urban schools that serve children from disadvantaged backgrounds and have limited space
Racism is not connected to students’ mental health in the plan
It doesn’t say how many students can ride the bus
People don’t like the idea of wearing masks all day
The report itself anticipates and addresses these criticisms. The Globe notes some but not all. Here is the reasoning
Number of students isn’t capped because the relevant constraints are adequate space between desks and proper behavior. If a room is larger it can accommodate more students. The report encourages use of new spaces like libraries and cafeterias
No one in the country (or world?) is seriously suggesting testing all school age kids. It’s expensive, slow, unpleasant, impractical and unnecessary. Maybe there will be cheap, spit tests at some point. They can be used if the need is real
Daily temperature checks produce too many false negatives and false positives, offering a false sense of security and causing students to miss school when they don’t need to. These checks are good for other illnesses, like the flu where fever is a good indication of active infection, but it’s of limited use for COVID-19
There’s no magic in 6 feet. Three feet seems to work fine in other countries’ schools, especially in combination with other measures, like wearing masks. Schools with 3 feet of distance abroad have not had outbreaks. Kids aren’t going to be safer out of school
Superintendents need to develop plans for different scenarios. Of course they do! If they just developed one plan it would have to be for remote instruction only. Is that what we want?
Of course the guidelines can’t be definitive in June about whether students can go back in September. But the goal is to get as many back as possible. To make that happen requires everyone to behave well over the summer (adults, especially!)
Although the plan isn’t going to eliminate disparities or solve racism, there are extra funds to help all schools and especially those with extra needs. And the best way to reduce disparities is with kids in school. Disparities widen (as I’m sure they did this spring) when normal routines are thrown off. For extra space, the guidelines suggest working with local community centers, libraries, etc.
Kids will need to wear masks on the bus. If the bus is crowded then buses will need to be added or kids will need to get to school in other ways. They can keep windows open, too.
It’s true that people don’t like wearing masks all day. The guidelines call for mask breaks and make special mention of how to work with people with breathing or communication problems. If we all behave there’s a good chance we can take our masks off sooner rather than later.
Notably, these guidelines are endorsed by people who know what they’re talking about and have children’s interests at heart. The healthy approach is to work within the guidelines to plan a return to in-person classes this fall. We should continue to challenge the guidelines and expect them to be updated as we learn more and as the situation on the ground evolves.
Meanwhile, we can all contribute to a safer back-to-school scenario by continuing to follow public health guidelines that are knocking the virus down in Massachusetts. The lower the level of community spread, the safer any reopening plan will be.