Should ICER be NICER? The case for analyzing the value of drugs

It’s a tree of ICE, for those who hold fast to it

The headline in today’s Boston Globe —Price watchdog’s influence on drug makers expands; As nonprofit assesses treatments, some fear it inhibits key options— could have been written by a drug industry lobbyist. [And maybe it was, since the online headline instead uses the squeaky phrase ‘mouse that roared.’]

The article itself is more balanced. Of course it quotes the parents of a couple of kids who take expensive meds, objecting to anyone putting a price tag on their lives. But it also quotes health economics experts pointing out that the price can’t be infinity.

The Institute for Clinical and Economic Review (ICER) follows a data-based approach to assessing the value of drugs, utilizing Quality Adjusted Life Years (QALY) and other well developed metrics. It provides guidance on what a drug could be worth, both on an absolute basis and relative to other treatment options. It doesn’t set prices or prevent a drug from being made available by a public or private health plan. At most, it helps contain the prices of drugs that enter the market and points out cases of outright rip-offs.

Elsewhere in the world (pretty much everywhere) there are real forces limiting drug prices and impacting access. In the UK for example, the National Institute for Health and Clinical Excellence (NICE) decides which drugs and treatments will be provided to patients in the National Health Service. Sometimes drugs are rejected or their use is heavily restricted. On the flip side, patients don’t pay for the drugs that are approved.

In the US the drug pricing forces are heavily weighted in favor of higher prices. We shouldn’t fret about an entity like ICER.

Many drug companies have decided to play ball with ICER by providing data to help justify the value of their products. Some, like Vertex and Serepta have pulled back, saying ICER is biased against drugs for rare diseases. I don’t read ICER’s analyses that way.

The quality of ICER’s research is high, but of course the reports are limited by the data and analytical techniques that are available to the organization. The correct response is to build up the availability of real world evidence (RWE), especially from clinical registries that demonstrate how a drug actually improves (or doesn’t improve) the lives of patients. Patient-generated data and information from claims and electronic medical records can be helpful as well.

With better data we can have answers we are more confident in, and we can accumulate evidence on how drugs perform after they are launched, which can offer a refined understanding of their value.

Thanks to the 21st Century Cures Act, enacted in 2016, there is an increased demand for the generation of RWE. The industry is ramping up its spending on RWE for drug approval, safety monitoring, and reimbursement. New analytical techniques and enhanced data availability from wearable devices and other electronic sources are ushering in a heyday for RWE.

—
By healthcare business consultant David E. Williams, president of Health Business Group.

 

 

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Moments of clarity in dementia patients at end of life: Glimmers of hope?

It happens unexpectedly: a person long thought lost to the ravages of dementia, unable to recall the events of their lives or even recognize those closest to them, will suddenly wake up and exhibit surprisingly normal behavior, only to pass away shortly thereafter. This phenomenon, which experts refer to as terminal or paradoxical lucidity, has been reported since antiquity, yet there have been very few scientific studies of it. That may be about to change.

* This article was originally published here

Chocolate Milkshake

updated post, orig pub: 4/26/09 This recipe is for a straight up, dessert-tasting, vegan Chocolate Milkshake. But I promise, this tall, frosty, creamy concoction is absolutely good for you.....Read more »

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Zero Waste Homemade Oat Milk

This Homemade Oat Milk requires only 2 ingredients and about 5 minutes of your time to prepare. Incredibly easy, it costs nearly nothing to make, on top of generating absolutely zero waste. It’s a no fuss, no mess and no straining needed recipe. Simply put: there’s nothing not to love about it! I don’t know […]

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* This article was originally published here

Sometimes, a non-invasive procedure will suffice

When a patient complains about chest pain, diagnosis will usually involve catheter angiography to evaluate the adequacy of blood supply to the heart. Researchers have now established that, in certain cases, the diagnostic reliability of non-invasive coronary computed tomography (CT) angiography is as good as that of coronary angiography - thereby dispensing with the need for invasive procedures.

* This article was originally published here

Shiitake Bacon Grilled Cheese

This Vegan Shiitake Bacon Grilled Cheese Sandwich is the ultimate savory comfort food. Whip it up in minutes and enjoy cheezy flavor and loads of mushrooms. I am always looking for delicious ways to add more mushrooms to my diet and this recipe really worked for me! Get the recipe...Read more »

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* This article was originally published here

Trump To Sign Executive Order Aimed At Health Care Costs

As a candidate, President Trump argued that the government should work to lower drug prices. As president, his administration is finding that his promise is more complicated to keep than expected.

* This article was originally published here

More than 5 million cancer survivors experience chronic pain, twice the rate of the general population

More than 5 million cancer survivors in the United States experience chronic pain, almost twice the rate in the general population, according to a new study.

* This article was originally published here

Homemade Creamy Cashew Butter

Stop spending fortunes on store-bought creamy cashew butter! 5 minutes and 3 ingredients are all you will be needing to make your own at home, for a fraction of the price. With it’s natural butteriness and subtle sweetness, raw cashew butter has to be, bar none, my favorite of all nut butters. Especially when it’s […]

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A Russian Biologist Wants To Create More Gene-Edited Babies

A Moscow scientist claims he has a safe way of editing genes in human embryos — a method that could protect resulting babies from being infected with HIV. Approval of the experiment seems unlikely.

(Image credit: Gregor Fischer/picture alliance via Getty Images)

* This article was originally published here

Rainbow-Colored Smoothies

I was craving some color and fun in the kitchen, so these Rainbow-Colored Smoothies happened! Today I want to show you how to use sweet, antioxidant-packed fruit (and other plant-based ingredients) to create a smoothie in every color of the rainbow..Read more »

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Vegan General Tso’s Tempeh

This healthier, vegan General Tso's Tempeh features chunks of crispy fried tempeh, all drenched in that deliciously sweet, tangy and slightly spicy sauce we all love so much.

Man, do I ever love me a good General Tso's... Anything! I mean typically, General Tso's is supposed to be made with chicken, right? But honestly, I think that the sweet and sticky and tangy and slightly spicy sauce that makes the dish what it is goes well with just about everything: tempeh, cauliflower, mushrooms, tofu, TVP, name it!  If I had my way, I'd have a recipe for each and every one of those options on the blog! But hey, there's plenty of other dishes worth exploring too, so this might have to wait a bit... 

For now, let's go with tempeh! While nothing will ever perform exactly like chicken, tempeh is a very decent "replacement", me finds. Once deep-fried, it gets all nice and crispy on the outside and keeps a soft, slightly chewy and tender interior. 

Cuz yeah... typically, General Tso's is supposed to be deep fried, to make those sauce-drenched morsels of food all nice and golden and crispy. While I do tend to agree with that concept, I often find that I'm not really in the mood for deep frying, or that I don't really have time for all the fuss...  With that in mind, I'm giving you the option here: to fry or not to fry. For the blog post, I went all out and took the deep-fried route, but say you were in a pinch, or simply preferred to pass on the deep frying, you could just as well take a short-cut and skip that entire deep-frying section. 

Although I must admit that if you forego the deep-frying, your tempeh nuggets won't be getting that nice, yummy, crispy exterior shell; so if time and mood permit, I say you should totally go for it. 

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* This article was originally published here

Raw Sprouted Chickpea Hummus

Because it uses raw, sprouted chickpeas as a base, this fluffy, creamy Raw Sprouted Chickpea Hummus is extremely nutritious - a veritable nutrition powerhouse - packed with all kinds of energy and healthful nutrients. Oh, and did I mention it's insanely tasty, too? Yeah, oh yeah...

Using raw sprouted chickpeas to make hummus has many, many benefits. Not cooking the chickpeas after they have sprouted not only preserves all their nutritional value, but sprouting them actually magnifies their vitamin and mineral content, improves the quality of the carbs  and protein they contain and neutralizes their anti-nutrients and enzyme inhibitors. This renders sprouted chickpeas very easy to digest with highly absorbable nutrients. Sprouts are also fairly low in calories, yet very filling because of their high fiber and water content.

Another undeniable advantage is that not having to cook the chickpeas before to use them makes the process of making hummus from scratch a total breeze! From start to finish, you'll have delicious hummus on the table in well under 10 minutes. Well, that's AFTER the peas have sprouted, that is... That sprouting process will take about 3 to 5 days, so it's not a recipe you can decide to whip up a the last minute...

If you have never made your own sprouts, I strongly suggest that you start! Sprouting, like many other things in life, seems pretty intimidating until you actually try it. 

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* This article was originally published here

Hypertension drug may hold promise for Alzheimer's disease

The blood pressure drug nilvadipine increased blood flow to the brain's memory and learning center, without affecting other brain regions among people with Alzheimer's disease. These findings indicate that the known decrease in cerebral blood flow in patients with Alzheimer's can be reversed in some regions. However, it is unclear if this translates to clinical benefits.

* This article was originally published here

Warm Pasta Salad with Tofu Rapini and Bell Peppers

This no fuss vegan Warm Pasta Salad Perfect is meant to be eaten warm, but is just as tasty at room temperature or even right out of the fridge, making it a perfect choice for any season or any occasion!

Here's another super quick, super easy, no fuss pasta recipe that I came up with yesterday. 

It was 4:30 in the afternoon, I had ZERO inspiration, close to nothing in the fridge, yet I had to come up with a blog post for today, AND make supper for HubB2B and I. So I grabbed whatever I thought would work great together (down to my last tablespoon of Dijon mustard, that's how bad I need to hit the grocery store!) worked a little bit of magic and this is what came out at the other end. 

You know what they say, right? Sometimes, the best recipes are created out of bare necessities. Well, this is definitely one of them! Man is this thing ever yummy! And the good thing is you can totally adapt it to whatever "necessities" you have available at the time, too. Use broccoli, kale, broccolini, spinach, collards, arugula, or whatever greens you happen to have on hand instead of the rapini. Likewise, you could totally replace the bell peppers with carrot sticks, mushrooms, zucchini, aubergines, tomatoes... feel free to add or sub!    continue reading

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* This article was originally published here

Pass The Brazier: Early Evidence Of Cannabis Smoking Found On Chinese Artifacts

Humans have been smoking pot to get high since the first millennium B.C. Archaeologists have found early evidence of cannabis use from wooden bowls exhumed from ancient tombs in western China.

(Image credit: Xinhua Wu/Science Advances)

* This article was originally published here

Salmonella resistant to antibiotics of last resort found in US

Researchers have found a gene that gives Salmonella resistance to antibiotics of last resort in a sample taken from a human patient in the US The find is the first evidence that the gene mcr-3.1 has made its way into the US from Asia.

* This article was originally published here

Fresh Strawberry Ice Cream

This dairy-free, vegan Fresh Strawberry Ice Cream is made using juicy-sweet summer strawberries and buttery cashews as the base. Cashews create my favorite DIY ice cream. The texture churns up ultra-creamy and rich, the sweetness perfect and the fresh strawberry flavor the star of the show. So if you are obsessed with summer berries right now like me, give this healthy treat recipe a try...Read more »

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* This article was originally published here

Mushroom Rapini Gnocchi

Ready in no time, this Mushroom Rapini Gnocchi recipe is so simple and easy to make, yet so crazy tasty, you'll probably want to add it to your regular rotation!

I've been all about quick and easy food making lately... For some reason, I just haven't really been in the mood for cooking; More often than not, I find myself whipping up huge salads filled with tons of veggies, nuts, dried fruits and legumes. 

But this recipe, I came up with one night that hubby-2-be and I were at the cottage and decided to stay an extra night, so we didn't have much of anything left to eat. I basically grabbed what we had on hand and tossed it all together. And then I had one bite and fell in love. I can't even tell you how many times I've had this exact same dish, since. 

Of course, to make it I use store-bought gnocchis, otherwise it would be anything BUT quick and easy. But decent store-bought gnocchis can be found. The ones I use are organic and made mostly from potatoes, as well as a few other simple ingredients. They can be kept in the pantry just like dry pasta, and can be a major life saver for those nights when you don't really have much to work with, you know. 

So grab a package of your favorite gnocchi, or make your own if you are so inclined, a bunch of rapini, a pint of mushrooms and a yellow onion, and try this simple, unpretentious but oh so delicious dish for yourself. I'm positive that you too, will fall head over heels for it. 

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* This article was originally published here

BLT Salad

This fast, easy and flavorful BLT Salad is perfect for lunch. You could also serve it alongside a pizza or pasta at dinnertime. Or you could double the portion size for a full on entree salad. Creamy vegan ranch dressing coats crisp romaine lettuce, juicy summer tomatoes and tempeh bacon bits too. Add some steamed broccoli if you'd like and a hefty portion on buttery avocado on top...Read more »

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* This article was originally published here

AI tool helps radiologists detect brain aneurysms

Radiologists improved their diagnoses of brain aneurysms with the help of an artificial intelligence algorithm developed by medical experts and computer scientists.

* This article was originally published here

Study links sleep-disordered breathing to age acceleration

Increasing severity of sleep-disordered breathing and sleep disruption are associated with epigenetic age acceleration, according to preliminary results of a new study.

* This article was originally published here

Disturbed sleep linked to mental health problems in natural disaster survivors

Preliminary results from a new study suggest that sleep disturbances are associated with mental health problems among survivors of a natural disaster even two years after the event.

* This article was originally published here

Peanut Butter Oatmeal Chocolate Squares

Peanut Butter Oatmeal Chocolate Squares... Need I say more? Chocolate, Peanut Butter... that's all you need to know, right? Oh, and also vegan, gluten-free, made with a bunch of wholesome ingredients, super quick and easy to make. But really, who cares? Peanut butter and chocolaaaaate! Oh yeah, I know!

Peanut butter and chocolate... simply put, they're a match made in heaven! Some dreamy food combination thought up by the gods themselves. Right? Right! 

If you agree with the above statement, then you need to stop what you are doing right now and immediately run to your kitchen to whip up a batch of these babies. You won't believe how much flavor they pack under their hood! Think Reese's Peanut Butter Cups, to the tenth power, in a much less sweet version. We're talking intense dark chocolate jab followed by a crazy peanut butter uppercut. These bars, they will send you straight to the floor, I tell you.

The best part is they are super super quick and easy to make! Ready in under fifteen minutes (well, the bad news is you then have to give them time to set... but just keep yourself occupied and that hour will totally fly by) and won't even dirty up the kitchen. All you need to make them are a few basic kitchen implements and a handful of simple ingredients.

Seriously... so easy, even a child could make them! 

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* This article was originally published here

Circling the wagons in Rhode Island: I’m quoted in the Boston Globe

I’m getting tired of this

Looks like Rhode Island would rather create a health system monopoly than allow in a competitor from Big Bad Massachusetts. Partners HealthCare has been trying to acquire the second largest hospital system in RI, but now the governor has pulled together the three biggest systems to see if they can come together instead.

Partners is staging a tactical retreat (see Partners pulls out of talks for Rhode Island health system) in the Boston Globe.

Thankfully, I am not privy to the details of how things operate in Rhode Island and I don’t know how hard these three systems’ heads are being banged together to get them to team up. But my guess is there’s a good chance the parties will fail to coalesce and that Partners will be back.

Here’s what I told the Globe:

“It was clear that some of the powers that be in Rhode Island want to maintain a Rhode Island-dominated health care system,” said David E. Williams, president of Health Business Group, a Boston consulting firm.

“I don’t think it’s actually going to solve any of their economic problems,” Williams said, “and I think it’s reasonably likely that Partners will be back at the table in three to six months after Rhode Island determines that going it alone is not viable.”

—

By healthcare business consultant David E. Williams, president of Health Business Group.

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* This article was originally published here

How Doctors Can Stop Stigmatizing — And Start Helping — Kids With Obesity

Physicians often harbor unconscious bias against kids and teens with obesity. It affects how they talk with their patients and can make kids' health worse. Some doctors are trying a new approach.

(Image credit: Andrea D'Aquino for NPR)

* This article was originally published here

'Well' Explores The Social And Political Underpinnings Of Health

In a new book, physician Sandro Galea calls for a change in how we talk about health in America. The real drivers of wellness, he argues, are not personal choice, but our history, policies and values.

(Image credit: WIN-Initiative/Getty Images/WIN-Initiative RM)

* This article was originally published here

Cashew Maple Spread

Much healthier than the fake, overly sweet store-bought stuff, this deliciously creamy Cashew Maple Spread requires only 2 ingredients and 5 minutes of your time to make! A heavenly treat that will no doubt become a pantry staple! 

When I was a kid, my mom would always buy relatively healthy food for us... Breakfast food items would include things like whole wheat bread, whole grain cereal, granola, apple sauce, peanut butter and all natural fruit jams. Sometimes, though, she would let me and my brothers choose a little indulgent treat for ourselves. Me? I would invariably choose the same thing: Map-O-Spread. Boy, oh boy did I love that stuff! If you're not familiar, it's a super crazy sweet, artificially flavored maple spread, made with sugar, sugar, and more sugar. Don't think I need to tell you that there's absolutely nothing healthy about it. 

Recently, I got some kind of a flashback that this thing existed and sort of started craving it. Of course, there was no way I was gonna give in to that! Besides, to be honest, I don't even know if it's still available at the store... Instead, I came up with this lovely, and much healthier, Cashew Maple Spread recipe. While it's not as sweet as the original — which is only a good thing, trust me! — this spread has the same creamy, sticky and velvety texture. 

And the best part is, it only requires 2 ingredients and 5 minutes of your time to come together... Faster than it would take to go to the store! 

I get the feeling I'll be indulging often... 

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* This article was originally published here

Partners names interim CEO. I’m quoted in the Boston Globe

Partners HealthCare moved quickly to appoint Dr. Anne Klibanski as interim CEO after the resignation of Dr. David Torchiana. I was quoted in the Boston Globe story about it:

The Boston health care consultant David Williams said naming an interim CEO gives the board some time to conduct a thorough search for a permanent replacement.

“They have a history of taking a senior physician and making them CEO of Partners,’’ said Williams, the president of Health Business Group. “Now I think they’re not sure if they want to do that again or if they want to look more broadly for, say, a business person.”

Partners would be wise to thing long and hard about what kind of a person should lead the organization. It may also be time to confront some of the internal contradictions and misalignments within the system and to consider restructuring. That may await the next CEO.

—-

By healthcare business consultant David E. Williams, president of Health Business Group.

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* This article was originally published here

Prescription drug costs steadily soar, yet price transparency is lacking

After reviewing tens of millions of insurance claims for the country's 49 most popular brand-name prescription drugs, a team found that net prices rose by a median of 76 percent from January 2012 through December 2017 -- with most products going up once or twice per year.

* This article was originally published here