PILLS PRODUCED ON 3-D PRINTERS “could radically transform the notion … about what a pharmacy is,” bioethicist Jim Ruble said on last week’s broadcast of Science Friday on National Public Radio. The Food and Drug Administration this summer approved the first 3-D-printed pill, SPRITAM, an epilepsy drug produced by Aprecia Pharmaceuticals. It’s another step “in the digital transformation of the pharmacy and health care,” Ruble, an associate professor in the University of Utah’s College of Pharmacy, told Science Friday host Ira Flatow. The process allows more of the active drug to be placed in a tablet and also enables it to be better absorbed by the patient. It could cut down on the number of dosages a patient must take each day, which could improve adherence — and thereby health outcomes. However, Ruble noted, it does raise tricky questions. Who bears the cost of making the technology broadly available? Is there the possibility of incorrect use if, for instance, people were able to print medications at home or in other nonhealth care settings? What about problems that vex other types of IT, such as hacking? As exceptionally promising as the concept is, he said, society needs to establish values and rules for proper use.
QUIT CALLING IT ALTERNATIVE MEDICINE; it’s either medicine or it’s not, argues Aaron E. Carroll in Tuesday’s New York Times. What’s the criteria? A treatment that’s been studied, tested and proven effective — whether it’s chemotherapy, acupuncture, aspirin or meditation — is medicine, contends Carroll, a professor of pediatrics at Indiana University School of Medicine. If the only argument is that something is more “natural,” or it has been used for a long time or by many people in other cultures, it should not be called medicine — alternative or otherwise, he says. The science matters.
HEALTH CARE IS GETTING UBERIZED and traditional providers better beware. The Wall Street Journal Tuesday reported about companies like Heal in California, Pager in New York City, RetraceHealth in Minneapolis and MedZed in Atlanta, which people can call for nonemergency care, like flu shots or stitching up cuts. The companies will send clinicians to the home or wherever the patient may be. Mobile medical technology lets the clinicians carry portable blood analyzers, handheld ultrasounds and other equipment with them. The appeal is obvious. For instance, as the WSJ’s Melinda Beck reports, Heal “promises to ‘get a doctor to your sofa in under an hour’ for $99.” The services carry malpractice insurance, Beck writes, “but say overall low overhead keeps prices down.” At this summer’s Health Forum–American Hospital Association Leadership Summit, some hospital leaders sounded off on how their field should hurry up and get with this new Uberized world. Read Marty Stempniak’s report in H&HN Daily.
THE INTERSECTION OF HEALTH CARE AND RELIGIOUS FAITH were the basis of two interesting pieces this week. New Yorker writer Amanda Schaffer described how the ban by Jehovah’s Witnesses on blood transfusions has led dozens of hospitals to develop “bloodless medicine” programs that are now gaining traction within the broader health care community. The American Medical Association says transfusions are one of the most overused therapies. Donated blood, Schaffer notes, “comes with risks for all patients, including the potential for immune reactions and infections.” Moreover, clinical trials have shown no worse outcomes for a broad range of conditions when restrictive transfusion practices were used. Bloodless medicine does require meticulous surgical practices and a “myriad of small precautions and coordinated, blood-saving techniques that begin well in advance of surgery."
THEN IN “CONFESSIONS OF A RELIGIOUS DOCTOR,” Chiduzie Madubata, M.D., offers a very personal and thoughtful essay on the tensions between his faith and his practice of medicine. The tensions were most pronounced during medical school when “the science would indicate one way to think about things, and my faith seemingly indicated another way to think about things, and at times, these would come into conflict.” How does he deal with such conflict? Read Madubata’s essay in KevinMD.com.
SPEAKING OF DRUGS, (OK, that was a couple of items up from here) Kaiser Health News’ Lisa Gillespie reported Wednesday that more than half of the nation’s large employers in 2016 plan to tighten control over their workers’ use of specialty drugs, which are climbing by double digits every year. More companies will direct employees to specialty pharmacies if they need certain drugs and will require them to get prior authorization before buying those drugs under the employer’s health plan. Gillespie reports that the moves are being made in anticipation of the Accountable Care Act’s so-called Cadillac Tax, slated to go into effect in 2018. If drug costs in those plans exceed limits set by the government, employers could face a 40 percent tax on the overage.