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NEJM—Health Policy and Reform

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Barry R Bloom
Imagine a global epidemic with more than 10 million new cases and 1.7 million deaths in a single year, far greater than the 28,600 cases and 11,315 deaths that were caused by Ebola virus disease in West Africa in 2014 and 2015. In addition, this imagined epidemic affects every country and kills..
January 18, 2018: New England Journal of Medicine
Mitesh S Patel, Kevin G Volpp, David A Asch
The final common pathway for the application of nearly every advance in medicine is human behavior. No matter how effective a drug, how protective a vaccine, or how targeted a therapy may be, a clinician usually has to prescribe it, and a patient accept and use it as directed, for it to improve..
January 18, 2018: New England Journal of Medicine
Amy L Fairchild, Ju Sung Lee, Ronald Bayer, James Curran
On July 28, 2017, the recently appointed commissioner of the Food and Drug Administration (FDA), Scott Gottlieb, announced a "new comprehensive plan for tobacco and nicotine regulation." To permit both scientific deliberation and product innovation, the FDA will delay rules on the regulation of..
January 18, 2018: New England Journal of Medicine
Amal N Trivedi, Bryan Leyva, Yoojin Lee, Orestis A Panagiotou, Issa J Dahabreh
BACKGROUND: The Affordable Care Act (ACA) required most insurers and the Medicare program to eliminate cost sharing for screening mammography. METHODS: We conducted a difference-in-differences study of biennial screening mammography among 15,085 women 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for screening mammography, as compared with 52,035 women in 48 matched control plans that had and maintained full coverage...
January 18, 2018: New England Journal of Medicine
George Bakris, Matthew Sorrentino
Like physical guidelines designed to ensure that hikers stay on the safest path through tricky terrain, expert medical guidelines aim to steer clinicians toward best practices. The new Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults issued by the..
February 8, 2018: New England Journal of Medicine
Sean Duffy, Thomas H Lee
What if health care were designed so that in-person visits were the second, third, or even last option for meeting routine patient needs, rather than the first? This question seems to elicit two basic responses — sometimes expressed in the same breath: "The idea will upset many physicians, who are..
January 11, 2018: New England Journal of Medicine
R Alta Charo, Douglas Sipp
The Food and Drug Administration (FDA) recently made long-awaited progress toward protecting patients from interventions involving human cell- and tissue-based products (HCT/P) of unknown safety and efficacy. By clarifying its position on the handling and therapeutic use of cells, the agency has..
January 10, 2018: New England Journal of Medicine
Lisa C Dubay, Genevieve M Kenney
Despite bipartisan agreement on a 5-year plan in both the Senate and the House of Representatives, Congress failed to reauthorize the Children’s Health Insurance Program (CHIP) last fall, causing uncertainty and worry for families and state CHIP directors alike. Families in several states,..
January 10, 2018: New England Journal of Medicine
Steven Joffe, Holly Fernandez Lynch
The Food and Drug Administration (FDA) is the gatekeeper of the country’s drugs and medical devices. Originally created to prevent the misleading of patients, it was later tasked with ensuring the safety of medical products. In 1962, Congress expanded the FDA’s mandate again, requiring it to..
January 10, 2018: New England Journal of Medicine
Janet Woodcock, Julie Dohm
Five years ago, methylprednisolone acetate and other drugs compounded by the New England Compounding Center (NECC; Framingham, Mass.) and administered to patients throughout the United States caused a fungal meningitis outbreak involving more than 750 infections and at least 64 deaths. The extent..
December 28, 2017: New England Journal of Medicine
Chintan V Dave, Abraham Hartzema, Aaron S Kesselheim
To the Editor: Low-cost generic drugs have improved outcomes in patients while saving the health care system more than $1 trillion in the past decade. However, the prices of some generic drugs, such as captopril (Capoten) and pyrimethamine (Daraprim), have risen substantially in recent years,..
December 28, 2017: New England Journal of Medicine
Lisa Rosenbaum
I recently cared for a middle-aged woman, Ms. G. who presented with an acute coronary syndrome. Some years ago, she’d had a cardiac arrest and was found to have extensive coronary artery disease, for which she underwent urgent multivessel coronary-artery bypass surgery. Though we often assume that..
January 11, 2018: New England Journal of Medicine
Katherine Baicker, Amitabh Chandra
In these times of heated rhetoric about what various health care reforms can and cannot accomplish, both hopeful and doomsday stories abound. Proponents and opponents of reforms often claim that their views are grounded in evidence, but it’s not always clear what they mean by that — particularly..
December 21, 2017: New England Journal of Medicine
Jeremy A Greene, Joseph Loscalzo
In the 21st century, the framework of biomedical research and clinical practice has begun to shift away from universal models of disease that generalize from close examination of diseased parts (organs, tissues, cells, or molecules) toward an approach that celebrates "personalized medicine" and..
December 21, 2017: New England Journal of Medicine
Paul S Mead
When plague first arrived in Madagascar in November 1898, its appearance mirrored events in port cities around the world. Alexandria, Bombay, Buenos Aires, San Francisco, Saigon, and Sydney were all affected as part of the "third pandemic," a global event that began in China but spread widely with..
December 20, 2017: New England Journal of Medicine
Jonathan J Darrow, Erin C Fuse Brown, Aaron S Kesselheim
In the past year, federal health policy has been characterized by pervasive uncertainty, but a consistent theme from the Trump administration and some prominent legislators has been opposition to regulation. Last spring, Congress took a substantial step toward making regulation by federal agencies..
February 1, 2018: New England Journal of Medicine
Lisa Rosenbaum
They called me Ms. Appropriate. When I was a cardiology fellow, health care costs were skyrocketing, and I considered devoting my career to curbing inappropriate use of medical resources. My first target, as a supervisor of cardiac stress tests, was referrals of patients for unnecessary testing —..
December 14, 2017: New England Journal of Medicine
Rebecca L Haffajee, Michelle M Mello
The opioid epidemic has claimed more than 300,000 lives in the United States since 2000 and could claim another half million over the next decade. Although heroin and illicitly manufactured fentanyl account for an increasing proportion of opioid-involved overdoses, the majority of persons with..
December 14, 2017: New England Journal of Medicine
Michael L Barnett, Josh Gray, Anna Zink, Anupam B Jena
The gravity of the opioid epidemic in the United States barely needs introduction. The numbers speak for themselves: in 2015, more than 33,000 Americans died from an opioid overdose, according to the Centers for Disease Control and Prevention — similar to the 35,000 and 36,000 deaths attributable..
December 14, 2017: New England Journal of Medicine
Robert L Goldenberg, Elizabeth M McClure
Pregnancy outcomes in low- and many middle-income countries are far worse than those in high-income countries. Maternal mortality may be up to 100 times as great in the highest mortality regions as in the lowest mortality regions, and neonatal mortality and the rate of stillbirths are 10 to 20..
December 14, 2017: New England Journal of Medicine
2017-12-15 05:15:07
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