GENERAL MEDICAL NEWS
The staff of The Reproductive Times here offers brief referenced notifications on interesting general medical and scientific news with broad relevance to reproductive medicine and biology. Some of these news items may become subjects of more detailed reporting in The Reproductive Times on later occasions. The purpose of these short notifications is to give readers the opportunity to get more detailed information by looking up the reference of the notification.
Image courtsey of The Buffalo News
REQUIRING PRIOR INSURANCE AUTHORIZATION AGAIN UNDER INCREASED SCRUTINY
It is no secret that physicians hate prior authorization requirements and – as those have multiplied – that feeling has, if anything, only strengthened. The issue was recently raised by Lisa Marshall with regards to cancer treatments in an article in Medscape Medical News.1 Working off a 2023 paper in JAMA Network Open that had offered further support for the notion that the need for prior authorization often causes harm to patients (the urgency of treating cancer care makes it a very good example), in a survey study of cancer patients, a full 22% of patients were found not to have received the care recommended by their treatment team because of pre-authorization requirements (1).
This is, of course, scandalous and only adds to the argument that insurance companies increasingly are not only insuring but are – for all practical purposes – managing clinical care, and for that they are not licensed! Interestingly, when Marshall contacted the national trade group, America’s Health Insurance Plans (AHIP), nobody returned repeated requests for an interview to comment on her story. Indeed, what is left for the health insurance industry to say?
References
1. Marshall L. Medscape Medical News. https://www.medscape.com/viewarticle/cancer-doesnt-wait-how-prior-authorization-harms-care-2024a1000hxt?form=fpf
2. Chino et al., JAMA Network Open 2023
THE FRAGMENTATION IN MEDICINE
The fragmentation of medicine into traditional medical specialties and sub-specialties is now almost a century old and largely unchanged. Now comes Vivek Subbiah, MD, an expert in early-phase drug development, who in a brief article in Nature Medicine argues that it is time for reform. More specifically, he suggests that “transforming the fragmented silos of medicine into a wheel of collaboration, holds the key to tackling complex health challenges for generations to come (1).”
We wholeheartedly agree! Increasingly, we find ourselves sharing more common research interests with colleagues in other medical specialties than in our own medical specialty of obstetrics and gynecology. This kind of realignment, of course, would have to start with medical school education and medical specialty training in residencies and fellowships. But a revolutionary reorganization of medicine along such lines appears increasingly unavoidable.
Reference
1. Subbiah V. Nat Med 2024;30:2394
RESIDENTS ARE JOINING UNIONS IN DROVES
Recently we heard a colleague at a prominent university complain that the postdocs at the university now had their own union and that this completely changed the relationships in their research laboratories. A recent article in Medscape Medical News, therefore, caught our immediate attention because it noted that residents are also unionizing in droves (1).
The subjects they are fighting for are adequate parental leave, fair pay, and – believe it or not – adequate healthcare. Five weeks of paternal leave in California are not considered adequate and the goal of the local union now is eight weeks. Mass General Brigham Hospital in Boston certified its union in June of 2023, but there is still no contract in place between residents and the hospital. A major complaint is that nurse practitioners and physician assistants are earning almost twice as much as residents.
Reference
1. Hochwald et al., Medscape Medical News. October 7, 2024. https://www.medscape.com/viewarticle/why-residents-are-joining-unions-droves-2024a1000iap?form=fpf
THE DISCUSSION ABOUT MISINFORMATION IS NOW ALSO HEATING UP IN MEDICINE
It increasingly appears we are drowning in misinformation. Traditional media accuse social media of being the main culprits, but as the most recent election campaign once again deftly demonstrated, our traditional media are also distributing misinformation. Like everybody and everything, medicine and science are also affected, and Science magazine, therefore, recently dedicated several interesting articles to the subject of misinformation.
All three articles are by Kai Kupferschmidt, a contributing correspondent for Science (1 - 3). In the first he noted that research on misinformation “has exploded,” though those trying to make some sense of the subject still face some basic challenges. And those start with the fact that the definition of what represents “misinformation” has really not been established yet. Even so-called “experts” strongly disagree (one of course under such circumstances must also wonder about the definition of what an “expert” is) whether, for example, lies, deepfakes, conspiracy theories, pseudoscience, propaganda, rumors, etc., indeed, represent misinformation.
A second major problem arises from the fact that, these days, everything seems – and to a degree is – politicized. As the articles notes, “we all are equally guilty” – especially in believing fake news about the other side. And a third problem is that the harm caused by misinformation is difficult to define because misinformation can change beliefs, and beliefs can lead to actions, and this sequence of events is, of course, for several reasons difficult to study, not the least because it would seem unethical to purposefully expose somebody to misinformation just to wait for that person to do something crazy.
And a final problem lies with the increasing difficulty of getting access to real life data often owned by companies which have no interest in sharing such data. Moreover, all of these problems are global.
A second article has the title (in very large letters) “YOU WON’T BELIEVE THIS,” and what is meant is that researchers are trying to “inoculate” people against misinformation by – as with some vaccines – giving small doses of (in this case) information about a certain subject ahead of time. Yes, this potential “therapy” indeed goes back to 1954, when some U.S. prisoners in the Korean war chose to stay in North Korea instead of coming back home. They were assumed to be “brainwashed,” and “experts” declared that our younger people must be taught more about American ideals to make them more resistant to enemy propaganda. It is basically the same theory that these days drives the concept of inoculation which is also called “prebunking.” However, it is only one among several experimental techniques currently under investigation which are trying to make people stop falling for and spreading misinformation.
The third article in many ways is the least revealing and least interesting because it basically features one researcher, Kate Starbird, PhD, whose research tracks falsehoods and then attempts to counter them in real time.
References
1. Kupferschmidt K. Science 2024;386(6721)478- 482
2. Idem: 483-485
3. Idem 386-489