My hospital system
@MassGenBrigham
is now vaccinating all employees, including those who work from home and have no clinical responsibilities.
We haven’t yet started vaccinating high-risk patients.
If we have extra doses, we should return them to the state for re-allocation.
Is your team role identified on your hospital ID badge???
Now out in
@JAMANetworkOpen
, we describe our experience rolling out Doctor badges to residents at BWH & MGH.
Are these badges helpful??
Read on to find out 👇👇👇 1/
Now begins the most awkward period in any relationship:
When 1 person dumps the other but they still have to live together for 5 years until the lease runs out…
Dana-Farber Cancer Institute and Beth Israel Deaconess Medical Center have announced plans to build a new inpatient hospital for adult cancer care in Boston, breaking the cancer hospital’s almost 30-year relationship with Brigham and Women’s.
Hate to say it, but if Donald Trump had started recommending
#Booster
vaccines before
@US_FDA
or
@CDCgov
weighed in, there would have been outrage.
A few thoughts 👇
🚨NEW PAPER🚨out today in
@JAMA_current
➡️Average prices for new drugs have increased 20%/year from 2008-2021!!! 💊💰📈
➡️In 2020-21, ~HALF of new drugs cost >$150k/yr (vs 9% in 2008-13)!
🔗
A few thoughts 👇
Today in
@NEJM
, Jerry Avorn and I caution against abandoning our time-tested approach to testing and approving drugs during
#COVID19
.
Recent comments by
@realDonaldTrump
are dangerous for patients and public health!
In a journal club with
@harvardmed
students last week we talked about this issue — death can’t be a censoring event in an analysis of clinical improvement.
These letters all raise points that should have made
@NEJM
think twice before publishing an industry-funded case series.
So, apparently, the statistics in the NEJM report on compassionate use remdesivir without a control group were wrong. 53 authors and not one knows how to conduct a Kaplan-Meier analysis??
Today I graduate with my MPH from
@HarvardChanSPH
!
Feeling immense gratitude to my mentors, the faculty and students at HSPH, and my friends and family for their support!
(Probably my last degree, but definitely not the end of my educational journey!)
Truly an honor to be recognized by
@VictorDzau
as an Emerging Leader in Health and Medicine scholar at
@theNAMedicine
annual meeting.
Such an inspiring group of colleagues.
Thanks
@akesselheim
for the mentorship and nomination! And to my family and
@PORTAL_Research
colleagues.
The one and only
@PaulSaxMD
elegantly puts pen to paper what all of us at
@BrighamWomens
are feeling about the recent DFCI news.
Oh, and I think this may be the first (and last?) time one of my Tweets ever gets cited in
@NEJM
.
New in
@JAMA_current
!!
55% of top-selling drugs in Medicare have little or no added therapeutic benefit over therapeutic alternatives, according to HTA ratings by 🇫🇷 🇨🇦 🇩🇪.
Led by Alex Egilman and
@akesselheim
@PORTAL_Research
.
We know that HCQ isn't effective for Covid-19... but that hasn't stopped people from using it!
NEW in
@JournalGIM
-
@akesselheim
Jerry Avorn and I examined which patients and prescribers used HCQ during the pandemic.
📜(free to read):
🔑findings 👇
A lot of people are framing today’s list as choices CMS made. That’s a bad framing.
Congress gave very explicit instruction to CMS about how to select drugs. There isn’t a lot of wiggle room.
We summarized the selection rules in our simulation:
Tomorrow
@JoeBiden
announces the first 10 drugs to face Medicare price negotiation.
According to predictions from the team at
@PORTAL_Research
, here’s the most likely drugs to be selected:
Eliquis
Enbrel
Ibrance
Imbruvica
Januvia
Jardiance
Myrbetriq
Trulicity
Xarelto
Xtandi
8/
In summary:
In this large prospective study of residents in multiple specialties, we found that Doctor badges were a simple, low-cost tool that reduced role misidentification, particularly among female residents.
In 2014, we founded the BWH house staff council to get trainee voices at the table.
We had some important short-term wins: long-term disability coverage, 9pm meal.
But the fact that residents want to unionize suggests that there’s still a lot of room to go. 1/
Five years ago today… starting intern year on
#OncNights
@BrighamMedRes
!
Good luck to all the interns embarking on the rewarding, challenging, and humbling journey that is residency!!
#NeverWorryAlone
Really exciting to see this momentous step for the Medicare program. Some quick reactions to this first list of 10 drugs:
1. Many drugs are no surprise - especially Eliquis, Xarelto, Januvia, Jardiance, and Imbruvica. All widely expected to make this list
🚨TODAY at 1:30PM ET I’ll be testifying before the
@HouseScience
Investigations and Oversight Subcomittee hearing about repurposing drugs to treat
#COVID19
.
Tune in to the livestream 👇
This misses the point.
The concern isn’t that this will slow down FDA decisions.
It’s that this threatens
@US_FDA
independence and could lead to decisions based on politics and not science.
Yet another misleading story that risks undermining the public health response while relying on uninformed anonymous sources. The memo maligned in this story is a good governance, housekeeping action, which will not slow down the important work of the FDA or any HHS division. 1/2
Honored and excited to be a part of this amazing program for the next 3 years.
Thanks
@theNAMedicine
for the opportunity and
@akesselheim
for the nomination.
Announcing
@theNAMedicine
Emerging Leaders in Health and Medicine! The Scholars are part of a new generation of leaders poised to shape the future of science, medicine, and health equity. Meet the Scholars:
#NAMEmergingLeaders
Who’s gonna tell him that even if expensive drugs are fully covered by insurance, they still make health care unaffordable??
We all pay for these billions of dollars from patent gaming through taxes, lost wages, premiums. Not just those who need Humira.
🚨New in
@JAMA_current
🚨
New Reforms to Prescription Drug Pricing in the US
Opportunities and Challenges
Our take on the monumental Inflation Reduction Act drug pricing reforms.
Bonus🎙️ interview with
@akesselheim
. Led by
@thomasmd
@PORTAL_Research
.
🚨NEW PAPER🚨 out today in
@JAMAHealthForum
Under the
#InflationReductionAct
, Medicare will soon start negotiating drug prices.
How will this work?? We dive deep using a historical simulation.
🧵👇
📜:
In clinic this week I got to *actually* use one of the best ICD10 codes I’ve come across: “W56.02XA — Struck by Dolphin, initial Encounter”
🐬🐬🐬
#medtwitter
#accuratebilling
Dr. Marty was a gem of a physician and a phenomenal human being who contributed so much to the
@BrighamMedRes
community. So saddened by this devastating loss.
Hoy en la ciudad de Santo Domingo, República Dominicana, murió mi hermano mayor Francisco Miguel Marty Forero por un accidente, prestigioso médico venezolano infectólogo, PAZ A SU ALMA
In summary:
1⃣Booster vaccines probably safe, but effectiveness unknown.
2⃣Unclear if boosters are needed (e.g. does immunity wane over time).
3⃣Offering booster vaccines in the US now may delay vaccine uptake in the rest of the world.
6/
Grateful for the opportunity to talk on behalf of millions of patients who struggle to afford their prescription drugs.
The
#InflationReductionAct
was a great start. Let’s keep pushing for more changes to lower prices!
ICYMI (37:55) -
This isn't a simple question of "following the science." It's a complex public health decision that should be analyzed through multiple lenses.
For such a complex issue, this is a clumsy role out by the
@WhiteHouse
.
7/7
I was tongue in cheek with my post yesterday
But seriously, I’m worried about the profound effect this change will have, particularly for
@BrighamMedRes
.
Onc was such a huge part of my training. Including my first intern rotation on Onc nightfloat (with
@MattRamsisMD
).
Now begins the most awkward period in any relationship:
When 1 person dumps the other but they still have to live together for 5 years until the lease runs out…
New paper out today (with
@akesselheim
) evaluating cost of a proposed policy to promote new antibiotic development.
@PORTAL_Research
Bottom line: $4.5 billion over 10 years! More details below... 1/6
NEW PAPER in Am Heart J re 💊💰
We found that AFib patients with higher
#NOAC
copayments had lower adherence.
Drugs only work if patients can afford to take them!
@akesselheim
@PORTAL_Research
3/ We reported initial results in
@JAMAInternalMed
🔵45% reported at least weekly role misidentification.
🔵Female residents 3.6x more likely to report misidentification
🔵 82% of female residents reported reduced misidentification after Doctor badge
@EricTopol
@NEJM
Glad this data is being collected, but without control group it’s VERY limited.
Most important sentence: “data from several ongoing randomized, controlled trials will soon provide more informative evidence regarding the safety and efficacy of remdesivir for Covid-19.”
Both
@pfizer
and
@moderna_tx
vaccines are ~95% effective.
How do they size up re side effects?
- Vaccines hurt your arm (duh!)
- Few systemic side effects with dose 1
- More systemic side effects with dose 2
- Most side effects MILD
Tl;dr - Get vaccinated. Either one!
This is sad. Retracted
@NEJM
paper based on falsified data continues to be cited 1 year later. Often with no mention of the retraction.
via
@JAMAInternalMed
part of
@JAMANetwork
A cluster randomized controlled trial of a novel mindfulness curriculum found no impact on pediatric intern burnout, mindfulness, or empathy. Ongoing research is needed to identify interventions that decrease burnout among trainees.
@FraimanYarden
Scott this is garbage spin, not analysis. The criteria aren’t unpredictable. CMS is just using more recent data than anyone else has access to. Enbrel and Entresto aren’t surprising at all. Farxiga and Stelara a little more so but sales of both have surged in the last 2 years.
Some surprises on list of 10 drugs that Medicare will set prices for. Many expected Ofev, Pomalyst, Xtandi, Invega to be on list. Instead Farxiga, Entresto, Enbrel, Stelara added. Those were expected to make list in 2027. It shows that Medicare's criteria is still not predictable
I’m not sure you could’ve convinced me that any news story this year about B-amyloid in Alzheimer’s could have been more scandalous than the FDA Aduhelm disaster…
…but this story absolutely is.
Shocking! There are serious concerns that key images may have been fabricated in multiple influential papers pertaining to the amyloid hypothesis of Alzheimer’s, and that this may have misdirected subsequent research efforts for the last 16 years
Congrats to
@bnrome
at
@PORTAL_Research
for being selected to the 2022 class of
@theNAMedicine
Emerging Leaders in Health and Medicine! Very well deserved honor and impressive group of scholar-leaders:
Pharma routinely argues that high prices are need to recoup expensive R&D costs.
But that isn’t true. In reality, they choose prices to maximize revenue.
Aduhelm, case and point 👇👇👇
The documents provide a rare glimpse at how drug companies decide on prices. Biogen surveyed insurers and neurologists, learning that anything over about $40,000 would be perceived as “overpriced.”
5/
So what’s the solution???
Why not negotiate prices of newly approved drugs based on evidence of clinical benefit?
In fact, the US is the only high-income country that DOESN’T evaluate and negotiate prices for new drugs.
📄
@ZekeEmanuel
Excellent reporting by
@GlobeSpotlight
🌎 🔦
It’s time for
@MassGenBrigham
and other Boston hospitals to rethink COI policy for execs.
If pharma-sponsored lunches and pens aren’t acceptable, neither should millions of 💵 for sitting on a board.
New
@OIGatHHS
report estimates that Medicare and Medicaid spent $18B on accelerated approval drugs with unconfirmed clinical benefit from 2018-2021!
Few thoughts 👇
@francisdeng
The reason USMLE was comfortable making this change is because they don’t lose any money. 100% of students still need to take it regardless of scoring...
but I’m with you. Curious to see what comes next.
Excited to share our new study in
@JournalGIM
(with
@DrStephMueller
) about duplicate imaging ordered after inter-hospital transfer.
Bottom Line: 1 in 4 patients had 1+ duplicate imaging study, and real-time shared EHR data may help...
🚨NEW PAPER🚨 in
@Health_Affairs
Led by superstar HS student Aayan Patel, we found that *1 in 5* generic drugs had a price spike (doubled in <1yr) from 2014-17.
💊🏷📈 With
@akesselheim
🔗
Brief highlights in 🧵👇
@walidgellad
@MassGenBrigham
Great to hear.
@MassGovernor
has been holding onto a tiered vaccine roll out despite the new federal recommendations to vaccinate all >65.
Seems like they allocated too many doses to big hospital systems, and those hospitals are using the tiers to justify not vaccinating pts.
Amazing how Pfizer is super interested in studying a booster dose…
…but not studying the efficacy of a single dose strategy.
Financial incentives matter.
Pfizer plans to file an EUA for a booster vaccine to counter Delta (+ do a clinical trial)
There are currently insufficient data to warrant that it'll be necessary. Beyond neutralizing antibodies, our immune response consists of memory B cells, T cells
9/
Since this study,
@BrighamWomens
has started distributing role identification badges to ALL patient-facing staff.
Hopefully our findings will convince other academic medical centers to follow suit.
Out now in
@JAMA_current
, Alex Egilman,
@akesselheim
, and I defend the use of foreign HTA assessments to evaluate drugs' clinical benefit.
And we argue that the US should get in the HTA game like all our peer countries!
@PORTAL_Research
5/ The fact that some MGB leaders believe that a union will harm teaching and mentoring is truly sad and disappointing.
As a faculty, I’ll 100% support residents and trainees, regardless of whether a union passes.
That is our duty.
This is a 🔥 take.
Non-profit hospitals blame their current financial woes on 📈 labor costs and 📉 clinical revenue.
But maybe it’s actually just from 📉 investments because the markets are down.
So what did we learn from this momentous CMS guidance about the drug price negotiation process?
Here's a brief 🧵with some early cliff notes.
No way I can adequately capture 93 dense technical pages in Tweet form, but here goes nothing...
👇👇
Too much
@CMSGov
#DrugPricing
news for 1 day??
New guidance on how CMS will negotiate drug prices.
Initial observation: Offer will be based on net prices of therapeutic alternatives.
More thoughts once I dig in further!
🚨 New in
@NEJM
🚨
There is bipartisan congressional support for legislation regulating pharmacy benefit managers (PBMs).
@ChristopherLCai
and I review what the current bills will and wont do.
Based on Pfizer CEO comments, it sounds like the we'll soon have data showing that booster vaccines increases antibody response. This is a surrogate measure for what we really care about -- reducing serious infections and (hopefully) transmission. 2/
Just finished my first day as an *attending* PCP
@TheJenCenter
! Grateful to all the staff who are helping me get accustomed, and feeling lucky to care for some amazing patients.
It’s a fallacy that making an ineffective drug available is good for patients... these drugs cause side effects and contribute to financial toxicity.
@US_FDA
should protect patients by requiring evidence of efficacy and safety.
Cc
@oncology_bg
@VPrasadMDMPH
Exciting new proposals from
@CMSinnovates
1️⃣ $2 generic drug list for part D
2️⃣ New payment models for cell/gene therapies
3️⃣ altering payment for accelerated approval drugs to incentivize faster post-market evidence
This week I one of my MCR patients stopped taking his GLP1ra because it was costing him >$300/mo. His insulin is >$100/mo and I learned today it will be (slightly) cheaper if he goes to Walmart and pays cash.
We cannot go on like this. We need
#PartD
reform. Badly.
Comparison of Hospital Online Price and Telephone Price for Shoppable Services from outstanding
@utmbhealth
medical student Merina Thomas
@UTMBGenMed
@UTMBProvost
2/ This idea started back in 2017-18.
Based on anecdotes from female colleagues about frequently being misidentified by patients and other staff as non-physician team members.
With support from
@DrJoelKatz
&
@MariaYialamas
, we distributed Doctor badges to
@BrighamMedRes