Good morning readers!
I don’t actually drink Chock full o’ Nuts coffee – I should probably just try it sometime! I prefer my McDonalds iced caramel coffees in the morning, even over Dunkin Donuts. But anyways, I digress. Here is this morning’s health links for your reading leisure.
- HIV-infected organs for transplants? Today’s New York Times is reporting on a push to lift the ban on HIV-infected organs for transplantation, based on an amendment in the National Organ Transplant Act. Why, you may say, would anyone want an HIV-infected organ?? Well, one reason is that HIV-positive patients who need organs can tap into this previously inaccessible pool – and yes, HIV patients have been able to receive transplants recently based on large clinical trial. Also, transplants are already being done between Hepatitis C infected patients. It’s kind of a win-win for HIV and non-HIV patients alike – HIV patients can access organs that uninfected patients would not want, and non-HIV patients may move up the list as HIV patients receive these transplants. There are some concerns even for HIV-infected recipients, such as if the donor organ has a more aggressive and resistant HIV strain. And curiously, the article mentions the potential for HIV-infected organs for non-infected patients because “contracting H.I.V. would be preferable to kidney or liver failure”.
- Will ACOs have a chance to make a difference? David Williams at Health Business Blog reflected on a podcast interview last Friday that interest in setting up ACOs may have already peaked. ACOs are accountable health organizations which represent a new payment and delivery model where a team of providers coordinate to provide care to a patient population, with payment incentives to ensure quality and bring down the overall costs of care. The problem is that there is tremendous risk on the side of providers who surely are less able to manage them than large insurers with deep pockets. The federal government has recently drafted some rules and guidelines for ACOs but David Williams’s interview with the SVP at Avalere Health reveals that the savings targets may be too ambitious. Another challenge is that the patient pool will be assigned retrospectively (instead of enrolled upfront) because patient choice cannot be restricted, but then how can ACOs not know who they are responsible for? It seems like the rules may be set up to bring out the best of all possible worlds, which is impossible.
- The challenge of personalized medicine in breast (or any) cancer. Derek Lowe at In the Pipeline wrote last week of the incredible complexity of identifying the genetic roots to breast cancer. In a study where breast cancer tumors were sequenced from 50 different patients, over 1700 different mutations were found (compared to normal tissue controls) and only 3 mutations showed up in as many as 10% of patients. What is just alarming is that the patient pool was already a homogeneous subset of estrogen-receptor positive patients (of which only 50% were estrogen sensitive). The most frequent mutation was found in the MAP31k gene, but if it only shows up 10% of the time, how much of an impact could it make? Derek Lowe seemed a bit deflated when he said: “No, instead of making me yearn for ever-more-personalized targeted therapies, this makes me think that early detection and powerful, walloping chemotherapy (and surgery) must be the way to go for now.” A targeted therapy strategy could be so unwieldy if the targets are different in every patient.
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