Des Moines Register. July 11, 2019
Can stem cells really replace joint surgery? Insurers need to track patient outcomes
“Stem cells have been called everything from cure-alls to miracle treatments. But don’t believe the hype. Some unscrupulous providers offer stem cell products that are both unapproved and unproven.” - U.S. Food and Drug Administration
Kaiser Health News recently reported a Des Moines-based stem cell company has persuaded 100 employers, including Hy-Vee and Meredith Corp., to include its services in health insurance plans. The Des Moines Register published the story.
Before some workers can undergo knee replacements, they must first visit a Regenexx clinic. The company claims injections of a patient’s “own cells” can help avoid more expensive orthopedic surgery. It says its treatments are exempt from approval by the U.S. Food and Drug Administration, a federal agency that strongly cautions consumers about unapproved treatments.
The story ruffled some feathers in Iowa.
Regenexx responded to a Register editorial writer’s follow-up questions with a link to a blog written by founder Dr. Chris Centeno criticizing the Kaiser reporting as incomplete and “one-sided.”
What most of us are left wondering: Do the treatments offered by Regenexx work?
It depends on whom you ask. It depends on what online testimonials you read and believe.
And therein lies the real conundrum in all this: Decisions about medical treatment are too often influenced by anecdotes, testimonials, advertising and the advice of daytime talk-show hosts. Instead, these decisions should be rooted in scientific studies and objective data.
But such unbiased information is frequently not readily available to consumers.
Yes, the FDA approves drugs and medical devices, tracks adverse events and issues recalls on dangerous products. Consumers have some assurances about the safety and efficacy of medications and pacemakers.
But in other areas, unbiased information is sparse to nonexistent. Good luck, for example, finding information about a doctor’s performance, reliability and outcomes.
Patients can read online reviews and check with the state medical board for sanctions, but they cannot know how cancer patients of a specific oncologist fare a few months or years after treatment. There is no public reporting system for complication rates of a certain anesthesiologist or ophthalmologist. Orthopedic surgeons may have no idea how well a patient did a decade after a broken bone or joint replacement.
Just because a treatment has been used for decades does not mean it’s the most effective treatment. Just because a doctor has been practicing for years does not mean she’s good.
And just because an employer is covering a procedure in a medical plan does not mean it’s effective.
The Kaiser story underscores the need for evidence-based health care rooted in unbiased, scientific studies and reliable data collected over time. Americans need more information when making decisions that affect health and life.
Health insurers, including Medicare and Medicaid, are in the best position to step up and gather information about outcomes. They know what procedures patients have undergone and can survey them years later to find out about pain, function and complications.
Gathering outcome information is the way to find out what treatments work best - something everyone, including doctors, insurers, taxpayers and patients need to know in a country that spends more than $3 trillion on health care annually.
The Kaiser story also underscores the struggles faced by employers that offer health insurance to workers. They are doing the right thing by providing health insurance, but are also working hard to contain costs.
That could drive them to consider covering medical alternatives that have not been approved by legitimate authorities, said David Lind, president of the Clive-based Heartland Health Research Institute. “Well-intentioned employers could expose their employees to potentially harmful care.”
People suffering from severe pain are desperate for relief. They may try anything, including remedies advertised on television or recommended by their bosses.
That is not how decisions about medical care should be made in this country.
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Quad-City Times. July 14, 2019
The power of a strong local press
In just the past few weeks, the Times and our sister paper the Dispatch-Argus have shown that a Rock Island alderman was using taxpayer money on personal expenses; in one case, the alderman used public money to buy custom cuff links and a bullet-proof vest. The city is now reworking its policy for aldermen’s expenses and seeking to recoup some of the misspent money.
We triggered resignations in the Rock Island County health department after the agency botched the handling of tuberculosis tests for recent immigrants.
We revealed the true depths of Western Illinois University’s enrollment problems at its Quad-Cities campus and showed that administrators lacked an adequate recruitment plan. The university’s president resigned not long after in response to myriad problems at WIU.
We’ve fought court battles, and won, most recently when a judge tried to block the public from the trial of a boy accused of trying to shoot his teacher in a North Scott classroom.
Our reporting in your kids’ schools has uncovered secret discussions on the Bettendorf school board about selling a school building and considerations to mislead the public. We’ve revealed other serious problems in the Davenport school district, too, where black students are disciplined at rates much higher than whites and administrators botched dozens of education plans for special-needs kids, forcing the state to intervene.
We’ve unearthed turmoil on Davenport’s civil rights commission, the board tasked with ensuring our community’s most vulnerable classes have an equal right to liberty.
We doggedly report on youth crime, digging deep into data to show trends, possible causes and, more importantly, potential solutions.
We shared concerns and raised a few of our own about how Davenport responds to flooding. A mayor’s task force formed last week is now revisiting the city’s policies.
Journalism isn’t cheap. In most of those stories, we paid expensive fees to obtain public documents. We sometimes seek the advice of lawyers to ensure we’re being fair and lawful when we exercise our First Amendment rights. And in many of those stories above, reporters worked for weeks, sometimes months, gathering the facts - chasing down leads, one source, one document at a time - to bring you the news, because we insist on doing things the right way, regardless of cost.
Still, it’s no secret revenue has fallen at most papers since the industry’s golden age. When big box stores close, they no longer advertise in the local paper. Much of the industry’s classified revenue has also dwindled with the rise of online marketplaces. Loyal and longtime readers continue to take a daily paper at home under the industry’s traditional business model, but a growing number prefer to read our news digitally.
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Sioux City Journal. July 14, 2019
Input from public should be key part of medical cannabis discussion
We do not quarrel with the decision on Thursday by majority Republican leaders in the Iowa Legislature to not put the state’s medical cannabis program on the agenda for interim study committees this year. That they pledged to put the issue “at the forefront of the 2020 legislative session,” as Senate Majority Leader Jack Whitver of Ankeny put it, strikes us as an acceptable plan in response to the veto of a medical cannabis bill by Gov. Kim Reynolds after this year’s session.
We urge lawmakers to make sure Iowans - in particular, Iowans who seek relief through medical cannabis for medical conditions from which they suffer - are given all reasonable opportunities during the next session of the Legislature to share feedback about the state’s law in open, transparent fashion. Public input should be a key part of this discussion.
We were disappointed Reynolds vetoed a bill we believe would have improved the state’s medical cannabis program.
The bill, which passed 96-3 in the House and 40-7 in the Senate, would have: 1) Removed the cap on how much tetrahydrocannabinol (THC, the compound in a cannabis plant associated with getting a high) is contained in medical marijuana and instead limited the amount of medical cannabis a patient can be prescribed to no more than 25 grams in 90 days. 2) Softened language through which Iowans could be recommended for the program, changing “untreatable pain” to “severe or chronic pain.” 3) Allowed physician assistants and nurse practitioners to recommend patients for the program.
Reynolds said she vetoed the legislation because the 25-gram cap would allow an individual to consume more THC per day than a recreational marijuana user. She said the state’s medical cannabis advisory board recommends a cap of 4.5 grams for 90 days. Supporters say the 3 percent THC cap limits the effectiveness of medical cannabis.
From the beginning of this discussion in 2014, we have for reasons of compassion supported a medical marijuana program in our state.
We acknowledge progress on medical cannabis in Iowa over the last five years, but suggestions of ways to make the program even better, such as a change in THC, deserve more discussion.
We believe Reynolds and lawmakers of both chambers and both parties share a commitment to identifying common ground on ways of improving what’s in place today. For the good of affected Iowans, that task should get immediate attention when the 2020 legislative session opens in January.
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