Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.
Deaths declined significantly in Massachusetts four years after comprehensive health care reform, according to an article being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M13-2275). In 2006, Massachusetts enacted a health care law that expanded Medicaid, offered subsidized private insurance, and created an individual mandate. As the model for the Affordable Care Act, effects of the Massachusetts’ health care overhaul have important policy implications. Researchers wanted to find out if expanded insurance coverage affected mortality rates in the state. Mortality rates before and after reform were compared to demographically similar counties in other states without such reform. The researchers found that deaths among its nonelderly residents decreased by 2.9 percent compared to the control group. The researchers estimate that Massachusetts’ health reform law prevented 320 deaths per year, which equals about one life saved for each 830 persons gaining insurance. The decline in mortality was concentrated among causes of death most likely to be preventable or treatable with timely health care, such as infections, cancer, and cardiovascular disease. Counties with lower median incomes and higher percentage of uninsured adults before the law was passed saw the largest health benefits and mortality benefits were nearly twice as large for minorities as it was for whites.
The $260 million Women’s Health Initiative (WHI) Estrogen Plus Progestin (E+P) clinical trial yielded a huge economic return on investment, according to a modeling study being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M13-2348). A decade ago, the NIH funded the WHI E+P clinical trial to determine the cardiovascular benefits of combined hormone therapy (cHT). The study showed that cHT use increased risk for cardiovascular disease, venous thromboembolism, and breast cancer. While the trial resulted in significant changes in clinical practice, the overall economic benefit to society has been questioned. Researchers used disease-simulation modeling informed by prescribing data and risk information from the WHI E+P trial to estimate the economic return on investment. They estimate that reduced cHT use led to 126,000 fewer breast cancer cases and 76,000 fewer cardiovascular events. These changes translated into 145,000 more quality-adjusted life-years and a net economic return of $37 billion or $140 for every dollar spent on the trial. In an accompanying editorial, Michael Lauer, M.D., director of the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute calls the reports of the WHI trials “seminal ‘black swan’ events in the history of clinical research” that had an enormous and undeniable effect on public health. The high-reward potential makes these types of trials worth the investment.
Investigators found social media to be an effective tool for researching the clinical presentation and treatment of a mass casualty event of nerve agent poisoning, according to an article being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M13-2799). Organophosphate (OP) nerve agents are some of the most lethal weapons of chemical warfare. In 2013 sarin gas, an OP agent, was used in Ghouta, Damascus, killing 1,400 civilians and severely affecting thousands more. Through videos, cell phone pictures, and social media accounts, the world witnessed the event in “real time.” This also marked the first time that a clinical syndrome (nerve agent poisoning) was examined through social media. Investigators sought to delineate the clinical presentation and treatment of a mass casualty event of nerve agent poisoning as shown in YouTube videos documenting the attack. Sixty-seven YouTube videos showing at least one victim for at least three seconds were reviewed. The YouTube videos enabled the researchers to observe the clinical signs of nerve agent poisoning and evaluate management protocols to better prepare for future events. The investigators believe that systematic gathering of smartphone data could be used as part of a clinical or epidemiologic investigation, especially in situations when direct access is restricted.