By: Jennifer Seedorff, Ph.D
On Monday, the United Nations’ World Meteorological Organization, WMO, joined the National Aeronautics and Space Administration, NASA, the National Oceanic and Atmospheric Admiration, and the Japan Meteorological Agency in concluding that 2014 was the hottest year on record. The only major science agency that has not explicitly agreed with 2014 being the hottest year on record, was the Hadley Center in Britain which concluded “the uncertainty ranges mean it’s not possible to definitively say which of several recent years was the warmest.” The World Meteorological Organization also noted “the difference in temperature between the warmest years is only a few hundredths of a degree – less than the margin of uncertainty.” These record temperatures were achieved despite the absence of an El Nino event, which typically temporarily increase temperatures. WMO Secretary-General Michel Jarraud noted, “The overall warming trend is more important than the ranking of an individual year.” Although experts may disagree on which particular year was the warmest on record, it is striking that 14 of the 15 hottest years on record have been in the 21st century, and we are only 14 years into this century. (Chris Mooney, The Washington Post)
Public Health – Precision Medicine
Details have begun to emerge on President Obama’s Precision Medicine Initiative, first announced during his State of the Union Address. On January 30th, President Obama rolled out the initiative in the East Room. Precision medicine refers to tailoring medical treatments to an individual, including their specific genetic makeup, disease mutations, microbiome, etc. Francis Collins, director of the NIH, and Harold Varmus, head of the National Cancer Institute, recently described the Precision Medicine Initiative in the New England Journal of Medicine, “The proposed initiative has two main components: a near-term focus on cancers and a longer-term aim to generate knowledge applicable to the whole range of health and disease.” They further commented that this initiative “will also pioneer new models for doing science that emphasize engaged participants and open, responsible data sharing. Moreover, the participants themselves will be able to access their health information and information about research that uses their data.” Funding for this $215 million initiative still needs to be approved by Congress. Jo Handelsman, associate director for science in the White House Office of Science and Technology Policy, referred to precision medicine as a “game changer” that “holds the potential to revolutionize the way we approach health in this country and ultimately around the world.” (Jocelyn Kaiser, ScienceInsider and Francis Collins and Harold Varmus, The New England Journal of Medicine)
Public Health – Medicare Reform
Medicare is in the process of reforming how it pays for medical care. It is planning a transition from a fee-for-service system that pays providers based on the quantity of services provided to a system that rewards providers, instead, for the quality of the services provided. This transition has intensified the debate over how to measure the “quality” of a service. Currently, quality is being measured in terms of process, how many patients with a given diagnosis are being given a specific intervention, for instance how many back pain patients are being advised against bed rest or how many chest pain patients in the ER are being given aspirin. On January 30th, a nonprofit advisory group, the National Quality Forum, submitted to Health and Human Services recommendations on 199 performance metrics for consideration. Christine Cassel, president of the National Quality Forum, said that many of their recommendations seek to replace narrow process metrics with “measures that matter” to patients. The Center for Medicare and Medicaid Services is publicly releasing many quality metrics on its Hospital Compare and Physician Compare websites, although comparing complication rates between physicians is not yet available. Beck reports that some doctors have criticized tying physician reimbursements to these outcome-based measurements arguing that whether a patient gets better is often out of their control. The transition to quality-based measurements has had its successes, including reducing the rate of central-line blood stream infections by 50% since hospitals were required to report them. According to Scott Wallace, a visiting professor at Dartmouth, “Measurement fatigue is a real problem in hospitals. But, to me, the only metric that matters is, did you get better?” (Melinda Beck, The Wall Street Journal)
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