Imagine a Dartmouth economics prof giving a talk in Texas about the “cowboy doctor problem.”

Whoa, Nelly, writes Carey Goldberg on the WBUR Boston CommonHealth blog.

Jonathan Skinner, the Dartmouth prof, says “cowboy doctors were associated with nearly 60 percent greater spending among patients near the end of life.”

A paper Skinner co-authored for the National Bureau of Economic Research concluded that “36 percent of end-of-life spending, and 17 percent of U.S. health care spending, are associated with physician beliefs unsupported by clinical evidence.”  Or what could be a half-a-trillion-dollar problem.


Another Dartmouth team, Drs. Steve Woloshin and Lisa Schwartz, got into a debate over the safety of 2 weight-loss drugs recently approved by the FDA. Medscape says the debate or disagreement “has escalated in the pages of a major medical journal” – JAMA Internal Medicine.  Excerpt:

“Drs. Woloshin and Schwartz wrote that both drugs – lorcaserin (Belviq, Eisai) and phentermine-topiramate (Qysmia, Vivus) – have been associated with “serious harm” and pointed out that neither has been approved in Europe due to safety concerns. And, they added, the postmarketing safety studies the FDA required of both companies were behind schedule. “Until there is more convincing evidence about the cardiovascular safety of these drugs, physicians and patients should approach them with caution,” they concluded.

On August 4, 2014, representatives from 2 obesity organizations responded in letters to the journal accusing Drs. Woloshin and Schwartz of trivializing obesity and also refuted many of their statements, both in matters of opinion and of fact. Steven R. Smith, MD, president of the Obesity Society, wrote one of the letters and Theodore K. Kyle and Joseph Nadglowski Jr., both of the Obesity Action Coalition, wrote the other.”


Also in JAMA Internal Medicine are two papers by Dr. Joseph Ross of Yale, which were praised by Dr. Richard Lehman in his weekly journal review blog for The BMJ.  Lehman wrote:

Once more it is time to praise Joe Ross. He has two articles waiting to see print in JAMA Internal. The first one tracks the continuing use of ezetimibe in the United States following the ENHANCE trial, which demonstrated that ezetimibe use lowered cholesterol levels, but did not slow the progression of atherosclerosis. He and his team looked at the records of 10?597?296 continuously eligible adults in the USA, and found that nearly three years after ezetimibe had been shown to do nothing, 186?272 of them were still ezetimibe users, i.e. 1.8% of the total adult population.

His second shorter paper looks at how many of the pivotal trials that led to FDA approval of new agents have been published in peer reviewed biomedical journals. They all should be, of course, together with full de-identified data so we can all see whether these new treatments really work. But 14% are not even published in summary form.


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