Many migraine sufferers skip effective behavioral treatment

Even when a headache specialist refers migraine patients for proven behavioral treatments like biofeedback, relaxation training or cognitive behavioral therapy, barely half of them go, suggests a small U.S. study.

Of 69 migraine sufferers treated at a large academic headache practice and referred for behavioral therapy, just 57 percent got as far as making an appointment with the behavioral practitioner, researchers found.

The patients who ignored their doctor’s recommendation cited time limitations as the main barrier to treatment. Concerns about cost and insurance coverage were also an issue. And some were skeptical about whether the treatment would work; others worried about the potential stigma of seeing a psychologist, the study team reports in the journal Pain Medicine.

“I hope that the impact of this study will be that more physicians, patients and payors will realize that these evidence-based treatments are being underutilized and are having an effect on the opioid epidemic,” lead author Dr. Mia Minen, chief of headache research at NYU Langone Medical Center in New York City, said in a telephone interview.

One in seven people in the U.S. experience migraine headaches, but they are most common in women and may afflict up to one in four women aged 18 to 44.

The severe headache pain of migraines can be accompanied by sensitivity to light and sound as well as blurred vision, nausea and vomiting. These headaches can be disabling and result in missed work and frequent doctor visits.

Opioids are still being prescribed as the first line of treatment for migraines when evidence shows that behavioral therapy is more effective and safer in treating migraines, Minen said.

“There should be more doctors initiating behavioral therapy and fewer insurance restrictions and limitations placed on these treatments to make them more accessible to patients so they can pursue them,” she added.

“I don’t think that people realize that behavioral therapy alone can result in a 50 percent reduction in headache days. It’s not only effective alone, but when combined with medications it can have a synergistic effect.”

For their study, Minen and her colleagues enrolled 234 patients with migraines who came to the NYU Langone headache center from July 2016 to March 2017.

Of these, 69 were referred for behavioral migraine treatment with a trained therapist, but Minen’s team was only able to reach 53 of them when they followed-up two to three months later. At that time, 30 patients had, at a minimum, taken the step of setting up an appointment for behavioral migraine treatment.

Apart from it’s small size, the study is limited by the fact that patients treated at an academic specialty headache practice might not represent all migraine sufferers, the authors note.

Minen said that patients who had previously seen a psychologist for any reason were more likely to actually begin behavioral therapy.

More than 80 percent of the patients had consulted with a primary care physician for their headaches. Patients had also sought help for their migraines in emergency rooms or with ophthalmologists. “This suggests that patients perceived greater barriers to accessing behavioral, compared with medical treatments for migraine,” the study team writes.

“For many years, a lot of patients with migraines were told the disorder was all in their head, or they were depressed or stressed out. It’s important that as headache specialists we emphasize to our patients that we are not sending them for psychotherapy when we recommend behavioral migraine treatment,” said Dr. Amaal Starling, a neurologist at the Mayo Clinic in Phoenix, Arizona, who wasn’t involved in the study.

“We need to explain that behavioral techniques teach skills to help manage migraines,” Starling said in a telephone interview.

“These patients fall through the cracks,” said Dr. Nauman Tariq, director of the Johns Hopkins Headache Center in Baltimore, Maryland. “They become a little defensive if we don’t do a good job of explaining why we want them to see a psychologist, but they are an important and necessary part of the headache team,” he noted.

“Behavioral therapy improves patients’ quality of life. They perceive less pain, miss less work and can enjoy their activities again,” said Tariq, who was not involved in the study.

SOURCE: bit.ly/2sLYaHu Pain Medicine, online June 5, 2018.

https://reut.rs/2JlwHay

New Enterprise Associates buys DaVita’s Paladina Health

• Venture capital firm New Enterprise Associates has acquired DaVita’s direct primary care business Paladina Health, the subsidy announced Wednesday. The deal is for around $100 million, CNBC reports.
• Paladina operates more than 50 physician offices across 10 states, including Colorado, Ohio, Florida and Texas, and plans to continue to expand, according to the company.
• The deal comes about six months after UnitedHealth’s Optum announced it would acquire DaVita Medical Group for $4.9 billion.

The deal is the latest amid a growing number: In 2017, there were 579 healthcare deals, the second highest number on record, according to a recent report by Mergermarket and West Monroe Partners.

The shift from fee-for-service to value-based care appears to be a major component of the pact.

“We’ve closely followed the ongoing shift to value-based care in the U.S., and believe that Paladina Health is a pioneer in the space,” said Mohamad Makhzoumi, NEA general partner and head of healthcare services and healthcare IT investing, in a statement.

Makhzoumi pointed to Paladina’s direct primary care model as desirable, saying it has shown high patient and provider satisfaction while keeping down costs. Under the model, physicians collect a monthly fee from employers to provide care for their workers, rather than accepting insurance.

But the model has shown some shakiness. Last year, Seattle-based DPC provider Qliance was forced to close its doors.

“DPC is no longer a new concept, but there remains a sufficient amount of execution risk,” Chris Miller, CEO of Paladina, previously told Healthcare Dive. “Strong players have exited the market, mostly due to business models that haven’t worked and the lack of barriers to entry.”

DPC models seems to be gaining traction as more businesses contract directly with providers for their employees’ healthcare needs. A recent survey from Willis Towers Watson found while only 6% of large employers currently have such an agreement, 22% are considering it for 2019.

https://bit.ly/2M5W2TC

Medicare Part D spending spikes 77% even with prescriptions down 17%

Medicare spending and out-of-pocket costs on brand-name drugs is up despite a decrease in prescriptions, a government watchdog says.

The Department of Health and Human Services’ Office of Inspector General found (PDF) that Medicare spending on brand-name drugs jumped 77% from 2011 to 2015. That spike in spending occurred even with a 17% decrease in prescriptions for such drugs.

Part D spending accelerated six times faster than inflation, the OIG also found. A report released earlier this year by Sen. Claire McCaskill, D-Mo. showed brand-name drug prices have jumped by 12% each year from 2012 to 2017.

“Generally, plan sponsors base their pharmacy reimbursement amounts on the prices that manufacturers set for their drugs,” the watchdog said. “Increasing manufacturer prices for brand-name drugs may result in increasing costs for Medicare and its beneficiaries, especially those beneficiaries who need access to expensive maintenance drugs.”

After accounting for manufacturer rebates, the watchdog found that brand-name drugs still increased by 62% during the same time frame.

Consumers have also felt the pinch of higher costs in their wallet.

The number of people who paid more than $2,000 in out-of-pocket costs nearly doubled during the five-year period, according to the OIG.

The report comes as the Trump administration attempts to tackle high drug prices, which could include pushing some Part B drugs into Part D. Recent analysis found that policy change could mean higher out-of-pocket spending for beneficiaries.

https://bit.ly/2JpVVRd

UnitedHealth part of $2.2B acquisition of hospitalist staffing company

UnitedHealth Group’s OptumHealth is part of a $2.2 billion deal to acquire a Washington-based hospitalist staffing company.

OptumHealth will be one of the two primary owners of Sound Inpatient Physicians Holdings, a physician staffing firm based in Tacoma, Washington, according to a ratings action issued by Moody’s on Thursday.

UnitedHealth’s care delivery arm will own the company alongside the private equity firm Summit Partners, which agreed to purchase the controlling stake of Sound from the Germany-based dialysis provider Fresenius Medical Care in April.

The announcement from Fresenius referenced an “investment consortium led by Summit.” UnitedHealth’s involvement has not been previously disclosed.

A UnitedHealth spokesperson had no immediate comment.

Moody’s assigned Sound Inpatient Physicians Holdings a “stable” rating based, in part, on the ownership stake by OptumHealth. The rating agency noted that “Sound will remain a highly leveraged physician staffing company with a high concentration within hospital medicine.”

UnitedHealth’s involvement in the transaction comes as the company is putting a bigger emphasis on care delivery, particularly through provider acquisitions. Last year, the insurer bought DaVita Medical Group for $4.9 billion. The acquisition added nearly 300 medical clinics across six states.

Last year, OptumHealth brought in $20.6 million in revenue and $1.8 million operational earnings.

During a presentation (PDF) at Berstein’s annual conference, CEO David Wichmann indicated that although the company’s M&A allocation was equally divided between benefits, services and international expansion between 2008 and 2012, the vast majority of M&A capital has been devoted to services over the last five years. And there are no signs the company is slowing down.

Although Wichmann did not mention the Sound acquisition, he pointed to new OptumCare markets “in the formative stages” of value-based payment approaches.

“We will methodically spend a decade or more to accomplish our long-term goals of entering and building out care delivery operations in 75 targeted markets serving 60% of the U.S.  population,” he said.

Moody’s expects Sound’s revenues to grow 10% over the next two years, reaching $1.4 billion in 2019. The staffing firm has roughly 3,500 employees.

Moody’s noted that Sound’s rating was constrained because it relies on profits generated through the Centers for Medicare & Medicaid Services’ Bundled Payments for Care Improvement Initiative.

“The stable outlook reflects Moody’s view that Sound will remain a highly leveraged physician staffing company with a high concentration within hospital medicine,” Moody’s analysts wrote. “It also reflects Moody’s expectation that Sound will grow primarily through organic means.”

https://bit.ly/2LvT9ux

Aspirin’s anticancer effect explored

According to new research, aspirin may reduce the risk of bowel cancer. The latest study to investigate this relationship outlines how the popular painkiller might manage this feat.

A simple, well-used pill may provide insight into bowel cancer.

Aspirin, the cost-effective, relatively safe, over-the-counter painkiller, is commonly taken to treat aches and pains.

Also known as acetylsalicylic acid, it is regularly used to prevent more serious conditions, too — such as stroke and blood clots in at-risk patients.

Over the years, evidence has been mounting that aspirin might also prevent bowel (colorectal) cancer.

For instance, a 20-year follow-up of five randomized clinical trials published in 2010 concluded that daily aspirin, taken over many years, “reduced long-term incidence and mortality due to colorectal cancer.”

Similarly, in 2010, another study looking at shorter-term aspirin demonstrated “a protective effect against [colorectal cancer] associated with the lowest dose of aspirin […] after only 5 years use in the general population.”

Although evidence is mounting, exactly how aspirin protects against certain cancers is still not understood. In a recent paper, published in the journal Nucleic Acids Research, scientists attempted to find out. They focused on a structure within the cell called the nucleolus.

The nucleolus and aspirin

The nucleolus is the largest structure within the nucleus of cells. Its primary function is to produce ribosomes, which are responsible for synthesizing all of the cell’s protein.

When the nucleolus is activated, it appears to drive tumor growth. This seems to be because, as cells divide and proliferate, they need to generate more ribosomes to keep up with increased protein demands — so the nucleolus needs to shift up a gear.

In fact, cancer cells spend the majority of their energy on the production of new ribosomes.

This makes the nucleolus a potential target for cancer researchers. Interestingly, other researchers have noted that nucleolus dysfunction might also play a role in Alzheimer’s and Parkinson’sdiseases.

The scientists involved in the new study, based at the University of Edinburgh’s Cancer Research Centre in the United Kingdom, took tumor tissue from colorectal cancer patients and examined aspirin’s effects on the cells in the laboratory.

They found that aspirin reduced the activity of a transcription factor called TIF-IA. Without TIF-IA, ribosomes cannot be produced in the nucleolus, thereby limiting the cell’s ability to produce protein.

“We are really excited by these findings as they suggest a mechanism by which aspirin may act to prevent multiple diseases,” says study co-author Dr. Lesley Stark.

“A better understanding of how aspirin blocks TIF-IA and nucleolar activity provides great promise for the development of new treatments and targeted therapy.”

Dr. Lesley Stark

Not every patient who has bowel cancer will respond to aspirin treatment, but understanding why it works at all will help to narrow down which individuals are most likely to benefit.

However, long-term use of aspirin is not recommended for the general population because it can increase the likelihood of internal bleeding.

So, understanding the mechanisms will help scientists to design other cancer drugs that work on the nucleolus or TIF-IA without increasing bleeding risk.

https://bit.ly/2Lybp6l

Lilly started at buy by Cantor

Cantor Fitzgerald initiates coverage on Eli Lilly (NYSE: LLY) with a Overweight rating and a price target of $100.00

https://bit.ly/2M7E43a

EDAP TMS: FDA OKd prostate tissue ultrasound ablation system

EDAP TMS SA (Nasdaq: EDAP) (“the Company”), the global leader in therapeutic ultrasound, today announced that it has received 510(k) clearance from the US Food and Drug Administration (FDA) for its Focal One device for the ablation of prostate tissue.

The Focal One high intensity focused ultrasound (HIFU) device is the first medical apparatus designed specifically for focal treatment of the prostate. Focal One fuses MR and 3D biopsy data with real-time ultrasound imaging, which allows urologists to view integrated, detailed 3D images of the prostate on a large monitor and direct high intensity ultrasound waves to ablate the targeted area.

With Focal One, urology surgeons can establish precise contours around the diseased tissue and ablate an even smaller portion of the prostate.  This lessens the damage to healthy tissue, and minimizes side effects of incontinence and impotence for patients.  Using Focal One, surgeons can customize the HIFU procedure for each patient and each clinical condition.

“Focal One is a great step forward in using this new and important ultrasound technology for prostate tissue ablation,” said Dr. Brian Miles, Urologist, Professor of Urology, Houston Methodist Hospital – Weill Cornell Medical College.  “Focal One’s ability to merge MRI images, ultrasound images and biopsy data in order to precisely outline and treat just the diseased tissue area of the prostate is truly remarkable.”

“We are thrilled that this innovative technology will now be available to patients and physicians in the United States,” said Marc Oczachowski, Chief Executive Officer of EDAP. “The FDA’s clearance of Focal One validates not only the power of our technology but also the years of hard work and dedication by our clinical trial investigators and EDAP’s outstanding employees. Focal One’s real-time imaging and 3D robotic features allow for greater precision, leading to improved targeting and treatment planning, and we are excited to be able to expand access to Focal One to the most important healthcare market in the world.”

https://bit.ly/2kTLudZ