"What goes up, must come down, spinning wheel got to go round"

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Kaitlyn Dmyterko,  staff writer

“What goes up, must come down, spinning wheel got to go round,” sings Blood, Sweat and Tears. While new drug therapies or procedures may treat patients for one condition, these same therapies also may have the potential to put patients at risk for another condition. However, similar to the lyrics of this '70s song, sometimes within the medical industry everything seems to come full circle.

This week, a study published in Circulation: Cardiovascular Quality and Outcomes adds to the substantial data already surrounding rosiglitazone (Avandia), which has been under scrutiny by the FDA for its potential to cause cardiovascular risk in patients.

And despite the call for additional warnings for the drug, researchers have found that its effects may be not much different than other thiazolidinediones (TZDs) in its class. In fact, when Avandia was compared to pioglitazone (Actos), results showed that the two diabetes therapies had similar adverse event rates—4 percent. However, FDA is still weighing decisions of a July 14-15 committee meeting, which spent almost 20 hours considering the pros and cons of the drug.

Additionally, a substudy of the JUPITER trial  found that rosuvastatin (Crestor) may be appropriate for use in patient populations at “intermediate risk” for cardiovascular events and who have low LDL cholesterol levels and heightened high-sensitivity C-reactive proteins. Previously, this patient population would not have qualified for statin use according to guidelines set forth at the beginning of the JUPITER trial in 2003.

Ridker and colleagues used the Framingham risk score and Reynolds risk score to assess patients' 10-year global risk and found that patients had similar risk reductions with rosuvastatin as the JUPITER trial, which showed an almost 44 percent reduction.

Moreover, new guidelines put forth by the European Society of Cardiology (ESC) found that troponin may be a vital biomarker for better detecting MI, particularly when other evidence of ischemia is lacking. If the troponin assay is missing, creatine kinase-MB (CK-MB) may be the “best alternative” for detecting the condition.

Lastly, with the recent push from the government to move toward meaningful use criteria that would replace outdated paper-based systems with electronic systems, such as CPOE-enabled EMRs and EHRs, among others, a report this week has outlined how these systems can add transparency, regulate medical practice and also produce a noteworthy ROI to practices.

While the McKinsey Quarterly report says that practices may experience an initial productivity loss and lofty costs overall, implementing these changes will lead to lower costs in the long run due to their potential to reduce medical errors and unwarranted testing.

The costs to make the switch from HIPAA 4010 to 5010 x12 and ICD-9 to ICD-10 alone are estimated to set back U.S. hospitals a whopping $120 billion; however, the report estimated that the productivity and cost reductions from this would provide an ROI two to four years subsequent to implementation.

Each week, changes to the medical industry affect practice, some for the good, some bad; however, the advances to technology and better awareness of disease states seem to have the potential to outweigh the minor snags.

On these topics, or others, please feel free to contact me.

Kaitlyn Dmyterko
Staff Writer