In some areas, it has become almost impossible to find independent physician practices. Many of these smaller practices have opted into being bought by hospitals and other large medical groups. So, what has prompted the increase of consolidation in the medical field? And what does this mean for patients?
The incentives of consolidation have been researched, but the results do not point to one reason. Dr. Laurence Baker, Professor of Health Research and Policy at Stanford University School of Medicine, explains that physicians running smaller practices might benefit from no longer having their own business. Another possibility, Dr. Christopher Ody, Research Assistant Professor at Kellogg School of Management at Northwestern University, explains, is that some hospitals may view consolidation as a way to improve the quality of healthcare and decrease the costs to help physicians and their patients. However, data has indicated that the factor with the largest role in consolidation has to do with increasing the amount that hospitals are getting paid, and decreasing the amount paid to pharmaceutical companies. Even though research has not provided an overarching incentive that drives consolidation, the data seems to point to increasing income for hospitals rather than providing patients with better care. Furthermore, hospital consolidation has not been shown to benefit the patient. Dr. Baker explains that data indicates that the cost of healthcare has not gone down for patients with consolidation. Since the cost of healthcare has increased for patients, many have started to wonder how consolidation has been able to continue and what is being done to control it.
In the medical field, it is important to maintain consistency in market concentration and ensure that the markets are still competitive. One way in which authorities in the medical field work to maintain market concentration is by regulating transactions that reach a price threshold. However, Dr. Ody explains that hospitals have been able to avoid these regulations by partaking in multiple smaller transactions that invest in a small number of physicians at a time in order to ensure that the cost is below the threshold for evaluation. By avoiding regulations, hospitals have been able to grow into much larger entities that generate a lot of power and income from smaller practices. Since consolidation has prompted increased healthcare costs, it currently appears to be detrimental to the medical field rather than helpful. Yet, it could be worth it if hospitals were able to determine a method of consolidation that decreases healthcare costs and improves the quality of care that is provided to patients.
Dr. Laurence Baker, Professor of Health Research and Policy at Stanford University School of Medicine
Dr. Christopher Ody, Research Assistant Professor at Kellogg School of Management, Northwestern University
Before a medication is released to the public, it’s safety and effectiveness must be put to the test. Clinical trials are a key part of this process, but experts say drugs are being proclaimed safe without enough attention on how the impacts differ between men and women.
Dr. Teresa Woodruff, Director of the Women’s Health Research Institute at Northwestern University, suggests the example of the drug Ambien, a common prescription sleep aid that was taken off shelves because of adverse events in women. Even though it was observed that there was a difference in how long it took for the body to clear the drug in men and women, the difference in efficacy was never quantified. The drug was later returned to shelves, but received new labeling instructing women to take smaller doses than men.
Dr. Melina Kibbe, Professor of Surgery at Northwestern University, says this is the first time a drug had explicitly instructed different dosing for men and women, but questions how many more drugs need to be reconsidered. Only one third of research subjects in clinical trials are women and, even if a study has exactly fifty-percent of each sex, issues still remain. “The problem is if you include both sexes but you report the data in aggregate then you won’t know if a drug has say a better effect in men versus women,” Dr. Kibbe explains.
Even before human clinical trials, research is conducted on predominantly male cells and animals, with very little focus on the variable of sex of the subject. Dr. Kathryn Sandburg, Director of the Center for the Study of Sex Differences in Health, Aging and Disease at Georgetown University, says researchers fall victim to the fall belief that there’s less variable in studying male subjects than female because of hormonal cycles. The opposite turns out to be true. Males actually have more variables to control. Recently, there’s been a push to have equality in research subjects, but private pharmaceutical companies are still not required to adhere to these guidelines.
Dr. Teresa Woodruff, Director, Women’s Health Research Institute, Northwestern University
Dr. Melina Kibbe, Professor of Surgery, Northwestern University
Dr. Kathryn Sandburg, Director, Center for the Study of Sex Differences in Health, Aging & Disease, Georgetown University
We usually associate food cravings for things like ice cream and pickles with pregnancy, but pregnant women and young children are among the most likely to suffer from another kind of craving – a disorder called Pica. Pica is characterized by an appetite for substances that are largely non-nutritive, such as ice, clay, chalk, hair, paper, drywall, paint, metal, stones, soil, glass or feces.
Dr. Sera Young, Assistant Professor of Anthropology and Global Health at Northwestern University, explains why clay is the most common pica craving — clay has been proven to help with nausea and other health issues that pregnant women experience.. She also believes pica is under-reported because doctors don’t ask the right questions and patients are ashamed to admit their odd cravings to doctors. Pica is usually seen as a tropical climate issue, but some studies show that one-third of women in upper New York State have experienced pica at some point in time, as have women in Chicago. Pica actually is not exotic or rare, and can be both helpful or harmful depending on what the individual is eating.
Dr. Richard Kreipe, Director of Child and Adolescent Eating Disorder Program at the University of Rochester, says that a common complication is that a ball of stuff, usually hair, can form in the body of a sufferer, causing many problems. He adds that many aspects of Pica, including its specific causes, are still a mystery due to lack of knowledge on the subject.
Pregnancy and early childhood are the most common time for a strange disorder that prompts people to eat non-food items such as clay or ice. Experts discuss its mysterious history.
Dr. Sera Young, Assistant Professor of Anthropology and Global Health, Northwestern University
Dr. Richard Kreipe, Professor of Pediatrics and Director, Child and Adolescent Eating Disorder Program, University of Rochester
Fetal Alcohol Syndrome can cause many physical and mental problems that last a lifetime. Dr. Eva Redei, Professor of Psychiatry and Behavioral Sciences at Northwestern University, says that most children who grow up with fetal alcohol syndrome usually never live independently because their neurodevelopment was stalled, and if they make it to adulthood they will require help. Babies with the most severe form of FAS are characterized by wide-set eyes, a flattened crease above the upper lip, a low IQ, and other cognitive and behavioral issues. About one percent of children born in the US have a severe form of fetal alcohol syndrome, with two to five percent falling on the fetal alcohol spectrum. But because there is no definitive test, some children are never diagnosed on the spectrum.
Dr. Joanne Rovet of Hospital for Sick Children explains that adults with fetal alcohol syndrome are at risk for mental illness. They also have an increased chance of getting in trouble with the law. About fifty percent of juvenile delinquents had prenatal alcohol exposure.
A study conducted by Dr. Redei on rats indicates that FAS can be treated at birth. Rats were given alcohol and split into two groups, with one group’s babies given a thyroid drug or a diabetic drug like metformin. The other group of babies which wasn’t given medication showed signs of FAS. Both drugs were shown to reduce or reverse the effects of prenatal alcohol exposure. Dr. Redei is now working on starting a human trial.
Maggie, parent of son with fetal alcohol syndrome
Dr. Eva Redei, Professor of Psychiatry and Behavioral Sciences, Northwestern University
Dr. Joanne Rovet, Senior Scientists, Hospital for Sick Children, Toronto, and Senior Professor of Psychology, University of Toronto
Synopsis: Only about a third of research subjects in clinical studies are women. In basic research on animals and cells, female models are even more poorly represented. This results in poor understanding of how new drugs work on women and occasional drug recalls when major side effects are discovered after the fact. Experts discuss why such an imbalance occurs, its results, and how the problem is being addressed.
Host: Reed Pence. Guests: Dr. Teresa Woodruff, Director, Women’s Health Research Institute, Northwestern University; Dr. Melina Kibbe, Professor of Surgery, Northwestern University; Dr. Kathryn Sandberg, Director, Center for the Study of Sex Differences in Health, Aging & Disease, Georgetown Univeresity
Synopsis: Millions of people can’t carry a tune when they sing and believe they’re tone deaf. However, most simply have trouble matching tones when they sing and would benefit from more practice. To the truly tone deaf person, all pitches sound alike. No amount of practice would help. Experts discuss the concept and offer hope to the karaoke-challenged.
Host: Reed Pence. Guests: Dr. Psyche Loui, Assistant Professor of Psychology and Neuroscience, Wesleyan University; Dr. Dominique Vuvan, post-doctoral fellow, International Laboratory for Brain, Music and Sound Research; Dr. Steven Demorest, Professor of Music Education, Northwestern University