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Annals of Internal Medicine Tip Sheet
July 24, 2018


Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.


1. American’s view of marijuana use is more favorable than existing evidence supports

Commercialization likely to blame for inaccurate public perceptions

Abstract: http://annals.org/aim/article/doi/10.7326/M18-0810

A nationally representative survey of U.S. adults suggests that Americans’ view of marijuana use is more favorable than existing evidence supports. Aggressive commercialization of marijuana is likely to blame, according to researchers. The findings are published in Annals of Internal Medicine.

Despite insufficient evidence regarding its risks and benefits, marijuana is increasingly available and aggressively marketed to the public. Whereas the marketing of tobacco and alcohol to consumers is heavily regulated, the promotion of marijuana products has no such constraints. As such, understanding how the public perceives marijuana use is important.

Researchers from the University of California, San Francisco and the San Francisco Veterans Affairs Medical Center conducted a probability-based online survey of 16,280 U.S. adults to evaluate public perceptions regarding the health benefits and risks of marijuana use. The researchers found that U.S. adults ascribe many benefits to marijuana that are not supported by existing evidence. Over a third of respondents believe that smoking marijuana prevents health problems, such as pain or multiple sclerosis. They also believe that marijuana is beneficial in treating insomnia, depression, and anxiety, for which efficacy and safety have not been established and possible harms may exist. In addition, a sizable group of survey participants responded that marijuana has no risk of addiction potential and also suggested that secondhand smoke from marijuana is safer than secondhand smoke from tobacco, despite no evidence to support those beliefs.

According to the researchers, the gaps in understanding of the health effects and safety of marijuana use are extensive, and the public may be underestimating its long-term risks. These national data underscore the need to invest in further research to better understand both the health effects of marijuana use and the public health investment necessary to better communicate potential health risks to the public.

2. Walmart drug program offers savings over Medicare program for generic cardiovascular medications

Abstract: http://annals.org/aim/article/doi/10.7326/M18-0965

A substantial proportion of Medicare Prescription Drug Programs (PDP) required patients to spend more out of pocket than Walmart’s Generic Drug Discount Program (GDDP) for commonly used generic medications. Findings from a brief research report are published in Annals of Internal Medicine.

To control the rising cost of prescription drugs, health plans are increasingly shifting costs to patients, which could adversely affect patients’ medication adherence and subsequent health outcomes. GDDPs, including one from Walmart, sell many commonly used generic medications for $4 per 30-day supply, regardless of insurance status. This type of program could lead to savings for patients.

Researchers from Yale School of Medicine compared out-of-pocket costs under several Medicare PDPs versus Walmart’s GDDP for 30-day supplies of 27 generic medications used to treat prevalent CVD-related conditions. The analysis involved 1,533 Medicare Advantage PDPs and 622 standalone PDPs and the goal was to see the proportion of plans that required patients to spend more than $4 out of pocket for their medications. Across all medications and tiers, the median proportion of plans that required patients to spend more than $4 out of pocket for covered medications was 21 percent. The median proportion differed significantly between Medicare Advantage PDPs and standalone PDPs. In particular, MA-PDPs consistently required patients to spend more out of pocket than standalone PDPs.

According to the researchers, these findings are counterintuitive considering that Medicare Advantage plans are responsible for acute care coverage, outpatient services, and other health care expenses for their beneficiaries and not solely pharmaceutical services like standalone PDPs.

3. VA Mission Act may inadvertently reduce number and quality of veterans’ health care choices

Abstract: http://annals.org/aim/article/doi/10.7326/M18-1539

De-facto privatization through the Veterans Affairs (VA) Mission Act may inadvertently reduce Veterans’ health care choices and diminish quality of care. An Ideas and Opinions piece is published in Annals of Internal Medicine.

Recently, Congress passed the VA Mission Act, a new model of Veterans health care delivery based on networks of community providers designed to provide greater choice for Veterans. Under the Mission Act, veterans will be covered whether they receive care at a VA facility or in the private sector. Authors from the University of Arizona College of Medicine explain the trade-offs associated with this new care model.

According to the authors, the Mission Act may divert funds from VA facilities, forcing some to cut back or close, which means Veterans could find their healthcare choices reduced. They say that real choice in health care implies that costs, quality and uniformity of care are similar in the private sector compared to the VA. But according to their evaluation, costs may increase and quality could decrease in many circumstances. For example, greater access to private sector health care might come with poorer performance on many process metrics and hither 30-day mortality rates. The lack of performance uniformity and health inequities intrinsic to commercial U.S. health care marketplace means that Veterans will face trade-offs between autonomy, access, and quality.

Also new in this issue:

Deriving Real-World Insights From Real-World Data: Biostatistics to the Rescue

Michael J. Pencina, PhD; Frank W. Rockhold, PhD; and Ralph B. D’Agostino Sr., PhD
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M18-1093

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