Community Medicine Journal Club

July & August 2016: Diabetes and Generic Insulin

posted Jul 24, 2016, 3:30 PM by PC/SM Chief Resident   [ updated Aug 20, 2016, 4:23 PM ]

Facilitator: Marce Abare

The goal of this CMJC is to review the history of insulin, the concept of "incremental innovation" and discuss the reasons for why we lack of a generic option.  We will also touch upon the subsequent public health implications and how this might affect caring for our patients with diabetes.

Please read the entire article, but come prepared to talk about your assigned section. Please review the questions. 

1. The origins of insulin - Cedric
2. Improving the product - Claude, 
3. Copying larger molecules - Blaney, Liz
4. The paradox of incremental innovation - Jules

*Louisa and Justine, you have no assignment because you have RSCE that day

Questions for discussion:
1. How do patents affect drug prices? How do patents distort R&D?
2. How much money does pharma make and where does it go?
3. Are high profits necessary for future research and development of life-saving drugs?
4. What are the major reasons why insulin, despite its public health significance, remains prohibitively expensive?
5. Greene writes that the "history of insulin highlights the limits of generic competition as a public health framework..." What are those limits? What are examples of other public health frameworks for drug pricing and access?
6. In adults with T2DM requiring basal insulin formulation, are long-acting insulin analogues superior to NPH insulin in controlling glycemia?
7. What are avenues for clinicians to influence drug pricing? the development pipeline?
8. How do price differentials affect your clinical practice?

Other references:

August 2015: Housing and Health

posted Aug 21, 2015, 4:05 PM by PC/SM Chief Resident   [ updated Aug 21, 2015, 4:07 PM ]

For this month's Community Medicine Journal Club we are going to be looking at the relationship between housing and health. 

The focal point of CMJC will be looking at a recently published RCT from Canada that compared the effectiveness of a Housing First model (founded in NYC) and treatment as usual for patients experiencing chronic homelessness. The paper looks at both housing and health related outcomes and will hopefully serve as a jumping off point for further discussion. 

I've assigned sections to help organize the session: 

Background: Liz Berger
Methods: Iman Hassan (study design; inclusion criteria)
Methods: Sire Sow  (intervention; outcomes)
Results: Shruthi Rajashekara
Discussion: Lalit Narayan

As background, I'd like you all to read the following Commonwealth Foundation In Focus: Using Housing to Improve Health and Reduce the Costs of Caring for the Homeless. It is a phenomenal overview of the issue with embedded links to relevant studies and articles. There is even mention of a Monte initiative that might pique some interest. 

July 2015: HIV Treatment Cascade

posted Jul 7, 2015, 3:49 PM by PC/SM Chief Resident   [ updated Jul 7, 2015, 4:06 PM ]

Facilitator: Dr Peter Selwyn

Peter Selwyn will be facilitating the CMJC for July. He would like to focus the discussion around the HIV treatment cascade. There is one primary article (#1) and an accompanying editorial (#2) that he would like for you to read.  The 3rd and 4th articles represent more local data (Monte specific) that he thought might pique your interest. He asked that you simply scan these articles if interested. 

Primary Articles

1. The State of Engagement in HIV Care in the US by Michael Muguavero et al. 
2. A Tale of Two Realities by Carlos del Rio & Kenneth Mayer


April 2015 - P4P

posted Mar 23, 2015, 2:32 PM by PC/SM Chief Resident

Facilitator - David Himmelstein

We will be looking at the same articles as the March CMJC as the jumping off point for a discussion with David.

Please glance of the 3 "required" articles to familiarize yourselves with the main points.

March 2015 - Pay for Performance

posted Mar 10, 2015, 8:46 AM by PC/SM Chief Resident   [ updated Mar 23, 2015, 2:30 PM ]

Facilitator - Steffie Woolhandler

All read this article
Stella/Sethi read this article
Hack/Abare/Dayal read this article

All skim (not required) from lay press:

February 2015

posted Feb 9, 2015, 11:48 AM by PC/SM Chief Resident   [ updated Feb 9, 2015, 11:53 AM ]

For Profit Hospitals
Facilitator - Aaron Fox

Please read this article from JAMA 2014
Please skim this article from Canadian Medical Association Journal 2002

January 2015

posted Jan 15, 2015, 3:13 PM by PC/SM Chief Resident   [ updated Jan 15, 2015, 3:19 PM ]

Implicit Bias - In Medicine and Current Events

Please read the following article from Mother Jones 2014

Please browse this website:

September 2014

posted Sep 17, 2014, 11:29 AM by PC/SM Chief Resident   [ updated Sep 17, 2014, 11:42 AM ]

Medical Marijuana and Opioid Analgesic Overdose
Facilitator: Aaron Fox

For this session, we will review the recent JAMA article by former PCSM chief resident, Marcus Bachhuber, entitled "Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States: 1999 - 2010."

Additional supplemental (not required) readings include:
This New York Times piece on the legalization of medical marijuana in New York State.
This NEJM review piece on medical marijuana.
This CNN piece written after the publication of Dr. Bachhuber's paper.

August 2014

posted Aug 21, 2014, 10:11 AM by PC/SM Chief Resident   [ updated Aug 21, 2014, 10:29 AM ]

Effect of Mass Incarceration on Health 
Facilitator: Catherine Trimbur

Please look at the three articles below

1-The popular press article link from the NYT  looks at mental illness and conditions at Rikers. We've included this to entertain a discussion about what the experience of incarceration is like for our many patients who pass through jail. 

2-Biswanger et al Release from Prison. This is a great study looking at the causes of increased mortality in the post incarceration period. This is included for a discussion about how we can take the experiences of patients in jail/prison and think through the challenges to health on reentry into the community. What should we be screening for, discussing with our patients as they are released?  

3-Rich et al Medicine and the epidemic of incarceration. This one is just for skimming/if you want to read more but I will say this is one of the best articles EVER! A fabulous overview of the health and public health issues related to incarceration and reentry. It is a quick read and Jody Rich is a fabulous researcher/doctor. 

July 2014

posted Jul 16, 2014, 6:56 AM by PC/SM Chief Resident   [ updated Jul 16, 2014, 7:10 AM ]

PCMH Talk with Matt Anderson

For this session, Matt Anderson will facilitate a discussion based on the questions below, the articles used in the PCMH CMJC from May 2014 (posted below), and finally the attached piece by Dr. Anderson.

1) How did the PCMH become the accepted model? (What are the implications of this process?)

2) What are the generally accepted components of the PCMH? (And what things might have been left out?)

3) Did the PCMH effort achieve the goals it set out to accomplish? (Why not?)

4) Can the PCMH be reformed and if so how? If it cannot be reformed, what should take its place?

And, for your own enjoyment, please see Dr. Anderson's piece from the Health Affairs Blog - "Nine Questions about My New Medical Home."

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