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Good morning. We're wishing Sen. Lamar Alexander a speedy recovery following his surgery yesterday. The good news is that all of his doctors were in-network and he will have no surprise medical bills, a source familiar said.

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  • Today's Vitals is 875 words, <4 minutes.
1 big thing: Russian misinformation campaigns target health fears

Illustration: Rebecca Zisser/Axios

Russian efforts to sow discord ahead of the 2020 elections appear focused on fear-mongering around health care issues, my colleague Sara Fischer reports.

Why it matters: Misinformation online can have real-world health and safety repercussions.

Driving the news: Earlier this month, the New York Times reported that RT, the Russia-backed television network based in the U.S., has been peddling unverified stories claiming that 5G wireless technology can be linked to cancer, autism, Alzheimer's and other health problems.

  • "Hundreds of blogs and websites appear to be picking up the network's 5G alarms, seldom if ever noting the Russian origins," the Times notes. "Analysts call it a treacherous fog."

Earlier this year, the CDC attributed a rise in measles outbreaks to misinformation that fueled anti-vaccination sentiments.

  • A study from George Washington University professor David Broniatowski and his colleagues in October found that Russian trolls using sophisticated Twitter bot accounts were attempting to fuel the anti-vaccination debate by posting about the phenomenon — from both sides — at a far greater pace than the average user.
  • Their efforts, Broniatowski notes, mimic misinformation tactics that Russian trolls have used in the past — supercharging the online discourse in America around one issue by inflating polarizing viewpoints about it from both sides.

Be smart: The most effective misinformation often plays into preconceived notions or fears that already exist in society, especially around health, safety and well-being.

  • Part of the recent backlash against big technology companies is over concerns that they will prioritize innovation and commercialization over public safety.

Go deeper: 2020 misinformation campaigns take aim at the latest spook issues

2. Medical AI has a big data problem

Illustration: Rebecca Zisser / Axios

Facing increasingly overworked doctors and labyrinthine insurance systems, hospitals are searching for a lifeline in AI systems that promise to ease hard diagnoses and treatment decisions, Axios' Kaveh Waddell reports.

Reality check: The data underpinning the very first systems is often spotty, volatile and completely lacking in critical context, leading to a poor early record in the field.

The big picture: Basic clinical decision support (CDS) systems have been around for decades, but a skepticism of technology leads many doctors to ignore or override them.

  • Now, experts say a nascent generation of CDS — infused with AI in academic labs and startups — may reduce the estimated 40,000–80,000 deaths a year that result from medical errors.

The grand vision: Researchers hope AI programs can point doctors toward the best medications, lab tests or treatment plans based on minute patterns discovered in huge numbers of patients' past experiences.

Yes, but: Record keeping is so bad that doctors laugh when you ask about it.

  • Electronic medical records, central to CDS predictions, are notoriously error-ridden.
  • Other quirks of health data also make problems for CDS systems.

The bottom line: It's the oldest problem in data science: garbage in, garbage out.

What's next: The FDA, which doesn't review most CDS systems, is considering policy changes that could head off some data issues. Scientists are pushing the agency to impose strict benchmarks and audits to prevent mistakes.

Go deeper.

3. How Medicare can help biosimilar uptake

A new analysis finds that relatively minor changes to Medicare's payment policies could help jump-start the fledgling market for biosimilars, Axios' Sam Baker reports.

The market for biosimilars is weak, and that means the drugs' expected savings aren't materializing. But Medicare could help kick things up a notch, according to Avalere estimates commissioned by a coalition of biosimilars manufacturers.

By the numbers: According to Avalere's calculations, biosimilars could reach somewhere between 26% and 46% market share if Medicare picked up the tab for seniors' out-of-pocket costs for the drugs.

  • That approach could save the government as much as $5 billion and seniors as much as $3 billion over 10 years, depending on the details, the analysis says.

Doctors' financial incentives matter just as much as patients', since most biologics and biosimilars are administered at a doctor's office.

  • Medicare could save billions over the long run by simply tacking on a payment bonus for biosimilars, the analysis says.
  • Letting doctors share in the savings that biosimilars bring to Medicare wouldn't save as much money, but would do more to help biosimilars as a class gain a stronger competitive footing.

Go deeper: How to jump-start a fledgling class of new, cheaper drugs

4. The market power of PBMs
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Reproduced from Adam Fein of the Drug Channels Institute; Chart: Axios Visuals

CVS Health, Express Scripts (now owned by Cigna) and OptumRx (owned by UnitedHealth Group) continue to control a vast majority of the drug insurance market, according to new estimates from Adam Fein of the Drug Channels Institute.

  • Those 3 pharmacy benefit managers handled more than 75% of all prescription claims in 2018, Axios' Bob Herman reports.

The big picture: Employers usually don't switch drug benefits companies because they don't want to enrage their workers with the changes, which has given the big 3 players longstanding power in the market.

5. Backlash against pending executive order

As the Trump administration prepares an executive order that would increase transparency in the health care sector, intense industry opposition may keep one of the most controversial measures under consideration from being included, the Washington Post reports.

  • The measure would require insurers and hospitals to disclose negotiated rates for services.
  • Industry has intensely criticized the proposal as anti-competitive. Some experts have also said that it could end up driving prices higher.