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Kidney disease intervention outcomes encouraging, despite null result

Manisha Jhamb, M.D., launched the Kidney-CHAMP study five years ago because she saw a looming tsunami of chronic kidney disease cases. She was pulled to…

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Manisha Jhamb, M.D., launched the Kidney-CHAMP study five years ago because she saw a looming tsunami of chronic kidney disease cases. She was pulled to find a way to assist the primary care physicians upon whom this burden would fall.

Credit: UPMC

Manisha Jhamb, M.D., launched the Kidney-CHAMP study five years ago because she saw a looming tsunami of chronic kidney disease cases. She was pulled to find a way to assist the primary care physicians upon whom this burden would fall.

Today, the results of her study are published in JAMA Internal Medicine. And, even though the study didn’t prove that Kidney-CHAMP staves off disease progression, Jhamb is encouraged that the intervention helped PCPs identify and triage patients with kidney disease, improving patient access to specialists and educational materials.

“Despite the null result, we found that the Kidney-CHAMP framework is scalable, provides equitable access and overcomes barriers on the provider, patient and health system levels,” said Jhamb, associate chief of the Renal-Electrolyte Division in the University of Pittsburgh School of Medicine and UPMC nephrologist. “The big positive is that we were able to implement this in more than 100 PCP practices across a large geographic area that included many rural communities in the midst of a global pandemic.”

Kidney-CHAMP, which stands for Coordinated HeAlth Management Partnership, uses the electronic health record to flag kidney disease patients for review by a multidisciplinary team of a nephrologist, pharmacist and physician. It then feeds individualized recommendations back to the patient’s PCP and their medical chart. During the next appointment, real-time reminders prompt the physician to review recommendations and place or change medication orders. Patients are referred to a telemedicine appointment with a nurse who provides personalized education.

Chronic kidney disease is a leading cause of death in the U.S. and occurs when the kidneys can no longer filter blood as well as they should, allowing excess fluid and waste to build up in the body. If left untreated, the kidneys will shut down and dialysis or a kidney transplant will be needed. But medications and lifestyle changes can delay and even prevent progression.

Starting in May 2019, Jhamb and her colleagues enrolled 101 UPMC-affiliated primary care practices in the Kidney-CHAMP trial, randomizing the practices to either receive the intervention or not. The main goal was to see if Kidney-CHAMP reduced risk of chronic kidney disease progression. Although Kidney-CHAMP neither helped nor hurt patient outcomes compared to those who received regular care, patients in the program were more likely to receive appropriate medications and very few physician practices opted out of the intervention.

Barbara Kevish, M.D., participated in the trial as a physician through Renaissance Family Practice, one of the primary care practices that received Kidney-CHAMP. The intervention continues to be offered to her patients through UPMC Health Plan.

“I say to my patients, ‘I have a kidney specialist who looked at your chart and gave me recommendations to help maintain your kidney function.’ And the patients love it because they get that specialized care without an extra appointment with a specialist,” said Kevish, who is also associate vice president of Medicare Medical Services at UPMC Health Plan. “From a primary care standpoint, it’s a no-brainer – this program isn’t extra work for me and it’s a value-add for my patients.”

Jhamb suspects that the COVID-19 pandemic, which shifted physician focus from chronic disease management to acute care nationwide, and too short of a follow-up period may be behind the null results. If they’d had more time, Jhamb suspects the study would start seeing positive outcomes.

In the meantime, Kidney-CHAMP formed a partnership with the UPMC Health Plan, and it has since been rolled out to more than 2,500 patients. Jhamb is especially encouraged because, for the first time in nearly 20 years, new therapies are being introduced to improve and prevent kidney failure.

“As soon as new medications become available, Kidney-CHAMP and its team of nephrologists and pharmacists review patient records to see who is most likely to benefit,” Jhamb said. “This provides support to busy PCPs who may not otherwise be aware of a brand-new medication or exactly which of their patients it could help.”

Additional study authors include Melanie R. Weltman, Pharm.D., Susan M. Devaraj, Ph.D., M.S., R.D., Linda-Marie Lavenburg, D.O., M.S., Zhuoheng Han, M.S., Alaa A. Alghwiri, Ph.D., Gary S. Fischer, M.D., Bruce L. Rollman, M.D., M.P.H., Thomas D. Nolin, Pharm.D., Ph.D., Jonathan Yabes, Ph.D., all of Pitt.

This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK116957, T32HL110849-11A1 and T32DK061296-19).


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Real retail sales rebound, forecast a continued “soft landing” for jobs growth

  – by New Deal democratAs per usual, real retail sales is one of my favorite indicators, because it gives so much information about the consumer, and…

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 - by New Deal democrat


As per usual, real retail sales is one of my favorite indicators, because it gives so much information about the consumer, and since consumption leads employment, it helps forecast the trend in the latter as well.


And the news this morning was good, as nominally retail sales increased 0.7% in March, while February’s number was revised higher by 0.3% to 0.9%. After accounting for 0.4% inflation in March, real retail sales increased 0.3%, and February was revised up to 0.5%.

To the extent there was bad news, it was that January’s -1.2% decline has still not been completely erased.

To the graphs: first, below I show the historical record for the past 15+ years of both real retail sales (dark blue) and real personal spending on goods (light blue), a similar but more comprehensive measure. The two metrics tend to trend together over time, although the latter has tended to increase more (hence I adjust to bring the trends more in line):



Here is the close-up post-pandemic view:



Real retail sales are still -2.9% below their April 2022 peak, and also about -1% below their nearer term August 2023 peak. Real spending on goods has been more positive. More importantly for the long term trend, real spending on goods has now completely caught up with real retail sales. The bigger picture is that real retail sales have trended neutral, while real spending on goods has trended higher.

Turning to the effect on employment, here is the longer term YoY% gains in both spending measures /2, which is the best match to forecast the near term trend in jobs (red):



Employment doesn’t respond to every noisy move in spending, but does tend to peak and trough about 6 months after spending, and responds to the longer term trend. If FRED allowed 6 or 12 month moving averages, the correspondence would be much closer.

With that caveat, here is the post-pandemic close up:



Historically negative YoY comparisons in real retail sales have usually meant recession, while positive comparisons have almost always meant continued expansion. Needless to say, that didn’t happen in 2022-23. The overall trend since mid year 2023 has been “less negative” to neutral, while real spending on goods has remained positive.

And as those YoY comparisons in consumption have improved, we have seen the decelerating trend in employment shift to a more consistent “soft landing” scenario. Thus real retail sales are forecasting continued growth in the neighborhood of the last few months’ numbers going forward through most of this year.


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Regeneron enters venture investing with $500M, poaches senior partner from ARCH

Regeneron, the 35-year-old drugmaker still led by its co-founders, is getting into the venture investing arena.
The New York pharma will commit $100 million…

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Regeneron, the 35-year-old drugmaker still led by its co-founders, is getting into the venture investing arena.

The New York pharma will commit $100 million per year for five years, it said Monday morning. The drugmaker is the exclusive limited partner for the fund, which launched this month under the name Regeneron Ventures. It will invest in biotech startups, devices, tools and “enabling technologies.”

Jay Markowitz

Leading the firm are former Regeneron senior vice presidents Jay Markowitz and Michael Aberman. Markowitz spent the past three years at ARCH Venture Partners as a senior partner, and Aberman was most recently CEO of seed-stage immuno-oncology biotech XenImmune Therapeutics.

Most large pharma companies have venture arms of their own. Regeneron is stepping onto the court as it matures into the next $100 billion market cap drugmaker. It fell below that arbitrary mark on Friday, with its stock $REGN closing down 1.7% on April 12.

The Tarrytown-based pharma has largely favored R&D pacts over acquisitions throughout its history and still operates as an entrepreneurial company with its co-founders Len Schleifer and George Yancopoulos still serving as CEO and chief scientific officer, respectively.

Michael Aberman

The venture team will invest “agnostic to therapeutic area, technology and stage of development,” Markowitz said in a statement. Regeneron’s therapeutic interests are quite broad: cardiovascular/metabolic, blood cancers, oncology, ophthalmology and infectious disease, among others.

“Our goal is to cultivate an ecosystem where the next generation of biotech companies can thrive, drawing on the lessons learned and successes achieved at Regeneron and throughout our careers,” Aberman said in the press release.

Regeneron’s entry into biotech venture investing comes as industry insiders cross their fingers that the optimism of the past few months sustains itself for a broader, deeper recovery for drug developers. Record amounts of capital were deployed on the public financing side in the first quarter of 2024 as PIPEs were all the rage. On the private side, venture dollars returned to pre-pandemic levels but are still far off the quarterly numbers of the 2020 and 2021 go-go days.

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CNN Is Wrong… Deflation Is A Good Thing

CNN Is Wrong… Deflation Is A Good Thing

Authored by Soham Patil via The Mises Institute,

A recent video by CNN states that lower prices…

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CNN Is Wrong... Deflation Is A Good Thing

Authored by Soham Patil via The Mises Institute,

recent video by CNN states that lower prices are bad for the United States economy and that consumers must get used to the newer, higher prices.

The video goes so far as to say, “We’re never going to pay 2019 prices again.”

The video claims that deflation is responsible for a long list of problems including layoffs, high unemployment, and falling incomes.

Americans should simply get used to paying more and more each year and be happy about it. Except, deflation is actually good for consumers despite the contentions of inflation-supporting economists.

The conclusion that inflation is a good thing is reached by the mishandling of economic terms.

While Austrian economics accepts that inflation is the expansion of the money supply, mainstream economics contends that inflation is an increase in the general price level in an economy. This skewed definition allows one to erroneously conclude that inflation causes prosperity by raising profits and incomes through higher consumer prices. The problem with this is that “price inflation” is also often caused by real inflation: the increase of the money supply. An increase in the money supply comes from the creation of additional units of money ex nihilo, out of nothing. The wealth of savers is diluted by the expansion of the money supply, which leads to the hardships many Americans face.

Further, while the video contends that the pandemic may have caused rising prices, it cannot explain the continual growth of prices even after the effects of the pandemic have subsided. The pandemic is not responsible for the continual trend of increasing prices; the growth of the money supply is.

Figure 1: The M2 in the United States, 1959–2024

Source: FRED. Data from the Board of Governors of the Federal Reserve System.

While the money supply of US dollars has increased steadily over the past few decades, a significant jump can be seen after 2019 when the Federal Reserve’s expansionary monetary policies caused a great rise in the money supply. This growth, uncompensated by additional production due to the pandemic, caused the price inflation that many now blame solely on the pandemic. The truth is that if the pandemic were the cause of prices rising a significant amount, the absence of the pandemic should account for a proportionally drastic deflationary period afterward. This never occurred, and thus the money supply paints a more honest picture of inflation than any index of a collection of prices ever could.

By contrast, deflation, as opposed to inflation, is often a good thing for consumers. Deflation means that the same unit of money is worth more today than it was yesterday. Consumers thus can buy more today than they could yesterday. Instead of actively being impoverished during conditions of inflation, consumers would rather be made richer during times of deflation.

The reason many economists are quick to champion inflation as creating prosperity is because central banks have previously used expansionary monetary policies to temporarily boost the economy by increasing aggregate demand. Several of these policies, often specifically lowering interest rates, cause a boom-bust cycle. When the money supply is expanded and cheap credit is abundant, firms are able to take on ambitious projects that they may not have been able to previously. Malinvestment results from the unsustainable credit expansion created by extremely low interest rates. There is greater demand for the factors of production, and an increase is seen in conventional metrics of economic growth such as gross domestic product.

During the process of malinvestment, an increase in employment occurs due to the firms having access to cheap and easy credit, allowing for greater business spending. However, when firms lose access to cheap and easy credit due to the central banks having to prioritize cutting inflation, jobs are lost. These job losses are not the fault of the deflation but rather the malinvestment during economic booms. Without malinvestment and inflation, resources would have been invested in more-profitable endeavors, making better use of these resources.

Artificially cheap credit causes a misallocation of resources by skewing price information. Eventually, a bust must follow the boom. In this period, deflation often occurs due to market actors coming to more-realistic valuations of the factors of production. After these realistic valuations come about, consumers are able to pay less for their goods and services . . . at least until the central bank causes the next boom-bust cycle.

In conclusion, it would be wrong to pinpoint deflation as a potential issue for the economy.

To do so would be to conflate the cause and effect of how money supply affects an economy.

Contrary to CNN’s video, the Federal Reserve throughout its history has not helped the cause of consumers, evidenced by the exponential growth of prices since its foundation.

Tyler Durden Mon, 04/15/2024 - 06:30

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