7 common habits that can damage the brain - IndiaTimes
- 7 common habits that can damage the brain IndiaTimes
- 3 Things You Should Never, Ever (Seriously Never) Do If You Want To Keep Your Brain Healthy YourTango
- Sleep and brain health WFSB 3
- 7 habits that impact your brain health | Daily Sabah Daily Sabah
- Psychiatrist Shares 5 Habits That Can Damage Your Brain Times Now
1 year 5 months ago
One-pill-a-day to prevent HIV: A doctor’s personal experience as a client
The first time I was offered the one-pill-a-day to prevent HIV was while working at a doctor’s office in Washington, DC, USA. The 2019 Annual Epidemiology and Surveillance Report of the District of Columbia, USA, reported an HIV prevalence of 1.8...
The first time I was offered the one-pill-a-day to prevent HIV was while working at a doctor’s office in Washington, DC, USA. The 2019 Annual Epidemiology and Surveillance Report of the District of Columbia, USA, reported an HIV prevalence of 1.8...
1 year 5 months ago
Advances in epilepsy treatment
EPILEPSY MAY be treated with antiepileptic medications (AEDs), diet therapy and surgery. Medications are the initial treatment choice for almost all patients with multiple seizures. Some patients who only have a single seizure, and whose tests do...
EPILEPSY MAY be treated with antiepileptic medications (AEDs), diet therapy and surgery. Medications are the initial treatment choice for almost all patients with multiple seizures. Some patients who only have a single seizure, and whose tests do...
1 year 5 months ago
Understanding epilepsy and its causes
EPILEPSY IS a disorder of the brain characterised by repeated seizures. A seizure is usually defined as a sudden alteration of behaviour due to a temporary change in the electrical functioning of the brain. Normally, the brain continuously...
EPILEPSY IS a disorder of the brain characterised by repeated seizures. A seizure is usually defined as a sudden alteration of behaviour due to a temporary change in the electrical functioning of the brain. Normally, the brain continuously...
1 year 5 months ago
3 Things You Should Never, Ever (Seriously Never) Do If You Want To Keep Your Brain Healthy - YourTango
- 3 Things You Should Never, Ever (Seriously Never) Do If You Want To Keep Your Brain Healthy YourTango
- Sleep and brain health WFSB 3
- 7 common habits that can damage the brain IndiaTimes
- 7 habits that impact your brain health | Daily Sabah Daily Sabah
- Psychiatrist Shares 5 Habits That Can Damage Your Brain Times Now
1 year 5 months ago
Medical News, Health News Latest, Medical News Today - Medical Dialogues |
Breastfeeding practices for three months tied to lower risk of childhood obesity, irrespective of mother's BMI: Study
USA: A recent study published in Pediatrics has suggested breastfeeding recommendations as a potential strategy for decreasing the risk of offspring obesity.
The study showed that regardless of the mother's body mass index (BMI) before pregnancy, consistently breastfeeding the infants in any amount during their first three months was associated with a lower risk of childhood obesity.
While previous studies have shown that breastfeeding may protect children against obesity and other chronic conditions, this relationship has not been studied much in women with obesity. ECHO Cohort researchers wanted to explore the possible link between breastfeeding practices in women with obesity and overweight before pregnancy and a child’s BMIz score. Researchers use BMIz scores to compare children’s height and weight to those of their peers, while the more familiar BMI assesses body weight concerning height.
In this ECHO Cohort study, researchers found that any amount of consistent breastfeeding during an infant’s first three months was associated with lower BMIz scores, calculated later at ages between 2 and 6 years, regardless of the mother’s pre-pregnancy BMI. This protective association appeared stronger for children with mothers who had obesity before pregnancy compared to those categorized as overweight during the same time. (A BMI of 25 to 29.9 is considered overweight, and a BMI of 30 or higher is considered obese.)
“Our findings highlight that each additional month of breastfeeding, whether a consistent amount or exclusively, may contribute to a lower weight later in childhood, especially for mothers who had obesity before pregnancy,” said Gayle Shipp, PhD, RDN of Michigan State University.
The study looked at BMI measurements from 8,134 pairs of mothers and kids at 21 study sites in 16 states and Puerto Rico. The researchers calculated BMI and BMIz scores from measurements taken at study visits, medical records, or self-reported data for the mother and child. Additionally, the study examined two breastfeeding situations: whether the mother ever breastfed or whether the mother was exclusively breastfeeding the infant at 3 months old. This continuous breastfeeding measure included the duration of any breastfeeding allowing for formula or other food and the duration of exclusive breastfeeding with no formula feeding or other food.
Exclusive breastfeeding at three months was associated with a lower child BMIz score only among women with a pre-pregnancy BMI in the normal range. Each additional month of any or exclusive breastfeeding correlated with a significantly lower child BMIz, particularly for mothers categorized as overweight (in the case of any breastfeeding) or as having obesity (for any or exclusive breastfeeding) prior to pregnancy.
“Health professionals can use this study’s findings as an opportunity to encourage and promote breastfeeding among all women, especially those who have obesity,” said Shipp.
Reference:
Gayle M. Shipp, Adaeze C. Wosu, Emily A. Knapp, Katherine A. Sauder, Dana Dabelea, Wei Perng, Yeyi Zhu, Assiamira Ferrara, Anne L. Dunlop, Sean Deoni, James Gern, Christy Porucznik, Izzuddin M. Aris, Margaret R. Karagas, Maternal Pre-Pregnancy BMI, Breastfeeding, and Child BMI, Pediatrics, https://doi.org/10.1542/peds.2023-061466.
1 year 5 months ago
Pediatrics and Neonatology,Pediatrics and Neonatology News,Top Medical News,Latest Medical News
Medical News, Health News Latest, Medical News Today - Medical Dialogues |
Food in space, salads isn't an healthy option says study
Lettuce and other leafy green vegetables are part of a healthy, balanced diet-even for astronauts on a mission. A fibre-rich diet helps alleviate and prevent constipation and lower cholesterol. It is proven to maintain a healthy body weight which reduces risk of developing heart disease and diabetes.
It’s been more than three years since the National Aeronautics and Space Administration made space-grown lettuce an item on the menu for astronauts aboard the International Space Station. Alongside their space diet staples of flour tortillas and powdered coffee, astronauts can munch on a salad, grown from control chambers aboard the ISS that account for the ideal temperature, amount of water and light that plants need to mature.
New research published in Scientific Reports and in NPJ Microgravity, University of Delaware researchers grew lettuce under conditions that imitated the weightless environment aboard the International Space Station. Plants are masters of sensing gravity, and they use roots to find it. The plants grown at UD were exposed to simulated microgravity by rotation. The researchers found those plants under the manufactured microgravity were actually more prone to infections from a human pathogen, Salmonella.
A notable problem is that the International Space Station has a lot of pathogenic bacteria and fungi. Many of these disease-causing microbes at the ISS are very aggressive and can easily colonize the tissue of lettuce and other plants. Once people eat lettuce that’s been overrun by E. coli or Salmonella, they can get sick.
With billions of dollars poured into space exploration each year by NASA and private companies like SpaceX, some researchers are concerned that a foodborne illness outbreak aboard the International Space Station could derail a mission.
Stomata, the tiny pores in leaves and stems that plants use to breathe, normally close to defend a plant when it senses a stressor, like bacteria, nearby, said Noah Totsline, an alumnus of UD’s Department of Plant and Soil Sciences who finished his graduate program in December. When the researchers added bacteria to lettuce under their microgravity simulation, they found the leafy greens opened their stomata wide instead of closing them.
“The fact that they were remaining open when we were presenting them with what would appear to be a stress was really unexpected,” Totsline said.
Totsline, the lead author of both papers, worked with plant biology professor Harsh Bais as well as microbial food safety professor Kali Kniel and Chandran Sabanayagam of the Delaware Biotechnology Institute. The research team used a device called a clinostat to rotate plants at the speed of a rotisserie chicken on a spinner.
“In effect, the plant would not know which way was up or down,” Totsline said. “We were kind of confusing their response to gravity.”
It wasn’t true microgravity, Totsline said, but it did the job to help plants lose their sense of directionality. Ultimately, the researchers discovered that it appears Salmonella can invade leaf tissue more easily under simulated microgravity conditions than it can under typical conditions on Earth.
Additionally, Bais and other UD researchers have shown the usage of a helper bacteria called B. subtilis UD1022 in promoting plant growth and fitness against pathogens or other stressors such as drought.
They added the UD1022 to the microgravity simulation that on Earth can protect plants against Salmonella, thinking it might help the plants fend off Salmonella in microgravity.
Instead, they found the bacterium actually failed to protect plants in space-like conditions, which could stem from the bacteria’s inability to trigger a biochemical response that would force a plant to close its stomata.
“The failure of UD1022 to close stomata under simulated microgravity is both surprising and interesting and opens another can of worms,” Bais said. “I suspect the ability of UD1022 to negate the stomata closure under microgravity simulation may overwhelm the plant and make the plant and UD1022 unable to communicate with each other, helping Salmonella invade a plant.”
Foodborne pathogens aboard the International Space Station
Microbes are everywhere. These germs are on us, on animals, on the food we eat and in the environment.
So naturally, UD microbial food safety professor Kali Kniel said that wherever humans are, there is a potential for bacterial pathogens to coexist.
According to NASA, around seven people at a time live and work on the International Space Station.
It’s not the tightest environment-about as big as a six-bedroom house-but it’s still the kind of place where germs can wreak havoc.
“We need to be prepared for and reduce risks in space for those living now on the International Space Station and for those who might live there in the future,” Kniel said. “It is important to better understand how bacterial pathogens react to microgravity in order to develop appropriate mitigation strategies.”
Kniel and Bais have a long history of bringing their subject areas of microbial food safety and plant biology together to study human pathogens on plants.
“To best develop ways to reduce risks associated with the contamination of leafy greens and other produce commodities we need to better understand the interactions between human pathogens on plants grown in space,” Kniel said. “And the best way to do this is with a multidisciplinary approach.”
A growing population on Earth, a greater need for safe food in space
It may be a while before humans can live on the moon or Mars, but the UD research has some big potential impacts for cohabiting outer space.
According to a United Nations report, the Earth could be home to 9.7 billion people in 2050 and 10.4 billion people in 2100.
On top of that, Bais, the UD plant biology professor, said food safety and food security measures are already at their peak across the world. With the loss of agricultural land over time to grow food, “people are going to soon think seriously about alternate habitation spaces,” he said. “These are not fiction anymore.”
And seemingly more often, the Centers for Disease Control and Prevention or the U.S. Food and Drug Administration will issue a recall on certain lettuce on Earth, telling people not to eat it because of a risk of E. coli or Salmonella.
With leafy greens being the food of choice for many astronauts and easy to grow in indoor environments such as a hydroponic environment in the International Space Station, Bais said it’s important to make sure those greens are always safe to eat.
“You don’t want the whole mission to fail just because of a food safety outbreak,” Bais said.
Solutions: sterilized seeds and improved genetics
So, if plants are opening their stomata wider in a microgravity environment and allowing bacteria to easily get in, what can be done?
It turns out, the answer isn’t that simple.
“Starting with sterilized seeds is a way to reduce risks of having microbes on plants,” Kniel said. “But then microbes may be in the space environment and can get onto plants that way.”
Bais said scientists may need to tweak plants’ genetics to prevent them from opening their stomata wider in space. His lab is already taking different lettuce varieties that have different genetics and evaluating them under simulated microgravity.
“If, for example, we find one that closes their stomata compared to another we have already tested that opens their stomata, then we can try to compare the genetics of these two different cultivars,” Bais said. “That will give us a lot of questions in terms of what is changing.” Any answers they find could help prevent future problems with rocket salad.
Reference:
Totsline, N., Kniel, K.E., Sabagyanam, C. et al. Simulated microgravity facilitates stomatal ingression by Salmonella in lettuce and suppresses a biocontrol agent. Sci Rep 14, 898 (2024). https://doi.org/10.1038/s41598-024-51573-y.
1 year 5 months ago
Diet and Nutrition,Diet and Nutrition News,Top Medical News,Latest Medical News
PAHO/WHO | Pan American Health Organization
WHO Executive Board opens today to discuss priority topics, including health emergencies, antimicrobial resistance, climate change, and universal health
WHO Executive Board opens today to discuss priority topics, including health emergencies, antimicrobial resistance, climate change, and universal health
Cristina Mitchell
22 Jan 2024
WHO Executive Board opens today to discuss priority topics, including health emergencies, antimicrobial resistance, climate change, and universal health
Cristina Mitchell
22 Jan 2024
1 year 5 months ago
Bermuda reports high demand for COVID & Influenza vaccine shots | Loop Caribbean News - Loop News Caribbean
- Bermuda reports high demand for COVID & Influenza vaccine shots | Loop Caribbean News Loop News Caribbean
- More appointments planned after vaccinations demand Royal Gazette
- Ministry Updates On Covid-19 Vaccination Efforts Bernews
- Covid-19 vaccine roll-out hit-or-miss for some Royal Gazette
1 year 5 months ago
What the Health Care Sector Was Selling at the J.P. Morgan Confab
SAN FRANCISCO — Every year, thousands of bankers, venture capitalists, private equity investors, and other moneybags flock to San Francisco’s Union Square to pursue deals. Scores of security guards keep the homeless, the snoops, and the patent-stealers at bay, while the dealmakers pack into the cramped Westin St.
Francis hotel and its surrounds to meet with cash-hungry executives from biotech and other health care companies. After a few years of pandemic slack, the 2024 J.P. Morgan Healthcare Conference regained its full vigor, drawing 8,304 attendees in early January to talk science, medicine, and, especially, money.
1. Artificial Intelligence: Revolutionary or Not?
Of the 624 companies that pitched at the four-day conference, the biggest overflow crowd may have belonged to Nvidia, which unlike the others isn’t a health care company. Nvidia makes the silicon chips whose computing power, when paired with ginormous catalogs of genes, proteins, chemical sequences, and other data, will “revolutionize” drug-making, according to Kimberly Powell, the company’s vice president of health care. Soon, she said, computers will customize drugs as “health care becomes a technology industry.” One might think that such advances could save money, but Powell’s emphasis was on their potential for wealth creation. “The world’s first trillion-dollar drug company is out there somewhere,” she dreamily opined.
Some health care systems are also hyping AI. The Mayo Clinic, for example, highlighted AI’s capacity to improve the accuracy of patient diagnoses. The nonprofit hospital system presented an electrocardiogram algorithm that can predict atrial fibrillation three months before an official diagnosis; another Mayo AI model can detect pancreatic cancer on scans earlier than a provider could, said Matthew Callstrom, chair of radiology at the Mayo Clinic in Rochester, Minnesota.
No one really knows how far — or where — AI will take health care, but Nvidia’s recently announced $100 million deal with Amgen, which has access to 500 million human genomes, made some conference attendees uneasy. If Big Pharma can discover its own drugs, “biotech will disappear,” said Sherif Hanala of Seqens, a contract drug manufacturing company, during a lunch-table chat with KFF Health News and others. Others shrugged off that notion. The first AI algorithms beat clinicians at analyzing radiological scans in 2014. But since that year, “I haven’t seen a single AI company partner with pharma and complete a phase I human clinical trial,” said Alex Zhavoronkov, founder and CEO of Insilico Medicine — one of the companies using AI to do drug development. “Biology is hard.”
2. Weight Loss Pill Profits and Doubts
With predictions of a $100 billion annual market for GLP-1 agonists, the new class of weight loss drugs, many investors were asking their favorite biotech entrepreneurs whether they had a new Ozempic or Mounjaro in the wings this year, Zhavoronkov noted. In response, he opened his parlays with investors by saying, “I have a very cool product that helps you lose weight and gain muscle.” Then he would hand the person a pair of Insilico Medicine-embossed bicycle racing gloves.
More conventional discussions about the GLP-1s focused on how insurance will cover the current $13,000 annual cost for the estimated 40% of Americans who are obese and might want to go on the drugs. Sarah Emond, president of the Institute for Clinical and Economic Review, which calculates the cost and effectiveness of medical treatments, said that in the United Kingdom the National Health Service began paying in 2022 for obese patients to receive two years of semaglutide — something neither Medicare nor many insurers are covering in the U.S. even now.
But studies show people who go off the drugs typically regain two-thirds of what they lose, said Diana Thiara, medical director for the University of California-San Francisco weight management program. Recent research shows that the use of these drugs for three years reduces the risk of death, heart attack, and stroke in non-diabetic overweight patients. To do right by them, the U.S. health care system will have to reckon with the need for long-term use, she said. “I’ve never heard an insurer say, ‘After two years of treating this diabetes, I hope you’re finished,’” she said. “Is there a bias against those with obesity?”
3. Spotlight on Tax-Exempt Hospitals
Nonprofit hospitals showed off their investment appeal at the conference. Fifteen health systems representing major players across the country touted their value and the audience was intrigued: When headliners like the Mayo Clinic and the Cleveland Clinic took the stage, chairs were filled, and late arrivals crowded in the back of the room.
These hospitals, which are supposed to provide community benefits in exchange for not paying taxes, were eager to demonstrate financial stability and showcase money-making mechanisms besides patient care — they call it “revenue diversification.” PowerPoints skimmed through recent operating losses and lingered on the hospital systems’ vast cash reserves, expansion plans, and for-profit partnerships to commercialize research discoveries.
At Mass General Brigham, such research has led to the development of 36 drugs currently in clinical trials, according to the hospital’s presentation. The Boston-based health system, which has $4 billion in committed research funding, said its findings have led to the formation of more than 300 companies in the past decade.
Hospital executives thanked existing bondholders and welcomed new investors.
“For those of you who hold our debt, taxable and tax-exempt, thank you,” John Mordach, chief financial officer of Jefferson Health, a health system in Pennsylvania and New Jersey. “For those who don’t, I think we’re a great, undervalued investment, and we get a great return.”
Other nonprofit hospitals talked up institutes to draw new patients and expand into lucrative territories. Sutter Health, based in California, said it plans to add 30 facilities in attractive markets across Northern California in the next three years. It expanded to the Central Coast in October after acquiring the Sansum Clinic.
4. Money From New — And Old — Treatments for Autoimmune Disease
Autoimmunity drugs, which earn the industry $200 billion globally each year, were another hot theme, with various companies talking up development programs aimed at using current cancer drug platforms to create remedies for conditions like lupus and rheumatoid arthritis. AbbVie, which has led the sector with its $200 billion Humira, the world’s best-selling drug, had pride of place at the conference with a presentation in the hotel’s 10,000-square-foot Grand Ballroom.
President Robert Michael crowed about the company’s newer autoimmune drugs, Skyrizi and Rinvoq, and bragged that sales of two-decades-old Humira were going “better than anticipated.” Although nine biosimilar — essentially, generic — versions of the drug, adalimumab, entered the market last year, AbbVie expects to earn more than $7 billion on Humira this year since the “vast majority” of patients will remain on the market leader.
In its own presentation, biosimilar-maker Coherus BioSciences conceded that sales of Yusimry, its Humira knockoff listed at one-seventh the price of the original, would be flat until 2025, when Medicare changes take effect that could push health plans toward using cheaper drugs.
Biosimilars could save the U.S. health care system $100 billion a year, said Stefan Glombitza, CEO of Munich-based Formycon, another biosimilar-maker, but there are challenges since each biosimilar costs $150 million to $250 million to develop. Seeing nine companies enter the market to challenge Humira “was shocking,” he said. “I don’t think this will happen again.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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1 year 5 months ago
california, Health Industry, Pharmaceuticals, States, Health IT, Hospitals, Prescription Drugs
Medical News, Health News Latest, Medical News Today - Medical Dialogues |
Brief dialysis may be best for patients with acute kidney injury
Patients with acute kidney injury requiring outpatient dialysis after hospital discharge receive the same care as those with the more common end-stage kidney disease, according to a study led by UC San Francisco.
But while patients with the latter diagnosis-typically caused by long-standing hypertension or diabetes-must remain on lifelong dialysis or receive a new kidney, some patients on dialysis for acute kidney injury have the potential to recover, the researchers reported in their study in the Journal of the American Society of Nephrology on Sept. 28, 2023.
“For those who have the potential to recover, remaining on dialysis may place them at unnecessary risk for heart disease, infection, organ damage and death,” said first author Ian E. McCoy, MD, of the UCSF Division of Nephrology.
Less than a quarter of patients in a typical midsize dialysis centers have acute kidney injury. It may result from acute infection or shock, causing reduced blood flow to the kidneys, as well as major surgeries and chemotherapy agents that are toxic to the kidneys.
Patients receive similar treatment, testing, despite different recovery potential
In the study, researchers tracked data from 1,754 patients with acute kidney injury and 6,197 patients with end-stage kidney disease at outpatient dialysis centers. Although lab tests suggested acute kidney injury patients needed less dialysis, the two groups were treated largely the same. Both were started on thrice-weekly dialysis, and the large majority of patients in both groups were not tested for kidney functioning in the first month of treatment.
Among the acute kidney injury patients, 10% died during the three-month study period-most likely from the conditions that prompted dialysis, according to the researchers. Of the 41% of patients who recovered kidney function, approximately three-quarters had discontinued dialysis without any changes to the dose, frequency and duration. This suggests that these patients could have been weaned at an earlier point, the researchers noted.
“More research is needed on safe weaning strategies,” said McCoy. “If a patient is weaned off too quickly, they could become short of breath, or they could develop electrolyte abnormalities that can increase the risk of dangerous heart rhythms.
“On the other hand, continuing dialysis unnecessarily is also risky, since patients experience high rates of heart disease, infection and mortality,” he said.
For kidney specialists taking care of acute kidney injury patients and dialysis providers operating the outpatient centers, there are powerful disincentives to wean patients off dialysis, McCoy said. “Deprescribing benefits the health care system, but not the dialysis provider, who will have an empty chair that is not easy to fill. At the same time, kidney specialists lose a multidisciplinary support team of nurses, dieticians and social workers when a patient recovers enough to discontinue dialysis.
“Kidney specialists are also paid less by insurance for non-dialysis care even though managing a patient with borderline kidney function is more time consuming and riskier than managing them on thrice-weekly dialysis. For these reasons, the default path of least resistance may be to continue dialysis.”
3 months of dialysis may mean indefinite dialysis
Approximately half of the patients neither died nor discontinued dialysis by the end of the study. For them, the future looked uncertain, said Chi-yuan Hsu, MD, senior author and chief of the UCSF Division of Nephrology. “After about three months of dialysis, they almost always are treated like they will remain on dialysis indefinitely,” he said.
“Doctors don’t seem to pay as much attention as they can to monitoring for early, subtle signs of recovery. When someone’s kidney function is at 30%, it’s obvious that they do not need dialysis, but when it’s subtle – 10% to 15% – it requires skill, attention, careful discussion with the patient and willingness to assume some risk in the weaning process,” said Hsu. “We suspect many doctors stop dialysis only when the signs are blindingly obvious.”
The worst-case scenario is a patient who may have recovered just enough kidney function to wean but has remained on dialysis. Drops in blood pressure with repeated dialysis may further inflict damage to the vulnerable kidneys driving kidney function below the threshold believed to be required for weaning, said McCoy. “The patient may now be facing dialysis for the rest of their life or end up needing a transplant, if they are well enough to be a candidate.”
1 year 5 months ago
Nephrology,Nephrology News,Top Medical News,Latest Medical News
Diaspora continues to support healthcare sector
“The donation, a significant move to enhance the islands’ healthcare service, is a generous gift from citizens Peter Benjamin and Cyril Sylvester”
View the full post Diaspora continues to support healthcare sector on NOW Grenada.
“The donation, a significant move to enhance the islands’ healthcare service, is a generous gift from citizens Peter Benjamin and Cyril Sylvester”
View the full post Diaspora continues to support healthcare sector on NOW Grenada.
1 year 5 months ago
Carriacou & Petite Martinique, Health, PRESS RELEASE, cyril sylvester, marissa mclawrence, ministry of carriacou and petite martinique affairs, peter benjamin, princess royal hospital, tevin andrews
STAT+: Pharmalittle: We’re reading about Sanders targeting pharma CEOs, insider trading, and more
And so, another working week will soon draw to a close. Not a moment too soon, yes? This is, you may recall, our treasured signal to daydream about weekend plans. Given the forecast, our agenda is modest. We expect to catch up on our reading, take a few naps, and promenade with the official mascots as often as possible. We also plan another listening party with Mrs.
Pharmalot, and the rotation will likely include this, this, this, and this. And what about you? This is a fine time to enjoy the great indoors. So why not tidy up around your castle? When done, you could park yourself in front of the telly and watch a few moving picture shows. Of if you’re feeling old fashioned, you could pull out the Scrabble board. Well, whatever you do, have a grand time. But be safe. Enjoy, and see you soon. …
U.S. Senate health committee chair Bernie Sanders has taken a step toward subpoenaing the chief executive officers at Johnson & Johnson and Merck related to an investigation into high drug prices in the U.S., STAT writes. The step is highly unusual, since the health committee has not issued a subpoena in more than 40 years. Sanders (I-Vt.) invited the J&J and Merck executives, along with Bristol Myers Squibb chief executive officer Chris Boerner, to testify at a Jan. 25 hearing. But only Boerner agreed, and only if at least one other chief executive participated. Instead, Sanders will hold a committee vote on whether to issue the subpoenas and authorize a probe into drug costs on Jan. 31.
But Johnson & Johnson is accusing Sanders of retaliating against the company and others that sued the Biden administration to stop a program to negotiate how much Medicare pays for high-cost drugs, Bloomberg Law reports. The allegation appears in a letter that was written one week before Sanders announced the Senate health committee would vote on whether it would use subpoenas to force J&J and Merck CEOs to testify on U.S. drug prices. The committee’s actions raise “significant concerns that the hearing is intended as retribution” against companies suing the Biden administration over the Medicare negotiation program, the letter says.
1 year 5 months ago
Pharma, Pharmalot, pharmalittle, STAT+
Caribbean still has no warning labels on unhealthy food
In 2021, Grenada opposed the Final Standard (FDCRS 5), resulting in vote shortfall of 75% majority needed
View the full post Caribbean still has no warning labels on unhealthy food on NOW Grenada.
In 2021, Grenada opposed the Final Standard (FDCRS 5), resulting in vote shortfall of 75% majority needed
View the full post Caribbean still has no warning labels on unhealthy food on NOW Grenada.
1 year 5 months ago
External Link, Health, caribbean community, caribbean private sector organisation, caribbean public health agency, caricom, carpha, daphne ewing-chow, Forbes, front-of-package warning label, noncommunicable diseases, octagonal warning label, paho
HOMS achieves milestone: first robotic thoracic surgeries
Santiago, DR.– In a groundbreaking development, a team of doctors at the Santiago Metropolitan Hospital (HOMS), led by thoracic surgeon Jonathan Vargas, has successfully conducted three robotic lobectomies for lung cancer – a first in the country.
Santiago, DR.– In a groundbreaking development, a team of doctors at the Santiago Metropolitan Hospital (HOMS), led by thoracic surgeon Jonathan Vargas, has successfully conducted three robotic lobectomies for lung cancer – a first in the country.
These cutting-edge surgeries contribute to the impressive tally of over 1,700 robotic surgical interventions at HOMS. The hospital has maintained optimal results, with no mortality and minimal complications well below the international average over nearly 11 years of experience.
Dr. Héctor Sánchez Navarro, Deputy Director of HOMS, expressed pride in the hospital’s continued advancement and role as the standard-bearer for robotic surgery in the Dominican Republic. The hospital now encompasses six specialties conducting robotic procedures, with the recent addition of thoracic surgery to existing specialties such as urology, oncology, obesity, gynecology, and colorectal surgeries.
Highlighting the hospital’s support for entrepreneurial Dominican doctors, Dr. Jonathan Vargas, with these three lung lobectomies, has become the country’s first robotic thoracic surgeon. Dr. Vargas was supported in these interventions by international expert Dr. Luis Herrera in thoracic robotic surgery, along with HOMS specialists Juan Félix Capellán, Director of Surgery, and José Álvarez Torres, Medical Director.
1 year 5 months ago
Health
STAT+: Klobuchar urges drugmakers to remove patents FTC calls improper and inaccurate
Amid a push to crack down on patent abuse by the pharmaceutical industry, a key U.S. lawmaker is urging six large drug companies to remove dozens of patents that were identified by regulators as improperly or inaccurately listed with a federal registry.
In a series of letters sent on Thursday, Sen. Amy Klobuchar (D-Minn.) demanded the companies explain why they have, so far, not responded to warnings issued two months ago by the Federal Trade Commission to remove more than 100 patents from the registry. The agency threatened the drug companies with litigation if they failed to comply.
The FTC had challenged a total of 10 companies over listings for patents on such medicines as asthma inhalers and epinephrine auto-injectors as part of an effort to mitigate actions that thwart competition. Among the companies to which the agency sent warnings are AbbVie, AstraZeneca, Mylan Specialty, Boehringer Ingelheim, and subsidiaries of GSK and Teva Pharmaceutical.
1 year 5 months ago
Pharma, Pharmalot, patents, Pharmaceuticals, STAT+
Rise in cases of Covid-19 and other respiratory infections
“The Ministry notes the most prevalent viruses identified as causes include coronavirus (SARS CoV2), respiratory syncytial virus (RSV), and influenza”
View the full post Rise in cases of Covid-19 and other respiratory infections on NOW Grenada.
1 year 5 months ago
Health, PRESS RELEASE, and religious affairs, coronavirus, COVID-19, Influenza, Ministry of Health, respiratory syncytial virus, wellness
KFF Health News' 'What the Health?': The Supreme Court vs. the Bureaucracy
The Host
Julie Rovner
KFF Health News
Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
The Supreme Court this week took up a case brought by two herring fishing companies that could shake up the way the entire executive branch administers laws passed by Congress. At stake is something called “Chevron deference,” from the 1984 case Chevron v. Natural Resources Defense Council. The ruling in that case directs federal judges to accept any “reasonable” interpretation by a federal agency of a law that’s otherwise ambiguous. Overturning Chevron would give the federal judiciary much more power and executive branch agencies much less.
Meanwhile, the Biden administration is struggling with whether to ban menthol-flavored cigarettes. Among smokers, African Americans consume the product at the highest rate, and the African American community is split, with some groups arguing that a ban would improve public health and others worried that making the product illegal would give police another excuse to harass black people.
This week’s panelists are Julie Rovner of KFF Health News, Joanne Kenen of Johns Hopkins University and Politico Magazine, Lauren Weber of The Washington Post, and Rachel Cohrs of Stat.
Panelists
Joanne Kenen
Johns Hopkins Bloomberg School of Public Health and Politico
Rachel Cohrs
Stat News
Lauren Weber
The Washington Post
Among the takeaways from this week’s episode:
- Congress looks ready to pass yet another temporary spending bill to keep the federal government running — this one extending to March. But it’s unclear whether all the health policies that have been attached to previous temporary “continuing resolutions” will continue to make the cut while lawmakers struggle with full-year funding issues.
- A grand jury in Ohio declined to indict Brittany Watts, who was charged by authorities with “abuse of a corpse” after having a miscarriage at home. The case underscores how women can be at legal risk for their pregnancy outcomes even in states where abortion remains legal.
- Also in Ohio, state pharmacy officials are moving to fine and place on probation a CVS store in Canton after inspectors determined that understaffing was threatening patient safety. In at least one case a patient was given a drug other than the one prescribed, and waits to fill some prescriptions stretched to a month. Ohio is also investigating other CVS locations in the state to ensure staffing is adequate.
Also this week, Rovner interviews Darius Tahir, who reported and wrote the latest KFF Health News-NPR “Bill of the Month” about a lengthy fight over a bill for a quick telehealth visit. If you have an outrageous or baffling medical bill you want to share with us, you can do that here.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: Stat’s “Pumping Milk at JPM Was a Nightmare. It’s Part of a Bigger Problem in the Industry,” by Tara Bannow.
Joanne Kenen: Undark’s “Why Incentives to Attract Doctors to Rural Areas Haven’t Worked,” by Arjun V.K. Sharma.
Lauren Weber: The Guardian’s “Majority of Debtors to US Hospitals Now People With Health Insurance,” by Jessica Glenza.
Rachel Cohrs: The Washington Post’s “Republican Governors in 15 States Reject Summer Food Money For Kids,” by Annie Gowen.
Also mentioned on this week’s podcast:
- The Washington Post’s “White House Weighs Menthol Ban Amid Dueling Health, Political Pressures,” by Dan Diamond and Tyler Pager.
- The Ohio Capital Journal’s “Ohio Attorney General Asks That CVS Store Be Put on Probation ‘for a Period of Years,’” by Marty Schladen.
- The Atlantic’s “The Supreme Court Is Making America Ungovernable,” by Lisa Heinzerling.
click to open the transcript
Transcript: The Supreme Court vs. the Bureaucracy
KFF Health News’ ‘What the Health?’Episode Title: The Supreme Court vs. the BureaucracyEpisode Number: 330Published: Jan. 18,2024
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Jan. 18, at 10 a.m. As always, news happens fast and things might’ve changed by the time you hear this, so here we go. We are joined today via video conference by Lauren Weber of The Washington Post.
Lauren Weber: Hello, hello.
Rovner: Joanne Kenen of Johns Hopkins University and Politico Magazine.
Joanne Kenen: Hey, everybody.
Rovner: And Rachel Cohrs of Stat News.
Rachel Cohrs: Good morning.
Rovner: Later in this episode, we’ll have my interview with my colleague Darius Tahir, who wrote the latest KFF Health News-NPR “Bill of the Month” about an unexpectedly large bill for a simple telehealth appointment. But first, this week’s news. So we’re a day away from the next deadline for Congress to pass a spending bill or else big chunks of the federal government shut down. In other words, the “let’s kick the can down the road a few more weeks and see how many spending bills we can get done” deadline is now here, again. So how many spending bills did Congress get done between — what, the end of November, the last time we did this — and now? Rachel, I see your eyes are rolling.
Cohrs: Yeah, I don’t think we have any actual appropriations in that time frame. I think there was just a lot of back-and-forth, not a lot of actual progress. So I think they’ve decided to kick the can down to March. As we’re taping in the morning, the Senate is scheduled to pass the CR [continuing resolution] to keep that two-pronged approach moving into early March, but extensions of health care programs in Medicaid and Medicare have been pushed now to the second March deadline, so those are expected to come up on March 8, right now.
Rovner: So remind us what those are. I saw you very helpfully have a story about it this morning.
Cohrs: I do, yes. Fresh from the trenches on that. So there were a number of health care programs that expired at the end of 2023, including payments for safety-net hospitals, including pandemic-era bonuses for doctors, for their Medicare pay. We also have funding for community health centers and multiple demonstration projects, programs for diabetes and other public health issues. So those are commonly known as extenders. They do just expire on a regular basis. We had a three-year term, but now we’re at the end of it.
Rovner: And they need to be extended. Hence, they’re called extenders.
Cohrs: They do need to be extended, yes. So Congress did take care of most of those items in the CR from September time frame, but they did not extend the bonus payments for doctors. So there were some very tense negotiations late last week where Republicans were really pushing to add those payments back into the extenders package as it sits right now, but those negotiations broke down and so what we’re seeing today, tomorrow, is just an extension of the same baseline and doctors are still without those increased payments.
Rovner: Right. That’s the Medicare cut that we talked about last week, actually, with the head of the AMA [American Medical Association].
Cohrs: Yeah, it’s controversial because it was … long story, but …
Rovner: There’s also a 3.7% actual cut and that’s still in effect, right? That’s not being taken care of?
Cohrs: No, that’s not being taken care of. I think if Congress doesn’t fix things, to my understanding, some specialties will see a cut, other specialties will see an increase, and there’s an across-the-board cut, though, because in the middle of the pandemic, Congress did not want to cut any doctors’ payments, so that was an increase on top of the kind of baseline amount. So when you’re saying cut, they’re kind of going back to the normal baseline for some physicians. Others are seeing that deeper cut because of some Trump-era rules and the conversion factors there.
Rovner: Yes. Medicare doctor payment, we’ll spend a whole episode on this at some point, but not today because we have something else confusing to take on. The award for incomprehensible health policy this week goes to the Supreme Court, who heard arguments Wednesday in two cases, Relentless Inc. v. the Department of Commerce and Loper Bright Enterprises v. Raimondo, i.e., Gina Raimondo, the secretary of Commerce. What is at stake here is not the merits of these cases — they are about fees paid by herring fishing boats — but whether the court should overrule something called Chevron deference, which is the policy that courts should defer to executive branch agency interpretations of ambiguous laws as long as that interpretation is reasonable. I know this sounds wonky, and it is wonky, but if the court overrules Chevron, it could have enormous ramifications for health policy, yes?
Kenen: Pretty much anything that has ever been regulated. That’s only a slight exaggeration. I mean, we don’t know what the court is going to do. We can expect that the court will trim, at least, Chevron, but we don’t know how far the court will go.
Rovner: Right. They didn’t have to take this case and the fact that they took it suggests they want to do something.
Kenen: They’ve been more than chipping away. We sort of get to that in a minute, but basically the question is when Congress doesn’t have the expertise that civil servants and agencies have, or in some cases, political appointees and agencies have. They are professionals who work in health care or the environment or herring fishing. They know more than even the smartest Congress person about their field of expertise, and traditionally Congress makes laws and tells the agencies to fill in the blanks, to do the regulations, to work out the details, figure out how this is going to work in the real world, and then everybody sues everybody else.
Chevron has basically said yes, the agencies can make up the rules. There are thousands of court cases and rules. It’s throughout the government, everything federal, so it’s not very hard to guess that Chevron will be changed. The question is: Will it be gutted? And who writes the regs? Or can Congress just put in language saying, “And we explicitly authorize the EPA or HHS or CMS, whatever, to fill in the blanks.” We don’t know how this plays out, but it’s messy.
Rovner: Obviously there are lawsuits that happen all the time anyway, even with Chevron, it’s just that Chevron is supposed to say when a judge gets a complaint in front of him saying “this regulation is contrary to what the law said,” the judge gets to decide whether or not it’s a reasonable interpretation. So it’s not like judges can’t overrule the agencies. It just says, in general, the weight should go towards the agency. Lauren, you wanted to add something?
Weber: Yeah, I just wanted to say I think this is relevant to the conversation we had just before this, because what this is aimed at doing is putting the power back in the hands, both of the courts and the Congress, but as we’ve just discussed, Congress is having a hard time passing things. So this is all part of the movement, in general, by conservatives to strip the administrative state, as they like to call it. And as Joanne pointed out, it’ll be quite interesting to see how this all plays out.
Rovner: Yes, and my favorite factoid about this case is that the lawyers who are representing the herring fishermen are being paid indirectly by Americans for Prosperity, the Koch Brothers, interest group that’s basically aimed at weakening the power of the regulatory state. It isn’t even very subtle here. Yes, Joanne?
Kenen: There’s been a lot of focus on Chevron, but there’ve been a number of cases that have already weakened Chevron without calling it weakening Chevron. I interviewed a lawyer, a law professor at Georgetown about a year ago, and she also wrote about a year ago a very good piece in The Atlantic that Julie couldn’t put on the notes. Her name is Lisa Heinzerling, I think it’s Heinzerling, and basically she said they’ve already really gutted Chevron. And the three cases, one was the EPA clean air case, power to regulate, and two were covid-related. One of them was the vaccine mandates for the workplace, and the court basically ruled that the agencies didn’t have the right to make those decisions.
What professor Heinzerling said, it’s called the major decision [questions] doctrine, that if it’s a really big thing, the agency can’t do it. Congress has to or the courts have to, and those big things include things like clean air. So, in her view, the major [questions] doctrine has already really gutted the agency’s power and made it harder to govern because, as she pointed out, it takes years to get a rule passed. She worked at the EPA, and it’s a very complicated, careful, long process and she basically said it’s another way of making the country ungovernable at a time when we have lots of things that need governing.
Rovner: To give myself a little plug here, I did basically a policy tracker at the beginning of the Biden administration tracking how long it was going to take [President Joe] Biden to undo a lot of the regulations and policies that the Trump administration put in, and I just updated it again last week when we talked about the conscience rule. It literally does take years for these things to happen. I mean, one presidential term is barely enough time to change the policies of the previous president, and I will link to my regulation tracker because somebody should look at it.
All right, well, moving on. I want to talk about an issue I’ve had on my podcast rundown since sometime last fall, but have never managed to get to, which is a proposed ban on menthol-flavored cigarettes. From a public health perspective, this is kind of a no-brainer. Menthol makes cigarettes smoke more palatable to smokers and, therefore, smokers smoke more, but it turns out to be super sensitive politically because African Americans are far more likely to smoke menthol cigarettes than any other group, and African American leaders themselves are split on whether such a ban would help or hurt. What are the arguments for and against this? Lauren, you’ve been kind of watching this, yes?
Weber: Yeah. Shoutout to my colleagues Dan Diamond and Tyler Pager who wrote a great story on this last week, but essentially the arguments for and against is menthol cigarettes are a leading cause of death for Black Americans. They’ve been historically marketed to the Black American community. What menthol does is it has a cooling effect when you smoke, so it makes it more enjoyable. As a smoking issue, you saw similar regulation issues come up when we talked about vaping regulation to different flavors, which also had similar backlashes when Donald Trump considered it, and actually when I was at KHN [KFF Health News], I got to write a story with Rachel Bluth about this where we talked about how Donald Trump really got gun-shy on this to some extent because he was worried about the voter implications. And we’re seeing that play out again right now because what is happening is that the tobacco lobby is telling Biden that he’s going to lose a large chunk of Black voters, which, as we are very clear, the 2024 election looks like it’s going to be quite tight, so that has real ramifications.
What’s interesting is that lobbying effort is obviously led by the tobacco companies, which have had a history of tactics and propaganda when it comes to preventing regulations that we’re all very well aware of, but they have rallied up quite a few folks in their favor, including some Black congressmen who have cited what the tobacco companies are telling them, which is that they’re concerned that this is targeting Black Americans, because why aren’t we just killing all cigarettes? Why are we just killing menthol cigarettes? That it also could lead to over-policing, which could lead to violence against Black Americans. This is the argument that the tobacco companies and their advocates are making. But the bottom line is really what this boils down to is I think the most effective argument that they’re making to the Biden administration is it could hurt your reelection chances.
To look ahead, the real deadline on this taking effect that all the advocates have been pointing to is Jan. 20, which, if you look at your calendar, is Saturday. So it’s not looking great for the promises to the advocates that this could happen in the Biden term. It’s unclear, still a toss-up. Dan Diamond reported that while the administration sees it as a toss-up, Robert Califf, who’s head of the FDA, is pretty resigned to it not happening, which to me seems to indicate, considering we are almost to the 20th, that it may not happen, but by the time this podcast airs, I could be wrong. So we will see how this plays out.
Cohrs: I just wanted to say that I think if you look at the OMB [Office of Management and Budget] regulatory schedule, they do have meetings on this rule scheduled out through mid-February, so could they cancel this tomorrow? Sure, and put it out, but at least what they’re saying publicly, it looks like they’re not planning to put that out tomorrow.
Rovner: Right, and I would say the deadline, it’s not technically a deadline, but what the agency has said is that it will take a year to basically, as we were just talking about, it takes a long time for regulations to become final, and Jan. 20 of 2025 is Inauguration Day. So if Biden were to not get reelected and they were to start this, it would be very easy for Trump or whoever else gets elected to stop it. Joanne, you wanted to add something.
Kenen: One point, though: This is an issue that’s been on the back burner, front burner, back burner, but it’s been 20, 30 years now, 20, 25-ish maybe? There has been a shift in that, I don’t remember whether it’s an official Black Caucus stance or just an informal … where the Black lawmakers in Congress had been opposed to the ban for the reasons, discriminatory, black market, it would hurt people as well as hurt some, help others. There’s now a split and that is a change. So whether there’s action this week, there is movement on it and, like we said, everything takes a long time, 25 years, but there has been movement on it, and it’s also a little bit more vivid who’s using tobacco dollars and who isn’t. So the public health needle has moved, maybe not in time for this year, but let’s see what happens next year. I mean, if it goes away now, it doesn’t go away for good.
Rovner: Lauren?
Weber: I think that’s a great point by Joanne that I just want to echo. This reminds me a lot … there was a story that The Post did in December where Peter Wallsten interviewed all of these lawmakers who voted against the AR-15 ban, and they talked all about how, if they could go back in time, they wished they had voted for it. They regret that political decision that they made due to the voter piece of this, and I do wonder if Biden is grappling with that similar longevity of, like, this would be a landmark public health ruling, this would be quite something that really would be protecting lives, but is it worth the voter cost? I think that, to me, is where this lies. But as Joanne said, I mean, this is not dead forever if this dies this week. It certainly has made progress.
Rovner: It’s a really interesting issue though. All right, well, speaking of smoking, the Department of Health and Human Services is recommending that marijuana be removed from the DEA’s [Drug Enforcement Administration’s] list of drugs with no medical use and a high potential for abuse, the so-called Schedule 1 drug. Instead, the department is saying it should be placed on Schedule 3, which are with drugs that can be abused but can also be helpful, like anabolic steroids and ketamine. Given that medical marijuana is now legal in 38 states and recreational marijuana is legal in 24, isn’t this just kind of recognizing reality?
Kenen: I mean there’s been pressure for years. I mean, Schedule 1 is heroin. It’s hard to make the case now that marijuana is as harmful as heroin or other Schedule 1 drugs. The FDA isn’t ready to say it should be completely unscheduled and just do whatever you like, but there’s a big difference between a 1 and a 3, and there’s a lot of gaps between federal law, including things that involve financing for the marijuana industry or the cannabis industry. So there’s a lot of gaps still between state law and federal law, but this is a partial closure of one of those many gaps. And it’s a recognition that, not just a political and social reality, but also a science reality. I mean, even if you’re not crazy, if you’re not that sanguine about marijuana, it’s still hard to make a case that it’s as dangerous as heroin. It’s not.
Rovner: “Reefer Madness” was a long time ago.
Kenen: Yeah, but it had a long tail.
Rovner: It did. Well, among the recognized uses for marijuana are to help combat nausea caused by chemotherapy and for stimulating appetite in patients with AIDS. Meanwhile, a kind of provocative study out this week from the University of Colorado found that weed can actually motivate people to exercise, which seems kind of the polar opposite of the idea that it just turns people into slackers and couch potatoes. Now that we have drugs that can help make people not hungry, how big a deal would it be to have another one that actually helps people exercise? I mean, I assume that there are a lot of things about marijuana that we don’t know, both good and bad.
Kenen: Julie, after you sent that around yesterday, I read that article, and there’s a lot of problems with that study. I mean, it was all people who smoke marijuana when they run or ingest it. So it wasn’t a scientific gold standard. I mean, if you ask a bunch of people, “Oh, do you like running high?” and they say “Yes,” and then say, “OK, do you want to be in our study about running high?” [laughs]
Rovner: In Colorado, where recreational marijuana has been legal for several years.
Kenen: I mean, there’s still a lot of unknowns. If you talk to the proponents of medical marijuana, they’ll tell you it cures everything. And I think all of us would be somewhat skeptical that marijuana cures everything. I’m not convinced that exercise motivation thing is … I mean, I could be persuaded, but that study didn’t persuade me.
Rovner: My point, though, is that, I mean one of the things that had been difficult over the years is that it had been hard to actually get marijuana to do medical studies like this. There was only one place that grew it. I think it was in Mississippi.
Kenen: In Mississippi, and it was really poor quality.
Rovner: Right. So I mean now we can at least presumably have better-quality studies on these kinds of things, right?
Kenen: I don’t think it’s great. I think it’s better.
Rovner: I said we can have, not that we do have.
Kenen: I mean someone else might know more. I read about this and I can’t remember the details now and maybe Lauren or Rachel remembers better than I do, but it’s not just from Mississippi, but it’s not from everywhere. There’s more supplies for medical, but I don’t think it’s abundant and perfect.
Rovner: But I think that’s one of the things that changing the schedule would actually help fix that, actually taking it off of Schedule 1 with heroin, as you point out, and putting it on Schedule 3 with other things that have been studied and have been found to have some medical uses. So another thing that we shall watch. Well, turning to abortion, a grand jury in Ohio decided not to indict Brittany Watts, who miscarried at home after being turned away from the hospital only to have one of the nurses there call the police. Officials in Warren, Ohio, wanted to try her for a crime called “abuse of a corpse.” We talked about this the last two episodes. Mind you, Ohio is a state that just voted to enshrine abortion rights in its constitution, and this was not an abortion. But I imagine this goes down in the “no matter where you live, you’re at legal risk for pregnancy loss” column, right? I mean, it does seem to be kind of ominous that there are still officials who still want to criminalize basically pregnancy loss, however it happens.
Weber: Yeah, I mean, I’ll chime in on this. I mean, this case has been watched by folks not only in this country but around the world because, just to remind the audience, Brittany Watts, she was miscarrying and was sent home from the hospital and what happened is that she miscarried into a toilet at home and law enforcement took the drastic steps of retrieving the fetus from the toilet to then charge her with this “abuse of a corpse” law statute after the hospital, by the way, had also clearly consulted with its legal team over what the appropriate action to cover the hospital was. Not to cover the patient but to cover the hospital.
So she miscarried at home. Then this very ancient law statute was pulled out, and I mean, we don’t know how many law statutes like this over what’s called “abuse of a corpse” exist. Legally, it’s also “Is a fetus a corpse?” — was that debate as well in this case? I mean, I think we’ll see what happens across the country, but yes, Julie, I think you’re correct that this is very concerning for women across the country who could have a miscarriage at home. Could you be legally liable for not handling that as some activist prosecution would prefer that you do?
Kenen: Right. I think in this case, she’d been into the ER and out a couple of times, and I think the last time she wasn’t discharged, she just left. But most miscarriages are very early in pregnancy and it’s an embryo. It’s not even a fetus yet, and it’s tiny. So how do you even define what a corpse is? Do you even know that you were pregnant? Losing a pregnancy is a trauma. It’s a medical condition and it’s a trauma. What happened to her, she lost a pregnancy. She had been in and out of the hospital. She didn’t feel like her needs were being met there. That’s why she left. There was a lot of confusion about what to do. There was no confusion that this was a naturally occurring miscarriage, a premature rupturing of her membranes. Nobody, including the nurse who called the cops, nobody said that she’s trying to do a self-abortion or that she’s doing anything illegal. She had a pregnancy loss.
Rovner: There was a medical examiner report that said …
Kenen: Yes.
Rovner: … this was a stillborn.
Kenen: Right. I don’t think people necessarily know what to do if you …
Rovner: Nor can you imagine should they know what to do. I mean, it’s not like she didn’t follow standard procedure. There is no standard procedure for this. Speaking of people in states where abortion is still legal, still having to pay attention, in Texas, the district court judge who tried to overturn the FDA’s approval of the abortion pill, mifepristone, granted a motion allowing Idaho and Missouri to intervene in the case, which the Supreme Court agreed to hear last month. This could be a big deal because it means that even if the original plaintiffs in the case, which is a group representing anti-abortion obstetrician-gynecologists is found not to have standing, which seems likely, according to most experts, it’s not clear that they are harmed in any way by mifepristone. The states will still be there to keep the case active. Although how the states are harmed by mifepristone is also kind of a stretch. I feel like the anti-abortion forces in these states just aren’t paying attention to the voters, and I guess they don’t have to. I mean, I think this and the Brittany Watts case sort of suggests that even if abortion is legal, even if the voters have spoken, there are still officials who think that it is their obligation to push their anti-abortion views as far as they can.
Kenen: I mean, we see how the elections have gone in every state that’s had a ballot initiative, and we haven’t seen the anti-abortion forces say, whoops, we lost and go home. I mean, they still have the Supreme Court ruling. They still have plenty of momentum. They’ve got a federal election, they’ve got a presidential election coming up, and it’s not going away, and they’re not the will of the voters. I mean, to be fair, many of them do believe that this is murder and that they’re morally obligated to keep fighting. I mean, if you want to acknowledge that, that that’s the belief for many, not necessarily all people on the … there are people who are doing it for political reasons too, but there are people who sincerely believe that they’re morally obligated to keep fighting this even if the voters have not been enlightened to the truth.
Rovner: All right. Well, finally this week, a continuing story out of Ohio that speaks to some of the serious issues with the health care workforce. The state Board of Pharmacy is recommending that a CVS pharmacy in Canton be fined and put on probation after inspections found dangers to patients from understaffing. According to the Ohio Capital Journal, which has been following this story pretty closely, inspectors found the understaffing so severe that it was taking two weeks for prescriptions to be filled and in at least one case a prescription was filled for the wrong medication. During an on-site inspection, the inside counter was closed, medications hadn’t been shelved, and it took an inspector 20 minutes just to get a staffer’s attention.
The Canton store is one of eight CVS pharmacies in the state to have been cited by the board. Now, we’ve heard similar stories, not just about CVS and not just about CVS in Ohio, but about Walgreens and other chain drugstores. Are regulators finally catching up with some of the anecdotal reports that we’ve been seeing about the stress that’s happening at the pharmacy counter?
Cohrs: I think this was a good example of a response to that, and Ohio has been on the front end of looking into pharmacies and the drug supply chain, so I think they are pretty well equipped to look into an issue like this. But I think it starts to quantify and just build the case that this does have patient impacts. It’s not just a little bit of a longer line. I mean some of the wait times for these medications — two weeks, a month. Just imagine going to the pharmacy and being told to wait a month for medication. It can be really problematic for patients. So I think, certainly, it’s not surprising to me that Ohio is kind of on the front end of this and it certainly could be the beginning of more enforcement if officials have the bandwidth to do it.
Rovner: I know. I guess the issue here is the pharmacists said during the pandemic that obviously it was a pandemic, they were having trouble getting people. They were being asked to do other things, which they still are, like give vaccines. And not just covid vaccines, it’s “now go get your shingles shot, go get your flu shot.” Everybody’s being pushed to these pharmacies and they’re not necessarily increasing staff to deal with the increasing workload. There is a point at which it starts to endanger patients, and we’re starting to see that point.
Kenen: Also they get paid for some of that, right? I mean they get paid for doing shots. And it’s not super, super labor-intensive. You have your technicians who know how to do it, you can do it pretty fast. And one reason that pharmacies do want to give shots is when you come in and you get your shot, you also end up picking up shampoo or whatever. So I mean it’s a way of getting people in the stores. There’s sort of different issues with pharmacies. I mean, I personally have had more than one time where I’ve been given the wrong medication. I look, and not only that, I don’t want to identify which pharmacy, they gave me the wrong one and I said, “This is the wrong one,” and they said, “Whoops, sorry, come back in an hour,” and I came back in an hour and they gave me the same wrong one. So I’ve never walked back in there again. I think there’ve been a number of reports, not as egregious as Ohio and CVS, about the pressure on the pharmacy techs and that they’re not enough of them, and I don’t know enough about the insides of that. Is it that there are not enough of them to hire because there’s a shortage or are the company’s not hiring enough of them and it’s working them to death? Not literally, but squeezing as much.
Rovner: Doing it for the bottom line.
Kenen: I mean we all probably have our theories. This is a relatively newish problem of the pharmacies being this overworked and we’ll be hearing more of it.
Weber: Yeah, I just want to add, I mean, Julie, you talked about the bottom line, and we’ve talked about on this podcast, I think two weeks ago, that study that came out about how private equity-run hospitals have less staffing and have higher patient errors. You can’t help but wonder if there’s some parallels here in the pursuit of profits possibly over patients.
Rovner: We’ve seen pharmacists at some of these chain stores basically say that, the ones who are there. Well, while we were talking about health workforce woes, Joanne, your extra credit speaks to this. So why don’t you go ahead and do it right now?
Kenen: Mine is an essay in Undark by a physician named Arjun Sharma and it’s called “Why Incentives to Attract Doctors to Rural Areas Haven’t Worked.” All of us know that there’s still a shortage of physicians and other health care workers, nurses, and everything else, probably pharmacists, in rural areas. I didn’t realize that the problem had actually been identified as far back as Teddy Roosevelt’s administration. Most of the efforts to resolve it actually were around 1965, when Medicare was passed and there was an official designation of these underserved areas. Basically, nothing has really worked, and this physician, Dr. Arjun Sharma, talked about the incentives. It’s not about money. That giving people loan forgiveness or extra pay to move off to this unknown rural life, temporarily or permanently, we know it doesn’t work because we’ve been doing it for 50, 60 years and it doesn’t work. He said his own experiences of having gone to a rural area is that he ended up loving the practice of medicine. He loved seeing patients in his community. He loved the different kind of interactions, and that he thought that was the way you might be able to pay someone to quit smoking, but getting somebody to go practice out in the middle of nowhere, you have to talk about why it’s wonderful and satisfying. And that the misconception is not that you’ll get money for going to the rural areas. The correct approach should be you’ll get satisfaction from practicing in a rural area.
Rovner: This is obviously another of the continuing mismatches in the U.S. health care system, such as it is. All right, well that is this week’s news. Now we will play my interview with Darius Tahir about the “Bill of the Month” and then we’ll come back and do our extra credits.
I am pleased to welcome to the podcast my colleague Darius Tahir, who reported and wrote the latest KFF Health News-NPR “Bill of the Month” installment. Darius, thanks for joining us.
Darius Tahir: Thanks for having me.
Rovner: So, this month’s patient did what a lot of us do in her situation. She didn’t feel well, thought she needed a professional consult, but it wasn’t really an emergency and, fearing it was covid or something else contagious, she booked a telehealth visit. Tell us some of the particulars of what happened here.
Tahir: So in fall of 2022, Elyse Greenblatt, a Queens, New York, resident, came back from a trip in Rwanda with a little sinus trouble. She thought it was covid but couldn’t rule it out, and so she’s like, “Why don’t I book a telehealth visit through my usual health system, Mount Sinai in New York City, just see what a professional opinion is like?” She had a very quick visit, as she remembers, and simply got prescribed some Flonase and some antibiotics. Sort of left it at that for a while.
Rovner: Which seems typical for …
Tahir: Very typical.
Rovner: So then as we say, the bill came. Now lots of insurers recommend telehealth, and lots of telehealth services compete on price. But that’s not what happened here, right?
Tahir: Right, absolutely. She looked in and saw that the app that she booked through, Mount Sinai’s personal record app, estimated a cost of $60 for a visit. That’s a competitive cost for a telehealth visit, I would say, an urgent care visit, but as it turned out, the doctor was out of network according to her insurer, Empire BlueCross BlueShield, and she ended up getting a bill of $660, which is way outside the average of this kind of telehealth urgent care visit.
Rovner: And this wasn’t anything fancy, right? This wasn’t like the doctor had to take this full medical history or anything?
Tahir: No, it was just, as she remembers, a very quick five-minute, 10-minute type visit and turned out to be very expensive because of the out-of-network nature of the visit.
Rovner: And, of course, this is exactly what the No Surprises bill was for — when you go to an in-network hospital and get a bill from an out-of-network doctor. Shouldn’t this have been considered a surprise medical bill?
Tahir: That’s a great question. So, as you mentioned, there was the [No] Surprises Act, which is a law that prevents patients from getting bills that are surprises to them, right? If you’re in a hospital, you kind of assume everybody’s in network, but maybe the anesthesiologist is out of network, in this case, Greenblatt usually goes to Mount Sinai and, usually, those doctors are in network. The problem is the specific doctor she saw in telehealth, who was provided to her luck of the draw, is out of network. So she gets hit with a big bill, $660, and goes on to protest it with the medical system. They’re kind of giving her the runaround.
Eventually, I hear about this story, and I’m like, OK, well I’ll ask some questions with Mount Sinai’s PR people. They eventually provide me with a form, a consent form, that consents to out-of-network charges. What’s kind of curious about this bill, and it’s both kind of legally curious and we’ll say ethically curious, is that both the bill and her medical record have time stamps about when the activity occurred. So she signs it one time, the medical record says another time, slightly earlier, than when the visit occurred. So you would think on its face that the consent was signed after the visit occurred. Now that’s a little weird that you’re suddenly getting a form after everything in the visit is happening.
Rovner: I mean, the bottom line here is that you’re supposed to consent in advance, not after the fact.
Tahir: In advance, exactly, yeah. It’s not just something that strikes you as normal, this is how business should be done, but it’s an interesting legal distinction as well. As you mentioned, you’ve got the No Surprises Act, which is a bill that’s supposed to protect us from surprise bills that we don’t expect, and one of the requirements of the bill is that if you do do this consent, it’s provided in a timely fashion. The other one is that if you go through a hospital where you’re covered, then there should also be coverage there because sometimes the hospital is covered, but the doctors within the hospital are not necessarily covered. And in this case, the doctor was not necessarily covered, even though she goes to the hospital system quite regularly and her services are generally covered there.
Rovner: Also, doesn’t the law say if you’re going to get out-of-network care, they have to tell you before you get the care?
Tahir: Precisely. So that is one of the requirements of the No Surprises Act, and the Mount Sinai PR person I spoke to said this is a little non-standard. This is kind of an exception, if it did happen. So, still, there’s a little bit of a loophole in the No Surprises Act. I spoke to a lawyer who was an expert in the No Surprises Act, and one of the things she pointed out about the bill is that you can’t really tell necessarily who’s putting in the bill, what entity, right? Is it the hospital? Is it some other entity? The No Surprises Act covers this laundry list of entities, including hospitals, including some outpatient facilities, but in this case, she couldn’t really tell what entity was billing Greenblatt and therefore couldn’t tell how that fit into the No Surprises Act scheme.
Rovner: And whether that entity was actually covered by the No Surprises Act.
Tahir: Precisely. So that’s kind of where we’re left.
Rovner: What eventually happened with the bill?
Tahir: It’s kind of still unpaid and unresolved more than a year after the actual service was rendered, so it’s kind of still in limbo.
Rovner: After a year. What can patients do to prevent this from happening to them? I mean, it sounds like this patient did everything right.
Tahir: Right. I guess you got to check and see that your doctors are always in network, as amazing as that sounds. Check the forms that you get, even though they’re often tons of them, there’s a HIPAA form, there are all these forms you get. I guess you’ve just got to be careful what you sign and pay attention to what you sign. Even though oftentimes when you’re going to the doctor, it’s an incredibly stressful time, yourself might be sick, a loved one might be sick, it’s tough to say, but you’ve got to pay attention to the fine print when you’re going ahead with this care, as incredible as that sounds.
Rovner: It’s not like it used to be. Darius Tahir, thank you so much.
Tahir: Thank you.
Rovner: OK, we are back. It’s time for our extra-credit segment. That’s when we each recommend a story we read this week we think you should read, too. As always, don’t worry if you miss it. We will post the links on the podcast page at kffhealthnews.org and in our show notes on your phone or other mobile device. Joanne, you’ve already done yours. Lauren, why don’t you go next?
Weber: Yeah. Mine is a piece in The Guardian by Jessica Glenza titled “Majority of Debtors to US Hospitals Now People With Health Insurance.” I think this is something that everyone on this panel knows, but I think it’s just a striking, if you take a step back and look at it, the concept of insurance for the average American would seem to think that would insure you from bad debts and from hospital debt. I think studies like this and stories like this are a good 10,000-foot-step-back reminder that this system is very broken and not working the way it should. So I think it’s just helpful to continue to realize, because this is a sea change from when only 1 in 10 folks that were insured had debt. I mean, so very much we are seeing a shift, and I think that’s important to consider as we talk about insurance issues throughout this podcast and throughout our coverage.
Rovner: It was in the early 2000s, I think, when standard deductibles started being in the four figures instead of the three figures. I mean, originally they were like $1,000, $1,500. Now people have $4,000 and $5,000 deductibles, but we know that people don’t have $4,000 and $5,000 in savings. So, of course, they’re in debt if they’re going to go get medical care. They do not have or any way to get the amount of money that they are expected to cough up before their insurance takes over, and how no one saw this coming, I can’t imagine because it’s been blaring in huge lights the whole time. Sorry, Rachel, go ahead.
Cohrs: My extra credit is a piece in The Washington Post. The headline is “Republican Governors in 15 States Reject Summer Food Money For Kids,” by Annie Gowen. And this published a week ago, I think, but it definitely flew under the radar for me. And I think it’s a great example of outside-of-D.C. journalism reporting on the consequences of state uptake on some of these optional policies that Congress passes. And I think the part that stood out most was a couple quotes, one from Iowa Gov. Kim Reynolds that said she opposed food assistance for low-income youth because childhood obesity has become an epidemic, and another where the governor of Nebraska was saying that he just doesn’t believe in welfare, so they’re not taking this money. Obviously, there is precedent for Republican governors not taking money that could help offer more services, make residents healthier, but this was just a pretty striking example, I think, because it does deal with kids and food insecurity. So I thought it was great accountability work for outside the Beltway.
Rovner: Basically, this is the summer school lunch program for kids because they’re not in school and they don’t necessarily get their lunch at school in the summer, so this is how they can get lunch, but apparently some governors say they don’t want to do that. Well, my extra credit this week is from Rachel’s colleague, Tara Bannow at Stat, and it’s called “Pumping Milk at JPM Was a Nightmare. It’s Part of a Bigger Problem in the Industry.” And in case there are listeners who don’t know, last week was the big J.P. Morgan Health[care] Conference in San Francisco, which each year draws the big money of health care to a hotel to chat each other up basically. Well, Tara Bannow, who does an awesome job covering the industry, is also back from parental leave and still breastfeeding, which means she needs a private place to pump on a regular basis.
The folks at JPM told her she would have access to a space, but turned out it was locked almost every time she needed it, and she ended up pumping in a bathroom stall, which is, and I won’t get into the details here, not ideal. Calls to other big health conferences suggested such problems would not happen there, but the suggestion of also that if there were more women in high places at these conferences, it wouldn’t be such an afterthought. It was a really, really good, thoughtful piece and good job.
OK, that is our show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review; that helps other people find us, too. Special thanks as always to our technical guru, Francis Ying, and our editor, Emmarie Huetteman. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me at X, @jrovner, or @julierovner at Bluesky and @julie.rovner at Threads. Joanne, where are you these days?
Kenen: I’m mostly on threads, @joannekenen1.
Rovner: Lauren?
Weber: Still on X @LaurenWeberHP.
Rovner: Rachel?
Cohrs: Still on X, @rachelcohrs.
Rovner: We will be back in your feed next week. Until then, be healthy.
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