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08/10/2022

Upcoming Podcast: Greg Segal Will Discuss Organ Procurement and Transplantation Policy Reform (August 16th)

Mr. Greg Segal, the founder and CEO of patient advocacy non-profit, Organize (www.organize.org), will discuss policy reforms to improve the supply and transplantation of human organs.   

Listeners may be aware the Senate Finance Committee held a recent, related hearing this past August 3rd.  Info is at: https://www.finance.senate.gov/hearings/a-system-in-need-of-repair-addressing-organizational-failures-of-the-uss-organ-procurement-and-transplantation-network.  

 

08/05/2022

NACHC's Jeremy Crandall Discusses Inflation Reduction Act-Related Policy Reforms (August 4th)

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Two weeks ago Senate Majority Leader, Chuck Schumer, announced the $739 billion Inflation Reduction (IRA) Act of 2022, compromise legislation agreed upon by Senator Manchin.  The bill includes just a few of the healthcare policy reform provisions House Democrats included in House legislation passed late last year, moreover extending expanded ACA marketplace insurance subsidies and allowing the Medicare program to negotiate drug prices.  The IRA also includes, as has been widely reported, $369 billion in tax credits over ten years intended to accelerate the adoption of renewal energy.   (Some have suggested the bill should be more appropriately titled The Temperature Reduction Act.)   The legislation likely, if not in fact, represents the last chance Congressional Democrats and the Biden Administration have to pass health and healthcare related policy reforms this Congress under reconciliation rules - that expire September 30th.  

During this 40 minute interview Jeremy begins by describing NACHC's mission.  He goes on to discuss extending ACA insurance subsidies in context of the patients his community community health, or Federally Qualified Health Centers (FQHCs), serve, how might the Medicaid funding cliff be addressed, i.e., approximately 16 million current enrolls would lose their coverage at the end of the current public health emergency, and provides comments on extending telehealth coverage expansion, workforce shortages and the climate crisis.        

Jeremy Crandall is the Director of Federal and State Policy for the National Association of Community Health Centers, where he works to address Download policy issues concerning Medicaid funding, 340B prescription drugs, FQHC payment and delivery reforms, behavioral and telehealth policies and primary care workforce issues.  Jeremy previously spent six years working on state-based issues at the Blue Cross Blue Shield Association and at the Pew Charitable Trusts.  For eight years prior still he worked in Maryland state politics with Attorney General Brian Frosh and State Delegate Heather Mizeur.

Information on NACHC is at: https://www.nachc.org/.  

07/13/2022

265th Podcast: Professor Josiah Rector Discusses His Recently Published Book, "Toxic Debt, An Environmental Justice History of Detroit" (July 12th)

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Toxic Debt, An Environmental History Justice History of Detroit, just published by North Carolina University Press in its Justice, Power and Politics series, is largely a history of failure by federal, state and local government officials to regulate the auto industry’s extremely harmful environmental and consequential human health effects.  This failure is substantially explained by the replacement of the, though imperfect, New Deal order with neoliberal policies.  (Re: neoliberalism, see, for example, Gary Gerstle, “The Rise and Fall of the Neoliberal Order,” published by Oxford University Press.)  As a result, Professor Rector documents largely post-Depression consequences experienced by the Detroit's  African American community.  Beyond low wages and ghettoization, Detroit’s African American population has disproportionately suffered adverse health consequences via industrial policies that knowingly caused unrelieved exposure to toxic air and water (think: Flint) and more recently health harms resulting from the denial of domestic water services, what Prof Rector terms, “the dehydration of Detroit.”  

This 43 minute interview begins with Professor Rector providing a brief overview of environmental harms during the Gilded Age or later 19th century.   The interview proceeds to his discussing numerous health harms African American workers suffered with increasing automation of the auto industry and the industry's non-response for half a century, the UAW, positive and negative effects of the New Deal, discusses related waste as energy policy, i.e., specifically Detroit's incinerator and its health harms imposed on African Americans, an overview of the Flint water crisis and the larger dehydration of Detroit problem  (and its health effects) and its interrelationship with financial deregulation in Detroit.              

Josiah Rector is a Professor of Urban History at the University of Houston specializing in 20th century U.S. urban environmental history, the history Rector of the environmental justice movement, and the history of capitalism.  He was previously a Visiting Professor of U.S. and Environmental History at Northland College from 2017-2019.  He also has extensive experience in public history.  He coordinated public history internships through the Next Gen Humanities Ph.D. Program at Wayne State University in 2017-2018 and he co-organized the Michigan Humanities Council’s Third Coast Conversations: Dialogues about Water Program for the Charles H. Wright Museum of African American History in 2018-2019.  He has published articles in The Journal of American History and Modern American History and he is currently planning a book on the political ecology of urban environmental disasters in the United States since World War II.   He earned his Ph.D. in History from Wayne State University, and his dissertation received the Urban History Association’s Michael Katz Award for Best Dissertation in Urban History, 2016.

Information on Professor Rector's book is at: https://uncpress.org/book/9781469665764/toxic-debt/.

07/09/2022

Prof. Frederica Perera and Dr. Kari Nadeau Discuss Climate Crisis-Related Children's Health Harms (July 7th)

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In mid-June Columbia's Professor Frederica Perera and Stanford's Dr. Kari Nadeau published a review article in The New England Journal of Medicine titled, "Climate Change, Fossil-Fuel Pollution, and Children's Health."  The article provides an overview of the numerous health harms inflicted on children around the world resulting from fossil fuel combustion's released of massive amounts of airborne fine respirable particles, additional health harms resulting from an increasingly destabilized climate, resulting health disparities and an overview of medical practice recommendations to minimize related health risks to children.  Concerning health harm, last year Harvard along with three UK universities concluded fossil fuel pollution was responsible for eight million deaths or 18% of total global deaths in 2018.  In the US, pollution resulting from fossil fuel’s use accounts for nearly 60% of total excess deaths.  

During this 38-minute interview Professor Perera and Dr. Nadeau begin by providing an overview of the numerous adverse health effects imposed on children resulting from both fossil fuel combustion and the innumerable harms resulting from global warming.  The authors identify solutions to mitigate the climate crisis, opine on efforts by the professional medical community to address the climate crisis, notes the work the Medicaid program needs to do to address related health harms to children, comment on their own university's efforts ,      

 Frederica P. Perera is Professor of Environmental Health Sciences and serves as Director of the Columbia Center for Children's Environmental Fpp1_2742 F Perera 3_med_3 Health.  Her areas of specialization include prevention of environmentally related developmental disorders and disease in children, cancer prevention through the use of novel biomarkers, environment-susceptibility interactions, and risk assessment.  Her recent research is also addressing the multiple impacts on children's health and development of fossil fuel combustion--both from the toxic pollutants emitted and climate change related to CO2 emissions.  She is the author of over 350 publications, including 300 peer-reviewed articles, and has received numerous honors.   She received her Ph.D, DrPH and MPH from Columbia University and her BA from Harvard. 

 

Dr. Kari Nadeau is the Naddisy Foundation Endowed Professor of Medicine and Pediatrics and Director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University.  Among other current activities she is currently working at the World Health Organization on air pollution IMG_0764 and climate change policy.   In collaboration with colleagues she has been awarded many patents, started 4 biotech companies, and worked in industry to shepherd two drugs through the FDA to approval. She also is an author of the Lancet Countdown in Global Climate Change 2020 and the book: The End of Food Allergy (published 2020).   Dr. Nadeau received her MD and PhD from Harvard Medical School through the NIH MSTP program. She completed a residency in pediatrics at Boston Children’s Hospital and a clinical fellowship in allergy, asthma and immunology at Stanford and at University of California, San Francisco.

06/09/2022

My Latest Climate and Health Essay, "FDA User Fee Legislation Needs to Mitigate the Pharmaceutical Industry's Carbon Pollution" (June 8th)

Yesterday, STAT published my latest climate and health related essay.  Here is the email text I forwarded to Senator Murray's staff director.  

This morning STAT published my latest, "FDA User Fee Legislation Needs to Mitigate the Pharmaceutical Industry's Carbon Pollution."   I'd appreciate your reading and distributing to your colleagues. 
This is my 11th or 12th related article published over the past few years.  Believe me, I take zero pleasure in drafting these - nor any of the numerous related HHS comment letters or any of the over 25 related podcast interviews.  Just so you're aware, I receive no compensation for this work.   
I hope you know the climate crisis reality continues to worsen, e.g., Nature Climate Change just published research showing atmospheric CO2 is now measured at 421 ppm (50% higher than pre-industrial era), the highest in human history or higher than any time in at least 4 million years.  Every week Kim Stanley Robinson's, "The Ministry for the Future," becomes less and less cli-fi.   As always, I am happy to discuss related policy reforms with the Chairwoman or your staff.
Thank you.
David Introcaso, Ph.D.          

 

06/08/2022

Alfred and Blair Sadler Discuss Their Just Published, "(P)Luck: Lessons We Learned For Improving Healthcare and the World" (June 7th)

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(P)Luck moreover details the nine year collaboration between identical twins, Dr. Alfred Sadler and Blair Sadler, an attorney, via their work at NIH,  Yale, the Robert Wood Johnson Foundation and the Hastings Center on Bioethics to advance national organ donation and transplantation policy, create the Physician Assistant profession, advance national emergency medical care and address related bioethical issues.   The work also provides insights regarding related challenges these fields face today and provides a list of lessons learned applicable to present day health care problems. 

During this 39 minute discussion, Dr. Sadler and Mr. Sadler begin by explaining the purpose of the work and how and why they chose to collaborate after completing medical and law school.   The conversation moves on to an overview of their collaborative efforts, they discuss challenges still facing organ donation and persisting ethical issues, for example, related to the ongoing pandemic and conclude with comments concerning a few of the 15 lessons learn they identify.              

Alfred Sadler, MD, ScD (Hon) FACP, is the Co-Founder of the Physician Assistant Program at Cal State University, Monterey FredPhoto Bay and is the President of the Cypress Foundation - dedicated to improving physician and PA workforce in the tri-county area where he lives.  He was trained in surgery at the Hospital of the University of Pennsylvania and in internal medicine at the Harvard Medical School and at Mass General Hospital  He practiced primary care in Monterey County for nearly forty years with an emphasis on underserved populations.  He is a a member of Alpha Omega Alpha and in 2018 was recognized as Physician of the Year by the Monterey County Medical Society.  He is a coauthor of The Physician Assistant: An Illustrated History

Blair Sadler, JD, is a Senior Fellow at the Institute for Healthcare Improvement and a member of the BlairPhoto
faculty at the University of San Diego's Rady School of Management.   A graduate of Amherst College and the University of Pennsylvania Law School, he was a law clerk for the Superior Court of Pennsylvania.  From 1980 to 2006, he was President and CEO of the Rady Children's Hospital in San Diego.  He has served on the board of the Hastings Center for 12 years and is a member of the board of Health Care without Harm, an environmental health advocacy organization.  He chairs the Board of Access Youth Academy in San Diego.

Information on their work is at: https://www.bookdepository.com/P-Luck-Alfred-Sadler/9781735873176?ref=grid-view&qid=1654425267966&sr=1-6.  

   

06/04/2022

Mr. Jim MacMillan Discusses Gun Violence Reporting (June 3rd)

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Listeners are certainly aware of never ending US gun violence.  For example, since 37, moreover 4th grade children, were shot with 19 killed in Uvalde, Texas on May 24th, there have subsequently been at least 14 subsequent mass shootings killing at least 10 and wounding another 61.   Over the past ten years, or since the Sandy Hook , there have been 950 subsequent school shootings.   Concerning federal policy, via the so called (Jay) Dickey amendment the Congress effectively banned the CDC from researching gun violence between 1996 and 2020.  Presently, it does not appear the Senate will act to pass substantive and widely popular policies designed to reduce gun violence.   As the British journalist, Dan Hodges, concluded in 2015, "in retrospect, Sandy Hook marked the end of the US gun control debate.  Once America decided killing children was bearable, it was over."

During this 36 minute conversation, Mr. MacMillan begins by providing an overview of the Center's mission and its work along with the Center's weekly newsletter, the roots of the problem, suicide reporting, his preliminary impressions regarding the Uvalde shooting, his related interaction/experience with the medical community, status regarding the Center's work informing policy reform and the specifics of his "better gun violence reporting" initiative.          

Mr. Jim MacMillan is the Founder and Director of the Philadelphia Center for Gun Violence and its parent organization, the Initiative for Better Gun Violence Reporting.  Previously, Mr. MacMillan was a Journalist in Residence at Swarthmore 1630105371322 College, a Fellow at the Philadelphia Social Innovations Lab at the U. of Penn and a Practitioner in Residence at the Institute for Global Leadership at Tufts University.  Mr. MacMillan was also an Ochberg Fellow with the Dart Center for Journalism and Trauma at Columbia University and a Knight Fellow in Medicine/Health Sciences Journalism with the Knight-Wallace Fellows at the U. of Michigan.  Previous faculty appointments include the U. of Missouri School of Journalism, Swarthmore College, NYU's Carter Journalism Institute and Klein College of Media and Communication at Temple University.  During his prior photo journalism career, Mr. MacMillian spent 17 years at the Philadelphia Daily News and with The Associated Press working in Boston and Baghdad during the war in Iraq.  His teams war reporting was awarded the Pulitzer Prize. 

Information on the Philadelphia Center for Gun Violence is at: https://www.pcgvr.org/.  

05/20/2022

Posted on the Podcast Blog: My Comments in Response to HHS's Environmental Justice Strategy RFI (May 20th)

Since listeners have encouraged me to post some of my non-published writings, please click on the "Blog" link just below the title banner, scroll down and you will see my comment letter in response to HHS's Request for Information (RFI) titled, "2022 HHS Environmental Justice Strategy and Implementation Plan Draft Outline."  At: https://www.govinfo.gov/content/pkg/FR-2022-04-08/pdf/2022-07514.pdf

Listeners will not be surprised my comments focus on the climate crisis, i.e., they reflect, in part, previous comments in my related March 28th STAT News article, again at: https://www.statnews.com/2022/03/28/hhss-failure-to-address-the-health-harms-of-climate-crisis-constitutes-environmental-and-institutional-racism/.  The comment letter, at 3,000 words, will also provide status of the National Academy of Medicine's healthcare industry decarbonization effort along with Congressional and White House efforts.  

Listeners are encouraged to submit comments in response to the RFI.  Comments were initially due May 19th, however, HHS extended the deadline to June 18th.  See the link to the RFI above for the HHS email address.    

05/12/2022

The Nature Conservancy's Dr. Robert McDonald Discusses International Efforts to Address Biodiversity Loss (May 11th)

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Coincident to the United Nations' 1992 creation of the Framework Convention on Climate Change (UNFCCC) agreement that governs international efforts to address the climate crisis/reduce Anthropocene warming, the UN also created the Convention on Biological Diversity (CBD) that attempts to address or maintain biodiversity or mitigate declining biodiversity worldwide.  The CBD has been ratified by every UN member state except the US.  Tragically, over the past thirty years both the UNFCCC and the CBD have achieved extremely limited success.  The CBD's current Global Biodiversity Framework (GBF) is largely an attempt to achieve the CBD's 2010 Aichi agreement that failed to attain any of its 20 biodiversity targets.  The GBF currently proposes 21 targets and 10 milestones.  The next CBD meeting, or Conference of Participants (COP) 15, is scheduled for this August in China where it is hoped signatories will reach consensus and approve the GBF.  Concerning the state of planetary biodiversity, currently an estimated 10% of insect species are at risk of extinction, 13% of bird species, 21% of reptile species, 25% of mammals and 40% of amphibians.

During this 35 minute interview Dr. McDonald begins by providing an assessment of overview of planetary biodiversity loss and his understanding of why on balance the US health care industry fails to appreciate the relationship or correlation between biodiversity, or the health of ecosystems, with human health.  He then provides an overview of the UN Convention of Biological Diversity, the failure of the 2010 Aichi agreement, the goals of the currently negotiated Global Biodiversity Framework and the likelihood of its adoption at the scheduled CBD meeting in China this August.   

Dr. Robert McDonald is Lead Scientist for Nature-Based Solutions at The Nature Conservancy. He researches the impact and dependencies of cities on the natural world and helps direct the science behind much of the Conservancy’s urban Tnc_36544076_1920x1920 conservation work.  Prior to joining The Nature Conservancy, Dr. McDonald was a Smith Conservation Biology Fellow at Harvard University where he studied the impact global urban growth is having on biodiversity and conservation.  He also taught landscape ecology at Harvard’s Graduate School of Design, i.e., helped architects and planners incorporate ecological principles into their projects.  He holds a BS degree in biology from The University of North Carolina at Chapel Hill and a PhD in Ecology from Duke University.  He has published more than 50 peer-reviewed publications and a recent book published by Island Press and titled, Conservation for Cities.  It documents the role green infrastructure can play in the well-being of urban residents. 

Information on the United Nation's Convention on Biological Diversity is at:https://www.cbd.int/.   

05/05/2022

260th Podcast Interview: Sherill Mason Discusses Proposed Skilled Nursing Facility (SNF) Policy Reforms (May 4th)

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There are currently approximately 15,500 Skilled Nursing Facilities (SNFs) in the US providing care to approximately 1.5 million Americans at an annual cost of approximately $175 billion.  Research has for decades demonstrated SNF care quality lags - made tragically evident by the ongoing COVID pandemic.  As MedPAC termed in its recent March report, the pandemic's effects on SNF patients have been “devastating.”  Dedicated podcast listeners may recall I’ve discussed SNF care quality, for example the long standing abusive use of antipsychotics as chemical restraints in December 2012, again in February 2018 when I noted in testimony before the Congress in 2007 the FDA's Dr. David Graham stated, "15,000 elderly people in nursing homes [are] dying each year from the off-label use of antipsychotic medications for an indication that the FDA knows the drug doesn't work," and again in August 2020.  (Last September the The New York Times published a lengthy investigative report that found SNFs had gamed the misuse of antipsychotics by fraudulently diagnosing their elderly patients as schizophrenic.)  Concerning recent policy reform proposals, they are numerous.  In late February the White House published a fact sheet that identified numerous reforms, in early April the National Academy of Medicine issued a report titled, “The National Imperative to Improve Nursing Home Quality" that did the same.  In mid-April CMS published its proposed 2023 SNF rule that also did so.  Listeners will recall I interviewed Sherill in August 2013 regarding  post-acute Medicare fraud and in September 2015 regarding a value-based home health care demo.  

During this 41-minute interview Ms. Mason begins by discussing the private equity's effect on the SNF industry and CMS' recent decision to make public SNF (and hospital) ownership information.  The discussion moves on to discuss policies including to improving SNF staffing ratios, payment reform, front line worker education and training, addressing the abusive use of antipsychotics and regulatory enforcement and penalties.      

Ms. Sherill Mason is Principal at Mason Advisors where she specializes in federal legislative, reimbursement and regulatory initiatives that impact the post acute health care industry.  Prior to establishing Mason Advisors, Ms. Mason was a senior policy analyst with Marwood Group, providing detailed analyses of post acute health care legislative and regulatory initiatives to hedge funds and mutual funds.  Before joining Marwood Group, Ms. Mason operated Mason & Garvey, LLC, a private consulting practice, for six years where she 1517742789513 analyzed health care reform legislation and its potential impact on the senior living industry.  Prior still, Ms. Mason served as Senior Vice President of Resident Care & Services for Sunrise Senior Living, with responsibility for program development and the quality of care and services provided to 40,000 residents by 30,000 employees in 370 communities, operating in the United States, the United Kingdom, and Canada.  For seven years Ms. Mason was a Director with the Senior Care Services advisory practice of KPMG LLP, and served as KPMG’s National Subject Matter Expert for the home health, hospice, durable medical equipment, and home infusion therapy industries.   Ms. Mason is a Registered Nurse and earned a Bachelor of Arts Degree in American Studies with Distinction from Eckerd College. Her remarks regarding senior care have been published in the New York Times, Wall Street Journal.com, and MSNBC.com. In 2004, she was listed in the Washington Post as one of the top ranked business women in Washington, D.C. Ms. Mason’s writings have been published in Faulkner & Gray’s 1997 Managed Home Care Source Book; RN Magazine; CARING; ADVANCE Magazine and Nursing Spectrum. She provided advice on senior care technology to Senator John Edwards’ 2008 presidential campaign. Ms. Mason provided assistance to the Senate Finance Committee as it crafted the IMPACT Act of 2014.  For several years Ms. Mason was a guest lecturer at University of Pennsylvania, lecturing senior nursing students and Wharton undergraduates on the Affordable Care Act and government reimbursement for health care.  

President Biden's February 28th fact sheet is at: https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/).  The NAM report is at: https://www.nationalacademies.org/news/2022/04/wide-ranging-systemic-changes-needed-to-transform-nursing-homes-to-meet-needs-of-residents-families-and-staff and information regarding CMS' proposed 2023 SNF rule is at: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2023-skilled-nursing-facility-prospective-payment-system-proposed-rule-cms-1765-p#:~:text=As%20a%20result%20of%20this,%241.7%20billion%2C%20in%20FY%202023.   The NBER paper discussed during this interview is at: https://www.nber.org/papers/w28474.