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3 posts from June 2019

06/20/2019

Brady President, Kris Brown, Discusses Current Policy Efforts to Curb Gun Violence (June 23rd)

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US gun violence is, in one word, obscene.  It is widely considered an epidemic, even the always cautious AMA termed it a "public health crisis" in 2016.  Through the first five months of this year there were 148 mass shootings that killed or wounded nearly 750 individuals.   It is worth repeating comments I made in April 2018 to introduce Dr. Al-Abga (whom treated victims of the 1999 Columbine High School shooting).  US gun deaths are 96 times higher than in Japan, 55 times higher than in the UK, 32 times higher than in Germany.  Gun violence is particularly common in schools.  Since 2000 there have been over 200 shootings in over 40 states at elementary, middle, high schools and at colleges and universities. Research suggests gun violence is explained largely by one fact: gun prevalence. The US makes up less than 5% of the world's population but owns nearly 45 percent the world's guns, or 300 million that one-third of Americans’ possess.  Ownership is, for example, 150 times higher than in Japan.  This fact largely explains why guns used to commit homicides far exceeds other developed countries.  US gun homicides are 471 times more prevalent than in the UK.  As for whether mental health issues explain US gun violence, the rate of severe mental disorders in the US is no greater than in comparative countries. 

During this 26 minute conversation Ms. Brown discusses Brady United's mission or work activities including its legal efforts relative to the 2nd amendment.  Moreover, she explains current efforts in the Congress to appropriate moneys for federal gun violence research (that has not been conducted for over 20 years) and recently House-passed bills that include regulating gun sales via extending background checks to private fire arm sales.  Ms. Brown also discusses policy plans by Democratic presidential candidates including Sen. Cory Borker to curb gun violence and she discusses the State of Virginia's upcoming special session next month in the wake of the May 31st Virginia Beach shooting that left 12 dead.  

Ms. Kris Brown is the President of Brady.  Ms. Brown began her career working on Capitol Hill for (now former ) Rep. Jim Moran (D-VA), advocating for the bill that would eventually KrisBrown-LipstickLobbyHeadshot_190225_192444become the Brady Act requiring background checks on federally licensed gun sales.  At Brady, she led the lunch of the organization’s safe storage campaign to End Family Fire and formed Brady’s “Team Enough” youth initiative after February 2018 Marjory Stoneman Douglas High School massacre in Florida.  A noted media commentator, Ms. Brown was, for example, featured in the November 2018 TIME magazine cover article titled, “Guns in America.”  Ms. Brown has also served as the Chief Legal Officer to a publicly traded company based in Switzerland and as a lawyer practicing at the law firm Weil, Gotshal & Manges.  She earned her law degree at George Mason University. 

For more on Brady go to: https://www.bradyunited.org/  

For information on the Enhanced Background Checks Act of 2019 go to: https://www.congress.gov/bill/116th-congress/house-bill/1112/text 

The recent debate sparked by FiveThirtyEight regarding the accuracy of CDC's gun injury statistics and titled, "The CDC is Publishing Unreliable Date on Gun Injuries, People Are Using It Anyway," is at: https://fivethirtyeight.com/features/the-cdc-is-publishing-unreliable-data-on-gun-injuries-people-are-using-it-anyway/

06/19/2019

Dr. Renee Salas Discusses Global Warming's Health Effects On Children (June 18th)

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This past June 4th the 9th Circuit Court heard oral arguments concerning Juliana v. the US, a case filed in 2015 by 21 children seeking a jury verdict on whether the US government, by failing to address the climate crisis, is protecting the plaintiff’s rights to life, liberty and the pursuit of happiness.  In its defense the US is arguing these children, now young adults, have “no fundamental constitutional right” to a “climate system capable of sustaining human life.”  In a May 30th essay published in The New England Journal of Medicine Dr. Salas and two colleagues agreed with the plaintiffs concluding , “As the Juliana plaintiffs argue - and we agree - climate change is the greatest public health emergency in our time and is particularly harmful to fetuses, infants, children and adolescent.” (Listeners may be aware this is my 7th climate crisis related interview since October.)

During this 26 minute interview Dr. Salas discusses her related research work, the amicus brief she and her colleagues forwarded in support of Juliana plaintiffs and other related litigation filed world wide.  Moreover, Dr. Salas explains the numerous adverse health effects children are suffering via the climate crisis including various birth defects, heart, lung and neurodevelopment illnesses, vector-borne diseases, harms from high heat and wildfire exposure, cognitive, behavioral and mental health effects, contaminated water, and numerous others.  She discusses what parents need to know or can do to protect their children and the extent the health care industry needs to (better) address its own contribution to greenhouse gas emissions/pollution or global warming. 

Dr. Renee Salas is Affiliated Faculty and a Burke Fellow at the Harvard Global Health Institute.   Her research addresses how climate change is impacting the healthcare system and developing evidence-based adaptation.She is also a practicing physician in the Department of Emergency Medicine at Massachusetts General Hospital and on faculty at Harvard Medical School.  Dr. Salas served as the lead author on the 2018 Lancet Countdown on Health and Climate Change U.S. Salas - HeadshotBrief and will again in 2019.   She lectures on climate and health nationally and internationally, has published in numerous scholarly journals and is the founder and past Chair of the Climate Change and Health Interest Group at the Society of Academic Emergency Medicine.  Dr. Salas received her Doctor of Medicine from the Cleveland Clinic Lerner College of Medicine with a Master of Science in Clinical Research from the Case Western Reserve University School of Medicine.  She also holds a Master of Public Health from the Harvard T.H. Chan School of Public Health with a concentration in environmental health.

Renee Salas, Wendy Jacobs and Frederica Perera's New England Journal of Medicine essay, "The Case of Juliana v US - Children and the Health Burdens of Climate Change," is at: https://www.nejm.org/doi/full/10.1056/NEJMp1905504 

The video of the 9th Circuit Juliana v the US oral argument is at: https://www.ca9.uscourts.gov/media/view_video.php?pk_vid=0000015741&fbclid=IwAR3K3vnHCO4M2KlcMZ1NSQ4ua1ZZhpdyA-hONwyj6N7uS0u1X5ojmuVVkCc

The amicus brief filed in support of the Juliana plaintiffs by 13 medical societies and over 65 medical professionals is at: http://clinics.law.harvard.edu/environment/files/2019/03/Juliana-Public-Health-Experts-Brief-with-Paper-Copy-Certificate.pdf

Again, my related essay, "Can the Climate Crisis Continue to Go Begging?" is at: https://www.3quarksdaily.com/3quarksdaily/2019/06/can-the-climate-crisis-continue-to-go-begging.html.

06/12/2019

175th Interview: University of Michigan's Professor Andrew Ryan Discusses Measuring for Spending Efficiency or Value in Healthcare (June 11th)

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Americans spend over $3.5 trillion or 6% of the GDP annually on health care.  One third, or over $1 trillion, of that spending is considered waste, i.e., health care that does not improve our health status.  Despite substantial efforts to improve health care value or spending efficiency via so called pay for value, performance based and alternative payment models, for example ACOs and bundled payment arrangements, health care providers, Medicare and other payers, do not generally measure for value - defined as outcomes (the numerator) achieved relative to spending (the denominator).   For example, the MACRA MIPS  program, that reimburses Medicare physicians, measures quality and spending separately, not simultaneously.  They are not correlated.  As a solution the government has been over the past few years advocating increasingly health care price transparency, specifically here price transparency.  If prices were transparent patients, less those riding in an ambulance, could shop for value. The problem is even if patients could intelligently shop for value, a big if, they would not get far because prices do not necessarily reflect value.  As I note in my Bloomberg Law essay posted as a run up to this interview, former Princeton economist, Uwe Rinehardt, use to explain this reality, or the fact that the same health care service can dramatically vary in price between/among provides, via the quip, "the finest health care in the world costs twice as much as the finest health care in the world."    

During this 28 minute conversation Prof. Ryan outlines his research interests, provides background on how measuring for quality, cost and spending efficiency has evolved, explains various methods of how spending efficiency is currently being measured (e.g., conditional and unconditional), to what extent pay for value or pay for performance arrangements have proven successful to date, what value-based payment models likely offer the most promise and what the patient can or should know about pay for value arrangements.  

Professor Andrew Ryan is United Healthcare Professor of Healthcare management and Professor or Health Management and Policy at the University of Michigan, Ann Arbor.  AmryanProfessor is also the Director of the Center for Evaluating Health Reform, the co-Director of the Center for Health Outcomes and Policy and the Associate Director of the Institute for Healthcare Policy and Innovation’s Data and Methods Hub.  Prior to coming to Michigan, Professor Ryan was an Associate Professor of Public Health in the Division of Outcomes and Effectiveness Research at Weill Cornell Medical College.  Among other awards he is the recipient of the 2009 AcademyHealth Dissertation Award for "The Design of Value Based Purchasing in Medicare: Theory and Empirical Evidence."  Professor Ryan earned his Ph.D. in social policy with a concentration in health policy from the Heller School of Social Policy and Management at Brandeis University. 

Professor Ryan's publications can be found at: https://sph.umich.edu/faculty-profiles/ryan-andrew.html.

The Bloomberg Law essay is again at: https://news.bloomberglaw.com/health-law-and-business/insight-containing-health-costs-requires-measuring-rewarding-spending-efficiency.