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4 posts from July 2019


Dr. Georges Benjamin Discusses the Climate Crisis and APHA's Center for Climate and Health (July 24th)

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The news is grim.  Our planet has just experienced its hottest June in recorded history and likely the hottest July.  This year will likely join ten others since 2000 as the warmest ever recorded.  Several studies just published in Nature and Nature Geoscience have concluded there has never been a period over the past 2,000 years when temperatures have changed as fast and extensive as in recent decades.  To make matters worse, the climate crisis substantially explains the fact our planet is currently experiencing its 6th mass extinction – 4 of the previous 5 were also caused by high atmospheric CO2 concentrations, the worst of these extinguished 90% of all planetary life.  Despite the increasingly dire evidence, the federal leaders continue to do nothing.  The White House and the Republican Party not only refuse to admit reality but argue Americans have no fundamental right to a climate system capable of sustaining human life.  Congressional House Democrats refuse to move any meaningful legislation - even if that means simply putting Republicans on record for opposing maintaining life on earth and the health care industry, in sum, is neither working to reduce its own carbon emissions nor lobbying for requisite federal policy reforms.  Listeners may be aware this is my 8th climate crisis-related interview since last October.

During this 29 minute conversation Dr. Benjamin assesses the current stay of play relative to federal action concerning the climate crisis, he discusses the challenges the climate crises poses relative to achieving health equity and moreover the work of APHA's Center for Climate, Health and Equity (and how individuals can become involved in the APHA's climate crisis work). 

Dr. Georges Benjamin has served as Executive Director of the American Public Health Association since 2002.  He also serves as publisher of APHA's nonprofit's monthly publication, The Nation's Health, the association's official newspaper, and the American Journal of Public Health. Previously, Dr. Benjamin served as Secretary and Deputy Secretary of the Maryland DownloadDepartment of Health.  Dr. Benjamin began his medical career in 1981 in Washington State where he served as Chief of the Acute Illness Clinic at the Madigan Army Medical Center.  He subsequently moved to Washington, D.C. to serve as Chief of Emergency Medicine at the Walter Reed Army Medical Center.  After leaving the Army, Dr. Benjamin chaired the Department of Community Health and Ambulatory Care at the District of Columbia General Hospital, was promoted to Acting Commissioner for Public Health for the District of Columbia and later served as Interim Director of the Emergency Ambulance Bureau of the District of Columbia Fire Department.  He is the author of more than 100 scientific articles and book chapters.  His most recent book is, The Quest for Health Reform: A Satirical History is an exposé of the nearly 100-year quest to ensure quality affordable health coverage for all through the use of political cartoons.  Dr. Benjamin is a member of the National Academy of Medicine of the National Academies of Science, Engineering and Medicine and also serves on the boards for several organizations including Research!America and the Reagan-Udall Foundation.  In April 2016, President Obama appointed Dr. Benjamin to the National Infrastructure Advisory Council.  Dr. Benjamin is a graduate of the Illinois Institute of Technology and the University of Illinois College of Medicine.  He is board-certified in internal medicine and a Fellow of the American College of Physicians, a Fellow of the National Academy of Public Administration, a Fellow Emeritus of the American College of Emergency Physicians and an Honorary Fellow of the Royal Society of Public Health.

For information on the APHA's Center on Climate go to: https://apha.org/topics-and-issues/climate-change/center  
The APHA's 2016 "Climate Change and Health Strategic Plan" (noted during this interview) is at: https://www.apha.org/-/media/files/pdf/topics/climate/apha_climate_change_strategic_plan.ashx?la=en&hash=03D148BBD2A45E2A2B98BC4C98D33F32118244E1 
Phillip Alston's (United Nations' Special Rapporteur on Extreme Poverty and Human Rights) report, "Poverty and Climate" (also noted or quoted during this interview - and must reading) is at: http://www.guninetwork.org/files/unsr-poverty-climate-change-a_hrc_41_39.pdf



Dr. Mark Fendrick Discusses Value-Based Insurance Designs (July 19th)

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One way to increase the value of insurance coverage is to eliminate or lower a patient's out of pocket costs (OOP), i.e., their co-pays and/or deductables, for health care services that are of high value, for example, vaccines and/or alternatively increase OOP costs for low value service, for example, certain imaging tests.  The concept is based on the straight forward rationale that, based on clinical evidence, certain health care products or services are proven to be more effective than others.  (This is the rationale for the Choosing Wisely program, at: https://www.choosingwisely.org/.)  OOP costs therefore should not be uniform for all services and medications, particularly when non-adherence rises along with rising health care OOP spending.  This largely explains the problem of medication non-adherence.  Phrased another way, we need need to solve for the increasing problem of under consuming high value care.  This idea was recognized in the 2010 Affordable Care Act, specifically Section 2713 [c] that eliminates patient cost sharing for specific preventive care services.  For example, OOP costs for significantly under-utilized breast and colorectal screenings, for which approximately only 72% and 60% of patients, respectively, are screened.  The value-based idea was furthered by the ACA-created CMS Innovation Center that in 2017 the launch the MA VBID demonstration - that was recently extended to 2024.  (This discussion is related to or can serve as a follow up to my May 11th conversation with Professor Andrew Ryan concerning measuring for value or spending efficiency.)

During this approximately 30 minute conversation, Dr. Fendrick discusses moreover the creation of the University of Michigan's VBID Center, provides his assessment of the current CMS Medicare Advantage VBID demonstration, the U. of MI Center's just announced V-BID X insurance design, VBID efforts at the state level and the Treasury Department's just-announced guidance allowing Health Savings Account/High Deductible Health Plans to practice VBID.   

Dr. A. Mark Fendrick is the Director of the Value-Based Insurance Design Center at the University of Michigan.  He is also Professor of Internal Medicine in the School of Medicine Amfenand a Professor of Health Management and Policy in the School of Public Health at the University of Michigan.  He has authored over 250 articles and book chapters and has received numerous awards for the creation and implementation of value-based insurance design.  Dr. Fendrick is an elected member of the National Academy of Medicine (formerly the Institute of Medicine or IOM), serves on the Medicare Coverage Advisory Committee, and has been invited to present testimony before the U.S. Senate Committee on Health, Education, Labor and Pensions, the U.S. House of Representatives Ways and Means Subcommittee on Health, and the U.S. Senate Committee on Armed Services Subcommittee on Personnel.  Dr. Fendrick is the co-editor in chief of the American Journal of Managed Care and is an editorial board member for three additional peer-reviewed publications.  He is also a member of the Institute for Healthcare Policy and Innovation at the University of Michigan, where he remains clinically active in the practice of general internal medicine.  Dr. Fendrick received a bachelor’s degree in economics and chemistry from the University of Pennsylvania and his medical degree from Harvard Medical School.  He completed his residency in internal medicine at the University of Pennsylvania where he was a fellow in the Robert Wood Johnson Foundation Clinical Scholars Program.

For information about U. of Michigan's Center for Value-Based Insurance Design to go: https://ihpi.umich.edu/center-value-based-insurance-design-v-bid.

A summary of the V-BID X proposal is at: https://www.healthaffairs.org/do/10.1377/hblog20190714.437267/full/.  The more complete white paper is at: http://vbidcenter.org/wp-content/uploads/2019/07/VBID-X-Final-Report_White-Paper-7.13.19.pdf.  

For information concerning Dr. Fendrick's mention of the just-released US Treasury guidance allowing HSA-HDHP plans the flexibility to cover specified medications and services prior to meeting the plan deductible go to: https://ihpi.umich.edu/center-value-based-insurance-design-v-bid


Katherine Eban Discusses Her Just-Published Work, "Bottle of Lies, The Inside Story of the Generic Drug Boom" (July 17th)

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Nine in 10 prescriptions are today filled using a generic drug saving Americans tens of billions annually.   A significant amount of generic drugs, along with active ingredients in all drugs, are manufactured overseas.  However, how safely or to what quality standards are these ingredients and generics produced?   Bottle of Lies, published in May, tells the story of appalling practices foreign generic manufacturers use to produce these drugs at the most minimal cost.  The work moreover provides a detailed account of Ranbaxy, the former India-based generic manufacturer that after eight years of investigation was fined a then record amount,$500 million, for significant fraud.  The work questions or brings to serious doubt the FDA's ability to adequately inspect overseas generic manufacturers ensuring these drugs are safe for consumption in the US or around the world.  Listeners may recall I interviewed coauthor Paul Weinberg in September 2017 concerning his related work, Blood On Their Hands, How Greedy Companies, Inept Bureaucracy and Bad Science Killed Thousands of Hemophiliacs and Rosemary Gibson this past December concerning her related, China Rx, Exposing the Risk of America’s Dependence on China for Medicine

During this 37 minute interview. Ms. Eban provides an overview of Ranbaxy's manufacturing practices revealed by former employee and whistleblower, Dinesh Thakur.  She explains the mindset, termed "Jugaad," used in India to produce generics.  She discusses the adequacy of the 2013 US settlement with Ranbaxy , the role the Japanese firm, Daiichi Sankyo, a  major Ranbaxy stakeholder, the FDA's ability to adequately inspect Ranbaxy and other generic manufacturers around the world, e.g., Cipla and Mylan, recent and future related Congressional action, how poor or inadequate manufacturing practices complicate remedying the drug shortage problem and what precautions consumers or patients can take before consuming generic drugs.  

Katherine Eban, an investigative journalist, is a Fortune magazine contributor and Andrew Carnegie fellow. Her articles on pharmaceutical counterfeiting, gun trafficking, and 1811011_HS_114_RTcoercive interrogations by the CIA, have won international attention and numerous awards.  She has also written for Vanity Fair, The New York Times, Self, The Nation, the New York Observer and other publications. Her work has been featured on 60 Minutes, Nightline, NPR, and other national news programs.  She lectures frequently on the topic of pharmaceutical integrity.  Her first book, Dangerous Doses: a True Story of Cops, Counterfeiters and the Contamination of America’s Drug Supply, was named one of the Best Books of 2005 by Kirkus Reviews and was a Barnes&Noble Discover Great New Writers pick.  Her account of reporting on 9/11 was anthologized in At Ground Zero: 25 Stories From Young Reporters Who Were There. Her work has also been awarded grants from the Alfred P. Sloan Foundation, the Fund for Investigative Journalism, the Alicia Patterson Foundation and the McGraw Center for Business Journalism at CUNY’s Craig Newmark Graduate School of Journalism.  Educated at Brown University and Oxford, where she was a Rhodes Scholar.   

Information on Bottle of Lies is at: https://www.harpercollins.com/9780062338785/bottle-of-lies/.  

Ms. Eban's FAQ regarding how to learn about generics or best to consume is at: https://www.katherineeban.com/faqs


"Can Medicine Be Cured?" (July 3rd)

Though I've been asked over the years to recommend readings I've avoided beyond noting those related to podcast interviews.   However, this work and lengthy review may be worth particular notice.  The book is Seamus O'Mahony's Can Medicine Be Cured? The Corruption of a Profession and the June review appearing in the Dublin Review of Books by Paul O'Mahoney is titled, "Made To Measure?"

At: http://headofzeus.com/books/can-medicine-be-cured

At: http://www.drb.ie/essays/made-to-measure-