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2 posts from December 2019


Harvard's Dr. Renee Salas Discusses the 2019 "Lancet Countdown on Health and Climate Change" Report (December 11th)

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The 2019 Lancet Countdown on Health and Climate Change (subtitled, Ensuring That the Health of a Child Born Today is not Defined by a Changing Climate), released in mid-November, identifies 41 indicators in five domains: climate change impacts, exposures and vulnerability; adaption, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and, public and political engagement.  Since this interview focuses on the first three domains, concerning the latter two, a few take-aways: in 2018 investment in fossil fuels increased slightly while investment in low-carbon energy slightly decreased; fossil fuel subsidies increased to $427 billion in 2018 or were 50% higher than in 2016; carbon pricing instruments in 2018 covered just 13% of global greenhouse gas emissions; in the US carbon prices averaged just $1/ton of CO2; regarding fossil fuel divestment, since 2008 investment funds committed to divestment equaled nearly $8 trillion with health institutions accounting for only $42 billion.  Concerning public engagement, in 2018 only 12% of health care companies referenced health in context of the climate crisis – however this was consistent with media and government communication that also does not typically connect the climate crisis with health.  Listeners may know I interviewed Dr. Jeremy Hess a year ago this week regarding 2018 Lancet Countdown report.   

During this 28-minute conversation Dr. Salas discusses moreover the Countdown's 2019 findings moreover regarding health impacts, exposures and vulnerabilities including heat-related illnesses, those related to greenhouse gas emissions/ambient air pollution, vector borne diseases and the disproportionate effects they have on children and the elderly.  Dr. Salas also discusses adverse effects the climate crisis is having on food security and nutrition, what, or what more, health care providers can do to respond to the crisis (including relevant changes in clinical training) and efforts during the just-concluded UN COP 25 (Conference of the Parties related to the UN's Framework Convention on Climate Change) meetings just held in Madrid - that Dr. Salas attended.

Dr. Renee N. Salas is an Assistant Professor of Emergency Medicine at Harvard Medical School and an Emergency Medicine Physician at the Massachusetts General Hospital (MGH). Salas_headshotShe received her Doctor of Medicine from the innovative five-year medical school program to train physician-investigators at the Cleveland Clinic Lerner College of Medicine. She concurrently obtained a Master of Science in Clinical Research from the Case Western Reserve University School of Medicine.  Subsequently, she received a Master of Public Health from the Harvard T.H. Chan School of Public Health with a concentration in environmental health while completing a Fellowship in Wilderness Medicine at MGH.  She now has a sole academic concentration on climate change and health. As a 2018 Burke Fellow, she is addressing the current research gaps in this field.  She served as the lead for the 2019 Lancet Countdown on Health and Climate Change US Brief and is a nationally recognized leader on this subject.

The 2019 Lancet Countdown report is at: http://www.lancetcountdown.org/2019-report/.  

The Lancet Countdown US Policy Brief is at: https://www.lancetcountdownus.org/2019-lancet-countdown-us-brief

Information on Juliana v the US, noted in the podcast introduction, is at: https://www.ourchildrenstrust.org/juliana-v-us

Information on Naomi Klein's work, On Fire, The (Burning) Case for a Green New Deal, mentioned during this podcast, is at: https://naomiklein.org/on-fire/.  


SIDM's Paul Epner Discusses the Pervasive Problem of Medical Misdiagnoses (December 3rd)

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Twenty years ago last month the National Academy of Sciences published the landmark report, “To Err Is Human, Building a Safer Health System.”  The report found upwards of 98,000 people die each year in hospitals alone as a result of medical errors.  One specific medical error, diagnostic error, was, and remains today, a substantial contributor.  Defined as a wrong, delayed or missed diagnosis, misdiagnoses continue to constitute a major public health problem, adversely affecting more than 12 million annually.  Approximately one-third of whom are seriously harmed and an estimated 40,000 to 80,000 die each year from diagnostic failures in hospitals alone.  Resulting costs are estimated over $100 billion annually.  Despite the problem's pervasiveness and dire effects, the federal government spends less than $10 million annually researching the problem.  (For perspective, the 2019 NIH budget was $39 billion.)   

During this 30 minute conversation, Mr. Epner briefly describes the Society to Improve Diagnosis in Medicine's activities, discusses the use/non-use of autopsies in reducing diagnostic errors, the extent to which improved imaging technology is reducing errors and the extent to which this issue is a disparities problem.  He, moreover, discusses efforts to increase funding to address the problem, needed payment reforms, efforts to identify related quality performance measures and recently introduced legislation to improve funding and research.   

Mr. Paul L. Epner, MBA, is the Chief Executive Officer and Co-founder of the Society to Improve Diagnosis in Medicine (SIDM).  He is also Chair of the Coalition to Improve Paul-epner-new-300x300Diagnosis, a collaborative with more than fifty of the country’s leading healthcare societies, health systems, patient organizations, and organizations focused on improving quality.  He recently was named to the National Steering Committee for Patient Safety.  Mr. Epner is a Past President of the Clinical Laboratory Management Association (CLMA) where he also created the Increasing Clinical Effectiveness (ICE) initiative.  He was recently a member of the CDC’s “Clinical Laboratory Integration into Healthcare Collaborative” and a consultant to their Laboratory Medicine Best Practices program (an evidence-based practice initiative).  Mr. Epner is an Associate Editor for the peer-reviewed journal, Diagnosis.

Information on SIDM is at: https://www.improvediagnosis.org/

The 2015 National Academy of Sciences expert committee report noted during this interview, "Improving Diagnosis in Health Care," is at: http://www.nationalacademies.org/hmd/Reports/2015/Improving-Diagnosis-in-Healthcare

Recently introduced legislation to address misdiagnoses, i.e., the "Improving Diagnosis in Medicine Act of 2019" (HR 5014), is at: https://www.congress.gov/search?q=%7B%22congress%22%3A%22116%22%2C%22source%22%3A%22legislation%22%2C%22search%22%3A%22HR%205014%20%22%7D&searchResultViewType=expanded