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5 posts from June 2021


More on the Climate Crisis (June 29th)

Today Stat News posted my essay with Walt Vernon titled, "Public Reporting, The First Step in Addressing the Health Care Industry's Bloated Carbon Footprint."   It's at: https://www.statnews.com/2021/06/29/public-reporting-health-care-greenhouse-gas-emissions/.   




Harvard's Eric Reinhart Discusses Why Mass Incarceration Makes Us All Sick (June 24th)

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The US prison and jail population is the largest in the world at two million.  With 4.2% of the world’s population, the US accounts for roughly 25% of the world’s prisoners.  African Americans, at 13% of the general population, account for 34% of the prison population.  Much like the effect COVID-19 has had Skilled Nursing Facility (SNF) residents, prisons and jails have also constituted killing fields.  Beyond this, prisons and jails serve as infectious disease multipliers, or as epidemiological pumps, spreading disease far beyond their walls.  For example, prior to the beginning of last year’s school year prisons and jails accounted for 90 of the 100 worst COVID-19 cluster cites.  Those incarcerated in jails and prisons have suffered a 5.5 times greater risk of a COVID-19 infection, experienced three times the death rate of those not incarcerated and so-called jail cycling has significantly accounted for COVID-19 infection rates in the general population, moreover in minority communities.  The combination of high rates of arrest and incarceration have consequently become, as Dr. Reinhart recently stated, both the symptom and cause of poor public health, not a solution for it.   (To appreciate further the extent to which mass incarceration affects prisoners’ health, in December 2016 I discussed the behavioral/mental health effects via wide-spread use of solitary confinement with Solitary Watch’s Jean Cansella.)  

During this 40 minute discussion Eric Reinhart begins by discussing why and how he chose Cook County Jail for his research and describes how he conducted his study.  In turn, he discusses and dismisses the possibility of reverse causality, details the magnitude of the jail cycling problem or the effect released inmates have on community or public health, discusses the use of decarceration in response to the pandemic and more generally as a solution for excessive punitivity/incarceration in context of carceral-community epidemiology. 

Eric Reinhart is lead health and justice systems researcher at Data and Evidence for Justice Reform (DE JURE), the World Bank.  He is a medical anthropologist, resident physician in
the Physician Scientist Training Program at Northwestern University’s Department of Psychiatry and Behavioral Sciences, and an advanced candidate in adult psychoanalysis at the Reinhart_photo_updated_01 Chicago Center for Psychoanalysis.  His writing has appeared in the New York TimesWall Street JournalJacobinBoston Reviewboundary 2Journal of Legal StudiesHealth AffairsNew England Journal of MedicineBritish Medical JournalThe Lancet, and the Proceedings of the National Academy of Sciences.

Reinhart's May Health Affairs blog post, "How Mass Incarceration Makes Us All Sick," is at: https://www.healthaffairs.org/do/10.1377/hblog20210526.678786/full/.

Reinhart and Chen's May 2021 Proceedings from the National Academies (PNAS) article, "Carceral-Community Epidemiology, Structural Racism, and COVID-19 Disparities," is at:  https://www.pnas.org/content/118/21/e2026577118.short.

Reinhart and Chen's June 2020 research article, "Incarceration and Its Disseminations: Covid-19 Pandemic Lessons From Chicago's Cook County Jail," is at: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00652?utm_campaign=covid19fasttrack&utm_medium=press&utm_content=reinhart&utm_source=mediaadvisory.

Reinhart's March "Medicine for the People" Boston Review essay is at: http://bostonreview.net/science-nature/eric-reinhart-medicine-people.

Information on Paul Farmer's Pathologies of Power: Health, Human Rights and the New War on the Poor is at: https://www.ucpress.edu/book/9780520243262/pathologies-of-power.


240th Podcast: Brian Alexander Discusses His Recently Published, "The Hospital: Life, Death and Dollars in a Small American Town" (June 22nd)

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In The Hospital, Mr. Alexander provides an account of Bryan, Ohio's Community Hospitals and Wellness Centers (or CHWCs) hospital’s efforts to stay solvent between 2018 and 2020.  The work, in many ways is a companion to Nick Freudenberg's "At What Cost, Modern Capitalism and the Future of Health (I interviewed Prof. Freudenberg on May 20th), is particularly timely because rural hospitals, that serve roughly one in five Americans, are closing at a record rate.  For example, 136 have closed since 2010 and currently over 500 are at risk of closing.   The demise of rural hospitals is largely due to decades of poor-to-dire economic circumstances, largely zero wage growth for non-degreed workers, particularly in Ohio and the five other Rust Belt states.  The consequence thereof has been approximately 100,000 annual "deaths of despair."  (See Case and Deaton's 2020 volume by the same title.)  The demise of rural hospitals generally and the threat to CHWC is the health care marketplace that Mr. Alexander terms, "cut throat."  Not surprisingly therefore, in “The Hospital” Mr. Alexander also profiles the health status and economic circumstances of several CHWC patients and their peers and describes healthcare marketplace realities and their effects on CHWC.      

During this 34 minute interview Mr. Alexander begins by explaining how and why he chose CHWC to profile.  He moves move on to discuss moreover the health status of CHWC patients' health and their economic circumstances (i.e., the role social determinants play), discusses CHWC's struggle to succeed in a health care market dominated by two large regional provider organizations, why the CHWC's CEO and board refused to merge with a large provider entity and discusses what he concludes from his two year study.     

Brian Alexander is a contributing writer to The AtlanticHis most previous work is the Glass House, The 1% Economy and the Shattering of the All American Town, winner of the Ohioana Book Awards.  He’s also written for The New York TimesLos Angeles 200052229 Times and Esquire, among others.  He’s presented at The Obama Foundation Summit and in Washington, D. C. to members of the Senate and House of Representatives.  Mr. Alexander lives in San Diego. 

Information on The Hospital is at: https://us.macmillan.com/books/9781250237361.

Information on Glass House, The 1% Economy and the Shattering of the All American Town is at: https://us.macmillan.com/books/9781250085801.


Ms. Priti Krishtel Discusses the Biden Administration's Support for a Temporary WTO COVID-19 Vaccine Patent Waiver (June 10th)

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Last October India and South Africa appealed to the World Trade Organization to temporarily waive patent or intellectual property (IP) rights such that COVID-19 production and distribution worldwide could be accelerated.   As of a month ago 80% of COVID-19 vaccines had gone to those in in high or upper middle income countries while only 0.2% had gone to those in low income countries - meaning it was projected to take until 2024 to inoculate developing world populations.  The Trump administration opposed a waiver.  In early May, the Biden administration announced it would support a so called TRIPS (Trade-Related Aspects of Intellectual Property Rights) waiver over the opposition the European Union (EU) and the pharmaceutical industry - though Moderna announce last fall it would not enforce its COVID vaccine-related patents).   Along with recent administration announcements to purchase and distribute over 500 million vaccines worldwide, the administration has evidently recognized the moral imperative and the fact COVAX, the WTO's initiative to pool vaccine resources, remains profoundly underfunded.      

During this 26 minute conversation Ms. Krishtel moreover explains why the Biden administration was unprecedented, the definition of a waiver, its timing and the practical issue of tech transfer.  She goes on to address or refute the industry's objections to a temporary waiver and discusses more generally inherent problems with the market-driven US patent system.  Among other issues, it undermines the purpose of public investment, socializes risk while privatizing profits (or places profits over people) and slows the worldwide diffusion of pharmaceutical know how.         

Ms. Priti Krishtel is the co-founder of Initiatives for Medicines Access and Knowledge (I-MAK),  a non-profit building a more just and equitable medicines system.  She has spent Priti-Krishtel-Headshot nearly two decades exposing structural inequities affecting access to medicines and vaccines moreover across the Global South.  Of late this work includes advocating for equitable access to COVID-19 vaccines across the globe and helping to ensure the Biden administration prioritizes equity the US Patent and Trademark Office's work.  I-MAK's work on the patent system has been cited repeatedly in Congressional testimony on prescription drug costs, most recently in hearings by the House Committee on Oversight and Reform.   To improve equity in the patent system, I-MAK recently developed a new tool called Participatory Changemaking that will provide an assessment of the patent system and bring together stakeholders from across the stakeholder spectrum, from patients to investors and policymakers, to drive sustainable, long-term change into what has long been an exclusionary process.  Ms. Krishtel and I-MAK have also put out a 10 point plan for the Biden administration to bring equity into the patent system.  She is a recent TED speaker, Presidential Leadership Scholar, and an Ashoka Fellow.

For information on I-MAK go to: https://www.i-mak.org/.   

Ms. Krishtel's recent British Medical Journal article noted during this discussion is at: https://www.bmj.com/content/bmj/373/bmj.n1344.full.pdf

The Ink interview noted during this interview is at: https://the.ink/p/doses-are-charity-knowledge-is-justice.



Dr. Robert Phillips Discusses the National Academy of Sciences, Engineering and Medicine's Recent Report, " Implementing High-Quality Primary Care" (June 8th)

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Podcast listeners are aware US healthcare significantly underperforms.   Among numerous other statistics, despite spending approximately twice what comparative countries spend on healthcare, the US has highest rates of preventable deaths.  Even wealthy Americans are more likely to, for example, die during childbirth, from cancer and from heart attacks than those in 12 comparative countries.  This is substantially due to the fact primary care in the US, as the National Academy of Medicine report states in its opening, is “slowly dying.”  The report further notes despite the fact primary care's value is beyond dispute, approximately 25% of Americans do not have a primary care physician and 80 million Americans live, per  HRSA, in primary care health professions shortage areas.  In turn, this is largely due to the fact only 5% of healthcare spending goes to primary care despite such visits accounting for 40% of all medical office visits.  Translation: primary care physicians are substantially undercompensated that contributes to a growing shortage of primary care clinicians.

During this 34 minute conversation, Dr. Phillips discusses several of the reports nearly 20 recommendations including recommending all Americans select a primary care provider or be assigned one and that there be created a HHS Secretary Council on Primary Care.  Among other subject covered in the report, Dr. Phillips discussed Primary Care Medical Homes (PCMHs), discusses measuring quality performance, value and risk adjusment particularly as it relates to adjusting for social risk or social need.      

Robert L. Phillips, Jr., MD, MSPH, is the founding Executive Director of the Center for Professionalism and Value in Health Care.  Dr. Phillips also currently practices part-time in a Smgray_PHILLIPS_Bob community-based residency program in Virginia and is Professor of Family Medicine at Georgetown University and Virginia Commonwealth University.  Prior to, or from 2012 to 2018, he was Vice President for Research and Policy where he led the launch of a national primary care clinical registry and a Measures that Matter research and development program for primary care.  Previously still, Dr. Phillips served as Director and Assistant Director of the Robert Graham Center in Washington DC.   He has also served on the American Medical Association’s Council on Medical Education and as President of the National Residency Matching Program.   Dr. Phillips was elected to the National Academy of Medicine (NAM) in 2010.  He currently serves NAM's Membership Committee and the Action Collaborative on Clinician Well-Being and Resilience.  He is a graduate of the Missouri University of Science and Technology and the University of Florida College of Medicine where he graduated with honors for special distinction.  He completed his family medicine training at the University of Missouri that was followed by a two-year fellowship in health services research and in public health. 

Information regarding the report is at: https://www.nationalacademies.org/news/2021/05/high-quality-primary-care-should-be-available-to-every-individual-in-the-u-s-says-new-report-payment-reform-telehealth-expansion-state-and-federal-policy-changes-recommended. 

The report is summarized in a May 4 JAMA Viewpoint essay, at: https://jamanetwork.com/journals/jama/fullarticle/2779749. 

Information on the report's webinar series, noted during the interview, is at: https://www.nationalacademies.org/our-work/implementing-high-quality-primary-care.