The Healthcare Policy Podcast ® Produced by David Introcaso

Austin Whitman, Climate Neutral's CEO, Discusses Climate Crisis-Related Greenwashing (September 27th)

Listen Now

Greenwashing is generally defined as a public relations or marketing practice used to deceptively persuade the public an organization is environmentally responsible.  In recent related news, after an Exxon lobbyist was caught on tape admitting efforts to undermine the Biden administration's efforts to address the climate crisis, last week the House Government and Oversight Committee requested documents by Exxon and others regarding the industry’s long running campaign to spread disinformation about the climate crisis and requested Exxon and other oil companies to testify before the Oversight Committee on Oct 28th.  Earlier this month NEJM published an editorial calling for emergency action to limit global temperature increases.  The editorial, intentionally or not, incorrectly stated the “health institutions have already divested more than $42 billion in asses from fossil fuels.”  This statistic is wildly incorrect.  Per the source NEJM cites, the $42 billion figure constituted the sum total of assets held by 23 international health institutions that had pledged to divest in fossil fuels.  The actual divested amount by these 23 organizations totaled $886 million total for 2018 and 2019.   Today, the National Academy of Medicine announced its "Action Collaborative on Decarbonizing the US Health Sector" (at: https://nam.edu/programs/climate-change-and-human-health/).  There is concern the action collaborative, composed of industry executives, will result at least in part in greenwashing whereby the industry reverts to form by pledging net zero emissions by some distant year.  

During this 32 minute interview Mr. Whitman begins by providing overall comments regarding greenwashing.  He moves on to offer an explanation of why the healthcare industry significantly lags behind other economic sectors in reporting its carbon footprint (see the Senay and Landrigan study cited below), discusses avoided emissions as part of a net zero formula, the value of the US adopting something akin to the EU's proposed Corporate Sustainability Reporting Directive (CSRD), other solutions to counter greenwashing, i.e., what constitutes more meaningful or genuine effort and his hopes for the upcoming UN COP 26 meeting in November and the DHHS's newly-created Office of Climate Change and Health Equity (OCCHE).         

Mr. Austin Whitman is the CEO of Climate Neutral.  Previously Mr. Whitman served as Vice President of Climate Change Capital, and as Vice President of M.J. Bradley & Associates, two leaders in climate-focused investing and asset management.  In 2019, Austin started Climate Neutral, a 501(c)(3) nonprofit aiming to accelerate the decarbonization of global emissions through its achievable certification framework.  The framework certifies brands who measure their carbon footprint, offset it with verified offsets, and create future reduction strategies.  Mr. Whitman is a graduate of Dartmouth College and Yale. 

Dr. Emily Senay and Philip Landrigan's 2018 JAMA-published research article, "Assessment of Environmental Sustainability and Corporate Social Responsibility Reporting by Large Health Care Organization," discussed during this podcast, is at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2695076. 

Listeners will recall I interviewed Mr. Whitman in September 2020 about entities attaining climate neutral certification.  Information on Climate Neutral is again at: https://www.climateneutral.org/. 

 

 

Professors Gibson-Davis and Hill Discuss The Effects of Wealth Inequality on Child Development (September 21st)

Listen Now

This interview discusses the recently published series of ten articles edited by Professors Gibson-Davis and Heather D. Hill titled, "Wealth Inequality and Child Development: Implications for Policy and Practice," appearing in the August issue of The Russel Sage Foundation's Journal of the Social Sciences. 

The US suffers both extreme economic inequality.  For example, per June Federal Reserve data, the wealthiest 1% of Americans control approximately $42 trillion in wealth compared to the bottom 50%’s $2.6 trillion.  Children represent the poorest age group, nearly half of all children live in poverty or near poverty.   A disproportionate percent of poor children are minorities, e.g., 30% of Black and 27% of Hispanic children live in poverty.  According to the American Academy of Pediatrics children who suffer poverty experience numerous health harms through their life course including infant mortality and chronic illnesses, among others, cardiovascular, immune and psychiatric disorders and related lifelong hardships including unemployment, poor education, housing and healthcare.  

During this 39 minute interview Professors Gibson-Davis and Hill editors begin by defining and discussing extremes or vast disparities in wealth inequality among families with children, e.g., the top 1% of families with children have 43% of all wealth among families among children, the bottom 50% have less than 0.1%, or  the difference between $29.5 million versus $300.  The authors discuss next childhood health effects, specifically the negative correlation between family wealth and children's BMI (the Boen, et al. article) and what explains this correlation, discuss the Conwell and Ye study, "All Wealth is Not Created Equal," i.e., Black families may not or do not enjoy the same economic standing of White families, e.g., Black families are less likely to own a home, and this translates to fewer opportunities for the Black family children.  The authors discuss next policy solutions, i.e., the Huang, et al. article concerning Child Development Accounts (CDAs), the Michelmore and Lopoo EITC article and the Jackson, et al. article regarding the dissimilar effect Medicaid expansion has on White family wealth versus Black family wealth.             

Heather D. Hill is a Professor and Director of the PhD Program in Public Policy and Management at the Evans School at the University of Washington.   Professor Hill is also a faculty affiliate of the West Coast Poverty Center and the Center for Studies in Demography and Ecology at the U of WA and the Institute for Research and Poverty at the U. of Wisconsin and a member of the Executive Council for the U of WA Population Health Initiative.  Previously, Professor Hill worked as a research analyst at Mathematica Policy Research in Washington, DC and spent two years as a Peace Corps volunteer in the Ivory Coast.  Professor Hill received a Ph.D. in Human Development and Social Policy from Northwestern University in 2007, her MPP from the University of Michigan and a BA in Political Science from the University of Washington.

Christina M. Gibson-Davis is a Professor in the Sanford School of Public Policy with a secondary appointment as a professor of Sociology at Duke University.  She is also a Faculty Reearch Scholar of DuPRI's Population Research Center and an Affiliate of the Ctner for Child and Family Policy.   Her research interests concern social and economic differences in family formation patterns.  Her current research focuses on the how divergent patterns of family formation affect economic inequality.  She earned her Ph.D. at Northwestern and her BA at Bates College.   

The Russell Sage Foundation's Journal of the Social Sciences August issue, again titled, "Wealth Inequality and Child Development: Implications for Policy and Practice."  is at: https://www.rsfjournal.org/content/7/3.  

Daniel George and Peter Whitehouse Discuss Their Just-Published Book, "American Dementia, Brain Health in an Unhealthy Society" (September 14th)

Liste 

Ken Langa's dust jacket summary appropriately states, the authors, "make clear that, in order to understand health and cognitive decline more fully, we must consider the quality and inclusiveness of the environment through which we travel from birth to death."  Alzheimer's or brain health should not be simply conceived or understood, the authors' argue, at a biological level but also the result of material conditions of life mediated by political-economic organizations that dictate public policy - and these from a brain health perspective are what's demented.   The work should remind listeners of my May discussion with CUNY Professor Nick Freudenberg regarding his work, At What Cost, Modern Capitalism and the Future of Health.  Dedicated listeners may recall I interviewed the Alzheimer's Association's Robert Egge in April of 2015.)

This 33 minute conversation begins with the authors explaining the problems associated with the paradigm used to define or understand Alzheimer's, i.e., the so-called amyloid cascade hypothesis - made evident by the recent, and very controversial, FDA approval of Biogen's drug, aducanumab (brand name Aduhelm).   The authors go on to discuss/define an alternative definition or paradigm to define Alzheimer's and brain health, one that recognizes or appreciates or accounts for the material conditions of life shaped/determined by socio-economic policies and how these have changed over the past 50 years via the advent of neoliberal policies (deregulation, etc.) compared to just previous post-WWII policies that included comparatively more progressive taxation, education, environmental and public health policies.  Among other comments the authors weigh in on the adequacy of healthcare industry efforts to address or counter-act the adverse brain health effects of neoliberal policy.                  

Prof. Daniel R. George, PhD, MSc, is a medical anthropologist and associate professor in the Department of Humanities and Public Health Sciences at Penn State College of Medicine.  His research on intergenerational issues in dementia care has been recognized by the global advocacy group Alzheimer’s Disease International.  In addition to teaching and research at Penn State, Dr. George has co-founded the Farmers Market in Hershey, PA and a Community Garden on the hospital campus.

 

Prof. Peter J. Whitehouse, MD, PhD, has a primary appointment as Professor of Neurology, with secondary positions as Professor of Psychiatry, Cognitive Science, Neuroscience, and Organizational Behavior at Case Western Reserve University. He is also Professor of Medicine at the University of Toronto. Dr. Whitehouse founded, with his wife, Intergenerational Schools, unique public, multiage community schools in Cleveland. He has served in national and international leadership positions in neurology, geriatrics, and public health.

For more information on the book and the authors' related work go to: https://sites.psu.edu/americandementia/. 

Noted during this interview is the authors' August 25th Scientific American article titled, "Alzheimer's Inc.: When a Hypothesis Becomes Too Big to Fail."  At: https://www.scientificamerican.com/article/alzheimers-inc-when-a-hypothesis-becomes-too-big-to-fail/.

Drs. Whitehouse and George are the coauthors of The Myth of Alzheimer's (St. Martin’s Press, 2008).

Finally, the Healthcare Policy Community Formally Recognizes the Climate Crisis (September 8th)

This past Monday, or nearly 30 years after the Kyoto Protocol and 33 years since NASA's Dr. James Hansen provided related Congressional testimony, NEJM along with other health journals around the world published this editorial, "Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity, and Protect Health," at: https://www.nejm.org/doi/pdf/10.1056/NEJMe2113200?articleTools=true.   

Among others missing from the over 200 health and medical-related journals that signed onto the editorial is Health Affairs and JAMA.     

About the editorial noting health institutions have already divested $42 billion of their assets from fossil fuels, that is far beyond incorrect.  If you read the 2020 Lancet report, that the editorial cites, of 1,157 organizations that committed to divestment between 2008 and 2019, 23 are health institutions (most of these are overseas), having combined assets of $42 billion.  Quoting the 2020 Lancet report, specifically page 30, "However, divestment from health institutions has decreased from $867 million in 2018 to $19 million in 2019."  These amounts, when you consider the size of the US healthcare industry, trivial. 

 

245th Interview: Dan Troy Discusses 3D Bioprinting Human Organs and the FDA's Regulation Thereof (September 7th)

Listen Now

Approximately 100,000 Americans are waiting an organ transplant.  The vast majority will are awaiting a a kidney - that, on average, will take five years.   Approximately 20 Americans die every day awaiting an organ.  These and related statistics rank the US well below other developed countries.  For example, only 30% of US kidney failure patients have a functioning transplant and only 3% have received a preemptive transplant.   For these reasons CMS recently announced three kidney disease demonstrations: the ESRD Treatment Choices demonstration that began this past January 1st; and, the Kidney Care First and the Comprehensive Kidney Care Contracting demonstrations scheduled to start this coming January 1st.   These efforts aside, the the optimal solution appears to be 3D bioprinting as an avenue for generating artificial organs.  The first demonstration of such occurred in 1999 when Wake Forest’s Institute for Regenerative Medicine’s implanted an bioprinted human bladder into a patient.  (This interview was conducted on September 3rd.)  

During this 32 minute conversation Mr. Troy begins by providing additional details concerning the state of organ transplantation in the US and internationally and meeting the demand going forward with increasing chronic disease and potential long term COVID health effects.  Mr. Troy provides an overview of how 3D bioprinting, discusses why FDA regulation is required, e.g., such that bioprinting has pathway to market and how bioprinting is regulated by the FDA, e.g., as a device and/or a biologic.   He too comments on the potential conflict of selling bioprinted organs in context of limitations under the National Organ Transplant Act of 1984, concerns regarding social stratification or who gets 3D printed organs, and the life, theoretical at least, of bioprinted human organs and to the extent bioprinted organs can be protected as intellectual property.                      

Mr. Dan Troy currently serves as Chief Legal Officer & General Counsel for Valo, the Boston-based drug development company.  Previously,  Mr. Troy served as the General Counsel of
GlaxoSmithKline from 2008 until 2018.  Before that, Mr. Troy was a partner in the FDA practice at Sidley Austin which he joined after serving as FDA Chief Counsel.   Previously still, he practiced constitutional, administrative, and appellate law at Wiley Rein and Fielding, served in the Office of Legal Counsel at the US Department of Justice, and clerked for DC Circuit Judge Robert H. Bork.  Mr. Troy earned his JD at Columbia Law School, where he was a Kent and Stone Scholar, and a BS from the Cornell University School of Industrial and Labor Relations.  He is the author of numerous publications and currently chairs the US Litigation Center.  In 2013, the Burton Awards named him a “Legend in the Law.”  

Mr. Troy's related June STAT essay, "3D Bioprinting Can Help End Organ Transplant Waitlists - if the FDA Stops Delaying,"  is at: https://www.statnews.com/2021/06/18/3d-bioprinting-organ-transplant-waitlists-fda-delay/.