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09/08/2021

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. 

 

09/07/2021

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

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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 Troy_Dan_600x431
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/

08/12/2021

Matt Salo Discusses Potential Medicaid Program Reforms Under Proposed Reconciliation Legislation (August 11th)

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This past Tuesday Senate Democrats passed a $3.5 trillion budget resolution what would allow Congressional Democrats to fund significant health care reforms along with education, immigration, climate crisis and other termed “care economy” policies.  Among other healthcare policies Congressional Democrats are working to fund are expansions to Medicare coverage, boost by $400 billion Medicaid Home and Community Based Service (HCBS ) waiver funding and address health equity issues.  Dedicated listeners may recall I interviewed Matt in March 2017.  

During this 40 minute interview, Matt Salo discusses, in sum, the merits of Medicaid reform policies Democrats have already outlined beginning with improvements in long term care, again, expanding HCBS waiver funding.  He discusses several related Medicaid reform policies NAMD has already identified, discusses Medicaid-related social determinants funding, the merits of expanding value based purchasing arrangements in the Medicaid program and issues concerning Medicaid access and provider participation in the Medicaid program.  

Mr. Matt Salo has served as Executive Director of the National Association of Medicaid Directors (NAMD) for the past Salo-headshot-1-150x150 decade.  NAMD represents all 56 of the nation’s state and territorial Medicaid Directors, and provides them with a strong unified voice in national discussions as well as a locus for technical assistance and best practices.  Mr. Salo formerly worked for 12 years at the National Governors Association where he forwarded the Governors’ health care and human services reform agendas.  He worked previously for five years as a health policy analyst for state Medicaid Directors at the American Public Human Services Association.  He also spent two years as a substitute teacher in the public school system in Alexandria, VA.  Mr. Salo holds a BA in Eastern Religious Studies from the University of Virginia.

Information on NAMD is at: https://medicaiddirectors.org/about/.

08/10/2021

TFAH's Adam Lustig Discusses Social Determinants of Health Policy Opportunities (August 9th)

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As listeners are likely aware the Biden administration has given priority to addressing health equity, meaning distributing health-related resources based on recipients’ needs.   This is not surprising since, in part, research published in JAMA in June 2019 by Zimmerman and Anderson concluded, "there has been a clear lack of progress in health equity during the past 25 years in the US."  (Think: the failure of neoliberalism.)  When discussing health equity, the issue of social determinants of  health (SDOH) are immediately begged since one’s social or lived environment is substantially more responsible than medical care in explaining one's health status and because the poor and/or minority population’s social and economic circumstances are comparatively far worse.  This explains why, as Trust for America's Health (TFAH) recent report titled, "Leveraging Evidence-Based Policies to Improve Health, Control Costs, and Create Health Equity," notes, race and ethnicity-based health disparities total over $90b annually in excess medical costs.  Listeners of this podcast are aware I’ve discussed the social determinants of health on several occasions over the past nine years.  For example, this past March I discussed the topic with UCSF’s Drs. Braveman and Gottlieb.  

During this 32 minute interview Mr. Lustig moreover discusses several of the policies outlined in TFAH's "Leveraging Evidenced-Based Policies" under five categories identified in the report:  access to high-quality health services; economic mobility; access to affordable housing; improving learning environments; and, health-promoting taxes.   

Mr. Adam Lustig is Senior Policy Development Manager at TFAH. H is responsibilities include leading TFAH’s Promoting Health and Cost Control in States (PHACCS) project.  The Download PHACCS project seeks to promote the adoption and implementation of effective, evidence-based state public health policies outside the healthcare sector that will have a positive impact on residents’ well-being.  Prior to joining TFAH, Mr. Lustig was the Senior Manager of Health Systems Transformation at the National Network of Public Health Institutes, where he developed strategies related to improving healthcare systems, alternative payment models, and supporting people-centered health systems.  Mr. Lustig has also held positions at the Advisory Board Company, the National Pharmaceutical Council and the University of Pennsylvania.  He received his MS in Health Policy from the Thomas Jefferson University College of Population Health and a BA in Public Policy from the State University of New York at Albany.

TFAH's report is at: https://www.tfah.org/report-details/leveraging-evidence-based-policies/.

Regarding economic mobility, listeners are encouraged to read the recent July 22 NEJM Perspective essay by Lucy Marcil, et al., titled, "Medical-Financial Partnerships - Beyond Traditional Boundaries."

08/09/2021

IPCC Report's Sixth Climate Assessment Report Published Today (August 9th)

Listeners of this podcast are well aware I've spent considerable time discussing the climate crisis, i.e., have posted over 20 climate crisis-related podcast interviews.  Therefore, it is important to note the United Nation's Intergovernmental Panel on Climate Change's (IPCC's) sixth climate assessment report was published today. 

Needless to say the report's findings are dire.  For example, about the report the UN Secretary General, Antonio Guterres, stated the report "is a code red for humanity," "the alarm bells are deafening . . . the evidence is irrefutable . . . greenhouse gas emissions . . . are choking our planet and putting billions of people at immediate risk."  

All report info is at: https://www.ipcc.ch/report/ar6/wg1/#SPM.   Please note this page identifies a 42-page "summary for policymakers."   I also recommend reading today's coverage in The Guardian.    

07/09/2021

Dr. Lawrence Krauss Discusses His Recently Published Book, "The Physics of Climate Change" (July 8th)

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In late May I interviewed John Kotcher regarding his survey that showed physicians worldwide had a limited understanding of the climate crisis and its health effects.  For example, 41% said they lacked sufficient knowledge to discuss the topic and less than half also believed the climate crisis is responsible for heat-related illnesses and increases in vector borne diseases.  Since the climate crisis will pose increasingly harmful human health consequences, especially for Medicare and Medicaid beneficiaries, health professionals would be well served by understanding the physics of climate change or what is causing planetary warming.  Concerning recent climate crisis-related events: North American just suffered its hottest June in recorded history; two recent studies recently concluded the climate crisis presently causes five million deaths annually and the earth’s energy imbalance approximately doubled between 2005 and 2019; and, a leaked UN Intergovernmental Panel on Climate Change report (the report is expected to be published later this year) warns a series of thresholds or tipping points may soon be crossed that will leave policy makers unable to control of limit global warming - meaning the earth will experience run away warming.  

During this 34 minute conversation Dr. Krauss begins by noting climate change or the climate crisis, like evolution, is empirical fact.  Dr. Krauss goes on to discuss in detail how and why the planet has warmed by on average 1.3 degrees Fahrenheit moreover over the past 60 years due to human-caused emissions of greenhouse gases (moreover from the burning of fossil fuels) or approximately 10 billion tons annually.  His discussion includes noting emissions to date will largely persist in the atmosphere for the next 1,000 years, that the planet will continue to warm if and when human-caused emissions are eliminated largely due to continued ocean warming and he discusses a few nonlinear feedback loops, for example, the release of carbon via melting permafrost, that will exacerbate the climate crisis.  Dr. Krauss concludes by explaining why he wrote the work or how it may help policymakers address the issue.   

Dr. Lawrence Krauss has recently retired as Director of The Origins Project at Arizona State University and was a professor at ASU’s School of Earth and Space Exploration and Department of Physics.  He now serves as President of The Origins Foundation and hosts The Origins Podcast.  Dr. Krauss 's work as a theoretical physicist included study of the interface Lkrauss between elementary particle physics and cosmology, focusing on the origin and evolution of the universe and the fundamental structure of matter.  He has written more than 300 scientific publications and ten popular books, including the international best-sellers, "The Physics of Star Trek," "A Universe from Nothing" and "The Greatest Story Ever Told--So Far."   He writes regularly for magazines and newspapers, including The New York Times and The New Yorker, and frequently discusses his work via radio and television programming.  He is the recipient of the highest awards from all three US physics societies and received the National Science Board's2012 Public Service Award.  Dr. Krauss earned his B.Sc. in math and physics with honors from Carleton University and his Ph.D. in physics from MIT.   

Information on the book is at: https://posthillpress.com/book/the-physics-of-climate-change.   

A video of a Dr. Krauss physics of climate change lecture is at: https://www.youtube.com/watch?v=lApLD5g1Nrs

06/29/2021

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/.   

 

 

06/25/2021

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.

06/23/2021

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.

06/11/2021

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.