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Substack Post: "How To Solve HHS’s Failure To Address The Climate Crisis" (September 12th)

For this week's post I noted my essay posted this past Friday by Health Affairs and titled, "How To Solve HHS's Failure to Address the Climate Crisis."  It is at:   It also appears via Substack at:

It opens with: 

"From an anthropocentric perspective the climate crisis is fundamentally a threat to human health if not survival. The World Health Organization defines it as “the single biggest health threat facing humanity.” Logic dictates that the Department of Health and Human Services (HHS) take the lead in mitigating climate-related health harms. President Joe Biden immediately recognized this reality in a January 2021 executive order that stated because the US has a “narrow moment” to take action he directed HHS to, in sum, decrease climate-related risks among the elderly, children, and people with disabilities.

However, after two rule-making cycles, the Centers for Medicare and Medicaid Services (CMS) has failed to take any regulatory action requiring Medicare and Medicaid providers to reduce their considerable carbon footprint. CMS’s last 2023 opportunity was via the hospital inpatient prospective payment rule finalized August 1."



Substack Post: The Inflation Reduction Act Offers the Healthcare Industry an Opportunity to Save Itself (Sept. 5th)

This writing makes note of the fact that the likely, if not definitively, more significant healthcare provisions of the Inflation Reduction Act are the new law's tax credits - because tax exempt entities, like the 60% of hospitals that are non-profit, can exploit them.  


Please read and as always feel free to comment.    


Substack Post: "Environmental Justice is - Still - Unrelated to the Climate Crisis" (August 29th)

Dear Listeners:

Today, I posted my latest Substack writing under this title.  It largely makes note of the fact the CDC's recently-announced Environmental Justice Index (EJI), the topic of my first or last Substack writing, fails to recognize or moreover account for climate crisis-related health harms - fossil fuel combustion and resulting anthropogenic greenhouse gas warming are of course the leading cause of environmental injustice.  

The post is at:

Thank you.



First Substack Newsletter Post: "HHS's Environmental Justice Index Constitutes Redlining" (August 22nd)

Dear Listeners:

Today, I posted my first Substack newsletter item.  The newsletter is titled, "Health Care Policy Analysis from DC."  This first post argues HHS' August 10th announced Environmental Justice Index (EJI), defacto, amounts to redlining, or the discriminatory practice that compromises minority populations' ability to access numerous financial and related services including healthcare insurance.  

The post is at:

Feel free to comment.

Thank you.


Greg Segal Discusses Organ Procurement and Transplantation Policy Reform (August 16th)

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During its recent August 3rd hearing titled, “A System in Need of Repair: Addressing Organizational Failures of the U.S.’s Organ Procurement and Transplantation Network," Senate Finance Committee Chairman, Ron Wyden (D-OR), characterized efforts by the federally-contracted not for profit, UNOS (United Network for Organ Sharing) regarding organ procurement and transplant as grossly mismanaged and incompetent.  After a two plus year investigation that included reviewing over a half million pages of documents, the committee found efforts by UNOS and nation's over 55 Organ Procurement Organizations (OPOs), rife with inefficiencies, medical errors and poor leadership, that combined helps to explain why, conservatively estimated, over 6,000 Americans, disproportionately minorities, die annually awaiting an organ.  Listeners will recall I interviewed Alfred and Blair Sadler in early June.  They, in part, discussed their work at NIH in the late 1960s drafting the Uniform Anatomical Gift Act.

During this 37-minute interview Mr. Segal begins by describing Organize's mission.  He next provides an overview of how the process of human organs are procured and transplanted, largely the work by UNOS and OPOs, identifies and discusses more substantive problems associated with the transplant process including the lack of financial, performance, transparency and regulatory pressures placed on OPOs.  These leads to Mr. Segal defining policy reform opportunities including requiring OPO's to report standardized process data and what action Senate Finance and the Congress should take, moreover, the Organ Procurement and Transplantation Network (OPTN) contract, under which UNOS is contracted, be significantly revised.                   

Mr. Greg Segal is the Founder and CEO of patient advocacy group, Organize.  The non-profit advocates for structural reforms to increase the supply Unnamed of lifesaving organ transplants every year.   Mr. Segal started Organize after his father waited five years for a heart transplant.  Organize served as Innovator in Residence in the Office of the Secretary of the U.S. Department of Health and Human Services from 2015-2016.  The group's research has been heavily cited by the ongoing Congressional investigations from the Senate Finance Committee and the House Oversight Committee into the U.S. organ donation system.  Mr. Segal's writings regarding the need for data-driven reforms to organ monopolies have appeared in MedPage, Health Affairs, CNN, STAT and JAMA.   

Information on Organize is at:

Documents related to the Senate Finance Committee's August 3rd hearing is at:  



NACHC's Jeremy Crandall Discusses Inflation Reduction Act-Related Policy Reforms (August 4th)

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Two weeks ago Senate Majority Leader, Chuck Schumer, announced the $739 billion Inflation Reduction (IRA) Act of 2022, compromise legislation agreed upon by Senator Manchin.  The bill includes just a few of the healthcare policy reform provisions House Democrats included in House legislation passed late last year, moreover extending expanded ACA marketplace insurance subsidies and allowing the Medicare program to negotiate drug prices.  The IRA also includes, as has been widely reported, $369 billion in tax credits over ten years intended to accelerate the adoption of renewal energy.   (Some have suggested the bill should be more appropriately titled The Temperature Reduction Act.)   The legislation likely, if not in fact, represents the last chance Congressional Democrats and the Biden Administration have to pass health and healthcare related policy reforms this Congress under reconciliation rules - that expire September 30th.  

During this 40 minute interview Jeremy begins by describing NACHC's mission.  He goes on to discuss extending ACA insurance subsidies in context of the patients his community community health, or Federally Qualified Health Centers (FQHCs), serve, how might the Medicaid funding cliff be addressed, i.e., approximately 16 million current enrolls would lose their coverage at the end of the current public health emergency, and provides comments on extending telehealth coverage expansion, workforce shortages and the climate crisis.        

Jeremy Crandall is the Director of Federal and State Policy for the National Association of Community Health Centers, where he works to address Download policy issues concerning Medicaid funding, 340B prescription drugs, FQHC payment and delivery reforms, behavioral and telehealth policies and primary care workforce issues.  Jeremy previously spent six years working on state-based issues at the Blue Cross Blue Shield Association and at the Pew Charitable Trusts.  For eight years prior still he worked in Maryland state politics with Attorney General Brian Frosh and State Delegate Heather Mizeur.

Information on NACHC is at:  


265th Podcast: Professor Josiah Rector Discusses His Recently Published Book, "Toxic Debt, An Environmental Justice History of Detroit" (July 12th)

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Toxic Debt, An Environmental History Justice History of Detroit, just published by North Carolina University Press in its Justice, Power and Politics series, is largely a history of failure by federal, state and local government officials to regulate the auto industry’s extremely harmful environmental and consequential human health effects.  This failure is substantially explained by the replacement of the, though imperfect, New Deal order with neoliberal policies.  (Re: neoliberalism, see, for example, Gary Gerstle, “The Rise and Fall of the Neoliberal Order,” published by Oxford University Press.)  As a result, Professor Rector documents largely post-Depression consequences experienced by the Detroit's  African American community.  Beyond low wages and ghettoization, Detroit’s African American population has disproportionately suffered adverse health consequences via industrial policies that knowingly caused unrelieved exposure to toxic air and water (think: Flint) and more recently health harms resulting from the denial of domestic water services, what Prof Rector terms, “the dehydration of Detroit.”  

This 43 minute interview begins with Professor Rector providing a brief overview of environmental harms during the Gilded Age or later 19th century.   The interview proceeds to his discussing numerous health harms African American workers suffered with increasing automation of the auto industry and the industry's non-response for half a century, the UAW, positive and negative effects of the New Deal, discusses related waste as energy policy, i.e., specifically Detroit's incinerator and its health harms imposed on African Americans, an overview of the Flint water crisis and the larger dehydration of Detroit problem  (and its health effects) and its interrelationship with financial deregulation in Detroit.              

Josiah Rector is a Professor of Urban History at the University of Houston specializing in 20th century U.S. urban environmental history, the history Rector of the environmental justice movement, and the history of capitalism.  He was previously a Visiting Professor of U.S. and Environmental History at Northland College from 2017-2019.  He also has extensive experience in public history.  He coordinated public history internships through the Next Gen Humanities Ph.D. Program at Wayne State University in 2017-2018 and he co-organized the Michigan Humanities Council’s Third Coast Conversations: Dialogues about Water Program for the Charles H. Wright Museum of African American History in 2018-2019.  He has published articles in The Journal of American History and Modern American History and he is currently planning a book on the political ecology of urban environmental disasters in the United States since World War II.   He earned his Ph.D. in History from Wayne State University, and his dissertation received the Urban History Association’s Michael Katz Award for Best Dissertation in Urban History, 2016.

Information on Professor Rector's book is at:


Prof. Frederica Perera and Dr. Kari Nadeau Discuss Climate Crisis-Related Children's Health Harms (July 7th)

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In mid-June Columbia's Professor Frederica Perera and Stanford's Dr. Kari Nadeau published a review article in The New England Journal of Medicine titled, "Climate Change, Fossil-Fuel Pollution, and Children's Health."  The article provides an overview of the numerous health harms inflicted on children around the world resulting from fossil fuel combustion's released of massive amounts of airborne fine respirable particles, additional health harms resulting from an increasingly destabilized climate, resulting health disparities and an overview of medical practice recommendations to minimize related health risks to children.  Concerning health harm, last year Harvard along with three UK universities concluded fossil fuel pollution was responsible for eight million deaths or 18% of total global deaths in 2018.  In the US, pollution resulting from fossil fuel’s use accounts for nearly 60% of total excess deaths.  

During this 38-minute interview Professor Perera and Dr. Nadeau begin by providing an overview of the numerous adverse health effects imposed on children resulting from both fossil fuel combustion and the innumerable harms resulting from global warming.  The authors identify solutions to mitigate the climate crisis, opine on efforts by the professional medical community to address the climate crisis, notes the work the Medicaid program needs to do to address related health harms to children, comment on their own university's efforts ,      

 Frederica P. Perera is Professor of Environmental Health Sciences and serves as Director of the Columbia Center for Children's Environmental Fpp1_2742 F Perera 3_med_3 Health.  Her areas of specialization include prevention of environmentally related developmental disorders and disease in children, cancer prevention through the use of novel biomarkers, environment-susceptibility interactions, and risk assessment.  Her recent research is also addressing the multiple impacts on children's health and development of fossil fuel combustion--both from the toxic pollutants emitted and climate change related to CO2 emissions.  She is the author of over 350 publications, including 300 peer-reviewed articles, and has received numerous honors.   She received her Ph.D, DrPH and MPH from Columbia University and her BA from Harvard. 


Dr. Kari Nadeau is the Naddisy Foundation Endowed Professor of Medicine and Pediatrics and Director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University.  Among other current activities she is currently working at the World Health Organization on air pollution IMG_0764 and climate change policy.   In collaboration with colleagues she has been awarded many patents, started 4 biotech companies, and worked in industry to shepherd two drugs through the FDA to approval. She also is an author of the Lancet Countdown in Global Climate Change 2020 and the book: The End of Food Allergy (published 2020).   Dr. Nadeau received her MD and PhD from Harvard Medical School through the NIH MSTP program. She completed a residency in pediatrics at Boston Children’s Hospital and a clinical fellowship in allergy, asthma and immunology at Stanford and at University of California, San Francisco.


My Latest Climate and Health Essay, "FDA User Fee Legislation Needs to Mitigate the Pharmaceutical Industry's Carbon Pollution" (June 8th)

Yesterday, STAT published my latest climate and health related essay.  Here is the email text I forwarded to Senator Murray's staff director.  

This morning STAT published my latest, "FDA User Fee Legislation Needs to Mitigate the Pharmaceutical Industry's Carbon Pollution."   I'd appreciate your reading and distributing to your colleagues. 
This is my 11th or 12th related article published over the past few years.  Believe me, I take zero pleasure in drafting these - nor any of the numerous related HHS comment letters or any of the over 25 related podcast interviews.  Just so you're aware, I receive no compensation for this work.   
I hope you know the climate crisis reality continues to worsen, e.g., Nature Climate Change just published research showing atmospheric CO2 is now measured at 421 ppm (50% higher than pre-industrial era), the highest in human history or higher than any time in at least 4 million years.  Every week Kim Stanley Robinson's, "The Ministry for the Future," becomes less and less cli-fi.   As always, I am happy to discuss related policy reforms with the Chairwoman or your staff.
Thank you.
David Introcaso, Ph.D.          



Alfred and Blair Sadler Discuss Their Just Published, "(P)Luck: Lessons We Learned For Improving Healthcare and the World" (June 7th)

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(P)Luck moreover details the nine year collaboration between identical twins, Dr. Alfred Sadler and Blair Sadler, an attorney, via their work at NIH,  Yale, the Robert Wood Johnson Foundation and the Hastings Center on Bioethics to advance national organ donation and transplantation policy, create the Physician Assistant profession, advance national emergency medical care and address related bioethical issues.   The work also provides insights regarding related challenges these fields face today and provides a list of lessons learned applicable to present day health care problems. 

During this 39 minute discussion, Dr. Sadler and Mr. Sadler begin by explaining the purpose of the work and how and why they chose to collaborate after completing medical and law school.   The conversation moves on to an overview of their collaborative efforts, they discuss challenges still facing organ donation and persisting ethical issues, for example, related to the ongoing pandemic and conclude with comments concerning a few of the 15 lessons learn they identify.              

Alfred Sadler, MD, ScD (Hon) FACP, is the Co-Founder of the Physician Assistant Program at Cal State University, Monterey FredPhoto Bay and is the President of the Cypress Foundation - dedicated to improving physician and PA workforce in the tri-county area where he lives.  He was trained in surgery at the Hospital of the University of Pennsylvania and in internal medicine at the Harvard Medical School and at Mass General Hospital  He practiced primary care in Monterey County for nearly forty years with an emphasis on underserved populations.  He is a a member of Alpha Omega Alpha and in 2018 was recognized as Physician of the Year by the Monterey County Medical Society.  He is a coauthor of The Physician Assistant: An Illustrated History

Blair Sadler, JD, is a Senior Fellow at the Institute for Healthcare Improvement and a member of the BlairPhoto
faculty at the University of San Diego's Rady School of Management.   A graduate of Amherst College and the University of Pennsylvania Law School, he was a law clerk for the Superior Court of Pennsylvania.  From 1980 to 2006, he was President and CEO of the Rady Children's Hospital in San Diego.  He has served on the board of the Hastings Center for 12 years and is a member of the board of Health Care without Harm, an environmental health advocacy organization.  He chairs the Board of Access Youth Academy in San Diego.

Information on their work is at: