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Category: Public Health

A Timex Healthcare System

By KIM BELLARD

Those of us of a certain age remember the Timex slogan that bragged about its watches’ durability: “It takes a licking and keeps on ticking.”  A recent article about our military, of all things, made me wish we had a healthcare system that prized that kind of durability. 

I can never resist analogies between the U.S. healthcare system and the U.S. military system.  They’re both huge, they’re both wildly expensive, they both rely on a combination of high tech and front-line people, and they both protect us from threats.  In some ways, both are the best in the world, and, in other ways, both have weaknesses that are embarrassing. And, as I wrote last year, both are often still fighting the wrong wars. 

The article is by national security expert JC Herz on the Atlantic Council’s website: A plea to the Pentagon: Don’t sacrifice resilience on the altar of innovation.   Boy, that sure applies to healthcare too. 

Ms. Herz notes how Americans love innovation, but:

This mythos informs a narrative that what is valuable is The New—the upgrade to something bigger, badder, and sexier…What the United States needs to reinvigorate its defense base, compete with China, and win the global economy must be more innovation.

Except the United States does not suffer from a lack of innovation; it suffers from a lack of resilience.

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Healthcare’s Million Dollar Blocks

By KIM BELLARD

Since I first heard about them, I have been fascinated, and dismayed, by the concept of “million dollar blocks.”  For those of you unfamiliar with the term, it doesn’t refer to, say, Beverly Hills,  Chicago’s Gold Coast, or Manhattan’s Hudson Yards — areas where the wealthy congregate.  No, it refers to city blocks for which society spends over a million dollars annually to incarcerate residents of that block.

I, of course, have to think about the healthcare parallels.

The concept dates back many years, credited to Eric Cadora, now at Justice Mapping, and Laura Kurgan, a professor of architecture at Columbia University, where she is the Director of the Center for Spatial Research (CSR).  The power of the concept is to use data visualization to illustrate the problem. 

Here, for example, is CSR’s map of Brooklyn for prison spending:

CSR describes the findings as follows:

The maps suggest that the criminal justice system has become the predominant government institution in these communities and that public investment in this system has resulted in significant costs to other elements of our civic infrastructure — education, housing, health, and family. Prisons and jails form the distant exostructure of many American cities today.

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Time to Reboot “Medicare-For-All”

By MIKE MAGEE

In the fog of the Covid pandemic, many are wondering what ever happened to prior vocal support for universal coverage and Medicare-for-All. Expect those issues to regain prominence in the coming months. A bit of recent history helps explain why.

The January 6th insurrection, followed by the past weeks two mass shootings, have served to remind our citizens that we must address a range of issues while continuing to confront the pandemic threat.

Modern civilized societies rely on a double-armed approach to maintain order, peace and security. The first arm is laws. But laws are of little value without even and unbiased enforcement.

The second guardrail of civility is culture. MIT professor Edgar Schein described it this way: “Culture has three layers: the artifacts of a culture — our symbols and signs; its espoused values — the things we say we believe; and, most important, its underlying assumptions — the way things really are.”

In the Senate chamber this week, and in Republican controlled state houses across the nation, Americans witnessed a colossal collision of reality and ideals in the form of new Jim Crow laws to suppress minority voting rights, and refusal to address gun violence.  In the wake of a constant stream of racial animus and mass shootings, this lethal epidemic demands a response as well.

Were these the only flashing alerts signaling danger ahead, that would be enough to cause sleepless nights. But unenforced or unevenly enforced laws, and value dissonance in America, do not occur in isolation, but are supported by an even more erosive underpinning – greed-induced economic inequality.

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You Can’t “Elon Musk” Healthcare

By SOFIA NOORI

On January 26th, Philadelphia discovered that the 22-year-old organizer of its largest COVID-19 vaccination site, Andrei Doroshin, had turned away elderly members of the Philadelphia community from their vaccine appointments. Instead, he pocketed extra vaccine vials to administer to 4 friends and girlfriend. An RN witnessed the event and reported it to authorities. 

Local news reporters quickly discovered that this incident was just the tip of the iceberg for Doroshin. A Drexel University graduate student with no experience in healthcare, Doroshin had enlisted his college friends to organize a group that would go on to win one of the biggest vaccination contracts from the city of Philadelphia. He told his friends that “this is a wholly Elon Musk, shoot-for-the-heaven type of thing,” and that “we’re going to be millionaires.” His organization had also amended its privacy policy allowing for patient data to be sold, administered large numbers of vaccines to people ineligible to receive the vaccine yet, and threw Philadelphia’s COVID vaccination program into chaos

For the people in the back: One can’t simply “Elon Musk” healthcare. We have seen this too many times – a privileged young upstart with little experience believes that s/he can transform healthcare and make millions – or billions – doing so. Examples abound: we only have to look a couple years into the past to remember Elizabeth Holmes, the Stanford dropout who founded Theranos and misrepresented its technology, or to Outcome Health, whose former CEO Rishi Shah defrauded investors by overinflating business metrics. If “move fast and break things” works in other sectors, many reason, why won’t it work in the 4 trillion dollar industry of healthcare? 

Healthcare is simply not the kind of business where one can shoot a rocket into the sky and accept the risk that it might explode. Simply put, this is people’s lives we’re dealing with. But a deeper layer involves trust in the medical establishment. U.S. healthcare is already marred by multiple grave issues: a complex bureaucracy, serious health inequities, and astronomical costs that can bankrupt a person in just one hospitalization. The trust that people have in U.S. healthcare has steadily dropped over the years. Further, the politicization of the COVID-19 pandemic and the U.S. government’s bungled response to it has only sowed further distrust, especially among marginalized and minoritized communities

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Restorative Justice: Don’t Presume “We’re Better Than This”

By MIKE MAGEE

“We’re better than this” is the common refrain heard from many political leaders following the deadly assault on our democracy on January 6th. We hear empty appeals for blind appeasement from the likes of Kevin McCarthy in the interest of “bringing our country together.” But for those of us who study medical history, pursuing this course takes our nation in exactly the wrong direction.

Rather, the model we must follow is the model of Germany in 1945, or South Africa in 1995. In both cases, strict legal and public accountability (retributive justice) were married with fundamental expansion of universal social services to rebuild confidence and trust in their government’s ability to assure safety and security, and an equal playing field for all of their citizens (restorative justice).

In sorting through the legacy of Hitler’s regime in Germany, the Allied forces established the International Military Tribunal.  One of the series of trials, opened on November 19, 1945 in the Palace of Justice in Nuremberg, delved into egregious examples of medical criminality, including Nazi experimentation on human subjects. These trials are often cited as an example of “retributive justice.” Of 23 defendants, 7 were hanged, 7 acquitted, and the rest given sentences of from 10 years to life in prison.

These judgments were conducted under the direction of U.S. judges and prosecutors and fully compliant with U.S. standards of criminal procedure. Yet another 25 years would pass before any of the 10 agreed-upon medical ethics research standards were integrated into US trial law.

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A War on Science is a War on Us

By KIM BELLARD

We’re in the midst of a major U.S. election, as well as hearings on a Supreme Court vacancy, so people are thinking about litmus tests and single issue voters – the most typical of which is whether someone is “pro-life” or “pro-choice.”  Well, I’m a single issue person too; my litmus test is whether someone believes in evolution. 

I’m pro-science, and these are scary times.

Within the last week there have been editorials in Scientific American, The New England Journal of Medicine, and Nature – all respected, normally nonpartisan, scientific publications – taking the current Administration to task for its coronavirus response.   Each, in its own way, accuses the Administration of letting politics, not science, drive its response. 

SA urges voters to “think about voting to protect science instead of destroying it.”  They cite, among other examples, Columbia Law School’s Silencing Science Tracker, which “tracks government attempts to restrict or prohibit scientific research, education or discussion, or the publication or use of scientific information, since the November 2016 election.”  Their count is over 450 by now, across a broad range of topics in numerous federal agencies on a variety of topics.   

The SA authors declare:

Science, built on facts and evidence-based analysis, is fundamental to a safe and fair America. Upholding science is not a Democratic or Republican issue.

Similarly, NEJM fears:

Our current leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.

Jeff Tollefson, in Nature, warns:

As he seeks re-election on 3 November, Trump’s actions in the face of COVID-19 are just one example of the damage he has inflicted on science and its institutions over the past four years, with repercussions for lives and livelihoods. 

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Now Is Not the Time to Forget About the AIDS Epidemic

By SOMA SEN

I keep hearing the voices of colleagues and friends that have been part of the AIDS epidemic compare it to the current COVID-19 pandemic. In fact Dr. Kathy Creticos, Director of Infectious Disease at Howard Brown Health spoke about the politicization of both the pandemics. 

“Here we are in 2020 with this disease that kills people, that we don’t have any treatments for, that we really don’t understand the full manifestation and presentation biology of the virus,” Creticos said In the final segment of an interview with Contagion during International AIDS Society (IAS) AIDS 2020 Virtual Sessions. “We’re really dealing in the same situation as in the HIV epidemic.” 

Her words make me reflect on the levity with which the Raegan administration treated the AIDS epidemic and it’s parallel to the Trump administration’s treatment of the current pandemic. However, she makes an important distinction between the two when she says, “I think a lot of it has to do with the fact that COVID affects everybody, but HIV was certainly perceived as not affecting everybody.”

As an Asian American researcher with more than 15 years of experience in this area, whenever, I bring up the issue of the scourge of HIV/AIDS in our community, the common response both from inside and outside the community is “It’s not a problem in this community.” 

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Too Many Small Steps, Not Enough Leaps

By KIM BELLARD

I was driving home the other day, noticed all the above-ground telephone/power lines, and thought to myself: this is not the 21st century I thought I’d be living in.  

When I was growing up, the 21st century was the distant future, the stuff of science fiction.  We’d have flying cars, personal robots, interstellar travel, artificial food, and, of course, tricorders.  There’d be computers, although not PCs.  Still, we’d have been baffled by smartphones, GPS, or the Internet.  We’d have been even more flummoxed by women in the workforce or #BlackLivesMatter.  

We’re living in the future, but we’re also hanging on to the past, and that applies especially to healthcare.  We all poke fun at the persistence of the fax, but I’d also point out that currently our best advice for dealing with the COVID-19 pandemic is pretty much what it was for the 1918 Spanish Flu pandemic: masks and distancing (and we’re facing similar resistance).  One would have hoped the 21st century would have found us better equipped.

So I was heartened to read an op-ed in The Washington Post by ReginaDugan, PhD.  Dr. Dugan calls for a “Health Age,” akin to how Sputnik set off the Space Age.  The pandemic, she says, “is the kind of event that alters the course of history so much that we measure time by it: before the pandemic — and after.”  

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Can Community Be a Medicine?

By ARAS TOKER

Analysis on peer accountability focused community building efforts in making lifestyle changes through digital therapeutic programs

Before we jump ahead to the medicine piece, what the heck does a community even mean? In the past, communities were more likely associated with a group of people living in the same physical location such as a neighborhood, school, or a town. I remember my neighborhood soccer community very well, for instance. Instead of being born into or trying to fit in, community is something we choose for ourselves and express our identities through. With the advancement of accessing the high-speed internet globally, today’s community has no physical or geographical boundaries.

Community builder Fabian Pfortmüller brilliantly explains the difference between communities and other groups. He asserts that unlike project teams or companies who are optimizing for external purposes (collective goals); communities optimize for internal purposes (the relationship and the shared identity). His definition of a community deeply resonated with me and the communities that I had the opportunity to build.

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Pfortmüller’s definition of community
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Everyone has a role to play: Reducing your child’s risk of developing food allergies

By RUCHI GUPTA, MD, MPH

The average American elementary school class includes two students living with one or multiple food allergies. That’s nearly six million children in the United States alone. And these numbers are climbing. There was a staggering 377 percent increase in medical claims with diagnoses of anaphylactic food reactions between 2007 and 2016, two-thirds of these were children.

As parents, we want the absolute best for our children. For many years, guidance around food introduction was unclear. Parents were told that babies, and especially those considered at risk for food allergies, should avoid some allergy-causing foods such as peanuts until they were three years old.

But thanks to ongoing research from our nation’s top allergists and immunologists, we are beginning to learn more and more about food allergies, including what new and expecting parents can do to reduce the risk of their children developing food allergies. In fact, studies now show that introducing a variety of foods early is the best course of action and has been shown to reduce the occurrence of certain food allergies like peanuts for many children.

For instance, the partially FARE-funded Learning Early About Peanut Allergy (LEAP) study showed a remarkable 80 percent reduction in peanut food allergies in high-risk infants who were exposed to peanut foods at a young age. Shortly after LEAP, there was the Enquiring About Tolerance, or EAT, study. This project, led by top medical researchers at Kings College London, found significant reductions in allergies to both peanut and egg after introducing small amounts of the foods into infants’ diets. The LEAP-on study soon followed, and had the same children from the original LEAP study remove peanut from their diets for 12-months. The results showed that they maintained their tolerance to peanut, indicating early introduction to babies can result in long-lasting protection from peanut allergy.

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