Tag: SDoH

COVID-19: Hidden Coinfections and Chain Reactions Parasitic Infectious Relationships within Us

Apr 15, 2020• 21

By SIMON YU, MD, COL, USA (Ret)

Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention (CDC), opened up a new front in the Coronavirus War by saying we don’t just need to treat the acute disease, we need to treat the underlying conditions that make people more susceptible to serious disease progression. He focused on heart disease, and managing mitigating risk factors such as CVD, diabetes, hypertension and smoking in order to increase people’s odds for recovery. The initial focus has been pneumonia and acute respiratory distress syndrome (ARDS), with risk factors including asthma, chronic obstructive pulmonary disease, and emphysema.

Dr. Frieden calls for better management of people’s underlying health problems to help mitigate the impact of COVID-19. I would take this one step further and say we need to go beyond managing chronic diseases, and find and treat the pathogens that underlie and fuel their pathologies. Why?

In 2001, my work as an Army Reserve medical officer took me to Bolivia to treat 10,000 Andes Indians with parasite medications. Not only did this resolve their parasite problems, but many reported it helped them overcome a range of additional chronic health problems. When I returned to St. Louis, I began to dig deeper with my chronic disease and “mystery disease” patients and treat some of them for parasite problems, and saw many improve. I expanded this “search and destroy” mission with my patients to fungal and dental infections, as I learned many such infections – often overlooked in medicine today – are overlapping, synergistic, and can present as chronic illness.

Taking Healthcare Innovation Beyond the “Peloton Crowd” | Andy Slavitt, Town Hall Ventures

Feb 13, 2020• 0

By JESSICA DaMASSA, WTF HEALTH

Andy Slavitt, former Acting Administrator of the Centers for Medicare and Medicaid Services and founder and partner at Town Hall Ventures, talks about how venture capitalists and health tech startups can help make healthcare more affordable and accessible for the 130 million Americans beyond the “Peloton crowd.” We ask Andy if he thinks “social determinants of health” is more than just an industry buzzword, get his advice for startups motivated to make a difference, and hear his predictions for what will change healthcare in this new decade.

Filmed at J.P. Morgan Healthcare Conference in San Francisco, January 2020.

The Social Context and Vulnerabilities that Challenge Health Care in the San Joaquin Valley of California

Feb 4, 2020• 0

By ALYA AHMAD, MD

Call it what you want, white privilege and health disparity appear to be two sides of the same coin. We used to consider ethnic or genetic variants as risk factors, prognostic to health conditions. However, the social determinants of health (SDOH) have increasingly become more relevant as causes of disease prevalence and complexity in health care.

As a pediatric hospitalist in the San Joaquin Valley region, I encounter these social determinants daily. They were particularly evident as I treated a 12-year old Hispanic boy who was admitted with a ruptured appendix and developed a complicated abscess, requiring an extensive hospitalization due to his complication. Why? Did he have the genetic propensity for this adverse outcome? Was it because he was non-compliant with his antibiotic regimen? No.

Rather, circumstances due to his social context presented major hurdles to his care. He had trouble getting to a hospital or clinic. He did not want to burden his parents—migrant workers with erratic long hours—further delaying his evaluation. And his Spanish-speaking mother never wondered why, despite surgery and drainage, he was not healing per the usual expectation.

When he was first hospitalized, his mother bounced around in silent desperation from their rural clinic to the emergency room more than 20 miles from their home and back to the clinic, only to be referred again to that same emergency room. By the time he was admitted 2 days later, he was profoundly ill. The surgeon had to be called in the middle of the night for an emergency open surgical appendectomy and drainage. Even after post-operative care, while he was on broad-spectrum intravenous antibiotics, his fevers, chills and pain persisted. To avoid worrying his mother, he continued to deny his symptoms. Five days after his operation, he required another procedure for complex abscess drainage.

A System that Fails Migrant and Seasonal Agricultural Workers

Dec 23, 2019• 1

By PHUOC LE, MD, CONNIE CHAN, and BROOKE WARREN

I recently took care of Rosaria[1], a cheerful 60-year-old woman who came in for chronic joint pain. She grew up in rural Mexico, but came to the US thirty years ago to work in the strawberry fields of California. After examining her, I recommended a few blood tests and x-rays as next steps. “Lo siento pero no voy a tener seguro hasta el primavera — Sorry but I won’t have insurance again until the Spring.” Rosaria, who is a seasonal farmworker, told me she only gets access to health care during the strawberry season. Her medical care will have to wait, and in the meantime, her joints continue to deteriorate.

Migrant and seasonal agricultural workers (MSAW) are people who work “temporarily or seasonally in farm fields, orchards, canneries, plant nurseries, fish/seafood packing plants, and more.”[2] MSAW are more than temporary laborers, though— they are individuals and families who have time and time again helped the US in its greatest time of need. During WWI, Congress passed the Immigration and Nationality Act of 1917 ^[3] because of the extreme shortage of US workers. This allowed farmers to bring about 73,000 Mexican workers into the US. During WWII, the US once again called upon Mexican laborers to fill the vacancies in the US workforce under the Bracero Program in 1943. Over the 23 years the Bracero Program was in place, the US employed 4.6 million Mexican laborers. Despite the US being indebted to the Mexican laborers, who helped the economy from collapsing in the gravest of times, the US deported 400,000 Mexican immigrants and Mexican-American citizens during the Great Depression.

Concrete Problems: Experts Caution on Construction of Digital Health Superhighway

Nov 27, 2019• 1

By MICHAEL MILLENSON

If you’re used to health tech meetings filled with go-go entrepreneurs and the investors who love them, a conference of academic technology experts can be jarring.

Speakers repeatedly pointed to portions of the digital health superhighway that sorely need more concrete – in this case, concrete knowledge. One researcher even used the word “humility.”

The gathering was the annual symposium of the American Medical Informatics Association (AMIA). AMIA’s founders were pioneers. Witness the physician featured in a Wall Street Journal story detailing his use of “advanced machines [in] helping diagnose illness” – way back in 1959.

That history should provide a sobering perspective on the distinction between inevitable and imminent (a difference at least as important to investors as intellectuals), even on hot-button topics such as new data uses involving the electronic health record (EHR).

I’ve been one of the optimists. Earlier this year, my colleague Adrian Gropper and I wrote about pending federal regulations requiring providers to give patients access to their medical record in a format usable by mobile apps. This, we said, could “decisively disrupt medicine’s clinical and economic power structure.”