repatha®-evolocumab-product-shot-5-HR-300x189With all the public attention now focused on soaring drug costs, Big Pharma just can’t seem to stay out of the spotlight. Drug makers are keeping up their eyebrow-raising actions, as are purveyors of so-called “stem cell” treatments, and it’s worth noting some of what’s happening with these:

Will insurers, MDs, patients pay for $14,000-a-year cholesterol fighting drug?

doc-sleep-300x225Must doctors be absolutely impervious to common sense improvements in the way they train their own? Their bullheadedness has reemerged with the revisited decision by a major academic credentialing group to allow medical residents yet again to work 24-hour shifts.

The Accreditation Council for Graduate Medical Education clearly was on the defensive when it issued its memo on residents’ learning and working hours, guidance that academic medical centers and hospitals nationwide will rely on in setting workplace standards for the young doctors in whose hands so many patients will put their lives. The council noted that it had established a high-level task force to reconsider criticisms of residents’ stress and overwork and how this might imperil patient care, responding to an early rollback of shift hours:

“… The Task Force has determined that the hypothesized benefits associated with the changes made to first-year resident scheduled hours in 2011 have not been realized, and the disruption of team-based care and supervisory systems has had a significant negative impact on the professional education of the first-year resident, and effectiveness of care delivery of the team as a whole. It is important to note that 24 hours is a ceiling, not a floor. Residents in many specialties may never experience a 24-hour clinical work period. Individual specialties have the flexibility to modify these requirements to make them more restrictive as appropriate, and in fact, some already do. As in the past, it is expected that emergency medicine and internal medicine will make individual requirements more restrictive.”

Mick_Mulvaney_Official_Portrait_113th_Congress_cropped-249x300The  Trump budget for the federal government would be a huge step back from investment in medical research with consequences for many years in progress on promoting health and fighting disease.

The budget announcement, tilted so far toward guns over butter, proved so challenging to even members of Trump’s own controlling party that lawmakers hastened to underscore that Congress, and not the chief executive, theoretically, holds  the nation’s purse strings.

The president would boost allocations for the military by more than $50 billion, and significantly increase spending for homeland security, with billions for his proposed border wall as well as more customs and immigration agents nationwide. He would gut almost 80 federal programs, providing support for everything from the arts and public broadcasting to home weatherization, rural economic development, legal services for the poor, and meals on wheels food services for the old and sick.

AHCA-CBOAfter seven years, many dozens of repeal votes in Congress, and with the health of hundreds of millions of Americans at stake, can it be that the GOP’s plans to repeal the Affordable Care Act will come down to numbers?

The headlines about Obamacare’s potential replacement, the American Health Care Act, aka Trumpcare, may be rife with partisan politics. But after another helter-skelter week of attempted health care policy-making by Congress and the president, and with more crucial House action on tap in the days ahead, there’s lots of math that’s worth a review:

  • 14 million (2018), 21 million (2020), 24 million (2026)

Foxx-275x300Call it creepy or maybe a too-early April Fool’s joke. What else can be said about a Republican-backed measure, advancing in the House of Representatives, that puts Big Brother in charge— big time —in many workplaces via so-called wellness programs?

It’s called the  “Preserving Employee Wellness Programs Act.” This Orwell-inspired bill,  pushed by North Carolina Republican Congresswoman Virginia Foxx, gives employers scary control over their workers. Employees who participate in job-related health programs can be compelled to undergo genetic tests, and to provide the results to employers, albeit in supposedly anonymized fashion. If they fail to do so, they could face thousands of dollars in fines.

Disclosure of extremely personal, private medical information has been barred by the 2008 Genetic Information Nondiscrimination Act, aka GINA. It arose partly after a 1998 court case, in which clerical and administrative workers were allowed to sue their employer for requiring testing for “highly private and sensitive medical genetic information such as syphilis, sickle cell trait, and pregnancy” without their consent or knowledge during a general employee health exam. GINA has been key in blocking employers from tapping into genetic and other confidential medical information as part of increasingly popular but largely ineffective workplace wellness programs. Because most Americans, more than 155 million of them, get their health insurance at work, many companies have launched and expanded such programs as way to reduce their coverage costs.

rheumatoid-arthritis-hands-2-300x200More than 50 million Americans struggle with arthritis: Three in 10 of them find that stooping, bending, or kneeling can be “very difficult.” One in five can’t or find it tough to walk three blocks, or to push or pull large objects. Grown-ups with arthritis are more than twice as likely to report fall injuries.  Arthritics have lower employment rates, and a third of them 45 and older experience anxiety or depression. So what to do about this leading cause of disability, a painful condition whose woes will only grow as the nation ages and already is responsible for $81 billion in direct annual medical costs?

Experts from the Centers for Disease Control and Prevention recommend that those with the most common arthritis forms—osteoarthritis, rheumatoid arthritis, gout, lupus, and fibromyalgia—avoid a reflexive reach for pain-killing pills. Instead, they must keep moving. “Physical activity,” CDC experts said in a new study, “is a proven strategy for managing arthritis. …” It also “has known benefits for the management of many other chronic conditions” that also afflict those with arthritis—including heart disease, diabetes, and obesity.

Although arthritis commonly is associated with seniors, the majority of adults with the condition, more than 32.2 million Americans, are younger than 65. Arthritis is much more common among women than men, and much less so among Hispanics and those of Asian descent that among whites. It afflicts those with a high school or less education more than those who completed college or higher.

cdc-logo-300x226When it comes to the nation’s health, the Trump Administration and the GOP-dominated Congress seem determined to prove they know how to do penny-wise and pound-foolish. They’re amply demonstrating this with proposed slashes in the nation’s basic budget for public health. They’re calling for a $1 billion cut for the Centers for Disease Control and Prevention, notably in the agency’s funding to combat bioterrorism and outbreaks of disease, as well as to battle smoking and to provide critical medical services like immunizations. Their target is the Prevention and Public Health Fund, set up under the Affordable Care Act, aka Obamacare. With the ACA under fire by partisans who want to repeal and replace it, the fund was already imperiled. GOP lawmakers, determined to cut domestic spending, seem disinclined to come up with substitute sums.

Andy Harris, a Maryland Republican congressman, physician, and House appropriations health subcommittee member, has been quoted as calling the public health money, “a slush fund.” He argued that, “It’s been used by the secretary [of health and human services] for whatever the secretary wants. It’s a misnomer to call it the Prevention and Public Health Fund, because it’s been used for other things, and it’s about time we eliminated it.”

The Obama Administration did embarrass Congress by tapping the fund to provide emergency aid last summer to Florida, Puerto Rico, Hawaii, and other states battling tropical infections, including Zika and dengue fever. Congress took a long recess vacation, as states clamored for help for mosquito eradication and vaccine development to deal with Zika, a virus that can cause severe birth defects and other harms.

Medicaid-300x225Republicans have long fumed about the federal government’s role in health care, ever since Medicare for the elderly and Medicaid for the poor were both passed in 1965. Now, though, we’re at a crossroads, where a frontal assault on Medicaid could cause big damage to both programs.

The temptation for too many Americans, as I’ve written before, may be to skip over the Medicaid-related parts of the GOP proposals to repeal and replace the Affordable Care Act, aka Obamacare. That would be wrong because those parts of the American Health Care Act, aka Trumpcare, may be the most radical and will be detrimental to the poor, working poor, children, sick, disabled, and seniors. They will hit many millions more middle-class Americans than might be thought.

Opponents also say that Trumpcare and its Medicaid and health insurance changes will harm Medicare, the linchpin of health care coverage for seniors.

ahca-300x169The president and his GOP allies on Capitol Hill already have rammed through two U.S. House committees a plan to repeal and replace the Affordable Care Act, aka Obamacare. But to paraphrase a best-seller’s title, those who will be affected by the American Health Care Act, the AHCA, are from Earth, while the Republicans who are pushing Trumpcare must be from Pluto.

That’s because their Trumpcare, as evidence already has shown, will divide Americans as never before, while at the same time unifying them in opposition to it and disbelief about its current form.

Here’s what the suddenly engaged, now arm-twisting president Tweeted about the House legislation:  “Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster— is imploding fast!”

consent-300x170Modern medicine has become so complex, bureaucratic, and forbidding that it’s little wonder that patients—already ailing—don’t grasp the risks and consequences of treatments they prescribe. Overwhelmed patients also don’t demand that doctors fully brief them.

And shame on physicians for failing to help patients more in this critical area of caregiving, two doctors have written in an excellent New York Times Op-Ed column. The doctors—Mikkael Sekeres, director of the leukemia program at the Cleveland Clinic, and Timothy Gilligan, director of coaching, Center for Excellence in Healthcare Communication, at the Cleveland Clinic—deserve credit for calling out colleagues while describing the vital health care concept of informed consent.

My firm has detailed information on this important patient right in health care (click here to see).

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