Later On

A blog written for those whose interests more or less match mine.

Archive for the ‘Healthcare’ Category

Vaccine Refusal Will Come at a Cost—For All of Us

leave a comment »

Edward Isaac-Dovere writes in the Atlantic:

Imagine it’s 2026. A man shows up in an emergency room, wheezing. He’s got pneumonia, and it’s hitting him hard. He tells one of the doctors that he had COVID-19 a few years earlier, in late 2021. He had refused to get vaccinated, and ended up contracting the coronavirus months after most people got their shots. Why did he refuse? Something about politics, or pushing back on government control, or a post he saw on Facebook. He doesn’t really remember. His lungs do, though: By the end of the day, he’s on a ventilator.

You’ll pay for that man’s decisions. So will I. We all will—in insurance premiums, if he has a plan with your provider, or in tax dollars, if the emergency room he goes to is in a public hospital. The vaccine refusers could cost us billions. Maybe more, over the next few decades, with all the complications they could develop. And we can’t do anything about it except hope that more people get their shots than those who say they will right now.

If the 30 percent of Americans who are telling pollsters they won’t get vaccinated follow through, the costs of their decisions will pile up. The economy could take longer to get back to full speed, and once it does, it could get shut down again by outbreaks. Variants will continue to spread, and more people will die. Each COVID-19 case requires weeks of costly rehabilitation. Even after the pandemic fades, millions of vaccine refusers could turn into hundreds of thousands of patients who need extra care, should they come down with the disease. Their bet that they’ve outsmarted the coronavirus or their insistence that Anthony Fauci and Bill Gates were trying to trick them will not stop them from going to the doctor when they’re having trouble breathing, dealing with extreme fatigue, or struggling with other lasting effects of COVID-19. (A new study found that 34 percent of COVID-19 survivors are diagnosed with a neurological or psychological condition within six months of recovering from the initial illness.)

The economic costs of vaccine refusal aren’t yet a major part of the political conversation. That’s likely to change as we move past the first year of the pandemic. “You have a liberty right, and that unfortunately is imposing on everyone else and their liberty right not to have to pay for your stubbornness. And that’s what’s maddening,” Jay Inslee, the governor of Washington, told me. Inslee is 70, and fully vaccinated. The three-term Democrat was in a good mood because he was on his way to see his baby granddaughter, whom he hadn’t hugged in a year. But after what he’s gone through since early 2020—the first American COVID-19 outbreak and the first explosion of COVID-denialist demonstrations were both in Washington—he’s angry and sad that so many people are refusing to get their shots.

He had the latest numbers: 15 Washingtonians had died of COVID-19 the day we spoke. More than 300,000 state residents who had been eligible for a vaccine for at least three months still hadn’t gotten one, including 27 percent of those over 65. Some of those people hadn’t been able to get appointments. Some may have been nervous, but would eventually get a vaccine. Some had just refused, and will continue to do so. Those people are “foisting [their] costs on the rest of the community,” Inslee said. “There’s a long, long economic tail of disease prevalence as a result of people who refuse to get vaccinated.” But, he stressed, “it pales in comparison to people losing their lives.”

Inslee read me some data he had gotten from the Republican messaging maven Frank Luntz, which the governor said was going to inform new public-awareness campaigns that the state is developing to break through to Republican men, the people most likely to say they won’t get vaccinated, according to polling. Two appeals seem to work best: First, the vaccines are safe, and they’re more effective than the flu vaccine. Second, you deserve this, and getting vaccinated will help preserve your liberty and encourage the government to lift restrictions. (That last idea is what Jerry Falwell Jr. focused on in the vaccination selfie he posted this week, captioned, “Please get vaccinated so our nutcase of a governor will have less reasons for mindless restrictions!”) Inslee hopes that emphasizing those points will persuade more Republican men to get their shots. But he’s not sure it will work.

The prospect of lower health-care costs has led conservatives to back health-related regulations in the past. In 1991, Pete Wilson, then the Republican governor of California, signed a law mandating helmets for motorcyclists, and made a conservative argument for the new regulation. “We don’t know exactly how much money and how many lives will be saved with this legislation,” Wilson said at the signing ceremony, which was held at a hospital in the state capital. “But we do know that the cost of not enacting it is too great for a civilized society to bear.” Then again, President Ronald Reagan was famously resistant to seatbelt and airbag laws, which also reduce health-care spending.

Though there are some notable vaccination holdouts among Republican officials, most in Congress and in state leadership positions have encouraged their constituents to get the shots. “I saw on some program last week that Republican men, curiously enough, might be reluctant to take the vaccine. I’m a Republican man, and I want to say to everyone: We need to take this vaccine,” Senate Minority Leader Mitch McConnell said at an event in Kentucky this week. Brad Wenstrup, who worked as a podiatrist before becoming a Republican congressman from Ohio, has been so eagerly promoting the vaccines that he got trained to administer them. But the Republican politics around COVID-19 remain treacherous, and when I reached out to several Republican members of Congress, telling their aides I’d be eager to have them make a Wilson-esque fiscally conservative argument for vaccination, I couldn’t find anyone willing to make that case to me.

Calculating the exact long-term costs is tricky; we have only a year’s worth of data on the lasting health consequences of COVID-19, and even less on the efficacy of the vaccines and Americans’ resistance to getting them. Krutika Amin, who conducts economic and policy research for the Kaiser Family Foundation, tried to sketch out what the taxpayer bill might be. Before the pandemic, about . . .

Continue reading. There’s more.

Written by LeisureGuy

11 April 2021 at 11:17 am

Heart Stents and Upcoding: How Cardiologists Game the System

leave a comment »

Written by LeisureGuy

7 April 2021 at 12:48 pm

Why tearing down Fauci is essential to the MAGA myth

leave a comment »

Michael Gerson was a speechwriter for George W. Bush and is currently a columnist. Here’s a recent column that appeared in the Washington Post that reflects the despair of traditional Republicans (among whom he counts himself) in the face of MAGA madness:

MAGA political philosophy is not systematic, but it is comprehensive. Right-wing populism offers a distorted lens to view nearly all of life.

Through this warped lens, progress toward equal rights is actually the oppression of White people. Free and fair elections, when lost, are actually conspiratorial plots by the ruthless left. But perhaps the most remarkable distortion concerns the MAGA view of covid-19.

We have all seen the basic outlines of pandemic reality. Experts in epidemiology warned that the disease would spread through contact or droplets at short distances, which is how it spread. The experts recommended early lockdowns to keep health systems from being overwhelmed, and the lockdowns generally worked. The experts said Americans could influence the spread of the disease by taking basic measures such as mask-wearing and social distancing. The disease was controlled when people did these things. The disease ran rampant when they did not, killing a lot of old and vulnerable people in the process.

There were, of course, disagreements along the way about the length of lockdowns and the form of mandates. But on the whole, American citizens have witnessed one of the most dramatic vindications of scientific expertise in our history. We have been healthier when we listened to the experts and sicker when we did not.

This is the context in which the MAGA right has chosen to make Anthony S. Fauci — the director of the National Institute of Allergy and Infectious Diseases since 1984 — the villain in their hallucinogenic version of pandemic history.

It is worth disclosing when a columnist has a personal connection to a public figure. I have known Fauci since I was in government during the early 2000s and watched him help create the President’s Emergency Plan for AIDS Relief. He is the best of public service: supremely knowledgeable, personally compassionate, completely nonpolitical, tenacious in the pursuit of scientific advancement and resolute in applying such knowledge to human betterment. He has no other ambition or agenda than the health of the country and world.

Yet slamming Fauci was a surefire applause line at the Conservative Political Action Conference in February. Former Trump administration officials continue to target him. Republican members of Congress vie with one another to put Fauci in his place.

For Trump officials, including Donald Trump himself, this makes perfect sense. If Fauci has been right about covid, then playing down the disease, mocking masks, modeling superspreader events, denying death tolls, encouraging anti-mandate militias and recommending quack cures were not particularly helpful. If Fauci has been right, they presided over a deadly debacle.

When former Trump trade adviser Peter Navarro claims that Fauci is “the father of the actual virus” or former chief of staff Mark Meadows complains about Fauci’s indifference to the (nearly nonexistent) flow of covid across the southern border, the goal is not really to press arguments. It is to create an alternative MAGA reality in which followers are free from the stress of truth — a safe space in which more than half a million people did not die and their leader was not a vicious, incompetent, delusional threat to the health of the nation.

Metaphorically (but only barely metaphorically), there is a body on the floor with multiple stab wounds. The Trump administration stands beside it with a bloody knife in its hand. It not only claims to be innocent. It claims there is no blood. There is no body. There is no floor.

Congressional Republicans who criticize Fauci to prove their populist manhood are even more pathetic. Their self-abasement is voluntary. Watching Sen. Rand Paul (R-Ky.) debate science with Fauci during committee hearings is like watching Albert Einstein being disputed by his dry cleaner. Fauci is often reduced to making obvious points in a patient voice. Fauci deserves his Presidential Medal of Freedom just for his heroic forbearance.

All these critics of Fauci have chosen to attack the citadel of science at its strongest point. With squirt guns. While naked and blowing kazoos.

This useless exertion is somehow wrapped in the language of freedom. Freedom from the servitude of a piece of cloth on your face that might save your neighbor’s life. Freedom to light off fireworks below a potential avalanche. . .

Continue reading. The column concludes:

Fauci is practicing epidemiology. His critics are practicing idiocy. Both are very good at their chosen work.

Written by LeisureGuy

6 April 2021 at 12:11 pm

The health-care industry doesn’t want to talk about this single word

leave a comment »

A clear example of the extent of systemic racism in the United States is offered in a Washington Post column by Ron Wyatt, co-chairof the Institute for Healthcare Improvement’s equity advisory group and faculty for the IHI Pursuing Equity Initiative. Wyatt was the first Black chief medical resident at the Saint Louis University School of Medicine. He writes:

When I write about health policy or speak with medical colleagues about barriers to care, there is one word — and one word only — that evokes a wide range of responses. Some respond with silence; others with avoidance. Some respond with anger and defensiveness.

The word appeared at the top of a paper I submitted to the Journal of the American Medical Association in 2015 with David R. Williams, a professor of public health and African American studies at Harvard University. The title: “Racism in Health and Healthcare: Challenges and Opportunities.”

The editor of the journal at that time, Howard Bauchner, advised us that the word could not be published and that “racial bias” would be substituted into the title before publication. Using “racism,” he said, would result in “losing readers.” As authors and scientists, we compromised. We agreed to the change, and the article was published.

Just a few weeks ago, six years after that decision to compromise, Bauchner and I spoke by phone. He apologized, saying that progress has been made since then.

Has progress been made? JAMA recently announced that following controversial comments on racism in medicine made by a deputy editor, Bauchner was placed on administrative leave on March 25 while an independent investigation is completed.

Entrenched systemic racism — and the deliberate omission of the word in patient safety circles — is the cause of an astonishing level of preventable harm and death among communities of color that have been devalued and discounted for more than 400 years.

The covid-19 pandemic has laid bare the racial inequities of the U.S. health-care system. Too many health-care executives still perpetuate the ahistoric perspective that our country’s model provides safe and equal care for all. Yet the disproportionate number of deaths to covid-19 among racial and ethnic minority groups exposes the systemic and lethal barriers to care.

Last month, a major health-care trade magazine accepted another article that I contributed to with three colleagues, once again with “racism” in the title. When our editor sent us the final authors’ agreement, we noticed the word had been removed from the title and replaced with “intolerance.” This time, we were not willing to compromise. Our editor later informed us that the article would not be published in the May/June issue as scheduled. We were not given a reason.

I have worked all over the United States and internationally as a champion of addressing health inequity. I can say without hesitation — both as a doctor and a citizen — that racism in the United States is a public health crisis.

Having lived in rural Alabama, my family experienced these inequities personally. When my great uncle, who was like a father to me, fell ill, he was taken to a clinic that was segregated by skin color, and was subsequently admitted to a hospital in Selma in 1973. He died one day later. In 2015, I learned he had a ruptured appendix and was never seen by a physician.

I have advised and worked with large, complex health-care systems in the United States, Britain, Australia and Africa. I have collaborated with organizations such as the American Medical Association, the American Hospital Association and the Joint Commission. I have even discussed race as a risk factor for death with White health leaders, such as former president of the Institute for Healthcare Improvement Don Berwick.

Yet, I still sometimes feel that survival mechanism kick in to compromise and veil the truth that structural and systemic racism is a root cause of preventable harm and death across U.S. health care. I have been warned that if I did not continue to compromise, I would be labeled an “angry Black man” and that colleagues would distance themselves from me.

The days of compromise are over.

Solving systemic racism in public health must start with naming it. We must publish the word. We must say the word. If health-care providers are to be competent in caring for communities that have been marginalized and oppressed for centuries, then they must understand the role racism plays in poor health. This includes . . .

Continue reading.

Racists don’t like it when you point out their racism.

Written by LeisureGuy

5 April 2021 at 5:51 pm

Why Are Stents Still Used If They Don’t Work?

leave a comment »

Written by LeisureGuy

5 April 2021 at 9:34 am

The Real Reason Republicans Couldn’t Kill Obamacare

leave a comment »

Adapted from The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage, St. Martin’s Press 2021, and quoted from the Atlantic:

The affordable care act, the health-care law also known as Obamacare, turns 11 years old this week. Somehow, the program has not merely survived the GOP’s decade-long assault. It’s actually getting stronger, thanks to some major upgrades tucked in the COVID-19 relief package that President Joe Biden signed into law earlier this month.

The new provisions should enable millions of Americans to get insurance or save money on coverage they already purchase, bolstering the health-care law in precisely the way its architects had always hoped to do. And although the measures are temporary, Biden and his Democratic Party allies have pledged to pass more legislation making the changes permanent.

The expansion measures are a remarkable achievement, all the more so because Obamacare’s very survival seemed so improbable just a few years ago, when Donald Trump won the presidency. Wiping the law off the books had become the Republicans’ defining cause, and Trump had pledged to make repeal his first priority. As the reality of his victory set in, almost everybody outside the Obama White House thought the effort would succeed, and almost everybody inside did too.

One very curious exception was Jeanne Lambrew, the daughter of a doctor and a nurse from Maine who was serving as the deputy assistant to the president for health policy. As a longtime Obama adviser, going back to the 2008 transition, Lambrew was among a handful of administration officials who had been most responsible for shaping his health-care legislation and shepherding it through Congress—and then for overseeing its implementation. Almost every other top official working on the program had long since left government service for one reason or another. Lambrew had stayed, a policy sentry unwilling to leave her post.

On that glum November 2016 day following the election, Lambrew decided to gather some junior staffers in her office and pass out beers, eventually taking an informal survey to see who thought Obama’s signature domestic-policy achievement would still be on the books in a year. Nobody did—except Lambrew.

Yes, Republicans had already voted to repeal “Obamacare” several times. But, she knew, they had never done so with real-world consequences, because Obama’s veto had always stood in the way. They’d never had to think through what it would really mean to take insurance away from a hotel housekeeper or an office security guard on Medicaid—or to tell a working mom or dad that, yes, an insurance company could deny coverage for their son’s or daughter’s congenital heart defect.

A repeal bill would likely have all of those effects. And although Republicans could try to soften the impact, every adjustment to legislation would force them to sacrifice other priorities, creating angry constituents or interest groups and, eventually, anxious lawmakers. GOP leaders wouldn’t be able to hold the different camps within their caucuses together, Lambrew believed, and the effort would fail.

All of those predictions proved correct. And that wasn’t because Lambrew was lucky or just happened to be an optimist. It was because she knew firsthand what most of the Republicans didn’t: Passing big pieces of legislation is a lot harder than it looks.

It demands unglamorous, grinding work to figure out the precise contours of rules, spending, and revenue necessary to accomplish your goal. It requires methodical building of alliances, endless negotiations among hostile factions, and making painful compromises on cherished ideals. Most of all, it requires seriousness of purpose—a deep belief that you are working toward some kind of better world—in order to sustain those efforts when the task seems hopeless.

Democrats had that sense of mission and went through all of those exercises because they’d spent nearly a century crusading for universal coverage. It was a big reason they were able to pass their once-in-a-generation health-care legislation. Republicans didn’t undertake the same sorts of efforts. Nor did they develop a clear sense of what they were trying to achieve, except to hack away at the welfare state and destroy Obama’s legacy. Those are big reasons their legislation failed.

Obamacare’s survival says a lot about the differences between the two parties nowadays, and not just on health care. It’s a sign of how different they have become, in temperament as much as ideology, and why one has shown that it’s capable of governing and the other has nearly forgotten how.

Democrats were so serious about health care that they began planning what eventually became the Affordable Care Act more than a decade earlier, following the collapse of Bill Clinton’s reform attempt in the 1990s. The ensuing political backlash, which saw them lose control of both the House and Senate, had left top Democrats in no mood to revisit the issue. But reform’s champions knew that another opportunity would come, because America’s sick health-care system wouldn’t heal itself, and they were determined not to make the same mistakes again.

At conferences and private dinners, on chat boards and in academic journals, officials and policy advisers obsessively analyzed what had gone wrong and why—not just in 1993 and 1994 but in the many efforts at universal coverage that had come before. They met with representatives of the health-care industry as well as employers, labor unions, and consumer advocates. Industry lobbyists had helped kill reform since Harry Truman’s day. Now they were sitting down with the champions of reform, creating a group of “strange bedfellows” committed to crafting a reform proposal they could all accept.

Out of these parallel efforts, a rough consensus on substance and strategy emerged. Democrats would put forward a plan that minimized disruption of existing insurance arrangements, in order to avoid scaring people with employer coverage, and they would seek to accommodate rather than overpower the health-care industry. The proposal would err on the side of less regulation, spending, and taxes—basically, anything that sounded like “big government”—and Democrats would work to win over at least a few Republicans, because that would probably be necessary in Congress.

Proof of concept came in 2006, in Massachusetts, when its Republican governor, Mitt Romney, teamed up with the Democratic state legislature to pass a plan that fit neatly into the new vision. It had the backing from a broad coalition, including insurers and progressive religious organizations. Ted Kennedy, the liberal icon and U.S. senator, played a key role, by helping secure changes in funding from Washington that made the plan possible. “My son said something … ‘When Kennedy and Romney support a piece of legislation, usually one of them hasn’t read it,’” Kennedy joked at the signing ceremony, standing at Romney’s side.

Kennedy’s endorsement said a lot about the psychology of Democrats at the time. No figure in American politics was more closely associated with the cause of universal health care and, over the years, he had tried repeatedly to promote plans that looked more like the universal-coverage regimes abroad, with the government providing insurance directly in “single-payer” systems that resembled what today we call “Medicare for All.” But those proposals failed to advance in Congress, and Kennedy frequently expressed regret that, in the early 1970s, negotiations over a more private sector-oriented coverage plan with then-President Richard Nixon had broken down, in part because liberals were holding out for a better deal that never materialized.

Kennedy was not alone in his belief that the champions of universal coverage would have to accept big concessions in order to pass legislation. The liberal House Democrats John Dingell, Pete Stark, and Henry Waxman, veteran crusaders for universal coverage who’d accrued vast power over their decades in Congress, were similarly willing to put up with what they considered second-, third-, and even fourth-best solutions—and they were masters of the legislative process, too. Waxman in particular was an expert at doing big things with small political openings, such as inserting seemingly minor adjustments to Medicaid into GOP legislation, expanding the program’s reach over time. “Fifty percent of the social safety net was created by Henry Waxman when no one was looking,” Tom Scully, who ran Medicare and Medicaid for the Bush administration in the early 2000s, once quipped.

Obama had a similar experience putting together health-care legislation in the Illinois state legislature—where, despite proclaiming his support for the idea of a single-payer system, he led the fight for coverage expansions and universal coverage by working with Republicans and courting downstate, more conservative voters. He also was a master of policy detail, and as president, when it was time to stitch together legislation from different House and Senate versions, he presided over meetings directly (highly unusual for a president) and got deep into the weeds of particular programs.

Obama could do this because the concept of universal coverage fit neatly within . . .

Continue reading. There’s much more.

Later in the column:

Another problem was a recognition that forging a GOP consensus on replacement would have been difficult because of internal divisions. Some Republicans wanted mainly to downsize the Affordable Care Act, others to undertake a radical transformation in ways they said would create more of an open, competitive market. Still others just wanted to get rid of Obama’s law and didn’t especially care what, if anything, took its place.

“The homework that hadn’t been successful was the work to coalesce around a single plan, a single set of specific legislative items that could be supported by most Republicans,” Price told me. “Clearly, looking at the history of this issue, this has always been difficult for us because there are so many different perspectives on what should be done and what ought to be the role of the federal government in health care.”

The incentive structure in conservative politics didn’t help, because it rewarded the ability to generate outrage rather than the ability to deliver changes in policy. Power had been shifting more and more to the party’s most extreme and incendiary voices, whose great skill was in landing appearances on Hannity, not providing for their constituents. Never was that more apparent than in 2013, when DeMint, Senator Ted Cruz of Texas, and some House conservatives pushed Republicans into shutting down the government in an attempt to “defund” the Affordable Care Act that even many conservative Republicans understood had no chance of succeeding.

The failure to grapple with the complexities of American health care and the difficult politics of enacting any kind of change didn’t really hurt Republicans until they finally got power in 2017 and, for the first time, had to back up their promises of a superior Obamacare alternative with actual policy. Their solution was to minimize public scrutiny, bypassing normal committee hearings so they could hastily write bills in the leadership offices of House Speaker Paul Ryan and, after that, Senate Majority Leader Mitch McConnell.

Written by LeisureGuy

28 March 2021 at 4:52 pm

A grim view of the UK — and of the US

leave a comment »

Umair Haque views things through a dark lens, but he does make some good points. Rather than try to extract the essence, let me offer three of his recent columns for you to read, one after the other:

What Does it Look Like When a Society Commits Suicide? Brexit.

Can the World Resist Being Americanized?

Britain is Showing the World How Nationalism Implodes Into Fascism

I’m interested in hearing your thoughts after reading both.

If you want another, try one of these (from a search on “America failed state”).

Written by LeisureGuy

17 March 2021 at 6:45 pm

First vaccine to fully immunize against malaria builds on pandemic-driven RNA tech

leave a comment »

Monisha Ravisetti writes in The Academic Times about some very good news indeed:

Consistently ranked as one of the leading causes of death around the world, malaria doesn’t have an eective vaccine yet. But researchers have invented a promising new blueprint for one — with properties akin to the novel RNA- based vaccine for COVID-19.

Making a vaccine for malaria is challenging because its associated parasite, Plasmodium, contains a protein that inhibits production of memory T-cells, which protect against previously encountered pathogens. If the body can’t generate these cells, a vaccine is ineective. But scientists recently tried a new approach using an RNA-based platform.

Their design circumvented the sneaky protein, allowed the body to produce the needed T-cells and completely immunized against malaria. The patent application for their novel vaccine, which hasn’t yet been tested on humans, was published by the U.S. Patent & Trademark Oce on Feb. 4.

“It’s probably the highest level of protection that has been seen in a mouse model,” said Richard Bucala, co-inventor of the new vaccine and a physician and professor at Yale School of Medicine.

The team’s breakthrough could save hundreds of thousands of lives, particularly in developing nations. In 2019 alone, there were an estimated 229 million cases of malaria and 409,000 deaths worldwide. Of those deaths, 94% were in Africa, with children being the most vulnerable.

“It aects societies and populations that have the least amount of resources and expertise to manage these infections well,” Bucala told The Academic Times. “We need new vaccines, and we need more tools.”

Novartis Pharmaceuticals and the National Institutes of Health funded the work. GlaxoSmithKline is an assignee on the patent, which if approved, will allow the company to produce the vaccine and make it available to the public.

At present, the only vaccine to prevent malaria is called RTS,S. Approved two years ago, this vaccine is the result of nearly two decades of research, but is only about 30% eective. And after four years, that gure drops to 15%.

“It doesn’t work very well,” Bucala said. “And the research studies all have the conclusion that the people who fail to mount a vaccine response, or who get reinfected, have poor memory T-cell responses.”

Along with Andrew Geall, a pharmaceutical researcher who developed the RNA platform that the duo used, Bucala found a way to prevent the unwanted protein in Plasmodium, called PMIF, from inhibiting T-cell generation.

“Our research studies indicate that . . .

Continue reading.

Written by LeisureGuy

1 March 2021 at 5:18 pm

No, the Tuskegee Study Is Not the Top Reason Some Black Americans Question the COVID-19 Vaccine`

leave a comment »

April Dembosky reports for KQED:

As more surveys come out showing that Black Americans are more hesitant than white Americans to get the coronavirus vaccine, more journalists, politicians and health officials — from New York Gov. Andrew Cuomo to Dr. Anthony Fauci — are invoking the infamous Tuskegee syphilis study to explain why.

“It’s ‘Oh, Tuskegee, Tuskegee, Tuskegee,’ and it’s mentioned every single time,” says Karen Lincoln, a professor of social work at the University of Southern California. “We make these assumptions that it’s Tuskegee. We don’t ask people.”

When she asks the Black seniors she works with in Los Angeles about the vaccine, Tuskegee rarely comes up. People in the community are more interested in talking about contemporary racism and barriers to health care, she says, while it seems to be mainly academics and officials who are preoccupied with the history of Tuskegee.

“It’s a scapegoat,” Lincoln says. “It’s an excuse. If you continue to use it as a way of explaining why many African Americans are hesitant, it almost absolves you of having to learn more, do more, involve other people – admit that racism is actually a thing today.”

It’s the health inequities of today that Maxine Toler, 72, hears about when she talks to her friends and neighbors in LA about the vaccine. Toler is president of her city’s senior advocacy council and her neighborhood block club. She and most of the other Black seniors she talks to want the vaccine, but are having trouble getting it, she says, and that alone is sowing mistrust.

Those who don’t want the vaccine have very modern reasons for not wanting it. They tell Toler it’s because of religious beliefs, safety concerns or distrust for the former U.S. president and his relationship to science. Only a handful mention Tuskegee, she says, and when they do, they’re fuzzy on the details of what happened during the 40-year study.

“If you ask them what was it about and why do you feel like it would impact your receiving the vaccine, they can’t even tell you,” she says.

Toler remembers, and says the history is a distraction; it’s not relevant to what’s happening now.

“It’s almost the opposite of Tuskegee,” she says. “Because  . . .

Continue reading.

Written by LeisureGuy

27 February 2021 at 12:16 pm

The power of capitalism: Private equity ownership is killing people at nursing homes

leave a comment »

The power is not so much that capitalism kills people for the sake of profits (cf. Texas power grid, pollution from industry, the requirement for government laws to keep workplaces safe (and the endless efforts of corporations to repeal or evade those laws)), but that capitalism is able to continue the practice without encountering more effective opposition.

Dylan Scott reports in Vox:

When private equity firms acquire nursing homes, patients start to die more often, according to a new working paper published by the National Bureau of Economic Research.

Private equity acquisitions of nursing homes is a pressing topic: Total private equity investment in nursing homes exploded, going from $5 billion in 2000 to more than $100 billion in 2018. Many nursing homes have long been run on a for-profit basis. But private equity firms, which generally take on debt to buy a company and then put that debt on the newly acquired company’s books, have purchased a mix of large chains and independent facilities — making it easier to isolate the specific effect of private equity acquisitions, rather than just a profit motive, on patient welfare.

Researchers from Penn, NYU, and the University of Chicago studied Medicare data that covers more than 18,000 nursing home facilities, about 1,700 of which were bought by private equity from 2000 to 2017, the sample period they studied.

Their findings are sobering.

The researchers studied patients who stayed at a skilled nursing facility after an acute episode at a hospital, looking at deaths that fell within the 90-day period after they left the nursing home. They found that going to a private equity-owned nursing home increased mortality for patients by 10 percent against the overall average.

Or to put it another way: “This estimate implies about 20,150 Medicare lives lost due to [private equity] ownership of nursing homes during our sample period,” the authors — Atul Gupta, Sabrina Howell, Constantine Yannelis, and Abhinav Gupta — wrote. That’s more than 1,000 deaths every year, on average.

What accounts for such a significant loss of life when private equity takes over a nursing home? The researchers advance a few possible explanations.

For one, they note, the increased mortality is concentrated among patients who are relatively healthier. As counterintuitive as that may sound, there may be a good reason for it: Sicker patients have more regimented treatment that will be adhered to no matter who owns the facility, whereas healthier people may be more susceptible by the changes made under private equity ownership.

Those changes include a reduction in staffing, which prior research has found is the most important factor in quality of care. Overall staffing shrinks by 1.4 percent, the study found, but more directly, private equity acquisitions lead to cuts in the number of hours that front-line nurses spend per day providing basic services to patients. Those services, such as bed turning or infection prevention, aren’t medically intensive, but they can be critical to health outcomes.

“The loss of front-line staff is most problematic for older but relatively less sick patients, who drive the mortality result,” the authors wrote.

The study also detected a 50 percent increase in the use of antipsychotic drugs for nursing home patients under private equity, which may be intended to offset the loss in nursing hours. But that introduces its own problems for patients, because antipsychotics are known to be associated with higher mortality in elderly people.

The combination of fewer nurses and more antipsychotic drugs could explain a significant portion of the disconcerting mortality effect measured by the study. Private equity firms were also found to spend more money on things not related to patient care in order to make money — such as monitoring fees to medical alert companies owned by the same firm — which drains still more resources away from patients.

“These results, along with the decline in nurse availability, suggest a systematic shift in operating costs away from patient care,” the authors concluded.

The researchers make a point in their opening to stipulate that private equity may prove successful in other industries. But, they warn, it may be dangerous in health care, where the profit motive of private firms and the welfare of patients may not be aligned:

For example, patients cannot accurately assess provider quality, they typically do not pay for services directly, and a web of government agencies act as both payers and regulators. These features weaken the natural ability of a market to align firm incentives with consumer welfare and could mean that high-powered incentives to maximize profits have detrimental implications for consumer welfare. . . .

Continue reading.

Written by LeisureGuy

22 February 2021 at 1:53 pm

This town of 170,000 replaced some cops with medics and mental health workers. It’s worked for over 30 years.

leave a comment »

The question that immediately came to mind: Given that it worked, why has the approach not been widely replicated over that 30-year period? What are the barriers to learning? It’s a good model and a successful model, but people did not learn from it. Resistance to learning strikes me as a serious problem, one for which solutions should be found — and quickly.

Update: Resistance to change is an old problem. An example: After it was discovered that patients did much better after surgery (that is, they did not sicken and die nearly so often) when the surgeon washed his hands before performing surgery, the practice did not become common until an entire generation of surgeons of non-hand-washing surgeons had been replaced by a new generation for whom washing hands before surgery was normal. /update

Scottie Andrew reports for CNN:

Around 30 years ago, a town in Oregon retrofitted an old van, staffed it with young medics and mental health counselors and sent them out to respond to the kinds of 911 calls that wouldn’t necessarily require police intervention.

In the town of 172,000, they were the first responders for mental health crises, homelessness, substance abuse, threats of suicide — the problems for which there are no easy fixes. The problems that, in the hands of police, have often turned violent.

Today, the program, called CAHOOTS, has three vans, more than double the number of staffers and the attention of a country in crisis.

CAHOOTS is already doing what police reform advocates say is necessary to fundamentally change the US criminal justice system — pass off some responsibilities to unarmed civilians.

Cities much larger and more diverse than Eugene have asked CAHOOTS staff to help them build their own version of the program. CAHOOTS wouldn’t work everywhere, at least not in the form it exists in in Eugene.

But it’s a template for what it’s like to live in a city with limited police.

It’s centered on a holistic approach

CAHOOTS comes from White Bird Clinic, a social services center that’s operated in Eugene since the late 1960s. It was the brainchild of some counterculture activists who’d felt the hole where a community health center should be. And in 1989, after 20 years of earning the community’s trust, CAHOOTS was created.

“CAHOOTS” stands for “Crisis Assistance Helping Out On The Streets” and cheekily refers to the relationship between the community health center that started it and the Eugene Police Department.

Most of the clients White Bird assisted — unsheltered people or those with mental health issues — didn’t respond well to police. And for the many more people they hadn’t yet helped, they wanted to make their services mobile, said David Zeiss, the program’s co-founder.

“We knew that we were good at it,” he said. “And we knew it was something of value to a lot of people … we needed to be known and used by other agencies that commonly encounter crisis situation.”

It works this way: 911 dispatchers filter calls they receive — if they’re violent or criminal, they’re sent to police. If they’re within CAHOOTS’ purview, the van-bound staff will take the call. They prep what equipment they’ll need, drive to the scene and go from there.

The program started small, with a van Zeiss called a “junker,” some passionate paraprofessionals and just enough funding to staff CAHOOTS 40 hours a week.

It always paired one medic, usually a nurse or EMT, with a crisis responder trained in behavioral health. That holistic approach is core to its model.

Per self-reported data, CAHOOTS workers responded to 24,000 calls in 2019 — about 20% of total dispatches. About 150 of those required police backup.

CAHOOTS says the program saves the city about $8.5 million in public safety costs every year, plus another $14 million in ambulance trips and ER costs.

It had to overcome mutual mistrust with police

White Bird’s counterculture roots ran deep — the clinic used to fundraise at Grateful Dead concerts in the West, where volunteer medics would treat Deadheads — so the pairing between police and the clinic wasn’t an immediately fruitful one.

There was “mutual mistrust” between them, said Zeiss, who retired in 2014.

“It’s true there was a tendency to be mistrustful of the police in our agency and our culture,” he said. “It was an obstacle we had to overcome.”

And for the most part, both groups have: Eugene Police Chief Chris Skinner called theirs a “symbiotic relationship” that better serves some residents of Eugene.

“When they show up, they have better success than police officers do,” he said. “We’re wearing a uniform, a gun, a badge — it feels very demonstrative for someone in crisis.”

It seeks to overturn a disturbing statistic

And a great many people in Eugene are in crisis. . .

Continue reading. There’s much more.

Later in the article:

Most of CAHOOTS’ clients are homeless, and just under a third of them have severe mental illnesses. It’s a weight off the shoulders of police, Skinner said.

“I believe it’s time for law enforcement to quit being a catch-base for everything our community and society needs,” Skinner said. “We need to get law enforcement professionals back to doing the core mission of protecting communities and enforcing the law, and then match resources with other services like behavioral health — all those things we tend to lump on the plate of law enforcement.”

Written by LeisureGuy

15 February 2021 at 1:17 pm

Two different approaches to Covid relief: Democratic and Republican

leave a comment »

Just as a reminder: the specific and explicit mission statement of the Federal government is stated in the Preamble to the US Constitution:

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

I have put the relevant phrase in boldface.

As of this morning, the number of American deaths due to Covid is 459,712. The total number of American combat deaths for all wars from 1900 to the present — 121 years, including WWII, WWI, the Korean War, the Vietnam War, the Iraq Wars, the Afghanistan War, and others — is 427,214.

And those who survive are facing grievous economic hardship 2— not the very wealthy, of course, which is the segment of the public the Republican party serves, but the great majority of the American public, who have had to struggle with the impact of the pandemic and the lockdowns needed to contain it. They need help, and the Federal government’s mission is to help them.

Written by LeisureGuy

2 February 2021 at 9:42 am

A thought about the Schwarzenegger video

leave a comment »

After sleeping on it, I had a few thoughts on Arnold Schwarzenegger’s video that I blogged yesterday. Let me quote some of what he said:

 I was born in 1947, two years after the Second World War. Growing up, I was surrounded by broken men drinking away their guilt over their participation in the most evil regime in history.

My father would come home drunk once or twice a week, and he would scream, and hit us, and scare my mother. I didn’t hold him totally responsible because our neighbor was doing the same thing to his family, and so was the next neighbor over.

I heard it with my own ears and saw it with my own eyes. They were in physical pain from the shrapnel in their bodies and in emotional pain for what they saw or did. It all started with lies, and lies, and lies, and intolerance.

It struck me that those insights into the reasons for his father’s behavior are not the insights of Arnold had when he was a child, being abused (physically, emotionally, and psychologically). Children have little experience or knowledge, so they tend to accept that what happens to them is just the way things are — especially if the same thing is happening in the houses of neighbors.

I think Schwarzenegger’s description of the causes of his father’s behavior reflects an understanding that came much later. I strongly suspect Schwarzeneger came to see that explanation through some extended psychotherapy and counseling, probably undertaken to examine and understand his own behavior and feelings. Psychotherapy generally includes a look back at one’s childhood family environment since that influences and shapes one’s worldview and behavior strategies. A better, deeper understanding of what was really going on in the family at the time — what was causing the behavior one saw — can help a lot in untying any psychic knots causing current problems for the adult that child became.

The statements I quote above strike me as realizations that were facilitated by a good therapist — for example, the realization that his father was not “evil,” but was acting as he did because he did know how else to deal with what had happened to him and what he had done.

Obviously, I have no direct knowledge, but I’ve done some therapy myself, and that reading certainly is consistent with my experience.

Written by LeisureGuy

11 January 2021 at 9:40 am

Politically, the US seems to have an autoimmune disease. Example: Wisconsin health-care worker intentionally spoiled more than 500 coronavirus vaccine doses

leave a comment »

An autoimmune disease results when the body’s immune systems attack the body instead of protecting it. From what I see, the US seems to be suffering from a kind of autoimmune disease.  A health-care worker destroys protective vaccines — and more generally, many people attack the measures epidemiologists and public heath authorities put in place to protect them. Police regularly (and with impunity) brutalize and even kill citizens they have sworn to protect. “Conservative” (but actually radical) politicians attack and attempt to destroy election results when they don’t like what voters chose. One party (the GOP) makes it an explicit goal to prevent the other party (Democrats) from accomplishing anything, and in fact simply refuses to do its actual duty (the Merrick Garland nomination, the presidential transition process). The US seems intent on destroying itself.

Andrea Salcedo and Isaac Stanley-Becker report in the Washington Post:

An employee at a hospital outside Milwaukee deliberately spoiled more than 500 doses of coronavirus vaccine by removing 57 vials from a pharmacy refrigerator, hospital officials announced Wednesday, as local police said they were investigating the incident with the help of federal authorities.

Initiating an internal review on Monday, hospital officials said they were initially “led to believe” the incident was caused by “inadvertent human error.” The vials were removed Friday and most were discarded Saturday, with only a few still safe to administer at Aurora Medical Center in Grafton, Wis., according to an earlier statement from the health system. Each vial has enough for 10 vaccinations but can sit at room temperature for only 12 hours.

Two days later, the employee acknowledged having “intentionally removed the vaccine from refrigeration,” the system, Aurora Health Care, said in a statement late Wednesday.

The employee, who has not been identified, was fired, Aurora Health said. Its statement did not address the worker’s motive but said “appropriate authorities” were promptly notified.

Wednesday night, police in Grafton, a village of about 12,000 that lies 20 miles north of Milwaukee, said they were investigating along with the FBI and the Food and Drug Administration. In a statement, the local police department said it had learned of the incident from security services at Aurora Health Care’s corporate office in Milwaukee. The system serves eastern Wisconsin and northern Illinois, and includes 15 hospitals and more than 150 clinics, according to its website.

Leonard Peace, an FBI spokesman in Milwaukee, . . .

Continue reading. There’s more.

Later in the report:

The tampering will delay inoculation for hundreds of people, Aurora Health officials said, in a state where 3,170 new cases were reported and 40 people died Wednesday of covid-19, the disease caused by the coronavirus, according to The Washington Post’s coronavirus tracker.

“We are more than disappointed that this individual’s actions will result in a delay of more than 500 people receiving the vaccine,” the health system said in a statement.

Written by LeisureGuy

31 December 2020 at 12:31 pm

“Those of Us Who Don’t Die Are Going to Quit”: A Crush of Patients, Dwindling Supplies and the Nurse Who Lost Hope

leave a comment »

J. David McSwane reports in ProPublica:

Nurse Kristen Cline was working a 12-hour shift in October at the Royal C. Johnson Veterans Memorial Hospital in Sioux Falls, South Dakota, when a code blue rang through the halls. A patient in an isolation room was dying of a coronavirus that had raged for eight months across the country before it made the state the brightest red dot in a nation of hot spots.

Cline knew she needed to protect herself before entering the room, where a second COVID-19 patient was trembling under the covers, sobbing. She reached for the crinkled and dirty N95 mask she had reused for days.

In her post-death report, Cline described how the patient fell victim to a hospital in chaos. The crash cart and breathing bag that should have been in the room were missing. The patient wasn’t tethered to monitors that could have alerted nurses sooner. He had cried out for help, but the duty nurse was busy with other patients, packed two to a room meant for one.

“He died scared and alone. It didn’t have to be that way. We failed him — not the staff, we did everything we could,” she said. “The system failed him.”

The system also failed her. Since the pandemic’s early weeks, Cline had complained that the Department of Veterans Affairs, which runs the nation’s largest hospital system, wasn’t doing enough to protect its front-line health care workers. She had filed complaints about inadequate personal protective equipment with the agency’s inspector general and the Occupational Safety and Health Administration, but they had done nothing. Many months into a pandemic, they were still having to ration masks and being asked to reuse them for as many as five shifts.

From Cline’s perspective and that of other health care workers I spoke with from the VA hospital in Sioux Falls, the lack of masks was a symptom of larger failures at the agency overseeing the medical care of 9 million veterans. The hospitals lacked staff and scrounged to find gowns, medical supplies, ventilators — everything needed to battle COVID-19.

While every American hospital was stretched by the pandemic, the VA’s lack of an effective system for tracking and delivering supplies made it particularly vulnerable, according to a recent examination by the federal Government Accountability Office. When the pandemic hit, the agency relied on a few big contractors to supply everything from N95 masks to needles to isolation gowns. Those few big contractors fell victim to a global shortage of masks. And the VA had no reliable tracking system to tell officials what hospitals have, what they need or what was expired. At the Sioux Falls facility, things got so desperate, the supply chain for masks relied on a guy named Steve who gave them out one at time from a nearby warehouse, employees said.

As COVID-19 overwhelmed the antiquated system, VA leadership asked employees at more than 170 hospitals to enter inventory by hand into spreadsheets every day and did “not have insight” into how resources were being deployed, the report said. In other words, the local Best Buy or Walgreen’s had more efficient ways of managing inventory to get supplies to the right place.

The resulting scramble, which ProPublica has investigated over the past eight months, was a disorganized, poorly overseen effort to buy masks and other supplies from just about anyone who said they could deliver. Hoping to compensate for a disastrous lack of preparation, the VA awarded more than 100 contracts worth over $120 million to vendors with whom it had never done business.

The COVID-19 pandemic came at a tough moment for the agency, which was more than a year into a massive reorganization by the administration of President Donald Trump that left hundreds of jobs empty and sent the VA scrambling to hire contract positions to help with, among other things, procurement of supplies.

Kevin Lyons, an associate professor and supply chain expert at Rutgers Business School, said nothing the VA did before or during the pandemic showed it had a handle on its own purchase and delivery of supplies, let alone prepare for a global shortage. His research is exploring how the Trump administration’s purge of hundreds of VA staff members created a path to disaster.

VA Secretary Robert Wilkie had boasted about across-the-board staff cutbacks in November 2019, just weeks before the first confirmed U.S. COVID-19 case, noting that he had “relieved people as high as network directors to people at the other end of our employee chain.”

Lyons, an Air Force veteran, told me top VA officials have been able to claim all’s well — even as nurses and doctors describe continued shortages and rationing — because bureaucrats who awarded contracts did little or nothing to track how they worked out. He said the rapid-fire approval of contracts gave “the appearance that we’re doing something. But there was no connection between the nurses and the doctors who actually need it.”

“All they really care about is, you know, signing a contract, and then crossing your fingers and hoping that stuff comes,” Lyons said. “And that’s just not the way that supply chain is supposed to happen.” . .

Continue reading. There’s much more.

Written by LeisureGuy

30 December 2020 at 4:40 pm

When ‘The American Way’ Met the Coronavirus

leave a comment »

Bryce Covert writes in the NY Times:

The end of the year has been awkward for Gov. Andrew Cuomo. As he promotes his new, self-congratulatory book about navigating New York through its first coronavirus wave of in the spring, he is also battling a new surge of cases.

He’s not been too happy. At a news conference in late November, he lashed out at his constituents.

“I just want to make it very simple,” he said. “If you socially distanced and you wore a mask, and you were smart, none of this would be a problem. It’s all self-imposed. It’s all self-imposed. If you didn’t eat the cheesecake, you wouldn’t have a weight problem.”

His blunt rhetoric exemplifies how political leaders — in Washington and in red and blue states — are responding to the Covid-19 crisis. They’ve increasingly decided to treat the pandemic as an issue of personal responsibility — much as our country confronts other social ills, like poverty or joblessness.

Yes, it’s absolutely critical that we wear masks and continue to keep our distance. But these individual actions were never meant to be our primary or only response to the pandemic.

Instead, more than 10 months into this crisis, our government has largely failed to act. There is no national infrastructure for testing or tracing. States have been put in a bind by federal failure, but even so, many governors have dithered on taking large-scale actions to suppress the current surge.

As Governor Cuomo excoriated New Yorkers about mask-wearing, he took no responsibility for not shutting down indoor dining for weeks, well into the new spike.

“We’re putting a lot of faith in individual actions and individual collective wisdom to do the right thing,” Rachel Werner, the executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania, told me, “but it’s without any leadership.”

It’s no great mystery what the government could do to control the virus. Every expert I spoke to agreed on the No. 1 priority: testing.

“The primary thing we really should have had is ubiquitous testing, and the government has just not chosen to do that,” said Ashish Jha, the dean of the School of Public Health at Brown University and an early adviser to the White House Covid task force.

States can do only so much with their limited resources to roll out a testing regime; it requires the resources and heft of the federal government. And while the year-end relief legislation provides more money for testing, it’s not nearly enough, particularly for producing and sustaining rapid testing.

Dr. Jha said that early in his time on the task force there was a lot of interest in building a robust testing system. “But it was killed by the political leadership in the White House,” he said.

Then, the Trump administration allowed financial aid to businesses and households to dry up during some of the worst months of the pandemic — and only just struck a last-minute deal to partly revive it.

The inconsistent aid had a cascading effect. Governors like Mr. Cuomo, who don’t have the budgetary ability of the federal government to extend substantial business relief, ended up in a difficult situation as the virus surged in late summer and fall. New York had to keep high-risk businesses open, it was argued, so that they could earn whatever meager revenue they could. But what is “the economy” worth if it comes at the cost of our physical well-being, our very lives?

Calling Covid restrictions “Orwellian,” Kayleigh McEnany, the White House press secretary, said on “Fox & Friends” in late November that “the American people are a freedom-loving people” who “make responsible health decisions as individuals.” That, she said, is “the American way.”

I agree with her on one point: It is the American way to champion individualism over collective obligation. In 2019, 34 million Americans officially lived below the poverty line in this country, with many millions more struggling just above it — and that number has only increased since then. We could lift every family out of poverty by sending out regular checks; other countries use taxes to fund benefits that significantly reduce their poverty rates. Poverty, then, is a policy choice.

The pandemic gave us a crystal-clear window into this. The government’s initial response kept poverty from rising. But once stimulus checks and enhanced unemployment benefits started expiring, millions of people were pushed into destitution. It took Congress months to reach a deal to send more help, and even so, the latest relief bill cut back on stimulus spending and slashed supplementary federal unemployment benefits in half.

“We’ve basically had a complete abdication of the federal response,” Gregg Gonsalves, an assistant professor in epidemiology of microbial diseases at Yale, told me when asked about the interplay between public health and economic struggles.

If we want people to take individual actions to help curb the spread of the virus, we also need to invest in their ability to do so. The government could send every household masks — a plan the Trump administration nixed early on. It could pay Americans to stay home if they feel sick, test positive or work for a business that should close for public health reasons, to avoid choosing between their health and their bills.

“If you want people to do the right thing you have to make it easy, and we’ve made it hard,” Dr. Gonsalves noted. States, too, have been told they’re on their own, with Congressional Republicans refusing to agree to the money Democrats want to send to help fill the vast hole left by the pandemic. In response, some governors seem to be prioritizing businesses over public health, handing out ineffectual curfews to restaurants and bars rather than just shutting them down.

But to help . ..

Continue reading.

The meme of the independent individual, beholding to no one, going his or her own way without no community, no responsibilities to anyone save himself, is constantly promoted in movies, in books, and in stories — think of the Serge Leone/Clint Eastwood westerns as an archetype.

Written by LeisureGuy

29 December 2020 at 12:28 pm

Dr. David Suzuki on the covid-19 vaccine

leave a comment »

An interesting comment posted in Facebook:

Recently the Suzuki Elders received an email asking if we knew what Dr David Suzuki thought about the Covid 19 vaccine(s). The person asked “My husband and I are debating whether or not to have the corona virus vaccine administered to our family. We wondered “What would David Suzuki do?” Here, written in his usual fulsome manner, is David Suzuki’s response. We then asked for permission to post this letter to the larger public through our Elder Facebook page and Dr Suzuki agreed.

December 10 2020

I have a couple of responses to your query about the COVID vaccine. Vaccination, like antibiotics, is one of the great innovations of medicine and the story of how it came to be is a wonderful one. You may know it, but basically smallpox has been a terrible disease that practically wiped-out Indigenous people who had not encountered it before. In the 1700s it had been reported that milkmaids contracted cowpox from milking cows. They would get lesions on their hands and arms but would recover but never contracted smallpox that was a deadly disease, killing between 20 – 60% of its victims while 1/3 of the survivors went blind and almost all had disfiguring scars from the pox. Edward Jenner deliberately infected a boy with cowpox and when he recovered, Jenner injected smallpox (something that would never be done today) and the boy was immune.

That began vaccination that has saved millions of lives and in 1980 smallpox was eradicated worldwide. It’s now extinct. Now a big push is on to do the same with polio.

So, I am a big admirer of vaccination. It involves using the body’s own mechanism of immunity by injecting an antigen, usually a coat protein of a virus or sometimes a heat killed virus itself. The body recognizes a foreign material and creates antibodies to eliminate it. So, we have inbuilt defenses that vaccination accelerates. There have been contaminants in the past resulting from the way antigens are processed chemically. After widespread use, the Salk vaccine was found to carry a live virus that was ultimately found to be harmless. And there have been trace amounts of chemicals like mercury. But the whole basis of the anti-vax movement was a report that has been proved to be bogus, yet it is repeated over and over.

The speed with which the new vaccines have been developed is astounding. After more than 40 years, there is still no vaccine for HIV. The reason it has taken so long to get approval for the new ones is that there is a very elaborate assessment process to ensure safety.

Now the Pfizer and Moderna vaccines are radically different from the traditional antigen injection. It involves injecting the gene (mRNA) specifying the coat protein (spike) and the gene gets into our cells where they produce the spike antigen and that, it turns out, is a very powerful way of getting our immune system to respond. The efficacy of this method is amazingly high. There might be some consequences that we can’t find until the treatment has gone on for years (esoteric issues like what happens to the mRNA, can it get into the nucleus of a cell and integrate into its DNA). What excites me is that this new approach could allow us to create vaccines very rapidly for any new viruses that emerge in future.

I’m sorry I’ve gone on so long. Most of medicine is about relieving symptoms when we are sick and depending on the healing capacity of the body, but vaccination is really a medical intervention that works. Would I take the new vaccine of Pfizer or Moderna? In a flash. I’m in a high-risk category and while I know I’m in the last part of my life, I don’t want to risk hurrying the end. Would I have any concerns about unexpected deleterious effect? Nothing is absolutely sure in medicine but I have no worries at all. Get it to me quick.

There is an aspect of anti-vaxxers (I know you’re not coming at it from conspiracy) that I have to rant about. A lot of folks are saying it’s their right to decide whether or not to get a shot. It’s all about freedom. The thing that bugs me is that freedom comes with responsibility otherwise it’s just license to do anything. If people resist mandated vaccination as a constitutional right, what about the right of everyone else who is sharing the same air? I hope they have a complete airtight case around them so they only breathe their own air. And they should not be allowed to use public medical facilities if they do get sick because they’ve opted out of the system by abrogating their responsibilities.

Thank you for your query. Please know I am not a medical doctor.

– – – David Suzuki

Written by LeisureGuy

28 December 2020 at 10:41 am

Congress helped with US medical fees — and reminded us of how bad it is

leave a comment »

Paul Waldman writes in the Washington Post:

In the 5,593 pages of the covid-19 relief and spending bill that will soon become law, there are some awful things and some wonderful things. And at least one provision is both.

It’s a provision that protects patients from “surprise medical bills,” just one of many horrors unique to the American health care system. It’s wonderful that the relief bill addresses the problem. It’s awful that it was even necessary.

Here’s how surprise medical bills work. You have an injury or an accident or some other kind of medical crisis, and since you don’t want to get hit with a huge bill, you go to the emergency room of a hospital in your network. Then a few weeks later you get a bill for hundreds, thousands or even tens of thousands of dollars, because unbeknownst to you, someone who treated you wasn’t in your network. Surprise!

Maybe it was the doctor in the ER; it could have been someone who showed up when you were unconscious, so even if you had the presence of mind to ask every person in the room “Are you in my network?” as you were bleeding all over the place, you still wouldn’t have avoided the bill.

As The Post notes, “A study this year by the Kaiser Family Foundation of millions of insurance claims found that nearly 1 in 5 emergency room visits nationwide led to at least one unexpected bill for care outside the patient’s insurance network.”

This worked out great for the health care industry, as long as it didn’t attract too much attention. Insurers could avoid some costs, and as the New York Times reports, “Some private-equity firms have turned this kind of billing into a robust business model, buying emergency room doctor groups and moving the providers out of network so they could bill larger fees.” What an inspiring story of entrepreneurial creativity.

Now the responsibility has been taken off the backs of patients. But Congress excluded ambulance rides, which are usually not in-network and cost hundreds of dollars. And the new rules won’t take effect for another year.

To repeat: It’s great that Congress addressed this problem, even if imperfectly. And it’s absolutely insane that we have a health care system that victimizes us this way in the first place.

You probably know the basic problem: America pays far more than any other country on earth for health care, yet we have tens of millions of people with no insurance at all, and our health outcomes are no better than countries that spend much less. We spend twice as much per capita as the average country in the Organization for Economic Cooperation and Development, yet we have the lowest life expectancy among those advanced countries.

Underneath that broad reality is an orgy of exploitation and victimization in ways large and small, ranging from the bill that’s merely annoying to the one that drives you into bankruptcy.

That the industry has convinced us that we can do no more than tinker around the edges of this system has to count as one of the great propaganda triumphs in history. Wendell Potter, an insurance industry whistleblower, will be happy to explain how he and others spread the lie that the Canadian health care system is a nightmare when it’s superior to ours in almost every way, to convince people that serious reform is impossible and they should be happy with what they have.

Yet if you asked someone from anywhere else in the industrialized world how their country handles surprise medical bills, they’d answer, “What now?” That’s because they don’t have them. Nor do they have “medical debt.” Or “the uninsured.” Or “networks” a provider could be in or out of. It’s just not a thing.

That’s because while there are many different health care models — Britain’s is different from Canada’s, which is different from Germany’s, which is different from Japan’s — all start from the premise that everyone deserves care they can afford. When that requires strong government to make sure prices stay reasonable and patients are protected — even if it means your orthopedist might drive a Volkswagen and not a Porsche — that’s what they use.

Our system, on the other hand, is based on the premise that health care is, at its heart, a business that should continue to generate massive profits, with some regulation that curbs its worst excesses. The result is not only that we have to pay so much for a system with so many holes, but that periodically we learn about some horrific practice like surprise billing, which continues until it gets enough attention that Congress resists industry lobbying and gets rid of it. . .

Continue reading. There’s more.

Written by LeisureGuy

22 December 2020 at 4:17 pm

Impatience: a deep cause of Western failure in handling the pandemic

leave a comment »

Branko Milanovic writes at Global Inequality:

 In  October 2019, Johns Hopkins University and the Economist Intelligence Unit published the  Global Epidemic Preparedness Report (Global Health Security Report). Never was a report on an important global topic better timed. And never was it more wrong.

The report argued that the best prepared countries are the following three: the US (in reality, the covid outcome, as of mid-December 2020, was almost 1000 deaths per million), UK (the same), and the Netherlands (almost 600). Vietnam was ranked No. 50 (while its current covid fatalities per million are 0.4), China was ranked 51st (covid fatalities are 3 per million), Japan was ranked 21st (20). Indonesia (deaths: 69 per million) and Italy (almost 1100 deaths per million) were ranked the same; Singapore (5 deaths per million) and Ireland (428 deaths per million) were ranked next to each other. People who were presumably most qualified to figure out how to be best prepared for a pandemic have colossally failed.

Their mistake confirms how unexpected and difficult it is to explain the debacle of Western countries (where I include not only the US and Europe, but also Russia and Latin America) in the handling of the pandemic. There was no shortage of possible explanations produced ever since the failure became obvious: incompetent governments (especially Trump), administrative confusion, “civil liberties”, initial underestimation of the danger, dependence on imports of PPE…The debate will continue for years. To use a military analogy: the covid debacle is like the French debacle in 1940. If one looks at any objective criteria (number of soldiers, quality of equipment, mobilization effort), the French defeat should have never happened. Similarly, if one looks at the objective criteria regarding covid, as the October report indeed did, the death rates in the US, Italy or UK are simply impossible to explain: neither by the number of doctors or nurses per capita, by health expenditure, by the education level of the population, by total income, by quality of hospitals…

The failure is most starkly seen when contrasted with East Asian countries which, whether democratic or authoritarian, have had outcomes that are not moderately but several orders of magnitude superior to those of Western countries. How was this possible? People have argued that it might be due to Asian countries’ prior exposure to epidemics like SARS, or Asian collectivism as opposed to Western individualism.

I would like to propose another deeper cause of the debacle. It is a soft cause. It is a speculation. It cannot be proven empirically. It has never been measured and perhaps it is impossible to measure with any degree of exactness. That explanation is impatience.

When one looks at Western countries’ reaction to the pandemic, one is struck by its stop-and-go character. Lockdown measures were imposed, often reluctantly, in the Spring when the epidemic seemed to be at the peak, just to be released as soon as there was an improvement. The improvement was perceived by the public as the end of the epidemic. The governments were happy to participate in that self-deception. Then, in the Fall, the epidemic came back with vengeance, and again the tough measures were imposed half-heartedly, under pressure, and with the (already once-chastened) hope that they could be rescinded for the holidays.

Why did not governments and the public go from the beginning for strong measures whose objective would not have been merely to “flatten the curve” but to either eradicate the virus or drive it out to such an extent, as it was done in East Asia, so that only sporadic bursts might remain? Those flare ups could be dealt again using drastic measures as in June when Beijing closed its largest open market, supplying several million people, after a few cases of covid were linked to it.

The public, and thus I think, the governments were unwilling to take the East Asian approach to the pandemic because of a culture of impatience, of desire to quickly solve all problems, to bear only very limited costs. That delusion however did not work with covid.

I think that impatience can be related to  . . .

Continue reading.

Written by LeisureGuy

16 December 2020 at 2:30 pm

The deadliest days in US history

leave a comment »

Today (Wednesday, December 9) more than 3,034 deaths from coronavirus were reported across the US, according to Johns Hopkins. That’s more than the death toll from 9/11. The daily death toll from Covid-19 is likely to increase as the illness progresses in those who were infected at Thanksgiving gatherings.

And the President is completely ignoring this disaster and instead is spending his time trying to overturn an election he lost, an election whose results have been certified after being checked and double-checked.

Written by LeisureGuy

9 December 2020 at 8:39 pm

%d bloggers like this: