Later On

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Archive for the ‘Healthcare’ Category

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Written by Leisureguy

18 December 2021 at 10:58 am

Trump Admin Sabotaged COVID Efforts to Score Political Points, House Probe Finds

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Corbin Bolies reports in Daily Beast:

A House oversight panel found former President Donald Trump and his administration routinely undermined efforts to fight the coronavirus pandemic last year, prolonging a deadly public health disaster in the hopes of winning an election he eventually lost.

The conclusion was part of a 46-page report released Friday by the House Select Subcommittee on the Coronavirus Crisis. The report collated documents that had largely been released in the preceding months, including documents showing that the Trump administration prevented public officials from giving public briefings on the virus and attempted to play down the importance of testing.

But it also showed the Trump administration’s malfeasance throughout the first year of the COVID-19 pandemic in new ways, including the ways they infuriated public health officials who felt they couldn’t do their jobs.

Dr. Jay Butler, the deputy director for infectious diseases at the Centers for Disease Control and Prevention (CDC), told the panel how he felt the directive to change mask guidance for churchgoers in May 2020 may have put them at unnecessary risk. He wrote in one email that he felt “very troubled… that there will be people who will get sick and perhaps die because of what we were forced to do.”

The beleaguered COVID-19 response coordinator, Dr. Deborah Birx, also attempted to express her frustration with the administration’s lack of effort. She said she refused to participate in a meeting with a “fringe groups” of officials who pushed the idea of herd immunity.

“These are people who believe that all the curves are predetermined and mitigation is irrelevant—they are a fringe group without grounding in epidemics, public health or on the ground common sense experience,” she wrote in an August 2020 email to Marc Short, the then-chief of staff to Vice President Mike Pence. “I am happy to go out of town or whatever gives the WH cover.”

Birx also told the committee that Dr. Scott Atlas, the conspiracy theorist turned Trump adviser, worked to change guidance to avoid testing asymptomatic individuals exposed to COVID-19—even though it contradicted the science surrounding the virus.

The committee said these and other examples proved the  . . .

Continue reading. The President of the United States should, IMO, protect the public. Obviously, some disagree.

Written by Leisureguy

17 December 2021 at 3:13 pm

Guttmacher Institute staff say a ‘toxic’ work culture has the reproductive rights research giant in a ‘death spiral’

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Guttmacher Institute offers an example of how power and privilege can result in ignorance and blindness, leading to a kind of corruption of power. Tina Vásquez writes in Prism:

Last year, the police murder of George Floyd sparked months of protests over police brutality and racism, and triggered calls for accountability across industries—including the reproductive rights, health, and justice field. In June 2020, the racial reckoning came to the Washington, D.C., office of internationally renowned sexual and reproductive health and rights research organization, Guttmacher Institute. Because of the pandemic, this reckoning came in the form of a disastrous Zoom meeting.

Guttmacher’s current vice president for public policy, Heather Boonstra, reportedly began the June 2 meeting with the Washington, D.C., public policy team by acknowledging the murder of Floyd and offering some thoughts about racism and the importance of Guttmacher’s work, according to employees who were present. She then invited staffers to discuss their feelings and share how they were “finding equilibrium.” Staff members suggested that Guttmacher put supportive policies in place for Black staff and other employees of color, including loosening deadlines and implementing more proactive and explicit policies for leave without penalty. Staffers also tried to get managers to agree to more training on racial equity and microaggressions that would go beyond what Guttmacher had already offered, which they said felt like “token efforts” where even the facilitator conceded not enough time had been alloted to “cover everything.”

Their suggestions were met with a chilly reception. According to multiple employees, when staff suggested Guttmacher do something tangible for Black employees in other divisions of the organization, Boonstra became frustrated. Why were staffers talking about “workplace problems” instead of “police brutality?” she reportedly asked.

“I’m here to talk about George Floyd and the other African American men who have been beaten up by society,” Boonstra reportedly said.

Then, staffers told Prism, she called them “self-centered,” and said she was “disappointed” by their behavior.

But the June 2 meeting certainly wasn’t the first time leadership at the 53-year-old-organization was alerted to the urgent need to better support Black employees and other staff of color. While Guttmacher is widely celebrated for producing quality research, policy, and analysis, it’s also increasingly the subject of a great deal of speculation from workers in the wider reproductive health, rights, and justice movement. News of the organization’s reported turmoil isn’t entirely a surprise for those who’ve been paying attention. There have been social media posts and negative online reviews from former employees. Internally, workers say they have used every tool at their disposal—exit interviews, surveys, formal complaints, and even whistleblower reports to the board—in an effort to get Guttmacher management to address “systemic problems.” According to former and current staff members in the D.C. office, these problems include a pattern of tokenizing or pushing out staff of color (if they’re hired at all), retaliating against employees who raise equity and justice issues, verbally abusing staff, and systematically failing to meaningfully engage with reproductive justice organizations whose work centers Black women.

The core of many of these issues is reflected in the demographics of the organization’s Washington, D.C., office. Currently, the D.C.-based public policy division, which encompasses teams that focus on policy, federal issues, state issues, and global issues, is composed entirely of white women, including Boonstra. There have been no Black or Latinx members of Guttmacher’s policy team in at least a decade, and there has never been a senior Black or Latinx staff member in the history of Guttmacher’s D.C. office. The highest ranking D.C. employees are white women who have been with the organization for decades. While Guttmacher’s largely New York City-based executive leadership team is diverse, that’s a very new development at the Institute.

Despite these well-documented issues, the conversation in the June 2 meeting went nowhere, sources said. Slowly, everyone went off camera except for white managers, and Boonstra moved forward with the regular agenda. Boonstra then threw the meeting to “Anna,” a South Asian woman who’d just been promoted to management. Not coincidentally, Anna noted, at that time she was the only person of color in management on the policy team.

“I felt very used and abused in that moment,” said Anna, who is using a pseudonym for fear of retaliation. “I didn’t feel comfortable as a new person, as a brown person, trying to smooth over the mess they created. Combined, [management in the meeting] worked at the organization for decades, but they wanted me to lead a conversation about race. That’s pretty much when I decided to look for another job.”

Anna joined Guttmacher in September 2019 and stayed less than two years. Prism spoke to 11 Guttmacher employees for this reporting, including six from the Washington, D.C., public policy team with whom Prism conducted interviews and maintained contact for the course of one year. These current and former employees allege that the Guttmacher Institute is a “toxic workplace,” one they say is particularly inhospitable to caretakers, women of color, and disabled people.

‘Based in white dominant culture’

Workplaces routinely fail to live up to their stated values, but national reproductive health and rights nonprofit organizations are uniquely bad for workers of color. Namely, high-ranking staff members are overwhelmingly white women who—while purporting to advocate for marginalized communities—adhere to some of the most toxic tenets of white feminism. As author Rafia Zakaria explained in her recent book Against White Feminism, these are people who refuse “to consider the role that whiteness and the racial privilege attached to it have played and continue to play in universalizing white feminist concerns, agendas, and beliefs as being those of all feminism and all feminists.” For white feminists in the U.S., reproductive health and rights are primary issues and the overwhelming whiteness of national reproductive health and rights organizations is reflected in how these groups have historically operated—and how they continue to operate.

In a recent piece for The New York Times, journalist Amy Littlefield detailed how leading reproductive rights organizations like Planned Parenthood have been caught “flat-footed” as the Supreme Court appears poised to overturn Roe v. Wade. The pro-choice movement is at a critical inflection point, and it is “being forced to reckon with its mistakes,” Littlefield wrote. A similar story is unfolding at the Guttmacher Institute.

Across Guttmacher’s New York and Washington, D.C., offices are researchers, social scientists, public policy analysts, editors, writers, and communications specialists who focus on domestic and international issues related to sexual and reproductive health and rights. The public, the media, and policymakers rely heavily on Guttmacher to better understand the U.S.’ complicated and ever-changing web of anti-abortion laws and policies—and this is just one of the many reasons the organization’s public policy division is so important.

But over the last 11 months, more than 80%of Guttmacher’s D.C. public policy division has left, including every caregiver and the only two staffers of color. The federal team of the policy division no longer exists, according to employees who’ve been tracking these departures closely. The timing of the public policy team’s implosion couldn’t be worse. On Wednesday,  . . .

Continue reading. There’s much more.

Written by Leisureguy

17 December 2021 at 2:55 pm

This One Drug Will Make Medicare Premiums Skyrocket

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From the video description;

Seniors will pay record-high Medicare premiums in 2022 after the FDA approved an Alzheimer’s drug that costs $56,000 over the objections of medical advisors. There is zero evidence that the drug cures or reverses Alzheimer’s. Three FDA administrators quit in protest.

I get the strong smell of skullduggery.

Written by Leisureguy

16 December 2021 at 4:36 pm

McKinsey taught Big Pharma how to price-gouge

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McKinsey’s greedy grubby fingerprints are all over many instances of business bad practice and borderline criminal behavior. Cory Doctorow writes in Medium:

Continue reading.

Written by Leisureguy

15 December 2021 at 10:38 am

The HPV Vaccine Prevents Cancer, but Most Parents Don’t Let Their Kids Receive It

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After all, the vaccine doesn’t helo the parents, so why should they bother having their kids get it? (I’m not sure that is the actual thought process, but whatever it is, it leads to the same outcome as the attitude set forth in the title. And who knows what the parents truly think? We can observe only what they do, which is not to allow their kids to get a vaccine that prevents cancer.

Jane E. Brody reports in the NY Times:

Vaccine hesitancy is hardly limited to shots against Covid-19. Even the HPV vaccine, which can prevent as many as 90 percent of six potentially lethal cancers, is meeting with rising resistance from parents who must give their approval before their adolescent children can receive it.

The Food and Drug Administration licensed this lifesaving vaccine in 2006 to protect against sexually transmitted infection by HPV, the human papillomavirus. Most of us will get infected with HPV during our lifetimes, certain strains of which can lead to cancers of the cervix, vagina and vulva in women; cancers of the anus and back-of-the-throat in both women and men; and penile cancer in men. HPV can also cause genital warts.

But the vaccine only works if it’s administered before people become infected by the virus. And that often means getting vaccinated before teens and young adults have any form of sexual activity, including oral sex and skin-to-skin contact without penetration.

More than half of adolescents ages 15 to 19 report having had oral sex, and one in 10 say they have had anal sex. Unless they are vaccinated, more than 80 percent of women become infected with HPV by age 50. And while most infections clear on their own, enough persist to cause many thousands of cancers years later. There is no treatment for an HPV infection.

Yet Kalyani Sonawane, a researcher at the University of Texas Health Science Center, and her colleagues reported in March that parental intent not to vaccinate their adolescents against HPV rose from 50.4 percent in 2012 to 64 percent in 2018. Many parents resisted the vaccine despite their doctors’ recommendations, Dr. Sonawane said. Ironically, parents were most resistant — at 68.1 percent — to vaccinating girls, the very group for whom this vaccine was initially developed to prevent cervical cancer.

Researchers had long known that cervical cancer behaves like a venereal disease, transmitted through sexual contact. It is rare in virgins and most common among women with early sexual experience and multiple partners.

An infectious cause was suspected but difficult to prove. In 1968 on Page 1 of The Times, I reported a link between cervical cancer and a sexually transmitted virus called Type 2 herpes. It turned out to be a red herring. Finally, in the 1980s, the human papillomavirus was correctly identified as the cause of cervical cancer, which led to the development and marketing of a highly effective vaccine in 2006.

Now, if not for the slow adoption of the HPV vaccine by the parents of adolescents, we would likely be well on our way to eliminating nearly all cases of cervical cancer and the five other HPV-caused cancers, 45,000 cases of which are diagnosed annually in the United States, Dr. Abraham Aragones, a public health researcher at Memorial-Sloan Kettering Cancer Center told me.

Until recently, the vaccine’s ability to prevent cancer was presumed but not proved. Cervical cancer risk rises with age, most often occurring in midlife or later, so it can take many years to confirm the vaccine’s ability to protect against cancer.

Now a new study in Britain of an early version of the vaccine found that within 13 years of vaccine administration, there were 87 percent fewer cases of cervical cancer among young women immunized between ages 12 and 13, compared to unvaccinated women. Significantly lower cancer rates were also found among women immunized between ages 14 and 16 and between 16 and 18, although the greatest benefit occurred among those vaccinated at the youngest ages, before most girls were likely exposed to the virus through sexual contact.

The British study involved a vaccine called Cervarix, that protects against two variants of the virus. The current American version of the HPV vaccine, called Gardasil-9, is even more effective: It protects against nine variants of the virus and is expected to prevent more than 90 percent of HPV-related cancers, Dr. Aragones said. A recent analysis in JAMA Pediatrics found a similar decrease in cervical cancer incidence and mortality in young women since the vaccine was introduced.

Based on a steadily declining incidence of cervical cancer and a high rate of vaccine coverage in Australia, researchers there predicted that the country would have fewer than four new cases of cervical cancer per 100,000 women by 2028 and virtually none by 2066.

To be sure, regular Pap smears  . . .

Continue reading. There’s more.

Generally speaking, the parents making these medical decisions for their children have zero medical training — but still they somehow believe they are better informed than their doctors.

Written by Leisureguy

13 December 2021 at 4:14 pm

The therapists using AI to make therapy better

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Charlotte Jee and Will Douglas Heaven write in MIT Technology Review:

Kevin Cowley remembers many things about April 15, 1989. He had taken the bus to the Hillsborough soccer stadium in Sheffield, England, to watch the semifinal championship game between Nottingham Forest and Liverpool. He was 17. It was a beautiful, sunny afternoon. The fans filled the stands.

He remembers being pressed between people so tightly that he couldn’t get his hands out of his pockets. He remembers the crash of the safety barrier collapsing behind him when his team nearly scored and the crowd surged.

Hundreds of people fell, toppled like dominoes by those pinned in next to them. Cowley was pulled under. He remembers waking up among the dead and dying, crushed beneath the weight of bodies. He remembers the smell of urine and sweat, the sound of men crying. He remembers locking eyes with the man struggling next to him, then standing on him to save himself. He still wonders if that man was one of the 94 people who died that day.

These memories have tormented Cowley his whole adult life. For 30 years he suffered from flashbacks and insomnia. He had trouble working but was too ashamed to talk to his wife. He blocked out the worst of it by drinking. In 2004 one doctor referred him to a trainee therapist, but it didn’t help, and he dropped out after a couple of sessions.

But two years ago he spotted a poster advertising therapy over the internet, and he decided to give it another go. After dozens of regular sessions in which he and his therapist talked via text message, Cowley, now 49, is at last recovering from severe post-traumatic stress disorder. “It’s amazing how a few words can change a life,” says Andrew Blackwell, chief scientific officer at Ieso, the UK-based mental health clinic treating Cowley.

What’s crucial is delivering the right words at the right time. Blackwell and his colleagues at Ieso are pioneering a new approach to mental-health care in which the language used in therapy sessions is analyzed by an AI. The idea is to use natural-language processing (NLP) to identify which parts of a conversation between therapist and client—which types of utterance and exchange—seem to be most effective at treating different disorders.

The aim is to give therapists better insight into what they do, helping experienced therapists maintain a high standard of care and helping trainees improve. Amid a global shortfall in care, an automated form of quality control could be essential in helping clinics meet demand.

Ultimately, the approach may reveal exactly how psychotherapy works in the first place, something that clinicians and researchers are still largely in the dark about. A new understanding of therapy’s active ingredients could open the door to personalized mental-health care, allowing doctors to tailor psychiatric treatments to particular clients much as they do when prescribing drugs.

A way with words

The success of therapy and counseling ultimately hinges on the words spoken between two people. Despite the fact that therapy has existed in its modern form for decades, there’s a surprising amount we still don’t know about how it works. It’s generally deemed crucial for therapist and client to have a good rapport, but it can be tough to predict whether a particular technique, applied to a particular illness, will yield results or not. Compared with treatment for physical conditions, the quality of care for mental health is poor. Recovery rates have stagnated and in some cases worsened since treatments were developed.

Researchers have tried to study talking therapy for years to unlock the secrets of why some therapists get better results than others. It can be as much art as science, based on the experience and gut instinct of qualified therapists. It’s been virtually impossible to fully quantify what works and why—until now. Zac Imel, who is a psychotherapy researcher at the University of Utah, remembers trying to analyze transcripts from therapy sessions by hand. “It takes forever, and the sample sizes are embarrassing,” he says. “And so we didn’t learn very much even over the decades we’ve been doing it.”

AI is changing that equation. The type of . . .

Continue reading. There’s much more, and it’s fascinating.

Written by Leisureguy

8 December 2021 at 12:06 pm

A Harvard nutritionist and brain expert shares the 5 foods she eats every day to sharpen her memory and focus

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A particularly frustrating type of error message — or any sort of instruction — is being told what is wrong without providing any information on what is right. So, to accompany the previous post by Dr. Uma Naidoo, here are 5 foods not to avoid, from a CNBC article by Lauren Armstrong, who interviewed  Dr. Naidoo, a nutritional psychiatrist, faculty member at Harvard Medical School and author of This Is Your Brain on Food, “about what she eats to sharpen her memory, focus and overall brain health.”

1. Extra-dark chocolate

The article actually said “extra dark chocolate,” but I don’t think anyone who has some dark chocolate considers any of it “extra.” I feel certain that what was meant was “extra-dark” chocolate.

I love dark chocolate, but I find that I cannot keep it around. However much I buy seems to be a single serving — well, not quite true: I do keep dark unsweetened baking chocolate on hand for making chili. But a 100% cacao chocolate bar? It’s a single serving.

That said, I do buy 100% cacao chocolate bars from time to time — for my health, you know.

2. Berries

One of the Daily Dozen, so I eat a serving a day — usually frozen mixed berries (blueberries, raspberries, and blackberres, and sometimes also strawberries) that I thaw, but sometimes fresh.

3. Turmeric (with black pepper)

Again on the Daily Dozen list. I eat 1/2 teaspoon ground turmeric with lots of freshly ground black pepper, and I also often cook greens or other veggies with minced fresh turmeric root (again with lots of black pepper). The pepperine in the pepper coaxes the liver into allowing the good stuff from the turmeric to be absorbed by the body. I just earlier updated an earlier post to include fresh turmeric. I thought of it as I was mincing garlic, ginger, and jalapeño pepper.

4 Leafy greens

Again on the Daily Dozen list. I eat at least two servings a day, sometimes more. I had some of the tung ho I recently cooked earlier, and I’m about to go cook the collards now.

5. Fermented foods

I eat these daily, now that I started fermenting my own veggies. BTW, using some of the liquid from the fermented Cabbage & Red to start the Leek Kraut with Tarragon was not totally successful: after a couple of days, fermentation was slack. So I hydrated some of the starter culture and added it to the jar, so I think i’ll see some activity soon.

On the whole, I’m doing well with these foods, though I think I’ll make a point of buying 1 extra-dark chocolate bar per week. A good resolution, I think, and easy to keep.

Written by Leisureguy

30 November 2021 at 3:13 pm

A Harvard nutritionist and brain expert says she avoids these 5 foods that ‘weaken memory and focus’

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Four out of five ain’t bad. 🙂

The CNBC article by Dr. Uma Naidoo lists 5 foods, and offers reasons to avoid them. The foods, with my own reasons, are:

1. Added Sugars

I automatically avoid these because I eat a whole-food plant-based diet. Added sugars are always refined sugars (unless they use date sugar (ground whole dried dates), and no one does), and I don’t eat highly processed foods (the foods that you buy that contain such sugars are highly processed). Of course, you could also add (refined) sugar to you coffee or tea. I don’t. So yes, I avoid added sugars. (I do eat fruit every day, but the sugar in fruit does not affect your body in the way refined sugar does.)

2. Fried foods

This category focuses mainly on deep-fried foods (generally breaded, which involves refined and highly processed flour, thus I avoid), rather than (say) vegetables cooked in a tablespoon of olive oil. The specific foods mentioned: “French fries, tempura, samosas, fish and chips and chicken-fried steak.” Nope, not even close.

3. High-glycemic-load carbohydrates

Such carbohydrates are found in highly refined (and highly processed) foods: bread, cake, pastries, and the like, but also in potatoes and white rice. Potatoes (including sweet potatoes) are whole foods but they do impact my blood glucose, so I don’t eat them. White rice is a refined food (bran removed), and I eat only intact whole grain — but even so I avoid brown rice: blood-glucose impact. Black rice seems to be okay.

4. Alcohol

This one is apparently not to be avoided altogether, according to the author:

In 2018, in the British Medical Journal, they reported that people who had abstained from alcohol completely or who consumed more than 14 drinks per week had a higher risk of dementia compared to those who drank alcohol in moderation.

In general, men who consume more than 14 drinks per week or more than four drinks in a single day at least once a month are considered to be heavy drinkers, as are women who drink more than seven drinks per week or three drinks per day. But different people (and their brains) respond differently to alcohol abuse.

Still, it’s wise to be careful, and alcohol is indeed hard on the liver. My own view is that someone who partakes of alcohol daily should take a break. A recovering alcoholic I knew once told me that alcohol is sneaky, and I have always been cautious about it — perhaps because one of my grandfathers succumbed to alcoholism and died when I was an infant.

I do enjoy a drink — beer, wine, or spirits — as my blog readers know, but my limit is generally one drink, at most two, and I don’t drink at all most days. (Not drinking also helps the budget, of course: a twofer.)

5. Nitrates

These I doubly skip: highly processed (so not whole foods) and meat (thus not plant-based). Fuggedaboutit.

It’s interesting how much nutritional trouble one avoids by sticking to whole foods that are not meat, dairy, or eggs.

Written by Leisureguy

30 November 2021 at 2:23 pm

Health Insurance Deductibles Give Black Friday a Whole New Meaning

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Abdul el-Sayed writes in the New Republic:

A few weeks back, I had the opportunity to teach a course on pathways to universal healthcare in the United States. To be clear, I have a very particular viewpoint on this—I literally co-wrote the book on Medicare for All. But I do my best to explain precisely why Medicare for All is head and shoulders a more efficient, effective, and yes, even politically plausible approach to solving our healthcare crisis. 

Yet as someone who spends a lot of my time thinking about our healthcare system, I sometimes forget just how inured I’ve become to how broken it really is. And I was reminded anew by the disgusted reaction my students had to some of the most galling aspects of American healthcare we tend to take for granted. There were a lot of things they didn’t like, but none elicited quite the same reaction as the concept of a deductible. 

Many of you are probably shuttering just thinking about your deductible. That’s because, if you think about it, a deductible is the paywall to get the insurance you already paid for. It’s like signing up for a streaming service and then having to pay extra to watch the movie you wanted, except that it’s thousands of dollars instead of $14.99. Health insurance companies use deductibles to kick costs back onto their beneficiaries, who may choose to pay less up front in premiums (what you have to pay every two weeks to have health insurance). 

Deductibles have more than doubled over the past decade. One 2020 estimate put the median family deductible at $8,439. Considering the median American family earned $67,521 that same year, you can imagine the financial burden the deductible adds. It means that despite being insured, families are left paying out of pocket for every single healthcare interaction until they reach their deductible, which some families never reach. That’s on top of paying their premiums, which have increased by 55 percent over the past decade.

Given the rapidly increasing deductibles and the financial strain they put on families, the Kaiser Family Foundation calculated an annual “Deductible Relief Day,” the day when the average family finally pays down its deductible—like a bizarro, late-stage capitalism family Black Friday.  In 2019, Deductible Relief Day didn’t come until May 19—meaning that for nearly half the year, insured families had to pay out of pocket for their healthcare. 

And those deductibles renew every year. So for millions of families, time is running out to fit in those last-minute healthcare needs. When the clock strikes 12 in just 35 days on January 1, 2022, they’ll find their healthcare back behind the deductible paywall. It gives Black Friday a whole new meaning. 

Health insurers argue that deductibles are a simple “cost-sharing” strategy—forcing patients to have “skin in the game” when it comes to using healthcare (beyond their actual skin, I guess?). Cost-sharing, they argue, prevents beneficiaries from using unnecessary, “low-value” healthcare. They point to an out-dated 1970s-era experiment run by the Rand Corporation. It showed that patients who had to pay at the point of care did, in fact, use less healthcare, and that their health outcomes were no different than those who did not have to pay. The healthcare they forwent, the study suggests, was “low value,” unnecessary care. 

The experiment unlocked a Pandora’s Box of cost-sharing in health insurance plans. But there’s an obvious difference between the deductible they tested in the Rand experiment and the ones health insurers charge today: They are astronomically larger. 

Later studies have shown that deductibles don’t simply prevent “low value” care, but all care. One study of employees of a company that switched its coverage from a zero-cost-sharing plan to a high-deductible plan found that after the switch, their employees even used fewer diabetes medications and got fewer colonoscopies—high-value healthcare, indeed. Another study found that women who were forced into a high-deductible plan delayed breast cancer screenings. Those who went on to develop breast cancer had their treatment delayed by an average of nine months!

High-minded blather about reducing healthcare costs aside, health insurers are charging high deductibles because they can. It’s a simple, easy, and now accepted way to fleece patients by forcing them to pay for their insurance twice. After all, if it were just about cost-sharing, insurance companies could end deductibles entirely, and charge co-pays or co-insurance instead. If it was about forcing patients to have (more) skin in the game, these mechanisms that charge patients per healthcare use are arguably more effective. They charge patients for each use, rather than all or nothing depending upon the time of year, like deductibles do. But like cost-sharing in general, deductibles are simply about maximizing a bottom line. 

For families around the country, that means . . .

Continue reading. There’s more.

The US heathcare system is a sick joke.

Written by Leisureguy

26 November 2021 at 12:05 pm

Man Held in Hawaii for More Than 2 Years Over Mistaken Identity Sues the State

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Interesting how all the agencies involved refuse to comment. Maria Cramer reports in the NY Times (and that’s a gift link, so now paywall):

A man was forced to spend more than two years in a psychiatric hospital, where he was medicated until he became “catatonic,” an ordeal that began after the police in Hawaii mistook him for another person wanted for a crime, according to a federal lawsuit.

Joshua Spriestersbach, 50, was homeless in May 2017 and fell asleep outside a shelter in Honolulu, where he had been waiting in line to get food. An officer woke him up and arrested him on a warrant for a crime he had not committed.

It was the third time in six years that the police in Honolulu had confused Mr. Spriestersbach for another man who was wanted on drug-related charges.

But this time, Mr. Spriestersbach would spend 32 months in state custody, four of them in a jail in Oahu and 28 in a psychiatric hospital where doctors and psychologists refused to believe he was not the man the police said he was.

Instead, medical officials at Hawai’i State Hospital “determined him to be delusional and decompensating, and recommended more medication be administered to Joshua against his will,” according to the lawsuit, which was filed in U.S. District Court in Honolulu on Sunday and was reported by The Honolulu Star-Advertiser.

They then “got a court order to administer strong anti-psychotic medication that caused Joshua much physical and emotional anguish,” the lawsuit says.

The case drew widespread attention in August when his lawyers filed a court petition seeking to clear his name and vacate his 2017 arrest.

Mr. Spriestersbach, who now lives in Vermont with his sister, is still identified by the wrong name in Hawaii’s criminal database, meaning he could be arrested again if he ever returns, said one of his lawyers, Alphonse A. Gerhardstein.

“He’s deathly afraid,” Mr. Gehardstein said in an interview on Tuesday. “It’s outrageous that the officials there have not cleared up this warrant.”

Continue reading. Again: no paywall. This year’s Thanksgiving is going to be very meaningful for this guy.

Written by Leisureguy

23 November 2021 at 7:27 pm

Why Do We Think Mary Lincoln Was Crazy?

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Alexis Cole writes at Study Marry Kill:

Mary Lincoln was crazy. At least, that’s what we’ve heard. But why? Next week, I’ll send out a long essay on the long forgotten origin of that misnomer: Mary’s sensational 1875 insanity trial, a kangaroo court orchestrated by Robert Lincoln, her only surviving adult child, who hoped, like so many of men his time, to rid himself of a woman who embarrassed him. Robert’s plan backfired, but Mary’s legacy withstood the most damage. Mary was declared sane by the court and the press was sympathetic towards her situation—but in America’s collective memory, she’s still crazy. Next week’s essay will focus on the insanity trial, but it’s important to preface that narrative with some background. Mary was branded as“crazy” long before the trial began, and scholars have done little to correct the record.

We still live in a world full of armchair diagnosticians who call women crazy. But they’re not hoping these women get treatment; they want the women to control displays of emotions they deem unacceptable. Men receive comparatively mellow labels, even the most severe cases. A man who stalks a woman is called a “spurned suitor;” sexual harassment is often described as a “romantic overture.” A recent headline: “The body of Miya Marcano, a Florida college student who vanished after repeatedly rejecting romantic overtures from a maintenance worker in her apartment complex, has been found.” The fixation doesn’t have to be romantic. “Demon-Obsessed Teen Gets 35 Years in Slaying of Sisters.”

It’s well known that Mary witnessed Lincoln’s assasination, but less well known is that four out of five of Mary’s children predeceased her. “After my son died, I got really afraid that people would maybe judge me or think about me in the way that history has remembered Mary Lincoln,” Callie Hawkins, the interim executive director and the director of programming at President Lincoln’s cottage, told Gillian Brockell of the  Washington Post, in an article about a recent exhibition on Mary Lincoln’s experience of motherhood and bereavement “Which is to say, she was afraid they would think she was ‘crazy,’” Brockell added.

Death was a part of God’s plan. In the 19th century, struggling with it displayed a lack of piety. Mary’s conspicuous, prolonged mourning was an affront to society. “When [her second son] Eddy died, she tore out her hair; when [her third son] Willie died she was so overcome she couldn’t leave her bed for weeks and missed his funeral. She would cry loudly and wore black mourning clothes much longer than was socially acceptable,” Brockell wrote. Mary displayed a lack of submissiveness her era demanded. Women could faint on occasion, perhaps even weep at a moving scene, but sustained, barefaced emotion was to be controlled in front of others.

It doesn’t help that there are only a few books on the subject of her alleged insanity from small academic presses: The Insanity File: The Case of Mary Todd Lincoln (1986) by Pulitzer-prize winning historian Mark E. Neely, Jr., and the late R. Gerald McMurty, and The Madness of Mary Lincoln (2007) by Jason Emerson, a former U.S. National Parks Service interpreter who discovered a trunk of Mary Lincoln’s letters in a historic home (and apparently withheld access to others before publication).

Neither book gives much consideration to scholarship on women and medicine. Instead the authors grounded their conclusions in the reports of medical “experts” from the trial, some of whom had never met Mary, and then they got contemporary doctors to do the same thing. Emerson is particularly sympathetic to  . . .

Continue reading. There’s more, and it shows how we today have been looking at Mary Lincoln through a lens heavily distorted by old assumptions, prejudices, and cultural biases.

Written by Leisureguy

19 November 2021 at 11:22 am

Just how horrible and incompetent has Joe Biden been?

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Kevin Drum has a little list:

In the space of ten months, Joe Biden has:

  • Passed a $1.9 trillion COVID assistance bill.
  • Presided over a massive vaccination campaign that’s been successful despite shameless partisan opposition.
  • Withdrawn all US troops from Afghanistan with minimal American casualties.
  • Passed a $1.2 trillion infrastructure bill.
  • Gotten very close to passing a historic $2 trillion safety net bill.

Just sayin’.

Written by Leisureguy

7 November 2021 at 2:16 pm

Inside the Pharmacist Rebellion at CVS and Walgreens

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Matt Stoller has a very interesting post at Big:

Today I’m writing about a worker revolt inside chain pharmacies, and how the broader anger from workers all over the country relates to both market power and politics.

BIG Announcements

  • Because of reporting in BIG, the legislation working its way through Congress on expanding Medicare was changed. Under previous rules, Medicare could only buy from the hearing aid cartel, but now it is allowed to pay for over the counter hearing aids. That’s a good thing. The legislation doesn’t address the vertical integration of the hearing aid cartel, though I’m optimistic in the long term we’ll get there.
  • Farhad Manjoo in the New York Times featured my arguments on how to fix Facebook. I discussed why breaking apart Facebook would actually create a safer and better social networking ecosystem.

Will the Great Resignation Turn Into the Great Rebellion?

Writing about monopoly is largely about pointing out problems, but increasingly it’s also about showing a society waking from its slumber, and beginning to fight back. This particular story has to do with a rebellion inside some of the biggest health care providers in America – the firms that control the pharmacists who dispense our medicine.

These days, chain pharmacies in America are massive, with CVS alone touching a third of Americans not just through its massive retail footprint but through its various subsidiaries in other parts of health care. While big business might seem as American as apple pie, in fact the size of these firms is a new phenomenon. From the late 19th century to the 1970s, pharmacies were small-scale, often single proprietor shops or small chains. Pharmacists always played a dual role, operating as small businesses dealing with medical firms, hospitals, and powerful distributors, but also as health care providers for local communities, often the sole such provider in rural areas.

But roughly forty years ago, after we de facto legalized monopoly power by relaxing antitrust law, bigger chains emerged, using mergers and aggressive pricing tactics. In February of last year, just before the pandemic hit in force, I wrote about the most important of these chains, CVS, and how it gained power over what had been a decentralized industry. Here’s a partial list of acquisitions.

  • 1977, CVS buys 36-store-chain Mack Drug
  • 1990, CVS buys 490-store-chain People Drug Stores in the mid-Atlantic
  • 1997, CVS buys 2600-store-chain Revco D.S. across the midwest for $3.7 billion
  • 1998, CVS buys 200-store-chain in Michigan for $1.5 billion
  • 1999, CVS buys online drug store
  • 2002, CVS buys assets from bankrupt discount drug store chain Phar-Mor
  • 2004, CVS buys 1260-store-chain Eckerd stores, plus Eckerd Health Services and $1 billion mail order pharmacy benefits management business, plus three distribution centers from J.C. Penney
  • 2006, CVS buys 700-stand-alone Sav-On and Osco drugstores from Albertson’s
  • 2007, CVS buys Caremark RX pharmacy benefits manager for $26.5 billion
  • 2008, CVS buys 521-store-chain Long Drug Stores for $2.9 billion, including Rx America, a PBM with more than 8 million members
  • 2015, CVS buys Target corporation’s pharmacy business
  • 2018, CVS buys Aetna health insurance for $69 billion

Today, CVS spans not just pharmacies but health insurance, and pharmacy benefit management (PBM), which is a middleman that sits between pharmacies, doctors, and health insurance companies, taking a slice of every prescription pill and treatment sold. The market power of big pharmacy chains had a number of consequences, from lower pay for workers to higher prices and worse service to a slower roll-out of the vaccines. There are still upwards of 20,000 independent pharmacies in America, but every year it gets harder to stay in business.

What this means is that many pharmacists are now employees of big chains. And yet working as a pharmacist for a giant chain has also become increasingly difficult. Work loads have doubled over the last ten years, pay is down, and student debt loads are up (to nearly $200,000 for a recent graduate), even as the profits of Walgreens, CVS, and Walmart skyrocket. And that was before Covid, which put extra strain on pharmacists and technicians.

The worker stories coming out of the chain pharmacy world are awful. No bathroom breaks. No time for meals. Unforgiving corporate metrics like demerits for taking too long to answer the phone or fill prescriptions, requirements to ask a certain number of people per week to get a flu shot, and always a relentless push for more items to do than time to do them. And these sweatshop conditions for medical professionals don’t just mean an unpleasant day for a pharmacist or technician, it means more mistakes, and accidental deaths.

In fact, before the pandemic, the third leading cause of death in America was medical errors, at between 250,000 and 440,000 people a year, roughly the the size of Reno, Nevada dying annually. And of course, when there are safety issues caused by understaffing, the chains don’t stand by their pharmacists in front of state boards of pharmacy. If a pharmacist loses his or her license, they can’t practice.

All of this has caused deep concern within the profession. “I am a danger to the public working for CVS,” one pharmacist wrote in an anonymous letter to the Texas State Board of Pharmacy in April. Public officials and corporate executives have been hearing the complaints for years. But when things get really bad, the typical response from higher-ups for flagging morale is to… buy their pharmacists pizza. And that condescension from corporate executives and human resources officials is what finally lit the spark.

The key organizer of this rebellion is an Ivory Coast immigrant who lives in Oklahoma City named Bled Marchall Tanoe. Three months ago, . . .

Continue reading. It is interesting and may well impact you.

Written by Leisureguy

5 November 2021 at 4:07 pm

Hearing back from the hearing-aid industry

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Matt Stoller’s piece on hearing aids stirred up quite a storm. He describes some of the aftermath:

When I write about market power in specific industries, it often generates massive discussion within the industry. The cheer world, for instance, exploded in dialogue when I exposed how Varsity controls cheerleading, because I offered the moral framework of monopoly to show that their frustration wasn’t just whiny complaints but was situated in exploitative use of market power.

Similarly, my piece on the hearing aid cartel ricocheted inside the audiology world. A bunch of hearing aid users and audiologists contacted me privately with both praise and anger. As usual, several of the people saying ‘you got this right’ also said ‘don’t mention my name publicly I’m afraid of retaliation,’ which is, sadly, too common in American business. Here’s Johns Hopkins professor and hearing loss expert.

Clearly the analysis resonated, with leading hearing aid expert Dr. Abram Bailey saying on LinkedIn that it will “create quite the sh** storm.” In fact, the whole thread of comments from practitioners in the industry is interesting.

Manufacturing Costs Are $40 to $80

Frede Jensen, an engineer in the UK, noted the manufacturing costs are between $40 to $80 for hearing aids, though it’s important to note that production costs are only one part of the process of selling a hearing aid, and the actual device cost doesn’t include the critical services of a trained audiologist. Still, that amount is far lower than what people in the U.S., and other nations with similar setups like Australia, pay:

Regarding the NHS. Public data shows they, with their approved agents, buy 1 million+ mid-range hearing aids p.a. at an average price of USD78 each (to which they must add their own fitting overheads). This reflects the unit manufacturing costs of USD40 for basic to USD80 for advanced wireless models, including direct and R&D overheads.

The NHS contract hundreds of thousand basic hearing fittings (to the gold standard protocol, with REM, follow-up and 3 years patient management) to the private sector, including to Specsavers, at around USD450 for a single or USD600 for a binaural referral – although this can vary slightly between different local health authorities. This includes the cost of the hearing aid(s).

Jensen’s observations are confirmed by this market analysis by the Global Partnership for Assistive Technologies on the worldwide market for hearing aids. Some remarkable stats: . . .

Continue reading. There’s more — and the stats are quite interesting.

I’m glad President Biden kicked the FDA into acting on hearing aids (after the FDA ignored for four years the law passed by Congress). 

Written by Leisureguy

29 October 2021 at 11:57 am

Some significant requests from Pope Francis

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Pope Francis on October 16:

I ask all the great pharmaceutical laboratories to release the patents. Make a gesture of humanity and allow every country, every people, every human being, to have access to the vaccines. There are countries where only three or four per cent of the inhabitants have been vaccinated.

In the name of God, I ask financial groups and international credit institutions to allow poor countries to assure “the basic needs of their people” and to cancel those debts that so often are contracted against the interests of those same peoples.

In the name of God, I ask the great extractive industries-mining, oil, forestry, real estate, agribusiness to stop destroying forests, wetlands and mountains, to stop polluting rivers and seas, to stop poisoning food and people.

In the name of God, I ask the great food corporations to stop imposing monopolistic systems of production and distribution that inflate prices and end up withholding bread from the hungry.

In the name of God, I ask I arms manufacturers and dealers to completely stop their activity, because it foments violence and war, it contributes to those awful geopolitical games which cost millions of lives displaced and millions dead.

In the name of God, I ask I the technology giants to stop exploiting human weakness, people’s vulnerability, for the sake of profits without caring about the spread of hate speech, grooming, fake news, conspiracy theories, and political manipulation.

In the name of God, I ask the telecommunications giants to ease access to educational material and connectivity for teachers via the internet so that poor children can be educated even under quarantine.

In the name of God, I ask the media to stop the logic of post-truth, disinformation, defamation, slander and the unhealthy attraction to dirt and scandal, and to contribute to human fraternity and empathy with those who are most deeply damaged.

In the name of God, I call on powerful countries to stop aggression, blockades and unilateral sanctions against any country anywhere on earth. No to neo-colonialism. Conflicts must be resolved in multilateral fora such as the United Nations. We have already seen how unilateral interventions, invasions and occupations end up; even if they are justified by noble motives and fine words.

This system, with its relentless logic of profit, is escaping all human control. It is time to slow the locomotive down, an out-of-control locomotive hurtling towards the abyss. There is still time.

Written by Leisureguy

22 October 2021 at 2:42 pm

Merck Sells Federally Financed Covid Pill to U.S. for 40 Times What It Costs to Make

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This is one of the darker aspects of capitalism. Merck did not pay for the development of the pill, so they do not  have to recoup development costs. The high price seems due to greed alone: it’s a desperately needed medical to protect against a disease that has already killed more than 700,000 in the US, so Merck simply charges as much as they can.

Sharon Lerner reports in the Intercept:

A FIVE-DAY COURSE of molnupiravir, the new medicine being hailed as a “huge advance” in the treatment of Covid-19, costs $17.74 to produce, according to a report issued last week by drug pricing experts at the Harvard School of Public Health and King’s College Hospital in London. Merck is charging the U.S. government $712 for the same amount of medicine, or 40 times the price.

Last Friday’s announcement that the new medicine cut the risk of hospitalization among clinical trial participants with moderate or mild illness in half could have huge implications for the course of the coronavirus pandemic. Because it’s a pill — as opposed to monoclonal antibodies, a comparable antiviral treatment that is administered intravenously — molnupiravir is expected to be more widely used and, hopefully, will cut the death rate. In the first 29 days of the trial, no deaths were reported among the 385 patients who received the drug, while eight of the people who received a placebo died, according to the statement put out by Merck and Ridgeback Biotherapeutics, the two companies that are jointly launching it.

In addition to having huge implications for health, the pill could bring staggering profits to both Merck and Ridgeback Biotherapeutics. A small Miami-based company, Ridgeback licensed the medicine from Emory University in 2020 and two months later sold the worldwide rights to the drug to Merck for an undisclosed sum. Although Ridgeback remains involved in the development of the drug, some have described the deal as “flipping.”

Like the vast majority of medicines on the market, molnupiravir — which was originally investigated as a possible treatment for Venezuelan equine encephalitis — was developed using government funds. The Defense Threat Reduction Agency, a division of the Department of Defense, provided more than $10 million of funding in 2013 and 2015 to Emory University, as research done by the nonprofit Knowledge Ecology International has revealed. The National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, also provided Emory with more than $19 million in additional grants.

Yet only Merck and Ridgeback will reap the profits from the new antiviral, which according to Quartz could bring in as much as $7 billion by the end of this year. After the announcement of the encouraging clinical trial results on Friday, Merck’s stock price climbed, while stock prices of some vaccine makers sagged. Despite its initial investment, the U.S. government seems to be facing a steep markup in prices. In June, the government signed a $1.2 billion contract with Merck to supply 1.7 million courses of the medication at the $712 price. The transaction is due to take place as soon as molnupiravir receives emergency use authorization from the Food and Drug Administration.

Reasonable Terms

Good government advocates are pointing out that because federal agencies spent at least $29 million on the drug’s development, the government has the obligation to ensure that the medicine is affordable. “The public funded this drug, and therefore the public has some rights, including the rights you have it available under reasonable terms,” said Luis Gil Abinader, senior researcher at Knowledge Ecology International.

In an interview on CNBC, Ridgeback co-founder Wendy Holman noted that the company asked for but “never got government funding” to help manufacture molnupiravir. A whistleblower complaint filed by Rick Bright, the former director of the Biomedical Advanced Research and Development Authority, or BARDA, in May 2020, described Ridgeback’s unsuccessful efforts “to secure approximately $100 million” from BARDA to develop the drug as a Covid-19 treatment. The company’s press release about the study results also noted that “since licensed by Ridgeback, all funds used for the development of molnupiravir have been provided by Merck and by Wayne and Wendy Holman of Ridgeback.”

Abinader was critical of Ridgeback’s failure to acknowledge the government’s initial investment in the drug before the company acquired it. “What they want to do, apparently, is to shape the narrative about who paid for the development of this drug in order to avoid demands from the public to make it available at reasonable prices,” he said.

In an emailed response to questions submitted to Ridgeback Biotherapeutics for this article, Davidson Goldin wrote, “ . . .

Continue reading.

Written by Leisureguy

7 October 2021 at 11:10 am

What doctors know about nutrition, and the food that hospitals serve

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Written by Leisureguy

6 October 2021 at 7:19 pm

A powerful post on Reddit that shows the importance of kindness

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The longer I live, the more I see the importance of kindness. Read this post.

Written by Leisureguy

28 September 2021 at 10:37 am

The bias that blinds: Why doctors give some people dangerously different medical care

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Jessica Nordell writes in the Guardian:

I met Chris in my first month at a small, hard-partying Catholic high school in north-eastern Wisconsin, where kids jammed cigarettes between the fingers of the school’s lifesize Jesus statue and skipped mass to eat fries at the fast-food joint across the street. Chris and her circle perched somewhere adjacent to the school’s social hierarchy, and she surveyed the adolescent drama and absurdity with cool, heavy-lidded understanding. I admired her from afar and shuffled around the edges of her orbit, gleeful whenever she motioned for me to join her gang for lunch.

After high school, we lost touch. I went east; Chris stayed in the midwest. To pay for school at the University of Minnesota, she hawked costume jewellery at Dayton’s department store. She got married to a tall classmate named Adam and merged with the mainstream – became a lawyer, had a couple of daughters. She would go running at the YWCA and cook oatmeal for breakfast. Then in 2010, at the age of 35, she went to the ER with stomach pains. She struggled to describe the pain – it wasn’t like anything she’d felt before. The doctor told her it was indigestion and sent her home. But the symptoms kept coming back. She was strangely tired and constipated. She returned to the doctor. She didn’t feel right, she said. Of course you’re tired, he told her, you’re raising kids. You’re stressed. You should be tired. Frustrated, she saw other doctors. You’re a working mom, they said. You need to relax. Add fibre to your diet. The problems ratcheted up in frequency. She was anaemic, and always so tired. She’d feel sleepy when having coffee with a friend. Get some rest, she was told. Try sleeping pills.

By 2012, the fatigue was so overwhelming, Chris couldn’t walk around the block. She’d fall asleep at three in the afternoon. Her skin was turning pale. She felt pain when she ate. Adam suggested she see his childhood physician, who practised 40 minutes away. That doctor tested her blood. Her iron was so low, he thought she was bleeding internally. He scheduled a CT scan and a colonoscopy. When they revealed a golf ball-sized tumour, Chris felt, for a moment, relieved. She was sick. She’d been telling them all along. Now there was a specific problem to solve. But the relief was short-lived. Surgery six days later showed that the tumour had spread into her abdomen. At the age of 37, Chris had stage four colon cancer.

Historically, research about the roots of health disparities – differences in health and disease among different social groups – has sought answers in the patients: their behaviour, their status, their circumstances. Perhaps, the thinking went, some patients wait longer to seek help in the first place, or they don’t comply with doctors’ orders.

Maybe patients receive fewer interventions because that’s what they prefer. For Black Americans, health disparities have long been seen as originating in the bodies of the patients, a notion promoted by the racism of the 19th-century medical field. Medical journals published countless articles detailing invented physiological flaws of Black Americans; statistics pointing to increased mortality rates in the late 19th century were seen as evidence not of social and economic oppression and exclusion, but of physical inferiority.

In this century, research has increasingly focused on the social and environmental determinants of health, including the way differences in access to insurance and care also change health outcomes. The devastating disparate impact of Covid-19 on communities of colour vividly illuminates these factors: the disproportionate burden can be traced to a web of social inequities, including more dangerous working conditions, lack of access to essential resources, and chronic health conditions stemming from ongoing exposure to inequality, racism, exclusion and pollution. For trans people, particularly trans women of colour, the burden of disease is enormous. Trans individuals, whose marginalisation results in high rates of poverty, workplace discrimination, unemployment, and serious psychological distress, face much higher rates of chronic conditions such as asthma, chronic pulmonary obstructive disorder, depression and HIV than the cisgender population. A 2015 survey of nearly 28,000 trans individuals in the US found that one-third had not sought necessary healthcare because they could not afford it.

More recently, researchers have also begun looking at differences that originate in the providers – differences in how doctors and other healthcare professionals treat patients. And study after study shows that they treat some groups differently from others.

Black patients, for instance, are less likely than white patients to receive pain medication for the same symptoms, a pattern of disparate treatment that holds even for children. Researchers attribute this finding to false stereotypes that Black people don’t feel pain to the same degree as white people – stereotypes that date back to chattel slavery and were used to justify inhumane treatment. The problem pervades medical education, where “race” is presented as a risk factor for myriad diseases, rather than the accumulation of stressors linked to racism. Black immigrants from the Caribbean, for instance, have lower rates of hypertension and cardiovascular disease than US-born Black people, but after a couple of decades, their rates of illness increase toward those of the US-born Black population, a result generally attributed to the particular racism they encounter in the US.

Black patients are also given fewer therapeutic procedures, even when studies control for insurance, illness severity and type of hospital. For heart attacks, black people are less likely to receive guideline-based care; in intensive care units for heart failure, they are less likely to see a cardiologist, which is linked to survival.

These biases affect the quality of many other interactions in clinics. Doctors spend less time and build less emotional rapport with obese patients. Transgender people face overt prejudice and discrimination. The 2015 survey also found that in the preceding year, a third of respondents had had a negative encounter with a healthcare provider, including being refused treatment. Almost a quarter were so concerned about mistreatment that they avoided necessary healthcare. Transgender individuals can therefore face a dangerous choice: disclose their status as trans and risk discrimination, or conceal it and risk inappropriate treatment.

Even though medical providers are not generally intending to provide better treatment to some people at the expense of others, unexamined bias can create devastating harm.

hris was told that her symptoms, increasingly unmanageable, were not serious. Women as a group receive fewer and less timely interventions, receive less pain treatment and are less frequently referred to specialists. One 2008 study of nearly 80,000 patients in more than 400 hospitals found that women having heart attacks experience dangerous treatment delays, and that once in the hospital they more often die. After a heart attack, women are less likely to be referred to cardiac rehabilitation or to be prescribed the right medication. Critically ill women older than 50 are less likely to receive life-saving interventions than men of the same age; women who have knee pain are 22 times less likely to be referred for a knee replacement than a man. A 2007 Canadian study of nearly 500,000 patients showed that after adjusting for the severity of illness, women spent a shorter time in the ICU and were less likely to receive life support; after age 50, they were also significantly more likely to die after a critical illness.

Women of colour are at particular risk for poor treatment. A 2019 analysis of their childbirth experiences found that they frequently encountered condescending, ineffective communication and disrespect from providers; some women felt bullied into having C-sections. Serena Williams’s childbirth story is by now well known: the tennis star has a history of blood clots, but when she recognised the symptoms and asked for immediate scans and treatment, the nurse and the doctor doubted her. Williams finally got what she needed, but ignoring women’s symptoms and distress contributes to higher maternal mortality rates among Black, Alaska Native and Native American women. Indeed, Black women alone in the US are three to four times more likely to die of complications from childbirth than white women.

There’s also a structural reason for inferior care: women have historically been excluded from much of medical research. The reasons are varied, ranging from a desire to protect childbearing women from drugs that could impair foetal development, via notions that women’s hormones could complicate research, to an implicit judgment that men’s lives were simply more worth saving. Many landmark studies on ageing and heart disease never included women; the all-men study of cardiovascular disease named MRFIT emerged from a mindset that male breadwinners having heart attacks was a national emergency, even though cardiovascular disease is also the leading cause of death for women. In one particularly egregious example, a 1980s study examining the effect of obesity on breast cancer and uterine cancer excluded women because men’s hormones were “simpler” and “cheaper” to study.

Basic to these practices was an operating assumption that men were the default humans, of which women were a subcategory that could safely be left out of studies. Of course, there’s a logical problem here: the assertion is that women are so complicated and different that they can’t be included in research, and yet also so similar that any findings should seamlessly extend to them. In the 90s, the US Congress insisted that medical studies funded by the National Institutes of Health should include women; earlier, many drug studies also left out women, an exclusion that may help explain why women are 50%-75% more likely to experience adverse side-effects from drugs.

As the sociologist Steven Epstein points out, medicine often starts with categories that are socially and politically relevant – but these are not always medically relevant. Relying on categories such as race risks erasing the social causes of health disparities and may entrench the false and damaging ideas that are inscribed in medical practice. At the same time, ignoring differences such as sex is perilous: as a result of their exclusion, women’s symptoms have not been medically well understood. Doctors were told, for example, that women present with “atypical symptoms” of heart attacks. In fact, these “atypical” symptoms are typical – for women. They were only “atypical” because they hadn’t been studied. Women and men also vary in their susceptibility to different diseases, and in the course and symptoms of those diseases. They respond to some drugs differently. Women’s kidneys filter waste more slowly, so some medications take longer to clear from the body.

This dearth of knowledge about women’s bodies has led doctors to see differences where none exist, and fail to see differences where they do. As the journalist Maya Dusenbery argues in her book Doing Harm, this ignorance also interacts perniciously with historical stereotypes.

When women’s understudied symptoms don’t match the textbooks, doctors label them “medically unexplained”. These symptoms may then be classified as psychological rather than physical in origin. The fact that so many of women’s symptoms are “medically unexplained” reinforces the stereotype that women’s symptoms are overreactions without a medical basis, and casts doubt over all women’s narratives of their own experiences. One study found that while men who have irritable bowel syndrome are more likely to receive scans, women tend to be offered tranquilisers and lifestyle advice. In response to her pain and fatigue, my friend Chris was told she should get some sleep.

he doctor who finally ordered the right tests for Chris told her that he’d seen many young women in his practice whose diagnoses had been . . .

Continue reading. There’s much more, and it’s infuriating. It seems to have its roots in that a disproportionately large number of medical doctors and researchers are white men, an unknown number of whom are misogynistic and/or racist. I think an interesting study would be to take a large randomized sample of medical practitioners and researchers and administer a psychological test to determine the degree to which each is misogynistic or racist. I’m also wondering whether medical schools reinforce or combat those attitudes, or instead just ignore the problem. (I suspect they ignore the problem.)

UPDATE: After sleeping on it, I see that this as an institutional and systemic failure, not just the failure of individual doctors (though they are, of course, a part of the system). But the systemic/institutional aspects make the problem deep-rooted and will require a systemic and institutional effort to correct.

Written by Leisureguy

25 September 2021 at 6:27 pm

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