Later On

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

Archive for the ‘Healthcare’ Category

Why Americans Die So Much

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Derek Thompson writes in the Atlantic:

America has a death problem.

No, I’m not just talking about the past year and a half, during which COVID-19 deaths per capita in the United States outpaced those in similarly rich countries, such as Canada, Japan, and France. And I’m not just talking about the past decade, during which drug overdoses skyrocketed in the U.S., creating a social epidemic of what are often called “deaths of despair.”

I’m talking about the past 30 years. Before the 1990s, average life expectancy in the U.S. was not much different than it was in Germany, the United Kingdom, or France. But since the 1990s, American life spans started falling significantly behind those in similarly wealthy European countries.

According to a new working paper released by the National Bureau of Economic Research, Americans now die earlier than their European counterparts, no matter what age you’re looking at. Compared with Europeans, American babies are more likely to die before they turn 5, American teens are more likely to die before they turn 20, and American adults are more likely to die before they turn 65. At every age, living in the United States carries a higher risk of mortality. This is America’s unsung death penalty, and it adds up. Average life expectancy surged above 80 years old in just about every Western European country in the 2010s, including Portugal, Spain, France, Italy, Germany, the U.K., Denmark, and Switzerland. In the U.S., by contrast, the average life span has never exceeded 79—and now it’s just taken a historic tumble.

Why is the U.S. so much worse than other developed countries at performing the most basic function of civilization: keeping people alive?

“Europe has better life outcomes than the United States across the board, for white and Black people, in high-poverty areas and low-poverty areas,” Hannes Schwandt, a Northwestern University professor who co-wrote the paper, told me. “It’s important that we collect this data, so that people can ask the right questions, but the data alone does not tell us what the cause of this longevity gap is.”

Finding a straightforward explanation is hard, because there are so many differences between life in the U.S. and Europe. Americans are more likely to kill one another with guns, in large part because Americans have more guns than residents of other countries do. Americans die more from car accidents, not because our fatality rate per mile driven is unusually high but because we simply drive so much more than people in other countries. Americans also have higher rates of death from infectious disease and pregnancy complications. But what has that got to do with guns, or commuting?

By collecting data on American life spans by ethnicity and by income at the county level—and by comparing them with those of European countries, locality by locality—Schwandt and the other researchers made three important findings.

First, Europe’s mortality rates are shockingly similar between rich and poor communities. Residents of the poorest parts of France live about as long as people in the rich areas around Paris do. “Health improvements among infants, children, and youth have been disseminated within European countries in a way that includes even the poorest areas,” the paper’s authors write.

But in the U.S., which has the highest poverty and inequality of just about any country in the Organization for Economic Cooperation and Development, where you live is much more likely to determine when you’ll die. Infants in the U.S. are considerably more likely to die in the poorest counties than in the richest counties, and this is true for both Black and white babies. Black teenagers in the poorest U.S. areas are roughly twice as likely to die before they turn 20, compared with those in the richest U.S. counties. In Europe, by contrast, the mortality rate for teenagers in the richest and poorest areas is exactly the same—12 deaths per 100,000. In America, the problem is not just that poverty is higher; it’s that the effect of poverty on longevity is greater too.

Second, even rich Europeans are outliving rich Americans. “There is an American view that egalitarian societies have more equality, but it’s all one big mediocre middle, whereas the best outcomes in the U.S. are the best outcomes in the world,” Schwandt said. But this just doesn’t seem to be the case for longevity. White Americans living in the richest 5 percent of counties still die earlier than Europeans in similarly low-poverty areas; life spans for Black Americans were shorter still. (The study did not examine other American racial groups.) “It says something negative about the overall health system of the United States that even after we grouped counties by poverty and looked at the richest 10th percentile, and even the richest fifth percentile, we still saw this longevity gap between Americans and Europeans,” he added. In fact, Europeans in extremely impoverished areas seem to live longer than Black or white Americans in the richest 10 percent of counties.

Third,  . . .

Continue reading. There’s more, including this interesting factoid:

Air pollution has declined more than 70 percent since the 1970s, according to the EPA, and most of that decline happened during the 30-year period of this mortality research.

Related, via a post this morning by Kevin Drum:

Drum notes:

The US death rate from COVID-19 is no longer skyrocketing, but it’s still going up. Our mortality rate is 150% above Britain and more than 1000% higher than Germany.

I imagine the primary causes are widespread refusal (especially in Red states) to wear masks, to avoid crowds, and to be vaccinated, all obvious steps that significantly reduce the likelihood of infection and thus reduce the likelihood of death.

Note this headline in the NY Times this morning: “The U.S. is falling to the lowest vaccination rates of the world’s wealthiest democracies.” From that article:

. . . Canada leads the G7 countries in vaccination rates, with almost three-quarters of its population at least partially vaccinated as of Thursday, according to Our World in Data. France, Italy and Britain follow, with percentages between 70 and 73. Germany’s rate is just ahead of Japan’s, at around 65 percent.

The U.S. vaccination curve has leveled dramatically since an initial surge in the first half of this year, when the vaccine first became widely available. In a push to vaccinate the roughly 80 million Americans who are eligible for shots but have not gotten them, President Biden on Thursday mandated that two-thirds of American workers, including health care workers and the vast majority of federal employees, be vaccinated against the coronavirus.

Written by Leisureguy

13 September 2021 at 1:11 pm

Cut sugar to save lives — Researchers urge fallback approach

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MGH News and Public Affairs has an interesting article in The Harvard Gazette:

Cutting 20 percent of sugar from packaged foods and 40 percent from beverages could prevent 2.48 million cardiovascular disease events (such as strokes, heart attacks, cardiac arrests), 490,000 cardiovascular deaths, and 750,000 diabetes cases in the U.S. over the lifetime of the adult population, reports a study published in Circulation.

A team of researchers from Massachusetts General Hospital (MGH), the Friedman School of Nutrition Science & Policy at Tufts University, Harvard T.H. Chan School of Public Health, and New York City Department of Health and Mental Hygiene (NYC DOH) created a model to simulate and quantify the health, economic, and equity impacts of a pragmatic sugar-reduction policy proposed by the U.S. National Salt and Sugar Reduction Initiative (NSSRI).

A partnership of more than 100 local, state and national health organizations convened by the NYC DOH, the NSSRI released draft sugar-reduction targets for packaged foods and beverages in 15 categories in 2018. This February, NSSRI finalized the policy with the goal of industry voluntarily committing to gradually reformulate their sugary products.

Implementing a national policy, however, will require government support to monitor companies as they work toward the targets and to publicly report on their progress. The researchers hope . . .

Continue reading. I will point out that “hope” is not a plan.

There’s quite a bit more, including:

“Reducing the sugar content of commercially prepared foods and beverages will have a larger impact on the health of Americans than other initiatives to cut sugar, such as imposing a sugar tax, labeling added sugar content, or banning sugary drinks in schools.”

Ten years after the NSSRI policy goes into effect, the U.S. could expect to save $4.28 billion in total net health care costs, and $118.04 billion over the lifetime of the current adult population (ages 35 to 79), according to the model. Adding the societal costs of lost productivity of Americans developing diseases from excessive sugar consumption, the total cost savings of the NSSRI policy rises to $160.88 billion over the adult population’s lifetime. These benefits are likely to be an underestimation since the calculations were conservative. The study also demonstrated that even partial industry compliance with the policy could generate significant health and economic gains.

The researchers found that the NSSRI policy became cost-effective at six years and cost-saving at nine years. The policy . ..

Stephen Covey talks about how a person can relate to the world around him or her. See this post, which includes a link to a PDF summarizing some of Covey’s approach. In that PDF, I write:

Your circle of concern consists of those situations and events over which you have no control. If you focus your attention and energy on things in the circle of concern, you gradually adopt the reactive model (because you have no control over these things).

Your circle of influence consists of those situations and events which you do control or influence. Your own choices and your responses to situations, of course, are squarely in the center of your circle of influence. By focusing your attention and energy on things in the circle of influence, you can take action and see the results.

You can solve direct control problems by working on your habits, solve indirect control problems by changing your methods of influence, and simply accept those things over which you have no control.

Regarding packaged foods and sugary drinks: whether to consume those or not is squarely in the center of one’s circle of influence. One can make a choice. My own diet includes almost no prepared foods and certainly no beverages that contain sugar. (I do buy some salad dressings (but I choose those that contain no sugar). I admit that the  prepared mustard I buy has a little sugar, but I consume that in very small amounts.)

I am not suggesting individual choice as public policy, but as something one can do now as personal decision. Getting the food industry to change their products is a massive undertaking that will take years and involve constant pressure and monitoring. Changing one’s own diet is a relatively simple and easy task and accomplishes, for the individual, the same goal. Hillel the Elder: “If not you, who? If not now, when?”

Anyone reading this has the facts and can make a choice and decide on when to act on the choice. If not now, when? And I mean that literally — pick a day and on that day stop eating packaged foods and drinking beverages that contain refined sugar. (I personally don’t even drink fruit juice, but rather eat whole fruit.)

Written by Leisureguy

31 August 2021 at 10:48 am

Two photos show the toll the pandemic takes on health workers

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Get vaccinated. Wear a mask. — and for that matter, in your car, use the seatbelts. It’s not tyranny, it’s safety.

Written by Leisureguy

30 August 2021 at 8:44 am

Costa Ricans Live Longer Than We. What’s the Secret?

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Atul Gawande, a practicing endocrine surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School and the Harvard T.H. Chan School of Public Health, writes in the New Yorker:

The cemetery in Atenas, Costa Rica, a small town in the mountains that line the country’s lush Central Valley, contains hundreds of flat white crypt markers laid out in neat rows like mah-jongg tiles, extending in every direction. On a clear afternoon in April, Álvaro Salas Chaves, who was born in Atenas in 1950, guided me through the graves.

“As a child, I witnessed every day two, three, four funerals for kids,” he said. “The cemetery was divided into two. One side for adults, and the other side for children, because the number of deaths was so high.”

Salas grew up in a small, red-roofed farmhouse just down the road. “I was a peasant boy,” he said. He slept on a straw mattress, with a woodstove in the kitchen, and no plumbing. Still, his family was among the better-off in Atenas, then a community of nine thousand people. His parents had a patch of land where they grew coffee, plantains, mangoes, and oranges, and they had three milk cows. His father also had a store on the main road through town, where he sold various staples and local produce. Situated halfway between the capital, San José, and the Pacific port city of Puntarenas, Atenas was a stop for oxcarts travelling to the coast, and the store did good business.

On the cemetery road, however, there was another kind of traffic. When someone died, a long procession of family members and neighbors trailed the coffin, passing in front of Salas’s home. The images of the mourners are still with him.

“At that time, Costa Rica was the most sad country, because the infant-mortality rate was very high,” he said. In 1950, around ten per cent of children died before their first birthday, most often from diarrheal illnesses, respiratory infections, and birth complications. Many youths and young adults died as well. The country’s average life expectancy was fifty-five years, thirteen years shorter than that in the United States at the time.

Life expectancy tends to track national income closely. Costa Rica has emerged as an exception. Searching a newer section of the cemetery that afternoon, I found only one grave for a child. Across all age cohorts, the country’s increase in health has far outpaced its increase in wealth. Although Costa Rica’s per-capita income is a sixth that of the United States—and its per-capita health-care costs are a fraction of ours—life expectancy there is approaching eighty-one years. In the United States, life expectancy peaked at just under seventy-nine years, in 2014, and has declined since.

People who have studied Costa Rica, including colleagues of mine at the research and innovation center Ariadne Labs, have identified what seems to be a key factor in its success: the country has made public health—measures to improve the health of the population as a whole—central to the delivery of medical care. Even in countries with robust universal health care, public health is usually an add-on; the vast majority of spending goes to treat the ailments of individuals. In Costa Rica, though, public health has been a priority for decades.

The covid-19 pandemic has revealed the impoverished state of public health even in affluent countries—and the cost of our neglect. Costa Rica shows what an alternative looks like. I travelled with Álvaro Salas to his home town because he had witnessed the results of his country’s expanding commitment to public health, and also because he had helped build the systems that delivered on that commitment. He understood what the country has achieved and how it was done.

When Salas was growing up, Atenas was a village of farmers and laborers. Cars were rare, and so were telephones. A radio was a luxury. In the country at large, barely half the population had running water or proper sanitation facilities, which led to high rates of polio, parasites, and diarrheal illness. Many children did not have enough to eat, and, between malnutrition and recurrent illnesses, their growth was often stunted. Like other societies where many die young, people had big families—seven or eight children was the average. Many children left school early, and only a quarter of girls completed primary education. Salas said that most children in Atenas started elementary school, but each year more and more were pulled out to do farmwork.

Important progress was achieved in the nineteen-fifties and sixties in Costa Rica, with the kind of basic public-health efforts made in many developing countries. Salas was in kindergarten, he thinks, when his family was able to pipe running water to their home from the nearby city center. A national latrine campaign provided people with outhouses made of cement. National power generation brought electrical wiring. “The most happy person was my mother!” he said.

Vaccination campaigns against polio, diphtheria, and rubella reached Salas and his classmates when he was in elementary school, as did a child-nutrition program that the government rolled out across the country, with aid from the Kennedy Administration. “We had this lunch—hot food,” he recalled. “I still have the flavor in my mouth. It was very nice to have a plate of soup with rice.” His family, with its cows and its store, was never nutritionally deprived—Salas grew to six feet—but his friends were often hungry. And so school attendance jumped. “The mothers and the families saw that it was a good idea now to send the kids to school, because they were fed,” he said.

Along the way, the Ministry of Health provided an official in every community with resources and staff devoted to preventing infectious-disease outbreaks, malnutrition, toxic hazards, sanitary problems, and the like. These local public-health units, geared toward community-wide concerns, worked in parallel with a health-care system built to address individual needs. Still, both remained rudimentary in Atenas. The nearest hospital was sixteen miles away, in the city of Alajuela, and understaffed. “At that time, it was far, because the road was impossible,” Salas said.

So when did Costa Rica’s results diverge from others’? That started in the early nineteen-seventies: the country adopted a national health plan, which broadened the health-care coverage provided by its social-security system, and a rural health program, which brought the kind of medical services that the cities had to the rest of the country. Atenas finally got a primary-care clinic. “With two or three doctors,” Salas recalled. “With five nurses. With social workers. For everything.” In 1973, the social-security administration was charged with upgrading the hospital system, including in Alajuela and other rural regions. In this early period, the country spent more of its G.D.P. on the health of its people than did other countries of similar income levels—and, indeed, more than some richer ones. But what set Costa Rica apart wasn’t simply the amount it spent on health care. It was how the money was spent: targeting the most readily preventable kinds of death and disability.

That may sound like common sense. But medical systems seldom focus on any overarching outcome for the communities they serve. We doctors are reactive. We wait to see who arrives at our office and try to help out with their “chief complaint.” We move on to the next person’s chief complaint: What seems to be the problem? We don’t ask what our town’s most important health needs are, let alone make a concerted effort to tackle them. If we were oriented toward public health, we would have been in touch with all our patients, if not everyone in the communities we serve, to schedule appointments for vaccination against the coronavirus, the No. 3 killer in the past year. We would have coördinated with public-health officials to prevent cardiovascular disease, the No. 1 killer, by jointly taking aim at high blood pressure and cholesterol, smoking, and dietary salt intake. We would have made a priority of preventing disease, rather than just treating it. But we haven’t. [no money in it – LG]

In the nineteen-seventies, Costa Rica identified maternal and child mortality as its biggest source of lost years of life. The public-health units directed pregnant women to prenatal care and delivery in hospitals, where officials made sure that personnel were prepared to prevent and manage the most frequent dangers, such as maternal hemorrhage, newborn respiratory failure, and sepsis. Nutrition programs helped reduce food shortages and underweight births; sanitation and vaccination campaigns reduced infectious diseases, from cholera to diphtheria; and a network of primary-care clinics delivered better treatment for children who did fall sick. Clinics also provided better access to contraception; by 1990, the average family size had dropped to just over three children.

The strategy demonstrated rapid and dramatic results. In 1970, seven per cent of children died before their first birthday. By 1980, only two per cent did. In the course of the decade, maternal deaths fell by eighty per cent. The nation’s over-all life expectancy became the longest in Latin America, and kept growing. By 1985, Costa Rica’s life expectancy matched that of the United States. Demographers and economists took notice. The country was the best performer among a handful of countries that seemed to defy the rule that health requires wealth.

Some people were skeptical. Costa Rica had endured numerous economic crises before 1970; perhaps the subsequent decade of economic stability had made the difference. Or maybe it was the country’s large investment in education, which had lifted the proportion of girls who completed primary education from a quarter in 1960 to two-thirds in 1980. A careful statistical analysis indicated that such factors did contribute to child survival—but that eighty per cent of the gains were tied to improvements in health services. The municipalities with the best public-health coverage had the largest declines in infant mortality.

A big question remained, though: Could Costa Rica sustain its progress? Public-health strategies might be able to address mortality in childhood and young adulthood, but many people believe that adding years from middle age onward is a wholly different endeavor. Countries at this stage tend to switch approaches, deëmphasizing public health and primary care and giving priority to hospitals and advanced specialties.

Costa Rica did not change course, however. It kept going even farther down the one it was on. And that’s where Álvaro Salas comes in. . .

Continue reading.

Written by Leisureguy

26 August 2021 at 12:06 pm

A 3-part story about short bowel syndrome and the FDA

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I’m always wary of information I find on the internet, and I prefer trusted sources. Failing those, I like when posts include links to supporting evidence. (It’s also useful to know some sources not to trust: Dr. Mercola, for example, deals heavily in misinformation, particularly wrt Covid.)

Kevin Drum is for me a trusted source, and one reason is that he is also cautious about the information he gets via the internet — and via the media, that matter. (As he points out, journalists reporting financial trends very seldom correct for inflation and thus end up comparing apples and oranges.)

This post shows clearly how some internet “information” is totally bogus and apparently generated just for clicks and giggles. Drum writes:

This is a three-part story of heroism, intrigue, and ultimately treachery in the world of drug approval.


PART 1

Tyler Cowen points me this weekend to a righteous rant about the FDA from psychiatrist Scott Alexander at Astral Codex Ten. After blasting them for several COVID-related decisions, he tells us about another example of FDA folly: . . .

Continue reading. And do read the whole post.

Written by Leisureguy

7 August 2021 at 3:28 pm

How Bad is American Life? Americans Don’t Even Have Friends Anymore

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Umair Haque has a somewhat gloomy piece in Medium, which includes the chart above. He writes:

Continue reading.

Written by Leisureguy

27 July 2021 at 11:58 am

Tennessee is worse even than I thought

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Heather Cox Richardson writes:

Yesterday, news broke that, under pressure from Republican leaders, Republican-dominated Tennessee will no longer conduct vaccine outreach for minors. Only 38% of people in Tennessee are vaccinated, and yet the state Department of Health will no longer reach out to urge minors to get vaccinated.

This change affects not only vaccines for the coronavirus, but also all other routine vaccines. On Monday, Tennessee’s Chief Medical Officer Dr. Tim Jones sent an email to staff saying there should be “no proactive outreach regarding routine vaccines” and “no outreach whatsoever regarding the HPV vaccine.” The HPV vaccine protects against a common sexually transmitted infection that causes cervical cancer, among other cancers.

Staff were also told not to do any “pre-planning” for flu shots events at schools. Any information released about back-to-school vaccinations should come from the Tennessee Department of Education, not the Tennessee Department of Health, Jones wrote.

On Monday, Dr. Michelle Fiscus, Tennessee’s former top vaccine official, was fired without explanation, and Republicans have talked about getting rid of the Department of Health altogether, saying it has been undermining parents by going around them and straight to teens to promote vaccines.

Video editor J.M. Rieger of the Washington Post put together a series of videos of Republicans boosting the vaccine and thanking former president Donald Trump for it only to show the same people now spreading disinformation, calling vaccines one of the greatest scandals in our history, and even comparing vaccines to the horrors of the Nazis.

This begs the question: Why?

Former FBI special agent, lawyer, and professor Asha Rangappa put this question to Twitter. “Seriously: What is the [Republicans’] endgame in trying to convince their own voters not to get the vaccine?” The most insightful answer, I thought, was that the Republican’s best hope for winning in 2022—aside from voter suppression—is to keep the culture wars hot, even if it means causing illness and death.

The Republican Party continues to move to the right. During his time in office, the former president put his supporters into office at the level of the state parties, a move that is paying off as they purge from their midst those unwilling to follow Trump. Today, in Michigan, the Republican Party chair who had criticized Trump, Jason Cabel Roe, resigned.

Candidates who have thrown their hat into the ring for the 2022 midterm elections are trying to get attention by being more and more extreme. They vow to take on the establishment, support Trump and God, and strike terror into the “Liberals” who are bringing socialism to America. Forty QAnon supporters are running for Congress, 38 as Republicans, 2 as Independents.

And yet, there are cracks in this Republican rush to Trumpism.

Yesterday, on the Fox News Channel, House minority leader Kevin McCarthy (R-CA) admitted that “Joe Biden is the president of the United States. He legitimately got elected.” Trump supporters immediately attacked McCarthy, but the minority leader is only too aware that the House Select Committee on the Capitol Insurrection will start hearing witnesses on July 27, and the spotlight on that event is highly unlikely to make the former president—and possibly some of the Republican lawmakers—look good.

Already, the books coming out about the former administration have been scathing, but tonight news broke of new revelations in a forthcoming book by Pulitzer Prize–winning Washington Post reporters Carol Leonnig and Philip Rucker. Leonnig and Rucker interviewed more than 140 members of the former administration and say that Chairman of the Joint Chiefs of Staff General Mark A. Milley was increasingly upset as he listened to Trump lie about having won the election, believing Trump was looking for an excuse to invoke the Insurrection Act and call out the military.

Milley compared the former president’s language to that of Hitler and was so worried Trump was going to seize power that Milley began to strategize with other military leaders to keep him from using the military in illegal ways, especially after Trump put his allies at the head of the Pentagon. “They may try, but they’re not going to f—ing succeed,” he allegedly said.

In addition to damaging stories coming out about the former president, news broke yesterday that Fitch Ratings, a credit rating company, is considering downgrading the AAA rating of the United States government bonds. The problem is not the economy. In fact, the Fitch Ratings report praises the economy, saying it “has recovered much more rapidly than expected, helped by policy stimulus and the roll-out of the vaccination program, which has allowed economic reopening…. [T]he scale and speed of the policy response [is] a positive reflection on the macroeconomic policy framework. Real economic output has overtaken its pre-pandemic level and is on track to exceed pre-pandemic projections….”

Although the report worries about the growing debt, we also learned yesterday that the deficit for June dropped a whopping 80% from the deficit a year ago, as tax receipts recover along with the economy. Year-to-date, the annual deficit is down 18% from last year.

The problem, the report says, is . . .

Continue reading. The US is in crisis. The infection is the GOP.

Tennessee’s actions worse than ever

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From the Tennesseean a report that makes me believe that society will not avoid the collapse predicted as a possibility in the previous post:

Editor’s note: On Monday, July 12, the Tennessee Department of Health fired Dr. Michelle Fiscus, the top vaccine official in the Tennessee state government. Fiscus said she was scapegoated to appease Republican state lawmakers who are angry about efforts to vaccinate teenagers. After losing her job, Fiscus released a 1,200-word statement about the ordeal. Below is her statement in its entirety.

Today I became the 25th of 64 state and territorial immunization program directors to leave their position during this pandemic. That’s nearly 40% of us. And along with our resignations or retirements or, as in my case, push from office, goes the institutional knowledge and leadership of our respective COVID-19 vaccine responses.  I will not sit quietly by while our public health infrastructure is eroded in the midst of a pandemic.

We are a group of dedicated public health professionals who have worked endless hours to make COVID-19 vaccines, the ONE tool we have to effectively end the scourge of the COVID-19 pandemic, available to every person in our jurisdictions.  Along the way we have been disparaged, demeaned, accused, and sometimes vilified by a public who chooses not to believe in science, and elected and appointed officials who have put their own self-interest above the people they were chosen to represent and protect.

[COVID-19 VACCINES:Tennessee fires top vaccine official as COVID-19 shows signs of new spread]

On May 6, 2021, in advance of the approval of the Pfizer COVID-19 vaccine for 12-15 year olds and in response to multiple questions I had received regarding the rules around vaccinating minors, I reached out to Tennessee Department of Health’s general counsel to request a statement regarding Tennessee’s Mature Minor Doctrine that resulted from a Tennessee Supreme Court Ruling in Cardwell v Bechtol in 1987.

In response, I received a document attached to an email stating, “Sure—Attached is the new summary of the doctrine that has just recently been posted to the website and is blessed by the Governor’s office on the subject. This is forward facing so feel free to distribute to anyone.”

On May 10, 2021, I copied and pasted the language provided to me into a memo that was distributed only to providers who were administering COVID-19 vaccines. A recipient of that memo was upset that, according to Tennessee Supreme Court case law, minors ages 14-17 years are able to receive medical care in Tennessee without parental consent and posted the memo to social media. Within days, legislators were contacting TDH asking questions about the memo with some interpreting it as an attempt to undermine parental authority.

Let me be clear: this was an informational memo containing language approved by the TDH Office of General Counsel which was sent to medical providers by the medical director of the state’s immunization program regarding the guardrails set 34 years ago by the Tennessee Supreme Court around providing care to minors.

What has occurred in the time between the release of this memo and today, when I was terminated from my position as medical director of the vaccine-preventable diseases and immunization program at the Tennessee Department of Health, can only be described as bizarre.

On May 19th, TDH was asked to appear before the Government Operations Committee due to the concern that the memo was “a bit of a prodding or encouraging to vaccinate children without parental consent.” This was followed by a series of requests from members of the Committee for data around the impact of COVID-19 on children and a request to appear before the Committee again on June 16.

It was at that June 16th meeting that the Department was accused of “targeting” youth through Facebook messaging and its actions were described as “reprehensible” by one Committee member. That member went on to call for the “dissolving and reconstitution” of the Department of Health in the midst of a pandemic where one out of every 542 Tennesseans has died from COVID-19 on their watch and less than 38% of Tennesseans have been vaccinated.

It is the mission of the Tennessee Department of Health to “protect, promote and improve the health and prosperity of the people of Tennessee” and protecting them against the deadliest infectious disease event in more than 100 years IS our job. It’s the most important job we’ve had in recent history. Specifically, it was MY job to provide evidence-based education and vaccine access so that Tennesseans could protect themselves against COVID-19. I have now been terminated for doing exactly that.

Each of us should be waking up every morning with one question on our minds: “What can I do to protect the people of Tennessee against COVID-19?” Instead, our leaders are putting barriers in place to ensure the people of Tennessee remain at-risk, even with the delta variant bearing down upon us.

What’s more is that the leadership of the Tennessee Department of Health has reacted to the sabre rattling from the Government Operations Committee by halting ALL vaccination outreach for children. Not just COVID-19 vaccine outreach for teens, but ALL communications around vaccines of any kind. No back-to-school messaging to the more than 30,000 parents who did not get their children measles vaccines last year due to the pandemic.  No messaging around human papilloma virus vaccine to the residents of the state with one of the highest HPV cancer rates in the country. No observation of National Immunization Awareness Month in August. No reminders to the parents of teens who are late in receiving their second COVID-19 vaccine. THIS is a failure of public health to protect the people of Tennessee and THAT is what is “reprehensible”. When the people elected and appointed to lead this state put their political gains ahead of the public good, they have betrayed the people who have trusted them with their lives.

[COVID-19 VACCINES:GOP lawmakers accuse state health chief of ‘peer pressuring’ kids]

I was told that I should have been more “politically aware” and that I “poked the bear” when I sent a memo to medical providers clarifying a 34 year old Tennessee Supreme Court ruling. I am not a political operative, I am a physician who was, until today, charged with protecting the people of Tennessee, including its children, against preventable diseases like COVID-19.

I have been terminated for doing my job because some of our politicians have bought into the anti-vaccine misinformation campaign rather than taking the time to speak with the medical experts. They believe what they choose to believe rather than what is factual and evidence-based. And it is the people of Tennessee who will suffer the consequences of the actions of the very people they put into power.

The public health professionals at the Tennessee Department of Health have worked themselves to exhaustion to protect Tennesseans from this virus. They are heroes. They have prevented suffering and saved countless lives. They are to be honored and commended, not cursed and vilified. And the “leaders” of this state who have put their heads in the sand and denied the existence of COVID-19 or who thought they knew better than the scientists who have spent their lives working to prevent disease… who have ignored the dead and dying surrounding them — even when their own colleagues have fought for their lives — they are what is “reprehensible.”

I am ashamed of them. I am afraid for my state. I am angry for the amazing people of the Tennessee Department of Health who have been mistreated by an uneducated public and leaders who have only their own interests in mind. And I am deeply saddened for the people of Tennessee, who will continue to become sick and die from this vaccine-preventable disease because they choose to listen to the nonsense spread by ignorant people.

At this point,  . . .

Continue reading.

Written by Leisureguy

14 July 2021 at 3:34 pm

Tennessee Fires Vaccine Chief for Promoting Vaccines

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I do not understand whatever it is that Republicans substitute for thinking. Ed Kilgore writes in New York:

If you want a clear and dangerous sign of how far down the anti-vaxx rabbit hole Republicans are going these days, look no further than the shenanigans going on in very red Tennessee the last month. The backstory, as reported by the Nashville Tennessean, is pretty simple:

In May, the state health department’s vaccine chief, Dr. Michelle Fiscus, was asked for guidance on how to deal with vaccination requests for older adolescents. In response, she circulated to providers a memo concerning a well-established state judicial ruling that minors aged 14-17 can obtain medical services without explicit parental consent. (The memo was secured from her agency’s attorney and blessed by the governor’s legal counsel.) One of the providers receiving this memo let Republican legislators know that evil state bureaucrats were undermining “parental authority” and pushing their infernal vaccines on kids. This blew up into a major brouhaha at a June 16 legislative hearing in which lawmakers threatened to shut down the entire state health department over this obvious violation of personal liberty and God’s Law. It got heated:

Sen. Janice Bowling, R-Tullahoma, who repeatedly has spread vaccine misinformation during legislative hearings, insisted the state was misinterpreting its legal authority.

Bowling urged [State Health Commissioner Dr. Lisa] Piercey to “take action” to “remove the fear, the concerns and the anger that has gone across the state as a result of (Fiscus’) letter.”

Piercey did take action, not just on COVID-19 vaccinations, but all of them intended for minors. “The agency halted all online vaccination outreach to teens and deleted Facebook and Twitter posts that gently recommended vaccines to anyone over the age of 12,” the Tennessean reported. “Internal emails obtained by The Tennessean revealed agency leaders ordered county-level staff not to hold any vaccination events intended specifically for adolescents.”

And then having inadvertently stirred up this right-wing hornet’s nest by doing her job, Fiscus got the ax this week. She did no go quietly, releasing a statement that made it pretty plain she thought the legislators who indirectly forced her firing were destructive yahoos, and that her agency superiors were cowards for shutting down vaccination education efforts that had nothing to do with COVID-19.

I was told that I should have been more “politically aware” and that I “poked the bear” when I sent a memo to medical providers clarifying a 34 year old Tennessee Supreme Court ruling. I am not a political operative, I am a physician who was, until today, charged with protecting the people of Tennessee, including its children, against preventable diseases like COVID-19.

I have been terminated for doing my job because some of our politicians have bought into the anti-vaccine misinformation campaign rather than taking the time to speak with the medical experts.

Now it’s true we have no absolute proof Fiscus was fired for the reasons she claims. But her former employers refused to give the Tennesseean any comment on her termination, and the bang-bang-bang timing of it all leaves little doubt about the chain of events.

The sad truth is that Tennessee Republican legislators are just reflecting a national trend in their party of making the unvaccinated a constituency group that needs to be “protected” from efforts to save their lives (not to mention the lives of those they may infect, and of an entire nation needing herd immunity). But Fiscus says it best:

I am deeply saddened for the people of Tennessee, who will continue to become sick and die from this vaccine-preventable disease because they choose to listen to the nonsense spread by ignorant people.

At this point, you are going to get vaccinated or you are going to get sick. Yes, not getting the vaccine is a personal choice. It’s true that you are likely to survive COVID-19. It’s the 1 out of every 542 people surrounding you that will suffer the consequences of an unfortunate decision to remain vulnerable to this horrible disease.

In the unlikely event . . .

Continue reading.

Written by Leisureguy

13 July 2021 at 4:02 pm

The Scientific Consensus on a Healthy Diet

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The information on what to eat as a healthy diet is well-known, but people (in general) ignore it. No surprise, really: the effect of fossil fuel use on climate change is well-known, but people (in general) ignore that as well. I don’t understand why that is, but I imagine social pressure has a lot to do with it (along with ignorance, magical thinking, and despair). And, of course, corporations are entities drive by a focus on profit, not public health, and so we see many giant companies spending millions in marketing to induce people to eat unhealthy foods — and with great success (for the business, not for the consumer whose health decays).

Here are the sad facts:

Written by Leisureguy

30 June 2021 at 9:35 am

Disparate responses from disparate experience

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There’s an old saw that goes, “If you can keep your head when everyone around you is losing his, then you probably don’t understand the situation.” For example:

In the previous post (on my morning shave) I gave a  low-voltage example of this sort of error, which was my dismissing the practice of “blooming” the shaving soap because, when I tried it, it did nothing — blooming the soap or not made no difference. But I was limited by my experience (shaving with soft water) and did not understand what those who had to use hard water experienced.

That dissonance in that case is relatively mild, but in other situations a lack of insight due to (a) lack of experience and (b) not truly listening, can be devastating. The NY Times recently had a book review by Janice Nimura that discusses a disgraceful history of one long-running example of this type of error. She writes:

UNWELL WOMEN
Misdiagnosis and Myth in a Man-Made World
By Elinor Cleghorn

In order to recognize illness, you have to know what health looks like — what’s normal, and what’s not. Until recently, medical research generally calibrated “normal” on a trim white male. Such a patient, arriving in an emergency room clutching his chest as they do in the movies — and in the textbooks — would be immediately evaluated for a heart attack. But heart disease in women, inconveniently, doesn’t always come with chest pain. A woman reporting dizziness, nausea and heart-pounding breathlessness in that same E.R. might be sent home with instructions to relax, her distress dismissed as emotional rather than cardiac.

Heart disease has clear markers and proven diagnostic tools. When a woman’s symptoms are less legible or quantifiable — fatigue, vertigo, chronic pain — the tendency to be dismissive grows. In “Unwell Women,” the British scholar Elinor Cleghorn makes the insidious impact of gender bias on women’s health starkly and appallingly explicit: “Medicine has insisted on pathologizing ‘femaleness,’ and by extension womanhood.”

Cleghorn, framing her argument in terms of Western medicine, starts with Hippocrates, the Greek physician of antiquity who refocused medical science on the imbalances of the body rather than the will of the gods. Hippocrates understood that women’s bodies were different from those of men, but in his view, and for millenniums to come, those differences could be reduced to a single organ: the uterus. A woman’s purpose was to procreate; if she wasn’t well, it was probably her womb that was to blame. One Roman writer described the uterus as “an animal within an animal,” with its own appetites and the capacity to wander through the body in search of satisfaction. Most female afflictions could be reduced to “hysteria,” from the Greek word for womb. “The theory that out-of-work wombs made women mad and sad was as old as medicine itself,” Cleghorn notes. The standard cure was marriage and motherhood. As Hippocratic medicine was refracted through the lens of Christianity, the female anatomy was additionally burdened with the weight of original sin.

Moving steadily through the centuries, Cleghorn lays out the vicious circles of women’s health. Taught that their anatomy was a source of shame, women remained in ignorance of their own bodies, unable to identify or articulate their symptoms and therefore powerless to contradict a male medical establishment that wasn’t listening anyway. Menstruation and menopause were — and often still are — understood as illness rather than aspects of health; a woman’s constitution, thus compromised, could hardly sustain the effort required for scholarship or professional life. A woman with the means and the talents to contemplate such ambitions soon bumped up against the rigid shell of the domestic sphere. Her frustration and despair could cause physical symptoms, which her doctor would then chalk up to her unnatural aspirations. Conversely, a perfectly healthy woman who agitated for radical change — a suffragist, say — was clearly suffering from “hysteric morbidity.”

Though hormones eventually replaced wandering wombs as central to understanding women’s health, “old ideas about women’s bodies being naturally defective and deficient still pulsed through endocrinological theories,” Cleghorn writes. The marketing for early forms of hormone replacement therapy to relieve the discomforts of menopause was often directed at men. One horrifying magazine ad showed a radiant older woman laughing alongside male companions, with the tagline “Help Keep Her This Way.” Was hormone replacement therapy a way of liberating women from their reproductive biology, or keeping them cheerful for their husbands? And, as questions grew about estrogen and cancer, at what cost?

The intersection of class and race complicates things further. As early as 1847, the Scottish physician James Young Simpson argued in favor of anesthesia during labor and delivery, contradicting the age-old belief that the pain of birth was part of God’s judgment. (To this day, women who opt for an epidural instead of “natural childbirth” can feel a nagging sense of failure.) But even liberal-minded men like Simpson believed that what he called the “civilized female” needed his revolutionary innovation more than her less privileged sisters. Black women were thought to be less sensitive to pain and working-class women were considered hardier in general; certainly no one worried about whether these women could work while menstruating.

Each scientific advance came with its own shadow. Margaret Sanger may have  . . .

Continue reading.

Written by Leisureguy

18 June 2021 at 9:34 am

Some Hospitals Kept Suing Patients Over Medical Debt Through the Pandemic

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There is something deeply wrong with the US healthcare system. Jenny Deam reports in ProPublica:

Last year as COVID-19 laid siege to the nation, many U.S. hospitals dramatically reduced their aggressive tactics to collect medical debt. Some ceased entirely.

But not all.

There was a nearly 90% drop overall in legal actions between 2019 and the first seven months of 2020 by the nation’s largest hospitals and health systems, according to a new report by Johns Hopkins University. Still, researchers told ProPublica that they identified at least 16 institutions that pursued lawsuits, wage garnishments and liens against their patients in the first seven months of 2020.

The Johns Hopkins findings, released Monday in partnership with Axios, which first reported the results, are part of an ongoing series of state and national reports that look at debt collections by U.S. hospitals and health systems from 2018 to 2020.

During those years more than a quarter of the nation’s largest hospitals and health systems pursued nearly 39,000 legal actions seeking more than $72 million, according to data Johns Hopkins researchers obtained through state and county court records.

More than 65% of the institutions identified were nonprofit corporations, which means that in return for tax-exempt status they are supposed to serve the public rather than private interest.

The amount of medical debt individuals owe is often a small sliver of a hospital’s overall revenue — as little as 0.03% of annual receipts — but can “cause devastating financial burdens to working families,” the report said. The federal Consumer Financial Protection Bureau has estimated medical debt makes up 58% of all debt collection actions.

The poor or uninsured often bear the brunt of such actions, said Christi Walsh, clinical director of health care and research policy at Johns Hopkins University. “In times of crisis you start to see the huge disparities,” she said.

Researchers said they could not determine all of the amounts sought by the 16 institutions taking legal action in the first half of 2020, but of those they could, Froedtert Health, a Wisconsin health system, sought the most money from patients — more than $3 million.

Even after Wisconsin Gov. Tony Evers declared a public health emergency on March 12, 2020, hospitals within the Froedtert Health system filed more than 100 cases from mid-March through July, researchers reported, and 96 of the actions were liens.

One lien was against Tyler Boll-Flaig, a 21-year-old uninsured pizza delivery driver from Twin Lakes, Wisconsin, who was severely injured June 3, 2020, when a speeding drag racer smashed into his car. Boll-Flaig’s jaw was shattered, and he had four vertebrae crushed and several ribs broken. His 14-year-old brother, Dominic Flaig, tagging along that night, was killed.

Days after the crash, their mother, Brandy Flaig, said she got a call from a hospital billing office asking for her surviving son’s contact information to set up a payment plan for his medical bills.

Then on July 30 — less than two months later — Froedtert Hospital in Milwaukee filed a $67,225 lien against Boll-Flaig. It was one of seven liens the hospital filed the same day, totaling nearly a quarter of a million dollars, according to the Wisconsin Circuit Court Access website used by researchers and reviewed by ProPublica.

“It’s during the pandemic, we’re still grieving, and they go after Tyler?” Flaig said. “It’s predatory.” Tyler Boll-Flaig declined to be interviewed.

Froedtert Hospital is the largest in the Froedtert Health system, which includes five full-service hospitals, two community hospitals and more than 40 clinics. The health care system reported more than $53 million in operating income during the quarter ending Sept. 30, 2020 — double the amount from the previous year, according to its financial filings. It has also received $90 million in federal CARES Act money to help with its COVID-19 response and operating costs, a spokesperson said.

Only Reedsburg Area Medical Center, a nonprofit hospital in Reedsburg, Wisconsin, pursued more legal actions in the spring and summer of 2020, with 139 lawsuits and 22 wage garnishments, the study showed. Medical center officials did not respond to a request for comment.

In contrast, Advocate Aurora Health, the top-suing health network in the state before the pandemic, dropped to zero court filings after February 2020, the report found.

Stephen Schoof, a Froedtert Health spokesperson, said in an email he . . .

Continue reading.

Written by Leisureguy

15 June 2021 at 2:17 pm

Margaret Mead on the first archeological evidence of a civilization

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An interesting observation from Margaret Mead:

Years ago, anthropologist Margaret Mead was asked by a student what she considered to be the first sign of civilization in a culture. The student expected Mead to talk about fishhooks or clay pots or grinding stones.

But no. Mead said that the first sign of civilization in an ancient culture was a femur (thighbone) that had been broken and then healed. Mead explained that in the animal kingdom, if you break your leg, you die. You cannot run from danger, get to the river for a drink or hunt for food. You are meat for prowling beasts. No animal survives a broken leg long enough for the bone to heal.

A broken femur that has healed is evidence that someone has taken time to stay with the one who fell, has bound up the wound, has carried the person to safety and has tended the person through recovery. Helping someone else through difficulty is where civilization starts, Mead said.”

We are at our best when we serve others. Be civilized.

Ira Byock

Written by Leisureguy

10 June 2021 at 6:58 pm

He Bought Health Insurance for Emergencies. Then He Fell Into a $33,601 Trap Created by the Trump Administration.

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Jenny Deam reports in ProPublica:

In the spring of 2019, Cory Dowd suddenly found himself without health insurance for the first time. A self-employed event planner, he had just finished a Peace Corps stint that provided health benefits, but he was still more than a year away from starting a graduate program that would provide coverage through his university.

So, like countless others in an online world, he went insurance shopping on the internet.

But the individual insurance market he was about to enter was one dramatically changed under President Donald Trump’s push to dismantle Obamacare, offering more choices at cheaper prices.

Dowd is well-educated and knew more than most about how traditional health insurance works. But even he did not understand the extent to which insurers could offer plans that looked like a great deal but were stuffed with fine print that allowed companies to deny payment for routine medical events.

Not bound by the strict coverage rules of the Affordable Care Act, the short-term plans that Dowd signed up for have been dubbed “junk insurance” by consumer advocates and health policy experts. The plans can deny coverage for people with preexisting conditions, exclude payments for common treatments and impose limits on how much is paid for care.

Dowd, like millions of other Americans who have flocked to such plans in the past three years, only saw what looked like a great deal: six-month coverage offered through an agency called Pivot Health, whose website touts the company as a “fast-growing team obsessed with helping you find the right insurance for your needs.”

Monthly premiums for the two short-term plans he bought were surprisingly cheap at around $100 a month each, with reasonable co-pays for routine doctor visits and treatments. Best of all, the first plan he bought promised to cover up to $1 million in claims, the second up to $750,000. That should more than do it, he thought. Dowd was 31 and healthy but wanted protection in case of a medical emergency. He signed up and began paying his premiums without closely reading the details.

Then he was hit with the very kind of emergency he had feared. And he wasn’t protected after all.

Short-term plans have been around for decades, and are meant to temporarily bridge coverage gaps. Under the Affordable Care Act they were limited to three months. But when the Trump administration allowed them to be extended to nearly a year, they became a fast-growing and lucrative slice of the insurance industry.

Because these plans are not legally bound by the strict rules of the ACA, not only do they come with hefty restrictions and coverage limitations, but insurers can search through patients’ past medical histories to find preexisting conditions.

All companies selling short-term plans have to do is acknowledge that they are not ACA-compliant and may not cover everything — a disclosure the insurers insist they do.

Still, the Biden administration faces a challenge on what to do about the proliferation of such plans.

Once in office, President Joe Biden quickly moved to make enrolling in comprehensive ACA coverage easier and make plans more affordable. On Thursday, the Department of Health and Human Services announced 940,000 people had signed up for ACA plans this spring after enrollment was reopened in February. In many states, enrollment will run through the summer.

Yet, while health policy experts say ACA expansion is important, it does not specifically address those who remain in plans outside the health care law and could be at risk for financial ruin.

“The Biden administration is going to have to find a way to put the genie back in the bottle,” said Stacey Pogue, a health policy analyst for Every Texan, an Austin-based advocacy group.

True numbers of how many people have noncompliant plans remain elusive, as such plans often fly under regulatory radar and industry tracking. Still, an investigation last year by the U.S. House Committee on Energy and Commerce concluded that at least 3 million consumers had short-term limited duration plans in 2019, the last year for which information was available. That was a 27% jump from the previous year, when deregulation began in earnest, the investigation found.

“I would not be surprised if  . . .

Continue reading.

Written by Leisureguy

8 May 2021 at 10:24 am

Vaccine skepticism stems not from ignorance but from beliefs and values

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Sabrina Tavernise reports in the NY Times:

For years, scientists and doctors have treated vaccine skepticism as a knowledge problem. If patients were hesitant to get vaccinated, the thinking went, they simply needed more information.

But as public health officials now work to convince Americans to get Covid-19 vaccines as quickly as possible, new social science research suggests that a set of deeply held beliefs is at the heart of many people’s resistance, complicating efforts to bring the coronavirus pandemic under control.

“The instinct from the medical community was, ‘If only we could educate them,’” said Dr. Saad Omer, director of the Yale Institute for Global Health, who studies vaccine skepticism. “It was patronizing and, as it turns out, not true.”

About a third of American adults are still resisting vaccines. Polling shows that Republicans make up a substantial part of that group. Given how deeply the country is divided by politics, it is perhaps not surprising that they have dug in, particularly with a Democrat in the White House. But political polarization is only part of the story.

In recent years, epidemiologists have teamed up with social psychologists to look more deeply into the “why” behind vaccine hesitancy. They wanted to find out whether there was anything that vaccine skeptics had in common, in order to better understand how to persuade them.

They borrowed a concept from social psychology — the idea that a small set of moral intuitions forms the foundations upon which complex moral worldviews are constructed — and applied it to their study of vaccine skepticism.

What they discovered was a clear set of psychological traits offering a new lens through which to understand skepticism — and potentially new tools for public health officials scrambling to try to persuade people to get vaccinated.

Dr. Omer and a team of scientists found that skeptics were much more likely than nonskeptics to have a highly developed sensitivity for liberty — the rights of individuals — and to have less deference to those in positions of power.

Skeptics were also twice as likely to care a lot about the “purity” of their bodies and their minds. They disapprove of things they consider disgusting, and the mind-set defies neat categorization: It could be religious — halal or kosher — or entirely secular, like people who care deeply about toxins in foods or in the environment.

Scientists have found similar patterns among skeptics in Australia and Israel, and in a broad sample of vaccine-hesitant people in 24 countries in 2018.

“At the root are these moral intuitions — these gut feelings — and they are very strong,” said Jeff Huntsinger, a social psychologist at Loyola University Chicago who studies emotion and decision-making and collaborated with Dr. Omer’s team. “It’s very hard to override them with facts and information. You can’t reason with them in that way.”

These qualities tend to predominate among conservatives but they are present among liberals too. They are also present among people with no politics at all.

Kasheem Delesbore, a warehouse worker in northeastern Pennsylvania, is neither conservative nor liberal. He does not consider himself political and has never voted. But he is skeptical of the vaccines — along with many institutions of American power.

Mr. Delesbore, 26, has seen information online that a vaccine might harm his body. He is not sure what to make of it. But his faith in God gives him confidence: Whatever happens is God’s will. There is little he can do to influence it. . .

Continue reading.

Written by Leisureguy

29 April 2021 at 12:04 pm

Parents Want Justice for Birth Injuries. Hospitals Want to Strip Them of the Right to Make That Decision.`

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Carol Marbin Miller and Daniel Chang, Miami Herald, report in ProPublica:

Ashley Lamendola was still a teen when medical staff at St. Petersburg General Hospital delivered the awful news that would change her life forever: Her newborn son, Hunter, had suffered profound brain damage and would do little more than breathe without help.

“It was like an atomic bomb went off in my life,” she said.

Lamendola believed the hospital was partly responsible for Hunter’s birth injuries. But Florida is one of two states that shield doctors and hospitals from most legal actions arising from births that go catastrophically wrong. Lamendola filed a lawsuit against St. Petersburg General anyway, and when it appeared she was gaining traction, the hospital advanced an extraordinary argument.

It suggested that Hunter’s mother was not acting in her son’s best interest and that a critical decision about his future care should be put in the hands of an independent guardian and a judge. Lamendola, attorneys said, was pursuing her own self-interest by refusing to participate in the quasi-government program that compensates the families of children injured at birth.

Under the program, known as the Birth-Related Neurological Injury Compensation Association, or NICA, the state provides $100,000 upfront and pays for “medically necessary” care for the child’s lifetime. In exchange, parents give up their right to sue hospitals and doctors, lawsuits that can result in judgments or settlements in the tens of millions of dollars.

By choosing to “pursue her own speculative, complicated civil lawsuit” rather than permitting her son to accept his “vested” NICA benefits, Lamendola was trying to profit from Hunter’s injuries, St. Petersburg General attorneys argued in a court filing. They underscored the words “her own.

Had she accepted Hunter’s inclusion in NICA, “the Mother would be unable to pursue her own civil lawsuit, seeking her own separate monetary damages for the Child’s injuries,” the lawyers added.

“You carry a child for nine months, and then you finally get to hold them — eventually in my case,” said Lamendola, who was employed as a customer service rep at an AutoZone when she gave birth. “And you take care of their every want and need, and you put a child before you. I mean, once you have a child, there is no more you. It’s them. It’s us. It’s that baby that needs you and needs everything from you.

“I didn’t understand how somebody who wasn’t me could know what he wants and needs. I knew every sound, every movement, every seizure that he had,” Lamendola said. “And to think that somebody thought they knew better than me. It was wild to me.”

The battle between parents like Lamendola and hospitals like St. Petersburg General can seem like a gross mismatch: Lamendola was a single mom who made $10.50 an hour and lived with her mother. HCA Healthcare, which owns St. Petersburg General, is one of the nation’s largest for-profit hospital chains, with 180 hospitals, 280,000 employees and revenues of $51.5 billion in 2020.

For hospitals facing stunningly high settlements or verdicts, NICA, the state’s no-fault program, is a valuable legal tool — a club to bat away expensive lawsuits. At the cost of $50 per live birth, hospitals can protect themselves from multimillion-dollar judgments.

Paolo Annino, who heads the Children’s Advocacy Clinic at the Florida State University College of Law, said attempts to restrict a parent’s authority through the appointment of a guardian are unusual: In child welfare disputes, for example, parents must be found unfit by a judge before being stripped of their right to decide what’s best for their children.

“What we have here is a scenario where there’s no allegation of offending parents at all,” he said. “The parent is, with very few exemptions, the one who makes the child’s health care decisions.”

NICA came under fire this month after  . . .

Continue reading.

Written by Leisureguy

26 April 2021 at 1:31 pm

Vietnam defied the experts and sealed its border to keep Covid-19 out. It worked.

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Julia Belluz reports in Vox:

This story is one in our six-part series The Pandemic Playbook. Explore all the stories here.

Every January or February, Le The Linh and his wife pack their children into their car and drive 80 miles to visit family in Haiphong, a port city east of Vietnam’s capital, Hanoi, for Lunar New Year. But this time, as they reached the last stretch of the Hanoi-Haiphong Highway, a police officer approached and pointed them toward a group of guards in face masks under a makeshift tent. It was one of 16 checkpoints erected around Haiphong to control travel into and out of the city ahead of the Tet Festival holiday.

They joined a lineup of other travelers, nervously waiting for their turn in the rain. When they reached the front, the officials asked for proof of their travel plans, residency, and Covid-19 status.

“Don’t worry!” Linh exclaimed tensely. He could show, with his identity card, that they lived in an area that had no coronavirus cases recently.

The family was among the lucky ones let through. Travelers from areas near Haiphong that had recently recorded Covid-19 cases got turned away; a group of young people on motorbikes who tried to circumvent the checkpoint were arrested; still others chose not to travel at all, opting to meet family over FaceTime or Zalo (Vietnam’s answer to WhatsApp).

As the pandemic took hold last year, travel restrictions quickly proliferated — they were the second-most-common policy governments adopted to combat Covid-19. According to one review, never in recorded history has global travel been curbed in “such an extreme manner”: a reduction of approximately 65 percent in the first half of 2020. More than a year later, as countries experiment with vaccine passportstravel bubbles, and a new round of measures to keep virus variants at bay, a maze of confusing, ever-changing restrictions remains firmly in place.

But few countries have gone as far as Vietnam, a one-party communist state with a GDP per capita of $2,700. The Haiphong checkpoints timed for Tet were the equivalent of closing off Los Angeles to Americans ahead of Thanksgiving — within a country that was already nearly hermetically sealed. Last March, the government canceled all inbound commercial flights for months on end, making it almost impossible to fly in, even for Vietnamese residents.

Today, flights are limited to select groups, like businesspeople or experts, from a few low-risk countries. Everybody who enters needs special government permission and must complete up to 21 days of state-monitored quarantine with PCR tests. (Positive cases are immediately isolated in hospitals, regardless of disease severity.)

This strict approach to travel, global health experts say, is directly connected to Vietnam’s seeming defeat of Covid-19. Thirty-five people have reportedly died in total, and a little more than 2,700 have been infected with the virus during three small waves that have all been quickly quashed. Even on the worst days of the pandemic, the country of 97 million has never recorded more than 110 new cases — a tiny fraction of the 68,000 daily case high in the United Kingdom, which has a population one-third smaller than Vietnam, or the record 300,000-plus cases per day only the US and India managed to tally.

Last year, Vietnam’s economy even grew 2.9 percent, defying economists’ predictions and beating China to become the top performer in Asia. .. .

Continue reading. There’s much more, including god photos.

The US, of course, chose another path. To date, the US has seen 32,725,095 cases and 584,942 deaths.

Written by Leisureguy

23 April 2021 at 4:06 pm

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

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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

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Written by Leisureguy

7 April 2021 at 12:48 pm

Why tearing down Fauci is essential to the MAGA myth

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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

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