Readings To Consider vs. The Occasional Perspective - 1/18/21

Books and Articles worth a Review… 

An Overview of Biden Administration Health Care Priorities – The mainstream media has provided some coverage on “parts” of the health care priorities articulated by the incoming Biden Administration. I thought it might be helpful to provide an outline on those priorities starting with Covid-19 and continuing on to other important considerations.

  1. Covid-19 Plan – Biden in a major speech as well as through releases has stipulated a “7-Point Plan to Beat Covid-19”. The essence of the plan is as follows:
    1. Scale up testing – the intent will be to increase the number of testing sites offering “cost-free” as well as support the development and availability of at-home/rapid testing. In addition to testing, the plan calls for mobilizing 100,000 health care workers focused on supporting state and local efforts to conduct effective contact tracing and testing of at-risk populations.
    2. Provide adequate PPE supplies – While PPE supplies are less of an issue compared to several months ago, there are still issues. The plan calls for scaling up production and to restore national stockpiles utilizing the Defense Production Act. Another key element of the plan is to facilitate/support “domestic” production to ensure American independence.
    3. Engage the federal government as a leader of the response – The intent is to have the CDC step up with clear guidelines on criteria for responding to Covid-19 in terms of: when to open/close businesses, bars, restaurants, schools, gyms and other places where groups convene. A major component of this portion of the plan is to work with Congress to provide financial relief to state governments, local school districts and other adversely affected by the pandemic along with a Corona Relief Package for individuals taking them from the new $600 package to a total of $2000 in general relief.
    4. Deploy an equitable vaccination allocation plan – $25B is to be set aside for the manufacture and distribution of FDA-approved vaccinations. The intent is to make the process “free” to the public. In addition, transparency will be a requisite focus of the information which will be distributed widely for review and critique.
    5. Set a priority on elderly and high-risk individuals (NOTE: As I approach my 70th birthday in February, I leapt with joy when I read this portion of the plan – Thank Goodness 😊) – The Administration intends to establish a Racial and Ethnic Disparities (RED) Task Force to develop recommendations for managing these populations as well as the disparities issues. The CDC will also be establishing a national Pandemic Dashboard that denotes transmission rates by zip code for use by citizens.
    6. Restore national biodefense programs – The Trump Administration discontinued many of the in-place programs designed to monitor such world-wide problems as the global Covid-19 pandemic. The incoming Administration intends to re-establish the Obama Administration’s National Security Council Directorate for Global Health Security and Biodefense.
    7. Masks, Mask, MASKS! – Biden has been clear that masks are a priority ever since he made his first speech. He intends to put forward a “national mask mandate” for the first 100 days of the new Administration (= April 30, 2021) as well as advocate that the Governors and Mayors issue similar mandates in their respective jurisdictions.
  2. Return to a Use of Science-based Management in Public Health – The Administration intends to lead with science as the driver of decisions, the reliability of FDA-approved vaccines or medications.
  3. Override Executive Orders – The Administration is expected to override many of President Trump’s executive orders that were designed to undermine the Affordable Care Act. In fact, we should expect that the Democrats will focus on generally on increasing access and improving affordability plus expanding access in medically underserved communities in rural and urban America. The public insurance option will no doubt be back on the table as a competitor to private insurance as well as being made available to those with employer-based health plans. Elements that are likely to be included are 
  • Reinstatement of affordability requirements – to ensure that waivers do not adversely impact low-income consumers.
  • Reinstate HRA funded health plan purchases – so that retirement plans are not adversely impacted through use of funds for current rather than long-term needs.
  • iii. Tighter federal regulation – to increase benchmark plan requirements and levels of financial assistance for consumers in the marketplace.
  • iv. Protect coverage of contraceptives services – to recreate these services as an “essential” benefit as defined by the ACA and to reduce religious and moral exemptions.
  • v. Reinstate Obama-era regulations that strengthen marketplace risk pools.

4. Prescription Drugs – The most important of the various initiatives under consideration will be the passage of H.R. 3 and H.R. 1425 whereby the government will be able to negotiate directly with the manufacturers of drugs on pricing. Those negotiations are likely to not only include a government price but also an inflationary ceiling rate as well.

5. Reproductive Health – The Democrats’ agenda calls for the repeal of the Hyde Amendment that bans the use of federal funds to pay for abortions – except for life endangerment, rape, or incest) as well as restoration of funding for Planned Parenthood.

6. Broadband – The new Administration is also very committed to addressing the digital divide. Through the global pandemic, most everyone has become convinced that we need to “do something” to solve the lack of broadband in certain areas of the nation. Having kids sit in cars outside of Starbuck’s to do homework and hamstringing medical care delivery due to lack of sufficient bandwidth is increasingly recognized as a major problem. Biden’s “Lifeline Program” provides about $20B in funding to support the initiative. There is actually strong bipartisan support and a bridging between the urban and rural areas on this issue. As a result, we should not be surprised if this is not part of the “infrastructure” package discussed by Congress and the Administration (NOTE: I’ve been an advocate for some time of a National Broadband Infrastructure Deployment Initiative similar to the Interstate Highway funding of the 1960’s to dramatically alter the landscape of broadband capability across the nation. Such a broadband infrastructure could not only be used for education and health care but also for local commerce, remote workers and a vast number of other activities in our evolving digital society.). A secondary issue will likely be the restoration of the Federal Communication Commission’s (FCC’s) authority to enforce net neutrality principles and prohibit blocking, throttling and/or paid prioritization by broadband providers that raise consumer prices or impact competition.

On the other side of the equation, it is my strong sense that Medicare for All will be set aside in favor of re-enactment of those portions of the ACA that were set aside by the Trump Administration. In addition, I suspect that we will see a re-emergence of a strong focus on creating value-based care delivery plans by the Biden Administration as a move toward managing costs more effectively. In the later years of the Obama Administration there was a strong focus on value-based care which was sidelined during the Trump Administration. Expect a re-focus on this model of insurance with experimentation allowed under Medicare. With the large numbers of elderly already moving into Medicare Advantage programs – growing from 12 million to 24 million members – this could very well be one of the prime movers (or, the Big Gorilla in the Room) in the coming health care environment.

Readings To Consider vs. The Occasional Perspective - 10/16/20

Books and Articles worth a Review… 

A First! – The October 7, 2020 issue of the New England Journal of Medicine provided an editorial that was a first in the 208-year history of the publication going back to its origin in 1812. “Dying in a Leadership Vacuum” 34 editors weighed in on the decision in support of the decision with Eric Rubin, MD as Editor-in-Chief explaining that the events of the Covid-19 pandemic cut across all levels of leadership from the President, to Governors and other in leadership roles throughout the nation.

Enhanced Listening So We Can Learn and Act – I have recently taken on an old interest that I put on the shelf a number of decades ago (actually a whole bunch of them) and re-energized the interest. It is writing – not just blogs but on more general issues. I have been doing all these readings about how to get in touch with your other self (hmmmm) as part of an embrace for the age I’m now entering. So, check out my new article published on – //">The New Requirement: First Hear and Listen with Intent to Learn and Act. The article basically is a call for moving from the passive act of hearing auditory signals, to listening where we actually absorb what is being said to learning from the exchange with others to acting responsibly on behalf of the needs of society. It emanated from the lack of dialogue, debate and discussion that has taken an overriding grip on the American spirit. Any feedback is appreciated…

Readings and Other Considerations

Books, articles and other worthy perspectives for your a review… 

Activism in Health Care and Science – I was recently introduced to 314 Action, a group of individuals from the STEM community who founded the organization with some other grassroots supporters and political activists who believe in science.  It is an organization that is committed to electing more STEM candidates to office, advocating for evidence-based policy solutions to issues like climate change, and fighting the recent attacks on science from the political community. In essence, their action statement is to elect more leaders who will use their training as STEM professionals to influence policy-making based on facts ranging from climate change to health care to gun violence.  The efforts are not limited to Washington, D.C. and include efforts focused on local and state legislatures as well. Through their efforts, they intend to leverage their network of pro-science advocates to organize and effect change in areas where science is being maligned or disputed. As a unified STEM and pro-science community, we can combat the all-too-common attacks on basic scientific understanding. This activism cuts to the very heart of health care.  Consider their efforts as you make your choices…

JAMA Releases Top 10 Articles of the Decade – There’s so much information being disseminated these days in medicine and health care that it’s hard to stay up to speed.  The JAMA Editors culled through the ones from their journal; however, and came up with a list.  Here you go and, the downloads are free, that way you can catch up:

§  The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) – Mervyn Singer, MD, FRCP; Clifford S. Deutschman, MD, MS; Christopher Warren Seymour, MD, MSc; et al

§  2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) – Paul A. James, MD; Suzanne Oparil, MD; Barry L. Carter, PharmD; et al

§  Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial – Paulina Salminen, MD, PhD; Hannu Paajanen, MD, PhD; Tero Rautio, MD, PhD; et al

§  Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial – Jeff D. Williamson, MD, MHS; Mark A. Supiano, MD; William B. Applegate, MD, MPH; et al for the SPRINT Research GroupAudio Interview: Intensive Blood Pressure Control in Adults Aged 75 Years or Older

§  Development and Validation of a Deep Learning Algorithm for Detection of Diabetic Retinopathy in Retinal Fundus Photographs – Varun Gulshan, PhD; Lily Peng, MD, PhD; Marc Coram, PhD; et al

§  United States Health Care Reform: Progress to Date and Next Steps – Barack Obama, JD

§  Health Care Spending in the United States and Other High-Income Countries – Irene Papanicolas, PhD; Liana R. Woskie, MSc; Ashish K. Jha, MD, MPH Audio Interview: Health Care Spending in the United States and Other High-Income Countries

§  The Association Between Income and Life Expectancy in the United States, 2001-2014 – Raj Chetty, PhD; Michael Stepner, BA; Sarah Abraham, BA; et al

§  Eliminating Waste in US Health Care – Donald M. Berwick, MD, MPP; Andrew D. Hackbarth, MPhil Audio Interview: Association Between Income and Life Expectancy in the United States

§  Silencing the Science on Gun Research – Arthur L. Kellermann, MD, MPH; Frederick P. Rivara, MD, MPH

Readings To Consider vs. The Occasional Perspective

Books and Articles worth a Review… 

HeForShe – The United Nations is sponsoring a website where you can meet the visionary leaders taking action for gender equality in their countries, organizations and beyond. HeForShe IMPACT and Pilot Initiatives are intended to engage key decision makers around the world in the public and private sector to deliver parity by 2020, and drive change from the top.  Consider it!  These global leaders are on a journey to reach parity and achieve a  gender equal world for all. 

Vaping Ads on Television ??? – Are we crazy?  I was taken aback the other night in watching the news when an ad came on encouraging me to go out, buy this product and start vaping!  I was appalled.  On the one hand, we are now allowing vaping ads – which are now countered by FDA ads noting the dangers of vaping – when there is an epidemic of the use of these devices among teenagers.  By all accounts, nearly 20% of high school students now vape or, an 86% increase in vaping among that group in just one year from 2017 to 2018!  For all we know, over the coming weeks there will be the equivalent of the Marlboro Man jumping out of our screens – be they television or computer – counting the attributes of vaping.  LET’S STOP THIS INSANITY NOW!

Distortion By Technology – First, this is not a political statement.  It is warning sign on the veracity of information we see streaming across our devices and into our homes.  The wires went crazy a couple of weeks ago when distorted videos of House Speaker Nancy Pelosi (D-CA) were disseminated with edits that made it appear that she was having trouble speaking.  While it was disturbing, the issue is far greater than Nancy Pelosi and politics.  It is about the ability of technology to distort all sorts of information – with the capability growing by leaps and bounds every month!  I’m a big (huge 😊) fan of technology for solving problems.  But, we also need to keep our eye on technology as it “creates” problems as well.  This is not about politics – be they conservative or liberal.  This is about information upon which our society has become totally dependent.  Think about it.  What needs to be done? 

Seize Diastole – Considering the lessons of physiology and how they can be extrapolated to the world we live in is the focus of this excellent article by Colleen Farrell, MD at NYU.  If you need a copy, let me know.  I have it available.

Media to Consider - 4/19/19

Books and Articles worth a Review…

Eric Topol’s new book, Deep Medicine, is an absolute MUST READ for anyone in the health care world.  It will take you on a whirlwind tour of the technology forces which are being unleashed across all of society which will profoundly alter our notion of medicine and health care in the future.  We are the cusp of a major shift in capability that will make the discovery of antibiotics pale in comparison.  In particular, I believe his last chapter is the most profound.  He notes that we have historically recruited into medicine and the helping professions people who were brainy folks and who had the ability to store large quantities of data in their brains.  With the advent of clinically augmented intelligence where the computer becomes part of our armamentarium, he argues that we will need clinicians with must stronger skills in emotional intelligence.  I think he’s right.  Let’s start the debate now.  I hope there are some Deans reading this blog…

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