Category: Healthcare

‘Fourth Wave’ of Opioid Epidemic Crashes Ashore, Propelled by Fentanyl and Meth

Mary Pat Campbell

Link:https://kffhealthnews.org/news/article/fourth-wave-opioid-epidemic-fentanyl-millennium-health-report/

Excerpt:

The United States is knee-deep in what some experts call the opioid epidemic’s “fourth wave,” which is not only placing drug users at greater risk but is also complicating efforts to address the nation’s drug problem.

These waves, according to a report out today from Millennium Health, began with the crisis in prescription opioid use, followed by a significant jump in heroin use, then an increase in the use of synthetic opioids like fentanyl.

The latest wave involves using multiple substances at the same time, combining fentanyl mainly with either methamphetamine or cocaine, the report found. “And I’ve yet to see a peak,” said one of the co-authors, Eric Dawson, vice president of clinical affairs at Millennium Health, a specialty laboratory that provides drug testing services to monitor use of prescription medications and illicit drugs.

The report, which takes a deep dive into the nation’s drug trends and breaks usage patterns down by region, is based on 4.1 million urine samples collected from January 2013 to December 2023 from people receiving some kind of drug addiction care.

Its findings offer staggering statistics and insights. Its major finding: how common polysubstance use has become. According to the report, an overwhelming majority of fentanyl-positive urine samples — nearly 93% — contained additional substances. “And that is huge,” said Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.

Author(s): Colleen DeGuzman

Publication Date: 21 Feb 2024

Publication Site: KFF Health News

Fixing Medicare Starts With Cracking Down On A Multibillion-Dollar Catheter Scam

Mary Pat Campbell

Link: https://thefederalist.com/2024/02/20/fixing-medicare-starts-with-cracking-down-on-a-multibillion-dollar-catheter-scam/?utm_source=feedly&utm_medium=rss&utm_campaign=fixing-medicare-starts-with-cracking-down-on-a-multibillion-dollar-catheter-scam

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The New York Times reported recently about a sharp spike in Medicare spending on catheters, amid numerous signs that scammers have targeted that benefit to bilk the government out of taxpayer funds. With Medicare rapidly approaching insolvency, the problem is twofold: Criminals still consider the program such an easy source of cash — because the feds do such a poor job at finding and catching the crooks. 

Times reporters interviewed several seniors explaining how they had been billed for catheters they never received and do not need or use. It also noted that the number of Medicare beneficiary accounts billed for catheters rose roughly nine-fold last year, from 50,000 to 450,000. 

The pattern of Medicare spending on catheters echoes the increase in beneficiaries billed. Based on this graph from the Times story, it doesn’t take a doctorate in economics to realize that something fishy has happened regarding payments for catheters — and that, assuming most or all of the increase is due to fraud, Medicare has already given the scammers billions of dollars.

Over and above whether and when the feds can catch the scammers, the real question is: How did this happen? Or, given the federal government’s history of permitting fraud in federal health care programs, how does this keep happening?

Author(s): Christopher Jacobs

Publication Date: 16 Feb 2024

Publication Site: The Federalist

CDC Downplayed News of Vax Myocarditis

Mary Pat Campbell

Link: https://checkyourwork.kelleykga.com/p/cdc-downplayed-news-of-vax-myocarditis

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Excerpt:

With the recent discovery that the CDC drafted — but never sent — a Health Alert in May 2021 about myocarditis after mRNA vaccination, I put together this timeline about vaccine myocarditis news and updates from government officials. I include a combination of documents from CDC and FDA, as well as what was covered in the mainstream media.

I think this timeline shows a pattern in which CDC & FDA failed to adequately investigate and inform the public about the risks of myocarditis early in the vaccine rollout. However, there was public acknowledgement by the CDC, as early as May 20, 2021, about a potential pattern of myocarditis after the 2nd dose of mRNA vaccines, particularly in young men.

On June 1, 2021, the CDC confirmed that they had identified a higher than expected signal of myocarditis for young men after mRNA vaccination, but that they still recommended Covid vaccination for everyone in this age group. Despite a lot more analysis and discussion of myocarditis after that, and a changing landscape with widespread natural immunity, the CDC & FDA position has changed very little since that time.

Author(s): Kelley in Georgia

Publication Date: 19 Jan 2024

Publication Site: Check your Work on substack

I Am Afraid of Early Cancer Detection

Mary Pat Campbell

Link: https://www.sensible-med.com/p/i-am-afraid-of-early-cancer-detection?utm_source=post-email-title&publication_id=1000397&post_id=141592311&utm_campaign=email-post-title&isFreemail=true&r=15zk5&utm_medium=email

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Looking a bit more closely you see why Grail’s test is actually useless, or dangerous, or both. Let’s start with the sensitivity of the test. For a cancer screening test to work, it must find disease before it has caused symptoms — when it is in an early or premalignant stage. Say what you want about lung cancer screening, mammography, PSA, and colonoscopy (I’m talking to you Drs. M and P) but at least they look for, and succeed at finding, early stage/premalignant disease. Here is the sensitivity of the Galleri test by stage: stage 1, 16.8%; stage 2, 40.4%; stage 3, 77%; stage 4, 90.1%.

The test is nearly worthless at finding stage 1 disease, the stage we would like to find with screening. The type of disease that is usually cured with surgery alone.

How about specificity? Let’s consider a fictional, 64-year-old male patient who presents to his internist worried about pancreatic cancer. I pick pancreatic not only because it is a scary cancer: we can’t screen for it, our treatments stink, and it seems to kill half the people in NYT obituary section. I also chose it because it is the anecdotal disease in the WSJ article.

….

Working through the math (prevalence 0.03%, sensitivity 61.9%, specificity 99.5%), this means our patient’s likelihood of having pancreatic cancer after a positive test is only 3.58%. For our patient, we have caused anxiety and the need for an MRI. You almost hope to find pancreatic cancer at this point to be able to say, “Well, it was all worth it.” If the MRI or ERCP is negative, the patient will live with fear and constant monitoring. (You will have to wait until next week to consider with me the impact of this test if we were to deploy it widely).

If the evaluation is positive, and you have managed to diagnose asymptomatic, pancreatic cancer, the likelihood of survival is probably, at best, 50%.

Let’s end this week with two thoughts. First the data for the Galleri test is not good, yet. The test characteristics are certainly not those we would like to see for a screening test. Even more importantly, good test characteristics are just the start. To know that a test is worthwhile, you would like to know that it does more good than harm. This has not even been tested. The WSJ article scoffs at the idea that we would want this data.5

Author(s): Adam Cifu, MD

Publication Date: 15 Feb 2024

Publication Site: Sensible Medicine, substack

Americans’ Challenges with Health Care Costs

Mary Pat Campbell

Link: https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/

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  • About half of U.S. adults say it is difficult to afford health care costs, and one in four say they or a family member in their household had problems paying for health care in the past 12 months. Younger adults, those with lower incomes, adults in fair or poor health, and the uninsured are particularly likely to report problems affording health care in the past year.
  • The cost of health care can lead some to put off needed care. One in four adults say that in the past 12 months they have skipped or postponed getting health care they needed because of the cost. Notably six in ten uninsured adults (61%) say they went without needed care because of the cost.
  • The cost of prescription drugs prevents some people from filling prescriptions. About one in five adults (21%) say they have not filled a prescription because of the cost while a similar share say they have instead opted for over-the-counter alternatives. About one in ten adults say they have cut pills in half or skipped doses of medicine in the last year because of the cost.
  • Those who are covered by health insurance are not immune to the burden of health care costs. About four in ten insured adults worry about affording their monthly health insurance premium, and 48% worry about affording their deductible before health insurance kicks in. Indeed, large shares of adults with employer-sponsored insurance (ESI) and those with Marketplace coverage rate their insurance as “fair” or “poor” when it comes to their monthly premium and to out-of-pocket costs to see a doctor.
  • Health care debt is a burden for a large share of Americans. About four in ten adults (41%) report having debt due to medical or dental bills including debts owed to credit cards, collections agencies, family and friends, banks, and other lenders to pay for their health care costs, with disproportionate shares of Black and Hispanic adults, women, parents, those with low incomes, and uninsured adults saying they have health care debt.
  • Notable shares of adults still say they are worried about affording medical costs such as unexpected bills, deductibles, and long-term care services for themselves or a family member. Additionally, about half of adults would be unable to pay an unexpected medical bill of $500 in full without going into debt.

Author(s): Lunna Lopes, Marley Presiado, and Liz Hamel

Publication Date: 21 Dec 2023

Publication Site: Kaiser Family Foundation

Combating the black maternal and infant mortality crisis

Mary Pat Campbell

Link: https://cbs6albany.com/news/local/combating-the-black-maternal-and-infant-mortality-crisis

Excerpt:

She’s not alone, according to the CDC black women of all backgrounds are three times more likely to die from a pregnancy related cause than white woman. Black infants are also three times more likely to die than white babies.

Many black women report feeling silenced or ignored by healthcare providers during their pregnancy journey.

“It is 2023 almost 2024, and in this time, we should not be dying in birth. Period. You may be the medical professional, and you may have great textbook knowledge and you may have many degrees, but nobody is in my body but me, and nobody can tell me that this pain that I’m feeling is not there,” King said.

….

This month New York Governor Kathy Hochul called the issue a crisis and a disgrace. Hochul announced more than $4 million in funding for regional perinatal centers and said doula services will now be covered for all Medicaid enrollees beginning January first.

In a statement, Governor Hochul said, “as the first mom and grandma to serve as Governor of New York, I’m committed to doing everything in my power to tackle the disturbing rise in infant mortality.”

Esther is hopeful the attacks on this issue from all fronts will lead to better outcomes for women and babies in the future.

….

For more information about BirthNet visit this link.

Author(s): Emani Payne

Publication Date: 21 Nov 2023

Publication Site: CBS 6 Albany

‘Worse Than People Can Imagine’: Medicaid ‘Unwinding’ Breeds Chaos in States

Mary Pat Campbell

Link: https://kffhealthnews.org/news/article/medicaid-unwinding-disenrollment-redetermination-state-delays/

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Excerpt:

Seven months into what was predicted to be the biggest upheaval in the 58-year history of the government health insurance program for people with low incomes and disabilities, states have reviewed the eligibility of more than 28 million people and terminated coverage for over 10 million of them. Millions more are expected to lose Medicaid in the coming months.

The unprecedented enrollment drop comes after federal protections ended this spring that had prohibited states from removing people from Medicaid during the three pandemic years. Since March 2020, enrollment in Medicaid and the related Children’s Health Insurance Program had surged by more than 22 million to reach 94 million people.

The process of reviewing all recipients’ eligibility has been anything but smooth for many Medicaid enrollees. Some are losing coverage without understanding why. Some are struggling to prove they’re still eligible. Recipients and patient advocates say Medicaid officials sent mandatory renewal forms to outdated addresses, miscalculated income levels, and offered clumsy translations of the documents. Attempting to process the cases of tens of millions of people at the same time also has exacerbated long-standing weaknesses in the bureaucratic system. Some suspect particular states have used the confusing system to discourage enrollment.

Author(s): Phil Galewitz and Katheryn Houghton and Brett Kelman and Samantha Liss

Publication Date: 2 Nov 2023

Publication Site: Kaiser Health News

The Paradoxical Decline of Geriatric Medicine as a Profession

Mary Pat Campbell

Link:https://jamanetwork.com/journals/jama/article-abstract/2808221

DOI: JAMA. 2023;330(8):693-694. doi:10.1001/jama.2023.11110

Excerpt:

Thirty-five years ago, geriatrics officially became a specialty of medicine. At that time, there were 76 million baby boomers who would begin turning 65 in 2011, a compelling demographic imperative for this new specialty that specifically focused on older adults.

Geriatrics is a field especially attractive to some physicians because of its differences from other specialties, including elements beyond single medical conditions such as multimorbidity, polypharmacy, function, and cognition. Geriatrics also places a special emphasis on interdisciplinary team care for complex older patients, and the needs of family caregivers.

Author(s):Jerry H. Gurwitz, MD1

Publication Date: 4 Aug 2023

Publication Site: JAMA

Who Will Care for Older Adults? We’ve Plenty of Know-How but Too Few Specialists

Mary Pat Campbell

Link: https://kffhealthnews.org/news/article/who-will-care-for-older-adults-weve-plenty-of-know-how-but-too-few-specialists/

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Despite the surging older population, there are fewer geriatricians now (just over 7,400) than in 2000 (10,270), he noted in a recent piece in JAMA. (In those two decades, the population 65 and older expanded by more than 60%.) Research suggests each geriatrician should care for no more than 700 patients; the current ratio of providers to older patients is 1 to 10,000.

What’s more, medical schools aren’t required to teach students about geriatrics, and fewer than half mandate any geriatrics-specific skills training or clinical experience. And the pipeline of doctors who complete a one-year fellowship required for specialization in geriatrics is narrow. Of 411 geriatric fellowship positions available in 2022-23, 30% went unfilled.

The implications are stark: Geriatricians will be unable to meet soaring demand for their services as the aged U.S. population swells for decades to come. There are just too few of them. “Sadly, our health system and its workforce are wholly unprepared to deal with an imminent surge of multimorbidity, functional impairment, dementia and frailty,” Gurwitz warned in his JAMA piece.

This is far from a new concern. Fifteen years ago, a report from the National Academies of Sciences, Engineering, and Medicine concluded: “Unless action is taken immediately, the health care workforce will lack the capacity (in both size and ability) to meet the needs of older patients in the future.” According to the American Geriatrics Society, 30,000 geriatricians will be needed by 2030 to care for frail, medically complex seniors.

Author(s): Judith Graham

Publication Date: 10 Nov 2023

Publication Site: Kaiser Health News

Pulse oximeters’ inaccuracies in darker-skinned people require urgent action, AGs tell FDA

Mary Pat Campbell

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Link:https://www.statnews.com/2023/11/07/pulse-oximeters-attorneys-general-urge-fda-action/

Excerpt:

More than two dozen attorneys general are urging Food and Drug Administration officials to take urgent action to address disparities in how well pulse oximeters, the fingertip devices used to monitor a person’s oxygen levels, work on people with darker skin.

In a Nov. 1 letter, the AGs noted that it had been a year since the FDA convened a public meeting of experts, who called for clearer labeling and more rigorous testing of the devices, and that no action had been taken.

“We, the undersigned Attorneys General, write to encourage the FDA to act with urgency to address the inaccuracy of pulse oximetry when used on people with darker toned skin,” said the letter, written by California Attorney General Rob Bonta and signed by 24 other attorneys general.

Pulse oximeters’ overestimation of oxygen levels in patients with darker skin has, in a slew of recent research studies, been linked to poorer outcomes for many patients because of delayed diagnosis, delayed hospital admissions, and delayed access to treatment, including for severe Covid-19 infections. Higher amounts of pigments called melanin in darker skin interfere with the ability of light-based sensors in pulse oximeters to detect oxygen levels in blood.

….

The delay has frustrated health care workers who use pulse oximeters and have studied them and followed the progress toward creating new devices that work better. “I just get mad that these things are not on the market,” Theodore J. Iwashyna, an ICU physician at Johns Hopkins, told STAT. “Just last week in my ICU, I had a patient whose pulse oximeter was reading 100% at the same time that his arterial blood gas showed that his oxygen levels were dangerously low. I need these things to work, and work in all my patients.”

Author(s):Usha Lee McFarling

Publication Date: 7 Nov 2023

Publication Site: STAT News

How to Honor Breast Cancer Awareness Month

Mary Pat Campbell

Link:https://vpostrel.substack.com/p/how-to-honor-breast-cancer-awareness

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It’s not the orgy of pink that reminds me of breast cancer. It’s the Nobel Prize in Physiology or Medicine. I have a rooting interest, and so far I’ve been disappointed. I want the prize to go to UCLA cancer researcher Dennis Slamon, who in recent years has been on the Great Mentioner’s short list (an improvement since I started paying attention a decade or so ago).

Slamon’s work did two things: Beginning with HER2+ breast cancer, it demonstrated that cancers could be identified by specific genetic variants, rather than merely where they occur in the body. Then it showed that those variations could be targeted and treated with specific antibodies. The first practical result was the drug Herceptin, which treats the roughly 25 percent of breast cancer patients with an especially aggressive form.

….

The usual sources were still not interested in paying for research. But in 1989, Slamon was treating Hollywood honcho Brandon Tartikoff, best known for his stint as president of NBC, for Hodgkin’s lymphoma. Tartikoff’s wife Lilly was grateful for the care and asked Slamon what she might do to help him. He told her about the idea of finding a drug to treat HER2+ breast cancer. Soon thereafter, in a classic Hollywood moment, she ran into Ronald O. Perelman, who owned Revlon, at Wolfgang Puck’s original Spago restaurant. She gave him the pitch: You own Revlon. Revlon sells to women. Women get breast cancer. You and Revlon should support this research. He agreed to let his representative meet with Slamon.

At the meeting, Slamon was accompanied by his colleague John Glaspy, who is a notably blunt-spoken person. Even if they got government funding, Glaspy warned, it would take several years and by then “we’ll have a Rose Bowl full of dead women” from breast cancer. The pitch worked. 

….

In 1998, the drug was approved for treatment of Stage 4 HER2+ breast cancer and in 2006 it was approved for treating early stage cancers. A year later, it saved my life.

Author(s): Virginia Postrel

Publication Date: 9 Oct 2023

Publication Site: Virginia Postrel’s newsletter at Substack

Why do so many Black women die in pregnancy?One reason: Doctors don’t take them seriously

Mary Pat Campbell

Link: https://projects.apnews.com/features/2023/from-birth-to-death/black-women-maternal-mortality-rate.html

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Her pleas for help were shrugged off, she said, and she was repeatedly sent home from the hospital. Doctors and nurses told her she was suffering from normal contractions, she said, even as her abdominal pain worsened and she began to vomit bile. Angelica said she wasn’t taken seriously until a searing pain rocketed throughout her body and her baby’s heart rate plummeted.

Rushed into the operating room for an emergency cesarean section, months before her due date, she nearly died of an undiagnosed case of sepsis.

Even more disheartening: Angelica worked at the University of Alabama at Birmingham, the university affiliated with the hospital that treated her.

Her experience is a reflection of the medical racism, bias and inattentive care that Black Americans endure. Black women have the highest maternal mortality rate in the United States — 69.9 per 100,000 live births for 2021, almost three times the rate for white women, according to the Centers for Disease Control and Prevention.

Black babies are more likely to die, and also far more likely to be born prematurely, setting the stage for health issues that could follow them through their lives.

Author(s): KAT STAFFORD

Publication Date: 23 May 2023

Publication Site: AP news