Why does the US keep running out of medicine?

“According to a 2022 report from the National Academies of Sciences, Engineering, and Medicine, “on average, the number of ongoing drug shortages has been increasing and are lasting longer.” The root cause of that problem, per a report from the Food and Drug Administration, is the economics of the pharmaceutical market itself.

The reasons for shortages are generally consistent no matter the drug: either a shortage of raw materials or a problem at the plant where the drug is manufactured. Shortages for medicines that a patient can pick up at the pharmacy often draw the most headlines, but most of the medications that end up in short supply are generic, injectable drugs that are used in hospitals: usually, these drugs have only one or two suppliers. So if there is a problem at the factory of one company, there is not an easy way to scale up production to make up for a shortfall. And they are usually cheap, which means the companies that manufacture them do not have a strong economic incentive to produce any excess supply.”

““It makes a lot of sense when you think about it from their perspective. But when you think about it from the hospital perspective, it’s very frustrating.”

Some of these shortages have led directly to patient deaths. An Associated Press report in 2011 linked at least 15 deaths over the prior 15 months to drug shortages. A more recent study, following the year-long shortage of a drug used to treat septic shock, found higher mortality rates for patients who relied on a substitute. Even short of death, drug shortages can meaningfully change the care patients get — if, for example, a pregnant person undergoes a cesarean delivery, with its higher risk of complications and longer recovery time, because the drug that could have induced labor earlier is out of stock.

Experts do have ideas about how to make the pharmaceutical supply chain more resilient. But they require action by the federal government. Until that happens, there is little reason to think the pace and duration of America’s drug shortages will slow down.”

“These companies rely on razor-thin margins and massive scale to make their business work. They have a “just in time” production schedule, which means almost as soon as the product rolls out of the factory, it is delivered to health care providers. There aren’t warehouses with emergency stockpiles, because it wouldn’t really make financial sense for manufacturers to produce and store the excess supply.”

America’s increasingly atrocious access to maternity care, explained in 3 charts

“about 900 Americans died in 2020 from complications related to childbirth. Another 50,000 or more women experienced severe pregnancy-related complications. Four of five of those deaths were from preventable causes. In terms of scale and rate, America’s maternal mortality dwarfs the issues of other wealthy countries, and these gaps in maternity care shoulder much of the blame.”

Some Canadian Health Care Patients Say They’re Being Encouraged To Just Die Already

“The lesson here should not be that assisted suicide is bad, but heavy government involvement in health care decisions has an inescapable distorting influence. At the very least, how Canada manages health care access is a massive contributing factor. A survey from 2016 found that Canadians wait longer to access health care services than citizens in 11 other countries. The United States is one of the countries of comparison, but the survey also looks at other countries with government-managed health care systems like the United Kingdom and France. A 2020 study from the Canadian Family Physician journal notes that the country simply provides less freedom and opportunity for people seeking medical care than other countries, even when healthcare is centrally planned: ” What these countries do differently than Canada is they allow the private sector to provide core health care insurance and services, require patients to share in the cost of treatment, and fund hospitals based on activity (rather than the global budgets that are the norm in Canada).””

Why are American lives getting shorter?

“the US was one of only two among 21 selected similar wealthy countries — along with Israel — in which life expectancy continued to decline last year. While most countries suffered hundreds of thousands of untimely deaths during the first year of Covid-19, once people began to get vaccinated, life expectancies for almost all the 21 countries either stayed the same or began to rise again, many up to their pre-pandemic levels.

The US started off with lower pre-Covid life expectancies than other rich countries like South Korea, France, and Australia. It has been the case for decades that the United States spends exorbitant amounts on health care, yet has worse health outcomes than comparable countries. Even before the pandemic, people in the US faced the opioid epidemic, gun violence, and higher chronic disease rates than people in other rich countries.”

“Lack of health access and a robust public health care system exacerbated Covid-19’s effects, said Noreen Goldman, a professor of demography and public affairs at Princeton University. The lack of national coordination to address the pandemic, and lower vaccination rates, said Goldman, have also been a factor in outcomes being worse in the US than other comparable countries.
Young people were dying more from Covid-19 in 2021 than 2020, said Theresa Andrasfay, a demography researcher at the University of Southern California. While age remains the biggest risk factor, more middle-aged adults who are not vaccinated are dying. Additionally, she said, high rates of chronic disease, obesity, and diabetes had not yet affected mortality statistics, but when a disease — Covid-19 — came along that had these as risk factors, “it was like lighting a match.””

Rape victims can face huge hospital bills if they seek help

“When victims of rape or sexual violence seek emergency medical assistance following an attack, they may be saddled with hundreds or even thousands of dollars in medical bills, a new study published this week in the New England Journal of Medicine found.

These bills can further traumatize victims, the study authors warn, and deter others from seeking professional help. Only one-fifth of sexual violence victims are estimated to seek medical care following an attack.”

Hackers have laid siege to U.S. health care and a tiny HHS office is buckling under the pressure

“the Department of Health and Human Services’ Office for Civil Rights, which is tasked with investigating breaches, helping health care organizations bolster their defenses, and fining them for lax security, is poorly positioned to help. That’s because it has a dual mission — both to enforce the federal health privacy law known as HIPAA and to help the organizations protect themselves — and Congress has given it few resources to do the job.
“They’re a fish out of water … They were given the role of enforcement under HIPAA but weren’t given the resources to support that role,” said Mac McMillan, CEO of CynergisTek, a Texas firm that helps health care organizations improve their cybersecurity.

Due to its shoestring budget, the Office for Civil Rights has fewer investigators than many local police departments, and its investigators have to deal with more than a hundred cases at a time. The office had a budget of $38 million in 2022 — the cost of about 20 MRI machines that can cost $1 million to $3 million a pop.

Another problem is that the office relies on the cooperation of the victims, the institutions that hackers have targeted, to provide evidence of the crimes. Those victims may sometimes be reluctant to report breaches, since HHS could then accuse them of violating HIPAA and levy fines that come on top of costs stemming from the breach and the ransoms often demanded by the hackers.

Depending on the circumstances, it can seem like blaming the victim, especially since the hackers are sometimes funded or directed by foreign governments. And it’s raised questions about whether the U.S. government should be doing more to protect health organizations.”

Why monkeypox is a repeat of the data mistakes made with Covid-19

“the roots of this deadly problem long predate monkeypox outbreaks or the Covid-19 pandemic. The US has always had a fragmented health care system, with widely disparate experiences for patients based on state, insurance company, or hospital chain. Without systems to reliably record and share population-level data between decision-makers, health care workers can’t focus on helping the patients who need it most. The consequences are worse for marginalized people — such as Indigenous people, people with disabilities, or youth at risk for teen pregnancy — who were already facing inadequate care before the pandemic.

It doesn’t have to be this way. The US has an opportunity to learn from the tough lessons of the last few years and build on work to improve transparency and data sharing. With monkeypox already a global public health emergency, it’s vital for the data to be available, promptly and accurately, to coordinate an effective public health response.”

“Data comes in from over 900 health systems, or chains of hospitals under shared management; the largest include about 200 hospitals. But that’s just a fraction of the over 6,000 hospitals across the country. So when, for example, positive test results for Covid-19 or monkeypox, or cases of workplace exposure to pesticides, have to be reported to the state, public health boards in every state must coordinate with hundreds of different organizations and aggregate their data before they can share it with federal agencies. Except during an officially declared public health emergency — which, for monkeypox, is only a week old — the CDC has limited legal power to mandate reporting.

Data also isn’t collected the same way everywhere. There is a large number of different electronic health record systems currently in use in the US. They allow medical professionals to document a patient’s diagnosis and treatment, and in theory, share them more efficiently than in the days of paper-based records. But the software systems aren’t designed to be compatible with each other, so they cannot easily exchange data.”

“Undertesting doesn’t just affect the case numbers reported, but hurts patients’ access to treatment. Tecovirimat, or TPOXX, an antiviral drug that is most effective for treating monkeypox if started early, can’t be prescribed until a test comes back positive, and since it’s not officially approved by the FDA for monkeypox treatment, doctors need to jump through bureaucratic hoops to prescribe it. This leaves many patients suffering from untreated painful lesions for days or weeks.”

“With monkeypox, the US can lean on the systems and infrastructure built during the Covid-19 pandemic, but some programs, like those that reimburse providers for treating uninsured patients or provide free Covid-19 tests, vaccines, and antiviral drugs to community health centers, were already scaled down after funding was decreased. In order to pull together a national response, the US needs straightforward, transparent data reporting that can be compared and combined on a national level.

The final difficulty will be in keeping this momentum going. The declaration of a new public health emergency for monkeypox will help keep federal funding flowing toward projects like the new NCATS OpenData portal for monkeypox, but the need for better health care infrastructure won’t end when the emergency does. In a chronically underfunded public health system, short-term efforts may not be enough.”

Florida medical board moves to block gender affirming treatments for minors

“Florida’s medical board on Friday voted to begin the process of banning gender-affirming medical treatment for youths, a move that comes as Republican Gov. Ron DeSantis has become increasingly vocal in his opposition to such therapies.”

“The board also voted to start that process for requiring adults seeking such care to wait 24 hours before going forward with any medical procedures.”

“The American Academy of Pediatrics and the American Medical Association support gender-affirming care for adults and adolescents. But medical experts said gender-affirming care for children rarely, if ever, includes surgery. Instead, doctors are more likely to recommend counseling, social transitioning and hormone replacement therapy.
The proposed rule is the latest step taken by the DeSantis administration to tighten regulatory controls over gender-affirming care. Florida’s Medicaid regulator is also considering a rule that would block state-subsidized health care from paying for treatments of transgender people.”

The Sinema-Manchin split that shaped Dems’ deal

“After Manchin agreed with Senate Majority Leader Chuck Schumer on the party-line tax, health care and energy bill, the West Virginia Democrat found himself bargaining with fellow moderate Sen. Kyrsten Sinema. Both hard-nosed negotiators, the Arizona Democrat’s business-friendly tax-approach clashed sharply with Manchin’s more progressive positions on taxes.

Manchin sought to target the wealthy and ended up agreeing with Schumer to target the so-called carried interest loophole that allows some people to pay lower tax rates on investment income. He also signed off on a corporate minimum tax package that most Democrats believed Sinema supported.

Ultimately, Sinema took a scalpel to the corporate minimum tax and scuttled any changes to carried interest, which Manchin called particularly “painful.” Triangulating between them through all of it: Schumer, whose job was harmonizing the views of the very public Manchin with an often-silent Sinema.”