“Even if the CDC data isn’t perfect, many scholars agree that far too many people are dying during and after childbirth in the United States.
We have many sources of information about maternal mortality, said Laurie Zephyrin, a senior vice president for advancing health equity at the Commonwealth Fund. The CDC’s National Center for Health Statistics releases the numbers that have been most debated recently, but the agency also has a Pregnancy Mortality Surveillance System that employs medical epidemiologists to comb through death records from pregnancy up to a year after birth. Meanwhile, state and local maternal mortality review committees also independently investigate maternal deaths. “All three of these ways of collecting data are showing that we have a problem in this country,” Zephyrin said.
We can also understand US maternal health better by putting it an international context. Comparing maternal mortality across countries can be complex, for some of the same reasons it’s complicated to count maternal deaths within the US. Some countries use a pregnancy checkbox like the one added in the US while others do not, leading to concerns that other nations may be underreporting maternal deaths, making the US look worse by comparison.
However, we know that the US lags behind other countries when it comes to policies proven to improve maternal (and overall) health. Among wealthy countries, the US is the only one without universal health care, said Munira Gunja, a senior researcher with the Commonwealth Fund’s International Program in Health Policy and Practice Innovations. It’s also the only one without federally mandated paid parental leave, and it’s the only country that doesn’t provide home visits and other comprehensive postpartum care, instead often limiting birthing people to a lone doctor’s appointment six weeks after birth. “The US is a clear outlier, particularly when it comes to postpartum support,” Gunja said.
Meanwhile, everyone involved in the debate over counting maternal deaths agrees that Black birthing people are dying at a disproportionately high rate. That disparity shows up whether you use the CDC’s method or Joseph’s, and it’s indicative of bigger problems within the US health care system, experts say. Black Americans in general have a lower life expectancy than white Americans, and Black babies are more likely to be stillborn or die in infancy. “This is across the board, not just in maternal health,” said Angela D. Aina, co-founder and executive director of the Black Mamas Matter Alliance.
Some have argued that the language of “crisis” is unproductive, frightening pregnant people and prospective parents and clouding the search for solutions. “The constant drumbeat that maternal mortality is ‘commonplace’ and that pregnancy is ‘deadly’ doesn’t empower me with information to make my own decisions,” Jerusalem Demsas writes at the Atlantic. “It just stresses me out.”
Reasonable people can disagree over what constitutes a crisis and over the best way to measure how often Americans experience the tragic situation in which a person who is already sick dies from their illness after giving birth.
But experts do not disagree on the basic premise that too many pregnant and birthing people are dying in America, that many of their deaths are preventable, and that we already know some of the reforms — from paid leave to better prenatal and postpartum care — that would save their lives.”
“As earlier threatened, the Food and Drug Administration (FDA) has just issued new rules that will significantly slow down the development of new diagnostic tests. Specifically, the agency requires that all laboratory-developed tests (LDTs) be submitted to its regulators before the tests can be offered to patients and physicians. As I explained earlier, LDTs are in vitro diagnostic (IVD) tests for clinical use that are designed, manufactured, and performed by individual laboratories. They can diagnose illnesses and guide treatments by detecting relevant biomarkers in saliva, blood, or tissues; the tests can identify small molecules, proteins, RNA, DNA, cells, and pathogens. For example, some assess the risks of developing Alzheimer’s disease or guide the treatment of breast cancer.”
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” “Laboratory developed testing services are not medical devices and subjecting them to medical device regulation will harm patient access to needed testing and compromise innovations that drive personalized medicine,” said American Clinical Laboratory Association President Susan Van Meter in a statement. “The rule will limit access to scores of critical tests, increase health care costs, and undermine innovation in new diagnostics.””
“Experts say the public’s disinterest in the latest Covid shots is likely a combination of poor messaging from authorities, a diminishing fear about a virus that three years ago was wholly unknown, and the political polarization of the pandemic itself. But whatever the reasons, that vaccine ambivalence still poses a health threat.
Elderly people and very young infants continue to have a higher chance than the rest of the population that they will be hospitalized with Covid-19. Vaccination rates have fallen off for the former group, who are also most likely to die from an infection, and they were never strong to begin with for the latter”
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“The known unknowns for the future, which could spur another round of investment and interest in updated Covid-19 vaccines, are biological. The virus has been evolving and will continue to evolve and could, in theory, reach a point where the current vaccines are ineffectual.
The other question mark is inside of us. The reason many people still enjoy protection from serious illness is because our body’s T-cells are familiar with the virus and can activate when they detect it. They may not be able to stop an infection entirely (that is the role of antibodies, which are quicker to fade) but they can stamp out the virus before a person becomes too sick.
What we don’t know today is how long our T cells’ memory will last, and how durable that immunity really is. The only way to find out is for more time to pass.”
“Research has shown that people will skip necessary care if they have even a small cost to pay, and recent surveys find one in three Americans say they have postponed medical treatment in the last year due to the cost.”
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“The Perry Undem survey, which polled nearly 2,700 Americans on behalf of the American Cancer Society’s Cancer Action Network, the Leukemia and Lymphoma Society, and RIP Medical Debt, also detected widespread struggles to afford health care. About 7 in 10 people say they have received a medical bill that they could not afford, it found, and more than 60 percent of Americans said they had made some kind of sacrifice — delaying care, skipping appointments, changing the food they buy at the grocery store, etc. — in order to afford health care in the past two years.”
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“About 40 percent of people said they were always or frequently unsure how much their medical services would cost after they received care, according to the Perry Undem survey; another 30 percent said they were uncertain about the costs at least some of the time. Nearly two-thirds of US patients said they were at least sometimes unsure how much their insurance plan would cover after being treated.”
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“About 6 in 10 Americans said they had experienced a problem using their health insurance in the past year, according to KFF.”
” The new study..compared the prices hospitals posted online (as required under new federal regulations) with the prices obtained in phone calls conducted by the team posing as potential patients.
They contacted 60 hospitals across the country, a mix of top-ranked facilities, hospitals that primarily serve low-income people, and the other hospitals in between. They asked about two procedures for which comparison shopping is more common: vaginal childbirth and a brain MRI.”
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“It was rare for the advertised price on the web to be the same as the price quoted over the phone. Less than 20 percent of hospitals provided the same price through an online price estimator as they did when someone spoke to a member of the billing department. In many cases, the disparity was significant, with more than a 50 percent price difference depending on whether you checked on a website or called for a quote.
And in a handful of cases, the price more than doubled depending on how you asked. At two hospitals, MRIs were listed online at $2,000, but “patients” were given a price of more than $5,000 when they called. Five hospitals offered a price of $10,000 for vaginal childbirth over the phone, but the price posted online were twice that much.
There didn’t seem to be a clear pattern of which quotes were higher. Sometimes they were higher over the phone, sometimes higher on the website.
The researchers said they took pains to make sure they were getting apples-to-apples comparisons, going so far as to give specific billing codes during their scripted calls with hospital staff. It didn’t matter.”
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“Research had already found prices for the same services vary wildly at different hospitals. The top-line findings of this new study reveal that it can be difficult to even determine what the price for a given service is at a given hospital. That is a problem both for the 10 percent of the US population that is uninsured as well as people enrolled in high-deductible health plans, which are becoming more common.”
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“the researchers made one other note in their study: They found poor correlation between brain MRI and vaginal childbirth prices within an individual hospital. In other words, some facilities would have high MRI prices compared to others but low prices for delivering babies — with no discernible economic reason for that disparity. It’s chaos.”
“Two decades ago, it became clear that Congress was intent on trying to curtail illicit methamphetamine production by restricting access to pseudoephedrine, a meth precursor that was also widely used as a decongestant in cold and allergy remedies such as Sudafed. Pfizer, the manufacturer of Sudafed products, responded by announcing that it would start selling alternatives containing a different active ingredient: phenylephrine.”
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“The main problem with phenylephrine: When taken orally, it is so thoroughly metabolized in the gut that almost none of it ends up in the bloodstream. “The new data appear compelling that the monographed dosage of oral [phenylephrine] results in no meaningful systemic exposure or evidence of efficacy,” says an FDA briefing document that was presented to the advisory committee. “Furthermore, the review suggests that higher doses…have also not shown efficacy. These findings are supported by in vitro and in vivo clinical pharmacology data showing that orally administered phenylephrine undergoes high first-pass metabolism resulting in less than 1% bioavailability.”
Legal restrictions on pseudoephedrine sales, in short, gave us reformulated products, including pseudo-Sudafed, that not only do not work as well but apparently do not work at all”
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“Legal restrictions on pseudoephedrine, by contrast, took it off the shelves and put it behind the pharmacy counter, whence it can be retrieved only under certain conditions.”
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“Restrictions on pseudoephedrine did affect the illicit methamphetamine trade, primarily by shifting production from small-scale U.S. operations toward large-scale Mexican traffickers. But by no means did that crimp the supply.”