young african american woman suffering from abdominal pain while sitting on bed

‘Below the Belt’ Exposes the Silent Crisis of Endometriosis Care

By Timothy Bonis

Premiering tonight on PBS, the film Below the Belt sheds light on endometriosis by documenting four women’s experiences with the disease.

Endometriosis is a silent crisis. One in ten women have it, yet, on average, people with the condition see seven doctors before they get diagnosed. Many experience severe pain, and the disease costs the American economy $80 billion annually in lost productivity, but the standard treatments are outdated and ineffectual.

Below the Belt exposes the failures in practice and policy that have led to the poor state of endometriosis care. Medical students usually don’t learn about endometriosis in medical school, and as a result, most general practitioners can’t recognize it. The majority of gynecologists treat endometriosis with hormones — which have serious side effects and bring little relief — and an ineffective surgery called ablation. Others continue to recommend the 20th-century approach, a hysterectomy. This dismal selection of treatments reflects the state of endometriosis research; historically, the disease has received less than $10 million in research funding per year (compared to $1 billion for diabetes, an equally common condition among women).

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an ambulance parked at the entrance of an emergency department

Psychiatric Care in Crisis

By Zainab Ahmed

Psychiatric care in the Emergency Department is all-or-nothing and never enough. Often, legal holds are the only intervention available, and they rarely are therapeutic. Upon discharge, our patients are, once again, on their own.

The ED acts as a safety-net for a failing health system, one that places little value on mental health services, either preventative or follow-up. The demand for acute psychiatric care is high; however, EDs have little physical capacity for psychiatric patients.

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Child holding paper family in LGBT rainbow colors.

Gamete Regulation and Family Protection in a Post-Dobbs World

By Courtney G. Joslin

Increasing numbers of people are forming families through assisted reproduction. Recently, there has been a push to impose new regulations on various aspects of this process. Some of these new laws open up participants to a range of possible penalties — civil, criminal, and/or professional discipline — for past “misconduct.” Other laws seek proactively to regulate the fertility care process. For example, some laws regulate the collection and dissemination of medical and identifying information about gamete providers — that is, sperm and egg donors. Other proposals seek to require gamete providers to agree to the release of their medical records.

It is surely important to assess and evaluate fertility care practices and to consider whether additional regulation is appropriate in this space. Particularly in the post-Dobbs era — an era marked by increasing attacks on reproductive health care (including access to IVF) and on LGBTQ people — it is also important to proceed cautiously and to consider how these proposals may adversely impact reproductive autonomy and family recognition.

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Close-up - barista prepares espresso in coffee shop.

The Infertility Shift

By Valarie K. Blake and Elizabeth Y. McCuskey

In vitro fertilization (IVF), like most medical care in the U.S., costs far more than most people can afford out-of-pocket: over $12,500 per cycle, with multiple cycles typically required. But, unlike most other expensive medical care, IVF rarely has insurance coverage to defray the cost.

In 2020, only 27% of employers with 500+ employees and 42% of employers with 20,000+ employees covered IVF in their employer plans. Companies like Starbucks and Amazon know this and use it to draw in employees at low (or essentially neutral) wages.

Recent reports reveal women working second shifts for these corporations solely to qualify for employer health benefits that cover infertility treatments. Starbucks, for example, covers IVF for employees who work 240 hours over three months, or roughly 20 hours per week. Frequently, in these low-wage positions, workers earn just enough to pay for their health insurance premiums and sometimes the associated cost-sharing requirements.

How did we get to a place where women must work an “infertility shift” beyond their full-time jobs to access medical care?

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Vaccine and syringe in front of EU flag.

The European Commission’s New Compulsory Licensing Proposal: A Step Forward?

By Sarah Gabriele

On April 27, 2023, the European Commission proposed new legislation that would allow companies to make drugs without the patent holder’s consent in emergency situations. The proposed legislation constitutes a step forward in the European Union’s effort to harmonize patent law in the Union, after the establishment of Unitary Patents and the European Patent Court.

In its proposal, the EU Commission acknowledges that intellectual property rights, and, in particular, patent rights play an important role in access to medicine, especially during public health crises. The COVID-19 crisis demonstrated how the need for protecting and incentivizing innovation clashed with the need to make products widely available. To solve this tension, the Commission recognizes that patent law already offers a solution: compulsory licensing.

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Narcan Naloxone nasal spray opioid drug overdose prevention medication.

Public Health Product Hops

By Michael S. Sinha, Edna Besic, and Melissa Mann

Members of Congress have been focused on drug pricing for the last several years, culminating recently in new drug pricing provisions within the Inflation Reduction Act of 2022. One reason for our drug pricing problem is that we allow manufacturers to charge whatever the market will bear for a new therapeutic. However, as we have also seen, manufacturers often engage in anticompetitive “games” aimed at extending market exclusivity and forestalling generic competition. One of these games is product hopping.

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Bill of Health - silhouette of COVID-19 vaccine vile held in front of company logos, cooperation and antitrust in vaccine production

Unlocking the mRNA Platform Technology: Walking the Talk with Investment Protection

By Aparajita Lath

Two articles published last month in the BMJ analyze the public investment and financing of mRNA COVID-19 vaccines, highlighting the extensive government funding that has supported the development of mRNA technology from 1985 to 2022.

However, rewards from these government investments are going back into the hands of pharma corporations and shareholders, with little thought given to public needs.

Together, these articles underscore the injustice of the present moment and emphasize the need to reform intellectual property protections for government-funded inventions of public health significance.

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handmade wooden chess board, two pawns face off.

FTC’s Proposed Non-Compete Rule: A Step in the Right Direction for Health Care and Biotechnology

By Aparajita Lath

In January, the Federal Trade Commission (FTC) released a new draft rule that would categorically ban non-compete clauses — contractual terms between an employer and an employee that prevent subsequent employment at a competing firm — across the country.

Banning non-compete clauses may help to promote competition and innovation in biotechnology and health care.

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Adderall bottle on shelf.

Losing Control of Controlled Substances? The Case of Telehealth Prescriptions 

By Minsoo Kwon

Telehealth services that specialize in the treatment of mental health concerns, such as Cerebral Inc., highlight the ongoing challenge of appropriately balancing accessibility of care with patient safety.

While increased accessibility of mental health care services through telehealth is a valuable goal, if our aim is the well-being of patients, safety must be paramount.

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