Image of a young woman sitting in her bedroom in workout clothes checking a smart watch health app

Do You Know the Terms and Conditions of Your Health Apps? HIPAA, Privacy and the Growth of Digital Health

As more health care is being provided virtually through apps and web-based services, there is a need to take a closer look at whether users are fully aware of what they are consenting to, as it relates to their health information.

There needs to be a re-evaluation of how health apps obtain consent. At the same time, digital health offers an important opportunity to embolden privacy practices in digital platforms. We ought to use this important opportunity. Read More

Image of a laptop showing a doctor holding a stethoscope. Telemedicine abstract.

How to Think About Prognosis by Telemedicine

Recently in these very pages, Evan Selinger and Arthur Caplan responded to an article in which Joel Zivot defended the use of telemedical technologies in informing patients and their families of dire news, in the context of the viral story of a doctor informing the family of Ernest Quintana of his imminent death via robotic video-link. Zivot argued that the use of technology to deliver such news is not the problem and what matters is the communicative skills of the physician. Selinger and Caplan respond that patients have basically different views on the propriety of using technology in these ways, and urge a regime of informed consent.

Selinger and Caplan are probably right on the short term policy question.

While we know there is a great deal of diversity in whether people think using telemedicine in this way is disrespectful, there is also no obvious answer among the alternatives. Warning people that this might happen and letting them opt-out, then, offers a short-term way to respect people’s preferences. And, as Selinger and Caplan acknowledge, that may be all that is needed. Over time, communication like this may become as anodyne as today it seems avant-garde. Read More

New HarvardX Course on the FDA and Prescription Drugs

Interested in learning more about pharmaceutical policy? Curious about the role of the FDA in ensure safe and effective drugs reach the market? Wondering why drug prices are so high in the US? Readers of my prior posts may enjoy learning more about these topics!

Check out a free HarvardX online course, “The FDA and Prescription Drugs: Current Controversies in Context,” put together by Petrie-Flom Center affiliates Dr. Aaron Kesselheim, Dr. Ameet Sarpatwari, Dr. Jonathan Darrow, and many others, that is now open for enrollment. (Disclosure: I did not play any role in the development or making of the course, but I am serving as a teaching assistant/discussion moderator for the course). Read More

A social inequality icon in São Paulo, Brazil's biggest city: The Paraisópolis Favela and the luxury buildings

Wealth Inequality is a Vital Public Health Issue

Every day, 10,000 people die because of a lack of health care. Yes, every day. That’s over 3.5 million people annually. This shocking statistic comes from a report released last month by Oxfam.

The primary topic of Oxfam’s report was not global mortality rates or health coverage. Rather it was about global wealth and income inequality. Oxfam’s title for the press release containing this information was “Billionaire fortunes grew by $2.5 billion a day last year as poorest saw their wealth fall.” Read More

Image of a child in a blue dress with pigtails receiving a vaccination injection.

Social Media’s Anti-Anti-Vaxxer Fight Ramps Up

According to the World Health Organization (WHO), “vaccine hesitancy,” which is “the reluctance or refusal to vaccinate despite the availability of vaccines” is among the top ten threats to global health in 2019. While there are many complex reasons why people may choose not to vaccinate their children, social media has received a great deal of scrutiny for its role in empowering and financing the movement opposing vaccines. Platforms have taken a wide range of actions in response.

Pinterest, for example, demonstrated an aggressive tactic, banishing results that are associated with certain searches related to vaccines, “regardless of whether those results might have been reputable.“In 2017, the platform altered its “community guidelines” after a 2016 study revealed that 75 percent of vaccine-related posts were negative. The guidelines aim to prevent misinformation and advice that has “immediate and detrimental effects on a pinner’s health and public safety,” and explicitly state that “[t]his includes . . . . anti-vaccination advice.” Now, if a user attempts to search “vaccination,” they’ll see a result stating “Pins about this topic often violate our community guidelines, so we’re currently unable to show search results.” And while users can still pin images related to vaccines, their posts won’t be visible in searches.

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No One Is Sovereign Over Genetic Sequences

Most of the time the sanctity of national sovereignty is invoked in international law, it’s covering for something bad. The debates about the interpretation of the Nagoya Protocol, a 2010 supplement to the Convention on Biological Diversity, are no exception.

A number of states party to the Protocol, a cryptic document designed to ensure the “fair and equitable sharing of benefits arising from the utilization of genetic resources,” enshrines a principle of state sovereignty over the genetic sequences of all life—including those of pathogens—within state territory.

This interpretation is not obvious on the face of the treaty. But neither is it foreclosed. The resolution of this question has profound implications for global public health: if the states that espouse this position are right, global genetic research will be impeded, possibly dramatically, and epidemics will be harder to fight. Read More

Medicaid Buy-In and Section 1332 State Innovation Waivers

As a new Medicare-for-all bill was introduced in the House recently, a number of state-level legislative projects are generating parallel excitement about Medicaid buy-in plans.

In his recent Bill of Health post, Rahul Nayak explained how Medicaid Buy-In would allow states to introduce a public option to their insurance marketplaces. Rahul points to some major questions about how buy-in plans might be implemented. Some of these questions relate to how these plans will operate within the federal statutory system that governs health care marketplaces and Medicaid. In a December Ohio State Law Journal article, for example, Professor Lindsay Wiley explored how Medicaid buy-in plans could be enacted within the waiver systems that shape state implementation of marketplaces and the availability of premium tax credits. Most recently, Emma Sandoe, in an interview for this blog, discussed the ways states are innovating in this space.

Specifically, states seeking to implement buy-in plans will navigate questions about how to leverage the Section 1332 waiver provision of the ACA. Section 1332 of the ACA allows states to apply for waivers of certain marketplace requirements. Through these waivers, states are empowered to provide insurance options that don’t meet all QHP standards and may receive premium tax credits to directly fund insurance products. How states choose to approach this waiver system will dictate what type of funds are available to subsidize coverage, the design of buy-in offerings, and the level of coverage buy-in plans will offer.

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Close up of a mosquito sucking blood on human skin. This mosquito is a carrier of Malaria, Encephalitis, Dengue and Zika virus.

Malaria Eradication: For Africa as America

There is a page in the history books waiting to be written for the eradication of malaria. In recent years, malaria has killed more people globally than war—it’s killed predominately children, and predominately in sub-Saharan Africa. Despite being curable, and eliminated from most developed countries, malaria is the fifth deadliest infectious disease in the world.

A team of scientists in Italy is looking to write that history. Read More

3D illustration of anatomically correct HIV Virus floating in the bloodstream

HIV Treatment: Functional Cures are Just One Aspect of Newsworthy Progress

Major news networks around the globe this week broke the story that a second HIV-positive patient appears to have been “functionally cured” of HIV.

In a welcome piece of good news, the world learned that an anonymous individual, known simply as “the London patient” has experienced a year and a half of sustained remission of the HIV virus without medication. The patient entered into remission after receiving a bone marrow transplant from someone naturally resistant to HIV infection. This is the second functional cure of HIV of its kind. The first such case occurred in 2007.

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Report: Maternal Mental Health Must be a Top Priority

The U.S. Preventive Services Task Force (USPSTF), published recommendations recently urging clinicians to refer pregnant and postpartum women to counseling if they are at risk of depression.

The recommendations respond to the prevalence of perinatal depression, which is considered to be the most common pregnancy complication. Perinatal depression, affects up to one in seven women and can develop at any time after a woman becomes pregnant, immediately following the brith of a child, or even up to a year after.

Among the many concerning potential consequences of maternal depression are premature births and low birth weights, as well as neglect and inattentiveness from mothers after the baby is born, which can subject infants to risk of additional problems, according to Karina Davidson, a USPSTF member who helped write the recent recommendations. Read More