Empty nurses station in a hospital.

The AMA Can Help Fix the Health Care Shortages it Helped Create

By Leah Pierson

Recently, Derek Thompson pointed out in the Atlantic that the U.S. has adopted myriad policies that limit the supply of doctors despite the fact that there aren’t enough. And the maldistribution of physicians — with far too few pursuing primary care or working in rural areas — is arguably an even bigger problem.

The American Medical Association (AMA) bears substantial responsibility for the policies that led to physician shortages. Twenty years ago, the AMA lobbied for reducing the number of medical schools, capping federal funding for residencies, and cutting a quarter of all residency positions. Promoting these policies was a mistake, but an understandable one: the AMA believed an influential report that warned of an impending physician surplus. To its credit, in recent years, the AMA has largely reversed course. For instance, in 2019, the AMA urged Congress to remove the very caps on Medicare-funded residency slots it helped create.

But the AMA has held out in one important respect. It continues to lobby intensely against allowing other clinicians to perform tasks traditionally performed by physicians, commonly called “scope of practice” laws. Indeed, in 2020 and 2021, the AMA touted more advocacy efforts related to scope of practice that it did for any other issue — including COVID-19.

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Medical student textbooks with pencil and multicolor bookmarks and stethoscope isolated on white.

We Need to Evaluate Ethics Curricula

By Leah Pierson

Health professions students are often required to complete training in ethics. But these curricula vary immensely in terms of their stated objectives, time devoted to them, when during training students complete them, who teaches them, content covered, how students are assessed, and instruction model used. Evaluating these curricula on a common set of standards could help make them more effective.

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College football on grass field in afternoon sunlight

There’s More Than Rules in Regulating Concussions

By Jack Becker

The football world has used a variety of methods to make the sport safer: Compare modern football to football a century ago, when at least 18 people died playing the game in 1905 alone and Teddy Roosevelt had to intervene. In recent years, concussions and brain trauma have become football’s scarlet letter. While leagues have already made changes to prevent brain injuries, there’s more to be done.

This post considers the application of Lawrence Lessig’s New Chicago School approach to regulation to the prevention of concussions (and other types of brain damage generalized under the word “concussions” for simplicity) in football.

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Seltzer in glass and can.

Vizzy and Fortifying Alcoholic Beverages

By Jack Becker

A few years ago, a Bill of Health post titled Jelly Beans, Booze, and B-Vitamins proposed fortifying cheap wines, hard liquors, and malt liquors with thiamine (vitamin B1).

The post suggested this as a public health measure to prevent Wernicke-Korsakoff syndrome (WKS) in the homeless alcoholic population. Wernicke-Korsakoff syndrome is a debilitating neurological disorder caused by thiamine deficiency. The disorder is significantly more prevalent in those with chronic alcoholism (up to 80% of whom become thiamine deficient), and it’s preventable by boosting thiamine consumption. For this reason, advocates started promoting the idea of fortifying cheap alcohol with thiamine decades ago.

Jelly Beans, Booze, and B-Vitamins explains that this initiative is complicated by the fortification policy put forth by the U.S. Food and Drug Administration (FDA), under which the agency does “not consider it appropriate to add vitamins and minerals to alcoholic beverages.” (While FDA and the Alcohol and Tobacco Tax and Trade Bureau [TTB] share jurisdiction over alcoholic beverages, TTB has followed FDA’s public health expertise in the past and would likely do so in this situation as well.) FDA similarly discourages companies from fortifying snack foods to avoid misleading consumers about their health value.

While the thiamine-in-alcohol proposal hasn’t gotten far enough to warrant official consideration, there’s a new fortified alcohol product making waves in the market. And while the stakes aren’t quite as high, it’s still a hard issue — a hard seltzer issue.

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Pink piggy bank and stethoscope on a gray background.

Medical Schools Need to Do More to Reduce Students’ Debt

By Leah Pierson

Today, the average medical student graduates with more than $215,000 of debt from medical school alone.

The root cause of this problem — rising medical school tuitions — can and must be addressed.

In real dollars, a medical degree costs 750 percent more today than it did seventy years ago, and more than twice as much as it did in 1992. These rising costs are closely linked to rising debt, which has more than quadrupled since 1978 after accounting for inflation.

Debt burdens

Physicians with more debt are more likely to experience to burnout, substance use disorders, and worse mental health. And, as the cost of medical education has risen, the share of medical students hailing from low-income backgrounds has fallen precipitously, compounding inequities in medical education.

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Woman sitting at desk experiencing back pain.

Can Lawyers Help Fix Back Pain (No, Not By Suing)?

By Jack Becker

A Pain in the Back

Back pain is a real pain in the back. Comprehensive data is tough to collect, but an estimated 60-80% of people will have to deal with back pain at some point in their life. Lower back pain, in particular, is the leading cause of global disability.

This issue has serious impacts beyond individual pain and suffering. According to a 2018 report by the Bone and Joint Initiative, Americans lost 264 million work days in a single year due to back pain. The report also claims that in 2014, the direct and indirect costs of musculoskeletal disorders were a staggering 5.76% of U.S. GDP, totaling hundreds of billions of dollars. While more conservative estimates put the costs closer to $125 billion, the impact is significant.

There are clear incentives for business or government actors to intervene, but where can they start? One option is to let lawyers lead the way.

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Close up view of graduation hat on dollar banknotes. Tuition fees concept.

Becoming a Bioethicist is Expensive. That’s a Problem.

By Leah Pierson

The financial barriers associated with becoming a bioethicist make the field less accessible, undermining the quality and relevance of bioethics research.

Because the boundaries of the field are poorly defined, credentials often serve as a gatekeeping mechanism. For instance, the recent creation of the Healthcare Ethics Consultant-Certified (HEC-C) program, which “identifies and assesses a national standard for the professional practice of clinical healthcare ethics consulting” is a good idea in theory. But the cost of the exam starts at $495. There is no fee assistance. Given that 99 percent of those who have taken the exam have passed, the exam seems to largely serve as a financial barrier to becoming an ethics consultant.

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Vegetables super heroes, vector broccoli, squash and avocado, cauliflower and beetroot. Eggplant, chili pepper and pumpkin, spinach, carrot and tomato with cucumber, garlic and radish cartoon veggies.

Fiber: The Hero American Nutrition Deserves

By Jack Becker

Metropolis has Superman. Gotham has Batman. Could America’s nutrition hero be fiber?

Since nutrition can be complicated, consumers need rules of thumb to make more informed decisions without comprehensive nutrition education.

We already have these for what not to eat: the villains of American diets — too much added sugars, saturated fat, and sodium. But we need to be equally clear in identifying a hero. Enter fiber.

Foods that are high in fiber are often nutrient-dense and healthy. So, if someone is struggling to figure out whether a food is healthy, fiber content could be a useful shortcut.

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