Twitter Round-Up (1/13-1/19)

By Casey Thomson
The flu, gun control, and legal action against the FDA – all amongst our Twitter feeds this past week. Read on for more:
  • Frank Pasquale (@FrankPasquale) retweeted a link to the FDA’s current legal trouble concerning their failure to disclose antibiotic resistance data. The Government Accountability Project (GAP) is accusing the FDA of violating the freedom of information law, failing to release data on antibiotic drug usage within the meat industry in order to, as they claim, protect industry secrets. This failure takes special significance when considering that, according to GAP, “80% of all antibiotics sold in the US are utilized by the meat industry.” (1/14)
  • Michelle Meyer (@MichelleNMeyer) retweeted an article in the Health Affairs Blog concerning how to improve the Learning Healthcare System (LHS), which adapts data into knowledge that directs evidence-based practice and health system change. Specifically, the U.S. Department of Veterans Affairs is developing two approaches, namely Point-of-Care Research (“a method of performing clinical trials within the daily practicalities of the [health-care system] (with the intent of advancing these systems to LHS)”), and the Collaborative Research to Enhance and Advance Transformation and Excellence (strengthening health services research, which analyzes the factors regarding the obtainment of care). (1/14)
  • Arthur Caplan (@ArthurCaplan) reported on the American College of Physicians’ new recommendation that all healthcare providers receive the influenza vaccine for this particularly harsh flu season, in addition to other listed immunizations. (1/15)
  • Frank Pasquale (@FrankPasquale) additionally added a post on the inequality of the 2012-2013 flu outbreak – namely, the disproportionate number of lower-income individuals who are contracting the illness. The article noted the results of a study which found that while the majority of efforts for vaccinations occur in more wealthy neighborhoods, covering poorer neighborhoods with vaccine care early benefits the wealthier neighborhoods more so than if such vaccinations were delayed. (1/16)
  • Arthur Caplan (@ArthurCaplan) also shared a link to an examination into New York’s newly passed major gun control law, which addressed gun control ownership of those with mental illness. Caplan dissolved claims that the new measures were “draconian,” noting that such practices of reporting individuals that may pose concern for the safety of others have already been in practice but that these new policies make the process of reporting a legal imperative, and simpler.
  • Daniel Goldberg (@prof_goldberg) shared an article on SAGE Journals about the experience of gender within the healthcare science environment, specifically looking at the subtle practices of masculinist actions taking place that may remain unnoticed or unchallenged. The report is based on the discussed experiences of healthcare scientists with men in healthcare science laboratories. (1/16)
  • Alex Smith (@AlexSmithMD) linked to an article on an intervention for “post-hospital syndrome”, commonly known as the Acute Care for Elders (ACE) Unit. The intervention, while evidence-based and already in place in many hospital locations, may be overlooked by practitioners or healthcare authors. This unit works to reduce the effects that often derive largely from the “allostatic and psychological stress” accumulated during a hospital stay. (1/18)
  • Frank Pasquale (@FrankPasquale) posted a report on bias in reporting on breast cancer clinical trials. The study found that “nearly one-third of reports on large, randomized studies over-emphasize some benefits of therapy,” in addition to providing “insufficient attention or discussion of treatment side effects.” Considering that such reports factor prominently in how doctors decide to pursue treatment and therapy for patients, this misreporting leaves many doctors unaware of the true consequences of tested treatments – and may cause them to decide plans for treatment that they would not otherwise pursue. (1/19)

Note: As mentioned in previous posts, retweeting should not be considered as an endorsement of or agreement with the content of the original tweet.

Defending Roe v. Wade, Defending Human Rights

By Elizabeth Sepper

Dr. Willie Parker is one of the few doctors in the United States who perform later-term abortions, up to 24 weeks.  He is one of three who provide abortions at Mississippi’s sole abortion clinic.  A Christian from the Deep South, Dr. Parker didn’t provide abortions for the first dozen years of his career.  But again and again he encountered women whose pregnancies endangered their lives, girls who had suffered rape or incest, and mothers who were too poor to raise another child.  He came to wrestle with the morality of abortion—torn between his religious tradition’s teaching against abortion and his moral commitment to his patients.  He listened to Dr. Martin Luther King’s sermon on the Good Samaritan.  According to Dr. King, the Good Samaritan was “good” because he did not consider himself but instead asked “What will happen to this person if I don’t stop to help him?”  Dr. Parker was moved to examine his own conscience and to ask, “What happens to women who seek abortion if I don’t serve them?”  From that day, he began to perform abortions. (This interview is well worth a read.)

Choosing to provide abortions is an act of bravery. Abortion providers face threats to their safety and families, targeted and expensive regulations, and professional and community stigma.  They share much in common with human rights lawyers, union organizers, and women’s rights advocates around the globe who are harassed by their governments and the majority.  This makes sense if we recognize abortion providers for what they are: human rights defenders, who work to ensure reproductive rights (the Center for Reproductive Rights has argued effectively for this framework under international law).

As we mark the fortieth anniversary of Roe v. Wade tomorrow, we should acknowledge the courage and commitment of these human rights defenders.  In the past two years, state legislatures passed more, and more novel, restrictions on women’s access to abortion and abortion providers’ practices than ever before.  The “graying” of current  providers represents a further challenge.  In the words of Justice Blackmun, “I fear for the future.  I fear for the liberty and equality of the millions of women who have lived and come of age in the . . . years since Roe was decided.”  But tomorrow I simply offer thanks to those who defend our rights on the front lines.

Overspent: Inauguration Day Thoughts on the Future of Health Policy

By Cassie Chambers

In honor of today’s presidential inauguration, I started making a list of exciting past, present, and future health policies advocated by the Obama administration. Thirty minutes later there was still just one word on my computer screen: OBAMACARE. Then, I came to terms with what the next four years represent for health policy: an empty page in healthcare history, colored only by the shadow of the Obamacare fight. In short: we’ve spent all of our health policy political capital, and the next few years are all about paying off the bill.

I could perhaps accept this bleak vision of the future if I thought that the Affordable Care Act had provided solid solutions to our current problems. But the compromises needed to pass the ACA left it littered with holes—including a lack of effective cost-controls that threatens to undermine the entire system. Because of these holes, there is one more truth we have to face: however expensive Obamacare was initially, we still haven’t paid the full price.

Read More

Petrie-Flom Interns’ Weekly Round-Up: 1/12-1/18

By Hyeongsu Park and Kathy Wang

  • After an estimated 500,000 patients in the United States have received all-metal hip replacements that are failing early in many cases, the Food and Drug Administration is proposing rules that will require manufacturers to produce clinical data to support their devices’ safety and effectiveness.
  • A study published in Science identified people from online searches of DNA sequences, age, and a state. The result raises concerns about the difficulty of protecting the privacy of volunteers involved in medical research.
  • The Obama administration says it will give states more time to comply with the new health care law after finding that many states lag in setting up insurance exchanges.
  • The Department of Health and Human Services (HHS) announced $1.5 billion in new grants Thursday for states to continue building their insurance exchanges under the Affordable Care Act. California, Delaware, Iowa, Kentucky, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon and Vermont received funding.
  • Pharmacies around New York City struggled to meet the demand for flu vaccinations on Sunday, a day after Gov. Andrew M. Cuomo declared a public health state of emergency in response to a drastic increase in the number of flu cases this year.
  • A new type of flu vaccine that requires less manufacturing steps and shorter production time won regulatory approval on Wednesday, and its manufacturer said that limited supplies are expected to be available this winter.
  • Quebec is slowly moving towards legal euthanasia. A committee of legal experts has delivered a 400-page report to the provincial government which argues that it should allow “medical assistance to die” when a patient is close to death and is suffering from unbearable physical or psychological pain.

Conference Announcement: Governance of Tobacco in the 21st Century

Governance of Tobacco in the 21st Century:
Strengthening National and International Policy for Global Health and Development

February 26-27, 2013
Harvard University, Cambridge, MA, USA

Keynote Speakers:
Dr. Nkosazana Dlamini-Zuma
Chairperson, African Union Commission
Dr. Margaret Chan
Director-General, World Health Organization

How do international laws and institutions regarding tobacco, trade, investment, agriculture and economic development intersect? What are the implications for global tobacco control efforts? How should public health concerns be taken into account in international economic policymaking? What is the proper balance between a government’s obligations to protect the health of its citizens and other international agreements to which it has subscribed? What are the broader implications for global governance and for global health?

This conference will bring together representatives from governments, intergovernmental organizations, civil society, business, and academia to explore these questions with the objective of:

  • Enhancing knowledge, information-sharing, network-building and learning across countries, contexts and policymaking arenas
  • Identifying strategies to strengthen the governance of tobacco at national and international levels;
  • Fostering greater policy coherence among actors working in health, trade and investment to ensure the protection of global health

The conference is being hosted by the Harvard School of Public Health’s Center for Global Tobacco Control and the Harvard Global Health Institute’s Forum on Global Governance for Health, with advice and support from the World Health Organization’s Tobacco-Free Initiative.

Additional support is provided by: American Legacy Foundation; American Cancer Society; the International Development Research Centre Canada; Campaign for Tobacco-free Kids; Harvard Law School; Framework Convention Alliance; O’Neill Institute for National and Global Health Law, Georgetown University; Institute for Global Tobacco Control, Johns Hopkins University; International Tobacco Control Policy Evaluation Project, University of Waterloo, Canada; Southeast Asia Tobacco Control Alliance (SEATCA).

Additional information is available here.  Registration is required.

Slipping Euthanasia in Belgium

Happy New Year billofhealthfans!!

As you all know Belgium legalized euthanasia in 2002 following the path of The Netherlands. The legalization came in the midst of a huge controversy. The influence of the Catholic Church is significant in Belgium. You might recall that in 1990 King Balduino refused to sign an Act legalizing abortion, something unseen in the history of Belgium. The solution could not be more ingenious: the King resigned for a couple of days, the Act was signed by the Prime Minister, and then Parliament restored Balduino in his throne.

According to a recent survey in Flanders, euthanasia and assisted suicide in Belgium follows a classical pattern: cancer patient between 65 and 79 years of age. The cases in which the individual is not in the terminal stage of his illness and requests assistance in dying are rare. Nothing significantly deviant from what is going on in other jurisdictions in which aid in dying (in its various forms) is permitted. At least that was the trend until last December 14th… Read More

Flu Vaccine Myths and Healthcare Providers

By Elizabeth Sepper

2013 is rife with reports of the terrible human costs of the flu.  Emergency rooms nationwide have been overwhelmed.  Art Caplan’s great blog post urges doctors to educate patients that the flu vaccine is not just for their benefit.  He tells healthcare providers to send a clear message by getting the flu shot themselves.  But what should we do when they refuse?

Flu vaccination of healthcare providers has come a long way.  Before 2009, rates never broke 49%.  Today, almost two-thirds of healthcare providers are vaccinated.

Still, one-third of healthcare providers do not protect themselves, their patients, and the public from influenza.  We remain far short of the national Health People 2020 target of 90%. Do these providers have religious beliefs that raise tricky constitutional and statutory questions?  Do they assert deeply held philosophical objections?  Media accounts suggest so.  We hear of the vegan customer service representative who refuses the flu vaccine because it is grown in chicken eggs, and the religious holistic nurse who objects both to vaccination and to wearing a mask.

But the main reason for going unvaccinated, according to the Centers for Disease Control, is that healthcare providers simply did not want to get vaccinated. Other common reasons: they think flu vaccines don’t work, fear experiencing side effects, or don’t think they will need the vaccine.  Some reasons do not reflect the evidence. Others suggest, as Art Caplan puts it that healthcare staff need to “stop thinking only about themselves.” Read More

Conference Announcement: Universal Health Coverage in Low-Income Countries: Ethical Issues

The Harvard University Program in Ethics and Health announces its annual conference, Universal Health Coverage in Low-Income Countries: Ethical Issues, to be held in Boston on April 18-19, 2013.

Description

Until very recently, universal coverage (“UC”) has been achieved in the health systems primarily in the wealthiest countries. Though there have been notable exceptions, including Cuba, it has been assumed that most of the world’s peoples would have to wait until economic development in their countries lifted them into the world’s upper class. The successful UC initiatives of middle-income countries such as Mexico, Thailand, and Taiwan demonstrated that UC was achievable without very high national GDP.

Graphic: Three dimensions

Can Universal Coverage be achieved in even the world’s lowest-income countries? China’s recent health reform, which in three years has extended health coverage to 95% of Chinese citizens, including innovative financing initiatives in some of the poorest provinces, has focused the attention of governments of low-income countries on UC. The World Health Organization’s annual report of 2010, Health Systems Financing: The Path to Universal Coverage, identified the prospects for UC in even the least-developed countries and sparked an international effort to pursue this once-elusive goal.

While maintaining a constructive and optimistic frame of mind is essential for progress toward UC, it is necessary also to identify the key ethical dilemmas arising in trying to extend the health system to all with so few resources. The choices are unavoidable:

  • Between goals of UC (including financial protection against catastrophic medical expenses; health; and personal and national overall wellbeing);
  • Between dimensions of UC (who is covered; what is covered; what share of costs are covered); and
  • Trade-offs within and between each of these

Each country will resolve these dilemmas in its own way. Our hope is that this conference will enhance their capacity for ethical deliberation in UC, so that the ethical choices can be made responsibly and thoughtfully.

Dates and Times

Dates: Thursday and Friday, April 18-19, 2013
Times: 8:00 AM – 6:00 PM Each Day

Location

The Inn at Longwood Medical (Best Western Boston)
Longwood Hall, 342 Longwood Avenue, Boston, Massachusetts

Agenda

https://peh.harvard.edu/events/2013/universal_coverage/agenda.html

Registration

No fee. Space limited. Registration required. Please register on our registration website.