A Virus Could Ask Better Questions?

TV Set 1 I get the part wherein cable news needs ratings to sell advertising, although exactly how much revenue can be accumulated from purveyors of unregulated supplements, interesting but not likely remunerative litigation, and vehicle insurance is beyond me.  So, the coverage of the ebola outbreak in western Africa isn’t surprising – it’s the Lost Airplane of the Day.  What is alarming is the lack of substance, and I’m thinking of the CNN broadcast in which a novelist is foisted off on the public as an expert on viral transmission.   Amid all the hysteria, we’re missing some important points.

What is the state of our medical research? What happened to our “stable research support trajectory? Instead of being entertained by the musings of a science fiction novelist, perhaps we could be hearing more from medical experts?  Say, from the National Institutes of Health?

“Dr. Francis Collins, the head of the National Institutes of Health, said that a decade of stagnant spending has “slowed down” research on all items, including vaccinations for infectious diseases. As a result, he said, the international community has been left playing catch-up on a potentially avoidable humanitarian catastrophe.

“NIH has been working on Ebola vaccines since 2001. It’s not like we suddenly woke up and thought, ‘Oh my gosh, we should have something ready here,'” Collins told The Huffington Post on Friday. “Frankly, if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would’ve gone through clinical trials and would have been ready.”  [HuffPo]

Why is the National Institutes of Health purchasing power down 23% from ten years ago? Or,  why does the following situation hold in terms of funding for research into infectious diseases?

“In fiscal year 2004, the agency’s budget was $28.03 billion. In FY 2013, it was $29.31 billion — barely a change, even before adjusting for inflation. The situation is even more pronounced at the National Institute of Allergy and Infectious Diseases, a subdivision of NIH, where the budget has fallen from $4.30 billion in FY 2004 to $4.25 billion in FY 2013.” [HuffPo]

We’ve endured a “ten year slide in research support,” meaning that we’ve not invested enough since 2004 to keep on track to provide pharmaceuticals and other research related to diseases such as that caused by the Ebola virus. Could it be that in the last ten years there has been a steady drum beat of opposition to federal funding … for almost anything? 

Our very own Representative Mark Amodei (R-NV2) announced back in January 2013 that federal spending was out of control, and Congress “hasn’t had the courage to fix it.”  In December 2013 he was pleased as punch with the Budget Act which cut federal funding, saying:

“This two year agreement moves us away from government by crisis and continuing resolutions, where so much of the status quo persists, and back to a legislative framework for reforming federal spending. It cuts the budget deficit by $23 billion without raising taxes at a time when the Senate wanted to increase spending by $1 trillion. It is 100 percent in line with the Budget Control Act deficit reduction numbers and does not end the sequester cuts, but replaces upfront, across-the-board cuts with targeted savings that are both larger and produce additional deficit reduction over the long term. The agreement is also $83 billion below the original Ryan Budget (2010) target for FY 2014.”

His current official website tells us:

“As a fiscal conservative, I believe that our nation’s deficit is out of control. We now borrow 42 cents for every dollar we spend. The bloated federal government spends some of that money on frivolous projects that benefit only a select group of special interests and other needless expenses.”

Now, in light of that ten year slide in appropriations for the National Institutes of Health, and the loss of the “stable research support trajectory,” can Representative Amodei still justify the reduction in NIH funding?  It isn’t like the NIH didn’t advertise what was going to happen under the terms of the budget act Representative Amodei was applauding:

“On March 1, 2013, as required by statute, President Obama signed an order initiating sequestration. The sequestration requires NIH to cut 5 percent or $1.55 billion of its fiscal year (FY) 2013 budget. NIH must apply the cut evenly across all programs, projects, and activities (PPAs), which are primarily NIH institutes and centers. This means every area of medical research will be affected.” [NIH]  (emphasis added)

Yes, “every area of medical research will be affected,” and that included the National Institute for Allergy and Infectious Diseases, a subdivision of the National Institutes of Health.   Remember that Government Shutdown in October 2013?  Not only did clinical trials get shut down at the CDC, but so did the processing of laboratory samples. [MedNewsToday]   All this makes a sentient person wonder how much more “reforming the budget” we can stand?

What is the status of our prevention and control capacity?  There’s a penchant on the right to try to attach the “sequester” to the President as if the budget he signed hadn’t been enacted by the Congress in 2013.  For those functioning in the real world,  it’s no secret that the Congress slashed funding for the CDC emergency preparedness program. [Vox]  Again, the CDC announced well in advance what the sequester cuts would do.

About $195 million was cut from “emerging and zoonotic infectious diseases,” another $19 million was cut from “public health scientific services,” also cut was $18 million from “global health” categories, and another $98 million from “public health preparedness and response” programs.  [CDC pdf]

$160 million less would be available in funding to on the ground public health in the United States, “a system already strained by state and local budget cuts.”  A further $33 million was cut from “state and local preparedness ability to respond to natural and man-made disasters.” [CDC pdf]

Do we have an institutional structure in place to enforce CDC guidelines on public health matters?   The CDC has issued guidelines for EMT responders in the wake of Ebola illness, now we have to ask, how are the guidelines to be implemented?  How are CDC guidelines to be implemented in hospital settings?   What the CDC issues are recommendations – what the privately owned hospitals actually DO is up to the administration and leadership in those hospitals.  And, now we get to the part where the people at ground zero are involved. 

The California Nurses Association surveyed its members and found that some were working in hospitals lacking “necessary protective equipment, such as HAZMAT suits, face shields, and fluid resistant suits and gowns.” Some also reported inadequate training on how to deal with Ebola, for example being given a video to watch without any hands-on, personal, training or rehearsals.  [CNA]

Obviously, those attending to patients with Ebola or SARS would need to use “Full Barrier” personal protective equipment, so the next obvious question should be – Does each local hospital, especially those in metropolitan areas served by international transportation hubs, have the Full Barrier PPEs, and have those who need them been trained in their use? And this state of affairs leads to yet another question.

What level of de-regulation in health care can we tolerate in order to provide the best public health services?    The NIH can research, and the CDC may recommend to their collective hearts content – but if the House of Representatives had its way every regulation would be scrutinized by Congress to see if it impinged in any way on the profitability of the health care provider.

When the House passed the REINS Act in 2013 language was added to require Congressional approval on health care related rules, in an amendment sponsored by Rep. Jason Smith (R-MO). [Hill]  Representative Amodei (R-NV2) and Heck (R-NV3) both voted in favor of the REINS Act, including as it did, the provision requiring Congressional approval of health care related regulations.  [vote 445]  Representative Titus (D-NV1) had the common sense to vote nay.  Worse still, for those who believe that hospitals should be required to act with some uniformity during a public health crisis, both Representatives Amodei and Heck voted in favor of the Smith Amendment. [vote 438]  Again, Representative Titus had the foresight to vote nay.

Not to put too fine a point to it, but Representatives Heck and Amodei voted in favor of a provision which would prevent the implementation of standards for isolation care and personal protective equipment/training if the hospitals could show that such regulations diminished their profitability.  Not only did Representative Amodei vote in favor of the Smith Amendment, and vote in favor of the REINS Act, he was one of the 164 co-sponsors.  The bill was sent to the Senate wherein it was, thankfully, buried in the files of the Committee on Homeland Security and Governmental Affairs.

In the instance of H.R. 367 (113th) nothing could be a better example of putting profits before people, especially considering the attachment of the Smith Amendment.

Our media would serve us far better if we were to be given background information on how our government and health care institutions could better protect us from – Ebola, MERS, SARS, Norovirus, drug resistant strains of bacteria, etc. and how funding priorities relate to national, state, and local preparedness.   It would beat listening to a novelist, a pundit, or some lady with a Ouija Board.

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