Tag Archives: public health

It’s the Planning Part That Makes Them Crazy: GOP attacks on Planned Parenthood

Sanger

It must be campaign season: the Republican Party is once again attacking Planned Parenthood.  This current manufactured outrage moment was coordinated with the debunked video from a shadowy outfit whose “investigators” come complete with phony identification documents. [HuffPo]  [DemoNW] Since the GOP seems to have nothing on offer regarding national infrastructure, comprehensive immigration policy reform, Middle East Peace negotiation, manufacturing policy, minimum wage levels, job training and education, or any substantive proposals on the expansion of health insurance coverage – it must be time to look for Distractions. And, what better distraction than Planned Parenthood?

These attacks appeal to the rabidly anti-contraception/abortion advocates in the Republican base.  We can assume that this element is a small minority of the U.S. population because (1) more than 99% of women aged 15-44 who have ever had sexual intercourse have used at least one contraceptive method. (2) Approximately 62% of all women of reproductive age are currently using a contraceptive method. (3) 83% of Black women, 91% of Hispanic women, and 90% of Asian women of child bearing age currently use a contraceptive method during intercourse. (4) 92% of all women with incomes of 300% or more of the federal poverty standard are currently using contraception, as are 89% of those with incomes at 0-149% of the poverty line.  [Guttmacher]

Contraception method chartAs the statistical reports, and the chart, demonstrate, those who oppose contraception are a definite minority, and the religious argument begins to unravel when another survey is highlighted: “Some 68% of Catholics, 73% of Mainline Protestants and 74% of Evangelicals who are at risk of unintended pregnancy use a highly effective method (i.e., sterilization, the pill or another hormonal method, or the IUD).” [Guttmacher]

As with the polling and survey reports on contraception, the polling on the abortion issue also illuminates the minority position of the radical anti-abortionists.   Note the trends reported by Gallup:

abortion polling It doesn’t even require a calculator to see that as of 2015 approximately 80% of the U.S. population believes that abortion is acceptable, at least under some circumstances.  Only 19% believe the medical procedure should be illegal in any situation.  [Gallup]

Thus we have circumstances in which 99% of those women who have had sexual intercourse using some form of contraception, and 80% of the nation believing that under some circumstances (usually involving the welfare of the mother) abortion procedures should be legal.  Why would a major political party attempt to use contraception/abortion as a political issue?

If it worked before – it will work again?  Republicans have utilized “wedge issues” with some effect before – gay marriage, gun safety, contraception/abortion.  And, Thomas Frank’s book concluded:

“…the Republicans use social issues in a bait-and-switch routine: people are enticed into voting Republican over social issues like abortion or gay marriage, and then Republican pols, once elected, ignore all that and govern like the pro-business, rich-people’s party that they are at heart.”  [Atlantic]

The problem for Republicans is that while they are the pro-corporate (not small business) party of the hedge fund managers and the large banks, the bait is becoming harder to find.  Therefore the need to find another way to access the anti-contraception/abortion vote – let’s try fetal tissue research!

The GOP has two problems with this wrinkle – first, they were for it before they were against it. [Think Progress] and secondly, who wants to argue that fetal tissue should be turned into medical waste instead of having the family opt for tissue donation for medical research?

Nor is fetal tissue medical research a new thing – it’s been done since the 1930s, and the 1954 Nobel Prize for medicine was awarded for work with fetal tissue that lead to the development of the polio vaccine. [USNWR] Current work with fetal tissue involves studies related to birth defects, spinal cord injuries, Parkinson’s Disease, eye diseases, and HIV/AIDS. [Reuters] Fetal tissue research also yielded vaccines for chicken pox, rubella, and shingles. [CNN]  If one is truly “pro-life” in the comprehensive meaning of the term, then the research into finding a vaccine for rubella is instructive:

“From 1964-1965, before the development of a vaccine against the disease, a rubella epidemic swept the United States. During that short period there were 12.5 million cases of rubella. Twenty thousand children were born with CRS: 11,000 were deaf, 3,500 blind, and 1,800 mentally retarded. There were 2,100 neonatal deaths and more than 11,000 abortions – some a spontaneous result of rubella infection in the mother, and others performed surgically after women were informed of the serious risks of rubella exposure during their pregnancy.”  (CRS = Congenital Rubella Syndrome) [HistVac]

Interesting isn’t it: The use of fetal tissue in medical research to develop a vaccine against Rubella meant FEWER abortions (both natural and medical)  and 2,100 fewer neo-natal deaths.  OK, now stand at a podium and tell the voters that you are in favor of bringing all fetal tissue research to a grinding halt even if it means more miscarriages and abortions? In the name of “Life?”  There’s a purpose for fetal tissue research at the other end of the age spectrum:

“Stem cell therapy for retinal disease is under way, and several clinical trials are currently recruiting. These trials use human embryonic, foetal and umbilical cord tissue-derived stem cells and bone marrow-derived stem cells to treat visual disorders such as age-related macular degeneration, Stargardt’s disease and retinitis pigmentosa. Over a decade of analysing the developmental cues involved in retinal generation and stem cell biology, coupled with extensive surgical research, have yielded differing cellular approaches to tackle these retinopathies…” [NCBI]

The radical anti-abortionists haven’t mentioned the research into how to attack the 2.7 million cases of macular degeneration in the U.S. [NEI]  Do we dare tell them that most of those cases are among Caucasian Americans?

Mac Degeneration by race And, here we have it: attacks on an organization, often the target of radical anti-abortionists, which lawfully provides fetal tissue to medical research facilities  currently working on ways to prevent, cure, or alleviate diseases prevalent in America, many of which are  deadly (ALS, Parkinson’s) or debilitating (macular degeneration).  All for what?

For an issue most Americans don’t have at the top of their priorities?

abortion issue

To attract 21% of the respondents in the 2015 polling?  To appease those for whom family planning is anathema?  Nothing better illustrates the hold over the Republican Party like its pandering to a small minority in the national audience, a minority like Quiverfull (see Duggars), for whom women are merely the instruments of men’s procreation?  To appeal to those who follow the Army of God manual and bomb abortion clinics or kill providers? To address those ignorant enough to miss the connections between significant medical research and the use of fetal tissue?

Or, to appeal to those who firmly believe that the Little Woman should be barefoot and pregnant – in the kitchen – not the Senate or the House.  Families which plan for their children, which can assume two incomes, which can maintain intimacy without unintended pregnancies, and who can afford the $3500 it costs for the average uncomplicated birth of a child in a hospital [Parents] are generally better off, and so are their kids.  Here we hit the rough patch. 

Planning is Everything.   It’s impossible to attack those families which are practicing birth control for rational reasons —  in the face of irrationality.  Critics of social welfare programs offer, “If you can’t afford them then you shouldn’t have them.”  If we accept this criticism, then what rational premise might one have for defunding the organization which promotes responsible parenting by making contraception available? 

However, “If you give’em birth control they’ll just be promiscuous!”  Notice the emphasis is on the female, “boys will be boys.”  It’s hard to separate this attitude from good old fashioned garden variety misogyny.  If we actually want fewer unplanned pregnancies, especially among younger women, then what is the rational argument for cutting funding for clinics like those sponsored by Planned Parenthood which inform young women about contraceptive options?

Only 3% of Planned Parenthood’s medical procedures involve abortion at any stage and in any manner. For the radicals this is 3% too many.  For the deluded among us – every woman must carry every pregnancy to term, no matter the cost to her physical well being or to her mental health. Every pregnancy must end in a birth – even if the fetus is so badly deformed that it won’t survive outside the womb for more than 24 hours?  How many of the radicals are even aware of anencephaly,  exomphalos and gastroschisis? [Patient]  Pre-natal care is required in order to detect abnormalities like anencephaly, and where do women – especially low income women – get pre-natal care? From their local Planned Parenthood clinic.  Which, we should add, provides pre-natal care for the pregnancies, planned or unplanned, of many middle and lower income women.

If the Republicans who are chanting for Investigations! Funding Cuts! and other assaults on Planned Parenthood understood just how ridiculous they sound, and how close to the radicals associated with the Army of God and the  Quiverfull movement they’ve moved, then they’d have a much better grasp as to how counter-productive their shift to the radical right will be received in a general election.  In their attempt to manufacture another “crisis” in “poutrage” and to generate a wedge issue, they’ve only succeeded in forming alliances with the most misogynistic elements of the Right Wing: Those who neither want nor countenance Planning in family relationships. 

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Emergencies: Creating and Sustaining Them in Nevada?

lack of planning Someone is asking the right question:

“Assembly Member Elliot Anderson (D-Winchester) then asked the biggest question of them all: Why is this “emergency measure” popping up now, and does it stand any better chance of passing the Senate than AB 148 or the proposed Fiore-Hansen SB 175 amendment. All Oscarson Therecould say was “I certainly hope so.” Meanwhile, a whole lot of students, teachers, and concerned family members certainly hope AB 487 meets the same fate as the dead AB 148 and the failed SB 175 amendment.” [LTN]

The measure under discussion is AB 487, another iteration of the ammosexual agenda Carry Everywhere nightmare, and it’s due for a hearing (of sorts) in the Assembly Judiciary Committee bright and early on Wednesday morning [pdf agenda] if it can get “emergency status.”  The tenacity of the gun advocates seems proportional to their delusion that somehow more guns will make up safer from more guns.  In case you missed it, this Salon piece does an excellent point by point deconstruction of the right wing’s ideological stance on the issue.

There’s another bill coming up on Wednesday which deserves more attention than it’s likely to get in the waning days of a legislative session, SB 292

“Section 1 of this bill provides that a board of trustees of a school district or the governing body of a charter school is not liable for any civil damages arising from any act or omission by a person employed by or volunteering at a school-based health center. Section 1 also defines “school-based health center” for such purposes.”

… Existing law limits the amount of noneconomic damages that may be an action for injury or death against a provider of health care based professional negligence. (NRS 41A.035) Section 3 of this bill limits noneconomic damages that may be awarded in such an action to $350,000, regardless of the number of plaintiffs, defendants or theories of liability. Existing law establishes a rebuttable presumption in actions for negligence”

This is NOT a School Nurse Protection Act, at least not the way it is worded.   Notice the phrase “…by a person employed by or volunteering at a school-based health center.”  So,  volunteers manning the school sick bay, and not school nurses, cannot render the school or charter operation liable for their actions or their failure to act?  If the person is a school nurse there are professional requirements for that.  However, (and this is a pretty big caveat) non-certified personnel may be allowed to administer medication, for which there are no pre-service nor professional development  specified training requirements. [NASBE] What could possibly go wrong?

But wait, there’s more! Senator Roberson seems intent upon his assault on the venerable Collateral Source Rule.  The Legislative Counsel Bureau explains what happens under SB 291:

“A common law doctrine, known as the “collateral source rule,” prohibits a defendant in a tort case from introducing into evidence proof of amounts that the plaintiff received or was entitled to receive from a source other than the defendant in compensation for the harms or injuries caused by the defendant.”

Existing law provides a limited exception to the collateral source rule by allowing a defendant in a case against a provider of health care based upon professional negligence to introduce evidence of amounts paid or payable to a plaintiff pursuant to policies of health or accident insurance, the United States Social Security Act, worker’s compensation statutes and other programs or contracts that pay for or reimburse costs of health care. (NRS 42.021)

This bill replaces the existing limited exception to the collateral source rule and instead requires a court, upon a motion by a defendant in any tort case, to reduce the amount of damages initially determined by the jury or other finder of fact by the amount of past medical expenses paid in relation to the injury or death sustained. However, this bill prohibits the court from reducing the amount of the damages by any amount: (1) paid for any treatment, care or custody provided by a provider of health care or medical facility on a lien; or (2) paid pursuant to medical payment coverage.  (emphasis added)

The “defendant” in this instance would be a negligent or otherwise incompetent health care provider.  Again, whatever success a plaintiff may have had in court against a person who negligently caused their pain, suffering, and possible disability – Senator Roberson would like to see reduced by any amount covered by Social Security disability benefits, worker’s compensation, or health or accident insurance.  The two bills are a double whammy for victims.

This session can’t end soon enough?

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Curmudgeon Junction: Short Term Thinking Long Term Losses

Halloween Pumpkin Want something to be afraid of this Halloween week?  No, it’s not Ebola, nor is it ISIS, nor is it that some undocumented person will cast an “impersonation ballot” at some polling station… it’s Short Term Thinking.  Today’s rant from Curmudgeon Junction is a general grouse about the lack of foresight intrinsic in our economic and political institutions. 

The Economics of Myopia

The whole artificial edifice of Shareholder Value would collapse in a heap if the Management Interests would take a longer view of their corporate health.  When one’s interests are aligned with quarterly earnings reports, and the effect on stock market prices, then what we will get are executives who place cost cutting measures above the long term interests of the corporation.  It will be necessarily more important to lay off expensive workers than to promote long term corporate loyalty.  It will be necessarily more important to engage in stock buy backs than to allocate resources to research and development.  It will be necessarily more important to invent ever more exotic tax treatments and financial products than to invest in corporate expansion.  It will be necessarily more important to conflate the interests of trade with the interests of financial markets.  It will necessarily be more important to accumulate a profitable financial product revenue stream than to invest in modern plants and equipment.  And, this is a recipe for a witch’s brew for short term “results” and long term losses.

What U.S. steel industry?  Yes, U.S. Steel is still in business, but it’s no longer producing 67% of this country’s steel. [USX] Did anyone notice when U.S. Steel was removed from the Standard and Poor 500 Index? [NYT] Yes, the company has diversified, but it also moved in and out of some very risky propositions in the process, and simply surviving isn’t a particularly impressive item in comparison to actually thriving. 

VWonder Bread is back on the shelves, but why did the process have to be such a mess?  Let’s start with what financial writers are pleased to call a “highly leveraged capital structure with little room for error.” [Forbes]  And, we can add in an obsolete line of products – where was the investment in product research and development? And,  we can add in relatively high labor costs – which were cut in return for a promise (unkept) that the management would allocate resources into more efficient plants and equipment… So, the Twinkies got the axe, (rather later than perhaps that product line should have in the face of changing consumer trends), and the whole jerry-built private equity backed operation couldn’t take the strain of having to turn a mismanaged company around in the face of immediate capital needs.

Chevron made much of its prowess in developing alternative energy, it even created a renewable power group (CVX) and then shut the lights down.

“In January, employees of Chevron’s (CVX) renewable power group, whose mission was to launch large, profitable clean-energy projects, dined at San Francisco’s trendy Sens restaurant as managers applauded them for nearly doubling their projected profit in 2013, the group’s first full year of operations. But the mood quickly turned somber. Despite the financial results and the team’s role in helping launch more than a half-dozen solar and geothermal projects capable of powering at least 65,000 homes, managers told the group that funding for the effort would dry up and encouraged staffers to find jobs elsewhere, say four people who attended the dinner.” [Bloomberg]

The renewable power group created a net profit of $27 million in 2013, well above the $15 million target, so why did Chevron pull the plug? 

“When you have a very successful and profitable core oil and gas business, it can be quite difficult to justify investing in renewables,” says Robert Redlinger, who ran a previous effort at Chevron to develop large renewable-energy projects before he left in 2010. “It requires significant commitment at the most senior levels of management. I didn’t perceive that kind of commitment from Chevron during my time with the firm.” [Bloomberg]

Translation: OK, the renewables were making money just not enough money to get the attention of top management.  More translation: the Renewables group wasn’t making enough money in the short term to get management support in the long run.

How many investments banks are there in the United States? If you guessed Zero you got it right.  None, zilch, zip. We now have Bank Holding Companies, as the former high flyers on Wall Street sought the protection of the Federal Reserve to avoid financial oblivion in September 2008. [MotleyFool]  After running, ever so willingly, into the arms of the government in their debacle of 1002-2008, the bankers now want to revert to playing by their own rules – Repeal Dodd Frank – and re-engage in the same short term behaviors which brought on the collapse of the financial sector in 2007 and 2008.

The Politics of Myopia

There’s never been a shortage of self-serving myopia in politics. Ever.  Nor has there been a surfeit of times in which there was less costuming going on in political campaigns than there were little goblins out seeking confectionary items to put in their pillow cases.  However, turning the politics of fear into an art form, is to emphasize the fear and trivialize the long term prospects of hope.

So, we have politicians ginning up fear of a virus – of which we now have ONE case in the entire country  of 330 million people – to secure short term votes based on “Did the administration do enough?” Has the administration been strong enough?”  Probably – given that we have ONE case in a population of 330 million.   Notice, we’re not talking about (1) What should U.S. funding priorities be for the research and development of vaccines for relatively rare viral diseases which occur primarily in third world nations? or, (2) What should be the U.S. contribution to world wide efforts to eradicate viral infections?  Those would be long term questions – and we seem to have the attention span of fruit flies when it comes to politics.

The Media and Myopia

While we’re on the topic of viral diseases – has it occurred to anyone in the management end of public media that Wolf! is not to be carried to extremes, or have we missed that point from the kindergarten reading list?  How many times have we been told that Swine Flu!  Avian Flu! West Nile Virus! MERS! SARS! was going to be the End of Humanity! Or, close to it.   Now, it’s Ebola – and the media circus begins once more.  Has it not taken hold in the imaginations of media management that there may come a time when something like the Spanish Flu – a real pandemic – may creep up on us and because the “Wolf!” cry has been offered up so often and in such a dramatic way, that health care professionals will have trouble convincing the public that “This time it’s REAL?”  Are the monthly, or weekly, ratings really so important in the short run that we’d take this risk in the long run?

How many editors across the nation are assigning people to cover stories for which the reporter is simply unqualified?  That’s not ‘on’ the reporter.  If a reporter turns in a story about race relations in a mid-western city based on impressions made during a few nights of protest, with little or no background knowledge of the historic context, do we blame the superficiality of the reporting on the writer – or on the management which decided to cut back on the number of writers in order to “increase shareholder value?”  How many media outlets retain the services of several persons with a background in economics or finance to craft articles about our economy?  How many media outlets hire individuals with a background in history/sociology to write about race and ethnic relations?   How many can afford to?

It’s one thing to blast the banality of much political reporting – and another to remember that national pundits aren’t reporters.  The pundits are time fillers.  It’s expensive to send reporters to New Hampshire, Colorado, or Nevada. It’s more expensive to send them to Ukraine,  Burkina Faso, and China.  It’s cheaper to keep a pool of reporters in central locations and send “teams” out to cover events – whether or not the team members have any expertise in the regions to which they are sent.

In return for short term economies we get a long term prospect of sensationalized reporting on the dramatic and very little contextual information about subjects of greater long term impact ( such as, the efforts of Middle Eastern nations to come to terms with the historic impact of post World War I boundaries).  Are we hearing about what mega-studies of student learning models tell us about how children actually learn, or are we getting packaged news about how children in one city measure up against children in another on a high stakes standardized test?

Are we hearing about how most bridges in the United States are designed to last 50 years, and the average age of bridges in this country is 43?  Do we know that in just ten years one out of every four bridges in this country will be over 65 years of age, that would be some 170,000 of them. [BridgeReport pdf] Or, do we wait until another one collapses and more lives are lost? 

And so it goes. We’ll shove more and more eye-catching events with less and less context into the great maw of 24 hour news cycles until the information is granulized into particles about which the Time Fillers will offer interminable speculation because that’s what they’re paid to do – speculate. In the short term it’s entertaining – in the long run it isn’t conducive to a well informed electorate.

Worse still, we’ll probably keep doing this until the old song lyrics are true: “I get all the news I need from the weather report.”

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A Tale of Two Epidemics

AIDS Ebola

Wake me up when there are more actual cases of Ebola infections in the United States than there are chattering heads on television screens launching uninformed speculative comments.  All this palaver might serve a purpose (other than generating ratings) if it weren’t composed of, and targeted toward, the intellectually disenfranchised.

We’ve seen all this before – Swine Flu, Bird Flu, MERS, SARS – each one a Threat to Humanity! Like never before. Like nothing we’ve ever seen. Except we have. It was AIDS.

By the end of 1981 there were 159 cases of AIDS recorded in the United States, it wasn’t until 1982 with 771 cases reported and 618 deaths that the CDC labeled the disease AIDS and associated it with male homosexuality, intravenous drug use, Haitian origin, and hemophilia A.  The CDC didn’t add women as being a group at risk until 1983, and cautioned blood banks that there might be a problem.  By then 2807 cases had been reported, and 2118 deaths were associated with the disease.

No one was screeching about the need for an AIDS Czar in 1984, and no one was calling for the government to “move faster.” But 7,239 cases were recorded, there were 5,596 deaths, and one Congressional hearing.

In 1985 we were introduced to the tragic story of Ryan White, who was barred from attending school in his Indiana home town. The Department of Defense announced it would screen recruits for AIDS, and actor Elizabeth Tayler, Dr. Michael Gottlieb, and Dr. Mathilde Brim announced the creation of the American Foundation for AID Research in September. There were 15,527 cases reported, and 12,529 deaths.

It wasn’t until 1986 that the U.S. Surgeon General called for a comprehensive program of sex and AIDS education, and more information on condom use. 1986 was also the year in which the National Institutes of Health planned the formation of the AIDS Clinical Trials Group.  Dr. Krim and Elizabeth Taylor testified before Congress about the need for clinical research, accelerated research, and more timely access to experimental HIV/AIDS medication.  In 1986 there were 28,712 cases reported, and 24,559 deaths.

“And the Band Played On” was published in 1987 while the FDA finally allowed condom manufacturers to advertise that the use of their product would reduce the possibility of contracting HIV/AIDS.  50,378 cases were reported, and 40,849 deaths.  In 1988 the federal government finally responded with legislation – the HOPE Act, during that year there were 82,362 cases and 61,816 deaths.  At the end of 1989 there were 117,508 cases of AIDS, and 89,343 deaths.  The numbers were worse in 1990, 160,969 reported cases, and 120,453 deaths.  1991, 206,563 cases, with 156,143 deaths.  Fast forward to another bad year, 1995 with 513,486 cases reported and 319,849 deaths, however the research funded earlier is beginning to pay off in terms of therapeutic drugs and better prevention education.  As of 2011 there were approximately 1.1 million people in the United States living with HIV/AIDs and more than 33 million living with the disease in other parts of the world. [AmFar]

There’s been enough hyper-partisanship about the way the Reagan Administration handled the AID epidemic. However, the President was not one to discuss it publicly – not until a September 17, 1985 press conference. There are conflicting stories about whether Reagan moved Koop to speak out, or if it were the other way round.  Democrats in Congress did manage to move the money, from $8 million in research funding in 1982 to $26.5 million in 1983 bumped up to $44 million, and more during the remainder of the decade.  [RCP]   What can be said with some certainty is that the Reagan Administration was painfully slow in addressing the calamity that was HIV/AIDS, and did not adopt a leadership role until late in 1985, some four years after the disease was first noted (1981).

The national media and D.C. press corps weren’t helpful either – Chris Geidner notes 13 instances researched by Jon Cohen during which the press corps erupted in laughter at insensitive comments made from the podium by White House Spokesperson Larry Speakes beginning in  October 15, 1982.

Myth Making

It doesn’t take too many little gray cells to figure out why conservatives are so adamant about “blaming the Ebola crisis” on the current President.  To discuss the executive branch reactions to a public health problem invites comparison to the Reagan years, and the comparison doesn’t polish the lustrous image of the the conservative President.

The Congress passed a budget in January 2014 which severely constrained the budgets for the CDC and the National Institutes of Health, calling for across the board cuts in spending – including research on the Ebola virus. [CNNOn March 23, 2014 Officials in Guinea confirmed 49 cases of Ebola infection, and by March 31 Ebola infections were at an epidemic level. As of May 2014 cases are reported in Liberia, and by the end of the month cases are confirmed in Sierra Leone. [NHReg]

On August 8, 2014 the World Health Organization issued a full-on warning about the spread of the Ebola virus in west Africa, saying, among other warnings, that the infections constituted an “extraordinary event,” and a public health risk to other countries.

The Obama Administration’s response in this instance is to be measured in days, not years. On August 5, 2014 the CDC issued a Level 2 travel alert for travelers to Nigeria, and a Level 3 travel alert notice remained in effect for Guinea, Liberia, and Sierra Leone. [CDC]  The agency had also deployed health professionals to the affected area as of August 4th – 6 to Guinea, 12 to Liberia, 4 to Nigeria, and 9 to Sierra Leone.  The CDC also initiated the use of the Epi-Info software tool to determine “contact tracing” to break the chain of transmission. [CDC]  By September 17th the President announced that 3,000 troops would be sent to Liberia to establish a command center to oversee the construction of 17 health care facilities of 100 beds each to isolate and treat victims. The U.S. mission would also be tasked with training 500 health care workers per week. [VOA]

By October 22nd the Administration had launched the deployment of 170 medical professionals from multiple agencies and departments, some of whom were part of the USAID’s Disaster Assistance Response Team to the core of the epidemic area in west Africa; had scaled up the deployment of DoD teams including members from the U.S. Naval Medical Research Center to operate three mobile laboratories providing 24 hour turnaround results on samples.  The Administration had obligated $300 million for fighting the outbreak in west Africa, including funds for the construction of one hospital completed and staffed by U.S. Public Health Service officers.  The efforts also included initiating 65 “safe burial teams” to help Liberians facing the epidemic.  [WH]

The conservative response to these measures was quick and predictable.  One opinion given much air time was that the mission to Liberia wasn’t a legitimate military operation in the commonly held sense of the term, and therefore beyond the scope of “fighting and winning wars.” Another complaint was that the Commander in Chief was sending soldiers, “valuable highly trained war-fighters” just to support health care workers. And, then there was the “why are we sending troops over there when we should be doing something here,” complaint – missing the point that this was precisely the argument for sending more troops to the Middle East in 2003. [MMA]

Meanwhile on the Home Front

Speaking of the domestic front – In March 2014, the Republicans in the U.S. Senate balked at the nomination of Dr. Vivek H. Murthy to be the Surgeon General because the doctor had run afoul of Chris Cox, the head lobbyist for the National Rifle Association.  Dr. Murthy’s experience in hospital emergency rooms caused him to believe that assault weapons do serious damage to human bodies, and that limiting ammunition sales might reduce the number of such fatalities and serious injuries. [NYT]  Right wing pundits called for the “immediate withdrawal of the nomination” in October 2014, so an “experienced professional” could be considered. [PJM]  The ever-media-seeking Senator Ted Cruz (R-TX) dismissed Murthy’s nomination saying, “And we don’t have one because President Obama, instead of nominating a health professional, he nominated someone who is an anti-gun activist,” which got an immediate smack down from Politifact.

While the obstructionists in the Senate blocked the nomination, the CDC was adjusting its guideline and issued revised, or “interim,” guidance for hospitals dealing with Ebola infections on August 8, 2014.  The August interim guidance sounds predictive in the case of the Texas hospital which later experienced infections:

“It emphasized that anyone collecting or handling such specimens are to follow standards compliant with the Occupational Safety and Health Administration bloodborne pathogens standards, including wearing appropriate personal protective equipment (PPE) and implementing other safeguards.

For specimen collection and laboratory testing, PPE recommendations include full face shield or goggles, masks to cover all of the nose and mouth, gloves and fluid-resistant or impermeable gowns. For laboratory testing, the recommendations also include use of a certified class II biosafety cabinet or plexiglass splash guard.”

Politics and Protocols

The CDC tightened the guidelines further, issuing revised guidance to health care workers and hospitals on October 20, 2014.  It also provided more stringent guidance for travel and airline operations, and prospective patient monitoring.

Back in the Senate, Arizona Senator John McCain issued a call for an “Ebola Czar” to coordinate the response to the cases on U.S. soil on October 12-13th. [Hill]  This would be the self-same Senator who decried the Administration’s appointment of “more czars than the Romanoffs.” [HuffPo]  The nomination of Surgeon General Murthy was still the subject of a Republican filibuster.  No sooner than President Obama had appointed an experienced administrator, Ron Klain, an individual with a solid reputation for dealing with complex bureaucratic issues, [CNN] than the GOP lambasted the appointment as “tone deaf and insensitive,” whatever that might mean; and, Senator Cruz criticized the appointment of anyone. [CNN]  The nomination of the Surgeon General nominee remains in Senate limbo.

All this partisan bickering was highlighted by the October 23rd performance of Rep. Jason Chaffetz (R-UT) who announced that the Surgeon General needs to be in charge of the efforts to prevent the spread of the Ebola virus, evidently unaware that his GOP colleagues in the Senate were filibustering the nomination of Dr. Murthy. [HuffPo]

While the Republicans squabbled over who should be appointed to what if anyone should be appointed to anything – the Administration continued to ramp up the coordination of public health efforts.

In addition to increasing the stringency of screening measures and travel restrictions,  activating post arrival monitoring, tightening CDC health care protocols, the Administration approved the creation of a Dedicated Response Team to be assigned to any hospital that receives a confirmed case of Ebola, a “Lessons Learned” training and outreach program based on what occurred in Texas, a Northern Command 30 person short notice assistance team to provide service to civilian medical professionals, and the offering of FEMA coordination for federal assistance to meet “needs on the ground.” [WHFS]

Now, imagine what might have been different if the Reagan Administration had adopted the same robust response to those first 159 cases of AIDS in 1981? Little wonder the conservatives are cranky.

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Fear mongering is hazardous to our health

Halloween Mask Finally, a headline making some sense: “Washoe health official: Worry about the flu not Ebola.”

“(Washoe County Health Officer) Dick said the “media barrage and sensationalism has frightened people,” emphasizing that medical responders are the ones who need to be trained and prepared.

“We are straining resources across my agency and the hospitals are ramping up and getting prepared for the training and drilling,” Dick said. “The community can help by getting a flu shot and not showing up at the emergency rooms with flu-like symptoms.”

That’s right – FLU – good old fashioned influenza.  And, no, we don’t have exact figures on the numbers of people in the United States who succumb to influenza each year because (1) the states aren’t required to report such cases in individuals over the age of 18; (2) the disease isn’t noted on death certificates very often; and (3) death may result from associated illnesses such as bacterial pneumonia well after the flu infection. [CDC] The CDC can offer some context, and report from 2012 studies that there are about 1,532 deaths from influenza a year, and that about 45.2% of youngsters 6 months to 17 years old have gotten a flu shot, while only about 26.3% of adults 18-49 have done so.  Adults 50-64 have a better rate, at 42.7%, and those over 65 have a 66.5% vaccination rate.  [CDC]

If these figures say anything, it’s that we’re less likely to get flu from those little Germ Bags who crawl on carpeting or share the contents of soda pop cans with alarming alacrity than we are from the “adults” in the room – except for Granny, who’s on Medicare and gets her flu shot without a hassle.

And here’s the part where the Affordable Care Act comes into play.

If a family enrolled in a new health care insurance plan on or after September 23, 2010 the plan will be required to cover recommended vaccinations without charging a deductible, copayment, or coinsurance.  This means FLU shots.  [HHS]

The CDC provides a schedule of vaccinations adults should receive, which is available in almost any format from PDF to an app for your Smartphone.  Because of the Affordable Care Act, influenza, tetanus, etc. vaccinations must be covered in comprehensive health insurance plans. Now, does anyone want to discuss “repealing the Affordable Care Act?”

And here’s the part wherein pure stupidity comes into play.

There were school closings and/or panics in Texas, Ohio, and Maine… because “Ebola.” [NYT] [Denver]  It seems a teacher from beautiful downtown Strong, Maine (Google that one) went to a conference in Dallas, Texas and has been asked to take a 21 day paid leave of absence. Let’s review. The immediate family of the man who died from the disease in Dallas has been cleared, having passed the time limit without infection – so a teacher who attended a conference across town is on leave?

There are continuous calls for a travel ban with west Africa. Which goes nowhere toward explaining why a musical group from Kenya (EAST Africa!) had a U.S. performance cancelled. Actually, the travel ban blather says more about the intrinsic American problem locating anything or anyone on a map than about a sentient reaction to a world health problem.

We’re going to stop flights from Freetown, Sierra Leone? What flights from Freetown?  The flights go through Casablanca (Morocco) and Brussels (Belgium) [VSL.org] Or, stop flights to and from Monrovia, Liberia?  Flights from Monrovia, Liberia to New York make stops in Casablanca, Montreal, Paris, and  Madrid [TripAdv]  A “flight ban” makes absolutely no sense – unless it’s being advocated that we stop flights from Brussels, Casablanca, Montreal, Paris, and Madrid.

What we could do instead of getting all panicky?

#1. Provide funding for the CDC and the National Institutes of Health to conduct research into the Ebola disease (and others) and increase funding for programs which improve local and state emergency preparedness, for both natural and man-made disasters.

#2. Stop worrying about who the “czar” is …and start worrying about when the Senate of the U.S. might confirm the next Surgeon General. 

#3. Provide funding for medical relief activities in countries such as Liberia, Guinea, and Sierra Leone, which will help curb the disease in place.

#4. Get a flu shot and don’t run to the ER with the sniffles.

#5. Vote for candidates who promise to do numbers 1-3.

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Filed under Health Care, health insurance

Republicans are a Public Health Hazard

 

Health Hazard

Just Saying… Nevada early voting begins on October 18, 2014. Register, and vote.

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Filed under health, Health Care

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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Filed under Amodei, Congress, conservatism, health, Health Care, worker safety