Why medical experts worry about President Trump touting chloroquine

https://www.politifact.com/article/2020/apr/07/why-medical-experts-worry-about-president-trump-to/?fbclid=IwAR2mxG7HzUAZgmfrwsC9cZtNL2-q8_xQSj6jbdjF45Aod7x8848A3voRYVw

Trump touts hydroxychloroquine as a cure for Covid-19. Don't ...

IF YOUR TIME IS SHORT

• Already, an Arizona man died and his wife was hospitalized after self-administering a variant of chloroquine, prompting the Centers for Disease Control and Prevention to send out a warning.

The American Medical Association says it “strongly opposes” prophylactically prescribing chloroquine as well as pharmacies and hospitals “purchasing excessive amounts” of the medication.

• Some people have health conditions that mean they shouldn’t take chloroquine because of potential side effects. 

• Putting too much focus on one specific treatment could make Americans lax about following social distancing guidelines.

In more than half a dozen public events since March 19, President Donald Trump has touted a possible treatment for coronavirus infection — using the malaria drug chloroquine or a related drug hydroxychloroquine, sometimes in combination with the antibiotic azithromycin.

“I hope they use the hydroxychloroquine, and they can also do it with Z-Pak (azithromycin), subject to your doctor’s approval and all of that,” Trump said at an April 4 briefing. “But I hope they use it, because I’ll tell you what: What do you have to lose?”

Trump reiterated praise for chloroquine in his April 5 briefing: “A lot of people are saying that … if you’re a doctor, a nurse, a first responder, a medical person going into hospitals, they say taking it before the fact is good.”

When a reporter asked Trump for “the conclusive medical evidence” to support his optimism, Trump dismissed the question as “fake news.”

Trump isn’t wrong that this drug combination might prove helpful, at least based on preliminary evidence. The treatment is currently being studied in clinical trials, according to the Centers for Disease Control and Prevention.

But randomized tests — the gold standard of medical evidence — have not been completed, and the lack of rigorous testing as a treatment against coronavirus has led many medical experts to be more cautious than the president. The drug has significant side effects, including damage to the heart and nervous system and suicidal thoughts. And a run on chloroquine could harm patients with lupus and other diseases that the drug is already used for.

Some medical experts are concerned that the president’s words from a White House lectern may be skewing Americans’ perceptions of the best way to fight coronavirus.

Not long after Trump began touting chloroquine, an Arizona man died and his wife was hospitalized after they ingested a fish-tank solvent that includes chloroquine phosphate. The woman told NBC News that they thought the compound was the same as the one Trump cited. Fish-tank cleaners are not the same as the drugs used for malaria, nor are they suitable for human consumption.

A few days later, the CDC released a warning, not just against using the fish-tank cleaner but also the malaria drug itself without a doctor’s orders.

In a statement to PolitiFact, the American Medical Association seconded such concerns, saying that no medication has yet been approved by the Food and Drug Administration for patients with coronavirus, also known as COVID-19. The association said it “strongly opposes” prescribing chloroquine as a preventive measure and also opposes pharmacies and hospitals “purchasing excessive amounts” of the medication.

On several occasions, Trump has reminded viewers of his briefings to consult with doctors about treatments. But at other times, he has trumpeted his own confidence in chloroquine as a treatment.

“I’ve seen things that I sort of like,” he has said. “So what do I know? I’m not a doctor. I’m not a doctor. But I have common sense.”

Experts said Trump’s high-profile endorsement risked overshadowing the views of medical experts.

“The evidence just isn’t there yet to prove that these drugs work, and while the risks from inappropriately prescribing them are rare, they can be serious,” said Joel F. Farley, associate head of the department of pharmaceutical care and health systems at the University of Minnesota College of Pharmacy.

Farley said he even worries about patients going through proper channels.

“Even if prescribed by a physician, I am not convinced that patients are being adequately screened or monitored for some of the more serious side effects, like cardiotoxicity,” he said. “I have heard anecdotal reports of physicians prescribing these medications for friends and family members, which doesn’t always come with an appropriate physical or health screening.”

Another worry among medical specialists is the possible stockpiling of chloroquine. This could harm patients with lupus or rheumatoid arthritis, who depend on the drug to treat their own conditions. “Being just stewards of limited resources is essential,” the American Medical Association said in its statement.

Finally, focusing on one potential treatment could overshadow the nitty-gritty things Americans need to do on a daily basis to stay safe.

“My biggest concern is that people will believe there’s some magic cure and not follow social distancing and other normal precautions in the belief that there’s a drug to ‘fix this,’” said Ally Dering-Anderson, a clinical associate professor at the University of Nebraska College of Pharmacy.

 

 

 

 

Health providers seek at least $1B in next coronavirus stimulus bill

https://thehill.com/policy/healthcare/487813-providers-ask-for-at-least-1-billion-for-next-coronavirus-stimulus-bill

Health providers seek at least $1B in next coronavirus stimulus bill

Lawmakers should allocate at least another $1 billion in emergency funding for the coronavirus response, according to a letter from health care provider groups to congressional leaders.

The letter from the American Hospital Association, American Medical Association and American Nurses Association urged lawmakers to ensure that the next economic stimulus package includes funding to ensure that hospitals, health systems, physicians and nurses are “directly supported” for preparedness response.

The groups said the additional funding is needed for specific priorities, including ramping up infection controls, increasing the number of patient beds, building or retrofitting separate areas to screen and treat coronavirus patients and obtaining scarce protection supplies like masks and ventilators.

The groups also said hospitals and nurses need financial support because of the impact of canceling elective surgeries and procedures due to shortages of protective equipment, as well as patient fears.

“Such cancellations could have devastating financial implications for hospitals, physicians and nurses already at financial risk and may limit access to care,” the groups wrote.

The House early Saturday passed legislation aimed at mitigating the economic impact of the coronavirus epidemic, including provisions that would ensure that workers can take paid sick or family leave, bolster unemployment insurance and guarantee that all Americans can get free diagnostic testing for the coronavirus.

The Senate is expected to vote on the bill later this week, as the House still needs to pass “technical” corrections.

 

 

 

MARTIN LUTHER KING JR.’S HEALTHCARE JUSTICE ADVOCACY MAKES AMERICA’S HOSPITALS BETTER TODAY

Martin Luther King Jr.’s Healthcare Justice Advocacy Makes America’s Hospitals Better Today

Image result for MARTIN LUTHER KING JR.’S HEALTHCARE JUSTICE ADVOCACY MAKES AMERICA’S HOSPITALS BETTER TODAY

Every January, the United States celebrates the lasting legacy of Dr. Martin Luther King Jr. Not widely known is how his civil rights advocacy made a lasting impact on modern-day hospitals, including children’s hospitals.

Today in 170 Children’s Miracle Network Hospitals, every young patient is treated regardless of their race or background. CMN Hospitals are deeply committed to offering world-renowned treatment to all kids in need and that’s why donations to your local hospital can make such a difference for families facing health crises.

Unfortunately, certain hospitals in America were still segregated in the not too recent past. When Brown vs. Board of Education passed in 1954, schools began to desegregate, and this paved the way for institutions like hospitals to follow suite. King’s healthcare justice advocacy advanced health care access in particular for the African American community.

A History of Unequal Healthcare

When patients enter a hospital, they expect to receive a standard of care that will improve their lives regardless of who they might be. That expectation, unfortunately, has not always been backed up by medical institutions across the United States. African Americans, in particular, experienced a history of receiving substandard care and outright abuse within the framework of medical science.

Notable examples of this include:

While the details of those specific examples weren’t publicly known in the 1960s, African Americans were certainly aware that they received care that was inferior to white patients. Doctors and hospitals continued perpetuating this double standard even after the passage of the Civil Rights Act in 1964. The disparity in treatment quality was so egregious that Dr. Martin Luther King Jr. spoke out against it, calling for an awakening in the conscience of the United States.

Desegregating Hospitals

King uttered his famous words on healthcare while addressing the press before attending the annual meeting of the Medical Committee for Human Rights, an organization formed because the American Medical Association was segregated at the time. “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death,” said King.

The Civil Rights Act of 1964 isn’t typically associated with healthcare. However, at that point in history, it was well known that some hospitals and medical institutions were resisting the push for desegregation, a practice which hospitals used to provide less than adequate care to African American patients. Hospitals would continue to hold onto such discriminatory practices unless something was done.

Legal Gains for Equality in Hospitals

The reason King spoke out so vehemently in 1966 was due to the passage of Medicare and Medicaid in 1965, something that was only possible due to the efforts of the Medical Committee for Human Rights and its head, W. Montague Cobb. The organization made use of the non-violent protest strategies of King and the Civil Rights Movement. The passage of the Social Security Act, which created Medicare and Medicaid brought federal funding into every hospital and medical institution in the United States, forever binding each facility to the Civil Rights Act, a stipulation of which was that any organization receiving federal funding could not discriminate on the basis of race.

From that point onward, hospitals that clung to the old ways of discrimination were subject to lawsuits from mistreated African Americans and pressure from activists like King and the Medical Committee for Human Rights. This gave King the legal ground to stand on when calling on hospitals to abandon the evil practice of systemic discrimination in 1966 with those now famous words from that 1966 conference.

While we know there’s more work to be done to promote equal healthcare access to every child in need across North America, we’re proud that our non-profit children’s hospitals can be a part of the solution.

Thank you, King.

 

 

 

 

Northwell CEO Urging Healthcare Providers to Mobilize for Gun Control

https://www.healthleadersmedia.com/strategy/northwell-ceo-urging-healthcare-providers-mobilize-gun-control

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The prominent executive is pushing beyond a letter he released last week and is now seeking to rally his peers around solving what he sees as a public health crisis.


KEY TAKEAWAYS

‘All of us have allowed this crisis to grow,’ he wrote in a letter published Thursday in The New York Times.

Healthcare CEOs should put pressure on politicians without resorting to ‘blatant partisanship,’ he said.

Northwell Health President and CEO Michael J. Dowling isn’t done pushing fellow leaders of healthcare provider organizations to take political action in the aftermath of deadly mass shootings.

Dowling addressed healthcare CEOs in a call to action published online last week by the Great Neck, New York–based nonprofit health system. Now he’s published a full-page print version of that letter in Thursday’s national edition of The New York Times, while reaching out directly to peers who could join him in a to-be-determined collective action plan to curb gun violence.

“To me, it’s an obligation of people who are in leadership positions to take some action, speak out, and prepare their organizations to address this as a public health issue,” Dowling tells HealthLeaders.

Wading into such a politically charged topic is sure to give some healthcare CEOs pause. Even if they keep their advocacy within all legal and ethical bounds, they could face rising distrust from community members who oppose further restrictions on firearms. But leaders have a responsibility to thread that needle for the sake of community health, Dowling says.

“I do anticipate that there’ll be criticism about this, but then again, if you’re in a leadership role, criticism is what you’ve got to deal with,” he says.

Dowling argues that healthcare leaders have successfully spoken out about other public health crises, such as smoking and drug use. But they have largely failed to respond adequately as gun violence inflicts considerable harm—both physical and emotional—on the communities they serve, he says.

“It is easy to point fingers at members of Congress for their inaction, the vile rhetoric of some politicians who stoke the flames of hatred, the lax laws that provide far-too-easy access to firearms, or the NRA’s intractable opposition to common sense legislation,” Dowling wrote in the print version of his letter. “It is far more difficult to look in the mirror and see what we have or haven’t done. All of us have allowed this crisis to grow. Sadly, as a nation, we have become numb to the bloodshed.”

His letter proposes a four-part agenda for healthcare leaders to tackle together:

  1. Put pressure on elected officials who “fail to support sensible gun legislation.” He urged healthcare CEOs to increase their political activity but avoid “blatant partisanship.” The online version of his letter links to OpenSecrets.org‘s repository of information on campaign contributions from gun rights interest groups to politicians.
  2. Invest in mental health without stigmatizing. Most mass murderers aren’t “psychotic or delusional,” Dowling wrote. Rather, they’re usually just disgruntled people who let their anger erupt into violence, which is why firearms sales to people at risk of harming themselves or others should be prohibited, he wrote.
  3. Increase awareness and training. Individuals shouldn’t be allowed to buy or access certain types of firearms “that serve no other purpose than to inflict mass casualties,” he wrote. Healthcare leaders should support efforts to spot risk factors and better understand so-called “red flag” laws that empower officials to take guns away from people deemed to be a potential threat to themselves or others, he wrote.
  4. Support universal background checks. In the same way that doctors shouldn’t write prescriptions without knowing a patient’s medical history to ensure the drug will do no harm, gun sellers shouldn’t be allowed to complete a transaction without having a background check conducted on the buyer, Dowling wrote, adding that a majority of Americans support this idea.

The letter notes that the U.S. has nearly 40,000 firearms-related deaths each year and that several dozen people have died in mass shootings thus far in 2019, including 31 earlier this month in separate shootings in El Paso, Texas, and Dayton, Ohio.

Corporate Responsibility

The way for-profit companies think about their relationship with the communities in which they operate has been shifting for some time. The most recent evidence of that shift came earlier this week, when the influential Business Roundtable released a revised statement on the principles of corporate governance, responding to criticism over the so-called “primacy of shareholders.”

The 181 CEOs who signed onto the new statement said they would run their business not just for the good of their shareholders but also for the good of customers, employees, suppliers, and communities. There’s some similarity between that updated notion of corporate responsibility and the sort of advocacy work Dowling wants to see from his for-profit and nonprofit peers alike.

Every single organization has a social mission, and large organizations that have sway in a local community have a responsibility to the community’s health, Dowling says.

“A healthy community helps and creates a healthy organization,” he says.

One major factor that may be pushing more CEOs to take a public stance on politically sensitive issues—or at least giving them the cover to do so confidently—is the generational shift in the U.S. workforce. Although most Americans overall say CEOs shouldn’t speak out, younger workers overwhelmingly support such action, as Fortune‘s Alan Murray reported, citing the magazine’s own polling.

Dowling says he has received hundreds of letters, emails, and phone calls from members of Northwell Health’s 70,000-person workforce expressing support in light of his original letter published online last week.

“The feedback has been absolutely universal in support,” he says.

But Which Policies?

Even among healthcare professionals who agree it’s appropriate to speak out on politically charged topics, there’s sharp disagreement over which policies lawmakers should enact and whether those policies would infringe on the public’s Second Amendment rights.

The group Doctors for Responsible Gun Ownership (DRGO) rejects the premise of Dowling’s argument: “Firearms are not a public health issue,” the DRGO website states, arguing that responsible gun ownership has been shown to benefit the public health by preventing violent crime.

Dennis Petrocelli, MD, a psychiatrist in Virginia, wrote a DRGO article that called Virginia’s proposed red flag law “misguided” and perhaps “the single greatest threat to our constitutional freedoms ever introduced in the Commonwealth of Virginia.” His concern is that the government might be able to take guns away without any real evidence of a threat.

While gun rights advocates may see Dowling as merely their latest political foe, Dowling contends that he’s pushing for a cause that can peaceably coexist with the constitutional right to bear arms.

“You can have effective, reasonable legislative action around guns that still protects the essence of what many people believe to be the core of the Second Amendment,” Dowling says. “It’s not an either/or situation.”

Others Speaking Out

Dowling isn’t, of course, the only healthcare leader speaking out about gun violence.

On the same day last week that Northwell Health published Dowling’s online call to action, Ascension published a similar letter from President and CEO Joseph R. Impicciche, JD, MHA, who referred to gun violence in American society as a “burgeoning public health crisis.”

“Silence in the face of such tragedy and wrongdoing falls short of our mission to advocate for a compassionate and just society,” Impicciche wrote, citing the health system’s Catholic commitment to defend human dignity.

The American Medical Association (AMA) and American College of Emergency Physicians (ACEP) each issued statements this month calling for public policy changes in response to these recent shootings, continuing their long-running advocacy work on the topic.

American Hospital Association 2019 Chairman Brian Gragnolati, who is president and CEO of Atlantic Health System in Morristown, New Jersey, said in a statement this month that hospitals and health systems “play a role in the larger conversation and are determined to use our collective voice to prevent more senseless tragedies.”

 

 

 

Anthem again irks docs with latest changes to reimbursement

https://www.healthcaredive.com/news/anthem-again-irks-docs-with-latest-changes-to-reimbursement/559747/

Anthem is again ruffling the feathers of providers, this time over a new reimbursement policy denying payment for certain follow-up office visits the same day a procedure is performed. 

The policy could impact many specialists and primary care doctors. Dermatologists are particularly upset over the change, which they call punitive and unnecessary with the potential to disrupt patient care.

“It is a nuisance. It makes absolutely no sense,” George Hruza, a practicing dermatologist and president of the American Academy of Dermatology, told Healthcare Dive.

It’s the latest in a string of controversial policies from Anthem. The Blue Cross payer that insures 40 million people has taken steps to rein in costs by enforcing different payment policies based on site of care and other factors. 

In the past several years, the Indianapolis-based for-profit said that it would no longer pay for emergency room visits if patients show up with minor ailments like the common cold. It also stopped paying for certain imaging tests at outpatient facilities owned by hospitals due to the unexplained wide variation in costs compared with freestanding imaging centers.

And this year, Anthem cut rates paid to hospital-based labs in an attempt to align them with independent labs, a strategy that garnered extensive discussion on lab giant Quest Diagnostic’s second quarter earnings call.

Anthem contends the latest change to office visit payments will prevent duplicative billing for similar visits. The change took effect March 1, according to a previous provider alert. Anthem told Healthcare Dive it’s an update to its claims systems and does not describe it as a new reimbursement policy.

Despite conversations with Anthem, Hruza said his organization hasn’t been given an explanation on what triggered the change and whether it actually addresses a problem or an abuse of the system. He said he understands the need to cut healthcare costs, but wonders how much savings the change will generate as some of the visits are below $100.

The payer proposed an almost identical change last year but later decided to pull it back after intense pushback from the American Medical Association and other provider groups. The newer policy is worse because doctors would receive no payment, and it’s more narrowly tailored to the same diagnosis, Hruza said.

‘Appropriate settings’

Anthem argues the policy is needed to move care to more cost-efficient settings.

“Our efforts to help achieve that goal include a range of initiatives that, among other things, encourage consumers to receive care in the most appropriate setting and also help promote accurate coding and submission of bills by providers,” Anthem said in a statement to Healthcare Dive.

Hruza is worried the latest iteration would cause patients delays in care.

He gave the example of a patient with acne prescribed a medication. He would want to see them for a follow-up in a few weeks. At that second appointment, if he saw the treatment wasn’t working well, he might prescribe a different medication. At the same time, he may drain an acne cyst, a minor procedure. That would trigger a denial, he said, because of the two visits revolving around the same diagnosis with the same-day procedure.

AMA is aware of the policy and has had meetings with Anthem about its concerns, a source for the organization that represents the nation’s doctors told Healthcare Dive.

For providers, the big fear is the change will result in unjustified claim denials and encourage other payers to adopt similar measures. Hruza said there is no recourse for contracted providers, particularly those that work in smaller practices, when these changes are made, given Anthem’s size as the nation’s second-largest insurer.

As deductibles rise and patients are shouldering a greater burden of the cost of care, insurers may be feeling the pressure from employers to wring out costs from the provider side, Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University, told Healthcare Dive.

“Employers are getting more and more wise to the fact that the reason we have a cost problem in this country is because of provider prices,” Corlette said.