Category Archives: Recommended Reading
Recommended Reading: Some Drugs—Especially Oncology Medicines—Have Been in Short Supply for Too Many Years
Health Affairs and the Robert Wood Johnson Foundation recently released an issue brief on the continuing shortages of certain drugs, most frequently injectable drugs for cancer treatment. According to the issue brief, there have been fewer reports of newly unavailable drugs in the last few years, but problems remain, forcing many patients to skip some treatments or sometimes opt for a less-effective drug. U.S. Food and Drug Administration (FDA) updates on drug shortages in just the first two weeks of September found sixteen injectable drugs in short supply, two of them new to the list.
Recent Government Accountability Office reports have found several reasons for the shortages, including:
- Difficulty acquiring raw materials
- Manufacturing problems
- A loss of drug products when factories are updated and modernized
- Low reimbursement by Medicare and other government payment programs
- FDA regulations that may slow down new drug approvals
The authors of the issue brief say that it is unlikely that Congress will act, and that the industry has and will make changes likely to help bolster some supplies. Also, thorough reviews such as the current issue brief help remind policymakers that some drug shortages remain.
Read the full issue brief.
In the last few days, the U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and the medical aid group Doctors Without Borders have sounded alarms on the growing needs of several countries in West Africa fighting the Ebola outbreak. The groups have called for increased funding, equipment and expert health personnel to help stem the rapidly increasing numbers of infections.
As of last week, there have been more than 3,000 cases and more than 1,500 deaths, making it by far the largest outbreak since Ebola was discovered during the 1970s, according to the WHO. CDC Director Tom Frieden, MD, MPH, who last week visited the main West African countries dealing with the Ebola outbreak, said the number of cases could spike to 20,000 if more isn’t done to stem spread of the disease in those countries.
In addition, a recent post on ForeignPolicy.com said that the epidemic must be controlled before it also poses a security threat. Liberia, which has seen the highest number of Ebola cases and deaths in the region so far, has been under the watch of an international United Nations (U.N.) peacekeeping force since a civil war ended in 2003. While the U.N. had planned to begin drawing down the force next year, U.N. Secretary General Ban Ki-moon said he’d like to delay any drawdown for at least three months because of the virus outbreak, which has needed troops to help secure order.
However, several countries want to pull out troops now in order to reduce the risk to their personnel and to citizens at home who they worry could be infected by returning soldiers. Ban has said that the nature of the illness poses little risk to the troops, who are unlikely to have contact with the bodily fluids of people who are ill—which is the way the virus spreads—and some of the countries involved are considering sending their own experts to assess the risks.
Earlier this year, Spokane County, Wash.,was chosen by the Robert Wood Johnson Foundation (RWJF) as a Culture of Health Prize winner for its efforts to improve community health by increasing graduation rates. As part of a new ongoing series, Health Affairs blog has featured a piece by local Spokane leader Ben Smith on the community’s health successes.
Just eight years ago, the high school graduation rate for Spokane Public Schools was below 60 percent and 18 percent of the county’s students lived in poverty. In addition, the students who did attend college or technical school often failed to earn their degree, leaving them unprepared to fill available positions in the county’s more technical fields.
To address these issues, Priority Spokane emerged from a collaboration of local businesses, educators, health organizations and community nonprofits—all committed to improving the future of Spokane County residents by improving education. A report linking lack of education to poorer health helped spur a dramatic change. Over the next several years, the county emphasized increased collaboration and a clear vision to improve the high school graduation rate to 79.5 percent overall.
Spokane County’s efforts include:
- Training teachers and childcare workers to mentor children who experience traumatic home events.
- Developing an early warning system for at-risk students.
- Establishing community attendance support teams that reengage truant students in school.
- Starting Spokane Valley Tech, a high school designed to help students build careers in science, technology, engineering and math.
To learn more about Spokane’s prize-winning efforts to improve health, read the Health Affairs blog post.
>>Bonus Content: Watch a NewPublicHealth video on Spokane's efforts to build a Culture of Health.
Better communication means better patient engagement, and better patient engagement means better health outcomes. Understanding this, Sense Health has developed an app to promote interactive, text-message-based communications between health care professionals and high-needs patients. Stan Berkow, CEO of the New York City-based company, said in a recent interview with AlleyWatch that the focus thus far has been on Medicaid patients with chronic conditions because they represent “an underserved population with a huge unmet need both considering the human element as well as the cost-burden.”
The app allows providers to create message-based conversations tailored to the particular needs of their patients. In a two-month randomized control trial with Montefiore Medical Center, which included 67 high-needs patients and 15 care managers, providers saw a 40 percent increase in self-reported patient adherence to appointments, a 12 percent increase in adherence to medications and a 7 percent increase in adherence to care plan goals.
“Our business is built on our belief that it is not only possible, but essential to personalize healthcare through the use of technology,” said Berkow. “The prevention and management of chronic health conditions requires behavior change, something that technology alone cannot provide. Sense Health is amongst those who realize that technology in health works best when there is a human touch behind the system and patients feel supported by their providers.”
The company recently joined the New York Digital Health Accelerator, which offers up to $100,000 in funding to companies engaged in developing digital health solutions. The accelerator is run by the Partnership Fund for New York City and the New York eHealth Collaborative.
Read the full interview at AlleyWatch.
Since March, several African countries have reported more than 1,000 cases of Ebola virus and more than 670 deaths. During a United Nations Foundation briefing in Washington, D.C., earlier this month, public health experts from the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization raised concerns about airline passengers from these countries spreading Ebola well beyond Africa. This week that fear became a reality when a U.S. citizen, Paul Sawyer, who had been in Liberia very recently as a consultant to the country’s finance ministry, fell ill on a flight from Liberia to Nigeria. Sawyer was hospitalized in Lagos, Nigeria, and died there of Ebola.
Several West African nations have responded by planning to set up monitoring stations at airports to identify people with fevers before they board planes. On a CDC conference call this week with reporters, Martin Cetron, MD, the CDC's director for Global Migration and Quarantine, said it makes more sense to put checkpoints in West African countries than to scan incoming passengers in the United States because there are few direct flights from West Africa, and fevers found among passengers entering the United States are unlikely to be Ebola.
“Ebola is contagious only when symptomatic, so someone unknowingly harboring the virus would not pass it on, “ said Stephan Monroe, deputy director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, during the conference call, also adding that even passengers showing symptoms are unlikely to pass the disease on to fellow travelers because blood and stool carry the most viruses. Cetron also said that those at highest risk for Ebola infection are family members who care for sick loved ones and health care workers who treat patients or accidentally stick themselves with infected needles.
"We do not anticipate [Ebola] will spread in the U.S. if an infected person is hospitalized here," CDC Director Tom Frieden told reporters. "We are taking action now by alerting health care workers in the U.S. and reminding them how to isolate and test suspected patients while following strict infection-control procedures."
The National Geographic recently took an in-depth look at the Ebola virus in Africa and the risk of it spreading to the United States. Read the full article.
Recommended Reading: Life Expectancy Gains Threatened When Older Americans Have Multiple Medical Conditions
A new study from the Johns Hopkins Bloomberg School of Public Health finds that nearly four in five older Americans are living with multiple chronic medical conditions. That’s very concerning, say the researchers, because their work shows that the more ailments a person has after retirement age, the shorter their life expectancy. The researchers say the new study is one of the first to look at the burden of multiple chronic conditions on life expectancy among the elderly and may help explain why increases in life expectancy among older Americans are slowing.
“Living with multiple chronic diseases such as diabetes, kidney disease and heart failure is now the norm and not the exception in the United States,” said Eva H. DuGoff, PhD, a researcher at the school of public health and the lead author of the new study. “The medical advances that have allowed sick people to live longer may not be able to keep up with the growing burden of chronic disease. It is becoming very clear that preventing the development of additional chronic conditions in the elderly could be the only way to continue to improve life expectancy.”
The study found that a 75-year-old American woman with no chronic conditions will live to be an average of 92, but a 75-year-old woman with five chronic conditions will only live to an average age of 87 and a 75-year-old woman with 10 or more chronic conditions will only live to the age of 80. Women continue to live longer than men and white people live longer than black people, based on data from annual U.S. surveys.
On average, life expectancy is reduced by 1.8 years with each additional chronic condition, the researchers found. But while the first disease shaves off just a fraction of a year off life expectancy for older people, the impact grows as the diseases add up. The study is based on an analysis of the records of 1.4 million Medicare enrollees and was published in the journal Medical Care.
Other groups are also beginning to look at this issue. Healthy aging will be this year’s focus of the President’s Initiative of the Association of State and Territorial Health Officers. A year-long focus on healthy aging will begin during the association’s annual conference in September.
Read the full study.
The public comment period for rules regulating the sale and use of e-cigarettes proposed in April by the U.S. Food and Drug Administration (FDA) ends on August 8, after which the agency is expected to release final rules governing the products. Experts say the timing is critical because sales of the products—which weren’t even on the market a decade ago—are heating up, with revenues approaching $1 billion a year, according to Forbes Magazine.
Last week, Health Affairs and the Robert Wood Johnson Foundation (RWJF) released a health policy brief about e-cigarettes that sets out key issues concerning the products and provides important background, particularly for people poised to comment on the FDA’s proposed rules.
Among the issues the policy brief addresses are e-cigarette safety; whether the devices ought to be regulated as a medical (smoking cessation) device or as a cigarette; and whether e-cigarettes pose a risk as a “gateway” drug to tobacco products. It notes that the FDA is currently funding close to 40 studies on e-cigarettes.
The issue is especially critical because sales to kids and teens are increasing, and there is still insufficient information on whether the vapor emitted by the devices pose a cancer risk. A 2013 study of 40,000 middle and high school students around the country by researchers at UC San Francisco found that e-cigarette use in that group doubled between 2011 and 2012, from 3.1 percent to 6.5 percent.
Read the policy brief from Health Affairs and RWJF.
>>Bonus Link: Read a NewPublicHealth post on initiatives by major cities to regulate the sale and use of e-cigarettes.
There are an estimated 7,350 homeless people living in San Francisco, yet there are only eight facilities in the city at which the homeless can shower. At each of these facilities, there are at most two shower stalls—meaning that there is at most one shower for every 460 homeless people.
Lava Mae developed a mobile approach to target this public health issue.
The refurbished San Francisco MUNI bus outfitted with two full-service bathrooms successfully made its first rounds on June 28. The bus will travel around the city providing the homeless with mobile public utilities and giving them much-needed access to clean water and sanitation. Without the limitations of stationary locations, Lava Mae is able to aide people across the city while also staying free from high real estate prices, rising rent and potential eviction.
"For at least a decade, bathrooms have stood in for the city's anxieties about homelessness, public utilities, and the changing economy," wrote Rachel Swan in a piece on public bathrooms in SF Weekly. Lava Mae founder Doniece Sandoval hopes that the program will take big steps in improving the health of the homeless and public sanitation by increasing the number and scope of available public restrooms.
The relationship between the health and wellbeing of the homeless population correlates directly with the health of the community as a whole. As the homeless population strives for a better quality of life, so does the community—one shower at a time.
Read the full story, “A Refurbished Bus Will Bring Showers to the Homeless in San Francisco.”
Last month the Washington Post held a live event, Health Beyond Health Care, that brought together doctors, bankers, architects, teachers and others to focus on health beyond the doctor’s office. The goal of the Washington, D.C., event—which was co-sponsored by the Robert Wood Johnson Foundation (RWJF) and others—was to showcase examples of novel places that are working to create cultures of health, such as a newly designed school that promotes physical activity and healthy eating in Virginia, and free outdoor exercise classes in Detroit.
Videos from the Post event are now online and include conversations with:
- Dan Nissenbaum, managing director in the Goldman Sachs Urban Investment Group, about community development.
- Brookings Institution fellow Alice Rivlin about the RWJF Commission to Build a Healthier America, which released its report Beyond Health Care in January.
- Chris Allen, CEO of the Detroit Wayne County Health Authority, about moving the community from a focus on sick care to a focus on prevention and wellness.
The Post's continuing coverage also includes articles about how city design can open up new opportunities for health; how greenways and complete streets can get people moving; and how workplaces can get a makeover for healthier employees.
Over the next few days, NewPublicHealth will report on additional efforts across the country to promote a culture of health across neighborhoods, schools, homes and workplaces.
Explore the Post’s special report on “Health Beyond Health Care” here.
An American Academy of Pediatrics symposium earlier this week focused on ways to prevent “toxic stress” in children and families, including addressing mental health education and treatment early in a child’s life. In a comprehensive interview during May’s Mental Health Awareness Month, David Shern, PhD, senior science advisor at Mental Health America and a member of American Public Health Association’s Mental Health Section, addressed the importance of this approach.
“[W]e can develop strong mental health which gives us increased resilience to deal with the adversities that we experience in life, to concentrate better, to be more productive, to be more emotionally well balanced,” he said. “So it’s important that when we think about the overall health of our population, we think not only about preventing illness, which of course is critically important, but also promoting strength and well being.”
Read the full interview with the American Public Health Association.