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ausetkmt · 3 months

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New Alzheimer's drugs bring hope. But not equally for all patients.

https://www.washingtonpost.com/health/2024/01/29/alzheimers-new-drugs-black-patients-leqembi/

ABINGTON, Pa. — Wrapped in a purple blanket, Robert Williford settles into a quiet corner of a bustling neurology clinic, an IV line delivering a colorless liquid into his left arm.

The 67-year-old, who has early Alzheimer’s disease, is getting his initial dose of Leqembi. The drug is the first to clearly slow the fatal neurodegenerative ailment that afflicts 6.7 million older Americans, though the benefits may be modest. The retired social worker, one of the first African Americans to receive the treatment, hopes it will ease his forgetfulness so “I drive my wife less crazy.”

But as Williford and his doctors embark on this treatment, they are doing so with scant scientific data about how the medication might work in people of color. In the pivotal clinical trial for the drug, Black patients globallyaccounted for only 47 of the 1,795 participants — about 2.6 percent. For U.S. trial sites, the percentage was 4.5 percent.

The proportion of Black enrollees was similarly low for Eli Lilly Alzheimer’sdrug, called donanemab, expected to be cleared by the Food and Drug Administration in coming months. Black people make up more than 13 percent of the U.S. population.

The paltry data for the new class of groundbreaking drugs, which strip a sticky substance called amyloid beta from the brain, has ignited an intense debate among researchers and clinicians. Will the medications — the first glimmer of hope after years of failure — be as beneficial for African Americans as for White patients?

“Are these drugs going to work in non-Whites? And particularly in Blacks? We just don’t have enough data, I don’t think,” said Suzanne E. Schindler, a clinical neurologist and dementia specialist at Washington University in St. Louis. “In general, the default is that they will work the same in everybody, but we don’t really know that for sure.”

The situation casts a spotlight yet again on the decades-long failure of researchers to reflect the increasingly diverse character of the patient population in the United States, and underscores the stark disparities in Alzheimer’s treatment and care. Black Americans develop the disease and related dementias at twice the rate of their White counterparts, but are less likely to receive specialized care and are diagnosed at later stages, studies show. That’s an urgent problem considering that the new drugs must be used early to have an effect.

In addition, a perplexing new issue appears to be contributing to low Black enrollment in trials and is fueling a debate among experts about the role of race, genetics and other factors. To qualify for the main trial for Leqembi — developed by the Japanese pharmaceutical giant Eisai and the biotechnology company Biogen of Cambridge, Mass. — participants were required to have elevated levels of brain amyloid, a defining characteristic of Alzheimer’s, and symptoms such as memory loss.

But brain scans showed that the African American volunteers were less likely to have excess amyloid than White patients and thus were excluded from the trial at higher rates. Almost half of Black applicants failed to meet the amyloid threshold, compared with 22 percent of White volunteers, according to Eisai. A similar pattern occurred with the Lilly drug and in some other studies, and sometimes involved other people of color, including Hispanics.

Experts are baffled by the findings. Why would amyloid levels — thought to be a key driver of Alzheimer’s — be different in people with similar cognitive problems?

“Is it the color of someone’s skin? Almost certainly not,” said Joshua D. Grill, an Alzheimer’s researcher at the University of California at Irvine. “Is it a difference in genetics? Or other health conditions, like cholesterol, blood pressure or vascular health? Or is it something else, that we haven’t measured?”

While the biology of Alzheimer’s is almost surely the same regardless of race, some researchers say the patients themselves might be different because of underlying health conditions. Some older Black patients diagnosed with Alzheimer’s, they say, might actually have vascular dementia stemming from heart disease, hypertension and diabetes — all conditions more prevalent among African American patients.

The risk of vascular damage also could be increased by a lack of access to health care and years of exposure to racism, as well as genetics, some experts say. And many patients could have a constellation of pathologies driven by other factors, they add.

Whatever the cause, experts say, the bottom line is the same: Patients who do not have excessive amounts of the sticky brain protein should not be treated with the amyloid-targeting drugs because the therapies are unlikely to work and pose substantial risks, including potentially deadly bleeding in the brain.

But that raises the specter of another disparity. If it turns out that a lower proportion of Black dementia patients and other people of color have excess amyloid, they could be left behind as the drug industry races to develop amyloid-reducing treatments. To counter that, experts are urging companies to accelerate work addressingother potential drivers of cognitive decline and to develop combination drugs with multiple targets.

“If we are just targeting amyloid, we can just miss a large potential population that might benefit from treatment,” said Lisa L. Barnes, a neuropsychologist at Rush University in Chicago.

‘A brain is a brain’

For now, the question remains: What should Black patients and their doctors think about the anti-amyloid drugs?

The answer, experts say, depends largely on the level of amyloid in their brains.

More than a year ago, Williford was diagnosed with early Alzheimer’s by David C. Weisman, a neurologist at Abington Neurological Associates, a large practice north of Philadelphia that treats patients and conducts clinical trials for drug companies. The clinic was one of the test sites for Leqembi.

After Leqembi receivedfull FDA approval last summer, Williford underwent tests to determine whether he was a good candidate for the drug. One test — a lumbar puncture, sometimes called a spinal tap — showed elevated amyloid in his brain. That means Williford and similar patients are likely to benefit from an anti-amyloid medication regardless of their race or ethnicity, Weisman and several other experts said.

“A brain is a brain is a brain, whether it is Asian, Hispanic, African American or White,” Weisman said. “A patient is either a good fit or a bad fit, and Robert is a good fit.”

Williford, who spent years working with troubled families in Philadelphia, began having memory problems a few years ago, said his wife, Cynthia Byron-Williford, 59.

“You could tell him almost anything, and he would almost immediately forget,” she said. “If I asked him to make a peanut butter sandwich for our grandson, he would come back three times and say, ‘What am I supposed to do?’”

With few treatment options, many physicians say they will offer anti-amyloid therapy to any patient who has elevated levels of the substance and passes safety tests.

Barry W. Rovner, a neurology professor at Thomas Jefferson University in Philadelphia, said he would not hesitate to offer Leqembi to African American patients who tested positive for amyloid. But, he added, because of the low numbers of Black individuals in the Leqembi trial, “I would say, ‘Look, this has not been tried in many Black people, so we don’t know precisely how it is going to work. But you don’t know precisely how it will work in any person.’”

From a research perspective, “You could say, as a group we don’t know if Black individuals respond the same way to anti-amyloid drugs because we don’t have the data,” Washington University’s Schindler said. “But on an individual level, it is different. If I had a Black patient who was amyloid-positive, I would start him on these drugs.”

But some Black patients might not be comfortable with the medication.

Zaldy S. Tan, director of the memory disorders center at Cedars-Sinai Medical Center in Los Angeles, said when African American patients are informed about the risks and benefits of Leqembi, and about the sparse data available for Black individuals, some will “take a pause and question whether they are willing to accept the uncertainty” and challenges of receiving the every-other-week infusion and multiple follow-up tests.

A promise of diversity

The best way to know for sure how drugs for Alzheimer’s — and other diseases — affect different populations is to have more diversity in trials, experts agree. But research participation by Black Americans and other people of color has been held down for years for several reasons.

The 20th century’s infamous Tuskegee syphilis study created long-standing mistrust about trials within the African American community. Men were left untreated to suffer and die even after an effective treatment emerged for the bacterium.

Alzheimer’s research, meanwhile, has long been centered in memory clinics at elite academic institutions, which tend to attract well-heeled patients with health insurance and other resources. The clinics have served as effective recruiting grounds for trials that end up with a predominantly White enrollment.

“We have done a poor job of making African American Alzheimer’s research inclusive,” said John Morris, a neurologist at Washington University in St. Louis. More than two decades ago, he created an African American advisory board at the school’s Knight Alzheimer Disease Research Center after realizing only 3 percent of trial participants were Black.

Others also are redoubling efforts to increase diversity. John Dwyer, president of the Global Alzheimer’s Platform Foundation, a nonprofit that runs trials, said the organization has sharply increased participation by people of color by sending dedicated teams of African American and Latino professionals into communities to build relationships with physicians and personnel at health centers, senior centers and places of worship. They stress to the communities how much they can benefit from the studies, he said.

Stephanie Monroe, vice president and senior adviser of health equity and access at the advocacy group UsAgainstAlzheimer’s, noted that low Black enrollment is not limited to Alzheimer’s trials. If all the drugs that have not been tested on people of color were eliminated, the shelves of pharmacies would be nearly empty, she said.

“That doesn’t work when you are almost a 50-50 minority/majority population,” Monroe said.

The FDA has issued guidelines for industry designed to bolster diversity in studies, while the National Institute on Aging recently pledged toprioritize funding requests that are “appropriately inclusive.”

The low Black enrollment in studies is just the latest controversy involving the anti-amyloid drugs. For years, earlier versions of the drugs failed repeatedly in trials. By contrast, Leqembi, in an 18-month trial, showed unambiguous, if modest, benefits, slowing disease progression by about 27 percent, or roughlyfive months. The drug, administered every other week, carries a list price of $26,500 a year.

In July, Lilly reported that its anti-amyloid drug, donanemab, was even more effective at removing amyloid. But like Leqembi, it can cause serious side effects, including brain hemorrhages. Some doctors think the drugs will provide bigger benefits when taken for a longer period or earlier in the disease, but others say the medications, which require repeated MRIs to check for side effects, leave much to be desired.

Both Eisai and Lilly said they are working hard to increase diversity in clinical trials. In the meantime, they said, patients with elevated amyloid should benefit from the anti-amyloid drugs, regardless of race or ethnicity.

“We have no pathophysiological reason to expect different efficacy between races and ethnicities for Alzheimer’s treatments that remove amyloid,”Lillysaid in a statement.

Eisai acknowledged that the Leqembi trial was not designed to test the drug in individual racial and ethnic subgroups. But it said in a statement that the totality of the evidence indicated that “all patients, regardless of ethnicity, benefited from treatment” with the drug.

“We and the U.S. FDA — as evidenced by the agency’s approval of Leqembi — believe that the benefits and risks in these patient populations and races has been established,” the company added. Eisai said volunteers who did not pass the amyloid threshold did not have Alzheimer’s and should be assessed for other conditions.

In an interview, Teresa Buracchio, acting director of the FDA’s Office of Neuroscience, said the agency “did not see a notable difference by race” in safety and effectiveness in the limited data available on subgroups in the Leqembi trial.

But other experts were skeptical, saying the number of Black patients in the Leqembi trial was too low to know whether the medication is safe and effective for African Americans. “Without having a representative population, it is impossible to assess,” said Barnes, of Rush University.Some researchers suggested that patients in underrepresented populations should wait for future advances in treatment.

‘We just want to get going’

On a recent day, nurse Christine Besso bustled in and out of Williford’s infusion room at the neurology clinic, taking his vital signs and inserting an IV line. “Let’s get this party started,” she said.

Byron-Williford, watching the process from a nearby couch, said she was not concerned about the low numbers of African Americans in the Leqembi trial.

“I think it will work or not work based on the individual,” she said, adding with a laugh, “and if it doesn’t work for him, it is because he is ornery.”

Byron-Williford said her husband’s health problems accelerated a few years ago after his son, who was in his early 20s, died unexpectedly. Williford became depressed and lost his appetite. Last summer, when he went to pick up his wife at a nearby hair salon, he drove around, lost. She later confiscated his car keys.

In the clinic, shortly after Williford’s infusion began, Weisman stopped in to check on him and discuss possible side effects. When Williford asked him how long he would be on the drug, Weisman shrugged, saying it depended on how he did on the drug and on test results.

“We are getting on an airplane, and we don’t even have a destination airport yet,” Weisman said. “We just want to get going.”

#Black Lives Matter #Alzheimers #Dementia #Black Lives #Black Health Matters #Black Medical Professionals #New Alzheimer’s drugs bring hope But not equally for all patients.#Mental Health Care

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aion-rsa · 3 years

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Memento and the Significance of Sammy Jankis

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“Have I told you about Sammy Jankis?”

On March 16, 2001, Christopher Nolan announced himself to the world with the US release of Memento. Not that everyone heard him straight away.

Despite garnering rave reviews on the festival circuit, Nolan’s mind-bending jigsaw puzzle of a movie failed to land a major distribution deal in the States. In the end Newmarket Films, the independent production company bankrolling the project, took the plunge and distributed it themselves.

Memento went on to earn more than $45 million at the US box office from a $4.5 million budget – a huge sum for an independent film.

Within five years, Nolan would move on to bigger and Bat-er things, but Memento remains among his most ambitious and effective films to date. A non-linear neo-noir that doubles up as a psychological thriller, it’s a film that continues to offer up subtle surprises on repeat viewing.

Guy Pearce takes centre stage with a mesmeric performance as Leonard, a man with short-term memory loss trying to track down his wife’s murderer. His pursuit is hampered by an inability to create new memories.

It’s a similarly disorientating experience for viewers who must piece together Leonard’s story while it plays out in reverse order. Allied to this is the story of Sammy Jankis, played by Stephen Tobolowsky, which intersperses that of Leonard’s and plays out across a series of black-and-white scenes shown in chronological order.

Narrated by Leonard, from an apparent recollection of a case he took during days as an insurance investigator, like our protagonist, Sammy also claims to be anterograde amnesiac – and that’s not all they have in common.

The film continues to alternate between the two narratives, with Leonard obsessively telling the tale of Sammy to anyone who will listen, before the two stories eventually converge in a climax where their shared plight becomes painfully apparent.

Despite its modest budget, Memento boasted an impressive cast. Pearce had shot to mainstream fame with LA Confidential a few years earlier while Joe Pantoliano, who played Leonard’s helper/fixer Teddy, was an established figure in the business along with his co-star from The Matrix, Carrie Anne Moss.

There was even a role for future Sons of Anarchy star and Nolan favourite Mark Boone Junior as the underhand manager of the motel where Leonard lives. Tobolowsky more than held his own though.

A seasoned character actor, by the time Memento came around he had enjoyed a memorable turn in Groundhog Day as the hilariously grating insurance agent Ned Ryerson. But it hadn’t been without its drawbacks in the years that followed.

Tobolowsky explained to Den of Geek: “The good news and bad news of being Ned in Groundhog Day is, guess what? You’re going to be Ned in Groundhog Day for the rest of your career. A lot of times when people are in comedic roles and want to do something more dramatic, it’s not available to them. Especially with something like Groundhog Day. An actor like me could get an opportunity to be in a drama but it might not work out because the audience would still see Ned Ryerson. Not this role. Sammy Jankis was so remarkably different.”

Landing the role of Jankis proved remarkably different too, starting with Nolan’s script, based on a short story written by his brother Jonathan called Memento Mori.

“My agent called me up and said John Papsidera, a casting director, wanted me to take a look at this script. John had a reputation for doing really unusual and generally good movies so I was very happy to. A standard first draft script is usually around 120 pages before a producer or director gets their hands on it. Because of the way it is formatted, one page should equal around one minute of screen time. I got the screenplay for Memento and it was like the Old and New Testament combined. I had never seen a script so big. I don’t remember the exact page numbers but it was in the 300s.”

Having seen his fair share of scripts over the years, Tobolowksy was apprehensive about reading what looked like the equivalent of “Gone with the Wind times ten.”

“I was thinking to myself ‘Oh God, this is going to be terrible. ’I even said to my wife, ‘ I know it’s going to be awful. It’s three times longer than normal but I’m going to read it just to be a good sport.’ I start reading and I’m halfway through and my wife comes in and I’m saying ‘damn it, damn it’ and she says ‘Terrible?’ and I say ‘No, so far really great but there’s no way these writers can continue at this level. It’s going to crap out by the end.”

“I get to the end and I throw the script across the room and my wife hears me, comes in, and says ‘Terrible?’ and I say ‘No, quite possibly the best script I’ve ever read.’” Nolan’s script was unlike any Tobolowsky had read, bringing the filmmaker’s vision for the movie to life in stunning detail.

“Chris and Jonathan wrote it in a way where they describe exactly what the camera is doing. Everything was perfectly described and you got a picture of the movie in your head, backwards and forwards in time. It was mind-blowing. I called up my agent immediately and said I had to meet Chris Nolan. I had to talk to him about Sammy Jankis.”

Despite few lines, the role of Sammy was a significant one. A part that much of the film’s plot ultimately rested on. Determined to make the role his own and shake off the ghost of Ned, Tobolowsky met with Nolan knowing he had a unique selling point when it came to the role.

“I said ‘Chris, I didn’t come here to read for you. There’s nothing really for me to read, but this is what I want to tell you: this is quite possibly one of the best screenplays ever written. You are going to have actors all over this city that will want to be in this. However, I am going to be the only person that wants to be Sammy Jankis who has actually had amnesia.’

Chris said: ‘You’ve had amnesia?’ and I was like ‘Yes, and this is how it happened…’”

Tobolowsky explained that during surgery for a kidney stone, doctors had used an experimental drug in place of the standard anesthesia.

“I’m a big guy, like six foot three and 210 pounds, so they gave me a new drug that they had been using on bigger people. It means they are able to give instructions to the patient like to get up on the operating table, rather than have orderlies lifting them. The patient performs the task and then forgets it had happened. It worked the same with the pain.”

It led to what he describes as “drug induced amnesia” as the medication worked its way through his system. “I would be in my living room and then boom! It was like I was just born. The worst was when I was standing over the toilet and suddenly didn’t know if I was about to pee or if I had already peed. Fortunately, I heard my wife yell ‘you finished ten minutes ago!’”

The description of his ordeal was enough to convince Nolan he was the man for the job – but that was only the start of the challenge for Tobolowsky.

“It was the most difficult part I have ever played in my life. When you are an actor, the thing that moves you through a scene is your motivation. But when your character can’t remember anything, you don’t have that.”

In order to better portray Sammy’s damaged mind, he began by breaking down the character’s actions into behaviors marked as either old or new.

“There are the old, every day, behaviors we don’t think about like making breakfast. The rote nature of that behavior means you might do it quickly, almost mechanically. Then there is the newer stuff that takes longer because you are trying to understand what you are doing for the first time.

“I had met people who have lost their memory, through Alzheimer’s or an accident, and noticed how these old behaviors were still familiar to them.”

This attention to detail was not lost on audiences.

In one small but memorable moment, Sammy greets Leonard at the door of his home with a look Leonard initially believes to be recognition and proof he is faking his condition.

It’s only later, when Leonard begins to understand his own plight, that Nolan has us revisit that same look, only this time with the realisation Sammy’s expression is instead one of desperate hope with that complex duality perfectly conveyed by Tobolowsky.

“That look was about putting out a message saying ‘I am sorry I may know you, so I don’t want to embarrass myself or you by acting like I don’t know you,’” Tobolowsky explains.

Later, after Leonard has rejected Sammy’s insurance claim, his wife, played by Frasier star Harriet Sansom Harris, decides to test the theory for herself by having him administer shot after shot of insulin, in the hope he will realise his mistake before she suffers a fatal overdose.

It’s then that we see Tobolowsky channeling the mechanical, emotionless actions of old, going through the motions of giving his wife the shot, as he has always done, oblivious to the tragic implications for both characters.

But Sammy is oblivious, with Tobolowsky’s emotionless, robotic approach to the repeated injections – something he has done for years – adding a layer of tragedy simultaneously to both characters.

“We all worked it out together in the moment. You let the truth emerge from the scene in the moment the camera is running.”

However, the true significance of Sammy in the wider story of Leonard only fully emerges later in the film after the latter’s revelatory encounter with Teddy.

It’s Teddy who reveals that he has been using Leonard to kill criminal associates. He claims to have tracked down the real “John G” behind the murder of Leonard’s wife years ago and, most tellingly, that Sammy’s story is actually Leonard’s, created to absolve himself of guilt.

Which begs the question: Are Sammy and Leonard simply one and the same person? And, if so, did Leonard kill his wife by accident?

While some degree of ambiguity remains, Tobolowsky says such notions played into Nolan’s decision to include a blink-and-you’ll-miss-it moment where Sammy, holed up in an old folk’s home, is for a brief flash, replaced by Leonard.

“Chris played with the idea on set. He said he had an idea for a moment where he would replace me with Guy. He wanted to try that out. That was determined while filming, the idea of the switch, which cements the idea of the two characters being one and the same.

“Chris was mining the depths of his script in the moment, which takes nerve as an artist. “

Reflecting on the experience, Tobolowsky only has positive memories of his experience on Memento, and the commitment shown by Pearce – particularly when it came to the tattoos that serve as reminders to Leonard of his past and forgotten present.

“Guy Pearce was just magnificent,” he says. “Every day, he would be in the chair getting those tattoos put on or removed. There would be long make-up breaks to get them adjusted perfectly and Chris would have it so that we would be shooting while Guy was in the makeup trailer.”

“Chris was a fabulous director to work with. Full of good humour and insight. The entire shoot was filled with energy and fun and that came from the top. I knew right away I was working with somebody very special. Chris takes chances.”

Tobolowsky holds his experience on Memento in the highest regard.

“When you do a lot of shows and movies, the idea is not how many you can squeeze in, it’s about which ones mattered to you. The work you did that affected you as a person and an artist. Something like Memento is profoundly affecting with the questions it asks.

“What haunts me about Sammy Jankis was that idea that if you cannot remember what you do, both your sins and your blessings, what kind of hell are you in? That final scene where Sammy is the old folk’s home, there is this question: Is he at peace? If you don’t know what is happening to you, what is your life? And what happens to Leonard?

He also credits the film with changing his career for the better.

“After I did Memento, I was considered for all sorts of roles that I wouldn’t have been before. It broke the Groundhog Day mold and showed what I was capable of.

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“There have been so many movies I have been in. Some terrible, some mediocre and a few classics. It always comes down to the script and director. Memento is one of the good ones. It’s a masterpiece. There’s nothing quite like it.”

The post Memento and the Significance of Sammy Jankis appeared first on Den of Geek.

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dinafbrownil · 4 years

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Must-Reads Of The Week From Brianna Labuskes

The Friday Breeze

Newsletter editor Brianna Labuskes, who reads everything on health care to compile our daily Morning Briefing, offers the best and most provocative stories for the weekend.

Happy Friday! And Happy Valentine’s Day, where we at KHN have compiled some of the best #HealthPolicyValentines from Twitter (this seems the right group for that level of wonkiness!). Check out some great ones, like this from Laura Marston:

“One vial a week Keeps me alive Used to cost $20 Now it’s $275.”

Now on to equally fun things, like budgets!

President Donald Trump released his proposed budget this week with only the vaguest of a health care plan mentioned. A mystery pot of $844 billion signaled deep cuts to Medicaid and subsidies under the health law. In particular, an obscure passage referred to “ending the financial bias that currently favors able-bodied working-age adults over the truly vulnerable.” Critics were scratching their heads how the released budget aligned with Trump’s promise to protect people’s coverage. “You can’t cut $1 trillion from these programs and protect the most vulnerable,” said Aviva Aron-Dine of the Center on Budget and Policy Priorities.

The Friday Breeze

Want a roundup of the must-read stories this week chosen by KHN Newsletter Editor Brianna Labuskes? Sign up for The Friday Breeze today.

Please confirm your email address below:

The Associated Press: Mystery $844B Pot in Trump Budget Signals Medicaid Cuts

The budget also calls for an almost 16% cut to the CDC (yes, the agency handling the coronavirus outbreak). But top officials say that’s because the administration wants the CDC to narrow its focus to its core mission of preventing and controlling infectious diseases and handling public health crises.

The Washington Post: Trump Budget Cuts Funding for Health, Science, Environment Agencies

Trump also wants to cut the budget for the National Institutes of Health by 6.5%. (Yes, that would affect the National Institute of Allergy and Infectious Diseases, which is working on a vaccine for the coronavirus.)

The Wall Street Journal: Trump Proposes $4.8 Trillion Budget, With Cuts to Safety Nets

Another odd little nugget in the budget: Trump wants to strip the FDA of its authority over tobacco products and create an agency within HHS solely for that purpose.

Stat: Trump Doesn’t Want the FDA to Regulate Tobacco

For a full breakdown of the budget’s details, check out our roundup here.

This week, the coronavirus strain got an official name, which is — drum roll, please —COVID-19. Although the announcement probably set off celebrations among scientists and researchers who have been driven up a wall because everyone has been simply calling it “coronavirus,” I am here to report that a day into its official designation 95% of headlines are stilling using only the generic term.

— It is, however, important to note that WHO officials were careful not to name the disease after a particular region or people so as to avoid further stigmatization surrounding any outbreaks.

Time: What’s in a Name? Why WHO’s Formal Name for the New Coronavirus Disease Matters

— As the death toll climbs in China, officials have expanded their “wartime” campaign to round up all the people who may be infected. But, as you can imagine, that is not going perfectly. Not only is it stoking tensions among an angry and scared nation whose residents aren’t happy with how the government is handling the crisis, but also it’s thrusting people who haven’t even tested positive for the virus into situations where they become vulnerable to infection.

The New York Times: China Expands Chaotic Dragnet in Coronavirus Crackdown

— Readers of The Friday Breeze know I’ve been harping on the fact that our national attention has been focused on COVID-19 even though we have only 15 (non-fatal) confirmed cases of it here and the common flu is far more deadly to us. Well, there’s a psychological basis for why we tend to panic over things that statistically are unlikely to affect us. Pretty much we can be terrible at accurately assessing risk.

The New York Times: Coronavirus ‘Hits All the Hot Buttons’ for How We Misjudge Risk

— It was a bit of a roller-coaster week with data coming out of China. At first, it seemed the cases were slowing down, but then the diagnostic criteria were tweaked, and all of a sudden we had nearly 15,000 cases added in one night.

The New York Times: Coronavirus Cases Seemed to Be Leveling Off. Not Anymore.

— CDC Director Robert Redfield said that the United States is essentially trying to buy time with its containment strategy, but it is quite likely there will eventually be person-to-person transmission of the virus here. (Which means people other than evacuees from Wuhan will start getting it.)

Stat: CDC Director: More Person-To-Person Coronavirus Infections in U.S. Likely

— And you can see how easily that could happen, given a U.S. evacuee was mistakenly released from the hospital even though she was infected with the coronavirus.

CNN: First US Evacuee Infected With Coronavirus Was Mistakenly Released From Hospital

— In an update from the cruise from h-e-double-hockey-sticks: Tensions continue to rise along with COVID-19 cases among the passengers and crew of a ship quarantined off the coast of Japan. As one health official said this week: Remember, quarantines are to keep those outside of its boundaries safe, not those within.

The New York Times: Quarantined Cruise Passengers Have Many Questions. Japan Has Few Answers.

— WHO has been heaping praise on China for its response to the crisis. And while other experts acknowledge the organization is in the tenuous position of not wanting to anger China enough that they break off relations, critics say the excessive compliments are setting a bad precedent about what a good pandemic response looks like.

The Wall Street Journal: The World Health Organization Draws Flak for Coronavirus Response

— Meanwhile, the coronavirus research filed is quite small. That’s because, despite the buzz these kinds of outbreaks create, eventually the world’s attention will be caught by a different shiny object and both the funding and interest in researching the virus will fade.

Stat: Fluctuating Funding and Flagging Interest Hurt Coronavirus Research

Supporters of Sen. Bernie Sanders (I-Vt.) got their wrists slapped by a powerful Nevada union this week for “viciously attacking” members and their families online. At the heart of the matter: The union had released information critical of Sanders’ “Medicare for All” plan. The clash put Sanders — who denounced any harassment as “unacceptable” — in an awkward spot just before the Nevada caucuses next week.

Politico: Nevada Culinary Union Lays Into Sanders Supporters After Health Care Backlash

A new survey found that even when patients plan ahead, many are still hit with surprise medical bills, especially if they receive anesthesia during a procedure. With health care spending rising again (driven by high costs like the out-of-pocket price tag for an emergency room visit), the report is a reminder that the issue is likely to be top of mind with voters come November.

Meanwhile, lawmakers well aware of that fact are moving forward with legislation that would favor an arbitration method for dealing with the surprise costs. This strategy is favored by hospitals and providers, and not embraced by insurers.

Reuters: Surprise Surgery Bills Happen Even When Patients Plan Ahead

Modern Healthcare: House Committee Advances Provider-Friendly Surprise Billing Fix

In a little bit of breaking news, a federal appellate court just shut down CMS’ approval of Arkansas’ Medicaid work requirement. The panel upheld a lower-court ruling that found the requirements arbitrary and capricious.

Modern Healthcare: D.C. Circuit Nixes Arkansas Medicaid Work Requirement

Juul has vowed time and again that it hasn’t marketed its products to teenagers. But new revelations from a Massachusetts lawsuit that the vaping company bought ads on Nickelodeon and the Cartoon Network are challenging those promises.

The New York Times: Juul Bought Ads Appearing on Cartoon Network and Other Youth Sites, Suit Claims

The VA is no stranger to controversy, but the latest bout comes at a bad time for the agency. The abrupt firing of the agency’s well-liked undersecretary in combination with allegations that VA Secretary Robert Wilkie sought to dig up dirt on a woman after she said she was sexually assaulted at a VA facility have shaken the agency just as it is preparing to launch an ambitious health plan.

The New York Times: Veterans Affairs, a Trump Signature Issue, Is Facing Turmoil Again

Meanwhile, Trump continued to downplay brain injuries sustained by troops from an Iran missile strike even as the number of cases jumped past 100.

The New York Times: More Than 100 Troops Have Brain Injuries From Iran Missile Strike, Pentagon Says

In the miscellaneous file for the week:

— It’s notoriously hard to get any gun measures passed … except these advocates seem to be having some success. Their strategy? Go hyper-local.

NBC News: How Moms Are Quietly Passing Gun Safety Policy Through School Boards

— What’s going on with the Equal Rights Amendment and why has it become a fight over abortion? Politico takes a deep dive into its history about how the battle around the amendment has shifted in the nearly 40 years since it was introduced.

Politico: How the Debate Over the ERA Became a Fight Over Abortion

— New parents eager to better balance family and work life in the only industrialized country in the world without a paid family leave policy have started bringing their babies to their offices.

Stateline: You Can Bring Your Baby to Work (But Wouldn’t You Rather Be at Home?)

— In another crushing disappointment, an Alzheimer’s drug that had sparked high hopes was the latest to fail to live up to expectations.

The Associated Press: Drugs Fail to Slow Decline in Inherited Alzheimer’s Disease

That’s it from me. And remember, if you ever feel like flexing your poetic muscles outside of Valentine’s Day, we accept haiku submissions year-round. Have a great weekend!

from Updates By Dina https://khn.org/news/friday-breeze-health-care-policy-must-reads-of-the-week-from-brianna-labuskes-february-14-2020/

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gordonwilliamsweb · 4 years