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Friday, December 6, 2024

The Wizard....OZ

 

TV’s Dr. Oz Invested in Businesses Regulated by Agency Trump Wants Him To Lead

President-elect Donald Trump’s choice to run the sprawling government agency that administers Medicare, Medicaid, and the Affordable Care Act marketplace — celebrity doctor Mehmet Oz — recently held broad investments in health care, tech, and food companies that would pose significant conflicts of interest.

Oz’s holdings, some shared with family, included a stake in UnitedHealth Group worth as much as $600,000, as well as shares of pharmaceutical firms and tech companies with business in the healthcare sector, such as Amazon. Collectively, Oz’s investments total tens of millions of dollars, according to financial disclosures he filed during his failed 2022 run for a Pennsylvania U.S. Senate seat.

Trump said Tuesday he would nominate Oz as administrator of the Centers for Medicare & Medicaid Services. The agency’s scope is huge: CMS oversees coverage for more than 160 million Americans, nearly half the population. Medicare alone accounts for approximately $1 trillion in annual spending, with over 67 million enrollees.

UnitedHealth Group is one of the largest healthcare companies in the nation and arguably the most important business partner of CMS, through which it is the leading provider of commercial health plans available to Medicare beneficiaries.

UnitedHealth also offers managed-care plans under Medicaid, the joint state-federal program for low-income people, and sells plans on government-run marketplaces set up via the Affordable Care Act. Oz also had smaller stakes in CVS Health, which now includes the insurer Aetna, and in the insurer Cigna.

It’s not clear if Oz, a heart surgeon by training, still holds investments in healthcare companies, or if he would divest his shares or otherwise seek to mitigate conflicts of interest should he be confirmed by the Senate. Reached by phone on Wednesday, he said he was in a Zoom meeting and declined to comment. An assistant did not reply to an email message with detailed questions.

“It’s obvious that over the years he’s cultivated an interest in the pharmaceutical industry and the insurance industry,” said Peter Lurie, president of the Center for Science in the Public Interest, a watchdog group. “That raises a question of whether he can be trusted to act on behalf of the American people.” (The publisher of KFF Health News, David Rousseau, is on the CSPI board.)

Oz used his TikTok page on multiple occasions in November to praise Trump and Robert F. Kennedy Jr., including their efforts to take on the “illness-industrial complex,” and he slammed “so-called experts like the big medical societies” for dishing out what he called bad nutritional advice. Oz’s positions on health policy have been chameleonic; in 2010, he cut an ad urging Californians to sign up for insurance under President Barack Obama’s Affordable Care Act, telling viewers they had a “historic opportunity.”

Oz’s 2022 financial disclosures show that the television star invested a substantial part of his wealth in healthcare and food firms. Were he confirmed to run CMS, his job would involve interacting with giants of the industry that have contributed to his wealth.

Given the breadth of his investments, it would be difficult for Oz to recuse himself from matters affecting his assets, if he still holds them. “He could spend his time in a rocking chair” if that happened, Lurie said.

In the past, nominees for government positions with similar potential conflicts of interest have chosen to sell the assets or otherwise divest themselves. For instance, Treasury Secretary Janet Yellen and Attorney General Merrick Garland agreed to divest their holdings in relevant, publicly traded companies when they joined the Biden administration.

Trump, however, declined in his first term to relinquish control of his own companies and other assets while in office, and he isn’t expected to do so in his second term. He has not publicly indicated concern about his subordinates’ financial holdings.

CMS’ main job is to administer Medicare. About half of new enrollees now choose Medicare Advantage, in which commercial insurers provide their health coverage, instead of the traditional, government-run program, according to an analysis from KFF, a health information nonprofit that includes KFF Health News.

Proponents of Medicare Advantage say the private plans offer more compelling services than the government and better manage the costs of care. Critics note that Medicare Advantage plans have a long history of costing taxpayers more than the traditional program.

UnitedHealth, CVS, and Cigna are all substantial players in the Medicare Advantage market. It’s not always a good relationship with the government. The Department of Justice filed a 2017 complaint against UnitedHealth alleging the company used false information to inflate charges to the government. The case is ongoing.

Oz is an enthusiastic proponent of Medicare Advantage. In 2020, he proposed offering Medicare Advantage to all; during his Senate run, he offered a more general pledge to expand those plans. After Trump announced Oz’s nomination for CMS, Jeffrey Singer, a senior fellow at the libertarian-leaning Cato Institute, said he was “uncertain about Dr. Oz’s familiarity with health care financing and economics.”

Singer said Oz’s Medicare Advantage proposal could require large new taxes — perhaps a 20% payroll tax — to implement.

Oz has gotten a mixed reception from elsewhere in Washington. Pennsylvania Sen. John Fetterman, the Democrat who defeated Oz in 2022, signaled he’d potentially support his appointment to CMS. “If Dr. Oz is about protecting and preserving Medicare and Medicaid, I’m voting for the dude,” he said on the social platform X.

Oz’s investments in companies doing business with the federal government don’t end with big insurers. He and his family also hold hospital stocks, according to his 2022 disclosure, as well as a stake in Amazon worth as much as nearly $2.4 million. (Candidates for federal office are required to disclose a broad range of values for their holdings, not a specific figure.)

Amazon operates an internet pharmacy, and the company announced in June that its subscription service is available to Medicare enrollees. It also owns a primary care service, One Medical, that accepts Medicare and “select” Medicare Advantage plans.

Oz was also directly invested in several large pharmaceutical companies and, through investments in venture capital funds, indirectly invested in other biotech and vaccine firms. Big Pharma has been a frequent target of criticism and sometimes conspiracy theories from Trump and his allies. Kennedy, whom Trump has said he’ll nominate to be Health and Human Services secretary, is a longtime anti-vaccine activist.

During the Biden administration, Congress gave Medicare authority to negotiate with drug companies over their prices. CMS initially selected 10 drugs. Those drugs collectively accounted for $50.5 billion in spending between June 1, 2022, and May 31, 2023, under Medicare’s Part D prescription drug benefit.

At least four of those 10 medications are manufactured by companies in which Oz held stock, worth as much as about $50,000.

Oz may gain or lose financially from other Trump administration proposals.

For example, as of 2022, Oz held investments worth as much as $6 million in fertility treatment providers. To counter fears that politicians who oppose abortion would ban in vitro fertilization, Trump floated during his campaign making in vitro fertilization treatment free. It’s unclear whether the government would pay for the services.

In his TikTok videos from earlier in November, Oz echoed attacks on the food industry by Kennedy and other figures in his “Make America Healthy Again” movement. They blame processed foods and underregulation of the industry for the poor health of many Americans, concerns shared by many Democrats and more mainstream experts.

But in 2022, Oz owned stakes worth as much as $80,000 in Domino’s Pizza, Pepsi, and US Foods, as well as more substantial investments in other parts of the food chain, including cattle; Oz reported investments worth as much as $5.5 million in a farm and livestock, as well as a stake in a dairy-free milk startup. He was also indirectly invested in the restaurant chain Epic Burger.

One of his largest investments was in the Pennsylvania-based convenience store chain Wawa, which sells fast food and all manner of ultra-processed snacks. Oz and his wife reported a stake in the company, beloved by many Pennsylvanians, worth as much as $30 million.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News' free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons license.

Sunday, December 1, 2024

Medical Tourism


The task of seeking care in a foreign country has been simplified by JetPatient


Medical tourism refers to traveling to another country for medical care. This phenomenon has grown significantly over the years due to several factors:

Reasons for Medical Tourism

Cost Savings: Medical procedures can be significantly cheaper in certain countries, even after accounting for travel expenses.

Quality of Care: Many countries offer high-quality healthcare services, with well-trained doctors and modern facilities.

Availability of Treatments:
Some treatments may not be available or may have long waiting lists in a patient's home country.

Privacy and Confidentiality: 
Patients may seek procedures in other countries to maintain privacy regarding sensitive health issues.

Combining Treatment with Travel:
Many patients take the opportunity to explore a new country while receiving medical care.

Common Destinations


India: Known for cardiac surgery, orthopedic procedures, and alternative medicine like Ayurveda.
Thailand: Popular for cosmetic surgery and wellness retreats.
Mexico: Often chosen for dental work and weight loss surgeries.
Costa Rica: Renowned for dental and orthopedic procedures.
Types of Treatments Sought
Cosmetic Surgery
Dental Procedures
Fertility Treatments
Orthopedic Surgery
Cardiac Surgery
 

Research: Patients should thoroughly research hospitals and doctors.
Accreditation: Check if the facility is accredited by international standards (e.g., JCI).

Legal and Ethical Concerns: Understand the laws and regulations regarding medical practices in the destination country.

Post-operative Care: Consider how post-operative care will be managed after returning home.

Conclusion
Medical tourism can offer significant benefits, but it requires careful planning and consideration to ensure safety and success.

For more information, use JetPatient

Saturday, November 30, 2024

Wearable Blood Pressure Monitors



My first experience with a BP monitoring watch was the Omron model in the middle, which, despite its digital nature, remained quite bulky and uncomfortable for daily use. Moving on, we have the fourth device in the lineup, YHE's BP monitoring smartwatch which works quite well and is definitely a more comfortable choice than the Omron one.

The Apple Watch, unfortunately, nor does the Galaxy Watch do not have a built-in blood pressure (BP) monitor. While it can track heart rate, ECG, and other health metrics, measuring blood pressure typically requires an external device. Some third-party apps and accessories can sync with the Apple Watch to provide BP readings, but these require additional hardware. Always check the latest Apple product features, as they may have been updated since then.

The Apple Watch was the first consumer-targeted device to offer monitoring. However, it can transmit results to a provider.

Several continuous glucose monitors  (CGM) track, and graph and are connected to a smartphone app. These devices have a memory chip for analysis at a later date.

Next up is Aktiia's watch, (about the size of a fitbit) known for its comfort and user-friendly design. This device employs optical sensors and PPG technology to continuously track blood pressure levels throughout the day and night. The collected data is securely transmitted to a cloud server via the Aktiia App, where advanced algorithms analyze the optical data to estimate your blood pressure.


And last, but not least, another great option is Biobeat's chest-worn BP monitor. I particularly appreciated its portability and lack of discomfort. However, before using it, I had to take reference measurements with a traditional blood pressure monitor. Additionally, to ensure the device remains securely in place, you must refrain from exercising or showering for 24 hours after application.



I think this image shows just how well the evolution of BP monitoring aligns with the digital health paradigm shift in healthcare.

Have you tried any of these devices before?

Kevin Hall: What Should We Eat? - by Eric Topol



The effect of ultra-processed food vs unprocessed foods

A group in Brazil introduced this new way of classifying foods that completely ignores the nutrient composition and says what we should be doing is classifying foods based on the extent and purpose of processing foods. And so, they categorize these four different categories. In the fourth category of this so-called NOVA classification scheme (see graphic below), they identified something called ultra-processed foods. There's a long formal definition and it's evolved a little bit over the years and continues to evolve. But the basic idea is that these are foods that are manufactured by industries that contain a lot of purified ingredients made from relatively cheap agricultural commodity products that basically undergo a variety of processes and include additives and ingredients that are not typically found in home kitchens, but are typically exclusively in manufactured products to create the wide variety of mostly packaged goods that we see in our supermarkets.


There are considerable competing theories about obesity, including calories consumed and calories burned. as well as the balance of carbohydrates fats, and protein, fasting,  and ketogenic diets. It may be these categories may be complementary. It may be that polygenic features are at work. There are other factors to be ruled out in specific individuals such as genetic and hormonal effects.

The basic message is that we have lots of competing theories about what is driving obesity. There are a few things that we all agree on. One is that there is a genetic component. That adiposity in a given environment is somewhere between 40% to 70% heritable, so our genes play a huge role. It seems like certain genes can play a major role. Like if you have a mutation in leptin, for example, or the leptin receptor, then this can have a monogenic cause of obesity

Energy Balance Model








Kevin Hall: What Should We Eat? - by Eric Topol

Friday, November 29, 2024

How Often Patients Visit the Doctor


Gary M Levin M.D.

How often do people visit the doctor?

If a country’s average doctor visits are high, it could be easy to assume the population isn’t healthy. At the same time not going enough may seem like there’s an accessibility issue.  As with most sociological data, the devil is in the details. And differences in payment systems, insurance plans, and how healthcare is delivered all play a part in why going to the doctor is more common or not.  This chart tracks the number of in-person doctor visits per year by country. Data is sourced from the OECD, as of 2021, or the latest year available. Figures are rounded.


As with most sociological data, the devil is in the details. And differences in payment systems, insurance plans, and how healthcare is delivered all play a part in why going to the doctor is more common or not.
Let's compare the United States which has an average number of doctor visits per year (2-3) and So. Korea  (13-16)

Comments:

I happened to do one of my master's projects on South Korea’s healthcare system….they have one of the best, low-cost, high-access, low-mortality systems in the world, with a pharmacy attached to nearly every outpatient clinic. In the US, access is sparse for nearly all outpatient specialties and is on a trajectory to get even worse. All while we pay extraordinarily high rates for our health insurance and have deplorable numbers on our mortality rates despite the advanced technology that we boast over other nations. Sad.

Gatekeeping primary care (with well-trained professionals and adequately organized) is one of the best measures to improve health systems in terms of cost-efficiency, quality, person-centredness, and prevention …only 6% to 10% of people are referred to specialist care (and accordingly they can focus on the matters they’re trained for) and the rest can be better solved at primary care level: all supported by evidence 😊 and a key message for all institutions dealing with health systems improvement. 

Note: a well-trained family doctor is a specialist…in general medicine 😉

the future for health systems looks pretty grim. Many of the populist and autocratic-dominated governments don’t show much realistic plans for sustainable health systems.  The good news is, that we have a lot of knowledge, evidence, and practices on how to make better health and social care systems.   Strong leadership and executive power are desperately needed in most systems more than ever, but voters should understand this is something different than populist rhetoric ☺️…in this respect, also the academic community has something to answer for…

 Useful tips

The article from Visual Capitalist explores global variations in the frequency of doctor visits by country, based on OECD data. Key insights include:  South Korea leads with 16 annual doctor visits per person, thanks to its efficient healthcare system and national insurance that covers over 70% of costs.   Japan and Slovakia follow with 11 visits annually, while Germany and Hungary average 10.

Conversely, Americans have one of the lowest averages, just two visits annually, largely due to high co-payments and reliance on nurse practitioners and other medical staff. Variations are influenced by differences in healthcare systems, payment models, accessibility, and the roles of non-doctor healthcare professionals.

Countries like Sweden, Canada, and Finland also report lower visits due to reliance on nurse practitioners and similar professionals.  The analysis highlights the complexities in interpreting healthcare data and the evolving demand for medical professionals worldwide.

Editor's commentary

Wow, I had no idea I was such an overachiever when it comes to doctor visits! Maybe I should start a loyalty program. On a serious note, it's interesting to see how different countries approach healthcare.  

Thursday, November 28, 2024

The United Health Group Uses Integration of Ownership of Medical Clinics to its Advantage

 

The question is our minds is this a monopoly with an unfair advantage over other insurers.  Will others follow this model?  Anthem, Blue Cross, Humana 

Everything is awesome: Don't forget the Lego - PubMed


Today, I received a call about a child swallowing a soft earbud. I advised him, "This too shall pass," but be sure to wash it well before using it again.

Aim: Children frequently ingest coins (generally with minimal reported side effects); however, ingesting other items has been subject to less academic study. Parental concern regarding ingestion applies across a range of materials. In this study, we aimed to determine typical transit times for another commonly swallowed object: a Lego figurine head.

Methods: Six pediatric healthcare professionals were recruited to swallow a Lego head. Previous gastrointestinal surgery, inability to ingest foreign objects, and aversion to searching through fecal matter were all exclusion criteria. Pre-ingestion bowel habit was standardized by the Stool Hardness and Transit (SHAT) score. Participants ingested a Lego head, and the time taken for the object to be found in the participant's stool was recorded. The primary outcome was the Found and Retrieved Time (FART) score.

Results: The FART score averaged 1.71 days. There was some evidence that females may be more accomplished at searching through their stools than males, but this could not be statistically validated.

Conclusions: A toy object quickly passes through adult subjects with no complications. This will reassure parents, and the authors advocate that no parent should be expected to search through their child's feces to prove object retrieval.

Everything is awesome: Don't forget the Lego - PubMed

Tags

MeSH terms
Adult
Child
Child, Preschool
Deglutition
Feces*
Female
Foreign Bodies*
Humans
Male
Middle Aged

Wednesday, November 27, 2024

Ultra-processed foods: How they affect your health and how to identify them | Fortune Well

In an age where convenience often trumps nutritional value, a growing body of research is raising concerns about the health implications of eating ultra-processed foods. These foods undergo extensive industrial processing, resulting in products that are convenient, hyper-palatable, and potentially detrimental to long-term health.
While processing itself is not inherently negative (think pasteurized milk or extra virgin olive oil), the extent of processing and its impact on nutrient density are critical factors to consider. Ultra-processed foods, which are commonly defined under a classification known as NOVA, contain additives and undergo significant alterations from their natural state. They tend to be energy-dense, nutrient-poor, and often have long shelf lives.
It’s raising concerns about their role in diet-related health outcomes such as heart disease, diabetes, and obesity, as our busy lifestyles may push us to reach for easy, quick, or low-cost, rather than cooking and eating more unprocessed or minimally processed foods like fruits, vegetables, eggs, nuts, or seeds.

Consider the level of food processing, the overall nutrient density of foods, and your overall dietary patterns, Passerrello suggested. Packaged cookies and sodas are energy dense but lack the nutrients our bodies need. While they may provide some energy and calories, they’re not supplying vitamins or minerals. This may lead to nutrient deficiencies over time, as well as unintended weight gain, according to Passerrello, who is also an instructor at the University of Pittsburgh.

However, there’s a spectrum. “The way our bodies respond to the calories and nutrients varies, depending on our age, activity level, and overall dietary patterns,” she says.

While the NOVA classification system provides the most common framework for understanding the continuum of food processing, several other classification systems, including one from the International Food Information Council, or IFIC, use slightly different criteria to define ultra-processed and processed foods. Generally, however, these guidelines agree that highly processed foods contain high amounts of total and added sugars, fats, and/or salt, low amounts of dietary fiber, use industrial ingredients, whether derived from foods or created in labs, and typically contain little to no whole foods.

It’s easy to find these highly processed foods on supermarket shelves: 

  • mass-produced bread
  • carbonated drinks
  • breakfast cereals
  • ice cream

These are just some products that typically contain artificial


















Ultra-processed foods: How they affect your health and how to identify them | Fortune Well

Tuesday, November 26, 2024

Vaccine Mandate by Blue Cross ruled wrong by Courts

This week on a special TUESDAY episode of VSRF LIVE we host an extraordinary episode featuring Jonathan Marko, the Michigan attorney behind one of the most significant vaccine mandate cases in recent history, and Lisa Domski, the plaintiff awarded nearly $13MM in damages.

VSRF Live #154: Landmark Legal Victory!

Jonathan Marko will share the story behind his client Lisa Domski, a Catholic woman who was awarded nearly $13 million in damages after being fired by Blue Cross Blue Shield of Michigan for refusing the COVID-19 vaccine. This groundbreaking case has major implications for vaccine mandates, workplace discrimination, and religious freedom. Lisa, an IT specialist, was terminated despite working remotely and providing ample documentation of her sincerely held religious beliefs.

Hear firsthand from Marko about the legal battle, the broader implications of this verdict, and what lies ahead for others seeking justice. Also joining us for a quick check-in will be our NYC firefighter friends with an update on their own case battling the tyrannical vaccine mandates in their city.

Support the work of VSRF at https://VacSafety.org/donate

Donations are tax deductible and we need your support to continue our work into 2024. Or to text-to-donate, text LIBERTY to 53555


Sunday, November 24, 2024

RA RA OO LA LA

 

SUNDAY NONSENSE


Rapd Advances in Medical Diagnostics with LLMs

Eric Topol presented several rapid advances in analysis with LLMs.

Eric Topol, Executive Vice President, of Scripps Research, leads a conversation with

Alison Noble, Oxford University Technikos Professor of Biomedical Engineering, and Vice President & Foreign Secretary, The Royal Society

Fiona Marshall, President, Biomedical Research, Novartis

Pushmeet Kohli, Vice President of Science, Google DeepMind

Topol goes on with his introductory comments.

LLM is moving at a pace we've never seen. Just last week, Evo was published in Science. This Wednesday, the Human Cell Atlas Foundation Model will be published in Nature. We've had multiple human methylome models, published in the last couple of weeks at [? Bolts One ?] yesterday. It's just dizzying.

That's, of course, the kind of life science side, and of course, it's much broader as already introduced by James and Jennifer in terms of the biomedical applications.

The Human Cell Atlas from a cell census to a unified foundation model

Sequence modeling and design from molecular to genome-scale with Evo

The science of AI is having an immense effect on researchers just beginning to explore the possibilities. All of these experts realized the ethical considerations of having a machine make decisions about human beings.  

Some suggested LLMs be used in developing nations. where oftentimes access to healthcare is non-existent.  If this is coupled with telemedicine its potential could be unlimited.

1. Diagnosis and Treatment

Medical Imaging: AI algorithms analyze medical images (like X-rays, MRIs, and CT scans) to detect anomalies such as tumors or fractures more accurately and quickly than traditional methods.

Predictive Analytics: AI can predict disease outbreaks and patient outcomes by analyzing vast datasets, helping healthcare providers make informed decisions.

2. Personalized Medicine

Genomics: AI assists in analyzing genetic information to tailor treatments based on individual genetic profiles, improving effectiveness and reducing side effects.

Treatment Plans: By analyzing historical data, AI can suggest personalized treatment plans that are more likely to succeed for individual patients.

3. Operational Efficiency

Resource Management: AI optimizes hospital operations by predicting patient admissions, managing staff scheduling, and reducing wait times.

Supply Chain Optimization: AI helps manage inventory, ensuring that necessary medical supplies are available without overstocking.

4. Patient Engagement

Chatbots and Virtual Assistants: AI-powered tools provide patients with instant answers to their questions, schedule appointments, and offer medication reminders, improving patient engagement and satisfaction.

Telemedicine: AI enhances telehealth services by providing real-time data analysis and support during virtual consultations.

5. Drug Discovery and Development

Accelerated Drug Discovery: AI models analyze biological and chemical data to identify potential drug candidates more quickly than traditional methods.

Clinical Trials: AI helps identify suitable candidates for clinical trials, improving recruitment efficiency and trial outcomes.

6. Monitoring and Care Management

Wearable Devices: AI analyzes data from wearables to monitor patient health in real-time, alerting healthcare providers to potential issues before they become critical.

Chronic Disease Management: AI systems support patients with chronic diseases by providing ongoing monitoring and personalized health recommendations.

Challenges and Considerations

While the potential of AI in healthcare is significant, challenges remain, including:


Data Privacy: Ensuring patient data is secure and used ethically.

Bias and Fairness: Addressing biases in AI algorithms to ensure equitable healthcare for all populations.

Integration: Effectively integrating AI systems into existing healthcare workflows and technologies.

Overall, AI is poised to revolutionize healthcare by improving outcomes, enhancing efficiency, and enabling more personalized care.

Conclusion

The integration of AI in healthcare is a dynamic and rapidly evolving field. By enhancing diagnostic accuracy, personalizing treatment, and improving operational efficiencies, AI has the potential to significantly improve patient outcomes. However, addressing the challenges of data privacy, bias, and integration is essential to fully realize its benefits in healthcare.



A Rare, Fatal Skin Disease Has Been Cured in Patients For The First Time : ScienceAlert

Toxic Epidermolysis Necrotic

A rare and potentially fatal skin infection with nightmarish outcomes may soon have a cure.

The infection starts as a seemingly harmless rash, and before a person knows it, more than 30 percent of the skin on their body begins to blister and peel off in sheets, usually starting with the face and chest before progressing to the mouth, eyes, and genitals. 

Without treatment the TEN has a 60% mortality rate

Infections, organ failure, and pneumonia can soon follow. In a third of all cases, the condition proves fatal. For those who survive, recovery can take months and usually requires similar treatment to burn victims.

The debilitating infection is an immune response to medication, called toxic epidermal necrolysis (TEN). While it is thankfully scarce, impacting a million or two people worldwide every year, its onset is highly unpredictable.

TEN is linked with more than 200 medications, and it can impact all age groups and ethnicities, although it tends to be more common in females than males and is 100 times more prevalent in those with the human immunodeficiency virus ( HIV).

The infection starts as a seemingly harmless rash, and before a person knows it, more than 30 percent of the skin on their body begins to blister and peel off in sheets, usually starting with the face and chest before progressing to the mouth, eyes, and genitals.

Infections, organ failure, and pneumonia can soon follow. In a third of all cases, the condition proves fatal. For those who survive, recovery can take months and usually requires similar treatment to burn victims.

The debilitating infection is an immune response to medication, called toxic epidermal necrolysis (TEN). While it is thankfully sporadic, impacting a million or two people worldwide every year, its onset is highly unpredictable.

TEN is linked with more than 200 medications, and it can impact all age groups and ethnicities, although it tends to be more common in females than males and is 100 times more prevalent in those with the human immunodeficiency virus ( HIV).

An international team of researchers, led by biochemists at the Max Planck Institute in Germany, now claim to have cured seven patients with TEN or a slightly less severe version of the infection, known as Stevens-Johnson syndrome (SJS). None of the patients reported side effects.


Key steps of the JAK-STAT pathway. JAK-STAT signaling is made of three major proteins: cell-surface receptors, Janus kinases (JAKs), and signal transducer and activator of transcription proteins (STATs). Once a ligand (red triangle) binds to the receptor, JAKs add phosphates (red circles) to the receptor. Two STAT proteins then bind to the phosphates, and then the STATs are phosphorylated by JAKs to form a dimer. The dimer enters the nucleus, binds to DNA, and causes transcription of target genes. The JAK-STAT system consists of three main components: (1) a receptor (green), which penetrates the cell membrane; (2) Janus kinase (JAK) (yellow), which is bound to the receptor, and; (3) a Signal Transducer and Activator of Transcription (STAT) (blue), which carries the signal into the nucleus and DNA. The red dots are phosphates. After the cytokine binds to the receptor, JAK adds a phosphate to (phosphorylates) the receptor. This attracts the STAT proteins, which are also phosphorylated and bind to each other, forming a pair (dimer). The dimer moves into the nucleus, binds to the DNA, and causes the transcription of genes. Enzymes that add phosphate groups are called protein kinases.[5]

The class of drugs, called JAK inhibitors (JAKi), seem to work by suppressing an overactive immune pathway.  Altogether, they identified six proteins involved in the JAK/STAT pathway that are upregulated in those with the skin infection.

The JAK/STAT pathway is the main driver of skin inflammation, damaged skin cells, and epidermal detachment.


Saturday, November 23, 2024

Inside UnitedHealth’s Playbook for Limiting Mental Health Coverage — ProPublica

Inside UnitedHealth’s Playbook for Limiting Mental Health Coverage — ProPublica



Testimony by Carter J Carter who became a therapist to help young people.
Rosemarie Marmor wanted to support victims of emotional trauma.
Kendra F. Dunlap wanted to serve people of color.

To understand the forces that drive even the most well-intentioned therapists from insurance networks, ProPublica plunged into a problem most often explored in statistics and one-off perspectives. Reporters spoke to hundreds of providers in nearly all 50 states, from rural communities to big cities.

The interviews underscore how the nation’s insurers — quietly, and with minimal pushback from lawmakers and regulators — have assumed an outsize role in mental health care.

It is often the insurers, not the therapists, that determine who can get treatment, what kind they can get, and for how long. More than a dozen therapists said insurers urged them to reduce care when their patients were on the brink of harm, including suicide.

All the while, providers struggled to stay in business as insurers withheld reimbursements that sometimes came months late. Some spent hours a week chasing down the meager payments, listening to music and sending faxes into the abyss.

Several insurers told ProPublica that they are committed to ensuring access to mental health providers, emphasizing that their plans are in compliance with state and federal laws. Insurers also said they have practices in place to make sure reimbursement rates reflect market value and to support and retain providers, for which they continually recruit.

Therapists have tried to stick it out.
They have forgone denied payments.
They have taken second jobs.
They have sought therapy for their own support.
But the hundreds who spoke with ProPublica said they each faced a moment in which they decided they had to leave the network.

Why I left the network

Health Care
What Mental Health Care Protections Exist in Your State?
Insurers have wide latitude on when and how they can deny mental health care. We looked at the laws in all 50 states and found that some are charting new paths to secure mental health care access.
by Annie Waldman and Maya Miller
Co-published with NPR News
Aug. 27, 7 a.m. EDT

 Series: America’s Mental Barrier: How Insurers Interfere With Mental Health Care
 
Accessing mental health care can be a harrowing ordeal. Even if a patient finds a therapist in their network, their insurance company can overrule that therapist and decide the prescribed treatment isn’t medically necessary.

This kind of interference is driving mental health professionals to flee networks, which makes treatment hard to find and puts patients in harm’s way.

ProPublica sought to understand what legal protections patients have against insurers impeding their mental health care.

Most Americans — more than 164 million of them — have insurance plans through employers. These are generally regulated by federal law.

Although the law requires insurers to offer the same access to mental health care as to physical care, it doesn’t require them to rely on evidence-based guidelines or those endorsed by professional societies in determining medical necessity. Instead, when deciding what to pay for, the government allows insurers to set their own standards.

“If insurers are allowed to home bake their own medical necessity standards, you can pretty much bet that they’re going to be infected by financial conflicts of interest,” said California psychotherapist and attorney Meiram Bendat, who specializes in protecting access to mental health treatment.

Federal lawmakers who want to boost patient protections could look to their counterparts in states who are pioneering stronger laws.

Although these state laws govern only plans under state jurisdiction, such as individual or small-group policies purchased through state marketplaces, experts told ProPublica they could, when enforced, serve as a model for broader legislation.

“States are laboratories for innovation,” said Lauren Finke, senior director of policy at The Kennedy Forum, a nonprofit that has advocated for state legislation that improves access to mental health care. “States can take it forward and use it for proof of concept, and then that can absolutely be reflected at the federal level.”

ProPublica reporters delved into the laws in all 50 states to determine how some are trying to chart new paths to secure mental health care access.

Many of the new protections are only just starting to be enforced, but ProPublica found that a few states have begun punishing companies for violations and forcing them into compliance.

Because of the Interference