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(04/14/17 4:34am)
At times, writing about the American healthcare system can feel a bit like pulling the fire alarm in a burning building. Many still cling to notions of American exceptionalism—unwavering in their belief that the American healthcare system in the best is the world. As such, I often feel like my writing is an attempt to dispel these illusions with a firm dose of reality. Simply put, the cost of care in our nation is a terrible burden to the individual and the collective nation. And, simply put, our health outcomes increasingly lag behind nations of similar wealth and technological advancement. Widespread awareness of this reality is critical to creating the sense of urgency necessary for meaningful change.
(03/31/17 5:01am)
Last week, Republican lawmakers pulled the American Health Care Act (AHCA), the bill they touted as the replacement for the Affordable Care Act (ACA), from consideration by the House. One of the primary concerns raised by opponents of the ACHA was access to healthcare—the Congressional Budget Office estimated that 24 million people would lose insurance coverage under the Republican plan. The fundamental issue that both the ACA and ACHA sought to address is the fact that without government or employer assistance, the cost of medical insurance and medical care is beyond the financial means of most Americans. Simply put, the cost of medical care, and thus medical insurance, is so expensive that most Americans are priced out of the market.
(03/10/17 7:06am)
When you think about the phrase “medical research” the image that probably enters your mind is a white-coated scientist, carefully pipetting chemicals, culturing cells or observing something under a microscope. For centuries, research in the basic sciences—chemistry, physics and biology—produced medicine’s most substantive advances. However, a shifting landscape of disease suggests that medicine will have to adopt discoveries from a broader array of disciplines, such as psychology and economics, if it is to effectively address the challenges of the future.
(02/24/17 5:52am)
One morning in prenatal clinic I was catching up with a patient early in her second trimester. The patient’s morning sickness had abated and she was excited about her pregnancy. We went over her medications—just a prenatal vitamin and a baby aspirin. She asked why the doctor had prescribed the aspirin and I explained that her doctor had started the medication because she had multiple moderate risk factors for preeclampsia, including obesity. The low-dose aspirin would significantly reduce the risk of preeclampsia, preterm birth and fetal growth restriction. She looked at me hurt, confused and a little angry before blurting out, “Are you calling me fat?”
(02/10/17 6:50am)
In 2007, President George W. Bush repeated one of the most frustrating misconceptions in American healthcare. “[P]eople have access to health care in America. After all, you just go to an emergency room.” This statement reflects a deeply flawed but pervasive notion that limited access to care through an emergency room is equivalent to meaningful access to healthcare.
(01/27/17 6:59am)
Throughout the 2016 election cycle, it seemed as though political factions could not even agree on objectively verifiable facts. As a medical student, the tone was reminiscent of another familiar debate where opposing sides disagree on the facts and emotions run high: vaccination. The consternation and debate over vaccines is not novel to the modern era. Cotton Mather, a proponent of smallpox inoculations in colonial Boston, had his house firebombed for his troubles. Recently, a large measles outbreak in California and subsequent legislation strengthening vaccine requirements thrust the topic into the national spotlight again.
(01/13/17 5:24pm)
New Year's Eve marked the end of a calendar year that, for me, was largely filled by my core clinical clerkships. For medical students, the first year of clinical rotations is a pivotal and transformative time—a transition from the tidy multiple-choice questions and lectures of first year to more nuanced complexity of the wards and clinics. It’s a time of excitement and of challenge.
(12/02/16 4:41pm)
This week, President-elect Trump released his choice for Health and Human Services secretary, Dr. Tom Price. Both Trump and Price favor “free market” healthcare reforms, such as expanding health savings accounts and creating individual tax credits for insurance. However, these “free market” policies fail to account for the ways in which the healthcare market is unique from any other market. Information asymmetry, a lack of cost and value transparency and the singular importance of the product mean that “free market” policies may not be an effective tools to drive change.
(11/18/16 2:50pm)
On Nov. 1, enrollment in state health insurance exchanges opened across the country. The exchanges are one of the most visible elements of the Affordable Care Act (also known as Obamacare), a sprawling law that ultimately reached 2,700 pages of print before its passage. Just seven days later, Donald Trump was elected president, with a promise to “completely repeal Obamacare.”
(11/04/16 2:10pm)
Fall is a season characterized by a change in colors. In nature, leaves fade from bright green to yellow, red and brown. In our shopping carts, everything from oven mitts to gourmet popcorn changes to a deep Pepto-Bismol pink for Breast Cancer Awareness Month. Despite the cheeriness of the pink items, in its current incarnation Breast Cancer Awareness Month is increasingly being co-opted by corporate interests at the expense of public health.
(10/21/16 7:06pm)
Sometimes referred to euphemistically as the “Silver Tsunami,” America’s population is rapidly aging. It is projected that the number of Americans over the age of 65 will double by 2060, growing to comprise nearly ¼ of the U.S. population. This demographic shift poses significant challenges, given the progression of chronic disease and disability that can accompany the aging process. While demographics may be shifting, the world that this aging population will inhabit is rapidly changing as well. Those who now find themselves in the over 65 population were born before the birth control pill was approved by the FDA, before the Internet was invented, and before the advent of commercial jet travel. Major technological shifts have shaped the lives, careers and health of these citizens. Well-designed technology, similarly, holds great promise as a tool for facilitating a healthier, safer and more independent life for these individuals as they age.
(10/07/16 8:29pm)
Two words are enough to infuriate a certain subset of the American public. These words are synonymous for the decline of America. These words are the epitome of why we don’t win anymore: “participation trophy.” To some, participation trophies represent the irrevocable erosion of the exceptionalism that has characterized our nation for generations. The idea that one should reward a child for participating in an athletic event regardless of that child's actual prowess, is simply sacrilege. However, I would argue that encouraging participation in athletics, rather than excellence, is the more important priority for our country.
(09/23/16 6:48am)
Several years ago I arrived at a large Georgian revival house just off the campus of a university. A party was in full swing. Music was blaring and a crush of people spilled onto the lawn—blue and red cups ubiquitous. Unfortunately, I wasn’t there to join the party, but to serve in my capacity as an EMT. We arrived to find a young man crumpled at the bottom of a short set of stairs. His skin was clammy, and he was barely responsive. Because his fall was unwitnessed, we strapped the patient to a rigid backboard to protect his spine. Each time the patient needed to vomit, my fellow EMT and I lifted and tilted the backboard, doing our best to direct the stream away from the patient’s airway. Under the unforgiving fluorescent lights, the back of the ambulance was filled with mixed scents of vomit, sweat, alcohol and the moans of the patient’s discomfort.
(09/09/16 1:17pm)
Antimicrobial products have a ubiquitous presence in American life. Chlorox wipes are available for your cart when you enter the grocery store. Tiny bottles of Purell are attached to key chains and tucked inside backpacks and purses, held tightly as talismans against the scourges of disease and illness. However, for years infectious disease experts have been warning that antimicrobial soaps have only served to exacerbate antibiotic resistance without inferring individual benefit. This week the FDA announced a plan to phase out the use of 19 antimicrobial chemicals in soaps. This ruling represents a move towards improved antibiotic stewardship, and also reflects a more nuanced understanding about the role of bacteria in health and disease.
(08/29/16 4:15pm)
Rates of unintended pregnancy are shockingly high in the United States. Of all pregnancies in the US, 50 percent are unintended. While many unintended pregnancies come to be desired, significant emotional, financial, and health concerns accompany an unplanned pregnancy. An unintended pregnancy is associated with an increased risk of late prenatal care, as well as fetal exposure to alcohol and tobacco. In the United States, the most common method of contraception is the oral contraceptive pill (OCP), used by 28 percent of women. American women must receive a prescription in order to obtain OCPs. This requirement creates an unnecessary barrier to access and does not protect patients. Removing the prescription requirement for OCPs would be safe, has global and national precedent, and would help to reduce the rate of unintended pregnancy.
(08/05/16 2:36pm)
This June, Pat McCrory, governor of North Carolina, signed a bill into law that allowed pharmacies across the state to provide naloxone, a drug that reverses an opioid overdose, to the public without a prescription. North Carolina is only the third state to pass such a law, following Maryland and Pennsylvania. This most recent law is part of a series of bills that North Carolina has enacted regarding harm reduction from opioid use. While harm reduction policies comprise only part of a comprehensive solution to substance abuse disorders, they represent a much needed change from the more punitive approaches of the past.
(06/27/16 7:16am)
The statistics are well known, and are the subject of public consternation by politicians and patients alike. The American health care system is the most expensive in the world, yet compared to their peers in other Organization for Economic Cooperation and Development (OECD) nations, Americans have poorer health outcomes including shorter life expectancy and greater prevalence of chronic conditions.
