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Friday, October 14, 2022

AMA asks the federal government to prosecute critics of radical gender medicine

 Last week, the American Medical Association, the Children’s Hospital Association, and the American Academy of Pediatrics sent a letter to U.S. attorney general Merrick Garland requesting that the Department of Justice “take swift action to investigate and prosecute” “high-profile users on social media” who have allegedly created a “campaign of disinformation” against children’s hospitals that offer “gender-affirming health care,” leading to threats and harassment, including a bomb-threat hoax at Boston Children’s Hospital.

The letter poses three significant problems. First, the medical associations obscure the radical nature of so-called “gender-affirming care.” The basic facts, which have caused justifiable public outrage, are well-established: according to the medical literature, American doctors have been administering puberty blockers, hormone therapies, and experimental gender surgeries on minors—including double-mastectomies for girls, which involves surgically removing the breasts, and vaginoplasties for boys, which involves surgically removing the penis and turning the tissue into an artificial vagina. Despite what trans activists have insisted, the medical evidence to support these procedures for minors is thin, weak, and contested. Medical authorities in Europe have recently turned against many of these practices.

Second, the AMA, CHA, and AAP provide no evidence, or even a working definition, of “disinformation.” The “high-profile users on social media” would undoubtedly include those of us who have published investigative reporting on radical gender medicine at children’s hospitals, often using original source materials published by the hospitals themselves. Rather than grapple with the facts, however, left-wing activists and medical providers have dismissed them with accusations of “disinformation”—even when journalists have directly quoted their own words. This unsubstantiated accusation of “disinformation” is even more troubling because, in addition to asking the Justice Department for investigations on these vague and undefined grounds, the medical associations also asked technology companies to silence critics of “gender-affirming care” on social media platforms, an essential public forum.

Third, the call to “investigate and prosecute” journalists, activists, and citizens critical of radical gender medicine is wholly contrary to the principles of free speech; if the attorney general were to carry out this request, it would be a violation of the First Amendment and a blatant attempt to criminalize political opposition and intellectual debate. At their founding, these three medical associations embraced the idea that they should be nonpartisan, neutral, and driven by scientific evidence. But by issuing this reckless call to prosecute critics, they have revealed themselves to be hostile to open debate and free scientific inquiry. They are behaving like dangerous ideologues rather than custodians of the public trust.

Ultimately, Attorney General Garland will decide whether to heed the AMA letter’s recommendation and begin prosecuting critics of radical gender medicine. On the surface, it would seem like a fool’s errand: there is no legal basis for prosecuting journalists for engaging in public criticism on a controversial topic. But Garland’s Justice Department has a troubling history of using the power of law enforcement to intimidate political opponents. Last year, using a letter from the National School Boards Association as a pretext, he mobilized the FBI counterterrorism division against conservative parents who were protesting, at school board meetings, about critical race theory in the classroom.

Is Garland following the same playbook with the AMA? To answer that question, I am preparing a public-records request to discover whether the Department of Justice had prior knowledge of the AMA’s campaign to silence journalists, as it did with the National School Boards Association’s campaign to silence parents. Either way, the intention of this gambit is clear: the most powerful medical and political authorities in the nation would like to make experimental gender surgeries a forbidden topic of debate.

Critics of radical gender medicine should remember that we are the underdogs: the AMA has a $460 million annual budget, and the attorney general has the entire federal law enforcement apparatus at his disposal. Still, the only way forward is to hold fast against their malicious intimidation campaign. If they believe that puberty blockers, hormone treatments, and genital surgeries are the best treatments for gender dysphoric minors, let them defend those practices in public—not silence or jail critics.

The 10 states with the most concentrated PBM markets

Michigan has the highest-concentrated commercial drug market in the country, an analysis from the American Medical Association published Oct. 13 found. 

The study examined the market share pharmaceutical benefit management companies have on a state and city level. The analysis found 3 out of 4 states have highly concentrated PBM markets, and 4 out of 5 metropolitan areas had highly concentrated markets.

Here are the ten states where one PBM held the largest market shares:

1. Michigan

Express Scripts has 88 percent to 89 percent of commercial drug market

2. Alabama

PrimeTherapeutics has 86 percent of commercial drug market

3. South Carolina

OptumRx has 83 percent of commercial drug market

4. Delaware

Express Scripts has 78 percent of commercial drug market\

5. Vermont
Express Scripts has 76 percent to 77 percent of commercial drug market

6.Alaska (tied) 

Express Scripts has 75 percent of commercial drug market

6. West Virginia (tied) 

Express Scripts has 75 percent of commercial drug market

7. South Dakota

CVS/Caremark has between 73 percent and 74 percent of commercial drug market

8. Tennessee

Express Scripts has 73 percent of commercial drug market

9. Louisiana

Express Scripts has 71 percent of commercial drug market

 

https://www.beckerspayer.com/payer/the-10-states-with-the-most-concentrated-pbm-markets.html

https://www.beckerspayer.com/payer/the-10-states-with-the-most-concentrated-pbm-markets.html

Group pushes back on bill to rename Medicare Advantage plans

 The Better Medicare Alliance, a national Medicare Advantage research and advocacy group, said the healthcare choices of the 29 million Medicare Advantage beneficiaries "deserve respect and support in Washington," in response to two U.S. representatives' proposal to rename the plans using that phrasing. 

Reps. Mark Pocan and Ro Khanna's legislation would also prohibit private insurers from using "Medicare" in plan titles or advertisements and impose "significant fines for any insurer that engages in this deceptive practice." The pair allege Medicare Advantage plans "often leave patients without the benefits they need while overcharging the federal government for corporate profit." 

Better Medicare Alliance President and CEO Mary Beth Donahue said in an Oct. 14 statement shared with Becker's that Medicare Advantage plan beneficiaries give the program a 94 percent satisfaction rate and save nearly $2,000 per year compared to traditional fee-for-service Medicare. She also said that in 2021, more than 80 percent of U.S. representatives signed a letter declaring support for seniors' Medicare Advantage coverage.       

"It's not hard to see why: Medicare Advantage delivers lower per-beneficiary costs to the government and has even been recognized by the Biden administration’s CMS for its success in reducing health disparities for beneficiaries of color," Ms. Donahue said. "We look forward to our continued work with all members of Congress and the Biden administration to protect seniors and strengthen Medicare by building on the innovations, affordability and value found in Medicare Advantage today."

The lawmakers' proposed legislation comes after The New York Times reported Oct. 8 that federal audits show that eight of the 10 biggest Medicare Advantage insurers have submitted inflated bills. Better Medicare Alliance said the report "cherry-picks" allegations and paints an inaccurate and incomplete picture of the program. 

https://www.beckerspayer.com/payer/group-pushes-back-on-bill-to-rename-medicare-advantage-plans.html

Flu activity highest in Southern states

 The U.S. is seeing flu activity rise earlier than usual, with Southern states reporting the highest levels of activity, according to the CDC's latest FluView report for the week ending Oct. 8. 

Overall, activity remains low, "but increasing in most of the country," the CDC said. HHS region 4 (Kentucky, Tennessee, Mississippi, Alabama, Georgia, South Carolina, North Carolina, Florida) and region 6 (New Mexico, Texas, Oklahoma, Arkansas, Louisiana) are reporting the highest levels of flu activity. 

All data in the FluView report are preliminary and may change as more reports are received, the agency said. 

Seven more notes: 

1. The CDC's state-by-state map of flu activity had not been updated for the week ending Oct. 8, making it unclear what flu activity level individual states reported. However, the CDC's report indicates one jurisdiction reported very high flu activity, five reported high activity, three reported moderate activity, 14 reported low activity and remaining states reported minimal activity. 

2. For the week ending Oct. 8, 1,322 lab-confirmed flu patients were admitted to the hospital. That's up from 885 admitted the prior week. 

3. Three flu-associated pediatric deaths that occurred in February, April and May were reported to the CDC for the week ending Oct. 8. A total of 43 flu-related pediatric deaths have been reported during the 2021-22 flu season. 

4. Clinical laboratories tested 53,565 specimens for influenza for the week ending Oct. 8. Of those, 3.3 percent were positive, most of which for influenza A. The positivity rate was 2.2 percent for the week prior. 

5. The percentage of visits to an outpatient provider for influenza-like illness — meaning fever plus cough or sore throat, not lab-confirmed flu — was 2.6 percent for the week ending Oct. 8. This is above the national baseline of 2.5 percent. 

6. Nationwide, 0.3 percent of 14,331 long-term care facilities reported at least one flu-positive test among residents for the week ending Oct. 8. 

7. The national flu, pneumonia and/or COVID-19 mortality rate is 8.7 percent, which sits above the epidemic threshold of 5.8 percent for the week. Among the 1,928 deaths reported for the week, 898 had COVID-19 and nine had the flu listed as an underlying or contributing cause of death. This indicates the current death rate for pneumonia, influenza and COVID-19 is primarily due to COVID-19, the CDC said.


https://www.beckershospitalreview.com/public-health/flu-activity-highest-in-southern-states-8-notes-from-cdc-s-flu-report.html


Allergy Meds May Make Drug Overdoses More Dangerous: CDC

Antihistamines were involved in at least 15% of recent overdose deaths, according to 2019-2020 data from 43 states and the District of Columbia.

Of 92,033 overdose deaths during this time period, 14.7% were antihistamine-positive and 3.6% were antihistamine-involved, reported Amanda Dinwiddie, MPH, of the CDC's National Center for Injury Prevention and Control in Atlanta, and co-authors.

Nearly all of these deaths included first-generation H1 antihistamines, primarily diphenhydramine (Benadryl; 71.1% of antihistamine-positive deaths and 66.5% of antihistamine-involved deaths), they noted in the Morbidity and Mortality Weekly Report.

First-generation H1 antihistamines are often used to treat allergy symptoms or aid sleep. They can cause sedative effects that may worsen when used with other sedative drugs like opioids.

They are also found in illicit drugs, Dinwiddie and co-authors noted.

"Diphenhydramine, a common over-the-counter first-generation H1 antihistamine, has been combined with opioids as an adulterant in illicit drug supply and can be used to reduce opioid-related side effects (e.g., itchy skin because of histamine release from opioid use)," they wrote.

Combining opioids and diphenhydramine can be especially dangerous, they added. "Naloxone [Narcan] administration is important for any overdose with suspected opioid involvement. Because antihistamines do not respond to naloxone, co-involved opioid and antihistamine overdoses might require naloxone administration plus other immediate medical response measures to prevent death."

Dinwiddie and colleagues evaluated overdose deaths using data from the State Unintentional Drug Overdose Reporting System (SUDORS) for 43 states and the District of Columbia during 2019-2020. SUDORS captures data on fatal unintentional and undetermined-intent overdoses.

A death was defined as antihistamine-positive if any antihistamine was detected on postmortem toxicology or was listed on the death certificate. It was defined as antihistamine-involved if the drug class was listed as a cause of death. Fewer than 0.1% of overdose deaths involved antihistamines alone.

The proportions of antihistamine-involved and diphenhydramine-involved overdose deaths were highest among women, those ages 35 to 44, and white people. Demographic patterns of antihistamine-positive and diphenhydramine-positive deaths were similar, except that deaths were more frequent among men and in the Midwest region.

"Most antihistamine-involved and diphenhydramine-involved overdose deaths co-involved opioids (82.8% and 82.7%, respectively), primarily illicitly manufactured fentanyls," Dinwiddie and colleagues observed.

The findings have several limitations, the researchers acknowledged. The study included only 44 jurisdictions and may not be nationally representative. Moreover, drug-testing methods were not standard across jurisdictions.

Antihistamine positivity may reflect allergy or other treatments and not necessarily misuse, they added. "It is also possible that some persons did not knowingly consume antihistamines and were exposed to these drugs through adulteration of the illicit drug supply with antihistamines," they pointed out.

"Despite these limitations, these data highlight the importance of continued surveillance to understand the drugs and drug combinations contributing to overdose deaths and to guide awareness efforts about the potential dangers of the unpredictable illicit drug supply and the intentional or unintentional co-use of substances, including antihistamines and opioids," Dinwiddie and co-authors concluded.

Fighting food poisoning: Sweeping poultry changes eyed

 The U.S. Department of Agriculture on Friday proposed sweeping changes in the way chicken and turkey meat is processed that are intended to reduce illnesses from food contamination but could require meat companies to make extensive changes to their operations.

Despite decades of efforts to try and reduce illnesses caused by salmonella in food, more than 1 million people are sickened every year and nearly a fourth of those cases come from turkey and chicken meat.

As it stands, consumers bear much of the responsibility for avoiding illness from raw poultry by handling it carefully in the kitchen — following the usual advice to not wash raw chicken or turkey (it spreads the bacteria), using separate utensils when preparing meat and cooking to 165 degrees. The USDA’s Food Safety and Inspection Service wants to do something about it by starting with the farmers that raise the birds and following through the processing plant where the meat is made.

Their food poisoning target: Of the more than 2,500 salmonella serotypes, the Centers for Disease Control and Prevention has identified three that cause a third of all human illnesses from chicken and turkey products. The agency proposes limiting the presence of these on poultry products.

The USDA estimates the total yearly cost for foodborne salmonella infections in the U.S. at $4.1 billion, which includes the cost of doctor and hospital visits, recovery and premature deaths.

In 1994, the USDA’s Food Safety and Inspection Service took a similar step by declaring some strains of E. coli a contaminant in ground beef and launched a testing program for the pathogen which has significantly reduced illnesses from the meat.

In an effort to curtail salmonella outbreaks in poultry, the agency is proposing a regulatory framework that would include testing incoming flocks of chickens and turkeys for the bacterial disease that commonly affects the intestinal tract and affects 1.3 million people annually with symptoms that may include diarrhea, nausea and vomiting which could last for several days. Officials hope testing chickens and turkeys before they enter the slaughterhouse will encourage farmers to adopt practices that reduce the bacterial infection on the bird before they reach the point of meat processing.

A second measure would require enhanced monitoring for salmonella during processing by adopting sampling for the bacteria at multiple stages inside the processing facility. The third major change would be to establish a maximum level of bacterial contamination allowed and possibly limiting the three specific types of salmonella that can make people sick. Meat that would exceed the limits or that would contain the types of salmonella prohibited could be withheld from the market.

The USDA says there are about 3,000 federally inspected plants that slaughter poultry but about 220 produce the vast majority of poultry products. The agency said it is difficult to say at this point how many would be affected by the future rulemaking.

The FSIS will begin a lengthy process of proposing new rules by holding a public hearing on Nov. 3 to get input from the poultry industry and others. The government’s goal is to come up with new rules and regulations that could be rolled out beginning next year and completed within two years.

The agency said it is taking its time to roll out these ideas and get input before establishing firm regulations. The agency hopes to begin rulemaking in mid-2023 and complete it in two years, said USDA Deputy Under Secretary for Food Safety Sandra Eskin.

“We know this is quite a pivot from where the agency has been historically and for that reason we’re trying to be as transparent and deliberative and collaborative as possible,” Eskin said.

Consumer advocates have pushed for such action on poultry products for years. Eskin said the administration of President Joe Biden is pushing to make the changes.

Seattle-based lawyer Bill Marler, one of the nation’s leading lawyers to represent consumers sickened by food sources applauded the agency’s action which recognizes that controlling salmonella on animals before they reach processing plants is crucial to reducing meat contamination. He said FSIS should be bold and deem salmonella is a adulterant — a contaminant that can cause food-borne illness — in all meat as a starting point.

“What they’ve outlined is something that’s really unique that they have not ever done before but it doesn’t have a time line and doesn’t have regulations attached that would show it’s actually going to be accomplished. That’s my criticism,” he said.

The industry has been unable to meet government targets for reducing food-borne salmonella infections for a couple of decades. Meeting the new target set for 2030 of 11.5 infections per 100,000 people a year would require a 25% reduction, Eskin said.

Eskin said the industry has managed to reduce the number of chicken samples contaminated with salmonella by 50% from 2017 to 2021, but the rate of salmonella illnesses over the last two decades has not significantly declined. More than 23% of foodborne salmonella illnesses are attributable to poultry consumption with nearly 17% coming from chicken meat and more than 6% from turkey meat.

The North American Meat Institute, the trade association representing U.S. packers and processors of beef, pork, lamb, veal and turkey said efforts to combat salmonella are a high priority.

“We are encouraged to see FSIS is going through the regular rulemaking process. We look forward to reviewing the proposal and providing comment from the industry,” said Julie Anna Potts, the group’s president and CEO.

A spokeswoman for the National Chicken Council, which represents the companies that raise and process chickens for meat said they support efforts to reduce salmonella on chicken products.

“We are concerned that the proposed framework currently lacks industry input, research and data to support it,” said Ashley Peterson, senior vice president of scientific and regulatory affairs for the group.

https://apnews.com/article/health-business-iowa-us-department-of-agriculture-9b8d8c3f45150e69269d6a1db3847916

German health minister urges stepped-up COVID-19 measures

 Germany’s health minister on Friday urged the country’s 16 states to consider stepping up their measures against the coronavirus amid a rise in new cases.

Health Minister Karl Lauterbach said he favors requiring mask-wearing indoors, a measure that has largely faded in Germany except on public transport, in medical facilities and care homes.

“The direction we’re going in isn’t a good one,” Lauterbach told reporters in Berlin.

He added that it would be better for states to impose limited restrictions now than stricter ones later. “The sooner we step on the brake the better it will be,” he said.

German authorities registered over 114,000 newly confirmed cases in the past 24 hours, and 165 COVID-related deaths. The number of newly confirmed cases per 100,000 inhabitants over a seven-day period stood at 760, compared with 695 a week earlier.

Lauterbach said the actual number of cases could be three-to-four times higher, as many positive results with rapid tests are never reported to authorities.

A rise in cases in Bavaria has been linked to the recent Oktoberfest, which draws hundreds of thousands of visitors every year.

Lauterbach said more could have been done to limit the spread of the virus at the beer festival in Munich, such as offering or mandating on-site testing for visitors.

The Health Ministry launched a new nearly 33 million-euro ($32 million) advertising campaign Friday, using 84 case studies of real people affected by COVID-19 to encourage vaccinations.

Lauterbach said getting the shot remains an important way of protecting recipients and others. The risk of death for people over 60 drops by 90% if they get a fourth shot, he said.

https://apnews.com/article/health-germany-covid-berlin-1aa13eb870dc3a6c17a38835c8653791