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Friday, December 15, 2023

Oprah’s Weight Watchers is Ozempic-as-a-platform

 WW International (WW), formerly known as WeightWatchers, is jumping on the bandwagon of one of the biggest stories of the year — weight-loss drugs.

On Monday, the 60-year-old company announced the launch of the WeightWatchers GLP-1 Program, which offers behavioral support for those on weight-loss drugs such as Ozempic and Wegovy.

"This new GLP-1 Program is to help consumers who are on GLP-1 medications manage the unique behavioral needs they face while managing life on medications," a spokesperson told Yahoo Finance over email.

The program is intended to ensure consumers on GLP-1 drugs have "adequate nutrition — specifically protein and nutrient-dense foods, as well as hydration," the release stated. It includes daily nutritional and activity targets; a list of GLP-1 go-to foods and recipes; and trackers for weight, activity, and food, among other tools.

The announcement came a day after Oprah Winfrey, a WW International board member since 2015, revealed she is using weight-loss drugs. Winfrey, who has an $8.29 million stake in the company (based on Wednesday's close), did not specify which weight-loss medication she is on.

NEW YORK, NEW YORK - DECEMBER 11: Oprah Winfrey attends THR Presents Live: The Color Purple at Crosby Hotel on December 11, 2023 in New York City. (Photo by Arturo Holmes/The Hollywood Reporter via Getty Images)
WeightWatchers board member Oprah Winfrey, pictured here on Dec. 11, 2023, revealed she is using weight-loss drugs. (Arturo Holmes/The Hollywood Reporter via Getty Images) (Arturo Holmes via Getty Images)

The media mogul told People magazine that she changed her lifestyle recently by eating her last meal at 4 p.m., drinking a gallon of water a day, and using the WeightWatchers principle of counting points while on the drug.

At first, she said, she had an "awareness of [weight-loss] medications" but felt like she had to "prove" that she "had the willpower" to lose weight.

"I now no longer feel that way," Winfrey continued. She said that she is "absolutely done with shaming from other people" and that "medically approved prescription for managing weight and staying healthier, in my lifetime ... feels like relief."

This program is the latest move by WW International to become a more digital and tech-focused weight-management company. Earlier this year, WeightWatchers acquired Sequence, a subscription telehealth platform that offers access to healthcare providers that specialize in "chronic weight management" and are able to prescribe weight-loss drugs to patients.

'10% of US Physicians Work for or Under UnitedHealth. Is That a Problem?'

 UnitedHealth Group, the parent company of the nation's largest private insurer, UnitedHealthcare (UHC), is now affiliated with or employs approximately 10% of the US physician workforce, raising anti-trust and noncompete concerns as more payers and private equity firms pursue medical practice acquisitions.

The company added 20,000 physicians in the last year alone, including a previously physician-owned multispecialty group practice of 400 doctors in New York. They join the growing web of doctors — about 90,000 of the 950,000 active US physicians — working for the UnitedHealth Group subsidiary, Optum Health, providing primary, specialty, urgent, and surgical care. Amar Desai, MD, chief executive officer of Optum Health, shared the updated workforce numbers during the healthcare conglomerate's annual investor conference this week. 

Healthcare mergers and consolidations have become more common as physician groups struggle to stay afloat amid dwindling payer reimbursements. Although private equity and health systems often acquire practices, payers like UHC are increasingly doing so as part of their model to advance value-based care. 

Yashaswini Singh, PhD, healthcare economist and assistant professor of health services, policy, and practice at Brown University, says such moves mirror the broader trend in corporate consolidation of physician practices. She told Medscape Medical News that the integrated models could possibly enhance care coordination and improve outcomes, but the impact of payer-led consolidation has not been extensively studied. 

Meanwhile, evidence on private equity ownership is just emerging. In a 2022 study published in JAMA Health Forum, with Singh as lead author, findings showed that private equity involvement increased healthcare spending through higher prices and utilization. 

Consolidation can also raise anti-trust concerns. "If payers incentivize referral patterns of their employed physicians to favor other physicians employed by the payer, it can reduce competition by restricting consumer choice," said Singh. 

proposed merger between Cigna and Humana likely would have faced intense scrutiny as it would create a company that rivals the size of UnitedHealth Group or CVS Health. It might have streamlined its insurance offerings and leverage each other's care delivery platforms, clinics, and provider workforce. 

The Biden Administration has sought to strengthen anti-trust statutes to prevent industry monopolies and consumer harm, and the US Department of Justice and Federal Trade Commission have proposed new merger guidelines that have yet to be finalized. 

According to Singh, some of Optum's medical practice purchases may bypass anti-trust statutes since most prospective mergers and acquisitions are reviewed only if they exceed a specific value ($101 million for 2023). Limited transparency in ownership structures further complicates matters. Plus, Singh says instances where physicians are hired instead of acquired through mergers would not be subject to current anti-trust laws. 

The 'corporatization' of healthcare is not good for patients or physicians, said Robert McNamara, MD, chief medical officer of the American Academy of Emergency Medicine Physician Group and co-founder of Take Medicine Back, a physician group advocating to remove corporate interests from healthcare. 

"If you ask a physician what causes them the most moral conflict, they'll tell you it's the insurance companies denying something they want to do for their patients," he said. "To have the doctors now working for the insurance industry conflicts with a physician's duty to put the patient first." 

McNamara, chair of emergency medicine at Temple University's Katz School of Medicine, told Medscape that more than half the states in the US have laws or court rulings that support protecting physician autonomy from corporate interests. Still, he hopes a federal prohibition on private equity's involvement in healthcare can soon gain traction. Last month, Take Medicine Back raised a resolution at the American Medical Association's interim House of Delegates meeting, which he said was subsequently referred to a committee. 

Emergency medicine was among the first specialties to succumb to private equity firms, but McNamara said that all types of healthcare providers and entities — from cardiology and urology to addiction treatment centers and nursing homes — are being swallowed up by larger organizations, including payers. 

UHC was named in a class action suit last month for allegedly shirking doctors' orders and relying on a flawed algorithm to determine the length of skilled nursing facility stays for Medicare Advantage policyholders. 

At the investor meeting, Desai reiterated Optum's desire to continue expanding care delivery options, especially in its pharmacy and behavioral health business lines, and focus on adopting value-based care. He credited the rapid growth to developing strong relationships with providers and standardizing technology and clinical systems.

https://www.medscape.com/viewarticle/10-us-physicians-work-or-under-unitedhealth-problem-2023a1000vhg

Compounding Pharmacies Distance Themselves From Unlawful Sellers of Weight Loss Drugs

 While glucagon-like peptide-1 (GLP-1) agonists for diabetes and weight loss remain in short supply, some clinicians have turned to compounding pharmacies to fill prescriptions. Yet news reports and social media posts have called compounded products "knockoffs" and "counterfeit" and lumped them in with illicit products. 

Meanwhile, Novo Nordisk and Eli Lilly, makers of semaglutide and tirzepatide, respectively, have filed several lawsuits against compounding pharmacies alleging various claims, including that they are violating marketing rules and producing unauthorized products.

Compounding pharmacies are pushing back. The industry says it is being confused with unregulated companies selling purported semaglutide and tirzepatide, the active ingredients in blockbuster diabetes and weight loss drugs.

Scott Brunner, CEO of the Alliance for Pharmacy Compounding (APC), said misconceptions about the industry may make clinicians reluctant to prescribe any compounded drug, even when a patient could benefit from a custom dosage or when an essential drug is in shortage, as is the case with GLP-1 agonists. 

"What these online sites are doing is selling directly to a patient without a prescription, and they're telling the patient, 'Hey, this is semaglutide.' In some instances, it may well be — it's often marked 'research grade,' " Brunner said, adding that unlike with a compounded medication, a purchaser cannot verify what they are buying. "It's absolutely sketchy stuff. But that's not pharmacy, and that's not compounding."

The US Food and Drug Administration allows compounding pharmacies, normally tasked with making custom formulations, to produce "essentially a copy of a commercially available drug" when that drug is in short supply. 

APC, which represents about 130 facilities, issued a statement in October to correct "misstatements and errors" it said have appeared in media stories and communications from state boards of pharmacy.

APC also said scammers posing as legal compounding pharmacies may be contributing to perceptions that compounded drugs are unsafe. It recently alerted FDA regulators about a flyer advertising "GLP-1 mimickers" faxed to physician offices by a company falsely claiming to be an accredited compounder.

Provider Trepidation

The worry of the APC is not unfounded: some clinicians said they do not prescribe compounded GLP-1 drugs, citing a lack of certainty about ingredients and safety.

Fatima Cody Stanford, MD, MPH, MPA, an obesity specialist at Massachusetts General Hospital and Harvard Medical School, told Medscape Medical News she "won't consider compounding," even as some of her patients wait months to receive their first doses of branded GLP-1 drugs. 

"I don't have any data to support the compounded medication," Stanford said. Without the ability to show her patients clinical trial data that go with FDA approval, she said, "I won't use it." 

Stanford said she often prescribes older drugs that are commercially available, such as phentermine-topiramate or naltrexone-bupropion combinations, while a patient waits for a GLP-1 product. That way, she said, her patients "are not just sitting there, not on anything."

According to the FDA, compounded drugs do pose a greater risk of contamination and dosing errors than commercially available drugs because compounded versions do not undergo a premarket review for safety, effectiveness, or quality. Compounding pharmacies bulk order the same active ingredients found in an FDA-approved drug and prepare them on site, usually in much smaller batches made to order. 

Compounding advocates acknowledge that prescribers should opt for a commercially available drug when possible, but resist the idea that compounded drugs are inherently risky. Brunner said compound pharmacies operate under a rigorous compliance framework. 

For semaglutide, the manufacturer's clinical trial data offer " some reasonable level of confidence to support the use of the [active ingredient] in a compounded preparation," Brunner said.

The extent of safety issues with compounded GLP-1 drugs is unclear, according to the FDA, which in May cautioned that it received adverse event reports associated with compounded semaglutide. It also cited accounts of compounders using a different active ingredient than that in the commercially available drug. 

Charles Kohler, a spokesperson for the agency, told Medscapethat as of October 27, the agency had received more than 95 reports of adverse events linked to compounded semaglutide.

"While many of the events appear to be consistent with certain adverse events included in labeling for FDA-approved semaglutide products, the FDA is unable to determine how or if other factors, such as differences in ingredients and formulation between FDA-approved and compounded semaglutide products, may have contributed," Kohler said. 

Compounding pharmacies that distribute bulk orders to facilities such as hospitals are required to report "serious and unexpected" adverse events to the FDA, but community compounding pharmacies that fill prescriptions for individual patients do not have the same rule.

Kohler said the FDA's "ability to derive conclusions about safety concerns," is limited by the variable quality and low number of reports.

Ultimately, individual clinicians must decide whether they want to prescribe a compounded drug, Rita Jew, PharmD, MBA, president of the nonprofit Institute for Safe Medication Practices, told Medscape Medical News. Compounding pharmacies tend to use less automation, which Jew said can increase the chance for errors with potency or contamination, including lapses in sterilization. In addition, she noted that states have varying levels of regulatory oversight.

As with any intervention, "the doctor needs to balance the risk vs the benefit," in prescribing a compounded drug, Jew said. 

A Boon for Patients

Despite widespread hesitancy about compounded drugs, some clinicians say these versions are a boon for patients, who pay about a third of what they would for brand-name products, which run $900 to $1350 for a four-week supply. Insurers often do not pay for the drugs.

Using a compounder allows physicians to precisely tailor doses to minimize side effects and control the rate of weight loss, David Wertheimer, MD, a cardiologist and internist at the Wertheimer Center for Functional Medicine in Franklin Lakes, New Jersey, told Medscape.

Wertheimer said he has prescribed compounded weight loss drugs to more than 50 of his patients, many of whom have found the versions "incredibly effective." He said he has confidence in his local compounding pharmacy, which he has worked with for years.

"The one I use is accredited. It's a state-regulated facility, and they're very fastidious about the work they do," including sending a sample of each batch of semaglutide to an independent lab to assure purity and formula accuracy , he said. 

Wertheimer said he dreads the day the shortages end. 

"You just hope that if compounders are stopped from doing this, that there's going to be a cost-effective alternative for people," he said.

To an extent, manufacturers are already trying to curb compounding. Last month Novo Nordisk sued two compounding pharmacies in Florida, claiming the facilities sold products with impurities and incorrect potency

Vetting a Pharmacy

For clinicians who want to prescribe compounded drugs, experts suggested several steps for vetting a pharmacy and its products: 

  • For a community pharmacy that dispenses individual prescriptions, verify on the state board of pharmacy website that it is licensed in the state where the patient resides and has a clean disciplinary record.
  • For an outsourcing facility that distributes bulk products, check its FDA registration and inspection records.
  • Request a facility tour.
  • Check whether the company has Pharmacy Compounding Accreditation Board accreditation, which is based on compliance with quality and safety standards set by United States Pharmacopeia (USP).
  • Ask where ingredients are sourced and whether they meet USP requirements. Ask for a certificate of analysis to verify a drug's active ingredient.
  • Ask for documentation that the drug has undergone potency and sterility testing.

Wertheimer recommends maintaining a dialogue with compounding pharmacists for both clinical advice and to provide confidence in the quality of the operation. 

"Like in any area of medicine, there are ethical players and there are people who don't play by the rules," he said. 

Brunner, Jew, Kohler, and Wertheimer report no relevant financial relationships. Stanford accepted payments for consulting, travel and lodging, and food and beverage from Novo Nordisk and Eli Lilly, according to Open Payments

https://www.medscape.com/viewarticle/compounding-pharmacies-distance-themselves-unlawful-sellers-2023a1000vml

The Cartels Run the Show

 On Tuesday, December 5, more than 12,000 foreigners crossed the U.S. border illegally—the highest daily total of illegal immigrants ever recorded. We are currently witnessing the greatest illegal immigration crisis in American history.

In October, the House Committee on Homeland Security reported that Customs and Border Protection (CBP) encountered a record-breaking 269,735 illegal immigrants in the previous month, “marking another unprecedented milestone under…President Joe Biden’s open border policies.” This represents “an 86% increase” from June 2023. “Since President Biden took office there have been 7.5 million encounters nationwide” with illegal migrants, millions of whom have been “processed” and transported (often at taxpayer expense) across our country.

“[I]n addition,” the House Committee reports, “there are 1.7 million known gotaways” who have snuck into the United States by evading border patrol agents while they are distracted and overwhelmed with paper work. Illegal immigration has increased “more than 100% compared to FY 2019.” According to the New York Times, the illegal migrants come not simply from Latin America but from “more than 160 countries,” including Iran, China, Pakistan, India, Bangladesh, Chechnya, Tajikistan, Afghanistan, Kazakhstan, Uzbekistan, Yemen, and Somalia, as well as large parts of Africa and the Middle East.

The House Committee reported a tenfold increase in migrants apprehended at the border who were on the Terrorist Watch List. In Fiscal Year 2021 there were 15; in FY 2022, there were 98; and in FY 2023 (ending September 30, 2023), there were 169 migrants apprehended on the terror list. It is, of course, unknown how many of the 1.7 million “gotaways” are potential terrorists.

Only a few months into the Biden Administration (on April 10, 2021), the head of Border Patrol was asked on television, Who controls the border? He responded: “The cartels control the border now. It’s not even the border patrol. It’s not even the U.S. government.” Two months later, on June 19, the former acting director of Immigration and Customs Enforcement (ICE) reiterated that the cartels control the border: they “dictate everything.” Nothing moves (families, unaccompanied minors, single young men, women, fentanyl, heroin, cocaine) unless the cartels give their O.K.

In his trenchant new book, Overrun, Center for Immigration Studies Fellow and former Texas counter-terrorism official Todd Bensman illuminates today’s reality on America’s southern border. Bensman interviewed both border patrol officers and agents of the Mexican cartels. He explains that our border patrol has been ordered to “stand down” and not to interdict or arrest cartel traffickers as they have done under all previous presidents in American history. Instead Bensman describes a situation he witnessed in May 2021: “The [border patrol] officers chatted amiably with their former cartel adversaries and accepted the immigrant handoffs like relay racers accepting a baton from teammates with a first-name collegiality that comes with routine and time.”

In other words, the Biden Administration’s border policy has resulted in a de facto partnership, accommodation, and cooperation with the violent Mexican cartels. The cartels are stronger and richer than ever. Whereas in 2020 they earned 500 million dollars, last year under Biden they made an estimated 13 billion. While border patrol officers are kept busy “processing” illegal immigrants, giving them documents, and turning them over to NGOs for transportation throughout America, the cartel agents are bringing in record amounts of the deadly opioid fentanyl through the undefended sections of the border. The drug ended up killing 109,000 Americans over the last two years.

The Biden White House and its political appointees at DHS and the Justice Department have responded to criticism by repeating the mantra that there is no border crisis; that they have operational control of the border; and that the “border is secure.” Their own actions belie this utterly.

In clear violation of the Immigration and Nationality Act, they have released millions of dubious “asylum seekers” into the country before their claims were legally adjudicated. Significantly, on his first day in office, President Biden announced a freeze on all deportations—including those of criminal aliens guilty of manslaughter, vandalism, assault, and other offenses.

Biden’s appointees ended the “Remain in Mexico” program and Title 42, which limited the overwhelming number of migrants entering the country and temporarily eased the burden on local communities and the outnumbered, overrun border patrol.

They violated immigration law regarding the parole of illegal aliens. Under Section 212(d)(5)(A) of the Immigration and Nationality Act, illegal aliens may be granted parole only “on a case by case basis for urgent humanitarian reasons or significant public benefit.” For example, an unauthorized migrant needing an operation to save his life, or required to give testimony in an important court proceeding, may be paroled. Instead, DHS has granted mass paroles to large numbers of illegal migrants. For example, during one December on the southern border, more than 130,000, or 75 percent of the 174,000 migrants apprehended, were simply released “on parole.”

According to Congressman Mark Green (chairman of the Homeland Security Committee), DHS Secretary Alejandro Mayorkas “utterly abused” the CBP One mobile-phone application originally meant for legitimate frequent travelers. The Biden Administration created a system to permit (indeed, to encourage) illegal aliens to use the app to make an appointment to apply for asylum in the U.S. while still in their home country. By using the app, migrants can simply fly into the United States and receive parole upon arriving. The House Homeland Security Committee revealed that over a nine-month period, 278,431 appointments were made by illegal immigrants over the CBP One app, and 266,846 of them were released into the country on parole.

Senate Judiciary Committee Republicans worry that the Biden Administration has shown disregard for the safety of the tens of thousands of unaccompanied children transported to the United States by the cartels. There was a memorandum of agreement among federal agencies which sought to ensure that potential sponsors of the unaccompanied children were thoroughly vetted against any criminal concerns.

The Biden Administration terminated this memorandum of agreement and stopped the DNA testing and finger printing mandated by Congress for illegal migrants. The vast majority of the childrens’ sponsors are themselves illegal aliens. Early DNA testing revealed that 20 percent were not family members. Some, of course, are cartel agents posing as family members, who will keep the children in some form of servitude.

In its dispute with the State of Texas, the Biden Administration appears determined to facilitate the continuous entry of illegal immigrants. When Texas placed floating barriers in the Rio Grande to deter illegal immigration for (in the governor’s words) “tens of thousands, maybe hundreds of thousands” of illegal migrants trying to cross the border, Biden’s Justice Department responded with a lawsuit to force Texas to remove the barriers.

Laying Down the Law

There is a solution to this dire situation. Congress should enact the policy changes in proposed legislation (HR2) that passed the House in May, coupled with a companion bill that has been introduced by Republicans in the Senate. This legislation would require Biden’s DHS to follow current law and detain, not release, illegal migrants.

The proposed legislation would tighten asylum rules to make sure that asylum-seeking migrants are, in fact, genuine refugees who are threatened by real persecution in their home countries and not simply economic migrants. The Congressional Budget Office (CBO) explains that the legislation would “curtail the ability to grant asylum on the basis of generalized violence or criminal activity in a country” (as opposed to situations particular to the person seeking asylum). The screening standard for potential asylum-seekers would be changed from requiring that “there is a significant possibility” of the migrant facing persecution, to requiring that the migrant is “more likely than not” to be in danger of persecution.

Further, a migrant would be ineligible to apply for asylum if he or she had traveled through another country that is a party to the U.N. Refugee Convention of 1951 or the 1967 Refugee Protocol “but did not seek protection there” and simply continued traveling to the United States. This would prove that they were not under American law a legitimate asylum seeker, but likely an economic migrant.

Most importantly, the legislation would limit DHS’s parole authority. Instead of dealing with immigrant parole on a case-by-case basis (as required by law), the CBO reported that since the start of FY 2022, Biden’s DHS has “paroled about 1.5 million aliens into the United States.” Under the proposed HR2 legislation, CBO “expects about 4 million fewer aliens would receive parole over the 2024-2033 period.” Further, the legislation would end the practice of massive numbers of migrants gaining entry to our country illegally through Biden’s bogus CBP One app program. In addition, it protects vulnerable children from human traffickers and cartels by keeping families together during removal proceedings and reuniting children with their families back in their home countries.

The proposed legislation criminalizes visa overstays, traditionally about half of all illegal immigration. It cuts off funds to the self-interested NGOs that are profiting from, and abetting, illegal immigration by assisting the Biden Administration in transporting millions of illegal migrants (often secretly) throughout our nation. It mandates (as required by current law) that asylum seekers have their finger-prints and DNA taken. HR2 and the Senate companion also require resumed construction on the border wall; more up-to-date infrastructure for border protection; and more border patrol agents (while increasing their overtime pay).

Further, the proposed legislation also mandates E-Verify to insure that employers are not hiring illegal aliens. E-Verify is probably the greatest single disincentive to illegal immigration because it would (as required by current law) prevent illegal immigrants from working in the United States.

The illegal mass migration surge of the last two years is the greatest single crisis facing our nation today. If it continues through the next year and a half of Biden’s term and perhaps beyond until January 2029, the results will be catastrophic.

Biden’s response is that his administration proposed legislation to “fix” immigration on his first day in office. What Biden proposed would result in a large-scale amnesty for millions of current illegal aliens and a massive increase in low-skilled legal immigration. In other words, it would double down on the failed so-called “comprehensive immigration reform” legislation of the last 30 years, without even the fig leaf of enforcement measures that were included in prior iterations. This is ludicrously unserious. If adopted, it would create an enormous incentive for even more illegal immigration while undercutting the wages of the most vulnerable American workers.

What Biden and Senate Majority Leader Chuck Schumer are proposing now in pending legislation is simply more money to “process” more illegal migrants into the United States.

Biden and Schumer have major priorities in the forthcoming budget supplemental package. Republicans in the House and Senate should insist that nothing passes without embedding the core elements of HR2 (not amorphous funds for phony “border security,” which in reality means more migrant processing) into any supplemental budget bill that Congress passes. Otherwise, massive migration from every corner of the planet will continue unabated, perhaps until all of America looks like today’s migrant-occupied Roosevelt Hotel in New York City.

 is a senior fellow at the Hudson Institute and author of Sovereignty or Submission?, winner of the ISI (Intercollegiate Studies Institute) book award for 2012.

https://americanmind.org/features/facing-up-to-immigration/the-cartels-run-the-show/

WHY ARE YOUNG PEOPLE SO FRIGHTENED?

 The mental health crisis among America’s young people is well documented and frequently commented upon. The New York Post reports on a recent psychological study:

Gen Z perceives the world to be more dangerous than any previous generation in modern history, according to a new study.
***
“Despite risk analysis research demonstrating that we live in one of the safest times ever, Gen Z experiences a disparity in risk assessment from their older counterparts, essentially having the perception that risk is everywhere they turn,” lead researcher Professor Gabriel Rubin, of Montclair State University in New Jersey said in a statement.
***
The research has shown that Gen Z is presented with a world in which things are either safe or dangerous but have failed to understand that the many risks in life can be weighed.

“This research has so far revealed that the disparity in risk assessment has led many young people to feel anxious, depressed and even suicidal — especially young girls and women,” Rubin explained.

Why are young people so frightened, compared with prior generations? I speculate that there are several reasons.

First, the hysterical nature of contemporary news coverage. Children are told that the world is coming to an end due to global warming, and they suffered through the absurdly over-hyped covid epidemic. When a kid is forced to stay home and, when he ventures out, go around wearing a mask, no wonder he concludes that the world is a dangerous place.

Second, the feminization of our society and in particular our schools. Women have pretty much taken over our country, and especially the education of the young. It is a biological fact that women tend to emphasize security and men are more oriented to risk-taking. But most kids don’t have a lot to do with men. The institutions that historically have exposed them to men, like, for example, the Boy Scouts, tend to be in decline.

Third, the philosophy of Safetyism. This is, I think, closely linked to feminization, but the ubiquity of this emphasis on safety above all, the attempted exclusion of all risk–as though one could get up in the morning without taking numerous risks–stands as a causal factor on its own.

Fourth, financial incentives for mental health diagnoses. An unbelievable percentage of American kids are now being classified as “special needs.” Why is that? Because money follows the diagnosis. When I was growing up, sure, some kids were a little odd in various ways. (You could argue that most of us were.) But most of those kids grew up to live normal lives, and some of them got rich. But money changes everything, and the more “special needs” children a school has, the more money it gets. QED. Having been diagnosed and stereotyped, it is no wonder that this vast army of the allegedly impaired don’t approach life with a sense of confidence.

No doubt there are other factors, but those are some that occur to me. The consequences of raising a fearful generation are unknown, but perhaps catastrophic. Our country and our civilization were built by people who took risks. Sometimes they paid with their lives, but sometimes, too, they achieved extraordinary things. We can only hope that the venturesome traditions that have animated our culture for centuries have not entirely died out.

https://www.powerlineblog.com/archives/2023/12/why-are-young-people-so-frightened.php

Healthcare Is 99.84 Percent Consolidated

 Last week, the Biden administration “called out ... consolidation in healthcare markets, saying it too often leads to higher costs, worse quality and reduced care access, especially in rural areas.” President Biden has set a new record for the use of irony. 

In economic terms, healthcare is both a monopoly and monopsony. Most people know about the former but few recognize the latter. A monopoly is a market where one seller controls the market and can set prices. That of course applies to Washington’s regulatory control of healthcare. A monopsony is a market where one buyer determines what is sold, whether services or goods. Again, that describes Washington’s insurance rules for health benefits. Healthcare, as both federal monopoly and monopsony, is the ultimate in market consolidation. There is one buyer and one seller: Washington.

Biden asserts that, “consolidation has also led to a rapid decline in independent physician practices.” This is true. Patients are not the buyers of care services. Health plans, who control the money lump doctors into huge provider lists and pay them amounts that are contracted with insurance companies. Consolidation has cut the solo practitioner out of the equation.

Third-party insurance payment structure is how consolidation has taken over healthcare. For 170 million Americans, Washington controls their healthcare directly through Medicare, Medicaid/CHIP, Tricare, and the VA. For 134 million privately insured Americans, federal insurance regulations dictate their care. For 29 million uninsured Americans, Washington dictates care through EMTALA (Emergency Medical Transport and Labor Act of 1986).

The ultimate “consolidator” of healthcare, the single corporate entity in charge – is the federal government. 

 “The White House said it would launch a cross-government public inquiry into corporate greed in healthcare.” Greed can be defined as the intense, selfish desire for money. That describes the federal government in healthcare.

The primary function of any healthcare system is to provide medical care. Naturally, most of the money spent on healthcare, the system, should pay for health ... care, the service. Washington spent $4.3 trillion in 2022 on the U.S. healthcare system, amount greater than the entire GDP of Germany. Roughly half, $2 trillion, Washington paid to itself, paying not for care but for BARRCOME (bureaucracy, administration, rules, regulations, compliance, oversight, mandates, enforcement). What was left over was made available to pay for patient care. That is extreme federal “corporate” greed. 

Biden intends to have, “HHS [Health and Human Services] ... appoint a Chief Competition Officer and DOJ's Antitrust Division, and FTC will name Counsels for Health Care to lead these efforts.” This is just what healthcare needs: more spending on BARRCOME, diverting even more dollars away from patient care! Consider all the bureaucrats, not patients or doctors, who control healthcare. They work for CMS, HHS, IRS, FDA, CDC, NIH, OSHA, NRLB, etc. Look up the organizational chart of ACA. Each one of the boxes has multiple sub-boxes. Each sub-box is filled with titles of healthcare workers who never see or touch a patient, all of whom must be paid. That money is diverted from people who provide care to people who don’t. Such “bureaucratic diversion” is precisely what Obama did to pay for the ACA. And Biden wants to add even more BARRCOME!

Greed can also be the intense, selfish desire for power. This precisely describes what Washington has done in healthcare starting in 1965. With each new program touted to benefit the American people – Medicare, Medicaid, EMTALA, HIPAA, ACA, most recently Biden’s Anti-Inflation Act of 2022 – Washington has taken control of one more component of healthcare. Whether spending decisions or medical choices, ultimately, Federal Father (thinks he) knows best, is responsible for the children (the American public) and must (therefore) make all health decisions for us. 

Federal greed for power and money satisfied by consolidation. 

Finally, Biden says that consolidation “reduced care access, especially in rural areas,” another true statement. The ACA increased wait times to see a primary care physician to a medically unconscionable four months. Who is responsible for this reduced access? In 1965, Texas had 310 single source of care, small rural hospitals. Today there are less than 160 and more keep closing. They cannot afford to pay their nurses, doctors, or electric bills because Washington’s EMTALA forces them to provide care for no payment. 

If Washington investigates the causes and effects of consolidation in healthcare, will Biden investigate himself? 

Healthcare is not 100 percent consolidated. There is a tiny bubble of free market healthcare called direct-pay, cash-only, or “concierge” practice that represents 0.16 percent of healthcare spending. Providers in this bubble offer prompt, quality, compassionate, knowing-each-patient-by-name medical care for a small fraction of insurance costs. Fortunately for patients, the bubble is growing. 

Deane Waldman, M.D., MBA is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of the Center for Healthcare Policy at Texas Public Policy Foundation; former Director, New Mexico Health Insurance Exchange; and author of the multi-award winning book Curing the Cancer in U.S. HealthcareStatesCare and Market-Based Medicine

https://www.realclearhealth.com/blog/2023/12/15/healthcare_is_9984_percent_consolidated_999013.html

'Long Flu Is Real -- But Long COVID Is Worse, Study Says'

 In patients hospitalized for either COVID-19 or seasonal influenza, rates of death, negative effects on long-term health, and hospital readmissions were high, but less so for the flu patients, a comparative analysis showed.

Over 18 months of follow-up, patients hospitalized with COVID had an increased risk of death compared with those hospitalized for influenza (HR 1.51, 95% CI 1.45-1.58), translating into an excess death rate of 8.62 per 100 persons, reported Ziyad Al-Aly, MD, of the VA St. Louis Health Care System and Washington University in St. Louis, and colleagues in Lancet Infectious Diseasesopens in a new tab or window.

In addition, COVID was associated with a significantly increased risk of 64 of 94 prespecified health outcomes, including cardiovascular outcomes, coagulation and hematological outcomes, fatigue, gastrointestinal outcomes, kidney outcomes, mental health outcomes, metabolic outcomes, musculoskeletal outcomes, neurological outcomes, and pulmonary outcomes.

Meanwhile, seasonal influenza was associated with increased risk of six outcomes compared with COVID: angina, tachycardia, type 1 diabetes, and three of four prespecified pulmonary outcomes (cough, hypoxemia, and shortness of breath).

The cumulative rates of adverse health outcomes across all organ systems were 615.18 per 100 persons in the COVID group and 536.90 per 100 persons in the influenza group, corresponding to an excess rate of 78.72 (95% CI 66.15-91.24) per 100 persons in the COVID group.

"Five years ago, it wouldn't have occurred to me to examine the possibility of a 'long flu,'" Al-Aly said in a press releaseopens in a new tab or window. "A major lesson we learned from SARS-CoV-2 is that an infection that initially was thought to only cause brief illness also can lead to chronic disease."

Al-Aly and team also found that patients who had been hospitalized for COVID were at increased risks for hospital readmission and admission to the intensive care unit (ICU) during 18-month follow-up. In the COVID cohort, there were approximately 21 more hospital admissions (95% CI 16.10-24.86) and nine more ICU admissions (95% CI 6.68-11.82) per 100 persons compared with the influenza cohort.

The numbers of disability-adjusted life-years (DALYs) across all organ systems were 287.43 per 100 persons in the COVID group and 242.66 per 100 persons in the seasonal influenza group, translating to 45.03 (95% CI 37.15-52.90) higher DALYs per 100 persons in the COVID group.

"The main 'aha' moment for me was the realization that the toll of disease and disability is larger in the post-acute phase than the acute phase of illness," Al-Aly told MedPage Today. "This is true for both COVID and the flu."

Although both COVID and influenza pose potentially serious threats to long-term health, COVID remains a much more formidable threat, Al-Aly said. "COVID is really a multi-systemic disease, whereas, relatively speaking, flu is more respiratory," he noted. "We ought to take these illnesses seriously and do our best to make sure that people are protected through vaccination. Conceptualizing these illnesses as acute events -- as we often do -- ignores the much larger toll of disease and disability that emanates from the long phase of illness."

The study authors analyzed data from the healthcare databases of the U.S. Department of Veterans Affairs, and included 81,280 patients admitted to the hospital for COVID from March 1, 2020 to June 30, 2022 and 10,985 patients admitted for influenza from Oct. 1, 2015 to Feb. 28, 2019. Mean age was 71, 94.9% were men, and 73.9% were white.

Because the study evaluated risks of post-acute sequelae in people who required hospitalization for influenza or COVID, the results of the study cannot be extrapolated to those with milder infection, Al-Aly and team wrote. Moreover, the study population was comprised predominantly of older white men and may not represent the general population admitted to the hospital for influenza or COVID.

Disclosures

The study was funded by the U.S. Department of Veterans Affairs.

Al-Aly reported consulting for Pfizer, Gilead Sciences, and Tonix Pharmaceuticals.

Co-author Xie reported consulting for Pfizer and Guidepoint.

Primary Source

The Lancet Infectious Diseases

Source Reference: opens in a new tab or windowAl-Aly Z, et al "Long-term outcomes following hospital admission for COVID-19 versus seasonal influenza: a cohort study" Lancet Infect Dis 2023; DOI: 10.1016/S1473-3099(23)00684-9.


https://www.medpagetoday.com/infectiousdisease/uritheflu/107898