Health care has long been marked by disparities that affect different groups of people in various ways. Whether due to race, income, or geography, these disparities lead to unequal access to care and varying health outcomes. However, there is growing hope that artificial intelligence (AI) could be the tool we need to address these long-standing issues and create a more equitable health care system for all. [Newsweek]

Quality of care shouldn't be influenced by external factors like a patient's background or where they live. Instead, everyone could receive a treatment plan tailored to their unique health needs, informed by a deep understanding of their genetic makeup, medical history, and lifestyle. AI offers the potential to turn this vision into reality by enhancing the precision and personalization of health care.

The problem of health care inequality is multifaceted. Minority groups often experience poorer health outcomes, not because of inherent biological differences, but due to systemic barriers such as underrepresentation in clinical trials and limited access to quality care. For instance, African American women are statistically three to four times more likely to die from pregnancy-related complications than their white counterparts, as highlighted in a study published in The Lancet in 2019. AI, when properly implemented, can help overcome these challenges by providing data-driven insights that lead to more effective interventions.

AI's ability to analyze vast amounts of data quickly and accurately is one of its greatest strengths. By examining electronic health records (EHRs), genetic information, and even social factors, AI can identify patterns that might go unnoticed by human doctors. For example, AI can detect early signs of chronic conditions like diabetes, which disproportionately affects certain minority groups. The Centers for Disease Control and Prevention (CDC) reported that non-Hispanic Black adults (12.1 percent), adults of Hispanic origin (11.7 percent), and non-Hispanic Asian adults (9.1 percent), have diabetes at higher rates compared to non-Hispanic white adults (6.9 percent).

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ORLANDO, Fla. (AP) — Midwife Jennie Joseph touched Husna Mixon’s pregnant belly, turned to the 7-year-old boy in the room with them and asked: “Want to help me check the baby?”[AP]

Photo credit by John Rauox

With his small hand on hers, Joseph used a fetal monitor to find a heartbeat. “I hear it!” he said. A quick, steady thumping filled the room.

It was a full-circle moment for the midwife and patient, who first met when Mixon was an uninsured teenager seeking prenatal care halfway through her pregnancy with the little boy. Joseph has been on a decades-long mission to usher patients like Mixon safely into parenthood through a nonprofit that relies on best practices she learned in Europe, a place that experts say offers answers to an American crisis.

“I consider maternal health to be in a state of emergency here,” said Joseph, a British immigrant. “It’s more than frustrating. It’s criminal.”

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The US Supreme Court punctuated its term ending July 2024 with major rulings affecting federal agencies. The Court’s decision in Loper Bright Enterprises v Raimondo, jettisoning so-called Chevron deference toward agencies’ interpretations of statutes, and other cases have stirred doubts about whether agencies can continue to make bold, effective health policy.^1,2 These rulings have critical ramifications for health agencies, but the outlook is more complex than it might appear. [JAMA Network] . See Implications for Health Agencies below. 

Incursions Into Agency Authority

Loper Bright held that except where statutes give interpretive discretion to the executive branch, courts “under the [Administrative Procedure Act] may not defer to an agency interpretation of the law simply because a statute is ambiguous.” Instead, courts must independently determine the “best” interpretation.

Although that ruling garnered top headlines, other June 2024 decisions arguably rival its importance. In Corner Post v Board of Governors of the Federal Reserve System, the Court lengthened the time period when many agencies, including the US Food and Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS), can be sued. The justices concluded that a “claim accrues” under the default statute of limitations not from when the agency makes a decision but from “when the plaintiff is injured by final agency action.” Now, new plaintiffs can challenge old agency actions. In Securities and Exchange Commission (SEC) v Jarkesy, the Court concluded that the Seventh Amendment’s jury protections preclude the SEC from seeking civil penalties for securities fraud through in-house proceedings. This could spell the end of US Department of Health and Human Services (HHS) agencies imposing civil monetary penalties—eg, fines for “information blocking” and violating the Health Insurance Portability and Accountability Act—without having to go through court proceedings.³ In Ohio v Environmental Protection Agency (EPA), the Court blocked the EPA from implementing a new ozone standard because the agency had insufficiently addressed a particular concern raised in the public comment period. This sounds a warning to all agencies engaged in notice-and-comment rulemaking that not scouring comments (which can number in the tens of thousands) and responding appropriately could be a consequential misstep.

These rulings follow decisions in 2022 adopting the major questions doctrine, which requires clear congressional authorization for agencies to act on issues that courts find to be of great economic and political significance. This powerful, destabilizing doctrine felled the Occupational Safety and Health Administration’s COVID-19 vaccinate-or-test mandate and the Centers for Disease Control and Prevention’s eviction moratorium, among other policies, and lower courts have held that even modest actions like requiring masks on public transit trigger the doctrine.

Implications for Health Agencies > 

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The US has made some gains in reducing health inequities in its health care system over the past two decades, but still has along way to go to achieve equal care for all of its people, says a a major new review.  [The Nation's Health, APHA] & NASEM]  

Released in June the NASEM reports revisits a 2003 landmark NASEM assessment that called out inconsistencies in the way people are served across the U.S. health care system. The new report, "Ending Unequal Treatment Strategics to Achieve Equitable Health Care and Optimal Health for All, concludes that racial and ethic inequities remain a fundamental flaw of the health care system and are hold back the nation. 

Download the NASEM report here>

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The Food and Drug Administration on Thursday approved the latest slate of annual Covid vaccines, clearing the way for Americans 6 months and older to receive updated shots in the midst of a prolonged summer surge of the virus. [New York Times & FDA] 

See update here.

Pfizer and Moderna, the vaccine makers, are expected to begin shipping vaccines to pharmacies and doctors’ offices within days. The shots are tailored to a version of the virus that took off this spring before giving way to closely related variants, all of which appear to spread faster.

For the frailest Americans, who have been dying of Covid in growing numbers this summer, the shots could offer a reprieve from a virus that disproportionately endangers those whose vaccinations are out of date.

But the approval is occurring months after wily new variants began driving up infections, a matter of consternation for some scientists who have urged faster turnarounds for updated shots.

In recent weeks, people have been hospitalized with Covid at a rate nearly twice as high as during the same time last summer. By late July, Covid was killing roughly 600 Americans each week, a substantial drop from this winter but double the number from this spring.

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The Department of Public Health issued over $3.1 million in fines to 219 Illinois nursing homes during the second quarter of 2024, according to recent data.[Health News Illinois]

The agency cited five homes with $50,000 fines for “type AA” violations that led to resident deaths. They were:

• Alden of Waterford in Aurora for failing to send a resident to the hospital promptly when they became aware of the resident's critically low potassium level.
• Aliya of Palos Park for failing to ensure one resident's airway with a tracheostomy was free of obstruction by not removing the inner cannula during CPR attempts.
• Aperion Care West Chicago for failing to provide necessary supervision and safe swallowing strategies for a resident.
• Jerseyville Nursing and Rehab Center for failing to assess, monitor, provide treatments as ordered and provide pressure relief to prevent pressure ulcers.
• St. Anthony’s Nursing and Rehab Center in Rock Island for failing to have adequately qualified staff to provide basic life support and CPR.

Eighty-three homes received “type A” violations for incidents with a “substantial probability” for death or serious mental or physical harm.

See the full list here.

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WASHINGTON (AP) — Bleeding and in pain, Kyleigh Thurman didn’t know her doomed pregnancy could kill her. [AP]

Emergency room doctors at Ascension Seton Williamson in Texas handed her a pamphlet on miscarriage and told her to “let nature take its course” before discharging her without treatment for her ectopic pregnancy.

When she returned three days later, still bleeding, doctors finally agreed to give her an injection to end the pregnancy. It was too late. The fertilized egg growing on Thurman’s fallopian tube ruptured it, destroying part of her reproductive system.

That’s according to a complaint Thurman and the Center for Reproductive Rights filed last week asking the government to investigate whether the hospital violated federal law when staff failed to treat her initially in February 2023.

“I was left to flail,” said Thurman, 35. “It was nothing short of being misled.”

The Biden administration says hospitals must offer abortions when needed to save a woman’s life, despite state bans enacted after the Supreme Court overturned the constitutional right to an abortion more than two years ago. Texas is challenging that guidance and, earlier this summer, the Supreme Court declined to resolve the issue.

More than 100 pregnant women in medical distress who sought help from emergency rooms were turned away or negligently treated since 2022, an Associated Press analysis of federal hospital investigations found.

Two women — one in Florida and one in Texas — were left to miscarry in public restrooms. In Arkansas, a woman went into septic shock and her fetus died after an emergency room sent her home. At least four other women with ectopic pregnancies had trouble getting treatment, including one in California who needed a blood transfusion after she sat for nine hours in an emergency waiting room.

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More than half of US states are reporting signs that COVID levels are poised to continue their summerlong rise. [Medscape & CDC]

The latest CDC wastewater monitoring data shows that 27 US states are detecting "very high" levels of SARS-CoV-2, the virus that causes COVID. The label "very high" indicates the highest viral activity level used by the agency. There are four lower levels that can be reported: minimal, low, moderate, and high. Nationwide, the lowest level being reported is moderate, and there are no states reporting low or minimal levels. 

"If you see increased Wastewater Viral Activity Levels of SARS-CoV-2, it might indicate that there is a higher risk of infection," the CDC warns.

How Do COVID-19 mRNA Vaccines Work?

Some of the COVID-19 vaccines are known as mRNA shots. How are they different from traditional vaccines? And do they contain the real virus?

There are other signs that the summer COVID wave is nowhere near ending its now 13-week consecutive climb. The rate of positive COVID tests reported to the CDC is now more than 17%, up from 0.3% in early May. The rate of positive COVID tests is at its highest level since about 2 years ago. The region of the US that includes Texas, Oklahoma, New Mexico, Louisiana, and Arkansas had the highest combined regional positive rate of 24% for the week ending August 3.

An updated COVID vaccine that is recommend for all people ages 6 months and older will be available later this fall.

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The US Food and Drug Administration is poised to sign off as soon as this week on updated Covid-19 vaccines targeting more recently circulating strains of the virus, according to two sources familiar with the matter, as the country experiences its largest summer wave in two years. [KFF News]

The agency is expected to greenlight updated mRNA vaccines from Moderna and Pfizer/BioNTech that target a strain of the virus called KP.2, said the sources, who declined to be named because the timing information isn’t public. It was unclear whether the agency simultaneously would authorize Novavax’s updated shot, which targets the JN.1 strain.

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