This paper is composed of three distinct but interrelated parts that together map the past, present, and future of addressing racial inequities in Maternal and Child Health. Part I recounts the history and achievements of a Centers for Disease for Control and Prevention initiative in the 1980–90’s, led by the Prematurity Research Group in the Division of Reproductive Health, Pregnancy and Infant Health Branch. [Maternal Child Health Journal]

This initiative stimulated a paradigm shift in how we understand and address black infant mortality and the inequities in this outcome. Part II illustrates examples of some exemplary programmatic and policy legacies that stemmed either directly or indirectly from the Centers for Disease for Control and Prevention paradigm shift. Part III provides a discussion of how efectively the current practice in Maternal and Child Health applies this paradigm to address inequities and proposes a path for accelerating Title V agencies’ progress toward birth equity. 

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Medical practice is about the human interaction between clinicians and patients, but what does it mean when a technology with human-like attributes such as AI enters the examination room? How does the dynamic between clinicians and patients change when AI is involved? [JAMA]

In a recent interview, Kirsten Bibbins-Domingo, PhD, MD, MAS, editor in chief of JAMA and the JAMA Network, discussed this aspect of AI with primary care physician Ida Sim, PhD, MD (Video). Sim is codirector of a joint program between the University of California, Berkeley, and the University of California, San Francisco (UCSF) in computational precision health. She is also an elected member of the National Academy of Medicine and the American College of Medical Informatics.

The following is an edited version of the interview.

Dr Bibbins-Domingo: I think of you as a physician who’s been in this informatics research space for a long time. You’ve also thought about how we create structures for sharing data and making data more accessible, and now all of us are talking about AI, and it’s transforming how we’re going to practice. It’s transforming how we’re going to do science. Why are we talking with a different urgency right now?

Dr Sim:I t is an urgency, absolutely. I think November 30, 2022, is going to go down in history. That was the day when ChatGPT came out. I had been talking to other people here in Silicon Valley about ChatGPT-2.0, about DALL-E, and it was just mind-blowing what was going on in the computer science world that we were not seeing publicly. But November 30 changed that.

That was an inflection point, and this is why I think it’s so transformative. AI and machine learning are 2 different terms, but we won’t dissect those. A lot of the work previous to what the public sees has been machine learning. You take a bunch of data, stick it in a black box and out comes something. And that something is usually a prediction.

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NIH-funded research sheds light on link between COVID-19 infection and increased risk of cardiovascular disease and stroke. [National Institutes of Health]

SARS-CoV-2, the virus that causes COVID-19, can directly infect the arteries of the heart and cause the fatty plaque inside arteries to become highly inflamed, increasing the risk of heart attack and stroke, according to a study funded by the National Institutes of Health. The findings(link is external), published in the journal Nature Cardiovascular Research, may help explain why certain people who get COVID-19 have a greater chance of developing cardiovascular disease, or if they already have it, develop more heart-related complications.

In the study, researchers focused on older people with fatty buildup, known as atherosclerotic plaque, who died from COVID-19. However, because the researchers found the virus infects and replicates in the arteries no matter the levels of plaque, the findings could have broader implications for anybody who gets COVID-19.

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Health leaders said Tuesday that continued investments in public health and awareness campaigns are necessary to get ahead of the anticipated rise in long COVID cases in Illinois. [Health News Illinois]

Jerry Krishnan, associate vice chancellor for population health at the University of Illinois Chicago, said those in the clinical field are becoming more aware of the condition, but public awareness of the impact of long COVID remains low.

Initial research has shown that the economic toll of long COVID is over $1 trillion, Krishnan said. And that number is expected to keep increasing as individuals face symptoms like “brain fog” and persistent restlessness.

“We need to be thinking now about how to mitigate the health and economic burden of long COVID,” he told the Senate’s Public Health Committee during a hearing in Chicago. "It is definitely there, and just because it's not being tracked by the state doesn't mean it's gone.”

One of the main challenges, Krishnan said, is the lack of up-to-date data on COVID-19 trends in Illinois. 

He noted the Department of Public Health has stopped some of its COVID-19 reporting since the end of the public health emergency in May, which makes it more difficult to track trends and whether stakeholders are making any progress with their outreach efforts.

Dr. Melissa Simon, director of the Center for Health Equity Transformation in the Feinberg School of Medicine at Northwestern University, said raising public awareness is also a major step to addressing long COVID. As a practicing OB-GYN, she said she still regularly talks with patients who have no idea of the effects of long COVID, especially on vulnerable populations.

She said stakeholders need to prioritize historically underserved individuals, specifically Black and brown residents. While roughly 15 percent of adults who caught COVID-19 in Illinois experience long COVID, Simon said the challenge is knowing what racial and ethnic groups bear that disproportionate burden of long COVID.

Both Simon and Krishnan said an important step to addressing that issue is to better fund the public health infrastructure.

“I think that all of that data combined are very compelling to to underscore why this is such a critical issue to not ignore,” Simon said. “Even though COVID is a topic that people want to run away from, especially in the political arena, Dr. Krishnan and I fully agree that COVID is not gone, it's here to stay, and it could get worse again.”

Arti Barnes, chief medical officer for the Department of Public Health, told lawmakers they are talking with federal partners about the need for better diagnostic coding for long COVID that will “capture severity as well as the associated symptoms.” 

Additionally, she said they have discussed the need for clinic-based claims data and social security disability claims related to long COVID to help the department better understand the impact of the disease in local communities.

While those discussions are ongoing, Barnes said the department is working with providers to better identify long COVID conditions so they can best serve patients.

They are also continuing the public push for COVID-19 vaccinations, saying that being vaccinated remains one of the best ways individuals can protect themselves from long COVID, she said.

Sen. Robert Peters, D-Chicago, said long COVID-19 is an issue that lawmakers will need to take a closer look at when they return next spring, 

 “We really have to mainstream this, and we got to make sure that the data that was discussed earlier is better tracked, particularly for people that have those intersectional identities,” he said. “We (also) need to make sure that we are pushing up federal lawmakers on this issue.”

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Sen. Dick Durbin, D-Ill., filed a brief with other senators last week in support of allowing the Centers for Medicare & Medicaid Services to negotiate lower drug prices.  [Health News Illinois]

The amicus brief, filed in the District Court for the District of Columbia, argues that Congress was well within its rights when it approved a plan last year that gives the federal agency the authority to negotiate prices with drug manufacturers. 

The agency already negotiates costs with providers, lawmakers said, and the work is no different than what federal payers like the Department of Veterans Affairs are legally allowed to do.

“We’re telling the courts: The Medicare prescription drug program is squarely within Congress’s constitutional powers, and it’s working for families,” Durbin said in a statement.

Drug manufacturer Merck & Co. sued the federal government in June over the new authority, arguing it violates their constitutional rights by allowing the government to unilaterally impose its preferred price.

“The (law) wields the threat of crippling penalties to force manufacturers to transfer their patented pharmaceutical products to Medicare beneficiaries,” Merck said in its lawsuit.

 The Biden administration last month announced the first 10 drugs selected for Medicare price negotiation.

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I’m an ER doctor: Here’s what AI startups get wrong about “ChatGPT for telehealth” The explosion of telehealth might seem like a huge opportunity for AI. But it is also a huge risk. [Fast Company]

As a practicing ER doctor, I’m quite excited by the potential of LLMs like ChatGPT for health care. I already use it as a communication tool for some of my patients, and sometimes feed ChatGPT detailed prompts of patient symptoms to generate possible diagnoses I haven’t yet considered.

As a part-time advisor to healthtech startups, however, I’m increasingly concerned that many in Silicon Valley are confusing the capabilities of LLMs as they relate to the practice of medicine. Especially telehealth.

The omnibus bill President Biden signed last January extends telehealth flexibilities on patient appointments and insurance coverage through December 31, 2024. Assuming insurers continue following suit until then, we have about a year to deliver on the promise of telehealth.

This might seem like a glowing opportunity for a program like ChatGPT. Thanks to the pandemic, virtual care/telehealth is now a standard procedure, with roughly 1 in 4 patient appointments conducted remotely. So why not integrate an LLM into the remote treatment process, acting as a virtual nurse practitioner which communicates to patients through text? Indeed, there are already a number of startups roughly based on that use case.

After treating thousands of people remotely since the COVID era, I should explain in vivid detail how bad an idea this is. 

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A spokeswoman for the Department of Healthcare and Family Services confirmed Thursday that they are not pausing Medicaid disenrollments in Illinois. [Health News Illinois]

That comes as the Biden administration ordered 30 states on Thursday to halt procedural disenrollments over concerns that a glitch in their eligibility systems caused children and other individuals to unintentionally lose coverage during the Medicaid redetermination process.

While Illinois was one of the 30 states identified by the U.S. Department of Health and Human Services, HFS spokeswoman Jamie Munks noted an HHS press release said the federal agency required the pause unless states “could ensure all eligible people are not improperly disenrolled due to this issue.”

“Starting this month, ex parte redeterminations are being conducted at the individual level, and HFS is working on reinstating the cases that were closed July 31 that would have been deemed eligible with this change,” Munks said. “As a result, Illinois has not paused Medicaid disenrollments.”

Munks noted that if the ex parte process is not successful, the Medicaid members are then sent renewal materials.

CMS sent a letter last month to all state Medicaid directors asking them to evaluate whether children in their states are being affected by Medicaid eligibility systems. For systems deemed faulty, the agency asked states to pause “procedural disenrollments” until the issue can be fixed.

Munks said the agency has been “working for weeks on a solution to allow for ex parte redeterminations at the individual level before any additional disenrollments occurred.”

HHS said Thursday that nearly 500,000 children and other individuals nationwide who were improperly disenrolled from Medicaid or the Children's Health Insurance Program will regain their coverage due to efforts to address the issue. The agency estimates that fewer than 10,000 Illinoisans were affected by the system glitch.

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Federal help is coming to the state of Illinois to combat mental illness. [Fox 32] See video here.

There is now $130 million in grant money available across the U.S. for community-based mental health and substance abuse. 

Illinois is set to receive $8 million of that money.  The funding is coming from the U.S. Department of Health and Human Services to expand certified community behavioral health clinics across the country. 

The Biden-Harris Administration says it's an ongoing effort to tackle the country’s mental health crisis and beat the opioid epidemic.

The federal announcement was made at the Chicago-based Thresholds Center for Mental Health and Well-Being.

The organizations in Illinois will receive up to one million per year for four years.

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In the wake of growing alarm over the disproportionately high rates of maternal mortality in the U.S., maternal health experts have been pushing for changes — including expanding the midwife workforce. [STAT] Studies have shown that deliveries attended by midwives tend to have fewer complications and better outcomes, partially because midwife training relies less on medical intervention, leading to fewer C-sections.

The number of credentialed midwives — including both certified nurse-midwives, who can attend births in hospital settings, and a minority of certified midwives, who don’t hold a nursing degree — in the U.S. more than doubled from 1991 and 2012 and has continued to grow steadily in the years since. Universities have also expanded their course offerings, with the number of new students enrolled in accredited midwifery programs growing from 1,006 students in 2014 to 1,214 in 2018, according to the latest data available.

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Several months ago, I interviewed the late Sally Zinman, a heroine of our mental health movement of people with lived experience. I asked what changes she would like to see in the mental health system in the future. Without hesitation she said that the system should value and encourage self-determination and totally voluntary, noncoercive services. [MedPage]

I will discuss here the dangers of involuntary commitment, and demonstrate the ways that I believe Emotional CPRopens in a new tab or window (eCPR), which I will define below, contributes to Zinman's vision.

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