The American Medical Association (AMA) Code of Ethics urges physicians to "advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being." [Medscape] 

But how achievable is that level of physician activism in today's highly divisive US society? The differing attitudes among doctors, and how those attitudes shape actions taken or avoided, are shown in the Medscape Physicians' Views on Racial Disparities Issues Report 2022.

Survey respondents and commenters on the report expressed opinions that often sharply differed about the impact of racial disparities, how they influence delivery of patient care, and how they affect healthcare providers and staff.

How Dialed Into Racism Are Doctors?

Medscape surveyed doctors about 10 leading social issues. They ranked racial disparities third in terms of importance, behind healthcare access and substance/opioid abuse. Non-White survey respondents ranked racial disparities as an important issue somewhat more frequently than their White peers did.

"Even in extremely reputable professions like medicine, people are facing racism," one pediatrician respondent wrote. A family medicine physician respondent asserted: "We in medicine need to do better. I encourage insight about ourselves to learn about how to rectify injustice."

But other doctors felt certain social issues like racial disparities are disconnected from their professional duties. One commenter opined, "This topic is simply not our job as a physician. Keep your eye on the ball."

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Adults with hypertension saw a small, but consequential, rise in their blood pressure levels during the first eight months of the COVID-19 pandemic, while the number of times they had their blood pressure measured dropped significantly, according to a study supported by the National Institutes of Health.   [NIH]

The findings, which appear today in the journal Hypertension, represent one of the most extensive looks at blood pressure trends during the early months of the pandemic. Using data from three large U.S. healthcare systems, the findings add to growing evidence that blood pressure control worsened in people with hypertension during this period.

Still, the problem was not nearly as dire as they expected, possibly due to the rapid adoption of telemedicine and home blood pressure monitoring. The successful use of these alternatives to in-person office visits offers a reason to be optimistic about improving blood pressure control in future disasters and public health emergencies, according to the researchers.

Hypertension, or high blood pressure, affects over 1 billion people worldwide. Researchers have known for some time that poor blood pressure control is a risk factor for cardiovascular disease, including heart attack and stroke, as well as a risk factor for more severe COVID-19 disease. Yet, blood pressure control remains an ongoing challenge: Only about 1 in 4 U.S. adults with hypertension have their condition under control, according to the Centers for Disease Control and Prevention(link is external). The COVID-19 pandemic saw widespread stay-at-home orders and lockdowns, prompting some researchers to explore its impact on these patients.

In the current study – funded by the National Heart, Lung, and Blood Institute (NHLBI), part of NIH – researchers looked at the electronic data records of 137,593 adults with hypertension and compared blood pressure outcomes before the pandemic (August 2018 through January 2020) with those during the peak of the pandemic (April 2020 through January 2021). The data came from three large health systems: Cedars-Sinai in Los Angeles; Columbia University Irving Medical Center in New York City; and Ochsner Health in New Orleans. The average age of the patients was 66 years, and 57% were female and 30% were black.

The researchers discovered first that the number of blood pressure measurements patients had taken declined significantly in the first three months of the pandemic — by as much as 90% compared to before the pandemic. While these measurements gradually ticked up as the months passed, the total number of readings at the end of the study period remained below pre-pandemic levels. The researchers believe this was partly because of cancellations or postponements of face-to-face office visits.

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Consumers can start checking out Affordable Care Act marketplace health plans ahead of the 2023 open enrollment season, the Biden Administration announced.

“All families have the right to quality, affordable health care coverage. During this Open Enrollment period, consumers will have access to a variety of quality plan options at an affordable price.  We encourage consumers to visit HealthCare.gov and their state-based Marketplaces to preview plans and premiums now so that they’re ready to make selections when Open Enrollment begins on November 1,” said CMS Administrator Chiquita Brooks-LaSure.

CMS reported that 13 million Americans save on average $800 per year on health insurance. Through American Rescue Plan Act subsidies which have been extended for the next three years due to the Inflation Reduction Act, most consumers have access to health plans with a monthly premium of $10 or less.

Full article here>

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As providers deal with a surge of respiratory syncytial virus cases, pediatric health organizations in Illinois are struggling with declining beds and units dedicated to children. [Health News Illinois]

“We're in a crisis in Illinois, really around the region and the nation, trying to get kids that need to be admitted in the hospital,” Dr. Doug Carlson, medical director of HSHS St. John’s Children’s Hospital in Springfield, told Health News Illinois this week.

Pediatric beds dropped 30 percent in Illinois from 2019 to 2021, while pediatric intensive care unit capacity increased by 18 percent during that time, according to data provided by the Department of Public Health.

There are an average of 799 pediatric beds in Illinois this year, compared to 1,139 in 2019. Meanwhile, pediatric ICU beds are at 294, up from 263 in 2019.

It follows a recent trend in Illinois and across the country, with officials saying the decrease in pediatric units comes down to a matter of economics, as institutions make more money from adult patients.

Illinois hospitals reduced licensed pediatric beds by 27 percent from 2012 through 2017, according to a study released last year by Ann & Robert H. Lurie Children’s Hospital of Chicago. Thirty-three hospitals cut all pediatric beds at their facility during that period.

The New York Times reported earlier this month that 48 Illinois counties have no pediatrician at all.

However, the decline in beds is not necessarily all bad, said Dr. Matthew Davis, chair of pediatrics at Lurie Children’s. He said “converging efforts” in the prevention and management of chronic conditions are driving down the need for hospitalizations across the country among children and adolescents.

The issue arises when surges in viral illnesses occur such as with the current RSV spike.

“While in COVID, what hospitals with both adult and pediatric beds did was to essentially close the pediatric beds, and then open them for taking care of grown-ups with COVID,” Davis said. “It's much harder to do the opposite because nurses and respiratory therapists and the doctors who take care of children are differently trained, as children are not small adults. They have different health problems and different vulnerabilities and we need that specialized training in order to optimize quality and safety for kids in a hospital setting.”

A spokesman for IDPH said Thursday that only 6 percent of pediatric ICU beds in the state are open.

Officials at the University of Chicago Medicine Comer Children's Hospital said in a memo to staff earlier this month that pediatric emergency department volumes are up 32 percent from September and more than 150 percent from this time last year. Additionally, transfer requests “continue to climb as overwhelmed community hospitals seek to send us patients for specialized care.”

“Beyond the needs of our own patient community, Comer Children’s has been able to accept more than 670 transfer patients from area hospitals since Sept. 1,” they said. “With limited pediatric hospital beds available in Illinois and Indiana, we must do everything to stretch our finite resources so we can provide high-quality care for as many children as possible.”

The hospital has declined more than 500 other requests due to a lack of available beds.

Carlson said they have particular challenges in central Illinois, as more rural hospitals and providers go to them as a “safety net” to provide pediatric services. When a surge occurs, it only exacerbates the problem.

“We have a line of kids in regional emergency departments that are waiting for beds, and we call them as soon as we have a bed available,” Carlson said.

Davis said the decline in beds has made collaborations between hospitals and health systems even more important to ensure children receive care. He noted that Lurie Children’s accepted transfers from 129 different hospitals across Illinois in 2020 and 2021.

 “We, as a group of hospitals in the state, need to work extra hard to be there for each other in ways that sometimes don't have easy answers,” Davis said. 

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A new analysis of nearly 3000 counties in the United States found that a poorer local food environment is associated with higher heart failure (HF) mortality at the county level. [Medscape]

Previous research has established that food insecurity increases the risk for worse health outcomes. But few studies have looked specifically at HF outcomes and much of the work was restricted to single metropolitan areas or health systems, which may not have captured the diversity and variance of access to food across the US, explained study author Keerthi Gondi, MD, University of Michigan in Ann Arbor.

Further fueling their desire to look at the population level was the acute rise in food insecurity with the COVID-19 pandemic, he noted....

The full paper, published online October 25 in Circulation: Heart Failure, includes 2956 countries with an average FI% of 13% and average FEI of 7.8.

Counties with an FI% above the national median of 13.7% had higher HF mortality than those below the national median (30.7 vs 26.7 deaths per 100,000 people; P < .001).

The association with mortality was stronger for heart failure than with non-HF cardiovascular disease and all-cause mortality, Gondi said. "This, I think, demonstrates a unique relationship between heart failure and food insecurity."

Full article here> 

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WHO published a report highlighting the first-ever list of fungal "priority pathogens" – a catalogue of the 19 fungi that represent the greatest threat to public health.  The WHO fungal priority pathogens list (FPPL) is the first global effort to systematically prioritize fungal pathogens, considering the unmet research and development (R&D) needs and the perceived public health importance. The WHO FPPL aims to focus and drive further research and policy interventions to strengthen the global response to fungal infections and antifungal resistance.

Fungal pathogens are a major threat to public health as they are becoming increasingly common and resistant to treatment with only four classes of antifungal medicines currently available, and few candidates in the clinical pipeline. Most fungal pathogens lack rapid and sensitive diagnostics and those that exist are not widely available or affordable globally.

Full article here> 

WHO Fungal Priority List Download copy here> 

Other info>

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Parents who need to take a child to the emergency room are facing agonizing waits in many parts of the United States because of a shortage of hospital beds. [CNN Health]

Hospitals across the country say they are being overwhelmed by an early surge in respiratory infections including RSV, influenza and enterovirus. As a result, pediatric hospital beds are more full now than they have been in the past two years, according to a CNN analysis of data from the US Department of Health and Human Services.

Full article here> 

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The Model List of Essential Medicines of the World Health Organization (WHO) highlights medicines considered the most effective, safe, and important for priority public health needs.

In the years since its first publication in 1977, the Essential Medicines List has shaped the diffusion and reimbursement of new medicines in health systems around the world. The list, which remains a voluntary guideline for national formularies, was established with the goal of making included therapies widely available and affordable. However, the selection of medicines for inclusion in the list has been increasingly complicated by the escalating prices of new drugs entering the market. [JAMA Network}]

With the publication of its 2021 list, which comprised more than 400 medicines, WHO for the first time explicitly acknowledged that several medicines, including checkpoint inhibitors for lung cancers, were not on the list—despite being highly effective—due to prohibitively high prices.1 In this Viewpoint, we propose restructuring the list to formally remove consideration of cost and cost-effectiveness from the expert committee reviews of clinical effectiveness, safety, and public health value and chartering a new framework for pooled global negotiation and procurement of costly medicines eventually included in the list.

The recent update of the Essential Medicines List resurfaced a long-standing tension with some medications between high costs and essential need for health systems and patients. The roots of the current controversy can be traced to the introduction of the first antiretroviral therapies in the late 1990s that were costly; until then, cost (specifically, experts’ judgment about the affordability for low-income countries) had a central role in the consideration of whether a therapy should be included in the list. Full article here> 

Download PDF here>

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Reimagining Children’s Rights in the US [JAMA Network] "The US remains the only country without a national framework for securing the rights and well-being of all children ages 0 to 17 years.1 "

The US faces a pivotal moment of opportunity and risk regarding issues affecting children (aged 0-17 years). Although the US remains the only United Nations member state to not have ratified the Convention on the Rights of the Child (CRC), a child rights framework is essential for child health professionals seeking to advance many issues affecting children in the US.

The Reimagining Children’s Rights project (2020-2021) conducted an in-depth environmental scan of relevant literature and policy analysis using the Three Horizons design process to assess strategies that could advance the rights and well-being of children in the US.

The project was overseen by a steering committee and informed by an advisory committee composed of youth leaders and experts in children’s rights, advocacy, health, law, and a range of
child-specific issues (eg, youth justice, early childhood development), who provided expert input on strategic considerations for advancing children’s rights.

Seven findings about advancing children’s rights in the US are notable, all reflecting current gaps and opportunities for using a whole-child rights framework in the US, even without formal adoption of the CRC. Actionable strategies, tactics, and tools to leverage sustainable change in the multitude of issue areas can advance the current state of children’s rights. 

Read full article here>

Download six-page article here>

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We often hear talk from older generations about how much more difficult they had it when they were young -- and doctors are no exception. It's not uncommon to hear older physicians and younger physicians argue about whose training was more difficult. But how does medical school today actually compare with medical school in the past? Let's explore both sides of the argument to determine who had it tougher. [MedPage Today]

Video 

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