Health and Disability

Whilst decrying rapid increases in drug spending and prices, elected officials have actually made it increasingly difficult for insurers to do anything about it. As payers, insurers are the only parties in the health care system who have both the means and the incentive to counter drug firms’ pricing power. For example, insurers have aggressively steered patients from branded to generic drugs, saving billions in the process. However, much of the growth in drug spending is attributable to new drugs that do not yet face generic competition.

In normal markets, monopolies face constraints on their pricing power. The higher they set the price, the less they sell. Insurers want to present drug companies with the same trade off, but as I describe here, numerous policies enacted in the name of facilitating patient access limit insurers’ ability to do so.

The War on Drugs, mass incarceration of drug users, and the failure to provide proven harm reduction and treatment strategies has led to high levels of HIV, tuberculosis, and hepatitis B and C infection among prisoners - far higher than in the general population. With an estimated 30 million people passing in and out of prisons every year, prisoners will be key to controlling HIV and tuberculosis epidemics worldwide, according to a major six-part Series on HIV and related infections in prisoners, published in The Lancet and being presented at the International AIDS Conference in Durban, South Africa.

"Prisons can act as incubators of tuberculosis, hepatitis C, and HIV and the high level of mobility between prison and the community means that the health of prisoners should be a major public-health concern. Yet, screening and treatment for infectious diseases are rarely made available to inmates, and only around 10% of people who use drugs worldwide are being reached by treatment programmes", says lead author of the Series and President of the International AIDS Society Professor Chris Beyrer, John Hopkins Bloomberg School of Public Health, Baltimore, USA. "The most effective way of controlling infection in prisoners and the wider community is to reduce mass imprisonment of injecting drug users." ¹

When a certified nursing assistant in Hubbard, Iowa, shared a photo online in March of a nursing home resident with his pants around his ankles, his legs and hand covered in feces, the most surprising aspect of state health officials’ investigation was this: It wasn’t against the law.

The Iowa law designed to protect dependent adults from abuse was last updated in 2008, before many social media apps existed. It bars “sexual exploitation of a dependent adult by a caretaker,” which would have applied if the photo showed the resident’s genitals. It didn’t.

The nurse assistant was fired from Hubbard Care Center after a co-worker reported her to supervisors, but the state was unable to discipline her at all. She remains eligible to work in any nursing home in the state. Government documents did not name her.

“This was something no one expected,” said David Werning, a spokesman for the Iowa Department of Inspections and Appeals, of the case. The nurse assistant had used Snapchat to send the photo of the resident, who has dementia, to six colleagues, along with the caption “shit galore,” according to government reports.

Following ProPublica’s earlier coverage, Sen. Charles Grassley, the Iowa Republican who chairs the Senate Judiciary Committee, sent letters to social media companies and federal agencies asking what they are doing to stop the abuse. He’s taken Snapchat, in particular, to task because he said its online tool for reporting suspected abuse requires the affected person to file a complaint — a near impossibility for elderly people with dementia.

“When an individual tries to report a safety concern on behalf of someone else, say, an elderly nursing home resident, the tool produces the message: ‘We are unable to take action based on third-party reports,’” Grassley wrote to Snapchat on June 28. “An elderly nursing home resident victim is unlikely to have his or her own Snapchat account or have the knowledge or ability necessary to report abusive snaps on his or her own behalf.”

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To help sort the data out, Song's group pooled the data from 34 clinical trials on magnesium supplements, which together involved more than 2,000 people.

The daily dosage of magnesium supplements used ranged from 240 milligrams (mg) to 960 mg. Most trials had participants meet or exceed the U.S. Recommended Dietary Allowance for daily magnesium intake.

Sifting through the collected data, Song's team detected a small but significant link between magnesium intake and healthy reductions in blood pressure.

For example, the study found that taking about 368 mg of magnesium daily for about three months resulted in overall reductions in systolic blood pressure (the top number in a reading) of 2 millimeters of mercury (mm/Hg) and diastolic blood pressure (the bottom number) of 1.78 mm/Hg.

Higher magnesium levels were associated with better blood flow -- another factor linked to lower blood pressure, the researchers added.

Song and his colleagues believe that the benefits of magnesium in regulating blood pressure may only apply to people with a magnesium deficiency or insufficiency.

Still, the finding "underscores the importance of consuming a healthy diet that provides the recommended amount of magnesium as a strategy for helping to control blood pressure," American Heart Association spokeswoman Penny Kris-Etherton said in an AHA news release.

One third of U.S. consumers are interested in receiving text message reminders from their doctors to take prescribed medicine, according to the Locent Text Adherence Survey, in which the mHealth technology vendor polled 1,000 consumers with help from Google.

Millennials are the age demographic most interested in text reminders from doctors, the survey found. And 39 percent of consumers ages 18-24 years old said they were interested in receiving text message reminders from their doctors to take prescribed medicine. More than 31 million Americans make up that age group; consequently, that would mean 12 million consumers ages 18-24 years old are interested in receiving these reminders. That compares with only 22 percent of consumers ages 55–64 years old, the survey said.

At 36 percent, men are more likely than women, at 29 percent, to desire text reminders for taking medicine as prescribed. Locent and Google said these findings indicate text messaging could be a good conduit between doctors and male patients given that, according to a study by the Centers for Disease Control and Prevention, men are 80 percent less likely than women to use their healthcare providers.

In nursing homes across the country, residents like Mr. Piercy are plagued by cavities, gum disease and cracked teeth, in part because their mouths are not kept clean. While residents now require more dental care than in the past, nursing home employees are rarely prepared to provide it. Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

Even when care is available, few staff members are trained to cope with the rising numbers of residents with dementia who resist routine dental hygiene.

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University. “Aides change someone’s Depends, change a catheter or turn somebody every few hours, but teeth often don’t get brushed twice a day.”

The neglect can lead to terrible pain for the residents. Worse, new studies suggest that this problem may be contributing to another:pneumonia, a leading killer of  institutionalized older people.

All three women contracted the disease after medical procedures were done to their backs. All three struggled to find a physician with the understanding necessary to treat a disease that many consider to be rare and hopeless.