A Hard Pill to Swallow: Medication with built-in adherence monitor

https://goo.gl/xMjguZ

On November 13th the FDA approved Abilify MyCite, the first pill that contains a sensor to monitor whether or not the patient is taking her medication. This event ticks several boxes, cutting edge science and technology, a boon to the forgetful, a giant step forward for obtaining data and a giant step backward for what remains of privacy.

Ironically (Kafka couldn’t make this up) Abilify is a drug used to treat paranoia. One can only imagine the psychiatrist’s conversation with a paranoid patient. “So this new pill has a device in it that tells us whether you’re taking your medication or not. It will help us help you.” No problem.

The pill combines the antipsychotic, aripiprazole, with Proteus’s ingestible event marker (IEM). The IEM is activated in the stomach. There it sends a message to a wearable patch that transmits to a mobile application on the patient’s smart phone and is accessible to caregivers through a web-based portal. This last bit requires patient permission.

Abilify is commonly used in schizophrenia. About 1 percent of Americans, more than 32 million people, have schizophrenia. In fact, 1% of any population anywhere in the world is schizophrenic.


Rocking the Cradle: The Rights of Parents with Disabilities

https://goo.gl/15fQBT

On November 14, 2017, Washington College of Law’s Disability Law Society and Family Law Society hosted “Rocking the Cradle: The Rights of Parents with Disabilities.” The hosts invited four experts on the issue: Molly Burgdorf and Carla Carter, who are both civil rights analysts for the U.S. Department of Health and Human Services; Sarah DeCosse, who is an attorney advisor in the disability rights section of the civil rights division of the U.S. Department of Justice; and Joan Durocher, who is the general counsel and director of policy for the National Council on Disability. Each panelist spoke for about ten minutes in total, and a variety of issues relating to the rights of a parent with disabilities was covered.

Ms. Durocher started by talking about a report that the National Council on Disability created called Rocking the Cradle: Ensuring the Rights of Parents with Disabilities and Their Children. The report found that discrimination against parents with disabilities is extreme. It is one of the only groups in the U.S. who must fight to retain or even to gain parental rights. Ms. Durocher emphasized this by telling the story of a baby who was taken away from two blind parents simply because they were blind. Those parents had to fight from the start for the right to be allowed to keep their child. The report recommended a number of things to do to prevent situations like this from happening. It encourages states that list disability as a reason to terminate parental rights to eliminate such statutes. The report found that thirty-seven states have these types of statues on the books. In addition, the report also recommended that the Department of Education build parenting skills into its curriculum for people with disabilities. The report further asked for better data collection and for Congress to address the problem.

And Much More....


The Crisis of Rural Despair

https://goo.gl/599ata

"It's an epidemic in our community," says Skyler, now 27 and active in local suicide-prevention efforts. "There are so many different factors. We have a heavy prevalence of alcohol, heroin, and meth. We have miners working underground 24 hours a day with no sunlight. There's a lack of resources, and there's a stigma about discussing your issues. It's that old cowboy thing: Buck up and move on."

Nevada ranks last in the country in overall mental health, according to the nonprofit group Mental Health America, which rates the prevalence of mental illness and substance abuse in relation to access to care. A report earlier this year from the University of Nevada, Reno, found that 16 of the state's 17 counties have a severe shortage of mental health professionals. Fourteen are without a single psychiatrist, and a smattering of psychologists and social workers are spread over tens of thousands of square miles. In 2015, the state had the 11th highest suicide rate in the country. From 1981 to 2013, it was number two in suicide by self-inflicted gunshot wound—second only to Wyoming. 

In many ways, Nevada typifies the broader state of mental health in rural America. Since 1999, premature death rates have risen sharply among rural whites; analyses point to marked increases in suicide, drug overdoses, and liver disease, presumably related to alcohol abuse, which collectively were designated "deaths of despair" in a 2015 paper by Princeton economists Anne Case and Angus Deaton. Last year, the Centers for Disease Control reported that both suicide rates and drug overdose rates in rural areas have surpassed those in metropolitan areas. And rural areas everywhere are faced with a chronic lack of access to care. 

In 1948, Cornell University psychiatrist Alexander Leighton and his colleagues traveled Canada's maritime province of Nova Scotia to initiate what would become known as the Stirling County Study, a longitudinal study that continues to this day. Parts of the region were in the midst of economic decline, and the researchers found that psychiatricdisorders were higher in communities with "broken homes, few and weak associations, inadequate leadership, few recreational activities, hostility and inadequate communication, as well as poverty, secularization, and cultural confusion."

The Stirling County Study is a landmark from the early days of psychiatric epidemiology, when scientists began to look at social determinants of mental health. Many subsequent studies have echoed and elaborated on its key findings. "It's clear from data across the decades that there's a connection between the health of the economy, the health of communities, and the development of mental health problems," says psychologist Peter Keller, a researcher and past president of the National Association for Rural Mental Health.

Keller cautions against painting rural settings with a broad brush. Some are thriving, he says, some are chugging along, and some have creatively reinvented themselves after their former economic base disintegrated. Financial distress also isn't the sole source of psychiatric troubles. But many rural areas that have experienced years of systematic job loss, especially those that were built on manufacturing, have seen a cascade of human damage that can be traced in large part to the economy. In vast swaths of the country, young people face a future without financial stability, let alone upward mobility. Those who are middle-aged are not even treading water. The stressors add up, fostering conditions with grave outcomes.


Medicaid Leaves Many Hepatitis C Patients Behind

https://goo.gl/xMQrkV

As a liver disease doctor in Chicago, Illinois, Nancy Reau treats patients with hepatitis C, a viral infection that kills more people in the United States than 60 other infectious diseases combined, including HIV. Her practice has changed dramatically since 2013, when a flurry of miracle “cures” for hepatitis C were approved. Since then, Reau has successfully treated a majority of her hepatitis C-positive patients.

However, Reau still has about 30 patients who are waiting for treatment. These patients have one trait in common—they’re covered by Medicaid. Across the country, Medicaid programs continue to triage curative treatment, even as most other insurance providers have adopted a treat-all approach. Some Medicaid restrictions include sobriety tests and proof of extensive liver damage, which run counter to medical consensus.

Treatment denial “is a hard message for patients to stomach, especially a patient who has finally invested in taking care of themselves,” Raeu says. Often, she adds, “they fall out of the system.” For many state Medicaid programs, restricting access softens the financial blow of expensive hepatitis C cures. But for doctors, these restrictions are a nightmare, as they block access for their most vulnerable patients.

In recent years, the price of hepatitis C medications has dropped dramatically, yet more than half of state Medicaid programs were given a “D” or an “F” in recent report card compiled by Harvard’s Center for Health Law and Policy Innovation (CHLPI). With this report card in hand, lawyers at CHLPI and other advocacy groups have a new weapon in their legal battle on behalf of low-income people seeking a cure for hepatitis C.


Medicare Penalizes Group Of 751 Hospitals For Patient Injuries

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The federal government Thursday lowered a year’s worth of Medicare payments to 751 hospitals to penalize them for having the highest rates of patient injuries.

More than half also were punished last year through the penalty, which was created by the Affordable Care Act and began four years ago. The program is designed as a financial incentive for hospitals to avoid infections and other mishaps, such as blood clots and bedsores.

The penalties again fell heavily on teaching hospitals, although less than before. A third of them were punished this year, a Kaiser Health News analysis of the penalties found. Last year, the penalty was levied on nearly half of the nation’s teaching hospitals.

The 115 penalized academic medical centers this year include Denver Health Medical Center, Grady Memorial Hospital in Atlanta, The Mount Sinai Hospital in New York City, Northwestern Memorial Hospital in Chicago, Stanford Health Care hospitals in California and the University of California-San Francisco (UCSF) Medical Center, according to federal records.

“Academic medical centers serve patients with more-complex conditions who are at greater risk of hospital-acquired infections (HAIs) compared to community health care providers,” Stanford Health Care said in a written statement. “Hospitals with a high rate of immunocompromised patients will always seem to have higher HAIs.”

Hospitals that treat large proportions of low-income people also were fined more than hospitals with a more affluent patient base, the analysis found. About a third of those safety-net hospitals were penalized, roughly the same as last year.