Michigan Disability Resistance

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Medicare is currently exploring two alternative payment models for Hospital at Home services, which may allow more healthcare organizations to provide these options.

A recent report outlines five strategies for enhancing the way healthcare providers collect data on patient experience.

Although integrating artificial intelligence into healthcare has great potential, experts also need to understand the limitations of the technology.

What will drive positive changes in healthcare? A recent survey revealed six topics that experts believe will improve care.

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Acute care visits rose five-fold in time after coverage gap.

The longitudinal study including over 168,000 adults with type 1 diabetes found roughly a quarter experienced an interruption in their private insurance coverage between 2001-2015, reported Mary Rogers, PhD, MS, of the University of Michigan in Ann Arbor, and colleagues.

Following these insurance interruptions, patients experienced a five-fold increase in the use of acute care services compared to before their interruption in health coverage, the group wrote in Health Affairs. This increase in acute care visits from the 30 days prior to the interruption versus 30 days after the interruption also varied according to the gap length (P<0.001 for all):

• Gap length 31-60 days: incidence ratio ratio 5.25 (95% CI 4.14 to 6.64)
• 61-90 days: IRR 4.16 (95% CI 2.98 to 5.80)
• 91-120 days: IRR 7.19 (95% CI 4.76 to 10.85)

This increase in acute care visits was elevated after the interruption for both men and women, although was slightly higher among women.

"These acute care services are costly, and largely preventable with regular self-care guided by a primary care physician or an endocrinologist," Rogers noted in a statement.

More specifically, each individual interruption in insurance coverage was associated with a 3.6% (95% CI 1.2 to 5.9, P=0.003) relative increase in HbA1c level for these patients, increasing in a dose-response manner. Also associated with coverage interruptions were lower perceived health status by patients and a lower satisfaction with life.

"Type 1 diabetes requires intensive daily management, in order to simply remain alive, so interruptions to care and coverage of insulin and supplies can pose a major risk," explained Rogers, adding that "while we expected gaps in coverage to affect health in some way, the size of the effect and the frequency of gaps were striking."

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“I don’t see any reason why we waste resources on severely retarded people,” someone asked in the popular r/changemyview subreddit in 2014. “Why would we ever spend our resources on something like this rather then [sic] people that will benefit far more from them?” The harsh question netted over 300 replies with many people debating whether euthanasia is a “merciful” solution for people who are “not really human beings.” A few commenters said that the entire conversation dehumanized disabled people. Ultimately, the original poster concluded: “Even though my view on the burden on society remain unchanged, you’re right that there’s probably no real way to implement [a way to make value judgements on who should be allowed to live and die].”

While the original question is reprehensible, the conversation echoes a largely held opinion in the environmental movement about who “deserves” resources. The assumption that disabled lives are worth less is at the core of these conversations, and a failure to reckon with that warped premise alienates the disability community. Implying that nondisabled people need and deserve more resources than disabled people also distracts from finding real solutions to issues such as climate change, resource scarcity, and pollution.

Nowhere is this more evident than in the current fight over plastic straws, a cause célèbre of the environmental movement. “Stop sucking,” a cheeky environmental campaign exhorts, noting that millions of straws end up in the trash, and often the ocean, every year. A heartrending video of a sea turtle with a plastic straw sticking out of its nose has become emblematic for the war on straws, just as chilling images of birds ensnared in six-pack ringspushed consumers to demand changes to beer and soda packaging in the 1990s.

Straws represent independence for some disabled people who can’t drink on their own without one and would otherwise need the help of a caregiver to drink. Others need a straw even when drinking with assistance because of hand tremors, limited muscle control, or other issues. Telling disabled people they should rely on support or slop fluids all over themselves is infantilizing, but also dangerous: An aide isn’t always available to help someone take a sip and dehydration can be fatal.

While alternatives to plastic—such as glass, metal, silicone, and paper—exist, some express concerns about their practicality and usability; metal may cut a person’s mouth, for example, while paper isn’t sturdy enough for someone with limited muscle control. Mentioning the effect that banning straws might have on disabled people has become a dangerous proposition. On social media, the anti-straw brigade lectures about alternatives disabled people are already aware of or shames disabled people for needing to drink. “Quit harming the environment because you can’t take care of your own needs,” said one helpful commenter. “Sorry, the trouble cleaning and inconvenience still doesn’t trump the damage caused by plastics,” said another.

Picking a fight over straws may seem nonsensical, but the larger low-waste and zero-waste movements, which tend to be overwhelmingly white and nondisabled, frequently single out products that benefit the disability community, like straws or pre-cut fruits and veggies, as a wasteful use of natural resources. It’s a two-part logic: One, the planet’s resources are limited and growing scarcer, and two, the way to control that is by cutting back on the use of nonrenewables. This does little to explore which humans are using the majority of resources on Earth and where the real choke points of waste lie. And it feeds insidious attitudes about who should be “allowed” to use the resources that are available.

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The Prisoner’s Dilemma has some important implications for the world of business and economics. But today, as the fundamental structure of our world and industries are altered by exponential technologies, these implications ought to be questioned. In many ways, the Prisoner’s Dilemma oversimplified human nature and makes some erroneous assumptions about it. It was theorized at a time where basic economic models and theories determined how players in various markets behave. Today, these models are losing credence.

Even based on social realities, it’s often tempting to take a cynical view of human nature. Given the various unpleasant interactions that we tend to have with people — from a friend taking advantage of us to a business deal ripe with corruption — it’s natural that we jump to this view.

The selfish parts of our nature undoubtedly exist. But so do the good ones, and these parts warrant as much attention as the bad parts. According to neuroscientists, altruism — the practice of concern for the welfare of others — may be more hardwired in our brains than previously thought.

Neuroscience has demonstrated that giving is a powerful pathway for creating more personal joy. Helping others triggers impacts to our brain in many positive ways. When we help others, our brains release oxytocin, serotonin and dopamine. These hormones have the effect of boosting our mood and counteract the effect of cortisol (the stress hormone).

This might urge some people to ask: is giving itself inherently selfish then? Perhaps, but that’s not a bad thing. On a neurobiological level, studies suggest that giving social support to others may benefit the giver more than the receiver. In one study, that compared giving versus receiving, participants were asked about various scenarios in which they either gave or received support. In a series of fMRI neuroimaging tests, the study found that giving ultimately had greater benefits than receiving. In other words, from an evolutionary perspective, our brains are hardwired to feel rewarded more for magnanimity and selflessness than for meanness and selfishness.

The brain images showed than when a participant was giving support, certain brain areas showed more activation: 1) reduced stress-related activity in the dorsal anterior cingulate cortex, and right amygdala, 2) greater reward-related activity in the left and right ventral striatum and 3) greater caregiving-related activity.

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Tecovirimat is a drug on its way to FDA approval, but as F. Perry Wilson, MD, describes in this 150-Second Analysis, if anyone ever has to prescribe this drug we are in deep, deep trouble.

When I pitched reviewing this study to my producer, he said, "You want to talk about a drug no one is ever going to use?" Yes. Yes I do.

The drug is tecovirimat and the disease it treats is smallpox.

Smallpox, through the power of vaccination, was eradicated in 1980. This is Rahima Banu. She was one of the last recorded cases. She survived, by the way.

But how do you test a drug for a disease that no longer exists?

Well, smallpox may not exist. But monkeypox and rabbitpox exist and have been validated as animal models for human smallpox.

Would tecovirimat save animals infected with these viruses? The results were fairly compelling. The mortality rate for monkeys infected with monkeypox was 95% in the absence of the drug. With treatment (initiated at 4 days after the monkeys developed skin lesions), the mortality rate dropped to zero. Similar numbers were seen in the rabbitpox model.