Monthly Archives: July 2021

The Food and Drug Administration approved a new drug Aduhelm for the treatment of Alzheimers disease June 7 through its accelerated approval pathway. While some patient advocacy groups and creators of the drug including several University researchers see the drugs approval as a step forward, Aduhelms price and approval against the recommendations of advisors have garnered nationwide criticism and sparked a federal investigation into the communications between FDA staff and Biogen, the biotechnology company that developed the drug.

More than six million Americans suffer from Alzheimers disease, a form of slowly-progressing dementia for which there is no cure. Existing drugs that treat Alzheimers mediate symptoms of the disease but do not slow down or reverse the disease process. Since the approval of the last AD drug 18 years ago, patients and healthcare workers alike have waited for stronger treatment options to combat this devastating disease.

As the Baby Boomer generation enters the prime age range susceptible to the disease, the development of effective treatments is imperative, said University Professor of Neurology Brian Ott, who served as a principal investigator on several of the Aduhelm trials.

Stephen Salloway, professor of neurology at the Warren Alpert Medical School, also served as a principal investigator for Aduhelm phase one and phase three trials at Butler Hospital.

The new drug Aduhelm consists of monthly intravenous injections of aducanamab, an antibody molecule that fights off the build-up of amyloid beta proteins in the brain a hallmark feature of AD. Aduhelm is the first drug on the market to directly target these plaques with the goal of slowing disease development in its early stages.

Aduhelm really represents a turning point in how we approach the treatment of Alzheimers disease, Ott said. This is the first time that physicians will be able to prescribe a disease-modifying drug for Alzheimers.

Salloway said that the development of the drug opens a new treatment era for Alzheimers.

But the FDAs decision to approve the drug has raised a wave of concerns about its effectiveness, cost and the legitimacy of the FDAs approval process.

FDA Approval and Backlash

In November 2020, Aduhelm was brought to the FDA Peripheral and Central Nervous System Drugs Advisory Committee, which consists of experts in this area that advise the FDA upon assessment of a proposed drug, where it was almost unanimously rejected.

The panel evaluated data from two Biogen clinical trials designed to test the drugs effectiveness in treating AD. Although both of these trials were terminated early when Biogen determined that the drug was unlikely to be effective, a retrospective analysis found that one of two trials did produce positive results.

The advisory committee did not believe there was sufficient evidence that the drug would improve clinical outcomes given the conflicting results between trials, wrote Joel Perlmutter, professor of neurology at Washington University in St. Louis and a former member of the FDA advisory committee who resigned after Aduhelms approval, in a written statement provided to The Herald. Additionally, the committee expressed concern about brain swelling and bleeding, a side effect observed in approximately 40% of trial participants, Perlmutter wrote.

None of the committee members voted in favor of the drug ten of the 11 members voted against Aduhelms approval, with the last member voting that they were uncertain. Despite the negative recommendation by the committee, Aduhelm was approved through the FDAs Accelerated Approval Program.

The program allows the FDA to evaluate the efficacy of a drug based on its ability to reach a surrogate endpoint an outcome that predicts clinical benefit rather than directly measuring clinical benefit. The intention is to expedite the approval process of drugs they feel should be made available to the public urgently by forgoing expensive and time-consuming clinical trials.

By using amyloid plaque reduction in the brain as the surrogate endpoint for Aduhelm, the FDA determined that the drug was effective.

As part of the Accelerated Approval process, Biogen is required to conduct a post-approval study but does not have to produce results for another nine years. The FDA can reverse its decision based on the results of this study, but does not have to.

In all studies in which it was evaluated, Aduhelm consistently and very convincingly reduced the level of amyloid plaques in the brain in a dose- and time-dependent fashion. It is expected that the reduction in amyloid plaque will result in a reduction in clinical decline, the FDAs director of the Center for Drug Evaluation and Research, Patrizia Cavazzoni, wrote in the FDAs press release.

But there is little evidence so far to support the idea that clearing amyloid plaques will relieve AD symptoms, according to Perlmutter. He wrote that many studies on experimental drugs targeting these plaques have not shown a clinical benefit for people with non-genetic forms of AD.

We know that the drug does reduce plaques in the brain, based on the evidence, Ott said. But does that make a real difference on the clinical outcomes and patient functionality? Thats still up in the air, and another trial needs to be done.

I am extraordinarily disappointed that our unbiased advisory committee review was not valued, Perlmutter wrote in his statement. He resigned from the FDA panel in protest, along with two other committee members, including Mayo Clinic neurologist David Knopman.

Knopman wrote in his resignation letter to the FDA that justifying approval through the reduction of the plaques in the absence of consistent clinical benefit after 18 months of treatment is indefensible, and that the approval made a mockery of the advisory committees role, as reported by The New York Times.

On July 8, the FDA revised Aduhelms usage from treating all patients with AD to patients with mild cognitive impairment or mild dementia stage of disease, the population in which treatment was initiated in clinical trials, thereby narrowing the population the drug is available to.

In separate emails to The Herald, Salloway and Ott wrote that they approve of this change because it is more consistent with the evidence from the clinical trials. Salloway added that it is highly recommended that patients being offered this treatment have a positive amyloid

Additionally, on July 9, the Acting Commissioner of the FDA Janet Woodcock requested an independent investigation by the Office of Inspector General into the interactions between Biogen representatives and FDA members leading up to the approval.

Ramifications of Aduhelms unconventional approval

Aduhelms approval has serious potential to impair future research into new treatments that may be effective at treating AD, Perlmutter wrote. Enthusiasm (from either potential volunteer participants or funders) for new treatments may wane due to thinking that we already have an effective treatment, when in fact we do not.

There is also concern that Aduhelms unconventional approval may set a precedent that leads to a less stringent approval process for future drugs, noted Harvard Professor of Medicine Aaron Kesselheim, the third committee member who resigned, as reported by CBSnews.

Biogen has listed Aduhelm at a price of $56,000 a year per patient, but other sources claim that the price will be closer to $61,000 to $62,000 per year when factoring in the average AD patients weight, which is greater than the number used for Biogens approximation. Biogens listed price does not include doctors visits, amyloid plaque diagnostic testing and MRIs that will be necessary to monitor for side effects.

For many, this price will pose an insurmountable barrier to access, wrote the Alzheimers Association in a statement in favor of the drugs approval but calling for more affordability of the drug. It complicates and jeopardizes sustainable access to this treatment, and may further deepen issues of health equity.

At the moment, the Centers for Medicare and Medicaid Services has not said whether the drug will be covered under Medicare and Medicaid. But even with Medicare coverage, patients and their families would have to pay about $11,500 in co-insurance annually, since Medicare does not cover the entire cost.

According to an analysis by the Kaiser Family Foundation, Aduhelm would cost patients and taxpayers more than $29 billion per year. This estimate only accounts for one fourth of the Medicare population currently prescribed Alzheimers medication the real cost would likely be higher. This far exceeds the money spent on any other drug to treat any disease covered by Medicare Part B or Part D.

In this case, we have a new medication that costs a lot. And what were getting in return is not entirely clear, said Eric Jutkowitz, assistant professor of Health Services, Policy and Practice. We dont want to be spending money on something that doesnt work.

Spending on Aduhelm would take away from Medicaid and Medicare funds that would otherwise go towards underfunded services like long-term care or the development and testing of new AD treatments, Jutkowitz said.

Future plans for Alzheimers research

Still, Aduhelms approval has been celebrated by AD advocacy groups who have long-awaited new treatment options.

Aduhelm is certainly not a cure, but, at long last, it provides many with Alzheimers disease and their families an effective treatment, the Alzheimers Association wrote in a statement. They hope this drug will help close the vast unmet need of the Alzheimers community.

Salloway said that the FDA approval was a very wise decision and very much pro-patient in an interview with The Herald.

Though he understands the concerns voiced by critics of the drug, the totality of evidence amassed by the researchers including the drugs ability to reduce amyloid beta plaques, the positive phase three clinical trial and the clinical benefits observed in the phase two trial as well as the strong need for innovative Alzheimers treatments support the FDAs decision.

Contrary to the idea that the approval of Aduhelm will quench efforts to develop new drugs, Salloway said that he believes the presence of Aduhelm as a treatment could spur new drug development for Alzheimers by creating demand for new screening and preventative technologies.

Theres so much that needs to be done and there is no time to waste, he said. For instance, Salloway cited the ongoing need for new inexpensive diagnostic tools to test for amyloid beta plaque build-up in the brain, and the development of new combination treatments, which incorporate multiple medications and lifestyle changes to not only treat AD once it develops but also help prevent it.

Salloway and Ott hope that through a strong partnership with primary care, continued research and a focus on early and preventative treatment, clinicians will develop new care models to better care for Alzheimers patients.

With additional reporting by Gabriella Vulakh

Originally posted here:
FDA approval of new Alzheimer's drug Aduhelm, developed in part by Brown researchers, mired in controversy - The Brown Daily Herald

The number of COVID-19 cases has started to surge in the United States after months of decline, with the number of new cases per day doubling over the past three weeks.

Doctors and public health officials have said that the surge, in 43 out of the countrys 50 states, comes amid a rise in the Delta variant of the SARS-CoV-2 virus and stagnating vaccination numbers.

Health experts warn that the worrying increase in cases is linked to the Indian Delta variant, which accounts for as many 97 percent of infections in some states.

Centers for Disease Control and Prevention data updated last week shows that the Delta variant, also known as B.1.617.2, makes up 51.7 percent of all new infections making it the dominant form of the virus in the United States.

The Delta variant has been detected in all 50 states and accounts for more than 80 percent of new infections in Midwestern states such as Iowa, Kansas and Missouri, where vaccination rates are lagging.

In the United States, 59 percent of adults are fully vaccinated while 68 percent have at least one shot, according to CDC data.

U.S. Surgeon General Vivek Murthy said the number of new infections are coming as people refuse to get tested or vaccinated against COVID-19

Dr. Chris Pernell, a fellow at the American College of Preventative Medicine, called it a pandemic of the unvaccinated in an interview on Tuesday

Just a quarter of children aged 12-15 have received the vaccine, it has been reported

Dr. Chris Pernell, a fellow at the American College of Preventative Medicine, called it a pandemic of the unvaccinated in an interview with CNN on Tuesday.

This is primarily a pandemic of the unvaccinated. And we need to be very clear about that message, Dr. Pernell said.

She also hit out at states like Florida, Alabama, Arkansas, Indiana, Montana, Oklahoma, and Utah that have blocked COVID-19 vaccine requirements in schools.

To flat out prohibit COVID-19 vaccination is not in anyones best interest. When states make that move, they get in the way of good and effective public health, she said.

U.S. Surgeon General Vivek Murthy said the number of new infections are coming as people refuse to get tested or vaccinated against COVID-19.

Many people are thinking COVID is over. Why do I really need to get tested? and this is particularly happening in areas, unfortunately, where the vaccination rates are low which is exactly where we want to be testing more, he said.

He also voiced support for vaccine mandates in hospitals, adding: Healthcare workers have a responsibility to protect the patients.

Confirmed infections climbed to an average of about 23,600 a day on Monday, up from 11,300 on June 23, according to Johns Hopkins University data.

A chart shows the number of deaths from the coronavirus per day in the United States for the months of June and July

A chart shows that there have been a total of 607.577 coronavirus deaths in the United States

A chart shows the number of coronavirus infections per day in the United States for the months of June and July

A chart shows that there have been 33,898,168 coronavirus infections in the United States since the onset of the pandemic

Even states with high vaccination rates, such as California, Illinois, New York and Vermont are seeing cases rise. All but two states Maine and South Dakota reported that case numbers have gone up over the past two weeks.

It is certainly no coincidence that we are looking at exactly the time that we would expect cases to be occurring after the July Fourth weekend, said Dr. Bill Powderly, co-director of the infectious-disease division at Washington Universitys School of Medicine in St. Louis.

At the same time, parts of the country are running up against deep vaccine resistance, while the highly contagious mutant version of the coronavirus that was first detected in India is accounting for an ever-larger share of infections.

Nationally, 55.6% of all Americans have received at least one COVID-19 shot, according to the Centers for Disease Control and Prevention.

The five states with the biggest two-week jump in cases per capita all had lower vaccination rates: Missouri, 45.9%; Arkansas, 43%; Nevada, 50.9%; Louisiana, 39.2%; and Utah, 49.5%.

A total of 43 states and the District of Columbia are seeing their numbers of COVID-19 infections increase, according to data from John Hopkins University

Health experts blame the spread of the Indian Delta variant, which makes up more than half of all new infections in the country and up to 97% in some states

Even with the latest surge, cases in the U.S. are nowhere near their peak of a quarter-million per day in January. Deaths are running at under 260 per day on average after topping out at more than 3,400 over the winter a testament to how effectively the vaccine can prevent serious illness and death in those who become infected.

Still, amid the rise, health authorities in places such as Los Angeles County and St. Louis are begging even immunized people to resume wearing masks in public. And Chicago officials announced Tuesday that unvaccinated travelers from Missouri and Arkansas must either quarantine for 10 days or have a negative COVID-19 test.

Meanwhile, the Health Department in Mississippi, which ranks dead last nationally for vaccinations, began blocking posts about COVID-19 on its Facebook page because of a rise of misinformation about the virus and the vaccine.

Mississippi officials are also recommending that people 65 and older and those with chronic underlying conditions stay away from large indoor gatherings because of a 150% rise in hospitalizations over the past three weeks.

In Mississippi, COVID-19 infections have spiked by 57 percent from 192 cases recorded on June 28 to an average of 303 per day on July 12.

Additionally, the number of residents hospitalized with COVID-19 has increased 65percent between July 4 and Sunday, July 11, according to state data.

Only 33.4 percent of the population in Mississippi is fully vaccinated, CDC data shows.

We have a lot more vulnerability than we should, said Mississippi State Health Officer Dr. Thomas Dobbs during a livecast of the Mississippi State Medical Association on Friday, according to Mississippi Free Press.

We are way undervaccinated as a state. We have a vast pool of unimmunized people who are a perfect breeding ground for Delta variant, and its gonna kill folks. And its already killing folks.

Some neighborhoods in the Big Apple are witnessing a rise in cases in what health officials blame on low vaccination rates and more transmissible variants like the Delta variant

People check in for their COVID-19 vaccine at a mobile clinic in an East Los Angeles neighborhood which has shown lower vaccination rates especially among the young

Louisiana also has one of the nations lowest vaccination rates.State health officials said cases of the coronavirus are surging, largely among nonvaccinated people.

New Orleans officials said on Tuesday they are likely to extend virus-mitigation efforts currently in place at large sporting and entertainment gatherings until fall.

Those efforts include mask mandates or requirements that attendees be vaccinated or have a negative COVID-19 test.

In Louisiana, cases have increased by 115 percent from a seven-day rolling average of 389 per day on June 28 to 840 per day on July 12, according to Johns Hopkins data.

Just 35.8 percent of the state is fully vaccinated.

I do think were in it. We are seeing what is likely the beginning of increases, Dr Joe Kanter, Louisiana state health officer, told The Advocate.

But the political will may not be there in many states fatigued by months of restrictions.

In Michigan, Democratic Gov. Gretchen Whitmer is facing a drive to repeal a law that she used to set major restrictions during the early stages of the pandemic.

And Republican Gov. Kay Ivey of Alabama pushed back against the idea that the state might need to reimpose preventive measures as vaccinations lag and hospitalizations rise.

Alabama is OPEN for business. Vaccines are readily available, and I encourage folks to get one. The state of emergency and health orders have expired. We are moving forward, she said on social media.

In many states cases have doubles such as Louisiana, where just 35.8% are fully vaccinated. Cases have increased by 115% from a seven-day rolling average of 389 per day on June 28 to 840 per day on July 12

In Mississippi, with just 33.4% of residents fully vaccinated, COVID-19 infections have spiked by 57% from an average of 192 cases recorded on June 28 to an average of 303 per day on July 12

Dr. James Lawler, a leader of the Global Center for Health Security at the University of Nebraska Medical Center in Omaha, said bringing back masks and limiting gatherings would help.

But he acknowledged that most of the places seeing higher rates of the virus are exactly the areas of the country that dont want to do any of these things.

Lawler warned that what is happening in Britain is a preview of whats to come in the U.S.

The descriptions from regions of the world where the delta variant has taken hold and become the predominant virus are pictures of ICUs full of 30-year-olds. Thats what the critical care doctors describe and thats whats coming to the U.S., he said.

He added: I think people have no clue whats about to hit us.

President Joe Biden is putting a dose of star power behind the administrations efforts to get young people vaccinated. Eighteen-year-old actress, singer and songwriter Olivia Rodrigo will meet with Biden and Dr. Anthony Fauci on Wednesday.

While the administration has had success vaccinating older Americans, young adults have shown less urgency to get the shots. CNN reported on Tuesday that just a quarter of children aged 12-15 have received the vaccine.

Some, at least, are heeding the call in Missouri after weeks of begging, said Erik Frederick, chief administrative officer of Mercy Hospital Springfield.

Frederick tweeted that the number of people getting immunized at its vaccine clinic has jumped from 150 to 250 daily, saying it gives him hope.

Scientists had warned about the rise of the Delta variant in February.

The B.1.526 variant, which first appeared in samples collected in New York City in November, made up about 27 percent of viral sequences deposited into a database shared by scientists called GISAID, The New York Times reported in February.

COVID cases surge in 43 states as new cases per day DOUBLE over the past three weeks Source link COVID cases surge in 43 states as new cases per day DOUBLE over the past three weeks

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COVID cases surge in 43 states as new cases per day DOUBLE over the past three weeks - Texasnewstoday.com

By Moira Ritter, CNN Business

You mightve heard that everything is getting more expensive.

Well, thats mostly true. It wasnt easy, but we found a handful of items that are still cheaper than when the pandemic started last year.

Here are some of the things that are cheaper than they were in February 2020.

As the shift to remote work took hold at the start of the pandemic, the typical Americans closet shifted, too. Goodbye, suits and dresses. Hello, sweatpants and T-shirts.

Now that offices, restaurants and the rest of the world are starting to reopen, it might be a good idea to prepare your wardrobe. Fortunately, some clothing is still cheaper than it was pre-pandemic.

Both mens and womens apparel broadly are less expensive than pre-pandemic. Mens apparel has dropped 7.2%, while womens apparel has decreased 5.9% since February 2020, according to the Bureau of Labor Statistics.

Womens dress prices have fallen 12.1% during the pandemic. Mens suits and sports coats have decreased even more significantly. Suits are now 21.5% cheaper than they were in February 2020.

Another change that came with staying home: No more mass transit. Now that many Americans are vaccinated, trains and buses are gaining steam and becoming the norm once again.

Luckily, intracity mass transit is about 2.9% cheaper than it was last February.

If youre enjoying a night (or day) out this weekend, although your meal or drink might be more expensive than usual, you can take comfort in the fact that your ride was cheaper than it would have been 16 months ago.

Its baseball season, and what better way to celebrate summer and vaccination than joining a stadium full of other people and watching a game in person?

Sporting event admissions are 1.8% cheaper than before the pandemic. Although not the most monumental difference, its important to take our wins where we can, and even the smallest difference in price is a big deal when (almost) everything else is getting more expensive.

The demand for pets and pet supplies skyrocketed during the pandemic as Americans spent time stuck at home.

As we re-enter the world, though, you might consider restocking your pets toy basket once more, because pet supply prices are still lower than they were pre-pandemic.

Pets and pet product prices are 1.8% cheaper than they were in February 2020. Pet supplies and accessories are down 3.8% since the start of the pandemic.

During the pandemic, health care became even more important than before. So how has medical care dodged inflation? Preventative doctors visits and healthcare were moved to the back burner last year as people stayed home during the pandemic.

Since February 2020, medical care commodities, which include all medicinal drugs and other medical supplies, have gotten 2.3% cheaper.

Broken down into more specific categories, prices of medicinal drugs, which encompass both prescription and over-the-counter medicine, saw a 2.2% decrease. Prescription drug prices alone are down 2.9% over the past year and a half.

Medical equipment and supplies, which includes items like dressings, contraceptives, heating pads and wheel chairs, saw the biggest change with a 5.8% drop in price since before the pandemic.

The-CNN-Wire & 2021 Cable News Network, Inc., a WarnerMedia Company. All rights reserved.

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Prices are going up on almost everything. Here's why - kuna noticias y kuna radio

Rural adults are less likely than their urban peers to see a dentist for preventative treatments, according to the CDC.

Millions of rural residents have not seen a dentist in over a year, a recent CDC report reveals.

In 2019, before the coronavirus pandemic forced dentists to shut down, 42 percent of adults in rural areas did not receive dental care, according to the survey. In urban areas, roughly a third of adults did not see a dentist that year.

In both groups, people of color and low-income residents were less likely to have seen a dentist in 2019. These disparities were wider in rural areas, where issues such as transportation barriers, dentist and dental hygienist shortages and lack of health insurance are more common. The coronavirus pandemic has likely exacerbated the need, especially for low-income patients, the report says.

The things that really went by the wayside [with the pandemic] are the maintenance, the routine exams and the cleanings things that keep people healthy, said Katherine Jowers, who oversees oral health programs at the Asheville-based Mountain Area Health Education Center. Were still dealing with very old treatment plans for patients we havent seen in two years. Nothing was on fire so they didnt come, and now all of their plans are completely disrupted and we have to start from scratch.

Since cavities and other dental problems dont resolve on their own, what might have been small areas of decay that could have been addressed with a filling have likely advanced to more extensive decay that requires a root canal or even extraction.

Lower-income patients are already predisposed to forgoing preventative dental treatment because of cost, especially if they arent in pain, said Anahita Shaya, a dentist at the Brunswick County Health Department.

People are having to choose between the necessities of life, she added. If theyre having to pay for fillings and a cleaning out of their pocket and thats against having to pay their electric bill or mortgage or rent, [preventative dental care] is not always at the top of the list.

Oral health is an important part of overall wellness and if left untreated, tooth decay can lead to a whole host of other complications. Cavities have been linked to heart disease, pneumonia and sepsis, for example. Pregnant women with poor oral health have been found to have a higher risk of premature births and other complications.

Shaya sees some of these complications in her own practice, with patients turning to the emergency department for dental abscesses.

The same is true for communities nationwide. Dental abscesses accounted for 3.5 million visits between 2008 and 2014 and cost a collective $3.4 billion, research shows. Uninsured people and Medicaid beneficiaries accounted for the bulk of these emergency visits.

Though receiving antibiotics at the ER can cost $1,000 or more out of pocket, Blake Gutierrez, a dentist at MAHEC, said patients go there because they dont think there are other options. In most cases, however, emergency departments cant fully address a dental issue. At most, emergency providers can administer antibiotics and painkillers, but without dental treatment, the source of infection remains and can flare up again.

Even after an ER visit, patients may still be hesitant to seek dental care because of cost. Care Credit, a company that provides financing for dental and other health procedures, estimates that an extraction, the cheapest option for advanced tooth decay, can cost anywhere from $130 to $500, depending on the complexity of the extraction. Root canals, another common treatment, can cost $1,000 or more.

Rural North Carolinians have another significant challenge to deal with when seeking care: lack of dentists. Most dental providers congregate in urban areas, according to data from the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. Some rural counties, including Hyde, Tyrrell and Gates, did not have an active dentist in 2019, the data shows.

Greg Chadwick, dean of the East Carolina University School of Dental Medicine, keeps close tabs on that data. By his calculation, the state has roughly 5,600 active dentists, and most of them over 4,500 work in cities. The remaining 1,400 serve North Carolinas 80 or so rural counties.

A study published this year by the American Dental Association notes North Carolina has about 54 dentists per 100,000 residents, behind the national average of about 61 dentists per 100,000. Based on a 2015 analysis generated by the federal Health Resources and Services Administration, North Carolina is likely to remain a state with not enough dentists to meet the demand into the future.

That math alone makes it so patients in rural areas have to travel farther for care, he added, something that many residents struggle with. The only way to address these disparities is to make dental care more accessible, perhaps by coupling it with primary care as many community health centers do across the state.

These health centers arent always enough. MAHECs dental clinic, for instance, has a two-month wait for a cleaning and general exam. Another provider, CommWell Health a community health center with locations in Sampson and surrounding counties has seen a similar trend.

Time, said MAHECs Jowers, isnt on rural patients side, especially since the pandemic delayed care for so many of them.

Youre not addressing needs that were minor needs two years ago, she said. [Dentistry] is the type of health care where if you dont address the problem, it doesnt get better by itself.

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Even before coronavirus, almost half of adults in rural areas went without dental care - North Carolina Health News

Critics say universal healthcare limit American freedom, but it can provide citizens with a more affordable, healthier and happier healthcare system.

Jeremy C. Kourvelas| Guest Columnist

Tennessee Voices: A conversation with Amanda Bracht

Amanda Bracht, senior VP for clinical services of Mental Health Cooperative of Middle Tennessee, spoke with Tennessean opinion editor David Plazas.

Nashville Tennessean

It is no secret that the costs of healthcarein this country have long been spiraling out of control. Two-thirds of all bankruptcies in the United States are due to medical debt whereas medical bankruptcy is virtually non-existent in the rest of the industrialized world.

Americans spend over twice as much for healthcare. Premiums continue to rise with no tangible return on investment.Often critics of socialized medicine laud our quality of care as a reason to support our fractured system,but what good is this argument?

Universal healthcare would free small business owners from having to provide coverage while simultaneously enhancing the freedom of the worker. Lifespans could be longer,people could be happier and healthier in systems that are simpler and more affordable.

Losing your job is a direct threat to your health-- the added stress alone can be caustic.Mental health coverage could bedramatically improved under universal coverage.It'sno surprise that every country with some form of universal healthcare is statistically happier than the United States.

Health insurance was originally created to save patients from the economic impact of illness.Access to primary, preventative care would improve under universal healthcare.Catching diseases before they become emergencies not only leads to better healthcare outcomes, but its also cheaper.

Unfortunately we havea for-profit system and economic burden is the rule, not the exception.The foremost criticism of universal healthcare is long waits, but this tragically ignores the fact that the U.S. already has unacceptably long wait times, especially for specialists.

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People avoid treatment for fear of cost, ultimately depending upon the ER for treatment that could have been handled far more efficiently and inexpensively. Other countries, likeSwitzerland and the U.K., with universal health carebeat us in terms of wait times.

Medicare and Medicaid were created to cover seniors and low income populations, as they are most at risk of being uninsured. However, because their collective risk for illness is also higher, they have to be subsidized, in this case by tax dollars.Unfortunately, Medicaid varies dramatically by state and Medicare is running out of money.

Younger people are far less likely to use the healthcare coverage they pay for by the simple fact of being healthier.Currently, the majority buy insurance from for-profit companies that keep a large chunk of that cash.

In other words, money paid by patients for healthcare services is kept as private gains by denying coverage.If the healthier individuals were included in the same risk pools as those of higher risk, the surplus could instead subsidize, significantly bringing costs down in onestreamlined system.There is plenty of money to spare, as health insurance CEOs make tens of millions of dollars every year.

Those who argue against universal healthcare often claim that it limits the freedom to choose ones doctor, hospital or treatment. The freedom to choose the doctors thatwe want is already limited by forcing us into networks.

In our current system, losing your job means you can lose your doctor.With universal coverage, you could lose your job and still be able to keep your doctor without a single interruption. Universal healthcare is a fiscally responsible system that facilitates more freedom,more health service and better outcomes.

Jeremy C. Kourvelas is the Vice President of the Public Health Graduate Student Association and a Master's candidate at the University of Tennessee, Knoxville.

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Universal healthcare provides Americans the security need in uncertain times | Opinion - Tennessean

Sometime in 2019, I was multi-tasking and racing between exam rooms amid a controlled chaos that defines an average day in my busy clinic. I was behind as usual, and I could sense the frustration in the air from my patients who had been waiting for a while. I knocked and entered a room to meet a patient for follow up on his MRI study.

The encounter was brief, as the patient was notably irritable from having to wait. At the end of the appointment, the patient's final comment stuck with me for weeks to come: "How come you can't call me with this result?"

Initially, I was insulted, to be honest. I thought to myself, I could literally call all my patients for follow ups, but then I wouldn't really need to work in a clinic and what type of practice would that be?

Fast forward a year. The world has turned upside down and, ironically, I am one of the providers who utilizes telehealth the most in my large organization. I estimate about 90% of my visits were telehealth visits during the first four months of the pandemic.

Several studies have found over the years that patients are willing to engage with physicians via technology, and many patients have reported high satisfaction with their telehealth experience.

For years, however, thanks largely to reimbursement and regulatory challenges, and sometimes limited technology access, telehealth didn't quite catch on as much as many hoped.

But since the start of the COVID-19 public health emergency, our organization has expanded its telehealth capabilities. In addition, our state workers compensation system has rolled out several temporary telehealth policies to allow injured workers to receive virtual medical treatment during this pandemic.

A brief background about myself and my practice: I am an occupational medicine physician working under a not-for-profit health care system. My clinic is situated in a suburb surrounded by many industries and in a densely populated community. My visit type is 95% work injury-related with the rest employment-related exams. My patient population is the working class, ages 14 and older.

My organization's leaders assumed at first that face-to-face interaction was the preferred healthcare experience, and that telehealth visits dehumanized the medical encounter.

To test this assumption, I surveyed my patients.

Our telehealth visits are all pre-scheduled utilizing a web-based application. We use a HIPAA-compliant software that allows for two-way, high definition video and audio. We can also effortlessly share media online. There were no exclusions in this survey. I included patients who did not have a smart device or lived in a poorly networked area.

Over the course of three weeks, from the end of August through early September 2020, I collected a total of 115 surveys. About two-thirds of the patients I surveyed were follow-up patients. All new injury visits were done in-person. Each result was from a unique individual.

The survey consisted of one question: Considering the current COVID-19 pandemic, would you prefer a virtual visit (video or phone) or an in-person/in-clinic visit?

The survey question was given to the patient either on paper or read word-for-word in the case of virtual visits. The patient could only select one preference. Much to my surprise, 60% of in-person patients preferred a virtual encounter and 86% of virtual patients wanted their future visits to remain virtual.

Here are some comments from my patients:

"I like the first visit to be in-person but follow up visits can be virtual."

"Virtual is good, but when I had that spasm last time, I actually preferred an in-person, so you can feel it."

"Virtual visits are nice considering the pandemic, but I'd like to be looked at and examined every now and then."

"I'm an essential worker, so virtual visits are convenient for me."

"I don't see anything you cannot do virtually that you have to do in-person."

"I kinda like this, this is the collateral beauty of the pandemic."

According to a similar survey in 2013, where healthcare consumers (1,547) were pooled from around the world, 74% of them were comfortable with virtual doctor visits. Here I highlight an example where modern patients, with modern technology, prefer a new way of medical experience virtually.

I learned several lessons through this experience.

First, have robust and easy-to-use telehealth software and affirm that it is HIPAA-compliant. Next, targeting your patient population is critical. Younger generations (Gen X, Y and Z) are much more comfortable with adopting technology. Also, be flexible and have a threshold to convert the virtual visit to in-person when situations arise.

In addition, avoid telehealth visits during the acute infection and trauma phase. Advertise and offer telehealth visits to patients who live far and/or have limited transportation. Consider grouping the telehealth visits separate from the in-person visits for better workflow.

Finally, make plans to have in-person visits intermittently for the virtual patients, and remember, follow-ups and patients with chronic conditions are the best candidates for telehealth visits.

Today, 76% of hospitals use telehealth technology.5 Telehealth services save time and money for all parties involved. Its advantages and benefits are immeasurable. Timeliness of care is critical to better quality of care.

Through telehealth, one can access the healthcare system easily and more quickly than ever before simply at the touch of a button. Loss of productivity is hugely minimized since the patients do not have to take a half-day or a whole day off work just to attend a doctor's appointment.

According to one survey, nine in 10 Americans stated that they would cancel or reschedule a preventative care appointment due to workplace pressures.6 Less transit to and from the doctor's clinic reduces traffic congestion, traffic accidents and air pollution.

Over the years, a few of my patients have informed me that they were involved in motor vehicle accidents either coming to or leaving my clinic. I, too, find myself rushing to make it to my own medical appointments during or after work. The anxiety and stress related to being on time have caused a few near accidents of my own.

Telehealth helps reduce unnecessary visits to urgent care or the emergency room before a worker goes to see a doctor, he/she can first consult with a healthcare provider via telehealth to determine whether such a visit is necessary or indicated.

A research study showed that telehealth visits for the most common health conditions save employers an average of $472 per visit. Telehealth allows a team-based approach and collaboration where other support members can join in on the virtual visit, e.g. dietician in a weight loss visit, prosthetist and/or orthotist in an amputee visit, vocational counselor in an occupational medicine appointment.

Telehealth is here to stay, and it will be a large platform in the future of medical delivery. We must learn to adopt and use it to our advantage instead of as a perceived hindrance.

Future challenges and opportunities include insurance recognition for proper reimbursement, establishing best practices, training and certification on utilizing the platform, tightening cyber security, and, finally, expanding into every aspect of medicine (e.g. ancillary telemedicine services like telepathology and telepharmacology).

To the patient I met last year, who wanted his MRI results given virtually, I want to say, thank you!

Dr. Archie Adams is a board-certified occupational medicine provider. He currently sees patients at MultiCare Centers of Occupational Medicine in Puyallup, Washington.

More here:
One physician's perspective on why patients prefer telehealth visits - Healthcare IT News