The Right to Choose and an amendment that would make abortion illegal and consider it murder.

September 24, 2020 by

Picture credit Liberal Dictionary.com at  https://www.liberaldictionary.com/right-to-choose/

09.2020

On January 24th, of this year, Idaho Representative Heather Scott introduced and read Bill 361.   As written, the bill would have repealed existing law to provide that abortion shall be illegal and the attorney general shall direct state agencies to enforce this act.  The Republican Representative attempted to sneak the bill in hopes of permanently altering choices available for women in Idaho.  

Current issues Idaho women and families already face include lack of funding for Planned Parenthood services, poor education related to choice, and lack of providers who are legally eligible to perform abortions.   Additionally, as of September 1st Idaho women and families are now faced with the following restrictions:

  • Abortion would be banned if Roe v. Wade were overturned.
  • A patient must receive state-directed counseling that includes information designed to discourage the patient from having an abortion, and then wait 24 hours before the procedure is provided.
  • Private insurance policies cover abortion only in cases of life endangerment, unless individuals purchase an optional rider at an additional cost.
  • Health plans offered in the state’s health exchange under the Affordable Care Act can only cover abortion in cases of life endangerment, or in cases of rape or incest.
  • Abortion is covered in insurance policies for public employees only in cases of life endangerment, unless individuals purchase an optional rider at an additional cost.
  • The parent of a minor must consent before an abortion is provided.
  • Public funding is available for abortion only in cases of life endangerment, rape or incest.
  • An abortion may be performed after viability only if the patient’s life is endangered.

Limited access, choices and resources in Idaho forces those individuals in need of abortion to look outside the state for resources.   Stakeholders to include Planned Parenthood of Idaho, Prochoice America, and the Idaho ACLU have all worked locally to raise awareness and support family planning choices.  Continued education and support of women and families in crisis are necessary for the preservation of women’s health and wellbeing in Idaho. 

How can we be sure the meat we eat is antibiotic free? AMR in animal and human health settings, “One Health” approach in Vietnam

September 3, 2020 by


In recent years, Viet Nam has witnessed a growing threat of antimicrobial resistance. It has been brought by the excessive and irrational use of antibiotics at all levels of the health care system and the public as a whole. It is difficult to quantify the magnitude of the problem, due to a lack of adequate surveillance systems, but some estimate that by 2050 antimicrobial resistance could be responsible for killing 10 million people a year globally, the equivalent of 1 person every 3 seconds – more than cancer kills today.

AMR is a global human and animal health concern which is influenced by the use of antimicrobial agents in both human and veterinary medicine, as well as in the plant sector. Therefore, human and animal health sectors have a shared responsibility to prevent or minimize antimicrobial resistance selection pressures on both human and non-human pathogens.

“AMR is a problem not just in our hospitals, but on our farms and in our food, too. Farmers and veterinarian must share responsibility, both by using antimicrobials more responsibly and by cutting down on the need to use them, by effectively applying biosecurity and good farming practices” stated by Mr. JongHa Bae, The Representative Food and Agriculture Organisation of the United Nations (FAO) in Viet Nam.

The One Health concept promotes the enhancement of human, animal and ecosystem health through multi-sectorial governance support and policies to combat health security threats. In Vietnam, antimicrobial resistance (AMR) in animal and human health settings poses a significant threat, but one that could be minimized by adopting a One Health approach to AMR surveillance.

Efforts to Eliminate Schistosomiasis in Nigeria, A Multifaceted Approach

August 22, 2020 by

Schistosomiasis was described in papyrus papers thousands of years ago by ancient Egyptians. Then it was re-described by Theodore Bilharz, a pioneer parasitologist, 150 years ago in Cairo, Egypt. Schistosomiasis is among a group of neglected tropical diseases hitting sub-Saharan Africa. There are more than 25 million individuals infected and more than 100 million at risk in Nigeria. Among the different types of schistosomiasis, Schistosoma Haematobium affects the urogenital system causing blood in the urine and other symptoms and predisposes to urinary cancer.

source: http://www.bio.davidson.edu/people/midorcas/GISclass/GISwebsites/grayson/Schistosomiasis.htm

Despite the global efforts over the past 50 years, we only achieved limited success in Nigeria. Most of the campaigns designed used Praziquantel for prevention and treatment, as it has shown great success in multiple countries. Unlike other previously endemic states, the use of chemotherapy was not sufficient to address this major problem in Nigeria due to several limitations. In 2012. The World Health Organization (WHO) and World Health Assembly (WHA) adopted a multifaceted plan to eradicate schistosomiasis. The plan aims at strengthening the local health systems, using chemotherapy, appropriate sanitation, and water systems, as well as promoting hygiene education and snail control. There will be multiple designs for this approach to address the different challenges in the different states.

In order to succeed in this battle, all the stakeholders should cooperate and understand their role. The Federal ministry of health in Nigeria should communicate and supervise the local communities closely to ensure that there is no waste of resources. The pharmaceutical companies play a fundamental role by supplying millions of praziquantel pills with the help of non-governmental organizations (such as the carter center). The schools and religious leaders should educate the citizens about this disease and the role of both chemotherapy and sanitation to lead a healthy and productive life. The local community leaders are responsible for maintaining the momentum to achieve the utmost benefit for their people in spite of the conflicting perception for this campaign.

Six years after the WHA declaration, there was a substantial success demonstrated by treating approximately 75 % of school aged children. There is a new road map issued by the WHO for the tropical diseases for 2021-2030 to address the gaps and finish the incomplete mission.

Once we have a safe and effective vaccine against COVID-19 (SARS-CoV-2), what then…?

August 20, 2020 by

We did it! With unprecedented speed, cooperation, and billions of dollars, the world has access to a vaccine against COVID-19. We are now ready to distribute it to everyone and finally rid the United States and planet of this deadly pandemic, where over 170,000 Americans have died as of August 20, 2020. 

Sounds simple enough, in theory. Yet, in a recent survey, 35% of the U.S. population plan to refuse an available vaccine while others remain undecided. COVID-19 vaccine hesitancy is a major obstacle to successful vaccine program implementation, including creation of critical herd immunity.

How do we target our efforts to maximize the number of people vaccinated while working within the current legal, political, and ethical landscape? 

We anticipate full support of universal vaccination from such organizations as the CDC, FDA, NIH, AMA, AAP, state and local departments of health. At the same time, we expect strong opposition from vocal groups such as antivaxxers, as well as those strongly advocating for individual liberty, including members of organized anti-government groups.

While we would recommend doing all we can to strongly encourage participation, including addressing those undecided or hesitant, we realize voluntary participation will not be enough. To maximize the efficacy of a vaccine program, we would initially target two main groups whose almost universal vaccination would be feasible and extremely important to society.

First, we would vaccinate all health care workers.  We would expect widespread buy-in from those on the front lines who understand the stakes, respect the science, are easily reachable, and are most at risk of acquiring the virus and passing it to others. They are also experienced with other vaccine requirements such as mandated yearly influenza vaccination.

The second and likely controversial target, would be universal vaccination of children attending school, thereby enabling safer opening of in-person schools, a goal almost unanimously shared. This gateway would benefit from the experience of local boards of education and previous guidance from the AAP in dealing with vaccine hesitancy

Importantly, it will be especially crucial to strategize on how best to counter prolific misinformation in the public domain.

India’s Mental Health Policy- Challenges in Successful Universal Implementation

August 20, 2020 by

In response to the rising burden of mental health disorders in the country, Government of India launched its first Mental Health Policy in 2014. Some of the objectives of the policy are universal access to mental healthcare, increased utilisation of mental healthcare services across the country, sensitising communities to reduce stigma associated with mental health problems and progressively increasing financial allocation for mental health promotion and care. The policy has also laid out strategic recommendations and actions for achieving these objectives such as setting up of community-based rehabilitation services, implementation of community-based programmes focussed on screening, early identification and treatment, and support of families and care givers.

The government has also ratified the Mental Health Care Act (MHCA) in 2017 and re-strategized National (NMHP) and District Mental Health Programme (DMHP). However, in reality the access to mental healthcare in India is far from universal. Understandably, India’s vast size and diversity are major hurdles to a country-wide implementation of any initiative or program. Different states are socially, culturally and economically very different, and in extension, the burden of mental health disorders is also different. A 2019 report published by Lancet shows significant variation amongst the states, both in prevalence of mental disorders and associated risk factors. Therefore, it is important that any policy or program be adapted to local context and factors before its implementation.

Crude prevalence of major mental disorders in the states of India, 2017; Source: The Lancet Psychiatry

At present, implementation of the mental health policy is very scattered throughout the country. While some states have successfully integrated mental health into primary healthcare framework through implementation of DMHP and community participation, other states are conspicuously lagging behind. The states of Gujarat and Karnataka are two examples of the former category, having achieved success through good inter-departmental co-ordination and well-defined roles and responsibilities. Both states have appointed special mental health officers to foresee implementation of programmes.

In Gujarat, the State Mental Health Authority (SMHA) is responsible for recruiting and/or training the mental health staff such as psychiatric social workers and mental health nurses. The state has also adopted WHO Quality Rights(WHOQR) toolkit. Established in 2014, the WHOQR project is being implemented by the Department of Health and Family Welfare of Gujarat and the Centre for Mental Health Law and Policy at the Indian Law Society and is supported by WHO and local partners.

Similarly, Karnataka SMHA includes members from different departments such as Health and Family Welfare, Women and Child Development and Medical Education and provides clear rules and guidelines for efficient inter-departmental functioning. The state government has also launched the Manochaitanya Programme, the first-of-its kind dedicated public mental health programme by a state government, aimed at integration of mental health care at Primary and Community health centres.

To conclude, the Department of Health and Family Welfare for a state should be responsible for identifying gaps and providing the necessary technical support and resource-planning. Secondly, interdepartmental co-ordination is necessary and needs to be steered by SMHAs. Last but not the least, regular monitoring and evaluation by Mental health officers is needed for successful implementation of the programmes at local and community level.

Should we lose the War on Drugs?

August 20, 2020 by

Amidst the global pandemic, it is easy to overlook dual epidemics the United States was facing before COVID-19 hit. The War on Drugs and the Opioid crisis are parallel epidemics with each fueling the other to contribute to the US having the highest rate of incarceration of any developed country in the world. For one sobering statistic, Human Rights Watch and the ACLU report that one person is arrested for drug possession every 25 seconds in the US. Every 25 seconds! So in about the time it took to read to this point, someone was arrested and their life changed forever. Although the drug problem has been ongoing since the 1970’s, it has reached a new plateau since the early 2000’s. In that time, the high frequency of drug use has primarily been driven by over-prescription of narcotics based on misleading information from pharmaceutical companies and naïve medical providers. As more information was discovered on the true addictive potential of these medications, strict regulations were implemented, often leading to withdrawal and pushing users to seek narcotics elsewhere, often illegally. With the “War on Drugs,” possession of these narcotics would then lead to arrest with potential imprisonment, often up to several years even for a first offense.

The good news is that slowly but surely progress is being made. Many states have exchanged incarceration for drug-treatment programs and mental health assistance. Also, money that historically has gone to prisons has been shifted to support these programs and sentencing guidelines which have mandated excessive prison sentences for low-level drug offenses have begun to change allowing the individuals to serve less, if any, prison time. As many of these policies are initially set at the federal level, it is up to the Department of Justice and Congress to recognize the failures of the “War on Drugs” and shift the focus from incarceration (which has not been shown to reduce drug offenses) to treatment and rehabilitation. While the Drug Enforcement Agency and police officers are bound to follow the laws set in place by Congress, as the front-line workers, they also have the opportunity to advocate for the injustice they see in following this guidance. Often those making the rules do not see the effects downstream and only through combined advocacy can we shine the light on the problems created by the War on Drugs.

Mitigation of COVID-19 transmission in nursing homes in Michigan through universal testing of nursing home residents and employees

August 19, 2020 by

Nursing homes and assisted living facilities are a major source of COVID-19 cases in Unites States. While 10 percent of the country’s cases have occurred in long-term care facilities, deaths related to COVID -19 illness in these facilities account for more than 42 percent of the total mortality. .As of August 17th, 2020,  Michigan state has reported 2083 COVID related deaths among individuals who lived in nursing facilities and 21 deaths among staff members (Figure: Data from MDHHS (Michigan Department of Health and Human Services).

Michigan nursing home, long term care Cases
Michigan nursing home, long term care deaths

A number of risk mitigation strategies have been developed by the state to control the spread of the pandemic in nursing homes. Due to the risk of asymptomatic carriers spreading COVID-19, a strategy for universal SARS-CoV-2 testing of nursing home residents and employees once a week, with rapid turnaround, would allow for the identification, isolation, and treatment of infectious but asymptomatic residents. This would require a new policy by the State of Michigan Health Department to be introduced to be followed by all the nursing homes in the state.

On a national level, the Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA) has allocated approximately $5 billion, to protect residents of nursing homes and long-term care facilities from the impact of COVID-19, however most of the upfront funding is directed to support increased testing, staffing, and PPE needs. There will also be funding available for those establishing COVID isolation facilities. However, the HHS does not address state specific needs for universal COVID testing in Nursing Homes, especially in states with high incidence of COVID 19 ,  At the same time , the Centers for Medicare & Medicaid Services, (CMS) ,  proposed that rapid point-of-care diagnostic testing devices to  be distributed to nursing homes, and through the new funding from the Provider Relief Fund, CMS Is now  requiring, rather than recommending, that all nursing homes in states with a 5% positivity rate or greater test all nursing home staff each week. The CMS , being more  closely involved in Nursing homes functioning and their outcomes, understands the need of nursing homes better and would be able to allocate more funds in the right direction for universal testing, This will help with decrease in the rate of infection and reduce overall morbidity and mortality and cut costs despite an initial investment.

At the state level, Director of the Department of Health and Human Services (“DHHS”), State of Michigan, plays a crucial role in policy making for universal COVID testing in nursing homes in Michigan. Michigan Department of Health and Human Services (“MDHHS”) issued an order requiring nursing homes to conduct diagnostic testing for COVID-19 of all staff members once. However, there is no such regulatory requirement of testing of nursing home residents. With the help of federal funding and utilizing the funding from state government, MDHHS would need to set up a task force to mandate testing of all Nursing home residents. This would also help in mitigating COVID spread, incase a second wave was to hit the state in fall or winter months.

Local healthcare organizations with representatives from health care workers and administrators working on ground Zero have a pivotal role to play in advocacy of this policy with the DHHS. One such organization is Health Care Association of Michigan (HCAM),which  is the professional association representing nursing and rehabilitation communities including for and not for profit, county medical care and hospital based providers. HCAM currently represents 350 nursing facilities in the state of Michigan. This  association has been contacting  legislators and urging  them to fight for the needed resources, both funding and equipment, for nursing facilities during this crisis. A signature campaign for Universal Testing of COVID 19 in Nursing Homes from Health care providers across the state would pressurize the DHHS to pass a policy and allocate sufficient funds pertaining to the issue .

 Additional support to this campaign and policy could be garnered from Laboratory Corporation of America (LabCorp) with LabCorp’s COVID-19 RT-PCR , being one of the few FDA approved labs for testing COVID 19, the company would have vested interest in universal testing to increase their margin for profit .A collaboration with the State of Michigan to provide testing at lower rates if universal testing is made available to nursing home may be a mutually beneficial option for both parties involved.

The most important stakeholders in development and implementation of this policy would be the Individual nursing homes’ Management and administration The downside to the policy is that private nursing homes may have to bear cost of COVID 19 testing and related infrastructure and personnel, Additionally, universal  testing would increase the number of COVID positive cases , thus increasing demands from separate areas for isolation of these patients . Also, increase in COVID positivity rate may be detrimental to the reputation of the nursing home. All these concerns would need to be brought up by representatives from HCAM and addressed by the MDHHS , with  the goal of providing affordable testing and quality metrics to nursing home administration , so that they participate both in the development of the policy as well as implementation.

To conclude, a policy mandating  universal COVID 19 testing of nursing home residents and employees, is the need of the hour to mitigate the spread of COVID 19 in this high risk population , and the regional professional organizations have a major role in advocating for this policy to  state government ( with help of federal resources) .

Support the neglected population during COVID-19 pandemic: advocacy for the new policy of protecting food delivery drivers

August 19, 2020 by

During the COVID-19 pandemic, we should not neglect a key transmission chain involving a special population in every large city on mainland China: food delivery motorcycle drivers. They are incredibly vulnerable to the pandemic because of the increased demands of food delivery and outreaches to different people. whereas, mostly from adjacent villages, they bear heavy workloads of food delivery and earn comparatively low wages in the city (Figure 1 and 2). Moreover, the food delivery company provide little protections and compensation for them.

Figure 1. the Time magazine uniquely depicted the everyday life of a food delivery driver during the COVID-19 pandemic. https://time.com/5805947/time-coronavirus-covers/
Figure 2. Zhihu, a Chinese website similar to Quora, provided a picture of food delivery drivers working in the rain. https://zhuanlan.zhihu.com/p/27081917

With increased recognition of food delivery drivers’ current conditions, On July 10th 2020, the China Disease Prevention And Control Bureau, affiliated to the National Health Commission Of The People’s Republic Of China, officially issued the policy of health protection of food delivery and express delivery personnel from the COVID-19 epidemic. The new policy encompasses four significant aspects:  protection preparation before work, in-delivery protection, living environment protection, and emergency responses. while multiple stakeholders, including the government, food delivery companies, restaurants, customers, PPE manufacturers, and labor union, advocate this policy, some state different opinions. City sanitation departments worry the new policy could produce excessive garbages contributing to the plastic crisis. and some delivery divers object the law for its mandated inconvenience.

Still, given the drivers’ low social-economic status and vulnerability to the pandemic without proper protections, The new rule mandates the food delivery companies and the restaurants to offer necessary physical protections and financial supports to secure safety and enhance the welfare of delivery drivers. Thus I believe this policy could intervene and sever possible transmission routes via food delivery and enhance the motorcycle delivery drivers’ welfare effectively. Food delivery companies and the restaurants should enforce the new policy and gradually adopt using recycle food containers.

Expand Access to Evidence-Based Treatment for Opioid Use Disorder in the United States: “X the X Waiver”

August 18, 2020 by

While more than 2 million people had an opioid use disorder (OUD) and nearly 70% of overdose deaths involved opioids in 2018, access to medication-assisted treatment (MAT) in the United States remains limited. In fact, only 5% of providers are licensed to prescribe buprenorphine, a medication that is also approved by the Food and Drug Administration for the treatment of OUD. Buprenorphine is considered safe when used as directed, and it has been found to be highly effective in treating OUD.

Source: Getty Images

The “X Waiver,” established as a result of the Drug Addiction Treatment Act (DATA) of 2000, remains a requirement to prescribe buprenorphine in the United States. Although the Comprehensive Addiction and Recovery Act (CARA), signed into law by President Obama in 2016, expanded the qualifications associated with prescribing MAT to include nurse practitioners and physician assistants, the X waiver represents a significant and ongoing barrier to MAT access and utilization. In the midst of an epidemic of fatal and non-fatal overdoses, it is essential to expand access to MAT by eliminating the X waiver. Additionally, eliminating the X waiver would support efforts to reduce stigma surrounding OUD, which has also been identified as a barrier to addressing the opioid epidemic. It is also important to note that eliminating the X waiver would increase the number of patients in recovery for OUD, which would reduce healthcare expenses associated with emergency department visits and in-patient hospital stays, as well as skin and soft tissue infections, hepatitis B and/or hepatitis C viral infection, and infectious endocarditis.

The “X the X Waiver” movement has already gained support from the American Society of Addiction Medicine (ASAM), the American Academy of Family Physicians (AAFP), the American College of Emergency Physicians (ACEP), and health care providers that have seen the impact of the opioid crisis firsthand; however, additional support from prescription drug monitoring programs, state-level medical boards, law enforcement, and other stakeholders is needed. Advocacy groups should work to address concerns among these stakeholders related to diversion, which has been found to be less likely with increased access to MAT.

Source: U.S. Department of Health and Human Services

Moving forward, the American Academy of Addiction Psychiatry (AAAP) and Dr. Elinor McCance-Katz, the Assistant Secretary for Mental Health and Substance Use (SAMHSA), should also reconsider their current stance on eliminating the X waiver. With more than 130 deaths linked to opioids in the United States each day, and considering the challenges presented by the COVID-19 pandemic, we cannot afford to limit access to evidence-based MAT options such as buprenorphine.

The Big Ten: Calling Time Out on Division I Football during the CoVID-19 Pandemic

August 18, 2020 by

When SARS-Cov2 inevitably made it’s way to the United States in early 2020, the impact it would have on every day life was unforeseeable. Controlling the transmission of such a virulent pathogen requires prompt action and expansive buy-in from leaders and citizens alike. While social distancing has been one of the earliest and best-supported strategies for limiting the spread of SARS-Cov2, it has been met with negligent resistance from many Americans. A critical demographic contributing to the rise of cases have been youths and young adults. From February to July, the WHO found the percentage of cases aged 15-24 years multiplied three-fold from 4.5% to 15%.

As the summer comes to an end, colleges and universities bear the heavy burden of devising a safe and effective teaching model. Compliance with CDC guidelines for school settings has kept many, but not all, institutions from resuming a fully in-person on-campus curriculum for the coming fall semester. The Department of Education has also provided resources for remote-learning in an attempt for campuses to avoid densely packed dormitories and congested lecture halls.

(Image Credit: The New York Times)

Surprising and vocal advocates of remote learning and fall campus closures are National Collegiate Athletic Association (NCAA) football teams. In particular is the Big Ten, a Division I college football conference that include famed and elite teams with cult-like followings. In early August, the Big Ten collectively decided to adopt a new policy to postpone their fall 2020 football season to comply with CDC guidelines. This was critically received by many players who rely on the NCAA to transition into professional teams. Many college athletes also depend on team sponsored scholarships to fund their tuition. Some have gone so far as to petition for resuming the football season, gaining hundreds of thousands of signatures from loyal and passionate fans.

While having audience-free collegiate games air on television are one option, football in its very nature is a contact sport that would defy social distancing regulations. To further complicate matters, NCAA games regularly compete out of state and would make infected players potent vectors of coronavirus transmission from one community to the next. Unfortunately, a vocal and powerful voice in support of resuming the fall season comes from the White House. Under the guise of patriotism, Mr. Trump has supported the movement to have the season reinstated, despite the risk it poses to players, their fellow students, their families and their communities. If successful, reinstating the fall 2020 season could overwhelm health care providers and hospitals in college towns while simultaneously digging the United States deeper into the COVid-19 pandemic. The threat is real.