Category: Pediatric News

Tom Price as HHS Secretary – Good for Kids?

Many are describing President-elect’s choice of Representative Tom Price as the secretary of health and human services as “scary” and a “radical choice.”

To understand why, you should both understand what he believes and what his job will be.

The HHS Secretary

HHS Secretary Sebelius at a meeting of the Interagency Autism Coordinating Committee.
HHS Secretary Sebelius, NIH Director Dr. Francis Collins, and others, listen to a speech at the a meeting of the Interagency Autism Coordinating Committee, July 10, 2012. (HHS photo by Chris Smith)

Surprisingly, few people probably know the name of the current HHS secretary – Sylvia Mathews Burwell.

She succeeded Kathleen Sebelius, who resigned in 2014, mostly over problems with the healthcare.gov website and roll-out of the Affordable Care Act.

What does the HHS Secretary do?

As head of the United States Department of Health and Human Services, the HHS Secretary is a member of the President’s Cabinet and overseas the:

  • Administration for Children and Families (ACF)
  • Administration for Community Living (ACL)
  • Agency for Healthcare Research and Quality (AHRQ)
  • Agency for Toxic Substances and Disease Registry (ATSDR)
  • Centers for Disease Control and Prevention (CDC)
  • Centers for Medicare & Medicaid Services (CMS)
  • Food and Drug Administration (FDA)
  • Health Resources and Services Administration (HRSA)
  • Indian Health Service (IHS)
  • National Institutes of Health (NIH)
  • Substance Abuse and Mental Health Services Administration (SAMHSA)

As you probably recognize at least a few of those names, like the FDA, CDC, and NIH, you likely know that these agencies “administer a wide variety of health and human services and conduct life-saving research for the nation, protecting and serving all Americans.”

That work can be seen in the current strategic plan of the HHS:

  1. To Strengthen Health Care
  2. To Advance Scientific Knowledge and Innovation
  3. To Advance the Health, Safety, and Well-Being of the American People
  4. To Ensure Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs

And it can be seen in many of the current problems they are tackling, such as combating the opioid epidemic, lead poisoning hazards, the Zika virus, and continuing to get more people insurance coverage, etc.

Problems with Tom Price as HHS Secretary

So what might be the problem with Rep. Tom Price as HHS Secretary, after all, he is a doctor and has been endorsed by the AMA?

“The Association of American Physicians and Surgeons recommends a policy of Non-Participation to all physicians as the only legal, moral, and ethical means of concretely expressing their complete disapproval of the spirit and philosophy behind these amendments.”

THE PRINCIPLES OF MEDICAL ETHICS OF THE ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

Tom Price is a member of the Association of American Physicians and Surgeons (AAPS), an organization of doctors that was opposed to the establishment of Medicare and Medicaid and which tells its members that it is “legal, moral, and ethical” to not treat patients on Medicare and Medicaid.

The AAPS is also against birth control and pushes a lot of anti-vaccine misinformation that can scare parents away from getting their kids vaccinated and protected against vaccine-preventable diseases!

A Radical Choice

In describing Tom Price as a “radical choice” for HHS Secretary, the New York Times stated that he is “a man intent on systematically weakening, if not demolishing, the nation’s health care safety net.”

In addition to supporting the repeal of Obamacare, Tom Price is a climate change denier, and has been in favor of:

  • block granting Medicaid
  • turning Medicare into a voucher program, which many think is a step towards privatization
  • barring all federal funds for Planned Parenthood, even though the very great majority of their activities have nothing to do with abortion
  • limiting participation in Children’s Health Insurance Program (CHIP) and voting against expanding CHIP several times
  • cutting billions of dollars from the Supplemental Nutrition Assistance Program (SNAP or food stamps) as it was converted to a State Flexibility Fund in the 2015 GOP proposed budget
  • continuing to ban research on gun violence at the CDC as he did not sign a letter with a bipartisan group of 146 other members of Congress, led by Congressman David Price, calling for a lift of the de-facto ban on federal gun violence research

And although his nomination was supported by the AMA, the American Academy of Family Physicians (AAFP), and the Association of American Medical Colleges (AAMC), there are many doctors and medical students who think that “Price’s stances are incompatible with the values of the medical profession and with the stated missions of the above organizations.”

The AAP on the Nomination of Tom Price

What has the American Academy of Pediatrics said about Tom Price’s nomination?

“Above all, HHS should strive to implement an agenda with children at the core and ensure that all children have access to high-quality, affordable health care so they can thrive throughout their lifetimes. All children, regardless of their immigration status, should have affordable health care coverage, insurance with pediatric-appropriate benefits, access to timely and affordable primary and subspecialty pediatric care and mental health services, and receive comprehensive, family-centered care in a medical home.”

AAP’s Blueprint for Children

As is their style, they have not issued a statement, but reviewing the AAP’s Blueprint for Children, it isn’t too hard to figure out what they would say.

Members of the American Academy of Pediatrics routinely volunteer to lobby members of Congress to support pediatric issues, like CHIP re-authorization.
Although they are not always successful, members of the American Academy of Pediatrics routinely volunteer to lobby members of Congress to support pediatric issues, like CHIP re-authorization.

The Blueprint, which “presents specific policy recommendations for the federal government to align its activities to promote healthy children, support secure families, build strong communities, and ensure that the United States is a leading nation for children,” states that they:

  • oppose block grants for Medicaid and other entitlement programs
  • support renewing and strengthening CHIP
  • support maternal and reproductive health programs
  • want to improve access to Medicaid services
  • support protecting and strengthening federal nutrition programs for children and families, including SNAP and WIC
  • support federally funded research to build the evidence base for a public health response to violence, including research on gun violence coordinated by the Centers for Disease Control and Prevention (CDC)
  • want the administration to aggressively addresses climate change
  • support the enactment of comprehensive immigration reform that prioritizes the health, well-being, and safety of children
  • want the administration to address factors that make some children more vulnerable than others, such as race, ethnicity, religion, sexual orientation or gender identity, and disability

And perhaps the thing that is most apparently in conflict with Tom Price’s nomination, the AAP states that they want the HHS secretary and Congress to:

Support and improve the ACA. The ACA has made important progress for children. Congress should improve upon this progress and enhance pediatric benefits in the marketplaces, allow families that are not eligible for CHIP to purchase CHIP plans in the health insurance marketplaces, improve affordability of plans for families (especially those with children with special health care needs), and strengthen rules to ensure that adequate pediatric networks exist in marketplace plans.”

Tom Price is not going to support and improve the ACA (Obamacare), strengthen CHIP, or improve access to Medicaid services. He is basically against just about everything the American Academy of Pediatrics supports and has been working for.

We don’t need a statement from the AAP to know what that means.

 

What Does Polio-Like Mean?

afmPolio has been in the news a lot lately.

Well, not exactly polio.

The term “polio-like” has been in the news.

This follows a large outbreak of enterovirus D68 (EV-D68) respiratory infections in 2014, some of which seemed to be associated with the development of acute flaccid myelitis (AFM).

While there were no reports of EV-D68 infections in 2015, there have been “limited sporadic EV-D68 detections in the U.S. in 2016.”

Polio-Like Syndromes

Similar to coxsackievirus, which causes hand, foot, and mouth disease, EV-D68 is a non-polio enterovirus. On the other hand, the virus that actually causes polio is just a different type of enterovirus.

Because they are all enteroviruses, some get differentiated as being non-polio.

To make it even more confusing, some non-polio enteroviruses can cause a polio-like syndrome. And both polio and non-polio enteroviruses can cause acute flaccid myelitis.

Acute Flaccid Myelitis

AFM is a syndrome characterized by sudden onset of limb weakness, sometimes accompanied by cranial nerve dysfunction (such as facial drooping or difficulty speaking). In many cases, distinctive lesions in the gray matter (nerve cells) of the spinal cord may be seen on neuroimaging.

CDC definition

Acute flaccid myelitis caused by the polio virus can usually be recognized because it is associated with an unvaccinated person who traveled to an area that still has cases of polio and who has “one or more limbs with decreased or absent tendon reflexes in the affected limbs, without other apparent cause, and without sensory or cognitive loss. Paralysis usually begins in the arm or leg on one side of the body (asymmetric) and then moves towards the end of the arm or leg (progresses to involve distal muscle groups).”

Since 2014, at least 230 children in 34 states have developed acute flaccid myelitis. Most had some improvement in function and a small number had a complete recovery, just as a small number had no improvement.

And of course, none of them had polio. In fact, the last polio outbreak in the United States was in 1979.

So maybe we should stop saying “polio-like,” as it likely just confuses people, few people likely know what “polio-like” symptoms actually are, and these cases have nothing to do with the polio virus.

Unfortunately, “despite extensive testing, CDC does not yet know the cause of the AFM cases.”

Still, the CDC recommends standard precautions to try and avoid AFM, including handwashing, avoiding other people who are sick, getting vaccinated (to avoid polio), and protecting your kids from mosquitoes (West Nile virus can cause AFM too).

For More Information on Polio-Like Syndromes

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Are Drug Coupons Behind the Jump in the Cost of an EpiPen?

The high price of Mylan’s EpiPens is getting a lot of attention lately.

In a way that’s good. Not just so that something will finally be done about high drug prices, but because more people need to know about food allergies and about the importance of having and using EpiPens. That is one thing Mylan got right. Their education and awareness campaigns not only encouraged parents to get EpiPens for their kids, but they strongly encouraged them to use them.

Just a ploy to sell more EpiPens? Not when you realize that many people are afraid to use their EpiPens, even when they are having a severe allergic reaction.

Still, they certainly got greedy with the continued price hikes.

Although we are getting used to hearing about high drug prices, they typically aren’t for drugs that your pediatrician prescribes everyday.

You were likely outraged when Martin Shkreli raised the price of Darapim to $750 a pill, but you probably still have no idea what it is used for. On the other hand, you may have or almost certainly know someone with an EpiPen.

An epinephrine autoinjector is traditionally the only treatment for people having anaphylactic reactions to peanuts, insect bites and stings, or other serious allergic reactions.

Why fuss about the cost of a life-saving drug or device? A product that can save your child’s life in a manner of seconds would be priceless to most people.

Much of the issue is that they went from costing about $100 in 2006 to over $600 today. Even last year, a set of two EpiPens (one dose) cost up to $450. So it would be nice to have that option to save lives and save money. Afterall, the very same EpiPens are much cheaper in most other countries.

Surprisingly, it has been the media and not parents or patients who are doing most of the complaining about the high cost of EpiPens. Most of us have insurance and can use a coupon to waive their copay and effectively get their EpiPens free. Those without insurance may not be able to see a doctor to get a prescription, but if they can, may be eligible for Mylan’s patient assistance program.

So who is paying full price?

Mostly people with high deductible insurance plans, at least until they realize that they might save money going with a more costly insurance plan without a deductible, especially if family members have other medical problems, like asthma.

Why asthma?

Have you priced an asthma inhaler lately? Those that you use to prevent asthma can easily cost $300 to $400 each month. A rescue inhaler can cost another $100.

Competition hasn’t helped us get less expensive asthma inhalers. You will need a coupon for that.

Drug coupon use by patients could “come at the cost of higher long-term expenses for themselves and society.” That was a warning in the New England Journal of Medicine editorial “Prescription-Drug Coupons — No Such Thing as a Free Lunch.”

Unfortunately, instead of heeding the warning back in 2013, some companies adopted it as a business model.

Martin Shkreli didn’t do anything original when he bought the rights to the antiparasitic drug pyrimethamine and rebranded it as Darapim, raising the price 5,000%.

For example, although Lupin Pharmaceuticals makes many generic medications, they chose to license Suprax, an expensive antibiotic with a coupon, as a branded generic. So while a similar generic antibiotic, such as cefdinir, might cost about $50, Suprax costs about $250 to $400 for a 10 day course. It will also likely be on the highest and most expensive tier of your insurance, which is why they offer a coupon.

Impax Laboratories, another big maker of generic drugs, takes the cake though. They are selling Emverm for $596 a pill. A chewable pill that is used to treat pinworms, with two doses over two weeks, that means one treatment to stop your child’s butt from itching can cost almost $1200 – unless you use their coupon. An inexpensive generic version of the very same medicine, Vermox, was discontinued in 2011.

It was discontinued by Teva Pharmaceuticals, who then sold the rights to the drug to Amedra Pharmaceuticals, which was then acquired by Impax.

An off-patent, generic drug, Vermox should have been getting cheaper, not having its price soar. The fact that they offer consumers free coupons, meaning they won’t actually pay for the drug, likely explains how they get away with it.

Of course, we all end up paying. There is no free lunch, except maybe when the drug reps for these companies drop off those coupons at your doctor’s office.