Category Archives: Health

What the CDC eviction ban means for tenants and landlords: 6 questions answered

by Katy Ramsey Mason, University of Memphis

Editor’s note: The Centers for Disease Control and Prevention issued an order on Sept. 1 banning evictions of people who lost work as a result of the pandemic. To benefit, renters must sign a declaration that they don’t make more than US$99,000 a year or $198,000 for those filing a joint return and that they essentially have no options other than homelessness. But the order, which takes effect on Sept. 4, leaves some questions unanswered. We asked Katy Ramsey Mason, an assistant professor of law and director of the University of Memphis Medical-Legal Partnership Clinic, to answer some of them.

The CDC order may offer some tenants breathing room. Angela Weiss/AFP via Getty Images

1. What does the order do?

The order prohibits property owners from evicting covered tenants from any residential property because of nonpayment of rent before Dec. 31, 2020. It does not apply to any evictions that might be brought on grounds other than nonpayment, such as nuisance or alleged criminal activity.

It requires tenants to sign and submit a declaration to the landlord certifying under penalty that they qualify for protection under the moratorium. It does not relieve tenants from the obligation to pay rent – all of it comes due on Jan. 1, 2021 – and it allows landlords to continue to charge late fees and other penalties as permitted by law.

2. Who qualifies?

The CDC’s order applies to as many as 40 million renters across the country who could be at risk of eviction for nonpayment of rent.

It is more comprehensive than the Coronavirus Aid, Relief and Economic Security (CARES) Act eviction moratorium, which expired on July 24 and only applied to an estimated 12.3 million renters, or about 28% of rental properties nationwide. The new order applies to tenants who live in any rental property in any place in the U.S. and its territories that does not already have an eviction moratorium with the same or greater protections than the CDC order. There are still 20 states with some form of a moratorium in place, about half of which are more comprehensive than the CDC’s moratorium. All of those moratoriums are unaffected.

Other than the financial requirements, to qualify for relief under the CDC order a tenant must certify that he or she is not able to pay full rent due to substantial income loss and has attempted to obtain government assistance with rent, and must commit to making partial rent payments to the extent of his or her ability.

3. What authority does the CDC have to do this?

The CDC is invoking its powers under federal law to take action to prevent the spread of communicable disease if it finds that state or local prevention measures are insufficient. The order emphasizes the link between homelessness and the spread of COVID-19 and states that the high levels of homelessness that would result from widespread evictions would increase the risk of interstate transmission of the virus.

4. What does it mean for landlords?

The CDC’s order is certain to be unwelcome news for many landlords, who have already been struggling through the pandemic.

Many tenants have been unable to pay rent, and nonpayment evictions have been limited by state moratoriums and the coronavirus relief bill. According to the 2015 American Housing Survey, slightly less than half of rental properties are owned by “mom and pop” landlords, while the rest are owned by business entities. If landlords are not able to pay their mortgages and other costs, it could result in a loss of affordable housing units across the country.

Under the CDC’s order, landlords can continue to collect rent and charge late fees and other penalties, but they cannot evict tenants who don’t pay. The order also does not allocate any additional funding to assist tenants or landlords with unpaid rent, but encourages local governments to use coronavirus relief funds that have already been distributed towards rental assistance programs.

5. How will it be enforced?

Unlike the CARES Act moratorium, which had no enforcement mechanism, the CDC eviction moratorium imposes significant criminal penalties on violators. An individual who violates the order can be fined up to $100,000 and/or one year in jail. If a death results from the violation, the fine increases to up to $250,000.

If an organization or company violates the order, the monetary fines increase to a maximum of $200,000 if there is no death and $500,000 if there is a death. The order authorizes the Department of Justice to “initiate court proceedings” to seek those penalties.

6. What happens when the order expires?

When the order expires on Dec. 31, landlords will again be able to initiate eviction proceedings in accordance with state law – unless the moratorium is extended. If tenants have been unable to pay their full rent up to that point, they will be responsible for all of the arrears that have accrued – putting them at risk of losing their homes in the middle of winter. Some members of Congress have been pushing for additional funding to assist tenants – and landlords – with unpaid rent, but negotiations over another relief bill remain stalled.The Conversation


Republished with permission under license from The Conversation.

Prisoners in US suffering dementia may hit 200,000 within the next decade – many won’t even know why they are behind bars

by Rachel Lopez, Drexel University

Prison officials are bracing for a silver tsunami that will flood correctional facilities with elderly and often vulnerable prisoners.

Like the rest of the United States population, the prison population is aging fast. The U.S. Census Bureau projects that by 2030, people over the age of 55 will account for almost one-third of all incarcerated people. That means that American prisons will house upward of 400,000 older prisoners, about the same population of New Orleans, representing a near doubling of the number of older prisoners currently behind bars.

Caring for these elderly prisoners suffering from physical and mental frailty will create significant challenges for prisons.

As an expert in human rights law and a former commissioner on Pennsylvania’s Sentencing Commission, I am concerned about the burden this places on already overstretched prisons, but also the cost to human dignity. Furthermore, my research suggests that indefinitely detaining someone who does not understand why may violate the United States Constitution’s prohibition on cruel and unusual punishment.

An inmate at California Men’s Colony prison. Andrew Burton/Getty Images

 

Dying behind bars

America’s large aging U.S. prison population is the direct result of the “tough on crime” policies of the 1980s and 1990s, when three-strike laws and mandatory life sentences without the possibility of parole condemned many to die behind bars.

The Federal Bureau of Prisons spends approximately US$881 million per year caring for the elderly in their custody. My home state of Pennsylvania spends $3.2 million on medication for this population each month.

An 82-year-old prisoner being assisted on the breakfast line at California Men’s Colony prison. Andrew Burton/Getty Images

Part of what is driving this cost is the expense of caring for those with serious medical conditions, especially those with dementia. Last year, the federal government opened its first unit dedicated solely to caring for prisoners with dementia. The unit is staffed by nurses, correctional officers and other prisoners who receive special training to help them care for those with Alzheimer’s disease and dementia.

The challenge of caring for this population will only compound as it grows. If researchers’ estimates are correct, by the end of this decade around 70,341 to 211,020 of the elderly prison population will have dementia. Most will be unable to perform the regular activities of daily life and will eventually require around-the-clock nursing care.

Unusual cruelty

Finances are not the only concern regarding this elderly incarcerated population. There is also the cost to human dignity.

The Eighth Amendment of the U.S. Constitution upholds this principle by outlawing cruel and unusual punishment. To justify punishment, the Eighth Amendment requires that there be some penological purpose, such as retribution, rehabilitation or deterrence.

Recent U.S. Supreme Court cases suggest there is no such justification for indefinitely incarcerating those with dementia. In February 2019, the court in Madison v. Alabama – which centered around a prisoner who developed severe dementia after a series of strokes – held that it is unconstitutional to execute someone who cannot rationally understand their death sentence because it serves has no retributive purpose.

A prisoner in the hospice wing of California Medical Facility. Andrew Burton/Getty Images

The reasoning behind this ruling is centuries old. Dating back to the United States’ founding, those with limited mental capacity were entitled to special protections in the criminal context.

Sir William Blackstone, a renowned 18th-century English jurist whose commentaries on English common law deeply influenced the Founding Fathers of the United States, believed it was cruel and unusual to execute someone who lacked mental capacity.

As the U.S. Supreme Court would later echo, Blackstone reasoned that “furiosus solo furore punitur” – madness is its own punishment. Living with dementia can also feel like a punishment. People with dementia suffer gradual, irreversible loss of memory, judgment, daily functioning and health.

The effects of the disease are compounded by incarceration. Because of their profound impairments, people with dementia are sometimes unable to understand that they are in a prison, much less why. Elderly prisoners with dementia are also at an increased risk of victimization, sexual assault and bullying from other prisoners.

Additionally, because they struggle to understand and follow prison rules, they are also more likely to be subjected to harsh punishment while incarcerated. Some are punished with solitary confinement, which further degrades their physical and mental health.

Life and death

While Madison vs. Alabama addressed death sentences, a 2012 U.S. Supreme Court case provides precedent for the conclusion that the justices’ holding could be extended to life without the possibility of parole. In Miller v. Alabama, the court compared a life sentence to a death sentence, as it “forswears altogether the rehabilitative ideal.”

In other words, both sentences result in the condemned person having no ability to redeem themselves. While the court had suggested in previously cases that the death penalty is in a category all its own, in Miller it suggested that life sentences “share some characteristics with death sentences that are shared by no other sentences.”

Furthermore, when it comes to prisoners with dementia, life sentences cannot be justified as a deterrence. Simply put, how can someone adjust their behavior to avoid punishment, if they do not understand that the punishment is a consequence of their own bad acts?

Forcing those who cannot understand their punishment to live the remainder of their days behind bars appears to be exactly the type of excessive and cruel punishment that the Eighth Amendment was meant to protect against. As the elderly prison population balloons, society may need to reconsider the real world consequences of life without parole sentences.

In my view, the cost, both to taxpayers and to our basic human dignity, is too high.


Republished with permission under license from The Conversation.

New Coronavirus sick leave law – who’s eligible, who’s not and how many weeks do you get

by Elizabeth C. Tippett, University of Oregon

On March 18, President Donald Trump signed the Families First Coronavirus Response Act into law.

The legislation is an emergency intervention to provide paid leave and other support to millions of workers sidelined by school closures, quarantines and caregiving.

An obvious question you’re probably wondering is, “How will it affect me?”

The bad news is that the law does not provide blanket coverage for all workers. Instead, it’s a confusing mess – legislative Swiss cheese, full of exceptions and gradations that affect whether you are covered, for how long and how much pay you can expect to receive.

With schools closed, parents such as Jennifer Green, left, and Lisa Spalding, right, must stay at home with their children. Suzanne Kreiter/The Boston Globe via Getty Images

 

I study employment law and have combed through the bill to make sense of it. The law also provides emergency funding for unemployment insurance and subsidizes some employer health care premiums, but my focus here is on the core elements pertaining to sick and family leave.

Here’s what I learned.

Small, medium or large

To figure out whether you are covered, the first thing you’ll need to answer is how many people work at your company.

If your employer has 500 or more workers, it is excluded from the new law. Instead, workers at those companies will need to rely on any remaining sick leave benefits available under company policy or state law.

Several states, including New York, California and Washington, are also considering emergency legislation tied to the coronavirus pandemic and may offer some relief for workers at these bigger companies. These workers can also make use of the 1993 Family and Medical Leave Act, which provides for unpaid leave if the employee or a family member falls seriously ill.

In addition, some large employers have made new accommodations for their workers. Walmart, the nation’s largest employer, for example, has extended its sick leave benefits for hourly workers. And coffee chain Starbucks expanded its existing sick leave policy to provide paid leave of up to 26 weeks if an employee contracts COVID-19 and is unable to return to work.

If your company employs fewer than 500 people, you should be covered by the new law. But there’s another exception: Businesses with fewer than 50 employees can make use of a hardship exemption if providing leave might put them out of business.

School closures

Assuming your company is covered, the amount of leave available – and how much workers can expect to get paid – will depend on the reason you aren’t able to report to work or do your job remotely.

Here’s where it gets really complicated.

If you are stuck at home due to the closure of a child’s school or day care, you will be eligible for leave under two separate parts of the new law – paid sick leave and family and medical leave.

Congress seems to have structured the law to allow working parents sidelined by a school closure to use both forms of leave at once. Parents would request up to 12 weeks of leave as family and medical leave for a school closure. But since this part of the law doesn’t offer pay until the third week, parents could use the new sick leave provisions to receive income for the first two weeks.

Whether you’re using sick or family leave, you can expect to receive two-thirds of your usual pay, or up to US$200 per day. The money would come directly from your employer who will be reimbursed by tax credits.

Alternatively, people could use the sick leave for the first two weeks and then take 12 weeks under family leave, for a total of 14 weeks, but that would include two weeks that are unpaid.

If you have any available vacation or sick pay under your company’s policy, you may want to use that first since it typically provides full pay.

What happens if you get sick

Workers who are directly affected by the new coronavirus can expect more generous income replacement – but only briefly.

If you are under government-ordered quarantine or isolation, self-isolating at the instruction of a health care provider or experiencing COVID-19 symptoms and seeking a medical diagnosis, you can make use of the new federal sick leave law for up to two weeks. During this time, you should receive your usual pay, capped at $511 per day.

If you become seriously ill beyond two weeks, the new law does not offer additional paid leave. However, you may be eligible to take another 12 weeks of unpaid leave under the 1993 Family and Medical Leave Act. This covers only companies with more than 50 people and workers employed there for longer than 12 months. During this time, your job is protected, but you may be required to use any accrued sick leave or vacation available under company policy.

The rules are similar if you are caring for someone who is under government-ordered quarantine or isolation or has been ordered to self-isolate by a health care provider. The only difference is that your income would be only two-thirds of your usual pay, capped at $200 a day, for two weeks.

And again, if you are caring for a family member who becomes seriously ill, you may be able to take up to 12 weeks of unpaid leave under the 1993 act without losing your job.

In normal times, legislation like this would have been considered broad and ambitious, but as the crisis deepens, its exclusions will likely leave vulnerable workers exposed. With another stimulus bill in the works, Congress will have another chance to help Americans whose lives have been turned upside down by this pandemic.


Republished with permission under license from The Conversation.

Coronavirus quarantines and your legal rights: 4 questions answered

by Latisha Nixon-Jones, University of Oregon

The unknown is frightening. And with the spread of a deadly and communicable disease – the coronavirus is both – individual liberties may be temporarily sidelined to protect the larger community.

Indeed, history has shown us that whenever the United States has encountered a biological threat, the government invariably weighs individual freedoms against the compelling need to protect the rest of us from a widespread epidemic. More often than not, a clampdown on civil liberties occurs. 

As a disaster law scholar, I study vulnerable populations during various stages of disaster response. In the age of coronavirus, people are asking me questions about their rights. Here are some answers.

1. I had contact with someone who has the coronavirus. Am I required to go into quarantine or isolation?

The answer: It depends. The Constitution gives states the power to police citizens for the health, safety and welfare of those within its borders. This means states have the right to quarantine an individual, community or area to protect the surrounding community. With testing supplies in limited quantity and high demand, citizens are strongly encouraged to self-isolate. However, if you are a citizen who came into contact with a person with the coronavirus in a different country and then flew home, CDC officials at the airport have the right to detain you and force you into quarantine.

That said, quarantine and isolation laws vary widely, as do the consequences of breaking them.

In some states – including California, Florida and Louisiana – breaking an order of quarantine or isolation can result in misdemeanor criminal charges. Jail time could be up to a year, along with penalties ranging from US$50 to $1,000.

Those under quarantine can have visitors, but physical interaction may be limited to prevent the spread of the disease. Limitations, depending on your state or local regulation, can include confining you to a specific physical space and barring physical touching, including hugging and kissing.

Quarantined individuals do have the right to challenge the quarantine order.

You can find a list of state laws about quarantine and isolation on the National Conference of State Legislatures website.

Federal, state and local governments have the power to enforce quarantines. 

2. Who can enforce quarantines?

All three levels of government have the power to quarantine.

States can quarantine citizens who present with symptoms within their borders. Local governments can quarantine smaller communities or areas of individuals that present with the coronavirus symptoms. The federal government too has responsibilities; it has the power to prevent the entry and spread of communicable diseases from foreign countries.

And the Centers for Disease Control and Prevention has the authority to detain and examine anyone arriving in the U.S. suspected of carrying the coronavirus. That includes passengers from airplanes, motor vehicles or ships.

The CDC can also issue a federal isolation or quarantine order, which allows state public health authorities to seek help from local law enforcement to administer and enforce the federal quarantine orders.

3. Under what circumstances can I be tested for coronavirus?

At this time, no legislation has been passed to create a legal right to testing.

You must contact your doctor to get approval to be tested. If you don’t have a doctor, contact your public health authority. Currently not everyone can be tested due to the shortage of tests.

The CDC website bases testing criteria on the following ailments: You have a fever; you develop virus symptoms; you recently traveled to an area with an ongoing spread of the virus; or you have been in contact with someone known to have the coronavirus.

But with the current shortage of tests, you still may not be able to be tested. As testing becomes available, the restrictions on testing may also change.

4. My state has declared a state of emergency; will that affect my rights?

According to the National Governors Association, as of March 17, “State emergency/public health emergency declarations have been issued for each state and territory, as well as the District of Columbia.”

A state of emergency allows a state to activate its emergency or disaster plan, along with the accompanying resources. It also allows states to help with local response efforts, including providing money for personnel and supplies.

The state of emergency can affect your rights because states have used emergency declarations to close or restrict the hours of private businesses, close schools and public buildings, and enforce curfews for citizens.

There are federal-, state- and local-level declarations of emergency.

The power to declare a federal state of emergency is given to the president under the Stafford Act and the National Emergencies Act.

In Oregon, the governor used its state of emergency, according to the Associated Press, to activate “reserves of volunteer emergency health care personnel, especially important in rural areas,” develop guidelines for private businesses and aid employees by defining the coronavirus as a valid cause for sick leave. The addition of the sick leave definition will allow employees to take leave to care for their own sickness or for an immediate family member.


Republished with permission under license from The Conversation.

Black kids and suicide: Why are rates so high, and so ignored?

by Rheeda Walker, University of Houston

Teen suicide rates among black youth are increasing. In 2016 and again in 2018, national data revealed that among children age 5-11, black children had the highest rate of death by suicide. For the years 2008 to 2012, 59 black youth died by suicide, up from 54 in the years 2003-2007.

Black youth may be less likely to share their thoughts of loneliness or depression than other youth, which could be a reason for higher rates of death by suicide among black youth. Motortion Films/Shutterstock.com

Also, the 2015 Centers for Disease Control and Prevention’s biennial Youth Risk Behavior Survey reported that, compared to non-Hispanic white boys, black high-school age boys are more likely to have made serious suicide attempts that require medical attention.

I am a professor of psychology and also director of the culture, risk and resilience research laboratory at the University of Houston, and I recently co-authored a study that suggests that new risk profiles may be needed for better suicide prediction in African Americans in particular.

Comprehensive suicide awareness

Suicide has become a leading cause of death in the U.S. among all age groups, but particularly in youth and young adults. It is the second leading cause of death among 10- to 34-year-olds. Parents, teachers and professionals must be able to both talk about it and understand the risks for vulnerable children of any race. But those of us who work with black youth may also need to address some myths about suicide in the African American community.

For example, one such myth has its start almost three decades ago, Kevin Early and Ronald Akers’ interviews with African American pastors concluded that suicide is a “white thing” and that black people are accustomed to struggling through life challenges without succumbing to suicide. those authors concluded that black people see suicide as a “white thing” but it is a myth that black people do not die by suicide.

Based on anecdotal conversations that many others and I have heard in day-to-day conversations and that sometimes emerge in popular media, this opinion about suicide in the black community has shifted relatively little.

More importantly, black youth at risk may even be more difficult to identify than non-black youth. One study referred to college age racial/ethnic minority people, including African Americans, as “hidden ideators” who are less likely than other youth to disclose thoughts of suicide. Because suicide is occurring and at shockingly young ages, comprehensive efforts are needed to address this public health problem.

Studies suggest that stigma about mental illness and the feeling that one will be outcast further or ignored may keep black youth from sharing their thoughts. Also, public health and mental health experts may be unaware that suicide risk factors could show up differently depending on ethnic group.

Simply put, a one-size-fits-all approach does not work for identifying suicide risk. And little or no action has been taken to address the increasing crisis. As an African American psychologist, I find this frustrating when children’s lives are lost – lives that could be saved.

African American youth face challenges that non-Hispanic white youth may not. 

Unique needs in African American mental health

Most mental health services are not designed with cultural and social nuances in mind. My research team has found consistently that the challenges that black kids face in navigating dual cultural contexts may increase their risk of suicidal thoughts.

In research on adults, we found that black men and women who used more Eurocentric or individualist approaches that was more self-focused rather than managing stress via the belief in a Higher Power were more likely to consider suicide. This was not true for those who used more culturally meaningful, spiritual coping.

When there are cultural differences, therapists must be willing to “think outside of the box” to fully evaluate risk for suicide. As an example, the racism that black Americans encounter increases stress for many. Thus, their stressors and mental health issues will need different solutions and approaches than treatments that work for white people.

In another study published in Comprehensive Psychiatry, we observed different patterns of risk for black adults compared to white adults who were admitted for psychiatric care. We examined sleep-related problems, which are elevated among black Americans, and suicide because sleep issues are a serious but understudied risk factor for suicide crisis. It turns out that inadequate sleep can escalate an emotional crisis. Our research found that problems staying awake for activities such as driving or engaging in social activities, which reveal inadequate sleep, were associated with a four-fold greater risk for suicide crisis compared to non-suicide crisis in black adults who were admitted for psychiatric treatment.

We have also found that experiencing racism is associated with thoughts about suicide for black youth and adults.

A caring, loving adult in a child’s life is essential. It is also important not to downplay a child’s feelings, telling her to cheer up or get over it. fizkes/Shutterstock.com

How to find help

Caring adults are a child’s first line of defense. If a child discloses that he is thinking about dying, it is important to ask him to share more about his ideas and if he knows he might die. If a child has a suicide plan, it is time to get professional help. The Crisis Text Line at 741741 could be an option for teens who need help to cool down in a crisis.

When it comes to finding a mental health professional, parents need an expansive list of referral options, including university-affiliated mental health clinics that offer evidence-based services on a sliding scale and federally qualified health centers for the uninsured. Regardless of the setting, a well-trained therapist may be of a different race.

Parents and caregivers must be willing to sit, listen and try to fully understand what is most upsetting for a child who is experiencing a difficult situation and a lot of emotions.

For those who believe that the alarming statistics will eventually reverse course without any action, this may be true. In the meantime, saving one life is worth the effort.

Thoughts of suicide do not mean that a child or teen needs to be hospitalized. It means they are in emotional pain and want the pain to end. Adults can investigate the problem and remove it or help the child deal with it. Online resources such as Stopbullying.gov include interactive videos that are useful to parents, educators and youth. Suggesting to a child that she “get over it” is less than helpful. A child who is already in a vulnerable state cannot problem-solve without meaningful support from the caring adults in charge.


Republished with permission under license from The Conversation.

Over 700 Doctors Who Were Paid More Than a Million Dollars by Drug and Medical Device Companies

Back in 2013, ProPublica detailed what seemed a stunning development in the pharmaceutical industry’s drive to win the prescription pads of the nation’s doctors: In just four years, one doctor had earned $1 million giving promotional talks and consulting for drug companies; 21 others had made more than $500,000.

Six years later — despite often damning scrutiny from prosecutors and academics — such high earnings have become commonplace.

More than 2,500 physicians have received at least half a million dollars apiece from drugmakers and medical device companies in the past five years alone, a new ProPublica analysis of payment data shows. And that doesn’t include money for research or royalties from inventions.

More than 700 of those doctors received at least $1 million.

“Holy smokes,” said Dr. Walid Gellad, an associate professor of medicine and health policy at the University of Pittsburgh, where he leads the Center for Pharmaceutical Policy and Prescribing. It is “quite striking” how much money doctors were earning from “other activities aside from patient care,” he said.

To identify the latest pharma millionaires and other spending trends, ProPublica analyzed more than 56 million payments made from 2014 to 2018 — the first five full years of the federal Open Payments initiative, which requires companies to publicly disclose the payments as part of the 2010 Affordable Care Act.

Prescription Drugs With Top Spending on Doctor Payments

Here are the drugs for which pharmaceutical companies spent the most money paying doctors, per year, excluding research and royalty payments. The list does not include payments to teaching hospitals. Data for 2014-2016 is from a prior release of Dollars for Docs and any subsequent updates are not reflected.

Credit: Moiz Syed/ProPublica. Source: ProPublica analysis of Open Payments data from the Centers for Medicare and Medicaid Services.

Some academics and physicians predicted that the exposure might cause companies to rethink making payments and doctors to rethink taking them. A flurry of studies matched the payment data with doctors’ prescribing choices and found links between the payments and the products doctors chose.

But ProPublica’s new analysis shows that the public reporting has not dampened the enthusiasm of the drug and medical device industry for having doctors deliver paid dinner talks and sponsored speeches or paying them to consult on products.

In fact, there has been almost no change in how much the industry is spending. Each year from 2014 to 2018, drug and medical device companies spent between $2.1 billion and $2.2 billion paying doctors for speaking and consulting, as well as on meals, travel and gifts for them. (These figures do not include research spending, but they do include royalties.)

Roughly the same number of doctors — more than 600,000 — received payments in any given year.

That consistency, some academics say, is conspicuous.

“It makes me wonder whether patients are using this information or whether physicians are even aware this information is out there,” said Dr. Joseph Ross, a professor of medicine and public health at Yale who has studied pharmaceutical marketing. “It’s almost like it’s not happening.”

Holly Campbell, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, defended company payments to doctors. “It is not necessarily a negative that the numbers have remained generally flat over the past five years,” she wrote in an email. “That statistic appears to be consistent with companies’ belief that their interactions with physicians have been and remain legitimate, even when subjected to sunshine.”

ProPublica first delved into the world of drug company promotional campaigns in 2010 when it gathered the payments made by seven companies that were required to make them public as part of settlements in whistleblower lawsuits. The payments were published in a database called Dollars for Docs, which allowed anyone to look up a doctor and see if he or she received a payment.

ProPublica updated Dollars for Docs with the latest data from the federal government on all payments.

Among their findings:

Consistency Breeds Familiarity

Over the course of five years, 1 million doctors, dentists, optometrists, chiropractors and podiatrists received at least one payment, most often a meal, from a company. Of those practitioners, more than 323,000 received at least one payment every year. About 240,000 received a payment in only one year. And the rest received payments in more than one year but in fewer than five.

For context, there are about 1.1 million doctors in the United States.

Dr. Aaron P. Mitchell, a medical oncologist and health services researcher at Memorial Sloan Kettering Cancer Center, said his research has shown that when doctors interact more consistently with a drug company they are more likely to prescribe that company’s cancer drug. The drug industry, Mitchell said, “knows that they need to cultivate relationships over more time, so that’s what they’re really trying to do. It’s not just one drug meal. It’s consistency.”

Some Drugs Are Promoted Heavily Year After Year

Of the top 20 drugs with the most annual spending on doctors from 2014 to 2018, six made the list in each of the years: Invokana to treat type 2 diabetes, the blood thinners Xarelto and Eliquis, the antipsychotic Latuda, the immunosuppressive drug Humira and the multiple sclerosis drug Aubagio. Another three drugs were on the list for four years: Victoza to treat type 2 diabetes, psoriasis treatment Otezla and the cholesterol-lowering drug Repatha. (Research funding and royalties are not included.)

Xarelto topped the list in spending for four years, totaling more than $123 million in payments from 2014 to 2018. In March, its makers, Johnson & Johnson and Bayer AG, agreed to pay $775 million to settle about 25,000 lawsuits claiming that the companies had failed to warn patients that Xarelto could cause fatal bleeding.

In statements, J&J and Bayer have said that the allegations lacked merit and that Xarelto is safe and effective. They noted that six cases that went to trial were decided in their favor.

Many drugs on the list are in categories where there is fierce competition. For example, seven of the top 20 in 2018 treat diabetes. And in most of the drug classes on the list, “there are more than one available drug — sometimes all with the same mechanism of action — indicated for the same condition selling for very high prices,” Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School, said in an email.

According to GoodRx, a drug discount website, the average cash price of a month’s supply of diabetes drugs Invokana, Jardiance and Farxiga is more than $600.

“Promotional spending is a major way that manufacturers in these situations distinguish themselves from each other — not by conducting comparative studies or by engaging in substantial price reductions,” Kesselheim said.

ProPublica and a number of researchers have examined the types of drugs that prompt the highest payments. Ross, of Yale, and a colleague published an analysis in the British Medical Journal in 2017 that found that the “top promoted drugs were less likely than top selling and top prescribed drugs to be effective, safe, affordable, novel, and represent a genuine advance in treating a disease.”

“Our findings suggest that pharmaceutical promotion should be met with healthy skepticism,” the analysis concludes.

Prosecutors Say the Payments by Some Drug Companies Are Kickbacks, Despite the Transparency of Open Payments

There is a perception among many physicians, including some in academia, that drug company payments are fairly benign — a moonlighting gig that educates other doctors about important medications. But since ProPublica began looking at physician payments, one drugmaker after another has paid tens, or even hundreds, of millions of dollars to resolve allegations of improper, or illegal, marketing tactics.

In fact, drug company whistleblowers and federal prosecutors have said explicitly that in some cases the payments were actually bribes and kickbacks. And this behavior has continued despite tools like Dollars for Docs.

Here are some recent examples:

  • Insys Therapeutics

    Spending: In 2014, the payment data shows, Insys Therapeutics spent $7.5 million promoting Subsys, a fentanyl spray for advanced cancer pain, making it one of the drugs with the most spending that year. Through 2018, the company’s total spending on the drug had reached $17.6 million.

    Prosecutors say: Insys paid doctors to speak about Subsys to other physicians during “educational lunches and dinners,” according to a Justice Department press release, from August 2012 to June 2015. The meals “were actually used as a vehicle to pay bribes and kickbacks to targeted practitioners in exchange for increased Subsys prescriptions to patients and for increased dosage of those prescriptions.”

    Penalty: This June, Insys agreed to plead guilty to five counts of mail fraud, pay a $2 million fine and forfeit $28 million. It also agreed to pay $195 million to settle a separate whistleblower case. At least eight company executives have now been convicted of crimes relating to the illegal marketing of the drug. Insys has said it completely restructured its operations, hired new leaders and has filed for bankruptcy protection.

  • Avanir Pharmaceuticals

    Spending: From 2014 to 2018, Avanir spent nearly $22 million on its drug Nuedexta, which treats pseudobulbar affect, or uncontrollable laughing or crying.

    Prosecutors say: An Avanir employee reported that one doctor at a long-term care facility, who was also a paid speaker for Nuedexta, put “entire units” of patients on Nuedexta. Another doctor at the facility, which had a number of dementia patients, routinely stopped the Nuedexta, only to have the first doctor restart it, according to a Department of Justice press release.

    Penalty: In September, the company agreed to pay more than $108 million to resolve criminal and civil allegations that it paid kickbacks to doctors and marketed the drug for unapproved uses, including behaviors associated with dementia. In a statement, Avanir said it fully cooperated with investigators “and engaged in extensive remedial measures. The individuals listed in the resolution agreements are no longer Avanir employees.”

Though relationships between drug companies and doctors continue, seemingly with little change, Kesselheim, of Harvard, said that the transparency “helps bring into light an area of the field that was in the shadows.

“Now we need to figure out what to do with this.”


Republished with permission under license from ProPublica.

Racism shortens lives and hurts health of blacks by promoting genes that lead to inflammation and illness

By April Thames, University of Southern California 

Negative social attitudes, such as racism and discrimination, damage the health of those who are targeted by triggering a cascade of aberrant biological responses, including abnormal gene activity. It is not surprising that reports documenting lifespan and causes of mortality have demonstrated a clear pattern: African Americans die sooner and bear a heavier burden of many diseases, including hypertension, heart disease, dementia and late-stage breast cancer.

Scientists have searched for genetic causes to health disparities between blacks and whites but have had limited success. The strongest evidence to date points to social-environmental factors such as poverty, health care inequities and racism.

Our society is plagued by racism and racial inequality which is not fully recognized by all, according to a recent study showing that many Americans overestimate our progress in fixing racial inequality. On the other hand, more Americans (65%) are aware that it has become more common for people to express racist or racially insensitive views, according to a U.S. survey.

Racism is not merely negative attitudes or treatment from one person to another. Racism has deep historical roots in American society, sustained through institutional policies and practices, whereby people of color are routinely and systematically treated differently than whites.

As an African American/white individual, I often experienced comments growing up like “You don’t sound black,” and “What are you?” that made me cringe. In college, I became intrigued by the field of psychology as it was a field that explained how prejudices, stereotyping and racism arise. My research as a clinical psychologist at USC is focused on understanding how societal factors interact with biology to create disparities in health outcomes. A recent study I co-authored showed that racism promotes genes that turn on inflammation, one of the major drivers of disease.

Less overt, but entrenched

Although racism may be less overt today than during the early 20th century, government policies and norms, unfair treatment by social institutions, stereotypes and discriminatory behaviors are sobering reminders that racism is still alive – and contribute to earlier deaths in addition to poorer quality of life.

For example, blacks are more likely than whites to receive drug testing when prescribed long-term opiates even though whites show higher rates of overdose. African Americans have shouldered the burden of racism for decades, creating a level of mistrust for societal systems, be it health care or law enforcement.

Terms such as “driving while black” illustrate how racism and discrimination have been deeply embedded in African American cultural experience. Just imagine trying to buy a home and being turned down because of your race. This is too common of an experience for African Americans. Nearly half (45%) reported experiencing discrimination when trying to find a home and in receiving health care, according to a Robert Wood Johnson survey that was developed by the Harvard T.H. Chan School of Public Health, Robert Wood Johnson Foundation and National Public Radio.

From macro to micro, the effect is widespread

Blacks’ exposure to chronic stress has often been cited as a reason for worse health outcomes. 

Until recently, we scientists did not know the mechanism linking racism to health. The new study from my lab here at USC and colleagues at UCLA shows that the function of genes may explain this relationship. As it turns out, our study showed that genes that promote inflammation are expressed more often in blacks than in whites. We believe that exposure to racism is why.

We previously showed how activating racism, such as asking people to write down their race before taking an exam, in the form of stereotyping impairs brain functions such as learning and memory and problem-solving in African Americans. This may partly explain the higher rates of dementia in African Americans compared to whites.

Researchers have well documented that chronic stress alters the function of brain regions, such as the hippocampus, that are targeted in brain diseases such as Alzheimer’s disease. This work has been expanded through the field of social genomics, largely pioneered by my colleague Steve Cole at UCLA. A relatively new field called social genomics demonstrates how the function of genes – termed gene expression – is influenced by social conditions.

Genes are programmed to turn off and on in a certain manner. But those patterns of activity can shift depending on environmental exposures.

Certain marginalized groups demonstrate abnormal patterns of gene activity in genes responsible for innate immunity. Innate immunity is how the body fights off and responds to foreign pathogens. Dr. Cole named this pattern/sequence of gene activity the Conserved Transcriptional Response to Adversity. It refers to the how genes controlling innate immunity behave under positive or negative environmental conditions.

When environmental stresses like socioeconomic disadvantage or racism trigger the sympathetic nervous system, which controls our fight-or-flight responses, the behavior of our genes is altered. This leads to complex biochemical events that turn on genes, which may result in poor health outcomes.

The Conserved Transcriptional Response to Adversity profile is characterized by increased activity of genes that play a role in inflammation, and decreased activity of genes involved in protecting the body from viruses.

We found that blacks and whites differed in the pattern of which pro-inflammatory and stress signaling genes were turned on. Our findings are particularly important because chronic inflammation ages the body and causes organ damage.

As my colleagues and I pulled this study together, we took into consideration the health disparities such as socioeconomic status, social stress, and health care access. For example, we recruited African Americans and whites with similar socioeconomic status. We also examined racial differences in reports of other types of stress events. Both groups reported similar levels of social stress.

For this particular study, none of these traditional factors explained why African Americans had greater expression in pro-inflammatory genes than whites. However, we found that experiences with racism and discrimination accounted for more than 50% of the black/white difference in the activity of genes that increase inflammation.

So what do these results mean for future health? I believe racism and discrimination should be treated as a health risk factor – just like smoking. It is toxic to health by damaging the natural defenses our bodies use to fight off infection and disease. Interventions tailored toward reducing racism-associated stress may mitigate some of its adverse effects on health. As a society we cannot afford to perpetuate health inequities by undermining or disguising the biological impact of racism.


Republished with permission under license from The Conversation.

The Pentagon’s New Laser-Based Tool Uses Your Heartbeat to Track You

by Shelly Fan

The government’s hefty arsenal of surveillance tools just welcomed a powerful new member. Rather than monitoring an external device—a bug or a smartphone—or even the exterior features of your face, the new tech aims straight for your heart. Literally.

First reported by MIT Technology Review, the US Pentagon is developing an infrared laser that captures a person’s unique “cardiac signature” from as far as 200 meters—the length of just over two football fields—away, as long as you’re still. According to Steward Remaly of the Pentagon’s Combating Terrorism Technical Support Office (CTTSO), even longer ranges may be possible with higher intensity lasers.

Although chilling, the tech builds on previous ideas.

Contact infrared sensors have long been used to monitor a person’s pulse, in a clinical setting or when traversing high altitudes. Here, the devices shoot infrared light into a finger and measure how much blood flow alters the refraction. Unlike this classic setup, the Pentagon’s new tech—dubbed Jetson—uses laser doppler vibrometry that detects minute movements on the skin caused by heartbeat.

Currently under development by Ideal Innovations, Inc., a veteran-owned biometrics, forensics, and scientific company based in Arlington, Virginia, the goal of Jetson is to positively identify an individual within five seconds using a “heartprint.”

“Existing long-range biometric methods that rely on facial recognition suffer from acquiring enough pixels at a distance to use the face matching algorithms and require high performance optics to acquire visual signatures at significant distances,” explained the CTTSO. “The Jetson effort…is a ruggedized biometric system that will capture cardiac signatures to aid in the positive identification of an individual” from a distance with little lag time.

Jetson is just the latest attempt at surveillance from a distance. Rather than old-school technologies such as fingerprinting or retinal scans, this new generation of surveillance technologies uses biometrics to monitor your every move—be it face, speech, heartbeat, or even brain activity—from a distance.

The tech may sound extreme, but Jetson is using the same playbook as biometrics for security. And to project where surveillance is going, it pays to look at biometrics research as the canary in the coal mine. Using your finger or face to unlock your phone is just the convenient side of things—what makes your biometric signature secure as a passcode is also what makes you identifiable as an individual.

Face Off

Facial recognition technology is no doubt the current crown prince of surveillance technologies. China readily adopted the tech as part of their Social Credit System, which monitors a civilian’s every move in public to generate a numerical score for compliance. Even here in the US facial recognition is welcomed by law enforcement. Amazon’s Rekognition system, for example, is reportedly “supercharging” police efforts in Oregon and other police departments, despite pressure from civil liberties groups, lawmakers, and even its own shareholders.

Surveillance loves facial recognition because the tech is relatively mature and can be done from a distance. And no doubt, there is value for the technology in long-range counterterrorism. For example, the technology can be used to remotely confirm the identity of a suspect—say, an ISIS leader—and in turn allow a state to authorize an attack.

The problem? Facial recognition software is far from perfect. A study by the ACLU using Rekognition found that the system incorrectly matched 28 members of Congress to mug shots, with the majority being African-American. Technological hiccups aside, a face is relatively easy to disguise. The perfect surveillance system needs to be efficient, effective, and low-error. In other words, it needs something more concrete, immutable, and physiological to target.

That’s where cardiac signatures come in.

Beat of the Heart

To Dr. Wenyao Xu at the State University of New York, the heart is a much better surveillance target than facial recognition. “Compared with face, cardiac biometrics are more stable and can reach more than 98 percent accuracy,” he said.

Back in 2017, his team developed a non-contact, remote biometrics device that uses dimensions of the heart as a person’s identifier for security. His system distills the geometry of a person’s heart—measured by refracting sound waves with Doppler radars—to identify the particular shape and size that characterizes an individual. But because it relies on sound waves, the system could only function up to 30 meters away—a fraction of the Pentagon’s ideal distance.

Other cardiac signatures have also been used for security. The Toronto company Nymi, for example, developed a wearable wristband that uses an employee’s electrocardiogram (ECG), which is also uniquely tailored to each individual, as an access passcode for an enterprise’s secure database.

Jetson extends this approach by co-opting an off-the-shelf device that normally measures vibrations from structures at a distance. The device further utilizes a gimbal to hold its laser beam steady, allowing it to keep its measurements on target. According to MIT Technology Review, the current system takes roughly 30 seconds to generate a good return signal, and it’s only effective if the target is staying put—either standing or sitting.

Despite these caveats, Remaly said that Jetson works with an admirable 95 percent accuracy if the conditions are optimal. In practice, though, this means Jetson isn’t accurate enough to be reliable on its own. If adopted into surveillance tech, it would likely work alongside other measures, such as facial recognition or gait analysis, as secondary confirmation.

In addition, unlike faces and fingerprints, cardiac signatures aren’t exactly standard collection data. For the technology to truly impact surveillance, the government needs to build a new database from scratch. However, the team argues, when deployed over a period of time—sufficient to capture the heartprint of an individual seen doing something they shouldn’t, for example—it may still be used to positively identify a person, even if his or her actual identity remains mysterious. What’s more, clothing isn’t a deterrent since the tech blasts right through.

Military use aside, the Pentagon foresees the technology trickling down into the cultural mainstream. A doctor could remotely monitor his patient’s cardiac rhythms, for example, without having to rely on electrical wires. Nevertheless, like technologies using echolocation to track an elderly person’s gait for falls, it’s an open question if the benefits warrant the invasion of privacy.

Biometrics Revolution

Monitoring the heart may be just the first step in a new age of long-distance biometrics surveillance.

Speech is another identifier under attack. According to the CTTSO, the already-completed project Beetlejuice uses a beam-forming microphone array to monitor an individual’s speech, in addition to performing speaker tagging, tracking, and locating. The tech relies on deep neural networks to reduce noise and allow near real-time situational awareness of incoming signals, filtering speaker, messages, languages, and location, the report stated.

“The capabilities will be integrated into a lightweight platform in support of operators on the move and handle a variety of noisy audio media…This unique combination will improve performance in both noise reduction, source location, and human language technologies,” the team explained.

Going even further, Xu and others are working on “brainprints” for security measures. Unlike facial or cardiac fingerprints, the brain offers an “inexhaustible” source of secure passwords based on its response to various stimuli, explained Xu.

Using EEG, which picks up neural electrical activity from electrodes placed on the scalp, the team can extract automatic and unconscious activation patterns as a “brain password” unique to a particular individual. Of course, so far there isn’t a way to remotely monitor someone’s brain activity or construct a database of initial readings. And unlike a face or retina, a brainprint changes when an individual is faced with another stimulus.

Nevertheless, a snapshot of brain activity perhaps most uniquely represents you, as an individual, and technological challenges haven’t exactly been a deterrent to agencies that stand most to gain (hydrogen bombs, anyone?).

If history’s any indication, security measures based on biometrics are ripe for hacking and tracking. Now, thanks to Jetson, smearing paint on your face or wearing thick jackets will no longer circumvent surveillance monitoring. San Francisco and Somerville, Massachusetts both recently blanket-banned facial recognition software in protection of civil rights, with New York likely to follow in narrower domains. It’s worth keeping an eye on what comes next.


Republished with permission under license from SingularityHub.

At least 2% of US public water systems are like Flint’s – Americans just don’t hear about them

by Laura Pangallozzi

More than five years after Flint’s water crisis first hit the news, the city has successfully lowered the lead levels in its water.

The most recently available testing, from the second half of 2018, puts the lead in Flint’s water at 4 parts per billion. That’s well below the level, 15 ppb, that the federal government currently regards as dangerous for public health.

No amount of lead in water is safe, but the lower level in Flint represents a substantial improvement over the 27 ppb reported by the Virgina Tech Water Study at the peak of the crisis in April 2015.

However, even Flint’s highest levels were not atypical for water systems that have problems. Most reports of elevated lead levels cluster in the range between 15 and 20 ppb.

Where lead problems occur

The federal Lead and Copper Rule requires public water utilities to sample home tap water yearly in neighborhoods most likely to face contamination.

If more than 10% of samples exceed 15 parts per billion of lead, the rule states that the water system must take steps to control pipe corrosion – the main source of lead in residential tap water – as well as to inform the public and the U.S. Environmental Protection Agency.

Water systems, especially in rural areas, can report much higher levels than the EPA cutoff. In 2017, for example, an elementary school in Tulare County, California, home to agricultural laborers, reported lead levels of 4,600 ppb. The school distributed bottled water to its students and replaced its well. The same year, a senior living center in Stroudsburg, Pennsylvania, had lead levels of 3,428 ppb. Such drinking water is truly poisonous, especially for children.

Large urban water systems tend to have lower contaminant levels than systems in rural areas, including for lead, because they have expert staff to run facilities. But when contamination occurs in urban systems, it affects more people. Flint’s water system serves 71,500 people and its woes drew the attention of the Obama administration. In 2004, when Washington, D.C. had similar lead levels, Congress intervened to demand a rapid fix.

Right now, Newark, New Jersey – an area that I have studied for more than 10 years – is in the hot seat for lead, but has not drawn similar attention. In June the city reported to the EPA lead samples more than 2.5 times higher than that of Flint at the peak of the crisis, the highest level in a two-year running problem.

The Pequannock facility, one of Newark’s two water treatment plants and the source of the issue, distributes water to the city and several surrounding communities. The Newark Water Department serves a total of more than 290,000 people.

Of cities with more than 100,000 in population reporting issues since the beginning of 2017, nearest in rank to Newark in terms of levels of lead is Pittsburgh; then Trenton, New Jersey; Fort Wayne, Indiana; Suez Water, headquartered in Hackensack, New Jersey, serving multiple communities; Portland, Oregon; Providence, Rhode Island; and Green Bay, Wisconsin.

Most cities reporting issues are in New England and the Middle Atlantic States, where older housing is more likely to have lead pipes that run from the water main into the home.

Shining a light on the problem: Missing data

What’s more, an undetermined number of water systems with lead problems in their water do not report heightened lead levels to the federal government, in violation of the law.

An investigative report commissioned by Congress, publicly released in October 2017, showed that about 2% of public water systems across the country exceeded the federal limit on lead between 2014 and 2016.

The report says that the number of water systems that do not report their problems at all is understated – in some cases badly so. Flint itself initially failed to report its elevated lead levels to the EPA. The congressional report, compiled by the Government Accountability Office, found a host of problems on this score, concluding that “data available from the EPA likely understate the number of sample results, violations and enforcement actions.”

As of December 2016, the end date of the GAO investigation, only about 47% of states had reported as required on their corrosion control methods, the primary way a lead problem is addressed.

The report recommended that the EPA require states to report data for small water systems, those most likely to fail to report, but the EPA folded this initiative into a revision of the Lead and Copper Rule that has not happened.

Without better data collection on lead contamination, Americans will never know how bad the problem really is in their communities.The Conversation


Republished with permission under license from The Conversation

How Black Pharmacists Are Closing The Cultural Gap In Health Care

SHILOH, Ill. — After a health insurance change forced Bernard Macon to cut ties with his black doctor, he struggled to find another African American physician online. Then, he realized two health advocates were hiding in plain sight.

At a nearby drugstore here in the suburbs outside of St. Louis, a pair of pharmacists became the unexpected allies of Macon and his wife, Brandy. Much like the Macons, the pharmacists were energetic young parents who were married — and unapologetically black.

Vincent and Lekeisha Williams, owners of LV Health and Wellness Pharmacy, didn’t hesitate to help when Brandy had a hard time getting the medicine she needed before and after sinus surgery last year. The Williamses made calls when Brandy, a physician assistant who has worked in the medical field for 15 years, didn’t feel heard by her doctor’s office.

“They completely went above and beyond,” said Bernard Macon, 36, a computer programmer and father of two. “They turned what could have been a bad experience into a good experience.”

Now more than ever, the Macons are betting on black medical professionals to give their family better care. The Macon children see a black pediatrician. A black dentist takes care of their teeth. Brandy Macon relies on a black gynecologist. And now the two black pharmacists fill the gap for Bernard Macon while he searches for a primary care doctor in his network, giving him trusted confidants that chain pharmacies likely wouldn’t.

Black Americans continue to face persistent health care disparities. Compared with their white counterparts, black men and women are more likely to die of heart disease, stroke, cancer, asthma, influenza, pneumonia, diabetes and AIDS, according to the Office of Minority Health.

But medical providers who give patients culturally competent care — the act of acknowledging a patient’s heritage, beliefs and values during treatment — often see improved patient outcomes, according to multiple studies. Part of it is trust and understanding, and part of it can be more nuanced knowledge of the medical conditions that may be more prevalent in those populations.

For patients, finding a way to identify with their pharmacist can pay off big time. Cutting pills in half, skipping doses or not taking medication altogether can be damaging to one’s health — even deadly. And many patients see their pharmacists monthly, far more often than annual visits to their medical doctors, creating more opportunities for supportive care.

That’s why some black pharmacists are finding ways to connect with customers in and outside of their stores. Inspirational music, counseling, accessibility and transparency have turned some minority-owned pharmacies into hubs for culturally competent care.

“We understand the community because we are a part of the community,” Lekeisha Williams said. “We are visible in our area doing outreach, attending events and promoting health and wellness.”

To be sure, such care is not just relevant to African Americans. But mistrust of the medical profession is especially a hurdle to overcome when treating black Americans.

Many are still shaken by the history of Henrietta Lacks, whose cells were used in research worldwide without her family’s knowledge; the Tuskegee Project, which failed to treat black men with syphilis; and other projects that used African Americans unethically for research.

“They completely went above and beyond,” says Macon (center) of Vincent and Lekeisha Williams, owners of LV Health and Wellness Pharmacy.

Filling More Than Prescriptions

At black-owned Premier Pharmacy and Wellness Center near Grier Heights, a historically black neighborhood in Charlotte, N.C., the playlist is almost as important as the acute care clinic attached to the drugstore. Owner Martez Prince watches his customers shimmy down the aisles as they make their way through the store listening to Jay-Z, Beyoncé, Kirk Franklin, Whitney Houston and other black artists. Prince said the music helps him in his goal of making health care more accessible and providing medical advice patients can trust.

In rural Georgia, Teresa Mitchell, a black woman with 25 years of pharmacy experience, connects her customers with home health aides, shows them how to access insurance services online and even makes house calls. Her Total Care Pharmacy is the only health care provider in Baconton, where roughly half the town’s 900 residents are black.

“We do more than just dispense,” Mitchell said.

Iradean Bradley, 72, became a customer soon after Total Care Pharmacy opened in 2016. She struggled to pick up prescriptions before Mitchell came to town.

“It was so hectic because I didn’t have transportation of my own,” Bradley said. “It’s so convenient for us older people, who have to pay someone to go out of town and get our medicine.”

Lakesha M. Butler, president of the National Pharmaceutical Association, advocates for such culturally competent care through the professional organization representing minorities in the pharmacy industry and studies it in her academic work at the Edwardsville campus of Southern Illinois University. She also feels its impact directly, she said, when she sees patients at clinics two days a week in St. Charles, Mo., and East St. Louis, Ill.

“It’s just amazing to me when I’m practicing in a clinic setting and an African American patient sees me,” Butler said. “It’s a pure joy that comes over their face, a sigh of relief. It’s like ‘OK, I’m glad that you’re here because I can be honest with you and I know you will be honest with me.’”

She often finds herself educating her black patients about diabetes, high blood pressure, high cholesterol and other common conditions.

“Unfortunately, there’s still a lack of knowledge in those areas,” Butler said. “That’s why those conditions can be so prevalent.”

Independent black-owned pharmacies fill a void for African American patients looking for care that’s sensitive to their heritage, beliefs and values. For Macon, LV Health and Wellness Pharmacy provides some of that vital support.

Avoiding Medical Microaggressions

For Macon, his experiences with medical professionals of backgrounds different from his own left him repeatedly disappointed and hesitant to open up.

After his wife had a miscarriage, Macon said, the couple didn’t receive the compassion they longed for while grieving the loss. A few years later, a bad experience with their children’s pediatrician when their oldest child had a painful ear infection sparked a move to a different provider.

“My daughter needed attention right away, but we couldn’t get through to anybody,” Macon recalled. “That’s when my wife said, ‘We aren’t doing this anymore!’”

Today, Macon’s idea of good health care isn’t colorblind. If a doctor can’t provide empathetic and expert treatment, he’s ready to move, even if a replacement is hard to find.

Kimberly Wilson, 31, will soon launch an app for consumers like Macon who are seeking culturally competent care. Therapists, doulas, dentists, specialists and even pharmacists of color will be invited to list their services on HUED. Beta testing is expected to start this summer in New York City and Washington, D.C., and the app will be free for consumers.

“Black Americans are more conscious of their health from a lot of different perspectives,” Wilson said. “We’ve begun to put ourselves forward.”

But even after the introduction of HUED, such health care could be hard to find. While about 13% of the U.S. population is black, only about 6% of the country’s doctors and surgeons are black, according to Data USA. Black pharmacists make up about 7% of the professionals in their field, and, though the demand is high, black students accounted for about 9% of all students enrolled in pharmacy school in 2018.

For Macon, though, the Williamses’ LV Health and Wellness Pharmacy in Shiloh provides some of the support he has been seeking.

“I still remember the very first day I went there. It was almost like a barbershop feel,” Macon said, likening it to the community hubs where customers can chitchat about sports, family and faith while getting their hair cut. “I could relate to who was behind the counter.”


Republished with permission from Kaiser Health News.