Episode 4: Sex n’ Drugs

Keifer and Ti are joined by classmate Misha Vadodaria to discuss the Fair Drug Pricing Act that was re-introduced in Congress this week. Ti takes the group to “Dinner @ the White House” [29:18] before playing “Fake News and Friends,” a quiz game about ridiculous news headlines. Finally, the group explores the data and rationale behind the wage gap between men and women in medicine [38:20].

Wasted: Sensible Solutions for Unused Prescription Drugs

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Most of us keep all of our medicine in a designated location in the house. Be it the medicine cabinet in the bathroom, the kitchen shelf just above the coffee maker, or the gallon-sized plastic bag we tend to see patients bring during their office visits, most of us have prescription drugs and over-the-counter medications stockpiled somewhere.

But when was the last time you took a moment to organize that medicine cabinet, figure out which medicines you are no longer taking, and review expiration dates?

There are safe ways to dispose of expired and unused medications. (No, I am not talking about flushing them down the toilet.)

The U.S. Drug Enforcement Administration (DEA) hosts a semi-annual National Prescription Drug Take Back Day, where you can take your expired and unused drugs to a designated collection site in your community to be disposed of appropriately. Typically, collection sites are at local police stations, fire stations, pharmacies, clinics, or hospitals. Collection sites are community-specific and can be found on the DEA website.

The most recent National Prescription Drug Take Back Day wrapped up on Saturday, April 29, and program organizers are waiting to see just how many drugs were collected. This time last year, the DEA set an all-time collection record.

On May 6, 2016, Americans turned in more unused prescription drugs than on any of the previous 10 events since it began in 2010, demonstrating their understanding of the value of this service. The DEA and over 4,200 of its state, local, and tribal law enforcement partners collected 893,498 pounds of unwanted medicines—about 447 tons—at almost 5,400 sites spread through all 50 states, beating its previous high of 390 tons in the spring of 2014 by 57 tons, or more than 114,000 pounds.

447 tons is roughly equal to the weight of five NASA Space Shuttles. With growing awareness of the opioid epidemic in our country, it is certainly possible that the record may have been broken again this year.

As future physicians, it will be important for us to spread the word and continue to facilitate awareness of community disposal programs like this to our patients. According to the DEA, the majority of prescription drug abusers report in surveys that they get their drugs from friends and family. By cleaning out medicine cabinets and disposing of medications appropriately, we can reduce accidents, thefts, and the misuse and abuse of these medicines—including the opioid painkillers that accounted for over 33,000 deaths in 2015.

Proper disposal of expired medications is crucial, but what if there were other, more efficient, more cost-effective options for the medications that are not expired and go unused? What if unused prescription drugs could be recycled and redistributed?

A recent ProPublica investigation found that nursing homes waste millions of dollars in prescription drugs every year. Marshall Allen, the author of the investigation, recently gave an interview on NPR. Medications are discontinued for many reasons, including when a patient passes away or gets discharged, “and so in most nursing homes around the country, they just throw those drugs away,” said Allen.

With the rising costs of healthcare and the unprecedented costs of prescription drugs these days, it is a little disturbing to hear that millions of dollars of perfectly good prescription drugs are literally being flushed down the toilet. As Allen reports, Medicare and other commercial insurance payers have already paid for the prescriptions, so why not recycle them?

That is exactly what a program in Iowa is doing. SafeNetRx retrieves unused prescription drugs and redistributes them to uninsured or underinsured patients for free. This program estimates that they receive close to $5 million worth of drugs in a year that they redistribute to communities in need.

“The National Academy of Medicine estimated in 2012 that the U.S. squanders more than a quarter of what it spends on health care – about $765 billion a year.”

Can you imagine what impact we could have on healthcare costs across the nation if we recycled and redistributed prescription drugs that would otherwise be thrown in the trash, incinerated, or flushed down the toilet?

When patients are non-compliant in taking their medication because they are unable to afford their prescription, they frequently wind up in the emergency room—putting greater financial strain on hospitals, taxpayers, and communities across the country.

From a health policy perspective, efforts have been made to pave the way for the donation and redistribution of drugs.

The National Conference of State Legislatures said 39 states had passed laws that allowed the donation of drugs. But almost half of these states with laws lack programs to get the drugs safely from one appropriate user to another, and many of those that do have programs are focused on cancer drugs, the analysis showed.

The logistics of such a program appear to be the biggest barrier to getting formalized prescription drug recycling off the ground, and this highlights a classic issue in writing health policy.

“It’s like people have created legislation and it’s a feel-good thing, but nobody’s come back to see why it’s not working,” says Mark Coggins of Diversicare, a chain of nursing homes in 10 states.

Though legislation to address these issues sometimes becomes law, too often it fails to provide adequate investment for carrying out the idea. In Iowa, SafeNetRx is state-funded for about $600,000 a year, and is considered a best-practice, common sense solution for recovering and redistributing prescription drugs to those most in need.

Many patients that benefit from the SafeNetRx program are saving hundreds, if not thousands, of dollars on prescription drugs (not to mention savings for the insurance companies), including low-income and fixed-income senior citizens with multiple chronic conditions.

The next time you clean out your medicine cabinet, or advise your patients to do so, consider where those medications could go. They could be thrown away, or they could go back in the hands of patients that need them the most. With little effort, you can be part of a life-saving solution that also saves millions of healthcare dollars.

If you’re interested in learning more and helping to solve this problem, I encourage you to explore what your state is doing to recover, recycle, and redistribute prescription drugs.

 

Image: Wise Rx Card

Episode 3: Legalizing Midwives in Alabama and AHCA Moves to the Senate

This week, classmate and fellow Kathryn Petersen joins Keifer and Ti on the podcast to talk about new legislation that would allow certified professional midwives to practice in Alabama [1:22]. After playing Diagnostocracy’s new game, “Who Said It?” [19:46], the group breaks down the passing of the newly revised AHCA, its future in the Senate, and what you can do about the fundamental, political divide in the health care debate [23:10].

Jimmy Kimmel’s Reminder That Health Care Should Save Lives

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No parent should ever have to decide if they can afford to save their child’s life. It just shouldn’t happen. Not here.

Nearly 10 million people have heard this emotional plea from the tearful monologue on Monday night’s “Jimmy Kimmel Live.” Kimmel opened the show with an emotional retelling of the birth of his son, Billy, on April 21. After a nurse noticed that the newborn was turning purple, doctors detected a heart murmur and tests revealed that oxygen was insufficiently reaching the rest of his body. Kimmel described the chaotic and terrifying scene that followed as doctors and nurses filled in, surrounding Billy with a sort of frenzied focus. Eventually, Kimmel learned that his son was born with a heart disease and would require immediate surgery.

Billy was diagnosed with Tetralogy of Fallot, a four-part heart defect that includes a ventricular septal defect, or a hole between the ventricles that allows mixing of oxygenated and deoxygenated blood to be pumped throughout the body. After sharing that the emergency, three-hour surgery was a success, Kimmel taught us why we cannot look away from the health care battle. This story provides context to American’s fraught response to the Republican’s debate over scaling back Obamacare’s preexisting conditions clause. This clause requires insurers to offer coverage to everyone who can pay for it and protects sicker individuals from being subjected to astronomically high premiums, as Kimmel explains:

Before 2014, if you were born with congenital heart disease like my son was, there was a good chance you would never be able to get health insurance because you had a preexisting condition…you might not even live long enough to get denied because of a preexisting condition.

The most recent changes to President Trump’s health care bill include an amendment by Rep. Tom MacArthur that would allow states to get waivers that allow insurers to set prices based on how healthy a person is. That is, coverage for those with preexisting conditions would become largely unaffordable and force those individuals to seek new coverage in high-risk pools. The bill would set aside money to subsidize these pools, but experts agree that the subsidies aren’t nearly enough to cover those new costs.

What is the potential impact of this change? Nearly 52 million people, or one quarter of adults under the age of 65, have preexisting conditions whose coverage would be in jeopardy if their state was granted this waiver. Not to mention that radically interfering with balance in the marketplace would lead to expensive and less effective delivery of care. (For a simple, cartoon explanation of this phenomenon, refer to this Vox article.)

This is an important distinction to make from Trump’s recent (false) claims that adequate and fair coverage of preexisting conditions “has to be” and is indeed in the new health care bill. Though a tough sell would await the bill in the Senate, it appears as though the new bill will go for a vote in the House later today.

Here is what else the proposed health care bill would change. It would:

  • repeal the individual and employer mandate
  • remove subsidies for out-of-pocket expenses that are used to pay deductibles and make co-pays in 2020
  • roll back tax increases on high incomes, prescription drugs, medical devices and tanning salons
  • cut federal funding for Medicaid expansion in 2020
  • allow states to waive essential benefit rules that include maternity care, emergency visits and preventative services
  • allow insurers to charge older customers five times as much as younger ones
  • change premium subsidies from income- and location-based to a rudimentary age-based subsidy

As we mentioned in our podcast, advocacy’s willpower at town halls and in the inboxes of elected officials forced responsible action on the American Health Care Act. Moreover, it reminded Washington that its constituents realize what they stand to lose with irresponsible health policy. As the vote nears, Kimmel reminds us that we can all agree on one thing:

If your baby is going to die, it shouldn’t matter how much money you make. Whatever your party, whatever you believe, whoever you support, we need to make sure that the people who are supposed to represent us, the people who are meeting about this right now in Washington, understand that very clearly. Let’s stop with the nonsense. This isn’t football. There are no teams. We are the team. It’s the United States. Don’t let their partisan squabbles divide us on something every decent person wants. We need to take care of each other.

 

Image: Jimmy Kimmel

Episode 2: The March for Science and DO Day on Capitol Hill

This week on Diagnostocracy, Ti and Keifer welcome students Jennifer Fields and Jesse Aquino to review the March for Science and the inevitably partisan role of science in politics. Jennifer and Jesse then discuss their experience advocating health policy while at DO Day on Capitol Hill earlier this month.