Hundreds of Supplements Tainted With Hidden Drugs

This is why people should use caution when taking supplements, and it also shows the risk of inadequate corporate oversight. Unlike pharmaceutical drugs, the American supplement industry is barely regulated at all.

The labels promise miracles: Fast Weight Loss! Eliminates Hunger! Burns Calories!

Now new research highlights how hundreds of brands of dietary supplements deliver so much kick from a modest blend of vitamins and herbs. The answer is many labels leave out one important ingredient: a hidden payload of pharmaceutical drugs and experimental chemicals.

A new analysis of 10 years of FDA records reveals that from 2007 to 2016, almost 750 dietary supplements were found to be contaminated with secret doses of totally unregulated drugs, including prescription medicines, banned and unapproved chemicals, and designer steroids.

Over 20 percent of these offending products contained more than one unapproved drug ingredient, and numerous contained a cocktail of clandestine chemicals – in two cases, as many as six unlisted ingredients.

For a US$35 billion industry patronised by about half of American adults, it’s possible this data could be just the tip of the iceberg, too.

“The drug ingredients in these dietary supplements have the potential to cause serious adverse health effects owing to accidental misuse, overuse, or interaction with other medications, underlying health conditions, or other pharmaceuticals within the supplement,” researchers from the California Department of Food and Agriculture, Sacramento, explain in their paper.

Given that supplement use is associated with some 23, 000 ER visits and 2,000 hospitalisations in the US each year, it’s clear we’re looking at a big problem here, but what’s even more shocking than the brazen selling of these illicit additives is how tame and toothless the FDA’s official actions were.

Of 746 products identified as adulterated by the FDA, just 360 (48 percent) were subsequently recalled, leaving more than half of the contaminated supplements available for sale.

“The agency’s failure to aggressively use all available tools to remove pharmaceutically adulterated supplements from commerce leaves consumers’ health at risk,” writes general internist Pieter Cohen from Harvard Medical School in a commentary on the new research.

Many of the tainted supplements analysed in the study contained sildenafil (the active ingredient of Viagra) to boost their powers of sexual enhancement. Another erectile dysfunction drug, tadalafil, was also common.

Other chemicals included hidden antidepressants, a withdrawn weight loss drug called sibutramine, and undeclared anabolic steroids or steroid-like substances.

It’s been argued however that since almost 75 percent of the offending supplements were sold online or through international mail order, they don’t represent the ‘mainstream’ of the supplements industry.

“These come from dark corners of the internet,” president of the Natural Products Association, Daniel Fabricant, told the San Francisco Chronicle.

“They’re not what you get at your health food store.”

Still, given that none of these products are actually subjected to the same stringent tests reserved for pharmaceutical drugs, it’s possible any supplement could contain anything – which is why Cohen advises choosing products that only contain a single ingredient and avoiding products that purport to offer spurious, medical-sounding benefits.

Why? Because as this research shows, many supplements turn out to be medicine after all – only it’s an unknown drug, potentially a banned one, and there’s no way of measuring your dose.

“If the company is saying it works like Viagra or you’re going to gain muscle like you’re on steroids – that’s not a supplement. That’s a drug,” Fabricant says.

“Dietary supplements are meant to maintain health, not to take 30 minutes before sex.”

The findings are reported in JAMA Network Open.

Innovative Immunotherapy Approach Eliminates Woman’s Breast Cancer

Immunotherapy is valuable at reversing cancer outcomes, as shown in the past months with the cancer “vaccine” that eliminated tumors in mice and now this immunotherapy that worked when other approaches didn’t.

“We’ve developed a high-throughput method to identify mutations present in a cancer that are recognized by the immune system,” Dr. Rosenberg said. “This research is experimental right now. But because this new approach to immunotherapy is dependent on mutations, not on cancer type, it is in a sense a blueprint we can use for the treatment of many types of cancer.”

The new immunotherapy approach is a modified form of adoptive cell transfer (ACT). ACT has been effective in treating melanoma, which has high levels of somatic, or acquired, mutations. However, it has been less effective with some common epithelial cancers, or cancers that start in the lining of organs, that have lower levels of mutations, such as stomach, esophageal, ovarian, and breast cancers.

In an ongoing phase 2 clinical trial, the investigators are developing a form of ACT that uses tumor-infiltrating lymphocytes (TILs) that specifically target tumor cell mutations to see if they can shrink tumors in patients with these common epithelial cancers. As with other forms of ACT, the selected TILs are grown to large numbers in the laboratory and are then infused back into the patient (who has in the meantime undergone treatment to deplete remaining lymphocytes) to create a stronger immune response against the tumor.

A patient with metastatic breast cancer came to the trial after receiving multiple treatments, including several chemotherapy and hormonal treatments, that had not stopped her cancer from progressing. To treat her, the researchers sequenced DNA and RNA from one of her tumors, as well as normal tissue to see which mutations were unique to her cancer, and identified 62 different mutations in her tumor cells.

The researchers then tested different TILs from the patient to find those that recognized one or more of these mutated proteins. TILs recognized four of the mutant proteins, and the TILs then were expanded and infused back into the patient. She was also given the checkpoint inhibitor pembrolizumab to prevent the possible inactivation of the infused T cells by factors in the tumor microenvironment. After the treatment, all of this patient’s cancer disappeared and has not returned more than 22 months later.

“This is an illustrative case report that highlights, once again, the power of immunotherapy,” said Tom Misteli, Ph.D., director of CCR at NCI. “If confirmed in a larger study, it promises to further extend the reach of this T-cell therapy to a broader spectrum of cancers.”

Simple Lung Cancer Scans That Could Save Thousands of Lives a Year

Cancer can be exponentially easier to treat or cure when it’s caught early.

A new study found that fewer than 2 percent of heavy smokers in the U.S. get recommended lung cancer screenings, an imaging test that can catch tumors when they are small and potentially curable. The numbers fall far short of screening for other types of cancer, including mammograms and colonoscopies—both procedures that are much more uncomfortable than the CT scan used to detect tiny tumors in the lungs.

Lung cancer is the leading cause of cancer death in the U.S., killing an estimated 150,000 Americans each year. For the past five years, such groups as the U.S. Preventive Services Task Force and the American Society of Clinical Oncology have urged people aged 55 or older who have smoked a pack a day (or the equivalent) for three decades or more to get checked for early stage disease. Medicare, the U.S. government’s insurance program for the elderly, pays for the procedure. None of it has made an impact.

“It’s still truly abysmal,” said Danh Pham, chief fellow of hematology/oncology at the University of Louisville’s cancer center in Kentucky, who will present the findings at the ASCO cancer meeting next month in Chicago. “We would like to make this a true call to action, whether it’s for more education or more research, to know why this disparity exists for lung cancer.”

It took a while for public health officials to start recommending routine lung cancer screening, because of questions about its accuracy and its ability to make a difference once the disease was detected. Subsequent studies confirmed the benefits for the heaviest smokers, with the use of screening intended for those most vulnerable to tumors.

The researchers analyzed registry data for everyone who underwent lung cancer screening in 2016 and found that 141,260 of the 7.6 million people eligible, or 1.9 percent, received it. By comparison, from 60 percent to 80 percent of eligible people get screening for breast, cervical and colon cancer, said Bruce Johnson, president of the American Society of Clinical Oncology and chief clinical research officer at the Dana-Farber Cancer Institute in Boston.

The testing shortfall could stem from primary care doctors’ failure to refer high-risk patients to one of 1,800 approved centers nationwide which provide the service. Psychological issues could also play a role, including fear of being diagnosed with a disease that smokers are constantly reminded of, Pham said.

“It’s very difficult to get patients to have this conversation with their doctors because of the stigma,” he said. “People may not want to know if they have lung cancer because it could confirm they’ve made bad lifestyle choices.”

Lung cancer deaths exceed those from breast, colon, pancreas and prostate cancer combined. There are very compelling reasons to get screened, said Johnson.

“If you screened the entire population of the U.S. who fit the criteria for having smoked enough and being the appropriate age, which is about 8 million people, you could save about 12,000 lives a year,” he said. “The majority of lung cancers picked up are early stage,” and finding them before the malignant cells spread reduces the risk of dying by about 20 percent, he said.

Saving a Few Hundred Billion Dollars a Year on Prescription Drugs in America

Cost savings of a few thousand dollars per household that are eminently possible — if Big Pharma can be defeated or at least constrained much more. The main basic problem is the patent monopolies that allow pharmaceutical companies to charge exorbitant prices, and a main solution is to use direct public funding as a more efficient process at producing innovation.

Broadly speaking, a prescription drug in the United States goes through three main stages of development: On the front end, researchers make a scientific breakthrough in their labs, discovering the building blocks of a new drug. Then it goes through the second stage, which includes the often-costly process of clinical research and trials. Last, once the FDA has reviewed and approved it, the drug goes on the mass market, sold at drugstores and doctor’s offices.

The United States is already involved in the earliest stages of drug development. It’s the top funder of basic science research in this country through the National Institutes of Health, which has an annual budget of $37 billion, more than what the federal government pays for Head Start and Pell Grants combined. Most agree that this is money well spent: Every one of the 210 new drugs approved between 2006 and 2010 trace their origins back to government funding.

The government is also involved in the third stage, as a top purchaser of medicines. Through Medicare, Medicaid, the Department of Veterans Affairs, and other programs, the federal government pays for $300 billion worth of prescription drugs each year.

Where the system runs into trouble is in the middle of the process, when the government hands over a glittering prize: the multi-decade patents that give private companies a monopoly on life-essential products. Through a mechanism established by the Bayh-Dole Act of 1980, private companies are allowed to claim patents on promising compounds discovered with government funding–and that means exclusive rights to manufacture and sell the resulting drug for a period of 20 years and often longer.

This isn’t just an outdated model; it’s also deeply inefficient. Companies can price medicines at hundreds of times what it costs to make them (it’s how a hepatitis C medicine could cost $1,000 for each pill that is manufactured for a few dollars), and with the government providing a guaranteed market for the drugs, companies like Gilead and Pfizer have had years where their reported profit margins exceeded a staggering 40 percent. All of the Big Pharma companies average between 15 and 20 percent profit each year. Most Fortune 500 companies are happy to claim half of that. There is “absolutely no reason why the taxpayer should be forced to subsidize a private monopoly and have to pay twice: first for the research and development and then through monopoly prices,” Senator Russell Long insisted when Bayh-Dole was passed in 1980.

[…]

If the United States were to move towards a NASA system, the federal government would have to find up to $75 billion in its budget to replace what private industry spends on R&D. But that’s not an insurmountable obstacle. There should be plenty of money available. Baker and other economists calculate that a NASA for drug development, which would eliminate patents and the price markups for prescription drugs that come with them, would save Americans hundreds of billions of dollars every year thanks to drugs being generic-level cheap from day one. The savings to government spending alone would be more than enough to pay for every penny of the $75 billion that the private pharma industry claims it spends on R&D–and replace it with research that is more widely shared and targeted more at public health than at quarterly profits. In this alternate universe, scientists and labs could switch their focus away from developing yet another iteration of an erectile dysfunction drug towards tackling challenges like tuberculosis.

 

New Bill to Lessen the Pain of the Dysfunctional U.S. Healthcare System is a Reminder of Its Critical Flaws

Massachusetts Senator Elizabeth Warren has introduced a bill that attempts to “curb pain” emanating from the corrupted for-profit healthcare system of the United States. Among other things, the bill’s provisions would implement helpful but admittedly inadequate measures, such as making it illegal for insurance companies to revoke a patient’s plan during their course of treatment. There could of course be many reminders about the more critical flaws of U.S. healthcare made in relation to this.

For one, the U.S. spends about twice as much on healthcare compared to other wealthy countries such as Canada, Britain, and Germany. If that spending — which is annually $3.4 trillion ( about 18 percent of annual U.S. GDP) — was reduced by around half, it would be an enormous savings that (all else unchanged) would actually have the U.S. running substantial budget surpluses.

That isn’t to say that budget surpluses are necessarily good (budget deficits can be helpful and natural), but it’s to point out that subtracting the almost $700 billion ($5550 per U.S. household) in budget deficit totals that the U.S. ran in fiscal year 2017 from a $1.7 trillion in healthcare savings would still be about a trillion dollars of budget surplus. It’s strange how rarely this simple point enters the mainstream press, what with the irrational and even harmful attention corporate media such as the Washington Post has given to budget deficits. More importantly though, it’s over a trillion dollars that could be spent productively elsewhere in the economy instead of harmfully allowing health insurance corporations receive it.

Interestingly enough, Berkshire Hathaway, Amazon, and JP Morgan Chase announced plans earlier this year to jointly form a healthcare company for their employees that’s “intended to be free from profit-making incentives.” This is another revealing insight into why a for-profit healthcare system is too flawed to function well — building a healthcare system around corporate profits simply raises the costs too much. The executives at those three corporations aren’t the only parts of the business community to understand this as they seek to reduce their own expenses.

Businessman Warren Buffett has even admitted that single-payer is “probably the best” healthcare system for the U.S. He has made a comparison between U.S. healthcare in 1960 and in 2017 — in 1960, U.S. healthcare spending was only five percent of annual GDP, and almost 60 years later there’s been almost a four fold GDP-based increase in healthcare spending. This reveals again that the amount of resources being devoted to the overall mediocre U.S. healthcare system is excessive.

The for-profit element of the system has other consequences outside of direct economic costs though. One of them is unnecessarily lost lives, with strong evidence finding that over 20,000 people die a year in the U.S. due to being unable to afford health insurance. It is simply a major moral disgrace that world history’s wealthiest country suffers from such a problem.

Also disgraceful is the staggering number of medical bankruptcies per year in the United States. The amount of those per year has been estimated at hundreds of thousands in the U.S. alone (far more than other wealthy countries) and medical bills have been a leading cause of Americans filing for bankruptcy for years. All other OECD countries besides Mexico have universal healthcare and have a much more efficient healthcare system to prevent many of those problems to begin with.

For a practical example, Medicare (a predominantly single-payer healthcare service run by the government) has administrative overhead costs of about 1 to 2 percent, which is usefully contrasted to the 12 to 20 percent overhead costs typically run by the for-profit health insurance industry. This is because inefficiently having thousands of different healthcare payer plans necessitates higher bureaucratic costs with too much paperwork.

And another notable part of the high U.S. health costs is due to the ridiculous prices of prescription drugs there. In 2017, the U.S. spent $450 billion (2.4 percent of GDP) on prescription drugs, an amount that could almost certainly be reduced by about $370 billion ($2930 per U.S. household) by having prescription drugs sold without patent monopolies and other unjust protectionist measures. In a time when at least nearly one in five Americans are unable to afford their medications adequately, this proposal for savings should be considered much more.

It should also be noted what happens an extreme amount of undeserved resources are diverted to harmful corporations such as the pharmaceutical ones. Pharmaceutical companies — such as Purdue Pharma — have used their excess profits to manufacture an opioid crisis (to seek even more profits) through flooding economically downtrodden communities with highly addictive opioids. This has resulted in opioids becoming the leading cause of death for Americans under 50, and it’s also largely been what’s resulted in a decline in the average U.S. life expectancy rate, a phenomenon that’s probably otherwise unheard of in other wealthy nations in the 21st century.

In all, the U.S. healthcare system suffers from significant problems that will require more than tweaking around the edges to solve. Its system requires a major alteration, and the sooner that happens, the less health-based suffering among its people there can be.

Developing Edible QR Codes for Future Medications

Quite a different approach than how medicine is administered today. There will need to be safeguards, however, such as by ensuring the legitimacy of the scans through cryptographic verification.

For the last 100 years, researchers have constantly pushed the boundaries for our knowledge about medicine and how different bodies can respond differently to it. However, the methods for the production of medicine have not yet moved itself away from mass production. Many who have a given illness get the same product with equal amount of an active compound.

This production might soon be in the past. In a new study, researchers from the University of Copenhagen together with colleagues from Åbo Akademi University in Finland have developed a new method for producing medicine. They produce a white edible material. Here, they print a QR code consisting of a medical drug.

“This technology is promising, because the medical drug can be dosed exactly the way you want it to. This gives an opportunity to tailor the medication according to the patient getting it,” says Natalja Genina, Assistant Professor at Department of Pharmacy.

Potential for reducing wrong medication and fake medicine

The shape of a QR code also enables storage of data in the “pill” itself.

“Simply doing a quick scan, you can get all the information about the pharmaceutical product. In that sense it can potentially reduce cases of wrong medication and fake medicine,” says Natalja Genina.

The researchers hope that in the future a regular printer will be able to apply the medical drug in the pattern of a QR code, while the edible material will have to be produced in advance to allow on-demand production of medical drug near end-users.

“If we are successful with applying this production method to relatively simple printers, then it can enable the innovative production of personalized medicine and rethinking of the whole supply chain,” says professor Jukka Rantanen from Department of Pharmacy.

The researchers are now working to refine the methods for this medical production.

U.S. Childhood Mortality Rate is 70% Higher Than Other Wealthy Countries

It is a moral disgrace for world history’s wealthiest country to have such a high child mortality rate. That’s part of the consequence of the U.S. lacking a national single-payer healthcare system, and it’s also a consequence of the U.S. Congress having prioritized support for the rich over reducing the plight of children.

American kids are 70 percent more likely to die during childhood compared with children in other wealthy, democratic nations, according to a peer-reviewed study published Monday by Health Affairs.

“This study should alarm everyone,” Dr. Ashish Thakrar, the study’s lead author and an internal medicine resident at Johns Hopkins Hospital and Health System, told CNN.

“The U.S. is the most dangerous of wealthy, democratic countries in the world for children,” he added. “Across all ages and in both sexes, children have been dying more often in the U.S. than in similar countries since the 1980s.”

The most common causes of death among children renews concerns about the American healthcare system, access to guns, and vehicle safety.

The risk of death is even higher for American infants and teenagers compared with their counterparts abroad. Babies in the U.S. are 76 percent more likely to die during their first year of life—often because of sudden infant death syndrome (SIDS) or complications related to being born prematurely—while 15- to 19-year-olds are 82 times more likely to die from gun violence, which Thakrar called “the most disturbing new finding.”

Thakrar and his fellow researchers examined the childhood mortality rates from 1961 to 2010 for the United States as well as 19 other nations in the Organization for Economic Cooperation and Development (OECD), including Australia, Canada, Japan, and several European and Scandinavian countries.

Thakrar told Vox‘s Sarah Kliff he believes the study’s findings are tied to a rise in childhood poverty in the U.S. during the 1980s, but also is in large part “the impact of our fragmented healthcare system” in the United States. For example, he said, “Mothers who are qualifying for Medicaid for the first time because they’re mothers might be seeing doctors for the first time. They might not have a family physician, or a clear support system.”

As numerous analyses and studies have shown over the years, the lack of a universal healthcare system in the U.S. has led to higher mortality rates and poorer healthcare outcomes than in countries that have robust systems that cover all people.

While the Republicans’ tax plan, which passed Congress and was signed by President Donald Trump late last year, partly dismantles the American healthcare system, lawmakers continue to put off refunding the national Children’s Health Insurance Program (CHIP)—which serves 9 million children—and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, which expired at the end September.

Although federal lawmakers passed a short-term spending measure that provided some funds for CHIP just before the New Year, states are continuing to warn recipients that without further funding, they will soon run out of money and no longer be able to provide necessary healthcare services.

“Multiple states have sent out letters warning families that their kids’ health insurance could end on January 31,” Kliff detailed in another article. “Congress did pass a temporary bill that it expected to extend CHIP’s life span until March—but it turns out they got the math wrong, and states may run out of funding as early as January 19. Eleven days from now.”

Thakrar told Kliff he is concerned about how funding instability for programs that provide healthcare to American kids will continue to impact childhood mortality rates in the United States.

“We’re seeing the effects of instability right now,” he said. “All across the country families are waiting to hear if CHIP will be reinstated, whether they’ll continue to have health insurance, their household visitations are at risk. Programs that have proven their benefit in the country still face constant instability.”

Artificial Sweeteners Harmful to Metabolism and Stimulate Fat Growth, Study Finds

Reducing sugar intake in general is probably a good idea. Artificial sweeteners haven’t received enough scrutiny though.

Artificial sweeteners have an effect on the body’s metabolism and can lead to excessive fat accumulation in people, especially those who are already obese, according to a recent study.

Dr. Sabyasachi Sen, an associate professor of medicine and endocrinology at George Washington University, led the study, explaining in a press release by the Endocrine Society that while many people rely on these artificial sweeteners as a low-calorie alternative to natural sweeteners, “there is increasing scientific evidence that these sweeteners promote metabolic dysfunction.”

Sen and his colleagues tested the popular low-calorie sweetener sucralose on stem cells taken from human fat cells. They placed these cells in Petri dishes for 12 days, adding 0.2 millimolars of sucralose. The dosage is based on the concentration of sucralose in the bloodstreams of people with high consumption levels of the artificial sweetener — about four cans of diet soda per day.

The researchers observed increased expression of genes that produce fat and inflammation. They also saw an increased accumulation of fat droplets in the cells, especially when they increased the concentration of sucralose.

The Pay of Doctors in America

The article by the economist Dean Baker illustrates why doctors in the U.S. have such high incomes. Directly, it’s basically because limits are imposed on foreign and domestic competition by restricting professional medical practice to those who have completed U.S. residency programs that are too limited in providing opportunities.

It’s $100 billion ($700 per U.S. family) a year in added costs to pay doctors as much as the U.S. does, but in a more ideal world, in world history’s richest country, good doctors could be permitted to make that much money. If the U.S. cut costs in substantial ways — such as switching to single-payer, saving $500 billion from only that annually — I wouldn’t have an issue with doctors making over 200k annually. I’d want a subsidy that allows doctors to earn that much income, however, rather than them earning it through a rigged market structure. That’s my view of the article and possibly the only major point expressed in it that I seem to disagree with the economist on.

Rx-Rolls-Royce

The United States pays more than twice as much per person for health care as other wealthy countries. We tend to blame the high prices on things like drugs and medical equipment, in part because the price tag for many life-saving drugs is less than half the U.S. price in Canada or Europe.

But an unavoidable part of the high cost of U.S. health care is how much we pay doctors — twice as much on average as physicians in other wealthy countries. Because our doctors are paid, on average, more than $250,000 a year (even after malpractice insurance and other expenses), and more than 900,000 doctors in the country, that means we pay an extra $100 billion a year in doctor salaries. That works out to more than $700 per U.S. household per year. We can think of this as a kind of doctors’ tax.

Doctors and other highly paid professionals stand out in this respect. Our autoworkers and retail clerks do not in general earn more than their counterparts in other wealthy countries.

Most Americans are likely to be sympathetic to the idea that doctors should be well paid. After all, it takes many years of education and training, including long hours as an intern and resident, to become a doctor. And people generally respect and trust their doctors. But they likely don’t realize how out of line our doctors’ pay is with doctors in other wealthy countries.

However, as an economist, I look for structural explanations for pay disparities like this. And when economists like me look at medicine in America – whether we lean left or right politically – we see something that looks an awful lot like a cartel.

The word “cartel” has some bad connotations; most people’s thoughts probably jump to OPEC and the 1970s crisis caused by its reduction in the supply of oil. But a cartel is not necessarily completely negative. It means that the suppliers of a good or service have control over the supply. This control can be used to ensure quality, as is the case with many agricultural cartels around the world. However, controlling supply also lets the cartel exert some control over price.

In the United States, the supply of doctors is tightly controlled by the number of medical school slots, and more importantly, the number of medical residencies. Those are both set by the Accreditation Council for Graduate Medical Education, a body dominated by physicians’ organizations. The United States, unlike other countries, requires physicians to complete a U.S. residency program to practice. (Since 2011, graduates of Canadian programs have also been allowed to practice in the U.S., although there are still substantial obstacles.) This means that U.S. doctors get to legally limit their competition. As a result, U.S. doctors receive higher pay, and like anyone in a position to exploit a cartel, they also get patients to buy services (i.e., from specialists) that they don’t really need.

There are two parts to the high pay received by our doctors relative to doctors elsewhere, both connected to the same cause. The first is that our doctors get higher pay in every category of medical practice, including general practitioner. If we compare our cardiologists to cardiologists in Europe or Canada, our heart doctors earn a substantial premium. The same is true of our neurologists, surgeons, and every other category of medical specialization. Even family practitioners clock in as earning more than $200,000 a year, enough to put them at the edge of the top 1 percent of wage earners in the country.

The other reason that our physicians earn so much more is that roughly two-thirds are specialists. This contrasts with the situation in other countries, where roughly two-thirds of doctors are general practitioners. This means we are paying specialists’ wages for many tasks that elsewhere are performed by general practitioners. Since there is little evidence of systematically better outcomes in the United States, the increased use of specialists does not appear to be driven by medical necessity.

In recent years, the number of medical residents has become so restricted that even the American Medical Association is pushing to have the number of slots increased. The major obstacle at this point is funding. It costs a teaching hospital roughly $150,000 a year for a residency slot. Most of the money comes from Medicare, with a lesser amount from Medicaid and other government sources. The number of slots supported by Medicare has been frozen for two decades after Congress lowered it in 1997 at the request of the American Medical Association and other doctors’ organizations.

Furthermore, Medicare exerts little control over the fields of specialization in the residency slots it supports, largely leaving this up to the teaching hospitals, which have an incentive to offer residencies in specialties from which they can get the most revenue per resident. This means they are more likely to train someone in neurology or cardiology than as a family practitioner.

Policymakers have a number of tools to use to introduce more competition, weaken the doctors’ cartel and get their pay more in line with counterparts elsewhere. One would be simply to fund more residency slots. Medicare could also limit the slots for many areas of specialization and instead insist that more of its funding go to train people as family practitioners.

A second route would be to end the requirement that foreign doctors complete a U.S. residency program in order to practice medicine in the United States. This means setting up arrangements through which qualified foreign doctors could be licensed to practice in the United States after completing an equivalent residency program in another country. The admission of many more doctors would put downward pressure on the pay of doctors in the United States, as insurers would have a new pool of physicians to add to their networks who will accept somewhat lower compensation.

Another approach is to not only change the rules around who can practice, but to change the rules around what doctors do. There are many procedures now performed by doctors that can be performed by nurse practitioners and other lower-paid health professionals. For example, many states now allow nurse practitioners to prescribe medicine without the supervision of a doctor, and there is no evidence that this has resulted in worse outcomes for patients. (It does, however, reduce health care costs.) The scope of practice of nurse practitioners and other health professionals can be extended in this and other areas for which they are fully competent. This would both directly save money and further reduce the demand for doctors, putting more downward pressure on their pay.

Yet one more approach is being tested in Missouri: While a doctor can’t practice independently without completing a U.S. residency program, Missouri will now allow foreign-trained doctors to practice under the supervision of a U.S.-trained doctor. This should also help to increase the supply of doctors.

51 Republican Senators Vote to Cut $1.5 Trillion from Medicare/Medicare to Give the Rich Tax Cuts

In a few words, that’s absolutely terrible.

Along strict party lines, the Republican-controlled Senate on Thursday night voted to pass a sweeping budget measure—one criticized as both “despicable” and “horrific” for providing massive giveaways to corporations and the super-rich while eviscerating funding for social programs, healthcare, education, and affordable housing.

The measure passed by 51-49 vote, with only one Republican, Sen. Rand Paul of Kentucky, joining every Democrat and the chamber’s two Independents who voted against it. Its approval now paves that way for massive tax giveaways to the wealthy and corporations envisioned by President Donald Trump and the GOP in both the House and the Senate.

“51 Republican Senators just voted to cut Medicaid by $1 trillion and Medicare by $500 billion so that millionaires and corporations can get a tax cut. It’s immoral and despicable,” said TJ Helmstetter, a spokesperson for Americans for Tax Fairness, in a statement immediately following the vote.

Though the budget resolution itself is nonbinding, MoveOn.org’s Ben Wikler notes how the Senate passage on Thursday represents the “starting gun for what might be the most consequential legislative fight of the Trump era: the looting of the U.S. treasury to reward billionaire GOP donors and mega-corporations, at the expense of the rest of us.” And with the Senate resolution now in place, a reconciliation process can begin with Republicans in the House, meaning the GOP can “shoot for a tax bill without a single Democratic vote.”

In the wake of its passage, Sen. Bernie Sanders (I-Vt.)—who earlier this week called the proposal “Robin Hood in reverse” for taking from the poor to give to the rich— said the “Republicans’ budget is not a bad bill. It’s a horrific bill.”

Statement from Patriotic Millionaires:

This morning, in response to the Senate’s passage of a budget resolution that would cut nearly $1.5 trillion from Medicare and Medicaid and give massive tax breaks to wealthy individuals and corporations, the Chair of the Patriotic Millionaires Morris Pearl, former Managing Director at BlackRock, Inc., released the following statement:

“The budget just passed by the Senate is not only irresponsible, it is downright cruel. This horrific budget would harm millions of vulnerable Americans all to give even more money to the richest among us. The Senators who voted to cut Medicare and Medicaid by a combined $1.5 trillion just to give millionaires like me a tax cut have betrayed their constituents, catering instead to the demands of their wealthy donors. Both the Senators and their donors should be ashamed to trade the future of this nation for their short-term financial self-interest.”

Here’s an image that illustrates what class war looks like:

Saddening

Horrible Trumpcare Proposal Returns, Threatening Millions

The cruelty of the proposal to remove the health insurance coverage of millions — to receive a tax cut for the richest people in the country — is being seen again, unfortunately. Even business interests with some moral decency should support the vastly more efficient single-payer model instead.

The Trumpcare zombie has risen from the grave to terrorize the American public once more.

Progressive organizations, lawmakers, hospital groups, and healthcare specialists have issued a “red alert” as reporting over the weekend indicated that Senate Majority Leader Mitch McConnell (R-Ky.) is considering a vote by the end of this month on what Sen. Bernie Sanders (I-Vt.) called Sunday “yet another disastrous Republican proposal to throw millions of people off health insurance.”

In an email to supporters Sunday night, Ben Wikler, Washington director of MoveOn.org, warned that the Republican Party “is now a hair’s breadth away—closer than they’ve ever been—to passing a devastating healthcare repeal bill, shredding the Affordable Care Act  (ACA), and gutting Medicaid.”

“All we need is one more [vote],” Sen. Pat Roberts (R-Kan.) concluded.

The plan under consideration was authored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.). Summaries of the bill indicate that, if passed, it would be every bit as harmful as the Trumpcare proposals that failed to escape the Senate in July.

The Graham-Cassidy plan—”Trumpcare by another name“—has yet to be analyzed by the Congressional Budget Office (CBO), but McConnell has asked for the scoring process to be fast-tracked, the Washington Post reports.

But even without a CBO score, experts have said there is enough evidence to conclude the plan would impose devastating and deadly cuts to key safety net programs and disproportionately harm America’s most vulnerable communities.

In a recent analysis, the Center on Budget and Policy Priorities (CBPP) found that the Graham-Cassidy plan would “gut protections for people with pre-existing conditions,” impose “damaging cuts” to Medicaid, and “cause many millions of people to lose coverage.”

By 2027, the Graham-Cassidy plan “would be virtually identical to a repeal-without-replace bill,” the CBPP concluded. “CBO estimated that the repeal-without-replace approach would ultimately leave 32 million more peopleuninsured. The Cassidy-Graham bill would presumably result in even deeper coverage losses than that in the second decade.”

Andy Slavitt, who ran the Centers for Medicare and Medicaid Services during the presidency of Barack Obama, posted a bullet-point summary of the proposal on Twitter last week. The post has since garnered over 42,000 retweets—just one indication of the groundswell of opposition the legislation will likely provoke.

Horrible Trumpcare

As the Post‘s Elise Viebeck and David Weigel observe, the GOP is working with an imposing deadline: September 30 marks the last day the Republicans can ram through budgetary legislation with merely a simple majority. Beyond that date, the GOP will need 60 votes.

The Senate may vote without an adequate CBO score too.

CBO-Scoring-Sept-2017