TIME Healthcare

The CDC’s New Tests Can More Quickly Check for Enterovirus

CDC Chief Dr. Thomas Frieden Updates Media On Dallas Ebola Response
Exterior of the Center for Disease Control (CDC) headquarters Jessica McGowan—Getty Images

Tests that took weeks will now take only days

The testing process for a common enterovirus known to cause reparatory illness is getting streamlined.

The Centers for Disease Control and Prevention (CDC) has developed a faster test for EV-D68, a strain of enterovirus that has sent hundreds of children to the hospital, particularly affecting those with asthma.

“CDC has received substantially more specimens for enterovirus lab testing than usual this year, due to the large outbreak of EV-D68 and related hospitalizations,” said Anne Schuchat, MD, assistant surgeon general and director of CDC’s National Center for Immunization and Respiratory Diseases, in a statement Tuesday. “When rare or uncommon viruses suddenly begin causing severe illness, CDC works quickly to develop diagnostic tests to enhance our response and investigations. This new lab test will reduce what would normally take several weeks to get results to a few days.”

The faster enterovirus testing will help the CDC track the recent outbreak of EV-D68, which began over the summer and appears to be continuing through the fall as children across the country return to school.

 

TIME medicine

FDA Approves Combined Hepatitis Drug

Harvoni
Harvoni, the first single medication to treat hepatitis C, was recently approved by the FDA. Gilead Sciences

Harvoni is the third hepatitis C drug approved in the past year

The Food and Drug Administration approved the first single medication to treat hepatitis C on Friday, green-lighting one pill in the place of multiple treatments. The new drug, Harvoni, is the third hepatitis C drug approved in the past year.

“With the development and approval of new treatments for hepatitis C virus, we are changing the treatment paradigm for Americans living with the disease,” said FDA official Edward Cox.

Harvoni, developed by Gilead Sciences, will be the first hepatitis drug to require a pill only once daily. A full 12-week treatment will cost $94,500, less than existing treatments, Reuters reports.

TIME Walmart

Why Walmart Workers Losing Healthcare Might Not Be Bad

Getty Images

Ironies abound

Talk about irony. In the same week that Walmart announced employees who work less than 30 hours will be losing their health care coverage, the company also announced that it’d be getting deeper into the business of selling insurance, making it easier for customers to price shop for insurance in stores. In some ways, this mirrors Walmart’s overall business model—keep prices down for consumers, but keep wages and benefits for employees low too.

Ironically, under the rules of Obamacare, it’s possible that those part time employees will get a better deal on health care exchanges, thanks to subsidies that help lower income workers buy insurance. It’s all part of the new landscape created by the Affordable Care Act. As Obamacare turns one year old, Joe Nocera and I discussed how it’s changed healthcare, business, and the economy, on WNYC’s Money Talking.

TIME Companies

Wal-Mart Cuts Healthcare Benefits, Citing Rising Costs

The massive retailer will no longer provide health benefits to employees who work fewer than 30 hours a week

Wal-Mart Stores WMT -0.03% is cutting health care benefits for many of its part-time workers, and making other employees pay a bigger share of their premiums.

The world’s largest retailer — citing rising health care costs as well as practices at rivals Target TGT -0.88% and Home Depot HD -0.26% — said it would no longer provide health benefits to employees who work fewer than 30 hours a week, a move that will affect some 2% of its U.S. workforce, or 26,000 people. Two years ago, the retailer stopped providing health benefits to newly-hired part-time workers, according to the Wall Street Journal. Employees who are covered will have to pay more for the benefit: its most popular and lowest cost associate-only plan will increase by $3.50 to $21.90 per pay period, a 19% jump.

“Like every company, Walmart continues to face rising health care costs. This year, the expenses were significant and led us to make some tough decisions as we begin our annual enrollment,” Sally Welborn, senior vice president of global benefits, wrote in a blog post.

In August, Walmart’s U.S. CEO Greg Foran warned investors that “pressure from health care” costs, as more employees enrolled in its health care plans than expected, would increase by $500 million this fiscal year.

“We don’t make these decisions lightly, and the fact remains that our plans exceed those of our peers in the retail industry,” Welcorn continued in her post. She said Wal-Mart covers more than 60% of U.S. associates’ total health care costs and more than 75% of their premium costs. That was better than the retail industry average of 54% of total health care costs and 68% of employee premiums, she said, citing data compiled by human resources consultancy Aon Hewitt.

This article originally appeared on Fortune.com

TIME Healthcare

Woman Delivers Baby After Womb Transplant

It's the first successful birth after such an operation

A 36-year-old woman who received a womb transplant has given birth to a healthy baby, a Swedish doctor announced according to a report in the Associated Press. The birth marks the world’s first successful birth following such an operation.

“The baby is fantastic,” said Mats Brannstrom, the doctor who delivered the baby. “But it is even better to see the joy in the parents and how happy he made them.”

Brannstorm, a professor of obstetrics and gynecology at the University of Gothenburg and Stockholm IVF, has been working on womb transplants for the past two years. He transplanted wombs in nine women, but two needed to have the organs removed following complications. At least two other women with pregnancies have passed the 25 week mark, he said.

[AP]

 

TIME Research

Why Pregnant Women Who Smoke Might Have Kids With Worse Sperm

Pregnant smoking
Getty Images

One more bullet point on a long list of reasons to quit smoking

Add diminished fertility to the long list of reasons why women should avoid smoking while pregnant or breast feeding. The mice sons—called pups—of mothers exposed to the smoke equivalent of a pack of cigarettes a day during that time wind up with sperm that struggle in the reproduction process, according to a new study in mice published in the journal Human Reproduction.

“Our results show that male pups of ‘smoking’ mothers have fewer sperm, which swim poorly, are abnormally shaped and fail to bind to eggs during in vitro fertilisation studies,” said study leader Eileen McLaughlin, a chemical biology professor at the University of Newcastle in Australia, in a press release. “Consequently, when these pups reach adulthood they are sub fertile or infertile.”

Unlike previous research, the new study looked at pregnancy in mice to try to determine not just the consequences of smoking during pregnancy but also the mechanism behind it. Cigarette toxins affect the stem cells in the testes, McLaughlin says, which results in permanently lowered sperm production—and these results likely apply to humans, she adds. “We also know that oxidative stress induced by these toxins causes damage to the nuclei and mitochondria (the cell’s ‘power’ supply) of cells in the testes and this results in sperm with abnormal heads and tails, that are unable to swim properly or successfully bind and fuse with eggs.”

The knowledge that smoking has devastating long-term implications for the health of children is nothing new. Previous studies have suggested that smoking stems fetus growth, leads to premature delivery and causes birth defects. Nonetheless, 20% of women in the United States continue to smoke during pregnancy. The number is higher in Australia, where the study was conducted.

“We would ask that smoking cessation programmes continue to emphasise that women should avoid smoking in pregnancy and while breast feeding as the male germ line is very susceptible to damage during early development and the resulting sub fertility will not be apparent for several decades,” said McLaughlin.

TIME Innovation

Five Best Ideas of the Day: September 23

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. As coalition bombs fall on Islamic State targets, the future of the Kurds hangs in the balance.

By Dexter Filkins in the New Yorker

2. To solve massive international health crises and prevent future ones, the world needs a Global Health Workforce Reserve corps.

By Michele Barry and Lawrence Gostin in the Los Angeles Times

3. In Ukraine, a bad peace is better than a long war with Russia.

By Anatole Kaletsky in Reuters

4. The spiraling costs of end-of-life care signal that significant change — in policy and mindset — is needed.

By Jenny Gold in Kaiser Health News

5. Communities need information to survive and thrive. The public library is primed to meet that need.

By Amy Garmer in the Knight Blog

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Healthcare Policy

Getting Poor to Get Help: How a Tragic Accident Trapped My Family in Poverty

Trapped in America's Safety Net
Trapped in America's Safety Net Courtesy University of Chicago Press

Campbell is the author of the new book, Trapped in America’s Safety Net: One Family’s Struggle.

When Andrea Louise Campbell's sister-in-law was horribly injured, she and her family had to spend down their money and assets to get the medical care they needed

Nearly one-third of American households live in or near poverty. The causes are myriad – and much contested. Those on the political right tend to cite the personal shortcomings of poor individuals while those on the left blame systemic barriers to upward mobility. But as my family has painfully learned, there is another shocking cause: government policy.

In February 2012 my sister-in-law Marcella was in a car accident on her way to nursing school, where she was working towards a career which she hoped would catapult her and my brother Dave into middle-class security. Instead, the accident plunged them into the world of American poverty programs. Marcella is now a quadriplegic, paralyzed from the chest down. She needs round-the-clock personal care and assistance. The only source – public or private – for a lifetime of such coverage is Medicaid. But because Medicaid is the government health insurance for the poor, she and my brother must be poor in order to qualify. (Medicare does not cover long-term supports and services, and private long-term care insurance is time-limited and useless to a 32-year-old who needs decades of care). Thus, Marcella and Dave embarked on a hellish journey to lower their income and shed their modest assets to meet the state limits for Medicaid coverage.

To meet the income requirement, my brother reduced his work hours to make just 133 percent of the poverty level (around $2,000 per month for their family). Anything he earns above that amount simply goes to Medicaid as their “share of cost” – a 100 per cent tax.

Worse: the asset limit. In California, where they live, they can own only $3,150 in assets beyond their home and one vehicle. They’re “lucky,” a social worker tells Dave: if not for the baby (Marcella was pregnant at the time of the accident; the baby miraculously survived), the asset limit would be $3,000. As if you can raise a child on $150. This asset limit was last raised in 1989. It has fallen by half in real value since then.

Dave and Marcella began to liquidate. Under California rules, retirement plans are not exempt from the asset test. Marcella had to cash in a small 401(k) account from a previous job, paying the early withdrawal penalty to boot. Dave had to abandon his hobby, working on old cars, which violated the asset test. He sold them all, keeping a 1968 Datsun pickup because its tiny value didn’t impinge on the asset limit. The pickup is 45 years old, weighs less than a Miata, and has no modern safety features. The only able-bodied adult in the family has to drive to work in an unsafe vehicle. And they had to empty their bank account, watching their hard-earned security disappear.

As Dave and Marcella spent down their assets, they had to keep track of every penny. They could only put the money into the exempt items, the house and the used wheelchair van they bought for Marcella. They could not use the money to pay credit card bills, household bills, or Marcella’s student loans from her undergraduate degree. And they are barred from doing any of the things the middle class is constantly advised to do: save for retirement. Create an emergency fund. Save for college with a tax-free 529 plan. Just $3,150 in assets – that’s it.

What happens in an emergency? One day the van’s wheelchair ramp stopped working. The repair cost $3,000—the sum of their meager assets. Fortunately their tax refund had just come in and went straight back out to pay for the repair. We don’t know what they’ll do next time.

What would help folks like Marcella and Dave?

True universal health insurance. A universal social insurance program for long-term care, not just Medicaid. And one modest change: no asset test. Policy is already trending in that direction. Under the Affordable Care Act, those newly eligible for Medicaid face no asset test. (Unfortunately those in the original eligibility categories, including the disabled like Marcella, are still under the old rule.) About half of the states have no asset test for any Medicaid recipient; perhaps someone realized that trying to ferret out the tiny amount of resources most Medicaid applicants have is inefficient. As for Dave and Marcella, I suppose they might move to a state with more generous rules. However, no state helps with wheelchair renovations. Lacking the assets to buy a new house elsewhere, they must remain in the home their friends renovated for them on an entirely volunteer basis.

It’s bad enough that America’s system of social supports is so limited. That the government also forces some of its citizens to get poor to get the help they need is an abomination.

 

Andrea Louise Campbell is professor of political science at the Massachusetts Institute of Technology. She is the author of Trapped in America’s Safety Net, out this month.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Healthcare

Obamacare Hasn’t Saved Our Rural Clinic

Rural Uninsured Receive Medical Care In Southern Colorado Clinics
Medical assistant Elissa Ortivez draws an MMR vaccination at the Spanish Peaks Outreach Clinic on August 5, 2009 in Walsenburg, Colorado. The Spanish Peaks Regional Health Center treats rural Coloradans who come for medical care from throughout southern Colorado, where hospitals and clinics are scarce. John Moore—Getty Images

Frank Lang is a family nurse practitioner.

Cost-per-patient shouldn't be the only factor determining where we send help

Thirty-eight years ago, a young nurse practitioner moved his family from Denver to Downieville, California, the Sierra County seat, to volunteer for the National Health Service Corps.

On my first night in town, I was hooking up the television for my children and by sheer coincidence received a fragmented radio signal through the TV receiver from the sheriff’s office: There was an emergency, and they needed medical help. I found the sheriff’s office and was whisked to the crisis—a car resting precariously on an embankment 150 feet below the road, with an unconscious person inside. I was lowered down by a tow truck cable, then secured the vehicle and started the patient on an IV. He was lifted back up on a Stokes rescue litter and taken by ambulance to the nearest hospital—in Grass Valley, 50 miles away.

What had I gotten myself into?

When I arrived in Downieville—population 500—in 1976, there was virtually no consistent primary medical care or integrated emergency medical services response to trauma and medical emergencies. An emergency like the one I’d attended depended on well-intentioned citizens getting into cars and trying to help out. No one knew what a nurse practitioner was; I lacked any credibility except what I could demonstrate or do for the ill or injured.

Luckily, I loved what I was doing from the start, and my work became our family’s story.

The National Health Service Corps (NHSC), which places health professionals in rural communities, had sent me to Downieville to open a health clinic. NHSC would pay my salary and clinical expenses for a couple years, then the operation would be taken over by the community.

I started by building the clinic’s infrastructure: buying equipment, hiring staff, developing integrated referral processes to make it easy for patients to see specialists, and creating an emergency response system. Because of Downieville’s geographic isolation, the clinic staff needed to be able to treat a wide variety of illnesses and injuries. We took classes at the UC Davis School of Medicine to fill in gaps, and I got licensed through the state to do things like dispense medication in the absence of a local pharmacy.

After the NHSC placement and funding ended, I decided to stay on in Downieville. The California State Rural Health Association funded my salary, and I wrote grants to foundations and nonprofits to build up the facility, though we still operated on a month-to-month basis.

In 2007, our peak year, the clinic offered access to a nutritionist, physical therapy, and home care, and had substantial savings in the bank. But then the recession hit, our grants started to dry up, and state funding levels dropped.

Over the past few years, Downieville has been caught up in changes for funding health clinics. Federal and state priorities have shifted from rural and frontier areas to underserved, urban population areas. When you do the math, the cost-per-patient equation will always come out in favor of a clinic in an urban area. As a result, a rural clinic must rely on the support of a larger, population-focused clinic.

In 2010, the number of patients we were seeing yearly decreased from 4-4,500 to 3-3,500, and we joined forces with a clinic in Grass Valley that sees 17,000 patients per year. Originally, the Downieville clinic was guaranteed continuing support for our 24 hour, 7 days per week medical care. But nutrition, physical therapy, and dental services were all cut. Behavioral health services are now accessed via telemedicine.

On October 1, Downieville’s medical care is scheduled to be reduced to three days per week. The integrated frontier healthcare delivery system I built over decades is being systematically dismantled; I worry that a patient will come into the clinic one day and be greeted by nothing more than an iPad.

The clinic is going to join forces with other community partners to develop an integrated 24 hour a day, seven days a week paramedic and clinic system. It won’t be ideal, but it is sustainable. And it will probably be paid for by the people it serves—with support from a western Sierra County health services fee for all landowners, increased user fees for community events, and higher ambulance fees.

Now, under the Affordable Care Act, everybody has insurance. Theoretically, this means people should have more access to healthcare. But that’s not true in Downieville. More insurance won’t help people if healthcare treatments are inconsistent or unavailable.

One of the changes expected to take place in this new healthcare landscape is more reimbursement for clinics. But such reimbursement is based on the number of people served. There are not enough patient encounters in frontier areas like ours to be sustainable without grant or government funding.

Frank Lang is a family nurse practitioner. He has a master’s degree from the University of Colorado School of Nursing and is a graduate of the University of California Davis School of Medicine Family Nurse Practitioner Program. He wrote this for Zocalo Public Square.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

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