February 8, 2023

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Healthcare Enthusiast

Three health stories you might have missed

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Happy Monday morning y’all. We hope everyone had a great Thanksgiving. Got new fave recipes? Send those (and news tips) our way: [email protected]

Today’s edition: A deep dive on the scarce oversight and fraud within the hospice industry via the New Yorker and Propublica. Federal health officials are cautiously optimistic that RSV cases may be peaking. But first … 

Your post-Thanksgiving catch-up: long covid treatments, abortion in Georgia and federal judges

Welcome back from the Thanksgiving respite, where on Capitol Hill, it’s a sprint to the next holiday break. This morning we’re diving into three stories you may have missed and why they matter.

  • Covid long-haulers are turning to treatments without robust scientific evidence as the slow pace of research into the condition frustrates advocates.
  • Georgia’s Supreme Court has reinstated a ban on most abortions as access to the procedure remains limited across the South.
  • Senate Democrats will continue to confirm federal judges next year, but the makeup of the courts over the last two years hasn’t shifted substantially.

Manufacturers are pushing to the market a spate of remedies purporting to treat long covid, often with little data behind them. But the sluggish pace of research into the condition has left covid long-haulers desperate for relief turning to pricey unproven treatments, our colleague Frances Stead Sellers reports.

One nonprofit is promoting ivermectin, which the Food and Drug Administration has approved to treat some parasitic worms. Major professional groups, like the American Medical Association, oppose using the drug outside of clinical trials, and it hasn’t been shown to effectively treat acute covid-19. Others are touting dietary supplements that aren’t regulated by the FDA, a process known as “blood washing” in Cyprus or $25,000 stem cell treatments in the Cayman Islands.

Yet, government-funded research into the condition has been slow. The National Institutes of Health is working to understand the biological basis of long covid, and recently announced its intent to investigate whether the antiviral Paxlovid helps with long covid — but the results aren’t expected until 2024.

Why it matters: Some outside experts contend more federal funding is needed to speed up the country’s understanding of long covid and develop treatments. But as we reported last week, Congress is highly unlikely to fulfill the Biden administration’s request for $750 million for long covid amid Republican resistance to more pandemic aid.

Most abortions are again paused in Georgia after the state Supreme Court reinstated a ban on the procedure after fetal cardiac activity can be detected.

The one-page order Wednesday came in response to an emergency petition from the state, The Post’s Kim Bellware reports. Georgia’s Republican attorney general had immediately appealed a Nov. 15 ruling from a Fulton County judge, who wrote that key parts of the law “were plainly unconstitutional when drafted, voted upon, and enacted.”

That legal rationale was novel, essentially saying that abortion bans weren’t constitutional if passed before Roe v. Wade’s decades-old protections were overturned. The state’s abortion providers had cautiously resumed scheduling abortions up to 22 weeks when the pause on Georgia’s ban was lifted, while antiabortion advocates expressed confidence the state Supreme Court would put the restrictions back in place.

Why it matters: Georgia was poised to become a destination for abortions for patients across the South if the procedure remained legal. Last week’s order isn’t the final word on the ban, but rather lets the restrictions continue while the Georgia Supreme Court considers the state’s appeal.

  • At least one major antiabortion group in the state recently told The Health 202 that it won’t pursue new legislation until the state Supreme Court settles the matter for good. “If we open up any of those code sections while it’s still being held up in the court, I think it just could create a lot of confusion,” Elizabeth Edmonds, the leadership director of antiabortion group Georgia Life Alliance, said in an interview shortly after the Nov. 15 pause on the ban.

Democrats narrowly kept the Senate in the midterm elections, granting President Biden the ability to continue to shape the federal judiciary. Though Biden has appointed more judges at this point in his presidency than his predecessor, they won’t have the same impact as those tapped under former president Donald Trump, The Post’s Aaron Blake writes. 

The reasons for this are complex, but are largely due to the fact that the GOP blocked former president Barack Obama’s picks for judges in 2015 and 2016. That strategy handed Trump 17 appeals court vacancies to fill when he assumed office in 2017, allowing Republicans to recast the most powerful judges below the nation’s highest court.

Biden has reduced the recent deficit of Democratic-appointed judges, but only one appeals court circuit has flipped back from a majority of Republican nominees to Democratic ones. 

Why it matters: Federal appeals courts have the power to block or uphold Biden administration policies — and administrative actions will likely increase over the next two years with a split Congress. For instance, such courts have been critical in temporarily blocking or allowing pandemic measures to continue, such as the whiplash over Biden’s vaccine mandates, before the Supreme Court weighs in. 

Fraud and exploitation plague the hospice industry

The hospice boom has spread across the country, but weak oversight of the industry behind the end-of-life care service has created widespread opportunities for fraud, abuse and exploitation of the dying and their families, according to a joint investigation out this morning from the New Yorker and ProPublica

The point of hospice is to help people experience as little pain as possible and to spend time with loved ones during the final days. The $22 billion industry is funded primarily through Medicare, which pays hospice companies a set rate per patient per day regardless of how much care they actually provide. 

Once hospice is up and running, though, oversight is generally scarce and federal regulators rarely go after bad actors. In an effort to bulk up their patient roster, some for-profit hospices have reportedly enlisted friends and family to act as make-believe clients, duped people into the program by advertising it as free home health care or stole personal information to enroll “phantom patients.” 

In some ways, the way federal regulators designed the hospice benefit rewards providers for recruiting patients who may not be dying imminently. That’s because longer stays translate into bigger payouts and stable patients require fewer expensive drugs and supplies than those in their final days, ProPublica’s Ava Kofman writes. 

But enrolling in hospice can inflict harm on patients who aren’t immediately dying, since they must agree to forgo curative care to be eligible for the service. For instance, some unwitting enrollees report being denied kidney dialysis, mammograms, coverage for lifesaving medications or a place on the waiting list for a liver transplant.

White House prescriptions

Federal health officials say they’re hopeful RSV cases have peaked

White House health officials were cautiously optimistic yesterday that spiking cases of respiratory syncytial virus (RSV) among children may have peaked, offering a glimmer of hope as the nation struggles to respond to a trifecta of respiratory illnesses. 

“In the last week, we’ve seen RSV peak and maybe turn down,” Ashish Jha, coordinator of the White House’s coronavirus response, said yesterday on ABC’s “This Week.” “I’m obviously hopeful that that trend is going to continue.”

Anthony Fauci, outgoing director of the National Institute of Allergy and Infectious Diseases, echoed Jha on CBS’s “Face the Nation.” He told host Margaret Brennan that, based on the virus’s behavior in other countries, he’s hopeful that cases in the United States will decline.

Key context: Fears of a possible “tripledemic” this winter have circulated in recent weeks as health-care providers across the country report an elevated and early start to flu season that has coincided with surging cases of RSV and the ongoing coronavirus pandemic. 

Margaret Brennan, host of “Face the Nation”:

  • New this a.m.: Nearly 9 in 10 covid deaths are in people 65 or older, which is the highest rate ever, our colleagues Ariana Eunjung Cha and Dan Keating report, citing a Washington Post analysis of CDC data.
  • U.S. abortion rates fell slightly in 2020, with more than 80 percent performed at or before nine weeks of gestation, according to new data from the CDC.
  • Measles is an “imminent threat in every region of the world,” the World Health Organization and CDC warned in a joint report out last week that found almost 40 million children missed their vaccine doses last year, The Post’s Andrew Jeong reports.

The Senate is back in session today. The House will be back tomorrow. Here’s what we’re watching this week:

Tuesday: The House Rules Committee will examine legislation aimed at improving the health and wellness of incarcerated pregnant women and their babies. The chamber is expected to vote on the legislation later this week. 

Also on Tuesday … The Post is hosting a discussion with Deputy Defense Secretary Kathleen Hicks and Burn Pits 360 co-founder Rosie Torres on new government investments aimed at supporting the physical and mental health of veterans. 

Wednesday: A Senate HELP subcommittee is holding a hearing on supporting the mental health of young people as they move from high school to college; the Senate Veterans’ Affairs Committee will examine Native American veterans’ access to VA health care and benefits

And on Thursday … The Post’s Yasmeen Abutaleb is sitting down with Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, to talk about the state of the pandemic, the future of public health and the lessons he’s learned from more than a half-century of public service as he prepares to step down from his government post next month. 

Covid hospitalized him for 453 days. Now he’s home for the holidays. (By Andrea Salcedo | The Washington Post)

The short life of baby Serhii, killed in a Ukraine maternity ward (By Samantha Schmidt and Serhii Korolchuk | The Washington Post)

Rare protests against China’s ‘zero covid’ policy erupt across country (By Lily Kuo | The Washington Post)

Thanks for reading! See y’all tomorrow.