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News Briefs

With Healthcare, U.S. Is Unlike Other Countries
Suneel Dhand, MD, explains why
by Suneel Dhand, MD/September 28, 2017/Medpage Today

The debate about the future of healthcare rages stronger than ever. As someone who grew up and
trained in a country with probably the most centrally controlled medical system in the world -- the
United Kingdom with her NHS -- my views have admittedly done a 180 over the last decade. I am
no longer as strong a believer in socialized healthcare as I once was, and actually believe the
future for America lies somewhere between the extremes, with a potential hybrid-type system, as I
wrote.

Unthinkable as it was only a decade ago, the current mainstream political discourse appears to
include serious consideration of a single-payer system. The momentum may eventually become
unstoppable, whether one agrees with this in principle or not (and there are many forms such a
universal access system could take). In the passionate and often heated debate, those who are
more gung-ho about a European-style government controlled healthcare system, frequently use
the line: "But every other developed country in the world has socialized medicine, why can't
America?"

here may indeed be a lot of merit in that argument, but there are also a lot of problems.
Let's start off with the counter-argument: But America is different from every other developed
country in the world. Put quite simply, and speaking as someone who has traveled the globe (and
it must be immediately obvious to anyone else who has done so), Americans and their collective
psyche are quite unlike any other society. Much of this likely goes back to the founding of the
republic itself, and the unique character of the nation. Founded on anti-authority and
rebelliousness, Americans rightly or wrongly have a centuries-old deep-rooted suspicion of
government and centralized control. A unique focus on individualism and self-reliance is also
inherently ingrained in the culture, that doesn't quite gel with the concept of socialized anything.

Many of the healthcare systems that exist in European countries sprung up from the ruins of World
War 2 -- a situation that fortunately did not apply to the American homeland. Today, America is
probably the most consumer-oriented society in the world, with the typical societal expectations of
choice and freedom that come with a free market economy. From what I've experienced during my
time in the States, many Americans simply wouldn't put up with the restrictions and paternalism
that are inherent in a socialized healthcare system. I remember one of the things that first struck
me when I started working in the United States, aside from the patient-centered nature of the
healthcare, was the uniquely American mentality of wanting to do everything possible and basically
"throwing the kitchen sink" at any clinical scenario, never wanting to give up. I'd never seen that
before. Of course, one could argue the outrageous unsustainable costs and futility of having this
attitude, but on a human level, there's something to be admired about this too.


It's been said before that America, being a nation of immigrants, is blessed with a peculiar gene
pool, the majority having descended from ancestors who had the "ambitious adventure gene."
People who upped and left, often at great risk, in search of a better future.

Despite the setbacks along the way and the transient daily politics, America still holds a special
place in the global consciousness. Everyone knows what's happening in America, and the
country's tumultuous ongoing story captivates billions around the world.

Americans today may not fully appreciate this, but go to any country in the world -- and the embassy
with the most people lining up outside trying to get a visa is invariably the embassy of the United
States.


So yes, American healthcare has its fair share of problems and challenges to overcome. We need
to do better to expand access and reduce costs. There's enormous work to do. But in answer to
that question about why every other Western developed country can do universal healthcare, but
America can't. My answer is always: No other country is like America, and Americans are unlike any
other group of people the world has ever seen.

Suneel Dhand, MD, is an internal medicine physician and author of three books, including Thomas
Jefferson: Lessons from a Secret Buddha. He is the founder and director of HealthITImprove, and
blogs at his self-titled site, Suneel Dhand. This post appeared on KevinMD.com.


Generic for Liquid Tamiflu Approved
by John Gever, Managing Editor, MedPage Today/September 15, 2017

WASHINGTON -- The first generic version of the influenza drug oseltamivir phosphate (Tamiflu) is
now approved, the FDA said Friday.

The generic product -- made by Nesher Pharmeuticals -- comes as a 6-mg/mL oral suspension,
making it appropriate for very young as well as older patients.

"[This] is of particular importance in patients that are not able to ingest capsules," the FDA said in
announcing the approval, noting that the product is okayed for patients as young as 2 weeks.

As with the branded version, the generic is indicated for acute treatment within 48 hours of flu-like
symptom onset. It can also be used for prevention in patients 1 year and older.

The FDA stressed that the drug should not be used as a substitute for flu vaccination. Also,
oseltamivir does not prevent other illnesses, including bacterial infections, that may co-exist with
influenza.


An ‘old wives’ tale’ drives calls for tetanus shots amid Houston flooding
By Helen BraswellL/AUGUST 29, 2017/STAT

People caught up in the tragedy of Hurricane Harvey face uncertainty and stress. But one thing
most of them don’t have to worry about right now is whether they need a tetanus shot.

Scattered social media posts from Texas have invoked the importance of tetanus shots for those
who have been wading through floodwaters; a U.S. congressman urged residents to start
considering whether they needed to get booster shots.

Those suggestions are based on the widespread belief that contact with floodwaters increases a
person’s risk of contracting tetanus, a potentially fatal infection.

That, health experts say, is simply untrue.

“It’s this old wives’ tale. It’s a myth,” Michael Osterholm, director of the University of Minnesota’s
Center for Infectious Disease Research and Policy, told STAT.

Osterholm expressed concern that public health authorities in the affected parts of Texas and
Louisiana — and in places taking evacuees from the flood zone — would try to mount mass
tetanus vaccination efforts.

Doing so would divert resources that are needed elsewhere and unnecessarily alarm people who
are already engulfed in a highly stressful situation, Osterholm said.

The Centers for Disease Control and Prevention does not recommend tetanus shots for people
who have been in floodwaters. “Exposure to flood waters does not increase the risk of tetanus, and
tetanus immunization campaigns are not needed,” the CDC website states.

The widespread belief may stem from the fact that being in floodwaters — which can be full of
debris and too murky to see through — does increase a person’s risk of experiencing a puncture
wound.

Taking part in the cleanup operations that follow these disasters also carries increased risk of
puncture wounds.

Both the CDC and the Occupational Health and Safety Administration recommend that workers
involved in flood cleanups ensure that their tetanus vaccination status is up to date.


For full article, see STAT.


Big Tobacco Won’t Let the FDA Cut Nicotine Without a Fight
By Anna Edney and Jennifer Kaplan/August 3, 2017/Bloomberg Businessweek

Lobbyists will likely lead the campaign against making cigarettes less addictive

In 2009 a Democratic Congress and president gave the U.S. Food and Drug Administration the
power to regulate tobacco. Eight years later, under a White House and Congress controlled by
Republicans, the FDA made its strongest use of that authority.

On July 28 it said it would move to cut the level of ­nicotine in cigarettes to nonaddictive levels. The
news shocked Washington and Wall Street, sending tobacco stocks plunging and lobbyists
scrambling to respond.

The policy is the latest sign that FDA Commissioner Scott Gottlieb, who was confirmed in early
May, is turning out to be among the most aggressive (and unpredictable) cabinet officials during
the early days of the Trump administration.

In less than three months, Gottlieb, a 45-year-old physician and cancer survivor, has moved quickly
on a number of issues not typically within the FDA’s purview, including the high cost of prescription
drugs and the opioid crisis. In June, Gottlieb took the rare step of asking a drug company to pull a
powerful opioid pain medication off the market. Although the company wasn’t legally required to do
so, it complied.

“I’ve pledged a deep commitment to taking aggressive steps to address the epidemic of addiction
to opioids,” Gottlieb said in announcing the nicotine policy. “I’ll pursue efforts to reduce addiction to
­nicotine with the same vigor.”

His proposal to make cigarettes less addictive could lead to the most sweeping effort to reduce
smoking in the U.S. since 1965, when President Lyndon Johnson signed a law requiring packs of
cigarettes to carry a health warning.

It also strikes an adversarial tone with the $130 billion tobacco industry, a surprising move for an
administration that’s rolling back regulations. It’s not clear whether Gottlieb personally sought
President Trump’s counsel before making the announcement.

An administration official says the White House ­supports the policy and disagreed that it was a
break from Trump’s antiregulation agenda.

See Bloomberg Businessweek for full article.

Maine Raises Smoking Age to 21 After Lawmakers Override Veto
By Matthew Haag/August 2, 2017/NY Times

Maine will become the fourth state to raise the smoking age to 21 and will adopt stricter
regulations on the sale of electronic cigarettes after lawmakers on Wednesday voted
overwhelmingly to override the governor’s veto.

Gov. Paul R. LePage, a Republican, had called the bill an attempt to “social engineer our lives,”
saying that if 18-year-olds can join the military and fight in wars, they should be allowed to decide
on their own whether to use tobacco.

Senator Paul Davis, a Republican who wrote the bill, said the governor’s remarks showed that he
had missed the point of the legislation.

“People who join the military don’t have 15-year-old kids following them around and being
impressed by their actions,” Mr. Davis told reporters after the Senate’s vote on Wednesday. “It’s
about the availability of cigarettes in schools.”

Starting in July, anyone under 21 will not be allowed to buy tobacco products in the state, which will
join California, Hawaii and New Jersey as the only states to raise the age limit to 21, from 18.
Maine’s new regulations will also apply to devices like e-cigarettes, which are popular among
teenagers; hookah pipes; and smoking accessories.

In the last two decades, tobacco use among teenagers in Maine has dropped drastically, mirroring
a similar decline across the country. But the state still ranks near the top for high schoolers who
smoke cigarettes: In 2015, 11.2 percent of Maine high school students smoked, just above the
national average of 10.8 percent, according to the most recent data from the Centers for Disease
Control and Prevention.





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