Monthly Archives: July 2015

Modernizing Medicine

There is a new wave of medicine that has been sweeping across the healthcare world. Telemedicine (also known as “remote healthcare”) is the new modern wave of healthcare. Telemedicine is the use of medical information exchanged from a single site to another via electronic communications to improve a patient’s clinical health status. The original purpose of telemedicine was to extend healthcare’s reach to rural areas to allow patients from these areas to be provided access to healthcare benefits. The technology that has become available after forty years of development now extends to services using two-way video calling, smart phones, and other wireless tools to provide services to the rural population in the United States. Since telemedicine creation the original purpose has expanded to include a variety of resources to both rural and urban patients in addition to the medical community. First, telemedicine provides primary care for those individuals in rural areas that may otherwise not have access to healthcare. Second there is the ability for doctor’s to monitor those patients who live remotely and need to have blood pressure or glucose levels checked on a regular basis. Third, the telemedicine field allows consumers to obtain specialized medical information, have access to discussion groups on health diagnoses, and provides peer support groups in times of need. Finally, telehealth is giving the medical field a makeover in how it shares information because doctors are now able to access more techniques and services through these devices to grow his or her technique in a particular field of study.

There are significant benefits from the expansion of telemedicine; healthcare can now be provided to a wider range of individuals, telemedicine is more cost efficient, improved the quality that as a nation we provide, and lastly there is more patient’s want to use telemedicine because it reduces the stress and time a person has to dedicate to ensuring his or her body is in good health.

As a result of the increase in patients and doctors alike wanting to use telemedicine, Congress would like to restructure how Medicare pays for telehealth. The representatives in support of this idea have proposed the Medicare Telehealth Parity Act of 2015. The act consists of three phases that are to be implemented over a four year period expanding the coverage of telemedicine not only to the members of the rural community but also to urban areas. Phase 1 consists of expanding the rural health centers and adding centers to metropolitan areas with a population less than a 50,000; this phase also includes the expansion of specialists such as diabetes educators and speech therapists. Phase 2 encompasses expanding telehealth sites to include metropolitan areas with populations of 50,000 to 100,000 people. The third and final phase of Congress’ plan is to then extend the telemedicine services to all geographic locations regardless of population size.

Bipartisan members of Congress that support the expansion of telecommunication have tried to introduce legislation that reimburses those companies that support telehealth endeavors. Unfortunately, in both 2013 and 2014 the bills did not leave the House Energy and Commerce Subcommittee on health despite the support the bill received from the Telecommunications Industry Association and American Telemedicine Association. The representatives are now hoping that the bill will get the chance to leave the Committee and that members of the healthcare community will sponsor this bill in order to have healthcare be available to every individual that needs it. This bill is legislation that would allow medicine to be provided to a larger demographic and ultimately benefit society by having healthcare be provided a little closer to home.

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Is Blood Discrimination Against the LGBT Community Really Over?

While June has undoubtedly been a groundbreaking month for the LGBT community with the Obergefell v. Hodges marriage equality decision, May was an important month as well. In May, the FDA followed through on its promise to reevaluate its current stance on blood donation from men who have sex with other men (MSM) by issuing a draft guidance proposing a 12 month deferral period. The draft guidance bars male donors who have “a history in the past 12 months of sex with another man.” The public will have 60 days to comment on the draft guidance and the FDA will ultimately issue a final guidance after reviewing the comments.

Currently, the FDA imposes a lifetime blood donation ban on “men who have had sex with other men (MSM), at any time since 1977.” he MSM rule was implemented in 1983 at the beginning of the AIDS crisis when the spread of the disease through transfusion was first recognized. The ban was initially created to be an outright ban on gay and bisexual men; however, in 1992 the FDA changed to its current policy to shift the focus from excluding whole populations it believes to be risky to excluding individuals engaging in risky behavior.

While it is FDA policy to limit donors based on risky behavior, the end result of the policy is an essential ban on gay and bisexual men.  If the risky behavior the MSM rule is trying to prevent is unprotected anal sex, then the guidance should not be directed exclusively at men who have sex with men. Women have anal sex, unprotected sex, and unprotected anal sex.

Both the current rule and the proposed guidance, perpetuate the stereotype that “gay sex, particularly anal sex, is deviant, disgusting, and diseased.” The rule also highlights the stereotype that if women engage in anal sex, it is an isolated, discreet, and accidental incident and also enforces the stereotype that heterosexual couples having unprotected sex are in a committed and monogamous relationship. But unprotected sex is seen as routine practice for those who identify as gay or bisexual because it is not possible for them to engage in a healthy, committed, and monogamous relationship since their sexual orientation by nature means they are sexually deviant.

Although a change from a lifetime ban to a 12 month deferral is progress, does it really go far enough? The new guidance will allow for a possibility of gay and bisexual men to donate, but the rule still stigmatizes them as a group. Many human rights and advocacy groups criticize the 12 month deferral for being too long because current tests can detect HIV as early as nine to eleven days after exposure.

The draft guidance also attempts to clarify the FDA’s policy on transgender donors. The note reads, “In the context of the donor history questionnaire, male or female gender is taken to be self-identified and self-reported. In instances where a donor has asserted a change in gender identification, medical directors may exercise discretion with regard to donor eligibility.” The FDA has been silent regarding transgender donors, as no official rule or draft guidance has been issued. As a result, blood donation and plasma centers have been left to create their own policy that has ultimately become a complete ban on transgender donors because blood banks and plasma centers view it as the simplest policy. Currently, there are multiple lawsuits around the country against blood and plasma donation centers for discrimination against transgender individuals. A transgender woman in Minnesota, Lisa Scott, is suing a CSL plasma center after being turned away. In Kent, Washington, Jasmine Kaiser is also pursuing legal action against CSL plasma center for being turned away because she was born biologically male.

Although the proposed guidance is a step in the right direction that will allow some gay and bisexual men to donate, the guidance is extremely lacking in its response to transgender donors.  The guidance is also only one step among many steps that should be taken to ensure equality in the way we screen blood donors. Until the FDA abolishes the MSM rule completely and creates proper policies to address transgender donors, discrimination against the LGBT community will continue.

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