Category: Blog

Although the word telehealth is new in most of our vocabularies, the idea itself is not. As early as 1925, doctors were diagnosing patients over the radio, and in 1959 patients and physicians were using video telecommunications to connect with one another. 

Telehealth now, however, is booming. In the year between March 2019 to March 2020, Telehealth usage increased an astounding 154%. Among Medicaid beneficiaries in a select five states, telehealth usage increased 15x from the pre-pandemic usage of 2.1 million visits per year, to over 32 million visits from March 2020 to April 2021.

Although telehealth has its inherent benefits , such as allowing patients to visit doctors from the comfort of their homes, thus saving them time, money, and allowing for fewer missed hours from work, it also has its drawbacks. Disadvantages to telehealth include racial disparities , possible technical difficulties between patient and doctor, misdiagnosis, and privacy concerns.

One of the leading disparities in telehealth is the digital divide. In a study conducted by the University of Houston, head researcher, Omolola Adepoju, found that only one in four families earning $30,000 or less have a smart device capable of running telehealth communications software such as Zoom or Skype. Further, the study found that 66% of African Americans and 61% of Hispanics have high-speed internet access, compared with 79% of white households.

Further challenges were illustrated by the National Center for Biotechnology Information (NCBI), which extracted 27 studies from seven databases, and organized the barriers and challenges to telehealth into seven categories. In order of frequency (most frequent challenge to telehealth, to least frequent): technical aspects, privacy/data confidentiality and reimbursement, physical examination and diagnostics, special populations, training of healthcare providers and patients, doctor-patient relationship, and acceptability and satisfaction.

The second biggest barrier to telehealth, as reported in the NCBI’s report, was privacy/data confidentiality concerns. Patients were afraid that using a telehealth service would subject their intimate data to security breaches. These fears were not baseless. During the COVID-19 public health emergency, the Department of Health and Human Services Secretary Alex Azar issued temporary waivers that waived Medicare’s licensure requirements and allowed health providers to use mainstream video-conferencing platforms like Zoom and Google Meet. Further, smartphone apps, sometimes used in place of Zoom and Google Meet, have been found to share personal health information  with third parties.

Although federal policies allowed for health care providers to use popular third party vide conferencing platforms, there are some simple steps we can take to ensure privacy when meeting with health care providers via telehealth. When sharing sensitive health information online, it is important to remember a few precautions we can take to limit the possibility of our information being hacked. First, make sure to keep your devices up to date with antivirus software; second, avoid using public Wi-Fi when accessing telehealth services; and third, avoid accessing telehealth appointments on shared devices. Further, once in an appointment, try to ensure that you are in a private room away from others, and if impossible, let your healthcare provider know, and then you may be able to send sensitive information via text or email through their own protected portal rather than speaking aloud.

As COVID-19 cases are trending down and are presenting less of a public health emergency (which the Department of Health and Human Services plans to officially end on May 11, 2023), it is time for lawmakers and politicians to seriously think about the impacts unregulated telehealth has on the privacy of its users, especially as it relates to marginalized groups.

Ozempic is an antidiabetic medication developed by Novo Nordisk in 2012 and the United States Food and Drug Administration (FDA) first approved the medication in 2017. Used for the treatment of type 2 diabetes, Ozempic is designed to be injected once a week in the stomach, thigh, or arm. In February, Novo Nordisk warned of supply constraints this year on Ozempic. In March, after months of shortages, the FDA announced that Ozempic is back on the shelves in the United States. The demand for Ozempic was assumed to be partly driven by prescriptions for non-diabetic patients seeking to lose weight, which is outside the drug’s approved indication.

Ozempic impacts weight via two key mechanisms. First, it affects the hunger centers in the brain,specifically in the hypothalamus, reducing hunger, appetite and cravings. Second, it slows the rate of stomach emptying, which effectively prolongs fullness and satiety after meals. The net result is decreased hunger, prolonged fullness, and, ultimately, weight loss. In a clinical trial sponsored by Novo Nordisk, 1,961 adults with excess weight or obesity who did not have diabetes were given 2.4 milligrams of semaglutide, the active ingredient in Ozempic, or a placebo once a week for 68 weeks, along with lifestyle intervention. Those who took semaglutide lost 14.9 percent of their body weight compared with 2.4 percent for those who took the placebo.

In 2022, Ozempic exploded onto the scene and gained attention among celebrities and TikTok influencers who were trying to lose weight in short periods of time. Although Ozempic can help someone lose fifteen to twenty percent of their body weight, any lost weight reportedly comes right back if you do not take the drug every week. Thus, people who start a prescription typically do not stop taking it, even when they reach their goal weight.

People taking Ozempic for both FDA approved and off-label use may experience side effects. These include nausea, dehydration, fatigue, malaise, diarrhea, and constipation. In rare cases, the medication could increase the risk of pancreatitis. Because the drug has not been systematically tested in people with lower body weights it is possible that patients outside of the group the drug is intended for could experience more intense side effects. Without more research, it is unclear just how damaging those side effects could be.

In addition to these physical side effects, there are also psychological side effects. Dieting is one of the leading risks for developing an eating disorder and medications such as Ozempic could lead to more disordered eating as people try to avoid regaining weight.

Doctors say there is not enough evidence to know whether Ozempic might be beneficial or dangerous for people who fall outside of the FDA’s criteria. As tempting as the prospect of a “miracle drug” for weight loss may be, experts caution against people seeking out the medication for off-label use.

“Its palliation is a daily task, its cure is a fervent hope.”- William Castle, describing leukemia in 1950.

In The Histories, Herodotus records the story of Queen Atoosa of Persia (Atoosa), specifically the unusual illness that struck her in the form of a bleeding lump in her breast rising from a malevolent form of breast cancer. Following the discovery, Atoosa self-quarantined, yet was persuaded by the Greek slave, Democedes, to excise the tumor. The rest of Atoosa’s story vanished from the Histories, but we do know Atoosa’s illness was the first recorded case of mastitis, often interpreted as a symptom of inflammatory breast cancer.

Atoosa’s story, however, was an exception in the fact that cancer was exceedingly rare in the distant past. Despite the existence of ancient medical literature terms for migraines (Mesopotamia), seizures (Egypt), and leprosy-like illnesses (Book of Leviticus), the ancient medical literature on cancer is absent. Explanations for this absence are no mystery. Cancer is mostly an age-related disease; the risk of breast cancer is one in 400 for women under thirty and one in seven for women over seventy. The spectrum of cancers is influenced by changes in modern life, including the decline in stomach cancers following the introduction of modern refrigerating.

Cancer’s name originated in the fourth century BC as karkinos, from the Greek word for “crab.” Cancer, seen as a tumor with swollen blood vessels around it, reminded Hippocrates of a crab dug in the sand with its legs spread in a circle. Hippocrates described illnesses as an unbalancing of the four cardinal fluids: blood, black bile, yellow bile, and phlegm. Inflammation was the excess of blood, jaundice was the excess of yellow bile, and tubercles was the excess of green phlegm. For Galen, the Greek doctor who practiced among the Romans in the second century AD, cancer indicated the excess of black bile. Galen supposed this excess was evident because it came from one other illness: depression. For Galen, depression and cancer were the physical and psychic diseases that intertwined due to the excess of black bile, and tumors were symptoms of deep bodily dysfunction.

Galen died in 200 AD, but his black bile theory of cancer persisted for centuries. This theory lost ground in the sixteenth century; however, due to the confirmation of the non-existence of black bile. New theories about the origins of cancer developed in the seventeenth and eighteenth centuries, including cancer being the result of viruses and organ lesions.

Critically, the modern understanding of cancer began in the eighteenth history, with physicians exploring the association between cancers and chemical exposure. In 1775, Percivall Pott noticed the development of cancers among chimney sweeps and suggested that testicular cancer resulted from soot. In the nineteenth century, Ludwig Rehn observed the association between exposure to aniline dye and bladder cancer of industrial workers.

The twentieth century saw major medical breakthroughs in our understanding of cancer, including Rous’s discovery of the first tumor virus, Papanicolau’s development of the Pap test, the establishment of the National Cancer Institute, confirmation of the link between cigarette smoking and lung cancer, and the development of radiation, chemotherapy, Rituximab, Gardasil, and the Cancer Moonshot program. The history of cancer is a story of discovery, centuries of an inability to understand cancer, and an untold amount of suffering and grief of those affected. I also present this history to highlight the advances in cancer treatment in recent decades and how those developments impact cancer mortality.

In January, the American Cancer Society released its Cancer Statistics 2023 report, which revealed that overall cancer mortality has decreased by thirty-three percent since 1991. Data also revealed that women between the ages of twenty and twenty-four had a sixty-five percent reduction in cervical cancer from 2012 to 2019; importantly, this age range was the first to receive the human papillomavirus (HPV) vaccine. Additional findings in the report include the following:

• A three percent annual increase in prostate cancer from 2014 – 2019.
• A more than fifty percent decline in mortality rates from cancer for children from 1970 to 2020.
• Persistent disparities in prostate cancer mortality rates among Black men, which are two to four times higher than those in any other racial or ethnic group.
• A continual decline in cancer mortality from 2019 – 2020 (1.5 percent), despite disruptions from the COVID-19 pandemic.
• Lung cancer incidence decreased on an annual basis for both women (1.1 percent) and men (2.6 percent).

The overall decline in cancer mortality in the United States results from reductions in smoking, advances in treatment, and increased early detection for some cancers, translating to 3.8 million fewer cancer deaths from 1991 – 2020. Significant declines in mortality rates from childhood cancer result from improvements in treatment and high participation in clinical trials for the most common cancers (e.g., leukemia), especially among children. Though a monumental achievement, the fight against cancer ensues and will require intense collaboration among policymakers and leaders in the medical sector to fund the development of more effective treatments and, eventually, a cure. Equally important will be a push to close inequities in treatment, as the risk of overall cancer death was twelve percent higher in Black individuals than White individuals; mortality rates in Black women remain about forty percent higher than in White women, despite a lower incidence of cancer.

Leadership from the White House is and will be critical in eliminating cancer. In 2022, the Biden Administration relaunched the Cancer Moonshot Initiative, committing the United States to reduce the death rate from cancer by half by 2047. The Administration also called on Congress to fund the President’s proposal to create the Advanced Research Projects Agency for Health (ARPA-H), a program aimed at further innovating health research, starting with a focus on cancer and Alzheimer’s. Numerous accomplishments followed the relaunch of the Initiative, which include over $200 million in grants issued by the Centers for Disease Control and Prevention (CDC) to advance prevention and screening, a large national trial launched by the National Cancer Institute to develop effective blood tests to detect one or more cancers, implementation of the PACT Act to expand health care access to veterans exposed to toxic burn pits, and proposed rules by the Food and Drug Administration to prohibit menthol cigarettes and flavored cigars.

Importantly, expanding health care coverage to victims of carcinogens from environmental disasters will be a critical prevention and treatment strategy. Recent environmental disasters such as the train derailment in East Palestine, Ohio highlight how victims of these disasters are at risk of developing cancers if federal officials do not respond quickly. The train derailment in East Palestine left a trail of toxic chemicals, including cancer-causing vinyl chloride. Lawmakers in Ohio and U.S. Department of Health and Human Services officials are calling for the use of Section 10323 of the Affordable Care Act (ACA), which promises Medicare to Americans exposed to certain environmental health hazards. Section 10323 was created in the wake of a vermiculite mine that spread deadly airborne asbestos in Libby, Montana, killing hundreds and sickening thousands. Following the disaster, former U.S. Senate Max Baucus (D-MT) inserted Section 10323 into the ACA to cover the whole community of Libby with Medicare. Similar conversations have arisen about providing Medicare coverage for the whole East Palestine Community, though legal experts, including Lawrence Gostin of Georgetown University Law Center, believe implementing this provision in East Palestine would be unlikely unless the federal government established a pilot program to ensure broader coverage. Even if the provision were to fail to cover the residents of East Palestine, the push to increase Medicare coverage for citizens knowingly exposed to carcinogens from environmental disasters is an important policy component the Biden Administration and future administrations should consider incorporating into their health care strategies. The fight against cancer, as illustrated by this history, has made significant progress. Much work remains to be done, and good policy can ensure the accomplishment of that work.

Ozempic is an injectable drug used to lower blood sugar in adults with type 2 diabetes and to lower the risk of heart disease. But over the past few months, Ozempic has been hailed as a “miracle drug” by celebrities, tech moguls, and social media influencers alike. In September 2022, an article from Variety described how Ozempic injections were used by celebrities across the industry to lose weight ahead of “major events”, with the most enthusiastic users being non-diabetic. Nevertheless, Ozmepic’s rise in popularity is not limited to Hollywood. As of today, TikTok videos with #ozempic have been viewed more than 637.6 million times and will likely continue to rise. While many videos feature prominent influencers on the app, dozens more feature ordinary users documenting their experience taking Ozempic with hashtags such as #ozempicjourney.

The recent popularity surge of Ozempic also coincides with the Food and Drug Administration’s (FDA) approval of another weight-loss drug known as Wegovy in 2021. Similar to Ozempic, Wegovy is a semaglutide injection intended to facilitate weight management in overweight or obese adults. By mimicking hormones that regulate food intake in the brain, Wegovy works as an appetite suppressor. The FDA’s approval of Wegovy resulted in higher demand for the drug and led many to seek out similar weight-loss prescriptions. The rising demand of these drugs led to a shortage of Ozempic in the United Kingdom in May 2022, followed by another shortage in the United States this past February. An article in Time magazine found that over five million prescriptions for Ozempic were written in 2022 alone, along with similar drugs. And in a study published by the New England Journal of Medicine, researchers found that adults with obesity but no diabetes had weight reductions of 5% or more after taking Ozempic for several weeks. 

Beyond its popularity on social media, Ozempic has also been known to have various side effects, including possible thyroid tumors, pancreatitis, kidney failure, and vision changes. One of the most documented side effects is referred to as “Ozempic face”, which can result in fat loss from the face and the appearance of sagging skin due to drastic weight loss. In addition, it is necessary to continue taking Ozempic indefinitely to maintain the weight loss. 

Currently, it is unclear how drugs such as Ozempic and Wegovy may affect people who are of normal weight or fall outside of the FDA’s criteria. While doctors have warned about the dangers of off-label use, the shortage of available prescriptions has made it more difficult for people with diabetes or obesity to have access to it. However, the rising popularity and recent shortages of Ozempic has led to a broader conversation on health and our relationship to food. In recent news, Weight Watchers has announced their acquisition of a telehealth company known as Sequence, which connects patients with doctors who can prescribe Ozempic and other drugs such as Wegovy and Rybelsus. Going forward, it may be useful to consider how the prescription of weight-loss drugs can be improved to provide affordable access for those with certain medical conditions and to educate the public on its effects. 

Gender-affirming care is a form of healthcare that includes medical, surgical, mental health, and non-medical services for transgender and nonbinary people. Early-gender affirming care is crucial to the well-being of transgender and nonbinary children (TGNB) and adolescents because it helps with social transitions and can provide resources while navigating the complicated American healthcare system. Overall, the gender-affirming care model affirms diversity in gender identity and highly focuses on the needs of each individual. 

Gender-affirming care is important. In the United States alone, an estimated 1.4 million people identify as transgender, and 1.2 million adults identify as nonbinary. Studies have shown that receiving gender-affirming care has been associated with lowering nearly 73% of the odds of suicidal thoughts among TGNB. Many prestigious medical organizations such, as the American Academy of Pediatrics, the American Medical Association, and the Endocrine Society, support gender-affirming care. 

Unfortunately, a number of bills have been introduced in the last two years attempting to limit, ban, or criminalize access to gender-affirming treatment for minors. Republican state senators have taken several measures to limit access to gender-affirming care by banning critical components of this care such as puberty blockers, hormone therapy, and surgeries for minors. For example, the “Arkansas Senate passed a bill prohibiting doctors from treating transgender, and nonbinary minors (TGNB) with puberty blockers and gender-affirming surgery…” To that end, Arkansas is not the only state to propose these types of bills. Just last month, Tennessee’s Senator Jack Johnson opened a discussion on a bill he is co-sponsoring to limit gender-affirming care such as hormone therapy and other medical services for TGNB. Moreover, there is recent news that Georgia Congresswoman Marjorie Taylor Green will introduce a bill calling gender-affirming care for minors a felony. Congresswoman Green called gender-affirming care “a new-disturbing ideology” that is making billions from “confused children who believe they are transgender.” Several states across the country have acted to restrict such care for minors. 

Although the ideology behind restricting gender-affirming care for minors was due to minors not having the “mental capacity to make such decisions,” republican senators are now also reaching out to take away access to affirming care from low-income people, including adults. Senator Jackson is also backing the HB1215 bill which prohibits Tennessee’s Medicaid program from working with healthcare insurance companies from covering gender-affirming care. Until this year, most proposed legislation targeted people under 18, but now some block Medicaid from covering it for all ages. 

While the opposition against gender-affirming care started to “protect” youth, now it is targeting all the transgender and nonbinary communities. Transgender rights advocates view bans on gender-affirming care as part of a broader attack on transgender rights. To have gender-inclusive health care means to have gender-affirming care as an option for transgender and nonbinary people.  

On January 3, 2023, the U.S. Food and Drug Administration (FDA) updated its risk evaluation and mitigation strategy (REMS) for reproductive health relating to “the abortion pill,” mifepristone. Mifepristone is a pill, used in combination with misoprostol, to terminate intrauterine pregnancies no later than 10 weeks past the individual’s last menstrual period. Additionally, it may be used for early-stage miscarriage management, and management of 2^nd and 3^rd trimester pregnancies where the fetus is no longer viable and has died before birth.

In 2011, the FDA implemented the Mifepristone REMS Program to place restrictions on the drug’s distribution and use. Specifically, it implemented an in-person dispensing requirement where the drug may only be dispensed in a clinic, medical office, or hospital through direct supervision of a certified clinician. This prohibited mifepristone from being sold in retail pharmacies or through the mail. The drug’s restrictions were criticized for creating barriers to patient access for medicated early-stage abortions and management of pregnancy loss. Additionally, those that opposed the restrictions claimed its implementation disproportionately harmed minority groups and communities that faced structural barriers to reproductive care. This accelerated throughout the COVID-19 pandemic, and advocacy efforts spearheaded by the American College of Obstetricians and Gynecologists pushed the FDA to reform the REMS program.

In 2021, the FDA completed a review of the REMS Program and set to modify the restrictions to help improve patient access and create efficiencies in health care delivery. Implementations of the Program’s modifications were halted until the FDA approved mifepristone’s updated prescription information by their manufacturer, resulting in the implementations officially going into effect on January 3, 2023. The FDA’s update removed the in-person dispensing requirement and a new pharmacy certification process was added that allows certain retail pharmacies to dispense mifepristone directly to patients who have a prescription. Additionally, given the impact of the Dobbs decision, this update will affect clinic practices based on the abortion laws and regulations of the state that the practices reside in.

Following the FDA’s updated policy, stores like Walgreen and CVS planned to offer mifepristone through their pharmacies in the states that legally allow abortions. However, on March 3, 2023, Walgreens publicly stated it would not be dispensing mifepristone in 20 states after being threatened by public officials. Headed by Missouri Attorney General Andrew Bailey with other attorney generals from Republican run states, a warning letter was issued to CVS and Walgreens on February 1, 2023. The letter alleged abortion pills sold through the mail would be federally illegal based on the Comstock Act, claiming the Act includes language that prohibits the mailing of articles designed to prevent conception or induce an abortion.

In early January of 2023, the Department of Justice (DOJ) noted that the Comstock Act does not prohibit abortion pills being mailed when those sending the pills lack intent that the drugs will be used for illegal purposes; however, Bailey argued against the DOJ and claimed the text of the Act is what governs, not “the Biden administration’s view.” Bailey further threatened CVS and Walgreens with civil litigation through either state attorneys or private citizens.

Walgreen’s announcement affects states where medication for abortions is legal, such as Alaska, Iowa, Kansas, and Montana. In a statement, Walgreens specified that once it was certified by the FDA to sell the abortion pill, the company will dispense the drug complaint to state and federal laws. The threat to selling mifepristone has opened a larger question about state authority in regulating FDA approved drugs and medicated abortion access. Since Walgreen’s announcement, activists have pushed to boycott Walgreens. Currently, there are 2 lawsuits arguing that states do not have the authority to regulate FDA approved drugs; one targeting a state’s restriction on abortion pills, and the other challenging West Virginia’s state abortion ban. If the court rules in favor of the plaintiffs in these cases there may be grounds to claim that FDA policy trumps state law on abortions, but more time is needed to determine the outcome of bans on the abortion pill through state and federal action.