What next?

As I finish putting together my end-of-year report, I can't help but reflect on how much I really wanted to do this year, but didn't accomplish. I had high hopes, but this was more challenging than I thought it would be. In this new year, pharmaceutical issues will still make headlines and are still a costly part of health care budgets. Here's what I've been tracking:

Bulk purchasing
S.18 Meeting Our Responsibility to Medicare Beneficiaries Act of 2005
Latest Major Action: 1/24/2005 Referred to Senate committee. Status: Read twice and referred to the Committee on Finance

H.R.5064 Title: To amend title XVIII of the Social Security Act to eliminate the MA Regional Plan Stabilization Fund and to extend health status adjustment.
Latest Major Action: 4/19/2006 Referred to House subcommittee. Status: Referred to the Subcommittee on Health, for a period to be subsequently determined by the Chairman

Post-marketing surveillance
S.3807
Title: A bill to amend the Public Health Service Act and the Federal Food, Drug, and Cosmetic Act to improve drug safety and oversight, and for other purposes.
Latest Major Action: 11/16/2006 Senate committee/subcommittee actions. Status: Committee on Health, Education, Labor, and Pensions. Hearings held

Open patents for essential medicines
S.4040 Public Research in the Public Interest Act of 2006
Title: A bill to ensure that innovations developed at federally-funded institutions are available in certain developing countries at the lowest possible cost.
Latest Major Action: 9/29/2006 Referred to Senate committee. Status: Read twice and referred to the Committee on the Judiciary

Of course there was National PharmFree Day activity as well. MedEd PharmFree Coordinator Justin and I hope to unveil a database of US academic medical centers' pharmaceutical policies soon, thanks to the help of an AMSA intern. Congrats to the newest member of the AMCs that have gone PharmFree, UC-Davis.

Here's hoping to continue AMSA's involvement in promoting and ensuring access to safe, effective drugs!

Random Acts of Unkindness: Reflections on American Policy and Culture

So I was all set to post a blog past Tuesday (12/12) when my life hit one of those unexpected detours that got me to thinking and compelled me to rewrite my thoughts, as well as changing what was on my mind. In my 30 years so far I’ve learned that when these curveballs come your way it’s best to take a moment, take a deep breath, and take the plunge into the rabbit hole appearing before you. Try not get mad—get even by making your new circumstance mean something. So my blog on the pharmaceutical industry will have to wait for another day, because today I have something else on my mind…

As some background and context let me start by introducing myself. I am a third year medical student at the University of Colorado in Denver. I also serve as a National leader in the American Medical Student Association as a Regional Programming Coordinator and member of the Health Policy Action Committee. During our third year at my medical school, we take a total of 7 “core” clerkships in different areas of medicine for 2 ½ to 10 weeks at a time. This past week was my last week of 5 in Family Medicine, where we are required to leave the Denver Metro area for a more rural medicinal experience.

On that fateful Tuesday a few days ago it was my last night in small-town Colorado before coming back to Denver for two days of exams and presentations to complete the clerkship. Now I’m ~11 weeks pregnant and starving most of the time, so I thought it would be a good treat to eat out that night, before going back to my host families home to pack my things up and dutifully post my pharma blog on this very site. It was ~5:30 and the sun was just going down when I pulled into the local strip mall and parked right across from the Applebee’s front door. Coming directly from the clinic, I had all of my medical garb as well as my textbooks and required paperwork for the clerkship. I always feel self-conscious going out in public with my medical stuff when I’m not actually working. I’m still more than a year away from actually being an MD (and closer to 10 years away from being done with my training) so it’s awkward when people approach you like you’re already a doc. Anyway, those are my excuses for putting my briefcase in the passenger floor and my white coat over it instead of taking them inside with me to dine.

As you might have already guessed, by the time I walked back out of the restaurant ~6:10, my driver’s side window had been smashed in and the briefcase and white coat with all their contents were gone, surely to never be seen again. First I was in shock and dealt with the situation calmly, calling the police, rattling off the list of valuables that were gone, picking the 10,000 bits of glass off my car seat and console so I could drive, and driving back to where I was staying without a window in the near freezing night air. Later, the despair and devastation of the reality of the situation set in and I had a good cry. My PDA, which organizes my whole life and cost almost $1000… gone. All my textbooks and materials to study for my final exam (in less than 2 days)… gone. All my assignments due for the end of the clerkship… gone. My final PowerPoint presentation for the clerkship and this blog article, as well as all the other info on my flash drive… gone. My white coat that had been a gift from a doctor who’s a good friend, and was the coat she wore as a medical student… gone. My stethoscope, a gift from the Alumni Association when I matriculated into medical school, and all of my other medical equipment and invaluable notes in the pockets of my white coat… gone.

Yes, in some ways I was “lucky”. I did have my wallet, house keys, and cell phone in the pocket of my jacket I wore in to the restaurant. I wasn’t hurt, and at least the car itself was still there and intact so I could drive home the next day (again with no window and chilly temp). But the most disturbing part of the whole experience, which grabbed me and just wouldn’t let go, was the heartlessness it took to ruin someone’s life in an instant in exchange for a lousy PDA. The rest of the stuff they took was utterly devoid of worth to anyone else on this planet, unless of course the thieves were healthcare professionals really pleased with scoring a new reflex hammer and Maxwell’s notebook, and most likely ended up in a dumpster somewhere.

Now it used to irritate me when I heard older generations spout off with statements that began with “back in my day” and “kids these days”, but as I’m getting older I have to say that I have noticed trends in people’s behaviors, the qualities exhibited in how they lead their lives, and the crimes they choose to commit. Unless of course I just notice it more now than I used to. Either way, I think the time has come where thoughtful Americans need to critically look at the culture we’ve created and policy that shapes it, before trying to spread that culture and policy across the globe…

Maybe it’s just because I’m sort of a Health Policy geek, but I can’t help but think that our policy defines the ethical boundaries of our culture which determines the behavior of the people. What, for example, does it say to children that the adults so far in the history of this nation have not made it a priority to provide basic healthcare to all of its people? What kind of message is it to them that some people are not worthy of basic human rights? I think it makes them understand our world from the viewpoint that there is a tier system in place to define who deserves what kind of opportunity and life. Ironically, that framework of a class system and a pre-determined fate is exactly what America supposedly is not, being “the land of opportunity”. I also think that most middle class and above Americans can easily make themselves unaware that this tiered level of opportunity in our country does actually exist. Being multi-generational white trash myself, and one of few from my social standing growing up to break the mold and not only go to college but go on to be a doctor, I vow to remember the perspective life gave me growing up, poor and uninsured, and all of the obstacles that existed in my path.

The overarching policy that shapes our economy tends to breed a self-centered viewpoint and competitiveness with your fellow citizen, so my argument is that our social policy needs to balance that viewpoint with those of humanity and sharing. That way it really can be the America we all want it to be, with a culture that not only embraces innovation, hard work, and determination to succeed, but also truly be the land of opportunity where basic human rights are just that, and not something to be earned. To truly be a land where each child does, in fact, have the real possibility to attain all their goals and ambitions.

I didn’t write this today to get sympathy for my own personal circumstance, but to point out that these random acts of unkindness that happen to millions of people in this country every day speaks volumes about the culture we live in. There is a level of selective sociopathic behavior that is tolerated and even encouraged. From corporate scandal, to politics, to violence, we hear countless stories of how the people of this society get away with as much as they can for as long as they can to personally get ahead. We must make the decisions in health policy, and national policy in general, to shape the country and culture we wish to have. I am compelled to keep fighting the good fight, not only because it is the right thing to do, but for (and selfishly so) the future of my first child on the way…

Dani Haakinson, MS3
University of Colorado SOM
Region X RPC, AMSA

World AIDS Day: Keeping Our Promise

Today is World AIDS Day, and the Guttmacher Institute has released the statement below. It is sobering, and, frankly, unconscionable, that some 25 years after the discovery of HIV (the virus that causes AIDS) we are unable to spread prevention information more quickly than this devastating virus has spread across developed and developing nation alike. AIDS is poised to become the third leading cause of death around the world - and you can help to stop it. We need better policies and more attention on the programs that work to prevent the spread of HIV.

Visit the World AIDS Day website and AMSA's Global Health AIDS Advocacy Network or World AIDS day sites to take action. Even if you aren't involved in a program or event today, it's never too late to stage one. AIDS will still be here, waiting for us to stop it.

Message from Sharon L. Camp, Ph.D.
President and CEO of the Guttmacher Institute

Keeping Our Promise to the World’s Youth

The theme of this year’s World AIDS Day on December 1 is accountability: Stop AIDS, Keep the Promise.

When it was first discovered in 1981, the virus that causes AIDS threatened to wreak havoc on the lives of millions worldwide, and today—with 40 million living with the virus and four million new infections this year—the virus has kept its dire promise.

On the other hand, the global community has fallen short of its promise to provide adequate funding for prevention, treatment and care. Our failure holds grave consequences for the world’s youth. We promised to take care of our future generations, but do today’s adolescents—tomorrow’s adults—have the knowledge, skills and resources to have healthy relationships and protect themselves against diseases such as HIV/AIDS?

Not quite.

Recent studies by the Guttmacher Institute and colleagues provide a good yardstick by which to measure our progress in the fight against HIV/AIDS in Sub-Saharan Africa, where the virus has hit the hardest. The findings are clear and troubling: Adolescents in Ghana, Uganda, Burkina Faso and Malawi are not getting the information they need to protect themselves from HIV.

• Awareness of AIDS is widespread, but knowledge of how to prevent HIV is not: Fewer than one in three adolescents in these four countries can both correctly identify ways of preventing HIV and reject major misconceptions about HIV.

• Fewer than three in 10 adolescents use any kind of contraceptive the first time they have sex. Most say they didn’t use a condom because they “felt safe” or didn’t have one.

• One of the best ways to reach young people before they become sexually active—school-based sex education—remains underutilized: Fewer than half of young women and fewer than 40% of young men ever attended sex education classes.

But the main message from our research is not pessimism, but hope. Young people are working hard to achieve their dreams. More than seven in 10 adolescents in Ghana, Uganda and Malawi expect to complete their education, and many young people aspire to good jobs that will allow them to support themselves and their families. Witness this exchange with one Ghanaian adolescent:

I: Now tell me what you will like your life to be like in the next five years.
R: I want to be at a teacher training college.
I: What could make this more or less likely to happen?
R: If I learn hard I can reach where I want to go.
I: But what do you think will not allow you to get to the training college by five years time?
R: If I become pregnant or infected with HIV/AIDS.

This World AIDS Day, young people from around the world are speaking up to draw attention to the need for well-funded, focused and sustained prevention efforts. We owe it to the next generation to support their dreams by promoting sound programs and policies and by opening our pocketbooks to invest in their futures and rid the world of this scourge.

According to a new report, AIDS is now promising to become the third leading cause of death worldwide. AIDS has a pretty good track record for keeping its promises. Will we?

Learn more about HIV and young people

If it ain't broke, don't fix it?

One of the pharm policy issues I've been trying to follow closely is the attempt to amend Medicare Part D to allow the US government to negotiate drug prices. When this legislation was being debated in Congress, this was a point under much contention. Our government funds a lot of the research it takes to develop drugs, why shouldn't it be able to tell the drug companies what they would pay? The US Department of Veterans Affairs does it, saving veterans and taxpayers money. The legislation was passed without granting the government to do this for seniors. In the past, AMSA supported S. 18 "Meeting Our Responsibility to Medicare Beneficiaries Act of 2005," but that's been stuck in committee since Jan. 2005.

Earlier this week, a Washington Post article noted that the success of the drug benefit may make it harder for the Democrats, soon to dominate Congress, to alter the legislation. Apparently, recent polls show that about 80% of Medicare Part D beneficiaries are satisfied with their plans, and that the cost of the program has been lower than expected. Will the Democrats be able to make changes? There does not appear to be a clear strategy yet just ideas about developing a government-run plan that negotiates drug prices and competes directly with private drug plans or price ceiling. This will be something interesting to watch as the Democrats take control.

May
Pharmaceutical Policy Coordinator

Med Student Wonks

Med Student Wonks
The shifting winds of power...

As health care activists, we have taken to a bipartisan approach to progressive health policy because of the Republican trifecta of the House, Senate, and White House. In many ways, the HPAC activists have been frustrated by the lack of real reform, but motivated and inspired by the ideas of making change immediately wherever it's possible. As the Congress swings to the left, we must wonder the real fate of bipartisan collaboration. The Republican leadership has made it clear with the nomination of John Bolton and Eric Keroack made it clear that for the remaining months of their term, bipartisanship is not the primary goal. Will the collaboration alluded to by new Speaker of the House Nancy Pelosi materialize? Will the White House sign bills in good faith or will veto power mark most of the bills that advance our nation's health for the next two years?

Where should our policy go from here? Is it time to take up the progressive policies we have at best tried to implement only incrementally? Will the will for reform in our health care system finally prevail or are we still waiting for the system to crash and burn before we are motivated to act?

I hope that the bipartisanship given so much lip service in so little time materializes in gains to the US public health and that we continue to engage in dialogue and a spirit of comraderie in the next two years.

Here's hoping,
Julia Skapik
Malpractice and Health Quality Coordinator

The Commission on the Future of Higher Ed - Taking Us ALL to the Cleaners

The federal Secretary of Education's "Commission on the Future of Higher Education" published a draft report on August 3rd that proposes a 50-75% CUT in federal student aid and offers to generously send the vast majority of students seeking aid into the private market to obtain loans for education. Their final report is due Thursday (that's tomorrow) and while they're ostensibly inviting public comment, they're doing so through a "public comment line." With only a day left, it's critical that we act now, both through the public comment line and through more direct avenues. To skip my rant and go straight to what to do, head to the bottom of this post.

This recommendation is particularly ironic in the face of numerous other facts they point out in their report: the FAFSA is too hard (have they tried navigating the private loan marketplace lately?), racial and ethnic minorities and poor families increasingly report financial barriers as their resons for not attending college of some sort, and the number of students completing college is going down. So, let me get this straight - the answer is to make it MORE difficult and MORE confusing to get aid for school?

Even worse, the Public Interest Research Group a non-profit coalition of state-based groups researching policy in the public interest, estimates that this proposal will cost students $32 billion dollars more in interest payments, and that $168 billion dollars in loans will be dumped on to the private loan market in the first five years.

So why do a bunch of med students care? Not only do we take out some the largest dollar amounts of any group on federal loans, and come into school with loans from undergraduate, but we already have a problem with diversity in the physician workforce. The Sullivan Commission reports that while racial and ethnic minorities make up 26% of the US population, only 6% of physicians are Latino, African American, or Native American. Cutting medical students out of the federal loan business will only serve to decrease the diversity of physicians in the workforce, which does both our patients and our profession a disservice. The report from the Commission on Higher Ed claims to be interested in diversity - seems to me they're more interested in a big kickback to the private loan industry.

A report from the American Association of Medical Colleges (AAMC) indicates that the average debt for medical students has increased exponentially from 22,000-27,000 in 1984 to $100,000-$135,000 in 2004. And that's just from medical school. Five percent of medical students have debt over $200,000. When you're staring that big gun in the face and you don't have a lot of financial prospects -- outside of working two part-time jobs while trying to finish college -- for supporting you through four years of college, the MCAT costs, and the interviewing costs, most people just say, "No, thanks." And increasingly, those people saying, "no, thanks" are disadvantaged minority students who have much to contribute to the culture of medicine.

Making higher education an "accessible opportunity for all" doesn't mean dumping us all out onto the private market to fend for ourselves -- the federal government system is in place to protect students (who often don't know a lot about lending) from predatory lenders and ridiculously high prices in the market -- it means making real strides towards real change that actually will widen the pipeline in the medical field and others for disadvantaged and minority students across the country.

We're calling on all of you to contact the Commission on Higher Education and tell them you don't think private loans are the way to go for students who need financial aid. The American Medical Student Association has written some suggested text, which can be use to email or call the public comment line, but can also be used at the PIRGs' Student Debt Alert Page to email the Chairman of the Commission. Email the Commission Contacts directly as well:

• Cheryl Oldham
  Executive Director
  Cheryl.Oldham@ed.gov
• Vickie Schray
  Deputy Director for Management and Planning
  Vickie.Schray@ed.gov
• Eleanor Schiff
  Deputy Director for Research and External Affairs
  Eleanor.Schiff@ed.gov
• Kristen Vetri
  Chief of Staff
  Kristen.Vetri@ed.gov

Adding your own comments or changing the text makes this a much more powerful message!!

Here is the contact information: HigherEdCommission@ed.gov (202) 205-8741
Dear Secretary of Education’s Commission on the Future of Higher Education:
As a medical student, I am very aware of the huge burden of debt that higher education students acquire over their years of study. I am therefore writing to urge you to change the provision in the latest draft report of the Commission that encourages students to take out private loans as opposed to federal student loans. Private loans increase the burden that students face due to their higher cost and lack of borrower protections. The change that the Commission recommends would cost borrowers at least $32 billion in additional interest payments based on the current private loan interest rates.

We agree with and strongly support your mission to assure equal access to educational opportunities; however, we feel that by recommending students to take out private loans, you are effectively hindering progress towards your stated mission. The diversity in medicine and in other workforce fields will only be negatively impacted by this change.

Please consider withdrawing the recommendation when you meet Thursday, August 10^th, 2006. We believe your focus should remain on increasing grant aid and making loan repayment more manageable. We hope that you would advocate for policies that encourage affordable higher education.

Thank you very much for your time.
Sincerely,

The Commission report is due out tomorrow and they NEED to hear from us!

Policy InAction

So why would medical students - who have just about zero time on their hands - really want to get involved in policy anyway? Let's put it this way: Medicine doesn't happen in a vacuum, and people don't get or stay well because we health professional types wave our hands, drugs, and exercise regimens around them. The truth of the matter is, we realize that larger forces play a role in our patients' well-being, and we need to participate in the process at all levels in order to alter those forces. In other words, policy (legislation, rules, regulations, processes, etc) matters to peoples' health, and we need to help ensure that the best policies for people's health get enacted just the way we would want to make sure the best possible drug regimen gets prescribed for a certain condition.

Personally, I got involved in health policy because I came to see the medical field as one giant revolving door. Patients come in to the clinic, the hospital, the ER, with an "owie" they got out there in the world - diabetes, heart disease, drug addiction - and we put a band-aid on it and send them back out into the same world that hurt them in the first place. And for some reason we're suprised when they come back the worse for wear the next time. If the band-aids aren't working, maybe we need to figure out what's causing all the cuts and scrapes. There's a lot of research these days to suggest that the society we Americans enjoy and the lives we live (often of necessity) might not be so good for our health. And I'm not just talking about Big Macs.

Med students, doctors, and other allied health professionals all have a vested interest in policy because it affects their patients' health. We have all made a pledge to protect patients' health, and that means looking at the way we do things and trying to figure out how it might be hurting or helping our patients. For too long, health professionals have left the policy to the politicians, staying out of the fray. It is time we took a hard look in the mirror and asked ourselves if staying out of the arena is really what we want for ourselves or our patients.

The American Medical Student Association (AMSA) - the country's largest medical student association, and the only completely student-run association - has answered boldly in the negative. We plan to jump into the politics, using our strength to help create and advance policies that protect patients' health in areas from environmental health to health disparities to health care delivery. We're here blogging because we want others to know what we care about, what we stand for, and why it is we feel compelled to fight this fight. And maybe, just maybe, get a few of you out there to stand with us.