“In fact, not only does the [Inflation Reduction Act] harm #healthcare - it funnels money toward the two entities that are currently the biggest problems in healthcare – Pharmacy Benefit Managers and insurers.”

Another amazing piece from @mass_marion
1/
“The proposal claims to give the government the ability to ‘negotiate’ drug prices in the Medicare space…That isn’t negotiation – that is price fixing. And, with the US already experiencing over 200 medication and solution shortages price fixing will only make things worse”
2/
“If politicians were actually paying attention to the market, they could see why [drug prices are high] - middlemen.

Instead, the current proposal actually finds a way to give these market leaches more money – and for that matter even more leverage over my patients.”
3/
“the bill proposes a permanent repeal of the Trump rebate (aka kickback) rule. And, while a rule created by Trump might be polarizing – the policy itself isn’t…The reason is simple; rebates are legalized kickbacks that PBMs collect from manufacturers.”
4/
“In 2020, David Balto published the estimate of kickbacks collected to be close to $200 billion per year.”

This bill will do far more harm than good

Vote no
@SenGillibrand @SenSchumer @Sen_JoeManchin @SenatorSinema
And read the article!
5/end

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More from @KGLiebowitz

Aug 5
NYS Senate bill S74A - Expansion of Medical Liability Awards - MUST be VETOED by @GovKathyHochul.
No, I'm not out to punish suffering families. The bill is poorly written
1. Language too vague regarding who is eligible to recover damages in wrongful death claims
1/
2. Not enough clarity regarding the types of losses and damages for which plaintiffs may receive compensation.
3. There are no payout caps, which have been adopted by many of the nearly 40 other states with these types of laws.
2/
As written, the bill will adversely affect the availability and affordability of medical professional liability insurance in New York. This will limit healthcare access.
As written, it will:
1. prompt an exodus of health care professionals from NY, and...
3/
Read 9 tweets
Aug 5
Re: the new Pediatrics study on TG kids.

I don't want my comments to get lost, because I think they're really important. Also, read the other threads

The scientific comm has been slipping away from the scientific method and data-driven conclusions, but this is NOT ok.

1/
(Here's the study)
Like I said in the QT, survey NOT designed to collect this info. Only 9 states were included in the analysis, and it could be argued that they were materially different from states that chose not to participate. Don't know, but...
2/

publications.aap.org/pediatrics/art…
it is a confounder.
2017 data: CO, DE, FL, HI, ME, MD, MA, MI, NV, NY, PA, RI, VT, VA, WI.
2019 data: CO, FL, HI, ME, MD, MA, MI, NV, NJ, NY, PA, RI, VT, VA, WI

Even if we overlook the state issue, it is well known that using a study to draw conclusions...
3/
Read 13 tweets
Aug 5
While I understand the sentiment, it is important to do a real risk-benefit assessment.
Most other vaccines have years and years of data
It isn’t worth it to get some of these diseases
Tetanus, for ex, is ubiquitous. It’s in the soil - not just on rusty nails…
1/
And the vaccine is pretty benign; I have only ever seen injection site swelling/pain from it. I can’t imagine not wanting to get the MMR; measles is very contagious and not a great thing to get. Polio-again, low risk, better to have than get the disease.
2/
I got the flu shot every year esp when working, reduces risk of getting sick from patients.
We gave the kids varicella though I had chickenpox; that fell into the what the hell category for me
Meningitis isn’t worth getting. Get the shot.
3/
Read 5 tweets
Jul 15
I am so unbelievably disappointed with the wreck of @CDCgov @US_FDA
Under @CDCDirector’s leadership, reliability of both have cratered (after years of decline)

The morons running @Twitter think they can engender respect for these agencies through censorship
Umm, no
1/
It’s really sad, because when I finished my MPH (epidemiology) there was no place I wanted to work after med school more than the CDC. Outbreak investigation! Research! Travel! And my words would really count!
You can tell I was idealistic
2/
I did a rotation there in med school working on a study about healthcare-associated infections
I could see the data was going to lead to changes. (And it did). So cool
And then…
And then….
Politics
I mean. These are political agencies. But still
3/
Read 8 tweets
Jul 13
This is horrifying.
1. People should NEVER wait this long. This is how people die in the waiting room
2. When you see this, the system. isn't. working.

IT'S NOT WORKING, OK?

3. WTH is a guy who broke his leg doing in the ER for follow up 6 mos after the fact?
1/
By definition, THAT ISN'T AN EMERGENCY
Which means (see #2): the system. isn't. working.

4. You can't staff medicine the way you staff a warehouse. Just-in-time delivery doesn't work in healthcare. Patients are not widgets and doctors/nurses/PAs/techs are not automatons
2/
If you can't get staff, ASK WHY
Consider:
stress
low job satisfaction
inflexibility of jobs
Pay
Mandates (vaccine/mask/holidays/cont ed)
Administration/regulations
EMR/documentation
Barriers to re-entry
Work/life balance
Failure to make jobs worthwhile
Insurance/billing
3/
Read 4 tweets
Apr 15
Some thoughts on prevalence and prevention....
I have a child with #celiacdisease. Global prevalence 1-2%
That means, even if undiagnosed, out of 1000 ppl, 10-20 of them will have #celiac
It's too many to be considered a "rare disease"
But not enough to be on everyone's radar
1/
There are a lot of kids with "something" but not a lot of kids with each "something." So if you add up all the kids w diabetes, celiac, cancer, cardiac disease you get to a bigger number
But each of these problems? Not huge
And - we can't really prevent most of these diseases.
2/
The burden of disease management falls on kids & their families
We don't serve #glutenfree food to everyone (except in my house!)
Or make sure foods have a low glycemic index
Or test to prevent spread of viruses that can wreak havoc on a compromised immune or cardiac system
3/
Read 7 tweets

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