Category: Medicine
Health insurance companies are not the main villain
First of all, insurance companies just don’t make that much profit. UnitedHealth Group, the company of which Brian Thompson’s UnitedHealthcare is a subsidiary, is the most valuable private health insurer in the country in terms of market capitalization, and the one with the largest market share. Its net profit margin is just 6.11%…
That’s only about half of the average profit margin of companies in the S&P 500. And other big insurers are even less profitable. Elevance Health, the second-biggest, has a margin of between 2% and 4%. Centene’s margin is usually around 1% to 2%. Cigna Group’s margin is usually around 2% to 3%. And so on. These companies are just making very little profit at all.
And:
In other words, Americans’ much-hated private health insurers are paying a higher percent of the cost of Americans’ health care than the government insurance systems of Sweden and Denmark and the UK are paying. The only reason Americans’ bills are higher is that U.S. health care provision costs so much more in the first place.
And:
In fact, the Kaiser Family Foundation does detailed comparisons between U.S. health care spending and spending in other developed countries. And it has concluded that most of this excess spending comes from providers — from hospitals, pharma companies, doctors, nurses, tech suppliers, and so on…
Recommended, here is the full post.
You Have Been Warned
New paper in Science, A single mutation in bovine influenza H5N1 hemagglutinin switches specificity to human receptors. If that isn’t clear enough, here is the editor’s summary:
In 2021, a highly pathogenic influenza H5N1 clade 2.3.4.4b virus was detected in North America that is capable of infecting a diversity of avian species, marine mammals, and humans. In 2024, clade 2.3.4.4b virus spread widely in dairy cattle in the US, causing a few mild human cases, but retaining specificity for avian receptors. Historically, this virus has caused up to 30% fatality in humans, so Lin et al. performed a genetic and structural analysis of the mutations necessary to fully switch host receptor recognition. A single glutamic acid to leucine mutation at residue 226 of the virus hemagglutinin was sufficient to enact the change from avian to human specificity. In nature, the occurrence of this single mutation could be an indicator of human pandemic risk. —Caroline Ash
Time to stock up on Tamiflu and Xofluza.
Addendum: See also A Bird Flu Pandemic Would Be One of the Most Foreseeable Catastrophes in History
A Bird Flu Pandemic Would Be One of the Most Foreseeable Catastrophes in History
Zeynep Tufekci writing in the NYTimes hits the nail on the head:
The H5N1 avian flu, having mutated its way across species, is raging out of control among the nation’s cattle, infecting roughly a third of the dairy herds in California alone. Farmworkers have so far avoided tragedy, as the virus has not yet acquired the genetic tools to spread among humans. But seasonal flu will vastly increase the chances of that outcome. As the colder weather drives us all indoors to our poorly ventilated houses and workplaces, we will be undertaking an extraordinary gamble that the nation is in no way prepared for.
All that would be more than bad enough, but we face these threats gravely hobbled by the Biden administration’s failure — one might even say refusal — to respond adequately to this disease or to prepare us for viral outbreaks that may follow.
…Devastating influenza pandemics arise throughout the ages because the virus is always looking for a way in, shape shifting to jump among species in ever novel forms. Flu viruses have a special trick: If two different types infect the same host — a farmworker with regular flu who also gets H5N1 from a cow — they can swap whole segments of their RNA, potentially creating an entirely new and deadly virus that has the ability to spread among humans. It’s likely that the 1918 influenza pandemic, for example, started as a flu virus of avian origin that passed through a pig in eastern Kansas. From there it likely infected its first human victim before circling the globe on a deadly journey that killed more people than World War I.
And that’s why it’s such a tragedy that the Biden administration didn’t — or couldn’t — do everything necessary to snuff out the U.S. dairy cattle infection when the outbreak was smaller and easier to address.
Will there be a large outbreak among humans? Probably not. But a 9% probabability of a bad event warrants more than a shrug. Bad doesn’t have to be on the scale of COVID-bad to warrant precaution. The 2009 H1N1 flu pandemic, while relatively mild, infected about 61 million people in the U.S., leading to 274,000 hospitalizations, 12,400 deaths, and billions of dollars in economic costs.
H5N1 will likely pass us over—but only the weak rely on luck. Strong civilizations don’t pray for mercy from microbes; they crush them. Each new outbreak should leave us not relieved, but better armed, better trained and better prepared for nature’s next assault.
*Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health*
That is the new book by Marty Makary. Since Makary has been nominated to head the FDA, I am surprised this work is not receiving more attention.
In the book, Makary is sympathetic to HRT, skeptical about a lot of antibiotic use (microbiome issues), says it is fine to ingest the cholesterol in eggs, and he is critical of earlier attempts to separate mothers and their babies. He believes silicone breast implants got a bum rap, and thinks we have screwed up the treatment of peanut allergies. A common theme is that there is too much groupthink in modern medicine and medical research. He wonders if we should be suspicious of fluoride, in part because of microbiome issues. He briefly worries about the ingestion of microplastics. I would not say I have concrete views on these questions, but overall I came away from this book comfortable with him running the FDA, at least relative to past candidates. I am skeptical of his views on fluoride, however, as the recent flurry of debate seems to have settled on a “fluoride is a net benefit” side. I also worry a bit he is picking on some easy cases (e.g., separating mothers from their babies), and not going hard enough on the incentive problems in U.S. health care and its research communities.
Makary is not obviously an accelerationist. Most of all, he likes to avoid groupthink and give matters a further look. While such a view is hard to disagree with, it makes me nervous in a bureaucratic context. In reality, “groupthink” is how many things get approved as quickly as they do. Just how many public health debates are we supposed to be reopening here? Should that be the priority of the FDA? Or should speeding up clinical trials and lowering their cost be the emphasis?
When he thinks about FDA matters, is he willing to have questions of incentives arise first in his thoughts? If so, that would be a break from his writing career so far.
I also would be curious to know why he thinks “his sides of these debates” will, on the whole, avoid groupthink more than the status quo has done. Lemon-picking from the status quo, even if we agree with him on every point, does not clarify this all-important question. Groupthink stems from incentives, and what kind of better incentives will he build into the U.S. health care system? He does write about “common sense,” and making things “physician-centered,” both fine and well, but I don’t see either of those as answering my questions in a scalable manner.
Makary wanted to approve and accelerate the Johnson and Johnson vaccine, a good sign in my view. Still, on some issues he will, for my tastes, be insufficiently consequentialist (“go ahead and let them try!”) and too worried about “getting the science right” and “sampling more data.”
Marty has strong academic and research credentials, here is his Wikipedia page. Here is more on what he has done, all positives in my view:
Makary is a director on the board at Harrow, an ophthalmic pharmaceuticals company, and an adviser to Sidecar Health, an insurance provider that aims to lower customer costs by eliminating provider networks and drug formularies.
He’s also chief medical adviser to Nava, a benefits brokerage, and chief medical officer at Sesame, a cash-pay health service market that offers compounded semaglutide, Stat reported over the weekend, raising questions about how Makary will approach the GLP-1 shortage brouhaha should he be confirmed.
Sesame’s founder, David Goldhill, wrote a well-known piece in The Atlantic about his father’s death from a hospital-acquired infection that references a surgery checklist Makary helped develop to reduce errors and adverse events.
During the pandemic he called for universal masking and opposed vaccine mandates. He supported national lockdowns and called for “first doses first.” He also raised doubts about children needing two doses of the Covid vaccine. Rather than relitigate whether those are all the correct views or not, I will simply note he is not a deregulator per se. He donated to Obama in 2008.
Here is a recent Russ Roberts podcast with Makary.
Overall, I see only upsides from this pick. Nonetheless I also see a good chance he focuses on reform directions where I think the expected benefits are small. So I am not excited by this pick, at least not yet.
Jay Bhattacharya at the NIH
Trump has announced the appointment, so it is worth thinking through a few matters. While much of the chatter is about the Great Barrington Declaration, I would note that Bhattacharya has a history of focusing on the costs of obesity. So perhaps we can expect more research funding for better weight loss drugs, in addition to other relevant public health measures.
Bhattacharya also has researched the NIH itself (with Packalen), and here is one bit from that paper: “NIH’s propensity to fund projects that build on the most recent advances has declined over the last several decades. Thus, in this regard NIH funding has become more conservative despite initiatives to increase funding for innovative projects.”
I would expect it is a priority of his to switch more NIH funding into riskier bets, and that is all to the good. More broadly, his appointment can be seen as a slap in the face of the Fauci smug, satisfied, “do what I tell you” approach. That will delight many, myself included, but still the question remains of how to turn that into concrete advances in public health policy. Putting aside the possibility of another major pandemic coming around, that is not so easy to do.
My main worry is simply that NIH staff will not trust their new director. The problem is not so much GBD, which can be compartmentalized as a “political” stance, but rather the earlier claims that many more people had Covid early than we had thought, and that expected fatalities were going to be quite low, with a maximum of 40,000. We all make mistakes, the question is how those mistakes get processed. If you interrogate Perplexity it will report “Bhattacharya has not publicly acknowledged or confessed to these mistakes in his early predictions.” You don’t have to agree with Perplexity (though contrary cites are welcome!), rather it suffices to say that reflects a common perception of the scientific community. He also seemed to be pushing those low fatality estimates for longer than might have been considered appropriate. And that is indeed a problem for his tenure at the NIH.
The danger is simply that NIH staff will double down on risk aversion, and they may not so readily support any attempt to make the grants themselves riskier, or rooted in the greater discretion of program directors, a’la DARPA and the like. They will fear that their director will not sufficiently follow the evidence, or admit when mistakes are being made and reverse course. Even if you fully agree with GBD and the like, I hope you are able to see this as a relevant problem. Every institutional revolution requires supportive troops on the inside, even if they are only a minority.
I very much hope this works out well, but in the meantime that is my reservation.
Alcohol estimates
The number of deaths caused by alcohol-related diseases more than doubled among Americans between 1999 and 2020, according to new research. Alcohol was involved in nearly 50,000 deaths among adults ages 25 to 85 in 2020, up from just under 20,000 in 1999.
The increases were in all age groups. The biggest spike was observed among adults ages 25 to 34, whose fatality rate increased nearly fourfold between 1999 and 2020.
Women are still far less likely than men to die of an illness caused by alcohol, but they also experienced a steep surge, with rates rising 2.5-fold over 20 years.
The new study, published in The American Journal of Medicine, drew on data from the Centers for Disease Control and Prevention.
*Gray Matters*
The author is Theodore M. Schwartz and the subtitle of this excellent book is A Biography of Brain Surgery. Excerpt:
Whil there is no proven ideal age for a brain surgeon, let’s just say that during the first five years after residency, we are still getting our sea legs. Over time, as with any learned skill, a subtle transition occurs. Suddenly, surgeries seem to take less effort. Movements become second nature as wel enter what psychologist Mihaly Csikszentmihalyi called a “flow state,” where pursuit of a single goal creates a transcendental state of purposeful concentration the task.
…One well-known neurosurgeon was once asked how he became so good at his craft. His answer? “there’s a graveyard full of my mistakes behind the hospital.”
Definitely recommended, the book also offers considerable detailed information about how brain surgery is done, which maladies lie behind brain surgery, and much more.
Human Challenge Trials Aren’t Riskier than RCTs
Nature: Keller Scholl got out of quarantine 13 days ago, and he’s still not feeling 100%. The itchiness — far and away the worst symptom, he says — is mostly gone, and now the graduate student just feels exhausted. “I’m trying to get enough sleep,” he says.
Scholl’s symptoms might be uncomfortable, but they are also of his own making. That’s because he signed up to be a volunteer in the first human ‘challenge trial’ involving Zika virus, a mosquito-borne pathogen that can cause fever, pain and, in some cases, a brain-development problem in infants. In standard infectious-disease trials, researchers test drugs or vaccines on people who already have, or might catch, a disease. But in challenge trials, healthy people agree to become infected with a pathogen so that scientists can gather preliminary data on possible drugs and vaccines before bigger trials take place. “Accelerating a Zika vaccine by a month, a few days, that does a lot of good in the world,” says Scholl, who studies at Pardee RAND Graduate School in Santa Monica, California.
Keller spent time here at GMU working with Robin Hanson and hanging out with the lunch gang. Way to go Keller! Thank you!
The rest of the article uncritically repeats the usual claims from so-called “bioethicists” that human challenge trials (HCTs) are unethical because they involve risks. Of course, HCTs carry risks—so what? Randomized controlled trials (RCTs) also require that participants are exposed to risk. Indeed, for participants in the placebo arm of an RCT, the risks are identical. Furthermore, since RCTs require more participants to achieve statistical validity than HCTs, they must expose more people to harm and, as a result, it’s even possible that more participants are harmed in an RCT than an HCT. Thus, HCTs are not necessarily more risky to participants than RCTs and, of course, to the extent that they speed up results, they can save many lives and greatly reduce risk to everyone else in the the larger society.
In my talk, The Economic Way of Thinking in a Pandemic (starting around 10:52, though the entire presentation is worthwhile), I explain the real reason why bioethicists and physicians hesitate over human challenge trials: they fear feeling personally responsible if a participant is harmed. “We exposed this person to risk, and they died.” Well, yes. But my response is, it’s not about you! Set aside personal emotions and focus on what saves the most lives.
Hat tip: Alexander Berger who pointed to this story that I had missed earlier.
The economic powers of the HHS secretary
That is the topic of my latest Bloomberg column, here is one excerpt:
One of the problems with an RFK Jr. ascendancy is that his core views, which run strongly against vaccines and pharmaceuticals, make it unlikely that any of these reimbursement revisions will be done in a rational or scientific way. The best evidence indicates that pharmaceuticals are a relatively cost-effective ways of saving lives, and conversely that many costly surgical procedures are not very effective. One of the main drawbacks of the US health-care system is often described as overtreatment, yet some vaccines and drugs — the Covid vaccines, GLP-1 medications and HIV-AIDS treatments, to name just a few — are yielding very high returns.
The danger is that, with RFK Jr. at HHS, the US would restrain health-care spending in exactly the wrong areas. The human costs of such a mistake are obvious, but from a more narrow fiscal perspective, a sicker America would lead to even more serious budgetary problems.
In any case, for all the recent talk and speculation about DOGE, the HHS secretary could well have more of an impact on the federal budget, for better or worse.
HHS also oversees liability protection for vaccines…
Worth a very serious ponder.
Will Trump Appoint a Great FDA Commissioner?
A German newspaper asked for my take on the nomination of RFK Jr. to head HHS. Here’s what I said:
Operation Warp Speed stands as the crowning achievement of the first Trump administration, exemplifying the impact of a bold public-private partnership. OWS accelerated vaccine development, production, and distribution beyond what most experts thought possible, saving hundreds of thousands of American lives and demonstrating the power of American ingenuity in a time of crisis.
By nominating Robert F. Kennedy Jr., a prominent anti-vaccine activist, President Trump undermines his own legacy, and casts doubt on his administration’s commitment to protecting American lives through science-driven health policy.
Many better choices are available. Here is my 2017 post on potential people to head the FDA, many of which would also be great at HHS. No indent. Key points remain true.
As someone who has written about FDA reform for many years it’s gratifying that all of the people whose names have been floated for FDA Commissioner would be excellent, including Balaji Srinivasan, Jim O’Neill, Joseph Gulfo, and Scott Gottlieb. Each of these candidates understands two important facts about the FDA. First, that there is fundamental tradeoff–longer and larger clinical trials mean that the drugs that are approved are safer but at the price of increased drug lag and drug loss. Unsafe drugs create concrete deaths and palpable fear but drug lag and drug loss fill invisible graveyards. We need an FDA commissioner who sees the invisible graveyard.
Each of the leading candidates also understands that we are entering a new world of personalized medicine that will require changes in how the FDA approves medical devices and drugs. Today almost everyone carries in their pocket the processing power of a 1990s supercomputer. Smartphones equipped with sensors can monitor blood pressure, perform ECGs and even analyze DNA. Other devices being developed or available include contact lens that can track glucose levels and eye pressure, devices for monitoring and analyzing gait in real time and head bands that monitor and even adjust your brain waves.
The FDA has an inconsistent even schizophrenic attitude towards these new devices—some have been approved and yet at the same time the FDA has banned 23andMe and other direct-to-consumer genetic testing companies from offering some DNA tests because of “the risk that a test result may be used by a patient to self-manage”. To be sure, the FDA and other agencies have a role in ensuring that a device or test does what it says it does (the Theranos debacle shows the utility of that oversight). But the FDA should not be limiting the information that patients may discover about their own bodies or the advice that may be given based on that information. Interference of this kind violates the first amendment and the long-standing doctrine that the FDA does not control the practice of medicine.
Srinivisan is a computer scientist and electrical engineer who has also published in the New England Journal of Medicine, Nature Biotechnology, and Nature Reviews Genetics. He’s a co-founder of Counsyl, a genetic testing firm that now tests ~4% of all US births, so he understands the importance of the new world of personalized medicine.
The world of personalized medicine also impacts how new drugs and devices should be evaluated. The more we look at people and diseases the more we learn that both are radically heterogeneous. In the past, patients have been classified and drugs prescribed according to a handful of phenomenological characteristics such as age and gender and occasionally race or ethnic background. Today, however, genetic testing and on-the-fly examination of RNA transcripts, proteins, antibodies and metabolites can provide a more precise guide to the effect of pharmaceuticals in a particular person at a particular time.
Greater targeting is beneficial but as Peter Huber has emphasized it means that drug development becomes much less a question of does this drug work for the average patient and much more about, can we identify in this large group of people the subset who will benefit from the drug? If we stick to standard methods that means even larger and more expensive clinical trials and more drug lag and drug delay. Instead, personalized medicine suggests that we allow for more liberal approval decisions and improve our techniques for monitoring individual patients so that physicians can adjust prescribing in response to the body’s reaction. Give physicians a larger armory and let them decide which weapon is best for the task.
I also agree with Joseph Gulfo (writing with Briggeman and Roberts) that in an effort to be scientific the FDA has sometimes fallen victim to the fatal conceit. In particular, the ultimate goal of medical knowledge is increased life expectancy (and reducing morbidity) but that doesn’t mean that every drug should be evaluated on this basis. If a drug or device is safe and it shows activity against the disease as measured by symptoms, surrogate endpoints, biomarkers and so forth then it ought to be approved. It often happens, for example, that no single drug is a silver bullet but that combination therapies work well. But you don’t really discover combination therapies in FDA approved clinical trials–this requires the discovery process of medical practice. This is why Vincent DeVita, former director of the National Cancer Institute, writes in his excellent book, The Death of Cancer:
When you combine multidrug resistance and the Norton-Simon effect , the deck is stacked against any new drug. If the crude end point we look for is survival, it is not surprising that many new drugs seem ineffective. We need new ways to test new drugs in cancer patients, ways that allow testing at earlier stages of disease….
DeVita is correct. One of the reasons we see lots of trials for end-stage cancer, for example, is that you don’t have to wait long to count the dead. But no drug has ever been approved to prevent lung cancer (and only six have ever been approved to prevent any cancer) because the costs of running a clinical trial for long enough to count the dead are just too high to justify the expense. Preventing cancer would be better than trying to deal with it when it’s ravaging a body but we won’t get prevention trials without changing our standards of evaluation.
Jim O’Neill, managing director at Mithril Capital Management and a former HHS official, is an interesting candidate precisely because he also has an interest in regenerative medicine. With a greater understanding of how the body works we should be able to improve health and avoid disease rather than just treating disease but this will require new ways of thinking about drugs and evaluating them. A new and non-traditional head of the FDA could be just the thing to bring about the necessary change in mindset.
In addition, to these big ticket items there’s also a lot of simple changes that could be made at the FDA. Scott Alexander at Slate Star Codex has a superb post discussing reciprocity with Europe and Canada so we can get (at the very least) decent sunscreen and medicine for traveler’s diarrhea. Also, allowing any major pharmaceutical firm to produce any generic drug without going through a expensive approval process would be a relatively simply change that would shut down people like Martin Shkreli who exploit the regulatory morass for private gain.
The head of the FDA has tremendous power, literally the power of life and death. It’s exciting that we may get a new head of the FDA who understands both the peril and the promise of the position.
China’s Libertarian Medical City
You’ve likely heard of Prospera, the private city in Honduras established under the ZEDE (Zone for Employment and Economic Development) law, which has drawn global investment for medical innovation. The current Honduran government is trying to break its contracts and evict Prospera from 
Honduras. The libertarian concept of an autonomous medical hub, free to attract top talent, pharmaceuticals, medical devices, ideas, and technology from around the world is, however, gaining traction elsewhere—most notably and perhaps surprisngly in the Boao Hope Lecheng Medical Tourism Pilot Zone in Hainan, China.
Boao Hope City is a special medical zone supported by the local and national governments. Treatments in Boao Hope City do not have to be approved by the Chinese medical authorities as Boao Hope City is following the peer approval model I have long argued for:
Daxue: Medical institutions within the zone can import and use pharmaceuticals and medical devices already available in other countries as clinically urgent items before obtaining approval in China. This allows domestic patients to access innovative treatments without the need to travel abroad…. The medical products to be used in the pilot zone must possess a CE mark, an FDA license, or PMDA approval, which respectively indicate that they have been approved in the European Union, the US, and Japan for their safe and effective use.
Moreover, evidence on the new drugs and devices used within the zone can be used to support approval from the Chinese FDA–this seems to work similar to Bartley Madden’s dual track procedure.
Daxue: Since 2020, the National Medical Products Administration has introduced regulations on real-world evidence (RWE), with the pilot zone being the exclusive RWE pilot in China. This means that clinical data from licensed items used within the zone can be transformed into RWE for registration and approval in China. Consequently, medical institutions in the zone possess added leverage in negotiations with international pharmaceutical and medical device manufacturers seeking to enter the Chinese market.
… This process significantly reduces the time required for approval to just a few months, saving businesses three to five years compared to traditional registration methods. As of March 2024, 30 medical devices and drugs have been through this process, among which 13 have obtained approval for being sold in China.
The zone also uses peer-approval for imports of health food, has eliminated tariffs on imported drugs and devices and waived visa requirements for many medical tourists.
To be sure, it’s difficult to find information about Boao Hope medical zone beyond some news reports and press releases so take everything with a grain of salt. Nevertheless, the free city model is catching on. There are already 29 hospitals in the zone including international hospitals and hundreds of thousands of medical tourists a year. The medical zone is part of a larger free port project.
Prospera is ideally placed for a medical zone for North and South America. The Honduran government should look to China’s Boao Hope Medical Zone to see what Prospera could achieve for Honduras with support instead of oppositon.
Hat tip: MvH.
Do you want a Democratic or Republican doctor?
Political polarization is increasingly affecting policymaking, but how is it influencing professional decision-making? This paper studies the differences in medical practice between Republican and Democratic physicians over 1999-2019. It links physicians in the Medicare claims data with their campaign contributions to determine their partyalignment. In 1999, there were no partisan differences in medical expenditure perpatient. By 2019, Republican physicians are now spending 13% more, or $70 annually per patient. We analyze four potential sources of this partisan difference: practice characteristics (i.e., specialization and location), patient composition, preferences for financial gain, and beliefs about appropriate care. Even among physicians in the same specialty and location treating patients for the same condition, Republican physicians spend 6% more, especially on elective procedures. Using a movers design, we also find large partisan differences for treating the same patient. We find no evidence that these partisan differences are driven by profit incentives. Instead, the evidence points to diverging beliefs. Republican physicians adhere less to clinical guidelines, consistent with their reported beliefs in prior surveys. The timing of the divergence matches the politicization of evidence-based medicine in Congress. These results suggest that political polarization may lead to partisan differences in the beliefs and behavior of practitioners.
That is from the job market paper of Woojin Kim from UC Berkeley. I found this one of the most interesting job market papers of this year.
How Low Socioeconomic Status Hinders Organ Donation
Past studies find that lower socioeconomic status (SES) individuals are less likely to donate organs. Building on the extended self literature, we propose that this effect occurs in part because the body is more central to the sense of self of lower-SES individuals. We test our predictions across seven studies (N = 8,782) conducted in different countries (United States and Brazil) with qualitative, observational, and experimental data in controlled and field settings. Results show that lower-SES individuals ascribe a greater weight to their bodies in forming their self-concept, which reduces their willingness to donate organs.
That is from a new paper by Yan Vietes and Chiraag Mittal. Via the excellent Kevin Lewis.
The Health and Employment Effects of Employer Vaccination Mandates
Health care facilities considering mandating staff vaccination face a difficult tradeoff. While additional vaccination coverage will directly reduce disease transmission within the facility, the imposition of a mandate may also cause vaccine-hesitant staff to quit, which could harm patient care. To study this tradeoff, we leverage comprehensive administrative data covering virtually all US nursing homes, including payroll-based records on approximately 500 million daily nurse shifts and weekly data on COVID transmission and mortality at each facility. We use a difference-in-differences framework to estimate the impact of employer-imposed vaccine mandates at 581 nursing homes on disease spread, employment outcomes, and several patient care metrics. While mandates did slightly increase staff turnover, the effects were concentrated on staff working less than 20 hours per week, and resulted in a reduction of less than two minutes per patient-day. Furthermore, there is only limited evidence of lower levels of care at mandate facilities in typically-monitored conditions such as patient falls, pressure ulcers, or urinary tract infections. In contrast, implementing a vaccine mandate led to large increases in staff vaccinations at mandate facilities, which directly led to less transmission of and lower patient mortality from COVID. We estimate that vaccine mandates saved one patient life for every two facilities that enacted a mandate, a large effect given the typical facility has around 100 beds. Our results suggest that the health benefits of mandates far outweigh the costs in terms of reduced patient care from staff turnover.
Yup. For some of you, it is time to read it and weep. Here is the full paper by
Ethiopia fact of the day
More than 6.1 million malaria cases, and 1,038 deaths, have been recorded in the country this year through the end of September, compared with 4.5 million cases, and 469 deaths, for all of 2023. Worse, cases are likely to soar far higher in the next couple of months because peak malaria season, driven by seasonal rains, begins in September and runs through the end of the year.
“We’re backsliding so fast — we’ve gone back a decade,” said Fitsum Tadesse, the lead scientist overseeing the malaria program at the Armauer Hansen Research Institute in Addis Ababa, the capital of the country.
Here is more from the NYT.