RUTHFULLY YOURS

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“Health equity” could be claiming new victims. More than 10 million nonblack Americans with chronic kidney disease may have seen their treatments or transplants delayed because of policy changes enacted after 2020’s “racial reckoning.” Some of those patients now face greater risk of death because national transplant organizations have embraced racial activism.

The United Network for Organ Sharing (UNOS), a quasi-governmental nonprofit that runs American transplant centers, enacted a significant policy change. The network compiles the national waitlist for kidney transplants and consults a formula that helps determine which candidates it will prioritize. Before 2020, the network used a formula that measured serum creatinine concentrations to assess a patient’s estimated glomerular filtration rate—the best-known measure of whether a patient has chronic kidney disease. Since black patients typically have higher serum creatinine concentrations than nonblacks with the same kidney function, the formula had applied an adjustment for black patients to ensure a more precise GFR estimate.

Activists in the wake of George Floyd’s death claimed that the formula’s adjustment was racist. This prompted the National Kidney Foundation and the American Society of Nephrology to create a task force to “reassess inclusion of race in the estimation of glomerular filtration rate.” The task force decided to nix the racial adjustment and set to work choosing a new formula that would not take race into account, which it released in 2021.

In December 2022, the board of UNOS’s transplant system issued a directive requiring all transplant centers to apply retroactively the new formula to determine black patients’ spots on the national waitlist. Last December, the network announced the results of its application of the new formula. Removing the racial adjustments had moved the waitlist’s more than 6,100 black patients up by an average of 1.7 years, with just over 500 receiving a transplant. Of course, this meant that some nonblack patients were correspondingly pushed back in line.

https://www.thefp.com/p/the-prophets-da-henderson?utm_campaign=email-post&r=8t06w&utm_source=substack&utm_medium=email

Welcome back to The Prophets, our new Saturday series about fascinating people from the past who predicted our current moment and make our world more understandable today.

Last week, we showed how civil rights hero Bayard Rustin predicted the rise of identity politics and affirmative action—and how they would divide us today. Today, Joe Nocera spotlights D.A. Henderson, the epidemiologist who warned that pandemic lockdowns won’t stop a disease, but could instead lead to a public health disaster. Bari Weiss

“In 2006, ten years before his death at the age of 87, the legendary epidemiologist D.A. Henderson laid out a plan for how public health officials should respond to a major influenza pandemic. It was published in a small journal that focused mainly on bioterrorism—and was quickly forgotten.

As it turns out, that paper, titled “Disease Mitigation Measures in the Control of Pandemic Influenza,” was Henderson’s prescient bequest to the future. If we had followed his advice, our country—indeed, our world—could have avoided its disastrous response to Covid. 

This month marks the four-year anniversary of lockdowns on a global scale. And though the pandemic has passed, its consequences live on. The lockdowns embraced by the U.S. public-health establishment meant that millions of young people had their education and social development disrupted, or left school for good. Mental health problems rose substantially. So did incidents of domestic violence and overdose deaths.

It didn’t have to be that way. 

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In his State of the Union address, President Biden touted the drug-price controls in his Inflation Reduction Act (IRA). Though the price controls have yet to take effect, Biden proposed expanding these measures, which threaten to destroy pharmaceutical innovation and harm the nation’s health.

The IRA’s drug-price controls are a solution in search of a problem. Two years ago, the Congressional Budget Office (CBO) found that per capita prescription-drug spending in real terms had fallen as a percentage of total spending on health care since the mid-2000s. Retail prescription drug prices have gone up at a slower rate than have hospital prices and health-care prices generally. According to researchers at the health-care data group IQVIA, U.S. drug spending is lower as a percentage of national health expenditures than the average drug-spending share across 11 developed countries.

While price-control proponents focus on drugs’ high list prices, the average net price of a prescription—the amount that users actually paid after subtracting manufacturers’ discounts and rebates—has been falling, according to CBO. This reflects the increased use of generic drugs, which cost far less than name-brand pharmaceuticals and now account for nine out of ten prescriptions. In fact, U.S. patients use more generics and pay less for them (16 percent less, on average) than do patients in other developed countries.

https://okaythennews.substack.com/p/science-summary-covid-19-vaccines?utm_source=substack&utm_campaign=post_embed&utm_medium=email

An unofficial series of 4 crucially important medical journal articles (JECP4), 2 by me, appearing in major academic publisher Wiley’s Journal of Evaluation in Clinical Practice reveals that claims made about COVID-19 vaccines’ effectiveness and safety were exaggerated in the clinical trials and observational studies, which significantly impacts risk-benefit analyses. Also discussed are the concerning topics of myocarditis, with evidence indicating that this one adverse effect alone means that the risks outweigh the benefits in the young and healthy; and perceived negative effectiveness, which indicates that the vaccines increase the chance of COVID-19 infection/hospitalisation/death, to say nothing about other adverse effects.

Whilst already planning for a holiday overseas on the advice of my treating team, I fortuitously was invited to share my research and discuss my ongoing persecution alongside brilliant and courageous doctors, scientists, academics, lawyers, and activists, such as Dr Robert Malone, who declared this research to be “excellent”, and “some of the best work, academically, in reevaluating the data”, culminating in an invitation to testify for US Senator Ron Johnson. So for those who are here because of the associated videos, and anyone else interested in this topic, please enjoy this much more detailed summary.

https://www.americanthinker.com/articles/2024/03/why_americans_no_longer_trust_the_healthcare_system.html

Trust is foundational in relationships, whether between individuals or between individuals and institutions. A Gallup survey from last summer found, “Americans’ faith in major societal institutions hasn’t improved over the past year following a slump in public confidence in 2022.”

Notable other examples where surprisingly few Americans have “a great deal or quite a lot of confidence” in major institutions include Congress at 8%, big business and television news at 14%, and the criminal justice system at only 17%. The medical system fared slight better with 34% of Americans expressing confidence. But two thirds have lost trust.

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Doctors, hospitals, and healthcare systems used to be held in high esteem, but no more. Aren’t these the “experts” in white coats? What happened to that trust? Why do only 1 in 3 Americans trust what was once a sacred healing profession?

Rasmussen Reports recently asked American adults three questions

On health-related issues, how much trust do you have in experts who give advice on TV and other media?
In terms of your own health-care decisions, which is closer to your attitude, that it’s safe to trust advice from experts, or that it’s important to do your own research?
Thinking back on the COVID-19 pandemic, were most of the experts basically right or wrong?

Not surprisingly, trust is low. What is interesting is the partisan divide, with Democrats far more trusting in medical instructions than Republicans.

https://www.city-journal.org/article/bad-policies-leaving-next-generation-of-surgeons-unprepared

What is going on in surgery? Why are young surgeons are coming out of residency programs unprepared for clinical practice? A 2013 Annals of Surgery report revealed that 40 percent of surgical residents lacked confidence to practice independently after five years of training, the typical length of a full general-surgery residency. According to the same report, one in five surveyed program directors “felt that new fellows arrived unprepared for the operating room,” and program directors deemed 66 percent of new fellows incapable of operating unsupervised for more than 30 minutes in a major surgery.

While these statistics are frightening, that report is 11 years old. Have things gotten better since? Judging by more recent reports and my conversations with peers, they have not, and in fact, have probably gotten worse. Surgeons I have recently spoken to have observed that too many young surgeons are poorly prepared and need remedial help, such as operating with a more experienced surgeon before they can be trusted to operate on their own. The young surgeons themselves seem to realize their inadequate preparation, as nearly 80 percent of post-general-training surgeons pursue a one or two-year fellowship in a subspecialty, which for some may be a way to get more surgical experience and put off entering general practice.

One possible explanation for young surgeons’ lack of preparation stems from the American Council on Graduate Medical Education’s 2003 decision to limit residents in training to 80-hour work weeks and no more than 24 consecutive work hours. For surgery residents, fewer work hours means less time spent caring for patients and performing surgeries. Only with time and repetition do surgical residents develop the requisite cognitive and technical skills necessary to learn sound surgical judgement—knowing when to operate and what operation to do—and how to operate safely under all circumstances. The hour reductions also have resulted in less continuity, as residents hand off patients to one another, diminishing residents’ sense of responsibility for patient care.

https://thehill.com/opinion/healthcare/4470475-pfizer-super-bowl-ad-proves-just-how-damaging-bidens-covid-response-has-been-for-america/

Why did Pfizer spend millions of dollars on a Super Bowl ad? And why are they paying Travis Kelce $20 million to act as their vaccine spokesperson?  

Because their reputation — and the reputation of America’s medical authorities — needs serious rehabilitation. A Gallup survey conducted last fall found only 18 percent of Americans have a very or somewhat positive view of the pharmaceutical industry, down from 25 percent in 2022. That’s a worse rating than any other industry group but retail.   

This is one of the most damaging leftovers of the Biden presidency.   

Joe Biden’s authoritarian approach to managing the COVID-19 outbreak, forcing all workplaces of 100 or more people to require the vaccine or regularly test their employees and the censorship of opposing views on vaccine side effects and on treatments, not only trampled on Americans’ rights — it may have led to preventable deaths.  

Nothing could have highlighted Americans’ distrust of the pharmaceutical industry more starkly than the Pfizer ad, which aimed to rebuild not only its brand but general attitudes toward medicine. It’s hard to imagine a world where a leading drug-maker feels the need to remind people that science has led to life-saving breakthroughs like the invention of penicillin and treatments for cancer, yet here we are. 

The ad, wedged between promotions for beer and donuts and other more conventional fare, combined a jazzy upbeat tune with pictures of the founders of Pfizer, seeming to place them in the same scientific galaxy as Sir Isaac Newton and Copernicus, who came alive in their portraits long enough to join in the fun. It was memorable, mainly because it seemed so out of place. 

Pfizer’s problem is, first, that sales of its COVID-19 vaccines and therapies have cratered as the disease has faded. But more important, Pfizer is dealing with backlash against Biden’s heavy-handed dictates about vaccines.