Missouri State of Mind

The San Jose Mercury News reports:

“Then they peered into the genome to predict the embryo’s susceptibility for common diseases that may develop decades later: breast cancer, colorectal cancer, pancreatic cancer, prostate cancer, atrial fibrillation, coronary artery disease, Crohn’s disease, ulcerative colitis, lupus, vitiligo, and Type 1 and Type 2 diabetes.”

IVF today, in utero tomorrow?

Our current saline shortage echoes earlier saline shortages, in that supply is often tight following natural disasters (2017 hurricane Maria in Puerto Rico taking out Baxter’s manufacturing plant, etc.). There is nothing like a pandemic being fought with multiple vaccination injections to highlight this, as well. The war in Ukraine’s reduction in availability of petroleum products to make plastics has also played quite a role. But, our saline supply (meaning not only the bags and saline solution itself, but including the vials and syringes for administration) has often been precarious. This most recent shortage may have been entirely predictable once it became clear all the stars were in alignment for another shortage. And, yet, we are completely reactive in the face of the acknowledgement that some U.S. hospitals are receiving less than half of the saline and saline administration equipment needed — children’s hospitals even less because production is even lower for the very smallest size saline bags and saline administration equipment. Those same saline and saline product producers remain largely non-responsive to the Cares Act requirement of reporting of potential pipeline problems.

There it is again, the bad penny that always turns up, we are distressed that some people grieve differently and longer than others. Almost like a ten year cycle cicada, this issue about pathologizing grief rises again, during COVID of course. This time, wearing black mourning for “too long” is cited as a marker of the disorder. And what of those Americans who come from communities where it is customary to wear black as a widow for all the days of your life. An entire culture diagnosed in one fell swoop.

Would Bloomberg Law have called Robert Bork an “antitrust crusader”? What is with calling Lina Kahn one? Sexist much?

Why is Missouri’s Medicaid expansion so slow to expand? Endless repetitive re-determinations might be a big part of the answer.

In making the Survey and Certification budgetary allocation, CMS may, among other things,
adjust the amount allocated to States that refuse to survey and certify compliance with all
applicable Medicare and Medicaid health and safety regulations. These state allocations would
be reduced for the current fiscal year and each successive year until the state resumes full
oversight of the entirety of Medicare and Medicaid regulations. These funds would be used by
CMS to support federal oversight alternatives in the state (including contractor support) to
safeguard the health and safety of those receiving care from Medicare and Medicaid certified
providers and suppliers.

CMS is talking tough to states failing to enforce the nursing home employees vaccination requirement.

Optum Rx has escaped antitrust litigation over insulin pricing because the federal judge has now apparently seen the light on the application of the indirect purchaser rule, after seeing it exactly the opposite way earlier in the very same litigation. Of course, people can change their minds. But people can also find some rules, with well developed exceptions like the conspiracy exception, confusing, perhaps unnecessarily so. As Spencer Smith has pointed out, the Supreme Court’s interpretation of the statute contradicts a plain reading of the statute.

So much rides on your status while you are “in the hospital.” Admitted? Under observation? Short stay admission? Here’s some good news from Justice in Aging over the hard fought right to appeal the unilaterally pronounced hospital status determination. This is the kind of legal work that will change people’s lives because of the tremendous medical debt it may avert from the out of pocket payment requirements for nursing home care following a non in-patient stay. Today, I am singing the praises of the unsung heroes at Justice in Aging.

The CDC’s proposed revised guidelines for Opioid prescribing are open for comment. The introductory background statement on the purpose of the practice guidelines merits consideration as well:

This clinical practice guideline is
voluntary; it provides recommendations
and does not require mandatory
compliance. It is intended to be flexible
to support, not supplant, clinical
judgment and individualized, patientcentered decision-making. This clinical
practice guideline is not intended to be
applied as inflexible standards of care
across patient populations by healthcare
professionals, health systems, thirdparty payers, organizations, or
governmental jurisdictions. The clinical
practice guideline is intended to achieve
the following: Improved communication
between clinicians and patients about
the risks and benefits of pain treatment,
including opioid therapy for pain;
improved safety and effectiveness for
pain treatment, resulting in improved
function and quality of life for patients
experiencing pain; and a reduction in
the risks associated with long-term
opioid therapy, including opioid use
disorder, overdose, and death.

Why so much throat clearing? Maybe it is because the last guidance document apparently got many Americans fired as patients.

“There are so many people here — beautiful and beautifully flawed people — and I want all of their stories to be told.” Michael K. Williams to the NYT in 2017.