Health in the Trump Administration: Four Things to Watch

What does the new administration mean for your health? With the Affordable Care Act on the chopping block and controversial bills such as the 21st Century Cures Act recently approved, here are four areas to watch closely under a Donald Trump administration.Pandemic preparedness: are we ready for The Big One?Expect to see a pandemic like the 1918 outbreak of Spanish flu every 100 years, infectious disease experts say. Scientists who model the spread of infections predict a pandemic every century and significant outbreaks, bigger than the recent Ebola epidemic, every 40 years.That means we're up for a pandemic - what I call The Big One - right about now. If Ebola was the stuff of nightmares, bear in mind that it was just a warm up. Ebola killed approximately 12,000 people -- one of them in the U.S. An estimated 50 million people died from Spanish flu in 1918. By today's population figures, a similar pandemic would kill 2 million Americans.The tardy and initially weak Ebola response showed just how ill-prepared we are for large outbreaks of infectious diseases. The World Health Organization was criticized by agencies around the world for ignoring early cries for help from aid workers in West Africa and for taking too long to muster up outbreak response teams.When the response did pick up, a lack of infrastructure in the most affected countries meant delays in diagnosing and properly burying people which helped the virus to spread. This is the norm: pathogens, poverty and pandemics go hand in hand.New diseases are discovered at the rate of one per year. "There's no playbook for these emerging infectious diseases," said Amy Pope, Deputy Homeland Security Advisor, at a conference on pandemic preparedness at Georgetown University last week. "We had tremendous plans for flu. Then we hit Ebola and all of a sudden, the plans didn't fit."Pope said she loses sleep over terrorism and pandemics. Protecting the U.S. from invading diseases means helping to set up strong public health systems around the world, she said. The incoming administration will have to continue the fight against outbreaks of Zika, antibiotic-resistant bacteria as well as the opioid epidemic, while at the same time readying itself to put up a strong fight against the next invading pathogen -- whatever that may be.Maternal mortality rates could worsenMore pregnant women die in Texas than in any other state. Texas is such an outlier when it comes to maternal death that researchers at the University of Maryland and Stanford University Medical School had to analyze the state's maternal death data separately from the rest of the country. The number of Texas women who died during pregnancy or shortly after childbirth doubled between 2010 and 2012.While pregnancy is becoming safer across the world, it's becoming more dangerous in the U.S. Maternal mortality here increased 27 percent between 2000 and 2013 but dropped in 157 other countries during the same time period.Reproductive health experts worry that this trend will worsen in Texas and other states because of proposed bills that would make it difficult for women to access safe abortions and would defund Planned Parenthood which provides cervical cancer screening as well as testing for HIV and other infections.Emboldened by the results of the presidential election, Texas Republicans have renewed their fight against women's reproductive rights. "Starting in 2017, we will have a friend in the White House..." Lt. Gov. Dan Patrick said in December.Before the start of the legislative session, Texas Republicans pre-filed 10 bills related to reproductive health including bills that would ban insurance coverage on abortions and one that wants to change the Texas constitution to give legal rights to embryos.More outbreaks of measles, mumps and whooping coughMeasles, mumps and whooping cough are back with a vengeance. Close to 50,000 Americans fell sick with whooping cough in 2012, according to the Centers for Disease Control and Prevention. That's the highest number since 1955. Measles was considered eliminated in the U.S. in 2000 but there were 34 outbreaks of the virus in 2013 and 2014 alone. In 2015, an outbreak of measles at Disneyland spread to six states and Canada and Mexico, sickening 147 people.In December, the number of mumps cases in North Texas surpassed 50 as an outbreak in Johnson County has grown and cases have been found in Dallas, Collin, Denton and Tarrant counties. The cases were linked to exposure at cheerleading camps. A growing movement of people who believe vaccines cause harm and choose to not vaccinate themselves or their children is causing a spike in cases. Vaccines, including those that protect against whooping cough, mumps and measles have been proven safe. These diseases, sometimes misunderstood to be mild childhood illnesses, can cause devastating damage. For every 1,000 children with measles, one or two will die. Other complications include pneumonia, seizures and swelling of the brain.Although the majority of school-aged children are vaccinated, it only takes a few unvaccinated children to establish an outbreak. Texas, along with 18 states, allows parents to opt out of vaccinating their children for non-medical reasons. The Texas Department of State Health Services says the number of parents filing conscientious exemptions went from 2,314 in 2003 to 44, 716 in 2016.Babies and the elderly are at highest risk of death and disability from most vaccine-preventable diseases. Infectious disease experts predict the number of outbreaks will continue to rise as the anti-vaccination movement grows.Potentially quicker drug approval - but at what cost?The 21st Century Cures Act appears to be a game-changer for patients. It promises money for medical research, funding for state health departments to tackle the prescription painkiller epidemic and quicker drug approval by the Food and Drug Administration. So why is it dividing the medical community?Experts warn that the bill may be great news for drug companies but it's bad news for patients. The 21st Century Cures Act allows drug companies to apply to the FDA for approval of a new medicine based not on rigorous clinical trials -- as is the standard now -- but on weaker data, said Dr. Giuseppe Giaccone, Associate Director for Clinical Research at Georgetown University.The bill supports real world evidence -- data from patients who have used certain medications or medical devices -- which is worrying scientists who say that placebo-controlled, randomized clinical trials provide the best level of evidence about the safety and efficacy of a medicine or device.Under the 21st Century Cures Act, "drug companies would just have to show some level of efficacy with minimal risk," said Giaccone. "That's good for the drug companies because it means they can get more things approved and quicker. But that's very bad for patient safety."Advocates for the bill say it will boost research by providing $4.8 billion to the National Institutes of Health, about half the amount included in an earlier version of the bill. "The promise of NIH funding is the sugar coating on a bitter pill," said Gregg Gonsalves, co-director of the Global Health Justice Partnership and Lecturer in Law at Yale Law School. "The bill was meant to give more money for research -- so what did we get? A reorganization of FDA and a change in the way clinical trials are done."  Continue reading...

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