Three logical, smart, and hopeful things happened in health care in the past few weeks. I’m glad to be able to tell you about them.
The first good thing is that the Rhode Island Department of Health joined Connecticut, Massachusetts, Vermont, Maine, Maryland, Delaware, New Jersey, Pennsylvania, and New York to form the Northeast Public Health Collaborative, so they can share their expertise, coordinate their efforts, and make joint recommendations on critical public health practices like vaccination.
This is a hugely important step because it ensures we will continue to hear calm and thoughtful recommendations about vaccination, emergency preparedness, nutrition, the spread of infectious disease, and other issues that impact the health of all of us. It is particularly important now that the CDC has been compromised by becoming a political football. We need a calm and thoughtful voice that uses a collective and deliberative process to evaluate the scientific evidence about diseases and treatments, which is what the CDC used to do.
The directors of state departments of health in the New England States and New York used to meet weekly, every Monday at 7 AM, to make sure we were all on the same page. This collaborative formalizes that process. Kudos to RIDOH Director Dr Jerome Larkin for his leadership in helping create the collaborative and bringing Rhode Island into it. I only hope and pray that the collaborative will insulate itself against the political pressure that health care industry profiteers – big pharma, retail pharmacy chains, hospitals, the insurance “industry”, and the private equity folks who drive too many health care decisions. CDC too often fell prey to their manipulations, even before it was politicized and weaponized.
And RFK Jr’s FDA is actually doing something important and useful! FDA Director Dr. Marty Makary is planning to restrict direct-to-consumer drug company advertising. This kind of advertising, which started in 1997 when FDA started allowing it, helped upend the relationship between doctor and patient. Before 1997, people used medicine when their doctors found them to be ill with a disease that was likely to respond to medication.
After 1997, people were told by commercials about diseases they sometimes didn’t know they had – and were pushed to use medication that were often expensive, medications which were generally paid for by their insurance company, not people themselves. All this contributed to over-diagnosis and over-treatment, with no demonstrable public health benefit. Note that health care cost inflation became double the rate of general inflation about that time. Drug company advertising wasn’t the only cause, but it was a likely contributor. So kudos to Director Makary and the FDA for moving in this direction. Let’s hope he and they are able to get it done, the lobbying of big pharma being a huge threat to reasonable policy.
Finally, the RI State Senate Study commission released its draft report on the feasibility of building a new medical school at URI. I sit on the commission. The draft report is detailed and precise.
I hope it is approved in close to its current form, which recommends building that medical school, which Rhode Island desperately needs. It finds that only about 16 Rhode Islanders a year go to Brown, and very few stay to practice here. (Some of us think the actual number is half that.) We need a medical school to train actual Rhode Islanders, and then we need to create incentives to make sure they do primary care and return to practice in their own communities, so we need both the medical school and more residencies in family medicine, pediatrics, and general internal medicine. And more fellowships in geriatrics – all of which a new medical school can help create –in places like Woonsocket, South Kingston, Johnston, Westerly – and Newport! Let’s hope URI, the Governor and the legislature decide to move forward and get that new medical school built.
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