As anticipation builds for President Biden’s State of the Union address [tonight]  the American Public Health Association commends the Biden administration for its efforts to address critical issues affecting the nation's well-being, while recognizing we still have a long way to go to ensure that everyone has an equal opportunity to be healthy. [APHA]

Throughout his presidency, Biden has prioritized initiatives to improve the health and well-being of communities across the country by following the science. Since taking office, the administration has guided the country through challenges from COVID-19 and the end of the public health emergency while emphasizing the importance of vaccines, combating misinformation and supporting funding for the nation’s federal, state and local public health systems. This funding has been a critical lifeline for the public health infrastructure, and it needs to continue if we expect to have a public health system that is prepared for the next pandemic or public health emergency.

Under Biden’s leadership, the U.S. Environmental Protection Agency has moved forward with several important rules to protect the public’s health, especially the nation’s most vulnerable groups, including children, the elderly and communities of color. Recently, the EPA finalized rules to significantly reduce methane emissions from the oil and gas industry, and issued more health-protective rules to reduce the dangerous particulate matter pollution that can lead to increased asthma attacks, heart attacks, strokes, lung cancer and premature death. 

The EPA is also moving forward with a new rule to reduce the amount of lead and copper in the nation’s drinking water supply and has secured billions in funding to help communities replace existing lead service lines — which negatively impact the health of more than 21 million individuals — to strengthen the nation’s commitment to environmental justice. We call on the EPA to finalize a critical rule to protect the public from the health threats associated with climate change by drastically reducing carbon pollution from fossil fuel-fired power plants.

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CDC Director Mandy Cohen joins Bloomberg News reporter Riley Griffin to discuss new Covid-19 guidance, the fentanyl crisis and maternal healthcare in America.

Watch Video here>

Increased attention to harmful race-based clinical algorithms—equations and decision-making tools that misuse race as a proxy for genetic or biologic ancestry¹—has led to the reconsideration of these algorithms in many medical specialties. Most such algorithms were developed or endorsed by medical specialty societies, ensuring their widespread use. [JAMA Network]

Advocacy to eliminate the misuse of race in clinical algorithms has grown from grass-roots efforts to organized, coalition-based efforts² supported by numerous medical societies. The American Medical Association (AMA) has specifically called for eliminating the misuse of race in clinical algorithms and implementing strategies to redress related harms.³ This call aligns with a growing movement to advance reparative approaches, which appropriately use race as a social construct, to identify and redress harms.⁴

Given the influence of medical societies in developing and legitimizing clinical algorithms, as well as anecdotal reports of societies’ efforts to eliminate harmful algorithms from use, we surveyed societies on their activities related to this and other equity issues. This article presents descriptive findings on organized medicine’s efforts to eliminate harmful race-based clinical algorithms.

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Adolescents who use substances have more psychiatric symptoms than peers who do not use.^1,2 There are, however, conflicting findings on whether various substances have unique or nonspecific associations with co-occurring psychiatric symptoms.^2,3 Similarly, dose dependence of these associations and presence of increased psychiatric symptoms among adolescents with infrequent use are debated.¹ With increasing rates of adolescent mental health–related problems, particularly suicide,^4,5 clarification on these issues is needed to inform screening, prevention and intervention, and policy.⁶ We examined associations between common substances and psychiatric symptoms among adolescents. [JAMA]

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The recently adopted federal guidance that shortens isolation recommendations for COVID-19 does not apply to Illinois health facilities, the Department of Public Health reiterated Monday. [Health News Illinois]

A spokesman for the agency referred to the Centers for Disease Control and Prevention notice released on Friday, which said the guidance is intended for a general audience. Nothing in the language supersedes accommodations required under federal civil rights laws.

The federal agency said Friday it now suggests those with a respiratory illness can return to normal activities when their symptoms improve over 24 hours and they no longer have a fever without using fever-reducing medication. They’re encouraged to continue taking steps to curb disease spread during the following five days, like wearing a mask.

Previously, the CDC recommended those testing positive for COVID-19 stay at home for five days. The new guidance brings a unified approach to a range of common respiratory viruses, like COVID-19, flu and respiratory syncytial virus, or RSV, according to the federal agency.

IDPH said Friday it will adopt the guidance going forward.

The CDC offers separate guidances for healthcare settings related to COVID-19, flu and general infection prevention and control.

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1. Margins for health systems improved in 2023 after a disastrous 2022. At the end of 2022, it looked like we would see massive health system failures. Systems rebounded in 2023 far better than many of us expected. The median hospital margin was -0.5% in January 2023 and 2.3% by year's end, according to Kaufman Hall. [Becker's Healthcare Review]

There is still much variation between systems' 2023 results, with Mayo Clinic reporting a 6% operating margin for example and Cleveland Clinic at 0.4% or Kaiser Permanente at 0.3%. It should be noted that while systems improved overall through 2023, the median margin is still too thin for comfort and 40% of U.S. hospitals continue to lose money from operations, with more than a dozen hospitals and health systems closing or filing for bankruptcy or otherwise reducing services in the last year.

2. The physician shortage in primary care and specialties is getting worse. The Association of American Medical Colleges issued a forecast in 2019 that the U.S. will face a shortage of up to 124,000 physicians by 2033. Numerous data points, albeit delayed, can paint a picture of how we are trending in the trajectory toward that end date, although more data — such as a national estimate of annual physician turnover — would certainly help the cause. 

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A USA TODAY analysis of Medicaid data for the 60 most used psychiatric drugs showed a growing number of people sought mental health treatment and medication during the pandemic as it pushed people into isolation and dismantled support systems.  [USA Today]

The analysis also revealed a lingering effect of the pandemic: Mental health-related prescriptions rose further in 2022, up 12% from 2019, outpacing the less than 1% growth in overall prescriptions. That includes prescriptions for generic Zoloft, the most common antidepressant medication, which rose 17% over the same period. 

More than half of these drugs saw an increase in prescriptions since 2019, and the steepest increase was among ADHD drugs: Concerta and generic Adderall. 

Full article here> 

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Question  Does exposure to mRNA COVID-19 vaccination during pregnancy increase the risk of adverse events in newborn infants? [JAMA Network]

Findings  In this population-based cohort study from Sweden and Norway that included 94 303 infants exposed to COVID-19 vaccination during pregnancy and 102 167 control infants born between June 2021 and January 2023, vaccination during pregnancy was associated with lower odds of neonatal intracranial hemorrhage, cerebral ischemia and hypoxic-ischemic encephalopathy, and neonatal mortality.

Meaning  In this large population-based study, vaccination of pregnant individuals with mRNA COVID-19 vaccines was not associated with increased risks of neonatal adverse events in their infants. 

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Gov. J.B. Pritzker’s proposed $23 million in funding to improve birth equity and maternal health outcomes for Black women would include grants for community health care providers and a $1 million pilot program to ensure low-income moms have diapers. [Sun-Times]

Pritzker highlighted the initiative on Monday at a former church on the South Side — the future home of the Chicago South Side Birth Center. Founded by Jeanine Valrie Logan, a midwife and advocate, the center will offer community-based health care and birth rooms.

The governor called the center a model for how Illinois can decrease Black maternal mortality. And Valrie Logan would be able to apply for a birth equity grant, part of a $4.4 million allocation the governor is seeking from the Illinois Department of Public Health.

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Experts from across four continents convened at the October 2023 RAISE (Responsible AI for Social and Ethical Healthcare) meeting to actively engage public and policy discourse and health care stakeholders in addressing concerns before policies crystallize into laws or regulations. [NEJM AI]

In the relentless pursuit of progress, humanity has engineered marvels that often pose complex questions and challenges for the societies that birth them. The recent integration of advanced large language models, such as ChatGPT and Bard, into both expert and public domains, is a quintessential example of such a dilemma.

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