WHARTON UNDERGRADUATE HEALTHCARE CLUB
NEWSLETTER APRIL 2014
Healthcare Apps By Puja Upadhyay
LETTER FROM THE CHAIR Welcome to this semester’s final issue of the WUHC newsletter! This issue’s featured story (pages 4 and 5) is a look at the sustainabilty of the health care system in the U.S. Other stories cover topics from global health to pharmaceutical ethics to superbugs. Also, make sure to check out the blog on the new website (www. wuhcpenn.org)! We hope you find the newsletter and blog valuable resources, and as always, feel free to contact us with concerns! Lucy Chen, Communications Chair email@example.com Committee Members: Stanley Cai Nirupa Galagedera Alex Hsu Stephanie Luu Puja Upadhyay Joseph Vick 2
Apps for smartphones are changing the way doctors and patients approach medicine. These new apps are based on a do-it-yourself technology that is easy to use for all individuals with smartphones. One app that is more geared toward doctors is Epocrates - one of the oldest and most established medical apps. It gives doctors general information about drugs, correct doses for children and adults, and reminds them about possible harmful drug interactions. The Physician’s Desk Reference, which is a compilation of manufacturers’ prescribing information on prescription drugs that is updated annually, has already been replaced in several offices by this app. Another app, Alivecor, is useful for both patients and doctors. It is a portable heart monitor that runs on a patient’s smartphone to produce electrocardiograms. Patients place their finger over a sensor which wirelessly communicates with the phone to produce EKG. This can be recorded and saved in the app for observing patterns over time. The app is useful for patients with irregular heart rhythms. Since it is very accessible and easy to use, one of the main benefits is reassuring patients that everything is fine. One app that is particularly useful for patients is Cellscope Oto. It combines an app with an attachment that turns an iPhone into an otoscope, which is a tool that physicians use to examine the inside of an ear. The patient can snap photos of their inner ear and send it to their doctors for a diagnosis, who can prescribe necessary treatments. The app can save patients unnecessary trips to the doctor if their worries are just a false alarm.
Graphic courtesy of www.nytimes.com.
Technological developments are influencing medicine greatly. While this shift in consumer participation in health care began with online health information sites, the doctor’s office is practically in one’s pocket now. Many believe that these tools can make health care more efficient by speeding diagnosis, improving patient monitoring and reducing unnecessary visits to the doctor, opening up space for more serious cases. However, these apps and supplementary devices do not come cheap, and patients are generally expected to pay out of pocket for these services. Using these devices correctly can take practice, but becoming more involved in one’s own health and health care can be an important step forward. Although these tools are a long way from replacing diagnoses all together, the technology is progressing. Works Cited Carrns, Ann. “Health Care Apps Offer Patients an Active Role.” The New York Times. The New York Times, 25 Apr. 2014. Web. Whalen, Jeanne. “Health-Care Apps That Doctors Use.” The Wall Street Journal. Dow Jones & Company, 17 Nov. 2013. Web.
Panel Recap: Ethics in the Pharmaceutical Industry By Stephanie Luu In the United States, pharmaceuticals make up about 10% of the national healthcare expenditure. How does the $300 billion pharmaceutical industry balance its business and economic incentives with corporate social responsibility? On Monday, April 14, WUHC partnered with the Penn Bioethics Journal to host a panel discussion featuring two experts in ethics in the pharmaceutical industry: Dr. Michael Santoro, Professor of Management and Global Business at Rutgers University and Elizabeth Schwarzbach, the Global Head of R&D Group Strategy for GlaxoSmithKline. Kicking off the discussion, Dr. Santoro stated, “If you don’t like the way markets work with the pharmaceutical industry, look at how the pharmaceutical industry would work without markets.” Explaining that pharmaceutical companies rely on innovation and patents to thrive, Dr. Santoro questioned why pharmaceutical companies should have the responsibility to bridge the income gap apparent in society. Philosophically, Santoro argued, it should be the government, through taxes, that is held responsible to take care of those too impoverished to afford basic necessities. What makes the pharmaceutical company so special? In defense of pharmaceutical companies, Dr. Schwarzbach explained, “When you’re talking a corporation [GSK] of this size, of 100,000 people, there’s corporate responsibility, but also personal responsibility. It’s up to every indi-
Graphic courtesy of www.psychcentral.com.
vidual within a corporation to act in decision-based values, which can be difficult.” Additionally, Dr. Schwarzbach also argued that pharmaceutical companies do have charity programs in place; for example, it is GSK’s policy to give back 20% of revenue in developing countries where their products are placed. For pharmaceutical companies, research and development is extremely costly. In order to discover more life-saving medications, pharmaceutical companies need capital. As medicine gets more complicated, the costs are also more expensive, Dr. Santoro explained. The panel illustrates how the ethics within the pharmaceutical industry has always been hazy. ACT UP, an HIV activist group, has always protested against the pharmaceutical companies for charging
astronomically high prices for antiretroviral drugs. At passionate rallies, the activists hold up signs that say “Greed costs lives.” With increasing public pressure and lobbying, pharmaceutical companies have lowered their prices, particularly in developing countries, in name of their public image. For example, in Brazil, there was a 72% price drop in HIV medication from $15,000 per patient annually to $4,162. Moreover, the line between what is and is not approzpriate is blurred when pharmaceutical companies spend a large amount of money to make documentaries about global health. For example, Merck produced “Rx for Survival” on PBS. Between each section is an advertisement for Merck, with happy actors stating how Merck puts patients “first.” Should they be allowed to do this? Penn Professor David Barnes questions in HSOC 010 if there is a complication of interests and incentives. It is tough to say, especially when the documentary is very wellmade. However, it is obvious that the documentary is pushing for a biomedicine approach to global health – advocating that medicines and drugs will be able to save countless lives from diseases. Ultimately, pharmaceutical companies do have an obligation to act socially responsible, like any other corporation, but it is still up for debate whether those responsibilities are unique given that their products are drugs with the potential to save lives.
Is the Health Care Indu
By Jose You have probably heard it numerous times and have read it in just about every recent health policy and economics article, but is the Affordable Care Act’s motto of “bending the cost curve” for health spending backpedalling? A report published April 8 by the Altarum Institute announced that health spending growth has reached a 7-year high. Their most recent analysis shows that national health expenditures (NHE) grew 6.7% during February 2014. This is the highest monthly NHE growth rate observed since March 2007. While Altarum acknowledges that this growth rate is not sudden but rather is the culmination of creeping monthly NHE growth rates beginning in the summer of 2013, this recent surge in the health care spending has
many economists and policy makers concerned about the long term effects it may have on the nation’s economy. Last week, Annie Lowrey of the New York Times published a piece entitled, “Health Care Spending’s Recent Surge Stirs Unease,” which presents some of the concerns from Washington. To many policy makers, this surge comes as a shock considering the decline in heath spending growth over the past decade. Others, like Douglas HotzEakin from the Congressional Budget Office, have expected growth in NHE, as the U.S. economy has improved from the last recession and as the health care market has experienced a recent influx of newly insured patients seeking care. Insurance enrollment rates have skyrocketed recently, not solely due to the ACA’s impact, but, as economic
experts suggest, from rising employment and greater economic confidence among consumers, resulting in the demand for more health care services. Many argue that recent recessions are the culprit behind declining growth rates over the past decade, beginning with the recession in the early 2000s and ending with the “Great Recession” in 2009. During that period, employers pressed for greater out-of-pocket payments for their employees’ insurance policies in order to counteract moral hazard concerns. High rates of unemployment left many people without insurance and, as a result, the inability to visit their doctor as often or needed. Medicaid reform in 2008 greatly reduced reimbursement to providers and restricted access to high-cost services. However, the effects from these issues have, for the most part, tapered off. Even so, as the NHE growth rate increases, many economists are unsure if the recent surge is the result of the waning of the recessions or the increase of ACA insurance enrollees in the market. It is still too soon to tell which ef-
ustry Too Big to Rein In?
eph Vick therefore, health care delivery reform is no longer an urgent priority.” Moreover, problems areas such as mismanagement in hospitals, as David Cutler suggests, could reduce health spending by 25 to 50 percent. For example, recent data has shown that there is a proliferation of proton beam accelerator facilities in the U.S., which have been known to cost hundreds of millions of dollars yet are still believed to be just as effective as other lower cost services for cancer treatment. As of now, the growth in health spending is still projected to outpace the growth of the nation’s gross domestic product. Many forecast that national health spending, by 2032, will amount to nearly a quarter of the GDP, meaning that every 25 cents of every Amer-
fect may be causing the recent climb in the NHE growth rate, but economists and policy makers are relying on current ACA strategies to slow the growth rate. The change from fee-for-service and other innovative approaches like accountable care organizations, Medicare generics replacing brand-name drugs, and expanding nurse practitioner roles all may be improving quality, but the savings have yet to be realized as health spending continues to rise. Mark McClellan, the current director of the Health Care Innovation and Value Initiative at the Brookings Institution and former administrator of CMS, states that “it would be a mistake to assume that slow growth in health care spending will continue, or that spending reflects high-value care and
ican dollar earned will be spent on health care services. As we draw nearer to that distant future, it is important to remember that slowing the growth of health spending requires a concerted effort from all stakeholders, including patients themselves, on efficient utilization across the care continuum. If you’d like to read more about this topic, check out the following links: http://www.nytimes.com/2014/04/23/ business/economy/forecasting-the-scale-ofhealth-spendings-climb.html?ref=policy&_r=0 http://www.nytimes.com/2014/04/19/ business/economy/health-care-spendings-recent-surge-stirs-unease.html?ref=policy http://altarum.org/sites/default/files/ uploaded-related-files/CSHS-Spending-Brief_ April%202014.pdf
The Emergence of the Priva
By Nirupa G
Historically, global health initiatives were associate However, since the 1990s, the private sector has increase
Incentives for Involvement need. This in turn spurs competition as rivals attempt to match each other’s efforts. Participating in global health endeavors simultaneously provides prime marketing opportunities for members of the private sector. Social change and public health advocacy allow businesses to share message of their company and their social impact goal with a wider audience and make meaningful consumer-producer relations with the use of pathos. Growing acceptance of the private sector has eased its transition to a major player on the global health scene and created a cycle of increased desires by other companies to engage themselves in the process to be economically competitive. There has also been a growing trend toward the joint partnership of the public and private sector. In fact, the U.S. Agency for International Development (USAID) has formed nearly 700 public-private partnerships, up from only 50 public-private partnerships in the 1980s.
ing, and distribution to more effectively disperse health treatment and prevention options, thereby reducing costs and increasing the efficiency of resource utilization. These companies engage themselves in global health by developing drugs or vaccines for diseases that do not typically affect local audience or by sacrificing some profits by providing products at lower costs. In the other case, businesses in non-health related industries now partake in global health initiatives as part of their philanthropic mission. Examples include the food industry’s interest in aiding the developing world. While it is true that by serving the health needs of developing nations, businesses may not maximize their short-term profits, there are numerous economic advantages in the long run. The term “social impact” has gained popularity in recent times. Positive social impact, or results that improve quality of life, are beneficial for companies because it allows them to create tangible change for people in
The 1994 World Development Report conveyed the message that health and wealth are related. For an individual nation, the health of its citizens is important for its overall economic well-being, as healthy citizens comprise a more efficient labor force and ravenous consumer market. With some markets half way across the world from their producers in an increasingly globalized world, poor health of one nation affects the overall world economy. Greater awareness of the connection between wealth and health has led many businesses to become more involved in global health. There are two distinct cases in which the private sector involves itself in improving global health. In one case, a company serves global health needs by continuing to advance the goals the company was established with, but in many cases must forgo something to cater to those in dire need. For example, pharmaceutical companies can employ their expertise in product development, manufactur-
Short of Full It should be noted that the growing influence of the private sector in global health has not been met without conflict. For example at the 2011 United Nations High Level Meeting on Non-Communicable Diseases, non-governmental organizations (NGOs) expressed disapproval with food and beverage industries contradictory desire to improve the state of global health around the world, while producing and marketing products that contributed to
ate Sector in Global Health
ed with governmental policies and humanitarian efforts. ed its presence in improving health outcomes on a global scale.
Change is Good: Noteworthy Examples In 2010, Johnson & Johnson embarked on their Every Mother, Every Child campaign to decrease mortality rates of mothers and children and improve overall well-being. The campaign is one step towards the achievement of the United Nations’ Millenium Development Goals. It has four constituent parts: 1. Application of mobile health technology for materal and prenatal care 2. Greater access to medical care via large scale intestinal worm drug dissemination for children 3. Advances in research and development of treatment and prevention of fatal diseases 4. Education programs for maternal health For more information on Johnson & Johnson’s efforts, check out http://sustainabledevelopment. un.org/index.php?page=view&type=1006&menu=1348&nr=1227
ExxonMobil also sponsored efforts for World Malaria Day. Check out http://www.bloomberg. com/article/2014-04-25/a9WlCkPnEdLY.html
l Acceptance the rising prevalence of non-communicable diseases such as obesity and type II diabetes. In addition, some still question the ethics behind businesses’ motives for contributing to the improvement of global health. One must consider the moral dilemma behind economic incentives for social change. Nonetheless, it will be interesting to see just how large of a role the private sector obtains in the advancement of global health.
Rise of the Superbugs By Stanley Cai
The World Health Organization announced April 30 that the superbugs have arrived. In its first global report on antibiotic resistance drawing on data from 114 countries, the WHO said that antibiotic-resistant superbugs are now a major threat to public health and could wreak devastating havoc on the world. Since antibiotics were first widely introduced in 1939, they have become staples of modern medicine that hasvesaved millions of lives to date (“Gramicidin”). But only 75 years later, the rise of antibiotic-resistant bacteria threatens to catapult medicine back into an era where deadly infectious disease runs rampant. A new family of antibiotic-resistant bacteria, Carbapenem-Resistant Enterobacteriacae (CRE), so named because of their ability to fight of carbapenem antiobiotics, has emerged in numerous medical facilities. No antibiotic has been effective in fighting off CRE infection, and mortality rates run as high as 40%. Scientists remain pessimistic about the prospect of finding a cure, because CRE bacteria can adapt resistances to future antibiotics quickly. Worse yet, the bacterium appear to be spreading quickly: thousands of infections have been reported throughout the United States, and 41 states are already affected. Equally as importantly, public awareness is lacking, and hospitals and nursing homes alike fail to screen patients containing the bacteria, let alone quarantine them. In the worst case scenario, the CRE bacteria could spread their resistance genes into more common bacterium strains, presenting a threat no longer limited to immunocompromised patients in hospitals, but to the entire world (Pompa). For years, scientists have known about the prospect of antibiotic resis-
Graphic courtesy of www.cnbc.com.
tance. The principle is simple: widespread usage of antibiotics would exert a selective pressure, where bacteria better able to withstand a particular antibiotic would survive to spread their genes. Over time, bacteria could acquire resistance to multiple antibiotics, and in the case of CRE bacteria, to all antibiotics known to date. In their battle against antibiotics, bacteria have the advantage of being genetically versatile, not only because of quick reproduction rates, but also because they possess the ability to transfer genes horizontally, so that different bacteria species can share plasmids with each other (“General Background”). Thus DNA coding for antibiotic resistance can easily spread from relatively isolated bacterium strains into more common ones, a development that would prove nearly apocalyptic for global health. Ever since 2008, when scientists at UVA first identified the common resistance gene in CRE bacteria, efforts at treating or at least curbing the disease have expanded exponentially. In New York City, a screening program
implemented in Montefiore Medical Center finally succeeded in cutting CRE infection rates in half for all nine of its intensive care units. Meanwhile, researchers have developed a new test that can identify bacteria carrying CRE plasmids within days, whereas most similar identification tests take months for results (Pompa). But none of these successes seem able to stem the inevitable. The law of nature prevails: selective pressures, exacerbated by misuse of antibiotics, will lead to the relentless rise of superbugs. Works Cited “General Background: About Antibiotic Resistance.” Alliance for the Prudent Use of Antibiotics. Tufts, n.d. Web. 26 Apr. 2014. “Gramicidin: Ushering in the Scientific Era of Antibiotic Discovery and Therapy.” The Rockefeller University. N.p., n.d. Web. 26 Apr. 2014. Pompa, Frank. “Deadly ‘superbugs’ invade U.S. health care facilities.” USAToday. N.p., n.d. Web. 26 Apr. 2014.