#16 - Healthcare News: May 2024 (Baltimore Overdose Crisis, Prison Healthcare, Bird Flu, UHG Cybersecurity)

Check out this month’s newsletter for the show notes of this episode!

Stay informed with the latest in Healthcare News. In this episode, we explore the key developments of May 2024, touching on a range of topics but focusing on the Baltimore overdose crisis, prison healthcare, bird flu, and the UHG cybersecurity attack. To enhance your listening experience, we've added chapter markers and timestamps in the description below, making it easy for you to jump to the segments that catch your eye. Let us know your thoughts!

Timestamps:

(00:00) Episode Introduction

(01:17) Baltimore Overdose Crisis

(04:18) Prison Healthcare

(07:38) Bird Flu

(10:02) UnitedHealth Cybersecurity Attack

(13:20) IVF, Abortion, and Maternal/Child Health

(15:19) Surgery and Medical Procedures

(16:57) Mental Health

(18:22) Viruses and Bacteria

(20:13) New Research, Studies, and Milestones

(22:39) Drugs and Alcohol 

(23:17) Climate and Environment

(24:01) Global Health

(25:00) Pharmaceuticals

(25:40) GLP-1 Drugs

(28:14) Medical Devices, Biotech, and AI

(29:29) Medicare/Medicaid and Health Insurance 

(30:54) Politics

(33:01) Outro

Linktree: linktr.ee/gustavofrancopod

Chapters

• 0:00 Episode Introduction
• 1:17 Baltimore Overdose Crisis
• 4:18 Prison Healthcare
• 7:38 Bird Flu
• 10:02 UnitedHealth Cybersecurity Attack
• 13:20 IVF, Abortion, and Maternal/Child Health
• 15:19 Surgery and Medical Procedures
• 16:57 Mental Health
• 18:22 Viruses and Bacteria
• 20:13 New Research, Studies, and Milestones
• 22:39 Drugs and Alcohol
• 23:17 Climate and Environment
• 24:01 Global Health
• 25:00 Pharmaceuticals
• 25:40 GLP-1 Drugs
• 28:14 Medical Devices, Biotech, and AI
• 29:29 Medicare/Medicaid and Health Insurance
• 30:54 Politics
• 33:01 Outro

Transcript

Intro

Hey everyone and welcome to another healthcare news episode. Today we’ll be covering everything from the month of May. I’ll start with a few of my favorites from this month. We’ll talk about Baltimore’s overdose crisis, the state of healthcare in US prisons and how they fail, the bird flue epidemic, and the UnitedHealth Group data breach that exposed health date of over 100 million Americans. After that, just like last month, I will run through the rest of all relevant healthcare news from this month so you can have a full picture of what’s going on. I’ll keep those sections very concise so make sure to check the timestamps for any section you might be interested in. With that, sit back and enjoy today’s episode.

Baltimore’s Overdose Crisis

Alright everyone, let’s start with a sad one, the Baltimore Overdose Crisis. This was all over the news this month, and even though some preliminary health data released by the CDC this month suggests that we had the first decrease in overdose deaths in the US in 5 years, the same sadly isn’t true for Baltimore. We’ve gotten to the point where we can literally call Baltimore America’s overdose capital. The NY Times had a pretty cool interactive post on it this month, and there they highlighted that “fatal drug overdoses have occurred on a third of the city’s blocks.” I mean think about that statistics, a body was even found right outside of the Health Department.

The shocking thing is that some might have seen Baltimore as the last place to have such a terrible drug overdose crisis. When drug overdoses first began to spike, Baltimore was literally seen as a national model for drug overdose response. Now, it’s pretty sad to say but they’ve definitely lost that title. In the past 6 years, 6,000 people died, and the fatal overdose rate has quadrupled from 2013, according to the CDC.

Data from the CDC also shows that from 2018 to 2022, Baltimore had 170 overdose deaths per 100,000. Knoxville, a city with in Tennessee with the second highest number of overdose deaths had 86 overdose deaths per 100,000, basically half of what Baltimore had. And of course, like all other health issues we talk about here, not all populations are hit the same due to all kinds of social determinants of health. So we can’t put a blanket statement and say that this death rate is the same for everyone living in Baltimore. For example, we see that overdose rates are significantly higher in black men in their 50s to 70s.

But now let’s look at what’s really causing these overdose deaths. Even though Baltimore was once seen as the heroin capital, heroin has become really hard to find in the state, and fentanyl is really driving this change. Since fentanyl is found in nearly all illicit opioids in the state, Baltimore really has to start thinking about how to lower the availability of these drugs but also control the desire of the population to take them, and provide care to those who may be addicted. Perhaps they can even learn a bit from Canada, a country that’s been battling with their own opioid crisis with some pretty creative and supportive. I’m copying a NY Times report in this episode’s newsletter that goes into detail into Canada’s response and is really cool so be sure to check that out.

Prisons

Now let’s touch on prisons. There are ton of health issues related to our prison system, and this month saw quite a bit of them pop up in the news so I thought it would be something interesting to talk about.

Let’s start off with medical care in prisons, I’m sure you’ve seen in movies, prisoners don’t have the best access to care and then care they get often times isn’t the best. In Oregon this month, an inmate had to go as far as faking a suicide just so they could get care for a serious infection, because inmates in the prison couldn’t get treatment for days because of healthcare workers staffing shortage in the prisons. In an inspection by the Federal Bureau of Prisons, the same prison showed long waiting times for mental care, drugs, dental services, and other medical services. Truth is that this is just one example but similar cases are happening everywhere.

Now let’s talk solitary confinement, The Prisoners’ Rights Project, a group that advocates for humane conditions in prisons in New York released a report this month that prisons are putting mentally ill and disabled in solitary cells. Thing is, two years New York banned the use of long term solitary for the mentally ill but it seems like prison officials aren’t following that and putting patients in there for hours on end. You can probably see how solitary confinement and mental disabilities don’t go really well together. The report even noted that inmates tried to harm themselves just so they would be let out of the cell. And hear this, half of all suicides in NY prisons are in solitary.

And mental illness and prisons are nothing new. Turns out that prisons are actually the number one provider of inpatient mental health care in the US. Number one in terms of numbers of patients not quality. The Treatment Advocacy Center estimated that we now have 10 times as many seriously mentally ill patients in prisons as we do in hospitals. So you pair this huge number of patients with most prisons being poor equipped to treat them, and you see how prisons should be the center of mental health care discourse in America.

Since we’re in the topic of prisons right now, I also want to talk about a nurse that got sentenced to prison. Yep, you heard that right. This month, a nurse in Pennsylvania got sentenced to life in prison after she admitted to trying to kill 19 patients and gave 22 patients excessively large doses of insulin - 17 of those patients died. Now how she got away with all of that goes way over my head. How does it take 17 deaths for people to notice? How could she keep practicing for so long? This piece was really disappointing to read.

Bird Flu

But let’s move on to the bird flu pandemic, and things here are not much better. In fact, this month, we saw the second and third cases of bird flu in our farmworkers. The third worker is the first to show respiratory symptoms.

The CDC still says that the risk of the virus becoming a public threat is low, but that doesn’t mean people aren’t getting worried. Similarly to what happened with the covid virus, new mutations of the bird flu virus have been identified. None of them seem to able to infect humans well, but it’s definitely a topic to worry about because a by chance alone, a mutation could happen at some point that makes the virus more easily transmitted to and between humans.

But for the current state of the virus, there are now 68 dairy herds affected by it. Last month, that number was 36. So it almost doubled this month. A lot of this can be attributed to the movement of animals between farms and across state lines. I don’t know if you’ve even seen one of those trucks carrying live chicken but it doesn’t look like the best place to stop the spread of the virus.

And the thing is, since the bird flu seems unlikely to become a human pandemic, tracking of the virus is significantly below par. There is little testing on farms to see who or what may be infected, however, the FDA did announce this month that pasteurized milk is free of any live forms of the live virus and they recommended against consuming any raw milk. There was also a study published in The New England Journal of Medicine this month showing that raw milk with the bird flu virus made mice sick, and I know we can’t extrapolate that to humans, but personally, I’m gonna stay away from it. On a positive note about the virus, the Biden administration passed legislation to provide up to $28,000 to dairy farms to cover any costs of protecting farmers, testing, and treating sick cows, so let’s hope that this helps preventing the spread of the virus.

UHG Health Data Cybersecurity

The UnitedHealth data breach has emerged as a significant cybersecurity incident, compromising sensitive data of potentially one-third of Americans. Here's a detailed breakdown based on the three articles provided:

Background and Incident Details

Breach and Initial Response:

• The breach occurred in February 2024, targeting UnitedHealth’s subsidiary, Change Healthcare.
• Hackers infiltrated the system through a Citrix remote access portal lacking multifactor authentication, a basic security measure.
• The intruders, believed to be associated with the BlackCat cybercrime group, pilfered data for over a week before deploying ransomware.
• The attack encrypted Change Healthcare's systems and locked backup files, severely disrupting operations.

Congressional Hearings and CEO's Testimony

Senate Finance Committee Hearing:

• On May 1, 2024, UnitedHealth CEO Andrew Witty testified before the Senate Finance Committee.
• Lawmakers criticized UnitedHealth for inadequate cybersecurity defenses and questioned why a critical server was left unprotected.
• The breach potentially impacted over 100 million people, disrupting billions of dollars in medical payments.
• Senator Ron Wyden highlighted the company’s failure in both preventing the attack and securing backup systems.

Details from the Testimony:

• Witty revealed that the ransomware attack dented UnitedHealth’s profit by up to $1.6 billion.
• UnitedHealth paid a $22 million ransom, one of the largest in history, to protect patient data, although it's unclear if all stolen data was retrieved.
• Lawmakers, including Senator Elizabeth Warren, raised concerns about UnitedHealth's size and its implications for systemic risk in the healthcare sector.
• Witty defended the company’s response as "swift and forceful," stating that systems were rebuilt on cloud-based infrastructure.

Ongoing Uncertainties and Data Recovery Issues

Unclear Data Status:

• Despite paying the ransom, it remains uncertain whether hackers still possess the stolen data.
• Cybersecurity experts noted a schism within the BlackCat group, with an affiliate claiming to still have Change Healthcare data.
• A secondary extortion attempt by another group threatened to leak patient records unless a new ransom was paid.

Law Enforcement and Policy Implications:

• The FBI and cybersecurity experts caution against ransom payments, arguing that criminals cannot be trusted to delete stolen data.
• UnitedHealth’s experience underscores the unpredictability of ransomware outcomes and the potential for re-extortion.
• Senator Wyden announced plans to draft legislation to enforce stricter cybersecurity standards, particularly for larger companies like UnitedHealth.

Patient Notification and Regulatory Actions

Notification Delays:

• Federal law mandates healthcare providers to notify individuals if their data is breached. However, the complex data ecosystem of Change Healthcare, which handles claims for numerous entities, complicates direct notification.
• The Department of Health and Human Services (HHS) stated that providers could delegate notification responsibilities to UnitedHealth.
• More than three months post-breach, the process of notifying affected individuals remains unresolved.

Regulatory Stance:

• Melanie Fontes Rainer, director of the HHS Office for Civil Rights, emphasized the need for direct notifications rather than passive announcements on websites.
• The agency aims to ensure that affected individuals are adequately informed about the breach and its potential impact on their personal health information.

Conclusion

The UnitedHealth data breach highlights significant vulnerabilities in healthcare cybersecurity, raising concerns about corporate responsibility, regulatory oversight, and the effectiveness of current defense mechanisms against sophisticated cyberattacks. The incident has sparked legislative initiatives aimed at bolstering industry standards and protecting sensitive health data from future breaches.

IVF, Abortion, and Maternal/Child Health

With that, now let’s move on to the fast paced section of this month’s news episode. Here I’ll just be listing things that happened this month in the healthcare field, and I encourage you to search more about anything that interests you.

Starting off, let’s talk about IVF, abortion, and maternal and child health. In Louisiana, abortion is already banned, but this month lawmakers passed legislature to make the possession of abortion medicine a crime - meaning that you could literally go to jail for having abortion pills.

This month, there was a really interesting article in the Washington Post titled “The South can be a dangerous place to be Black and pregnant.” The article even highlights data from the Kaiser Family Foundation, showing that Arkansas has a maternal mortality rate 4 times higher than that of California. I definitely recommend that you check it out, and I am gonna be linking it in our newsletter.

And did you know that Aspirin can help women at risk of pre eclampsia? I didn’t, and turns out most doctors don’t talk about it, but the US Preventative Services Task Force has been recommending it for 10 years.

On to child health, a study in the New England Journal of Medicine suggested that babies exposed to peanuts were less likely develop a peanut allergy later.

For children, there is also a worrying trend - widening racial disparities in child deaths. A new study in The Journal of the American Medical Association saw that between 2014 and 2020 death rates went up by 37% for blacks, 22% for Native Americans, and less than 5% for whites.

Another worrying trend is that drowning deaths among children seem to be going up according to a CDC Vital Signs report.

Surgery and Medical Procedures

Now let’s talk about surgery and medical procedures.

Sadly, Richard Slayman, the guy that had received that kidney from a genetically edited pig that we talked about in March news, passed away. Apparently the transplant was not related to his death, so program is planned to continue.

A study in the Journal of Neurotrauma this month that we may be ending life support care too early. The study looked at 80 patients that died care was withdrawn and 80 patients in similar conditions where care wasn’t withdrawn and 42 percent turned out to recover to some extent - a few to even go on an live a normal life.

We’ve talked quite a bit about colon cancer inn these news episodes since cases seem to rise and are happening earlier and earlier in people’s lives. This month, a meta-analysis in JAMA Network Open, outlined some of the early signs of possible colon cancer. They were blood in the stool, abdominal pain, changes in bowel habits, and anemia.

On a positive note, an expert committee that advises the FDA endorsed colon cancer blood test. The test, called The Guardant Health Shield Test, is definitely not the same as a colonoscopy but it can be a lot better than getting no screening at all.

Mental Health

Now let’s move on to mental health.

After a bunch of crimes have been reported in NYC subways, one of the ways authorities are dealing with this is by kicking out mentally ill homeless people from subway stations. They are seen as a threat to safety by many after a mentally ill homeless man pushed Michelle Go into the tracks leading to her death. But we have to figure out if these measures are good or if they do more harm than anything else.

Another measure to combat this issue could be the implementation of the “Michelle Go Act,” named after the woman that died. The act would expand medicaid funding to support psychiatric beds for many of the mentally ill in the subways, and it might be a better way to deal with them because then we’re also helping to treat them and not just kicking them out.

This month, another study by the Jama Network Open showed that PTSD seems to be rising in college students. In 2022, for example, the prevalence of PTSD among them was 7.5%, which is more than double the prevalence of PTSD 5 years ago. Most of these are attributed to “societal stressors.”

Viruses and Bacteria

Now let’s talk about viruses and bacteria. We had a whole section on the bird flu, but that’s not all that’s happening right now.

Monkeypox was a problem in 2022, especially among gay men. Now, turns out there is an even deadlier version of the virus devastating the Democratic Republic of Congo. Even though this version of the virus hasn’t been found outside of Africa yet, the growing epidemic in Congo only makes the likelihood of that higher.

And remember the dengue outbreak in South America that we’ve been talking about in the past few news episodes? Well turns out it’s not just in South America anymore. In Florida, there have already been 164 reported cases of the virus, that’s double what we had at the same point last year. This happens because Florida is such a hotspot for international travel to and from South America, and most of the cases are actually linked to international travel.

On a positive note, the FDA approved a self administered screening for HPV, a virus that causes cervical cancer. This could significantly increase access to screening.

This month, the Biden administration suspended funding for EcoHealth Alliance, a nonprofit involved in virus research with Chinese scientists, after allegations of misrepresenting work related to Covid-19. The decision, citing delayed reporting and possible grant violations, comes despite no direct evidence linking EcoHealth to the origin of the pandemic, but both Republican and Democrat lawmakers seemed to support the suspension.

New Research, Studies, and Milestones

Let’s touch on some cool studies and new research that came out this month.

In Alzheimer’s Disease, the APOE4 gene variant has long been known to be a risk factor. I actually do research on the APOE gene at Georgetown, so I’ll probably end up recording a full episode on it but this study this month suggests that this gene variant could be not just a risk factor but a cause of many cases of Alzheimer’s Disease, making this new subtype of Alzheimer’s caused by the APOE4 gene one of the most common genetic disorders, which could also mean gene therapies in the future.

In Washington D.C. this month, a 12 year old boy is the first to start the gene therapy treatment for sickle cells that was just approved by the FDA. This is a really exciting milestone and could be a way to cure the 20,000 people across the US that qualify for the treatment.

A new study published in the JBMR showed that hip fractures are actually more deadly for those elderly over 66 years old than even some forms of cancer. My episode coming out this month with Dr. Maria Fiatarone Singh talks a lot about the importance of exercise at old age to prevent these fractures so be sure to check it out on June 20th.

This month, the youngest child ever has become the first to get close to “normal hearing levels” in a gene therapy trial for genetic deafness. This is one more really exciting trial to keep an eye on these coming years.

The Office of Inspector General, which is part of the Department of Health and Human Services put out a report this month saying that most NIH funded clinical trials missed both gender and racial diversity goals and underrepresented certain groups. It’s long been known that historically women and African Americans were misrepresented in studies and this had significant clinical outcomes so it’s pretty sad to see that it’s still happening.

Drugs and Alcohol

Now in drugs and alcohol this month there were actually two really interesting studies this month.

A study published in the JAMA showed that instates that have legalized weed, adolescents were actually less likely to use the drug than in states where it was legal.

Another study published by the Society for the Study of Addiction found that weed became common than alcohol for daily use. Even though there are still many more people that drink than people that use weed, there are more daily users of weed than there are daily users of alcohol, which at least for me was pretty shocking to hear.

Climate and Environment

For the climate and the environment, the new NYC congestion pricing could bring cleaner air to the city. Some people do worry that it will lead to more car pollution outside of the congestion zones.

A new study in the journal Science Advances found that cooking with a gas stove is a health risk in itself, but turns out this risk isn’t evenly distributed. Households making under $10,000 a year are exposed to twice as much pollution as those making over $150,000 a year.

And a meta analysis published in Nature this month found that biodiversity loss, chemical pollution, climate change, and introduced species are all associated with harm caused by infectious diseases.

Global Health

In global health this month, the Philippines announced a significant shortage of 190,000 healthcare workers.

In the UK, Prime Minister of Britain Rishi Sunak apologized for one of the most tragic health failures in the country’s history. Over 30,000 people in the country were infected by infected blood in healthcare facilities and these could have been avoided. 3,000 died as a result of these infections and the burden of it all is placed in the healthcare system, which if more careful could have prevented them.

The World Health Assembly in Geneva happened this month, but turns out countries still were not able to reach consensus and unify in strategy to combat the next pandemic after Covid.

Business

Now let’s talk business.

Pharmaceuticals

Starting with pharmaceuticals, the FDA approved a drug to treat small cell lung cancer, which is a very deadly form of cancer affecting around 35,000 people a year in the US. The drug, by Amgen, was shown to triple patients’ life expectancy.

A Bayer drug showed pretty positive outcomes this month. The drug, which is in late stage trials for menopause treatment, was shown to reduce hot-flashes and sleep disturbances and increased overall quality of life during menopause.

GLP-1 drugs

Now let’s focus on the GLP-1 market, and always, there are a ton of developments here.

First off, a couple of studies this month continue to show the promising potentials of these drugs. Wegovy, for instance, was shown to reduce the risk of heart attack and strokes even if the patient even controlled for a patient’s weight.

Another study found that Ozempic significantly reduced the risk of death in a kidney disease study.

And yet another study showed that Wegovy was linked to lower risk of alcohol use disorder. This all comes to show the potential of these drugs and how they soon may be prescribed for a lot more than diabetes and losing weight.

However, one of the problems we will continue to face is that many patients that start the drug actually get off of it within a month. Blue Cross Blue Shield said that 30% of people prescribed it stopped taking it in the first month - way too early to see any results.

Another problem is of course the price of these drugs. Arguments have been brewing everywhere about this, and in Denmark, for example, doctors have been asked to move patients to cheaper forms of Ozempic. They announced that public subsidies will not be used for GLP-1 drugs unless there aren’t any other alternatives.

In the US, especially, the pricing of the drug is a problem, and Senator Sanders has been very vocal about it, pressuring Novo Nordisk to cut prices in the US or saying that it will ruin the US healthcare system, with estimates that we will have spent $1 trillion on weight loss drugs by the next decade. And remember, these drugs could be made by less than $5, yet Novo charges $1,349.02 each month for Wegovy and $968.52 for Ozempic. Now take that and the fact that 1 in 8 Americans have already taken a GLP-1 drug and you see how it can be a burden for our healthcare system.

But these GLP-1 companies don’t seem to be slowing down, they are trying as hard as they can to meet the demand. Eli Lilly just invested $5.3 billion to boost their weight loss drug supply.

Medical Devices, Biotech, and AI

Now let’s move on to medical devices, biotech, and AI, which always have pretty interesting news brewing.

DeepMind, an artificial intelligence company owned by Google released a new iteration of their tool for predicting protein structures, revolutionizing drug discovery and biology research, called AlphaFold 3. CEO Demis Hassabis envisions AlphaFold becoming a $100 billion business as they could partner with companies like Eli Lilly and Novartis to improve drug discovery.

And now remember that Australian scientist that we talked about last month, Richard Scolyer - the one that treated his brain cancer with an mRNA vaccine? Well, further research continues to show promising results for a potential mRNA vaccine for cancer, with initial trials in lab mice, pet dogs, and four glioblastoma patients showed increased survivorship, prompting a larger clinical trial to validate these findings and explore applications for other cancers.

Medicare/Medicaid and Health Insurance

Now let’s talk health insurance and medicare/medicaid.

Mississippi’s hopes of expanding Medicaid this month went downhill when state lawmakers failed to reach a compromise in the beginning of the month.

Senators are beginning to worry about MultiPlan, remember that business that we talked about last month which helps health insurers cut costs by suggesting a price they should pay for procedures and leaving the rest for the patient? Well, yeah, some government officials don’t seem very fond of their business model so they’ve called on them to explain what they do and why they do it.

Health insurance stocks fell this month after UnitedHealth Group reported a "disturbance" since states began to reduce Medicaid enrollees after the pandemic. As people leave Medicaid, insurers face pressure to ensure state reimbursements cover medical costs. This adjustment may take several quarters, according to UnitedHealth CEO Andrew Witty. Stocks of Medicaid-focused insurers like Centene Corp. and Molina Healthcare Inc. dropped over 8%, while UnitedHealth and Humana Inc. fell up to 6%.

Politics

Now let’s finish off with a brief politics section here. Trump, this month, first said he was open to restricting access to birth control but now says the opposite, supporting the access of birth control.

In transgender care, Dr. Hilary Cass, a prominent English pediatrician, published a report leading to restrictions on youth gender care in Britain, citing "remarkably weak" evidence for using puberty blockers and hormonal medications in adolescents. Despite her findings aligning with several European countries, U.S. medical groups, like the American Academy of Pediatrics and the Endocrine Society, maintain support for gender-affirming care, emphasizing its necessity and evidence-based support.

In more gender care news, South Carolina's Republican governor, Henry McMaster, signed a bill banning gender-transition surgeries, puberty blockers, and hormone treatments for minors. The law, effective immediately, also mandates school staff to inform parents if children wish to use a different name or pronouns. This legislation makes South Carolina one of about two dozen states with similar restrictions.

Outro

And with that, we come to the end of May 2024 healthcare news. If any news that I mentioned particularly interests you, feel free to shoot me a message on one of our social media platforms, and I would love to chat with you there. And once again, please leave your feedback so that we can work on making the show better, and don’t forget to rate the show on your podcast listening platform, that’s really important for us to keep pumping out quality content. Also, make sure to check our newsletter which is basically the show notes of our monthly healthcare news podcast episodes.

I’ll see you guys for another healthcare news episode next month. And for now, stay curious, stay informed, and most importantly, stay healthy.