By David Introcaso, Ph.D.
The podcast currently has 302 episodes available.
Beyond roughly 1,700 NFL players, five to six million children participate in tackle football. As a collision sport, brain (or TBI) and other neurological, bone, joint, ligament, muscle, organ and tendon injuries are commonly occur and frequently develop into long-term chronic conditions, particularly chronic pain. Not surprisingly, the avg life expectancy of an NFL lineman - who played as few as one game - is just 55 years of age. Prof. Goldberg’s book examines how the NFL has for decades masterfully, successfully employed a set of strategies or scripts termed the “Manufacture of Doubt,” to avoid governmental regulation. The NFL’s success constitutes a an ongoing serious public health problem in it circumvents the precautionary principle upon which the entire field of public health is based - that is precautionary measures should be taken in the presence of a high stakes human health hazard even if definitive proof is lacking.
Information concerning Prof. Goldberg book is at: https://www.press.jhu.edu/books/authors/daniel-s-goldberg.
Harvard Chan School of Public Health’s Dr. Troy Brennan argues in sum that because government Medicare, Medicaid and ACA marketplaces have grown and evolved, meaning the feds have improved their ability to competently regulate the healthcare market, employer-sponsored commercial plan coverage has become both comparatively unaffordable and increasingly irrelevant. Primarily for these reasons Dr. Brennan argues the US is headed toward or on the path to federally-sponsored and regulated healthcare administered by private or commercial payers. That is it appears increasingly likely the US will finally realize universal, socialized, single payer healthcare insurance or what he defines as Medicare For All, or more specifically Medicare Advantage for All in which commercial insurance plans serve a strictly administrative role.
Dr. Brennan’s book can be found at: https://www.press.jhu.edu/books/title/53759/transformation-american-health-insurance.
This century drug overdose deaths have equaled roughly 1.1 million largely due to overdose deaths among men that increased from 15,000 to 80,000. As Dr. LeBaron notes drug overdose fatalities this century have exceeded the sum of all service member deaths in all wars in US history. The vast majority of drug overdoses were opioid related that, e.g., increased from 50,000 to 82,000 between 2019 and 2022. While opioid drugs have been available for decades, the opioid - or the opioid use disorder epidemic is strongly correlated with opioid prescribing. As Dr. LeBaron notes between Purdue Pharma’s 1996 introduction of OxyContin and 2010, opioid prescriptions and overdose deaths increased fourfold, or in almost exact parallel. The CDC, only agency charged with controlling epidemics, published in 2016 its “Guideline for Prescribing Opioids for Chronic Pain in the US.” Tragically, the guideline was quickly weaponized, by payers and states. This led to significant decreases in prescribing that in turn led to dramatic increases in undertreated pain and not surprisingly increased suicides. In 2022 CDC updated its opioid guideline but as Dr. LeBaron notes in his conclusion reduced prescribing without improvements in prevention and treatment programming will backfire. Though the CDC last month announced preliminary data showing drug overdose deaths may have dropped by 10% or to 70,000 over the 12-month period ending this past April, the epidemic continues largely unabated.
Climate denial remains rife in the US. For example, in Washington, D.C., nearly 25% of the current members of Congress are, via their public statements, climate denialists. As for Health and Human Services (HHS), the department has steadfastly refused to promulgate any regulations to mitigate the healthcare industry’s massive carbon footprint that, for example, amounts to well over four times the annual cumulative greenhouse gas emissions of Exxon, Marathon Petroleum, Phillips 66, Chevron and BP.
In his just-published book Tad Delay provides an unsparing assessment of “the vast arsenal of denial that we rarely ever talk about,” i.e., “the scams, lies and misinformation that sustain the degradation of people and planet.” As I note during the discussion, Delay’s work can be read in context of Wainwright and Mann’s 2018 work, “Climate Leviathan” also published by Verso.
See: https://www.versobooks.com/products/2857-future-of-denial?srsltid=AfmBOoqF3FkLO1Aa5HBJhDrdFBE2ssKju6LOOjW0Og1x4l0YOE59Cup3
In the recent past, hunger, food insecurity and malnutrition have (re)gained policymakers’ interest largely due to the COVID pandemic and accelerating climate breakdown – that has among other things reduced the growth of global agricultural production by 30-35%. As a result, last year 2.8 billion of the world’s population could not afford a healthy diet. In the US, over 40 million Americans receive food assistance via the federal Supplemental Nutrition and Assistance Program (SNAP) in large part because grocery prices have increased by over 20% since 2021. Poor diet has long been known to be responsible for innumerable causes of disability and death. For example, the number of states with an obesity rate at or above 35% doubled over the past five years to 19. One in 10 Americans have diabetes and one in three will be diagnosed with cancer, both of which are related to poor diet. Diet-related diseases also help explain high US COVID morbidity and mortality rates.
Information concerning West Side Campaign Against Hunger’s efforts is at: https://www.wscah.org/.
Recently published research regarding the association between food security, health and dietary factors discussed during this interview is at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10857290/.
In late 2020 the Congress passed the No Surprises Act largely intended to address patient “surprise,” or out of network bills, typically the result of ER visits. Should settlement between the healthcare provider, e.g., hospital, and insurance company fail, the bill created an arbitration, termed Independent Dispute Resolution (IDR), process. To date the number of disputes going to arbitration have vastly outnumber those expected, the vast majority of provider-initiated disputes have been curiously backed by private equity, arbitration settlements takes take more than twice as long than the statutory limit, providers have been winning 75% plus of arbitrated cases and the median arbitration reimbursement is nearly four times what the Medicare program pays.
With me to discuss the topic is Nathan Martinez, an Arizona-based healthcare claims software developer.
During this interview we mention an April 2024 New York Times article that discussed efforts by insurers to reap, or game, greater out of network reimbursement. The article is at: https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills.html.
Over the past four decades the US has, per a 2019 JAMA-published study, made a “clear lack of progress on health equity.” Health equity or disparities have almost certainly worsened over the past five years due to COVID and accelerating climate breakdown. For example, air pollution in 2021 killed over 8 million globally including 2,000 children under age five daily. Foul air, nearly entirely the result of fossil fuel combustion, is 2nd only to malnutrition and hypertension as a risk factor for death among children and adults, respectively. In late May, HHS’s Centers for Medicare and Medicaid Services (CMS) hosted only its second annual health equity conference. Conference planners however ignored air pollution - as does CMS’ “Framework for Health Equity, 2022–2032” report. (Despite the fact I’ve produced this podcast for 12 years conducting over 300 interviews this, sadly, is my first interview with a student-led research group. I welcome learning of related efforts.)
Students interested in participating in the Health Disparities Think Tank are encouraged to review their website at: https://www.hdtt.org/.
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Mr. Burger joins me to discuss climate crisis-related litigation here and abroad and its effectiveness in curbing greenhouse gas emissions. Dedicated listeners may recall I interviewed Mr. Burger in May 2020 regarding the Trump administration’s unwinding of numerous environmental regulations.
Michael Burger is the Executive Director of the Sabin Center for Climate Change Law at Columbia University. Prior to, he was an associate professor at Roger Williams University School of Law and served as an attorney in the Environmental Law Division of New York City’s Office of the Corporation Counsel. He is a co-founder and member of the Environmental Law Collaborative, the incoming chair of the New York City Bar Association International Environmental Law Committee and is a widely-published scholar, a frequent speaker at conferences and symposiums and a regular source for media outlets. Mr. Burger graduated from Columbia Law School, Brown University and holds a MFA from NYU.
Per my noting Sabin provides a monthly climate litigation update, their June report is at: https://climate.law.columbia.edu/news/june-2024-updates-climate-case-charts.
Climate-related health effects are typically defined or limited to those resulting from extreme weather events, exacerbations of chronic disease and increases in vector borne diseases. Unfortunately, very little attention or even recognition is afforded the effects the climate crisis has on brain health largely via climate-fueled neurotoxin exposure. Mr. Aldern’s valuable if not indispensable work attempts to explain how the climate crisis infuses our air and water with neurotoxins that increase the range of brain disease vectors and spur PTSD and other psychiatric conditions that can spread intergenerationally.
Clayton Page Aldern is a senior data reporter at Grist. A neuroscientist turned environmental journalist, he holds a master’s in neuroscience and a master’s in public policy from the University of Oxford, where he studied as a Rhodes Scholar. He is also a research affiliate at the Center for Studies in Demography and Ecology at the University of Washington. Information on “The Weight of Nature,” is at: https://www.penguinrandomhouse.com/books/717097/the-weight-of-nature-by-clayton-page-aldern/.
In Dobbs v. Jackson Women’s Health Organization, the Supreme Court in June 2022 reversed the court’s previous 1973 Roe v Wade decision, and 20 related cases, wiping out a half century of constitutional protections for women’s reproductive rights. In Dobbs, the court found the Constitution now excludes a woman’s control over her body as well as the possible continuation of her life. Compelled pregnancy, involuntary childbirth and forced parenthood is not, the court ruled, an essential part of the “liberty” protected under the 14th amendment - or presumably even the freedom of “involuntary servitude” protected under the 13th amendment. Dobbs effectively demotes women to the status of an involuntary vessel entitled to no more respect than other forms of collectively-owned property. Since some have termed the Dobbs decision a “break the glass” moment, Ms. Hoffman has published her “post-Roe abortion rights manifesto,” that leverages her five decades of reproductive rights work to shed light on the repercussions of overturning Roe and work she believes now needs to be done, or redone, to ensure the safety and legality of reproductive rights.
Ms. Merle Hoffman is an American author, activist, feminist health care innovator who established one the first abortion clinics in the US, CHOICES Women’s Medical Center in Queens, New York. CHOICES also provides prenatal care, all-options counseling, GYN visits, mental health services, and trans health services. Ms. Hoffman was the publisher and editor-in-chief of On the Issues magazine (1983–99) and is also the author of Intimate Wars (Feminist Press, 2012). She is the cofounder of the National Abortion Federation.
Information on Ms. Hoffman’s book is at: https://www.skyhorsepublishing.com/9781510776951/choices/.
The podcast currently has 302 episodes available.