Category Archives: Public policy
Arthur Kellermann, MD, MPH, an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars and Health Policy Fellows programs, is professor and dean of the F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD. He is co-author of the new RAND report, “Redirecting Innovation in U.S. Health Care: Options to Decrease Spending and Increase Value.” Here, he shares recommendations for a brave new world of medical technology.
Americans take justifiable pride in our capacity for innovation. From putting the first men on the moon to developing the Internet, we lead the world in developing innovative technologies. Health care is no exception. The United States holds more Nobel prizes in medicine than any other nation.
Novel drugs, biologics, diagnostics, and medical devices have transformed American health care, but not always for the better.
Some innovations have made a big difference. Combination antiretroviral therapy changed HIV infection from a death sentence to a treatable, chronic disease. Before an effective vaccine was developed, Hemophilus Influenze type b, a bacterial disease, was a major cause of death and mental disability in young children. Today, it is virtually eradicated here and in Western Europe.
Michelle Mello, JD, PhD, is a professor of law and public health at the Harvard School of Public Health, and a fellow with the Edmond J. Safra Center for Ethics at Harvard University. She is a recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research.
For years, pharmaceutical companies have been lambasted in the media and government prosecutions for concealing information about the safety and efficacy of their products. In one particularly splashy example, GlaxoSmithKline (GSK) agreed to pay $3 billion in 2012 to settle criminal charges that it failed to report safety data concerning its antidepressant drug, Paxil, and its diabetes drug, Avandia, and engaged in unlawful marketing of these products and one other drug. One mechanism proposed for avoiding such problems is to establish a system through which participant-level data from clinical trials, stripped of identifying information about patients, would be available to the public.
A potential benefit of sharing clinical trial data would be that independent scientists could re-analyze data to verify the accuracy of reports prepared by trial sponsors, which might deter sponsors from mischaracterizing or suppressing findings. Data sharing would also allow analysts both within and outside drug companies to pool data from multiple studies, creating a powerful database for exploring new questions that can’t be addressed within any given trial because the sample is too small to support such analyses.
The potential value of shared data in improving our understanding of the safety and efficacy of drugs, medical devices, and biologics has sparked considerable discussion about how to make data sharing happen. Earlier this year, the European Medicines Agency—the counterpart to the U.S. Food and Drug Administration (FDA) in the European Union—decided to start making data from trials of approved products available in 2014. This begs the question, should the FDA follow suit?
I spent almost a month in Bangladesh producing a story starring Michael C. Hall for the last episode of the Years of Living Dangerously, a documentary series on climate change. In this blog post, I’m going to tell a story that came up in the research phase and one that highlighted, for me, what is possibly the biggest obstacle to getting anything done on this issue.
As someone who’s been studying social movements for a long time, I’ve seen that social change hinges on the tangibility of an issue and sometimes how well you can prove its existence. Yet, most scientists say climate change is invisible, that no one event can be pointed to and called an impact of climate change.
Working on the Years series highlighted this issue all the more since TV and film must show more than it tells. I was in a particularly difficult position trying to tell stories about climate change as a scientist, being bound by this adage that we can’t see it. Yet, when I went to Bangladesh, that adage stopped making sense. It’s not that my scientific mind retreated, but rather that my imagination was able to connect the dots of science in a way it couldn’t without putting science in a specific context, a place where people might already be affected.
National Nurses Week just ended, but several nurses are continuing the conversation, blogging about the reasons they aspire to leadership. Chelsea Savage, RN, MSHA, CPHRM, is a professional liability investigator at Virginia Commonwealth University Medical Center in Richmond, Va., and was recognized in 2011 as a young nursing leader by the Virginia Action Coalition.
Like many nursing advocates, I internalized my interest in social justice through my personal history. I was raised by a single mother on welfare, and my childhood had the added stress of an educational disadvantage. My mother, motivated by strong religiosity and the isolation from society characteristic of this construct, took me out of school in sixth grade and forced me into a passive homeschool process. I was given curricula, but not a teacher, so I taught myself and passed the General Educational Development test, better known as the GED, at 15.
I was introduced to nursing while volunteering at a hospital for two–and-half years and pursued an associate’s degree in nursing (ADN) for a year at age 16. Later, though, I dropped out of the ADN program. At 26, then a step-mom of three and a biological mom of one, I went back and earned my nursing degree.
Having said goodbye to my cultish upbringing, I was now driven by an insatiable curiosity and felt limitless educational potential. I went on to pursue a bachelor’s degree in philosophy, a graduate degree in health administration, and a fellowship in health law. I am now earning my doctorate in nursing practice (DNP) and am seen by some as a nursing leader.
For National Nurses Week, two nurses who serve in the U.S. House of Representatives share their views on nurse leadership with the Robert Wood Johnson Foundation (RWJF) Human Capital Blog. Lois Capps, D-Calif., has served in the House since 1998; and Diane Black, R-Tenn., since 2011.
Capps: We Must Increase Our Nursing Workforce
Human Capital Blog: Prior to running for Congress, you worked as a nurse and a nursing instructor. How does your background as a nurse help shape your agenda on Capitol Hill?
Rep. Lois Capps: When I began my career as a nurse, I never imagined I would become a member of Congress. But when my husband passed away shortly into his first term in Congress, I was encouraged by my friends and neighbors to run, and I won the seat in a special election. Despite the fact that nurses and other health care professionals often never think about engaging in policy-making careers, I knew my experience as a nurse would make me a great advocate for the health community in Congress. Just as nurses are the best advocates on behalf of our patients, we are naturally inclined to be the best advocates on behalf of our patients in the Capitol.
HCB: You have made addressing the nursing shortage a priority. What has Congress done so far to address past shortages, and what needs to be done to curb future ones?
Susan B. Hassmiller, PhD, RN, FAAN, is senior adviser for nursing at the Robert Wood Johnson Foundation, and director of the Future of Nursing: Campaign for Action.
I flew to Florida years ago to be with my father at the end of his life. He lay in a hospital bed, at times conscious of the family members gathered at his side and other times unaware of his loved ones surrounding him. I watched a nurse I didn’t know lean over and kiss his forehead.
At another hospital bed years later, I watched a nurse comfort my daughter as she labored to bring my first granddaughter into the world. “You’ll be okay,” she whispered to my daughter, giving her a hug.
The end of life and the beginning of life, marked by a compassionate nurse keeping vigil and offering comfort. In the midst of machines, a nurse provides a human touch and caring to patients and their family members.
The essence of caring is what first attracted me to the nursing profession. Now, more than 35 years later, the essence of caring still propels me in my work as the director of the Future of Nursing: Campaign for Action, a joint initiative of RWJF and AARP to transform health through nursing. One of the Campaign’s major focus areas is promoting nursing leadership.
RWJF Scholars in the News: How breast cancer treatment affects patients’ lives, nurses improving mental health care, male victims of sexual assault, and more.
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
Experts are looking at how treatment for breast cancer affects patients’ lives, HealthDay reports. A study by Reshma Jagsi, MD, PhD, an RWJF Physician Faculty Scholars alumna, finds that women who undergo chemotherapy treatment for breast cancer are more likely to end up unemployed than patients whose treatment does not include chemotherapy. Four years after treatment for early stage breast cancer, the study found, more than one-third of those who had chemotherapy were out of work, compared to just over one-quarter of women who had other treatments. “Many of us realize the chemotherapy is going to knock the wind out of your sails temporarily. We [as doctors] have tended to assume women bounced back, and the results here suggest that’s not the case,” Jagsi said. The HealthDay article was republished in U.S. News & World Report, WebMD, and Medicinenet.com, among other outlets.
In the latest edition of the Health Affairs “Conversations” podcast series, Sherry Glied, PhD, recipient of an RWJF Investigator Award in Health Policy Research, discusses lessons learned from the first open enrollment period of the Affordable Care Act. She and other experts also discuss Medicaid expansion, and payment and delivery reforms.
Children of single mothers who unexpectedly lose their jobs suffer severe negative repercussions well into their adult years, according to a study co-authored by Jennie Brand, PhD, MS, an RWJF Health & Society Scholars alumna. They are less likely to graduate from high school and college, and more likely to endure depression, the LA Times reports. Additionally, “[t]he kids, by virtue of having less education and having some social psychological issues, could themselves be at greater risk of job loss in the future,” Brand said. “That’s a concern too, that we could potentially see an inter-generational transmission of job instability.”
Mary Wakefield, PhD, RN, is administrator of the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services.
Most nurses can reflect on their careers and see multiple pivot points—times when decisions were made that directly shaped their professional trajectory. For some, those decisions were carefully planned and executed with an aim of staying in the boundaries of traditional and very meaningful nursing roles.
That, however, wouldn’t characterize my career path. Serendipity, willingness to operate at the edge of one’s comfort zone, seeing the relevance of nursing knowledge in non-nursing settings, and cultivating a mix of expertise and breadth of relationships in and outside of health care were all key to the path I took and most of the positions I’ve held.
Nurses may end up in very different places, but my bet is that we start from similar beginnings. For me, the appeal of nursing took root when I was still in high school, working part time in a small rural hospital and a nursing home in my hometown of Devils Lake, North Dakota. I remember clearly rushing five minutes across town to work occasional back-to-back shifts from evenings at the nursing home to night shifts in the hospital.
In recent years, millions of Americans have had medical devices implanted in their bodies—artificial hips and knees; pins, rods and screws used to support fractured bones as they heal; stents that help carry blood from the heart; and more. The U.S. Food & Drug Administration is charged with regulating the devices for safety and effectiveness, but in the latest Robert Wood Johnson Foundation (RWJF) Clinical Scholars video podcast, Sharon-Lise Normand, PhD, explains that the United States lacks a device identifier system that would help track the specific devices implanted in patients. Such data would be invaluable in cases of product recalls, as well as to gauge effectiveness. In the podcast, David Grande, MD, MPA, Associate Director of the University of Pennsylvania's RWJF Clinical Scholars program, interviews Normand about her work with the FDA to build a tracking database.
Normand is a professor of health care policy (biostatistics) in the Department of Health Care Policy at Harvard Medical School and in the Department of Biostatistics at the Harvard School of Public Health. The video podcast is part of a series of RWJF Clinical Scholars Health Policy Podcasts, co-produced with Penn’s Leonard Davis Institute of Health Economics.
The video is republished with permission from the Leonard Davis Institute.