A TYPICAL DAY ON CAPITOL HILL

It should come as no surprise that having 535 federal legislators representing a wide range of political beliefs and opinions on any given day would provide a vibrant scene for the exchange of opposing ideas on how best to address the wide ranging needs of the U.S. citizenry. Adding to the zest is the fact that the House of Representatives currently is ruled by Republicans, but only by the slimmest of majorities. All it takes is for just one or two of them to stray from political party colleagues and mayhem quickly is ensued. Already in recent months, Speaker Kevin McCarthy (R-CA) was deposed from that position for failing to satisfy a small group of other Republicans. Meanwhile, his successor Michael Johnson (R-LA) recently is being threatened with a similar ouster by another small group of dissidents. 

An important function for members of Congress is to enact 12 major spending bills ech year to keep federal machinery afloat. As in past years, they were not successful in doing so until six months after fiscal year 2024 began on October 1, 2023. Domestic issues, such as abortion and initiatives in foreign affairs, involving military aid for Ukraine, Israel, and Taiwan are sufficiently powerful for matters pertaining to appropriations legislation to grind to an immediate halt. Another key function for federal legislators is to furnish oversight of activities of the executive branch of government. Congressional hearings always have the potential to turn into a vast playground where invited witnesses are badgered by indignant legislators. Also, a threat of impeachment can hang in the air over some contentious deliberations. 

Often lost in the fog of various controversies, however, are the many occasions when bipartisan harmony is achieved. During COVID-19, social lockdowns required patients to remain at home where they were unable to leave to obtain health services. Telehealth made it possible for them to receive care in a different manner. Another group that has benefited from this technology consists of rural residents who may reside many miles from clinicians and health facilities. Presently, S. 2016, CONNECT for Health Act of 2023, has 65 co-sponsors in the Senate. The purpose is to expand coverage of telehealth services through Medicare, make permanent telehealth flexibilities that were enacted during COVID, make it easier for patients to connect with their doctors, and help improve health outcomes. Some features are: 

· Permanently removing all geographic restrictions on telehealth services and expand originating sites to include the home and other sites

· Permanently allowing health centers and rural health clinics to provide telehealth services

· Allowing more eligible health care professionals to utilize telehealth services

· Removing unnecessary in-person visit requirement for telemental health services

· Allowing for the waiver of telehealth restrictions during public health emergencies

· Requiring more published data to learn more about how telehealth is being used, impacts of quality of care, and how it can be improved to support patients and health care providers.

TECHNOLOGY AND HEALTH CARE

Similar to what is occurring in other sectors of the U.S. economy, developments in technology already play a role in transforming the health care sphere. Artificial intelligence and virtual reality are expected to continue making significant inroads in health professions education and patient care. Another facet of technology that also attracts increased attention is patient wearables. The New England Journal of Medicine is one of many periodicals that has had a focus on this topic. A final review of a series on wearable digital health technologies (DHTs) appeared in the March 21, 2024 issue. 

It highlights important challenges that must be met to integrate these devices into clinical guidelines and practice. The narrative deliberately is grounded in what is possible today, but speculations also are made about specific uses of wearable DHTs in the future. Six interlocking and vexing issues are identified as being at the foundation of delivering DHT-informed care. They are:  

Data Ownership

Who owns the raw and derivative data obtained from wearable DHTs? Ownership can be unclear, since data collection involves multiple stakeholders, including patients, device manufacturers, app providers, and data aggregators.

Patient Trust, Literacy, and Access

Fear that personal health data may be compromised or misused, especially with the increasing use of AI, is one of the most important trust issues. 

Standards and Interoperability

Although the broad field of DHTs, which includes electronic health records and telemedicine, has adopted data standards, the field of wearable DHTs, which is characterized by ongoing development, lacks such standards.

Integration into Clinical Environments

Integrating wearable DHTs into clinical care presents several workflow challenges that can affect both health care professionals and patients. One of the biggest challenges is the sheer volume of data generated by wearable DHTs, which can be overwhelming.

Patient Empowerment and Agency

For patients to have agency and empowerment in using data from their wearable DHTs, the challenges of control over the data, an understanding of how the data can be used effectively, and trust in the systems managing the data will need to be addressed.

Reimbursement and Return on Investment for Health Care Systems

A set of Current Procedural Terminology (CPT) codes exists for remote patient monitoring with wearables. Devices and procedures that do not meet existing CPT definitions still present serious challenges in securing reimbursement. 

HEALTH REFORM DEVELOPMENTS

Health care policy in the United States is dominated by three major concerns: reducing the number of individuals who lack insurance coverage, improving quality of health services, and reducing health costs. Considerations about the health workforce relate to the latter two of these concerns, but the   topic does not always receive the attention it deserves. While the federal government has some jurisdiction over workforce issues, the nation’s 50 states represent battlegrounds where organizations in the health professions compete over scope of practice issues. Members of some professions argue that they are capable of independently providing high quality care at lower cost, but they are opposed by claims that patient safety would be compromised if the scope of practice is broadened to include other groups. 

Meanwhile, the U.S. population continues to grow larger and much of that growth occurs among the oldest cohorts. Advancing age often is accompanied by increases in chronic disease and disability,   placing greater demands on the necessity of having a sufficient cadre of competently-prepared health care practitioners. Occasionally, studies are done that shed valuable light on what is occurring within the health professions. For example, a cross-sectional study published on April 9, 2024 in JAMA      Network Open involved 7,887 nurses who were employed in a non–health care job, not currently      employed, or retired, the top contributing factors for leaving health care employment were planned    retirement (39% of nurses), burnout or emotional exhaustion (26%), insufficient staffing (21%), and family obligations (18%). Age distributions of nurses not employed in health care were similar to     nurses currently employed in health care. Although the increase in new registered nurses is expected to outpace retirements, health care systems continue to struggle with recruiting and retaining these        individuals.  It certainly would be of immense value to have similar investigations undertaken in order to develop clearer profiles of other groups, such as physical therapists, occupational therapists, and      medical laboratory personnel. 

U.S. Dementia Care Spending By State: 2010–2019

A separate item in this issue of the newsletter is about dementia from the standpoint of biomarker     testing. According to a paper appearing in the April 2024 issue of the journal Alzheimer’s and           Dementia, the fourth largest cause of death for individuals 70 years of age and older in the United States is dementia. It is tremendously costly, leading to $80 billion per year in direct medical spending attributable to this disorder. Given the progressive nature of cognitive and functional impairment that accompanies dementia and the associated caregiving needs, the cost of informal care can elevate these cost estimates. 

Still, a concern is that existing estimates of the indirect costs of dementia are dated and do not report on differences across the nation. Researchers used data from multiple surveys to create cost estimates and projections for informal dementia caregiving at the state level from 2010 through 2050. In 2019, the annual replacement cost of informal caregiving was $42,422 per prevalent case, and the forgone wage cost was $10,677 per prevalent case ($58 billion overall). In 2019, it would have cost $230 billion to hire home health aides to provide all this care. If past trends persist, this cost is expected to grow to $404 billion per year in 2050. 

Vaccination For Healthy Aging

As noted above, the population is aging. In a paper in the May 2024 issue of the periodical Science    Translational Medicine, the WHO estimates that the number of individuals 65 years of age and older will grow to 2.1 billion during the next three decades, nearly doubling as a proportion of the global  population that is 65 and older and tripling the number of persons 80 and older. Also, as the world’s population ages, vaccination is becoming a key strategy for promoting healthy aging. Despite scientific progress in adult vaccine development, obstacles such as immune-senescence and vaccine hesitancy remain. In order to unlock the potential of adult vaccines fully, immunization programs must be        enhanced, misinformation dispelled, and investments made in research that deepens an understanding of aging and immunity. A strategy for harnessing the full potential contribution of vaccination to healthy aging entails key actions, e.g. expanding the knowledge base and allowing for timely development of new vaccines.

TRANSLATING CLINICAL RESEARCH INTO PRACTICE

A well-characterized gap exists between establishing scientific evidence and integrating it into routine clinical practice. It often is noted that only a small proportion of scientific innovation is translated into routine clinical practice and that even then, the process can take more than a decade, according to a manuscript in the April 2024 issue of the journal Mayo Clinic Proceedings. Whereas this lag may vary by measurement approach, funding mechanism, and other factors, more recently published estimates indicate that it takes an average of 14 years and $2 billion to bring a new drug or medical device from conception to market. This research-to-practice gap has not historically been an important consideration in academic clinical research. The clinical research enterprise typically rewards the conduct of descriptive or mechanistic studies that are highly controlled. Although growing attention has focused on the need to accelerate translation of knowledge into clinical practice, protocolized intervention trials for evidence generation are often designed without appreciable attention paid to evidence translation and therefore do not lend themselves to integration of innovation into feasible and sustainable health care programs and policies in real-world settings. Integration of translational and implementation science principles and practices into clinical research can advance the translation of scientific innovation into improved patient care and population health.  

The authors aim to prioritize and guide efforts to create greater efficiency and speed of scientific innovation across the translational science continuum to improve patient and population health. Key principles and practices rooted in translational and implementation science may be incorporated into clinical trials research, particularly pragmatic trials, to improve the relevance and impact of scientific innovation. Their thematic review intends to raise awareness on the value of translational and implementation science in clinical research and to encourage its use in designing and implementing clinical trials across the translational research continuum. These investigators describe the gap in translating research findings into clinical practice, introduce translational and implementation science, and describe the principles and practices from implementation science that can be used in clinical trial research across the translational continuum to inform clinical practice, improve population health impact, and address health care inequities.  

ROBOTS AND THE ART OF HUMAN SYNCHRONY

Currently a global multibillion-dollar industry, the increasing demand for robots with human-like social intelligence marks a significant milestone in technological history. Once primarily confined to dull, dirty, and dangerous work, such as stocking shelves, cleaning floors, and deactivating bombs—robots presently are elevated to join the human social world, with immense transformative potential for society. A good example is the provision of health and social assistance services to patients who live alone and are confined to their homes. According to the March 2024 issue of the journal Science Robotics, although their physical appearance is impressive, interactions with robots often are clunky, stilted, and awkward. One critical limitation is that current social robots lack the art of social synchrony, where nods, smiles, gestures, and speech are orchestrated carefully across conversation partners. For social robots to engage in human social interactions, social synchrony skills are essential. A paper in that issue of this periodical addressed the art of social synchrony by endowing one such humanoid social robot, Emo, with it.  

The device is a soft-skinned anthropomorphic facial robot that can display a wide range of nuanced facial expressions using 26 magnet-controlled facial actuators. It also has high-resolution cameras in its eye sockets to detect different types of facial expressions. Although Emo can mimic the human facial expressions that it detects, engaging in social synchrony involves a more refined planning and execution of responses. To achieve this outcome, Emo was trained using neural networks to predict the facial expressions of its human interlocutors based on their early facial movements. Emo’s predictive ability enables it to plan and execute its own facial expressions in response, achieving a more human-like social synchrony. Researchers also upgraded Emo’s processing capacity to run on lightweight computing facilities, freeing up processing power for the development of other functions, such as speech and listening. Using this simple and elegant approach, Emo’s social interaction skills have been upgraded from mere mimicry to the art of social synchrony. Such a development has profound implications for the future of social robots.  

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

The Gut Microbiota And Chronic Pain  

Emerging evidence, though much in animal models, suggests that gut health, or dysfunction (i.e., dysbiosis), may play a crucial role in modulating pain perception and contributing to development of various chronic pain conditions. A review article in the April 2024 issue of the journal Current Pain and Headache Reports aims to explore the current state of knowledge regarding the intricate relationship between the gut microbiome and pain. The paper furnishes a broad overview of the bidirectional communication between the gut microbiome and the central nervous system, the potential mechanisms by which gut microbes influence pain in select chronic pain phenomena, and the therapeutic potential of targeting the gut microbiome to alleviate pain. As the concern about opiate medications (e.g., “opioid epidemic”) grows, so does interest in other medications and interventions, such as lifestyle modification, with less perceived consequences.  

COVID: Dental Utilization And Expenditures, U.S. 2019-2021

The COVID-19 pandemic exacerbated the already low utilization of oral healthcare services across the United States. In Statistical Brief #555 in March 2024 of the Medical Expenditure Panel Survey, a comparison is made of dental service utilization and expenditures for the U.S. civilian noninstitutionalized population aged 2 and older from 2019 through 2021. Dental utilization and expenditures in the United States both declined in the first year of the COVID-19 pandemic. Total dental expenditures declined by 16.1% from 2019 to 2020, the number of individuals using dental services declined by 12.5%, and the total number of dental visits decreased by 19.0%. In 2020, around 131 million persons utilized dental care (40.8% of the total U.S. civilian noninstitutionalized population aged 2 and over), 18 million fewer than the year before (149 million; 46.7%). In 2020, the monthly dental visit volume dipped substantially for three consecutive months compared to the same months in 2019. 

HEALTH TECHNOLOGY CORNER 

A Fully Integrated Wearable Ultrasound System To Monitor Deep Tissues In Moving Subjects

Recent advances in wearable ultrasound technologies have demonstrated the potential for hands-free data acquisition, but technical barriers remain as these probes require wire connections, can lose track of moving targets, and create data-interpretation challenges. The March 2024 issue of the journal Nature Biotechnology has a report on a fully integrated autonomous wearable ultrasonic-system-on-patch (USoP). A miniaturized flexible control circuit is designed to interface with an ultrasound transducer array for signal pre-conditioning and wireless data communication. Machine learning is used to track moving tissue targets and assist data interpretation. The researchers demonstrate that the USoP allows continuous tracking of physiological signals from tissues as deep as 164 mm. On mobile subjects, the USoP can monitor those signals continuously, including central blood pressure, heart rate, and cardiac output, for as long as 12 hours.  

Noninvasive Diagnostic Tool For Ovarian Cancer

Ovarian cancer causes more deaths than any other gynecologic malignancy, with a five-year survival rate below 30% for patients diagnosed at advanced stages. Current serum-based biomarkers do not sufficiently detect all occurrences of early-stage ovarian cancer. A critical need exists for both additional detection methods and new targeted therapies that can improve patient survival. A new radiotheranostic system has the ability to detect and treat this disease noninvasively, according to new research published in the April 2024 issue of The Journal of Nuclear Medicine. A theranostic approach integrates the diagnostic and therapeutic agent into a single platform. This method offers great potential to solve the challenges presented by late-stage diagnosis and poor therapeutic response. Combining the highly specific huAR9.6 antibody with PET and therapeutic radionuclides, this theranostic platform may provide more personalized treatment to improve health outcomes for patients with ovarian cancer.

DEVELOPMENTS IN HIGHER EDUCATION

Inside Higher Ed’s 2024 Survey of College and University Presidents was conducted by Hanover Research. The study included 380 presidents from public and private nonprofit institutions, for a margin of error of 4.66%. Altogether, 380 presidents from 206 public and 174 private, nonprofit institutions participated. As is often the case, presidents generally viewed their own institutions more positively than higher education as a whole. The study included questions on such issues as campus speech, public perceptions of higher education, race on campus, artificial intelligence, general financial and economic confidence, and mental health. 

Currently in its 14th year, the survey has evolved in accordance with higher education trends. The 2024 edition marks the first time presidents were asked about artificial intelligence. They expressed decidedly mixed views on the technology: 50% of survey respondents said they were somewhat or very optimistic about the rise of AI, but only a third said they somewhat or strongly believe that their institution is  prepared to navigate its rise. Looking further afield, only 17% indicated they think the higher education sector as a whole is prepared to handle the technology. Not quite one in five presidents (18%) said their  institution has published a policy governing the use of AI, including in teaching and research. 

Renewed Efforts To Expand Student Loan Debt Forgiveness

The March 2024 issue of this newsletter indicated that efforts by the Biden Administration resulted in the automatic discharge of  $1.2 billion in loans for nearly 153,000 borrowers who are eligible for the  shortened time to forgiveness benefit under the Saving on a Valuable Education (SAVE) Plan. More recently, the April 6, 2024 issue of the Wall Street Journal reported that the administration is poised to issue a proposal aimed at reducing or eliminating student loan balances for millions of borrowers, marking President Biden's second attempt at large-scale loan forgiveness. The proposed regulation is anticipated to outline several categories that would qualify borrowers for debt relief, including financial hardship. Under the plan, borrowers with high debt loads and low incomes could see their loan balances reduced or eliminated. It also could outline a path to relief for borrowers who have carried their debt for decades; who now owe more than their initial loan amount because interest has accumulated; or who are eligible for relief through other federal programs, but they haven't applied.  

Regulations, which are set to be issued, come after the U.S. Supreme Court last year overturned the administration's first debt-cancellation plan that would have wiped away as much as $20,000 in student debt for borrowers making less than $125,000 a year. The exact timing of the renewed effort will depend on how quickly the administration can finalize the regulations. It is expected that once the proposal is completed, it is likely to face legal action from Republican attorneys general, who again will try to persuade the courts to block it. The Supreme Court in June 2023 did not approve the first student loan forgiveness plan.  

Student Mental Health And Well-Being

The American Council on Education (ACE) understands that institutional practices around campus mental health and well-being play a critical role in student success. Students with poor mental health are at risk of a lower GPA, discontinuous enrollment, or dropping out. ACE’s research and insights on campus mental health and well-being look to provide higher education leaders with the tools that they need for their institution to address mental health on their campus.​​​ Portion of a podcast by the ACE on March 21, 2024 was about the mental health crisis in higher education. The organization would like Congress to provide adequate funding to undertake campus initiatives in research and training, and enable academic institutions to have an increased ability to offer interstate mental health services.

HEALTH REFORM DEVELOPMENTS

HEALTH REFORM DEVELOPMENTS 

The health domain consists of key aspects involving health professions education, patient care, and clinical research. As noted in a paper published on March 21, 2024 in the journal JAMA Oncology, minority and socioeconomically disadvantaged population subgroups are underrepresented in clinical trials. That fact may reduce the generalizability of trial results and propagate health disparities, which leads to the necessity of focusing on social determinants of health (SDoH) as a means of making needed improvements. Examples of SDoH are low levels of education, lack of employment opportunities, and unsafe neighborhoods.  

The March 2024 issue of The Milbank Quarterly contains an article that highlights the negative influence played by the lack of adequate transportation as a SDoH. The authors propose applying a more holistic transportation justice framework to systemic problems in health care. They suggest ways to advance the impact of transportation interventions and highlight the limitations of how health  services researchers and practitioners currently conceptualize and use transportation. Incorporating a transportation justice framework offers an opportunity to address transportation and mobility needs more comprehensively and equitably within health care research, delivery, and policy. 

Limiting The Availability Of Junk Health Insurance Plans

Since the Patient Protection And Affordable Care Act (ACA) became law in March 2010, efforts have been made to provide coverage for the uninsured and to make health care more affordable. A concern is that some beneficiaries are purchasing lower quality insurance, or “junk insurance plans” that discriminate based on pre-existing conditions and provide little or no coverage. On March 28 of this year, the Departments of Health and Human Services, Labor, and the Treasury (collectively, the Departments) released the Short-Term, Limited-Duration Insurance and Independent, Noncoordinated Excepted Benefits Coverage, or Junk Insurance Final Rules. Short-term, limited-duration insurance (STLDI) is a type of health insurance that typically is designed to fill temporary gaps in coverage when an individual is transitioning from one source of coverage to another. Unlike most health insurance plans, STLDI plans are not subject to the ACA’s critical consumer protections, including guaranteeing  coverage for individuals with pre-existing conditions and prohibiting discrimination based on health status, age, or gender. These final rules will limit “short-term” plans to truly short-time periods, no more than four months instead of three years.  

Primary Care In The U.S. And Nine Other Nations

An Issue Brief released by The Commonwealth Fund in March 2024 posits that despite the importance of primary care, health systems around the world are facing challenges at the patient and provider level. Many nations struggle to ensure access to care, or first contact; continuity of care; comprehensiveness of care; and coordination of care. These four core components of high-quality primary care are essential to achieve better overall health outcomes. Factors, such as workforce shortages and growing administrative burdens, pose significant barriers to care. The Brief compares the state of primary care in the United States with nine other high-income nations. It updates an earlier Commonwealth Fund study comparing primary care performance in the U.S. with nine peer countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom.  

The findings reveal that although 86% or more of respondents in all 10 countries reported having a regular doctor or place to go for care, adults in the U.S., Sweden, and Canada had the lowest rates, and U.S. adults were the least likely to have a longstanding relationship with a primary care provider. Less than a third of U.S. primary care providers reported making home visits compared to more than two-thirds in all other surveyed countries. Physicians in the U.S. and Germany were most likely to screen their patients for social needs, such as housing and food insecurity. Fewer than four in 10 physicians in the U.S., Sweden, the Netherlands, and Germany reported adequate coordination with specialists and hospitals regarding changes to their patients’ care. A conclusion is that the U.S. trails its peers, particularly in access to and continuity of care. Patients in the U.S. are among the least likely to have access to primary care outside of regular business hours or a longstanding relationship with their primary care physician.

FEDERAL FUNDING SECURED FOR FY 2024

It took six months to complete the task, but Congress finally was able to finish all the steps necessary to produce a $1.3 trillion package of 12 spending bills to be signed into law by President Joseph Biden for the fiscal year that began on October 1, 2023. Democrat and Republican members in both legislative chambers were able to identify specific aspects of the various bills that engendered a feeling of satiety, while also acknowledging that there are several areas that will be added to the wish list when developing appropriations for the next fiscal year. For the current fiscal year, the results include: 

Health Resources and Services Administration (HRSA) Title VII and Title VII Health Professions Education and Training programs would receive $815.8 million, a $6 million (7.0%) increase over FY 2023 enacted levels. The bill also would boost discretionary funding for the National Health Service Corps ($128.6, a $3 million or 2.3% increase. The bill would provide $9.2 billion for the Centers for Disease Control and Prevention, a $4.5 million (0.5%) increase, and would provide $369 million, a $4.5 million (1.2%) cut, to the Agency for Healthcare Research and Quality. The total program level for NIH’s base would be $47.081 billion, $378 million (0.8%) below the comparable FY 2023 funding level. The reduction is the result of a scheduled decrease in funding available to NIH in FY 2024 through the 21st Century Cures Act.  

As a way of proceeding to develop spending bills for FY 2025, which begins next October 1, the President’s budget proposal, referred to by statute as the Budget of the United States Government, is required by law to be submitted annually, according to the Congressional Research Service (CRS). The President’s budget submission in practice is a statement of the Administration’s policy priorities and a unified plan for the allocation of federal budgetary resources. The President’s budget is a set of recommendations that Congress may consider, but is not required to adopt, however, it usually initiates the congressional budget process. Under current law, the President must develop and submit a consolidated budget to Congress no later than the first Monday in February prior to the start of the upcoming fiscal year. 

The President’s budget has become one of the institutional presidency’s most significant policy tools. Through the executive budget process, the President may set forth legislative and program objectives and attempt to influence the nation’s overall fiscal course. A wide range of agencies support the President in the process of formulating the budget proposal. Specifically, the Office of Management and Budget (OMB) is largely responsible for assisting the President in carrying out  budgetary duties. Along with OMB, the Council of Economic Advisors and the Treasury Department provide economic projections and revenue estimates. OMB coordinates the development of the President’s budget proposal by issuing circulars, memoranda, and guidance documents to the heads of executive agencies. These entities may then prepare their budget requests in accordance with the instructions and guidance provided by OMB.

USES OF ARTIFICAL INTELLIGENCE (AI) IN HEALTH CARE

A cursory inspection of the health professions literature reveals a burgeoning presence of articles discussing the ways in which artificial intelligence (AI) can be integrated productively in the relam of health care. For example, Barwise and co-investigators in the March 2024 issue of the Journal of the American Medical Informatics Association assert that inpatients with language barriers and complex medical needs suffer disparities in quality of care, safety, and health outcomes. Although in-person interpreters are particularly beneficial for these patients, they are underused. Consequently, this research team plans to use machine learning predictive analytics to identify patients with language barriers and complex medical needs to prioritize them for in-person interpreters. They believe that such efforts are the first study that elicits stakeholder perspectives on the use of AI with the goal of improved clinical care for patients with language barriers.  

On the mental health care side of the ledger, a paper by Dakanalis et al in the February 2024 issue of Cyberpsychology, Behavior, and Social Networking examines the potential of AI to revolutionize mental health care. The text discusses the rapid evolution of AI, particularly in image analysis for early physical health diagnoses, and its promising applications in mental health, including predictive analytics for various disorders. The article advocates for AI as a complementary tool rather than a replacement for human involvement in mental health services.  

Abadir and Chellappa in their article in the February 2024 issue of The Journals of Gerontology: Series A Biological Sciences & Medical Sciences view the integration of AI as a potentially transformative force. The future will require multidisciplinary collaboration among clinicians, AI engineers, and key stakeholders, including patient advocacy groups and older adults, to develop solutions that address the complex nature of aging effectively. A course is charted for an upcoming special issue in The Journals of Gerontology on AI-enabled wearables and sensors for older adults.  

THERAPEUTIC MISUNDERSTANDINGS IN MODERN RESEARCH

Failing to understand the distinction between research and clinical care, and the likelihood of benefit from participation in clinical trials is referred to as the “therapeutic misconception.” As described in a manuscript by Heynemann et al appearing in the February 2024 issue of the journal Bioethics, four decades have passed since the phenomenon termed the ‘therapeutic misconception’ first was described in the context of evaluation of participants' understanding of a randomized controlled trial (RCT) of a psychotropic agent. These investigators indicate that clinical trials play a crucial role in generating evidence about health care interventions and improving outcomes for current and future patients. A concern for individual trial participants, however, is that inevitably there are trade-offs involved in clinical trial participation, given that trials traditionally have been designed to benefit future patient populations rather than to offer personalized care. The evolution of the clinical trials landscape, including greater integration of clinical trials into health care and development of novel trial methodologies, may reinforce the significance of the therapeutic misconception and other forms of misunderstanding while at the same time (paradoxically) challenging its salience.  

Using cancer clinical trials as an example, the researchers describe how methodological changes in early- and late-phase clinical trial designs, as well as changes in the design and delivery of health care, have an impact upon the therapeutic misconception. They suggest that such changes provide an impetus to re-examine the ethics of clinical research, particularly in relation to trial access; participant selection; communication and consent; and role delineation. The central problem to which the therapeutic misconception draws attention is the conflation of clinical research with clinical care, two rather different enterprises with vastly different goals. Persistent conceptual challenges surrounding the therapeutic misconception and related misunderstandings are considered in the article. Next, some emerging and, as yet, unexamined implications for the therapeutic misconception with the evolution of clinical trial designs and the widespread movement towards seamless integration of clinical research into clinical care are highlighted . An intention is to deconstruct a well-recognized concept within research ethics, contextualize it in the modern clinical trials landscape, and offer some preliminary practical suggestions for operationalizing these ideas. 

TECHNOLOGY AND HEALTH CARE

Similar to what is occurring in other sectors of the U.S. economy, developments in technology already play a role in transforming the health care sphere. Artificial intelligence and virtual reality are expected to continue making significant inroads in health professions education and patient care. Another facet of technology that also attracts increased attention is patient wearables. The New England Journal of Medicine is one of many periodicals that has had a focus on this topic. A final review of a series on wearable digital health technologies (DHTs) appeared in the March 21, 2024 issue. 

It highlights important challenges that must be met to integrate these devices into clinical guidelines and practice. The narrative deliberately is grounded in what is possible today, but speculations also are made about specific uses of wearable DHTs in the future. Six interlocking and vexing issues are identified as being at the foundation of delivering DHT-informed care. They are:  

Data Ownership

Who owns the raw and derivative data obtained from wearable DHTs? Ownership can be unclear, since data collection involves multiple stakeholders, including patients, device manufacturers, app providers, and data aggregators.  

Patient Trust, Literacy, and Access

Fear that personal health data may be compromised or misused, especially with the increasing use of AI, is one of the most important trust issues.   

Standards and Interoperability

Although the broad field of DHTs, which includes electronic health records and telemedicine, has adopted data standards, the field of wearable DHTs, which is characterized by ongoing development, lacks such standards.  

Integration into Clinical Environments

Integrating wearable DHTs into clinical care presents several workflow challenges that can affect both health care professionals and patients. One of the biggest challenges is the sheer volume of data generated by wearable DHTs, which can be overwhelming.  

Patient Empowerment and Agency

For patients to have agency and empowerment in using data from their wearable DHTs, the challenges of control over the data, an understanding of how the data can be used effectively, and trust in the systems managing the data will need to be addressed.  

Reimbursement and Return on Investment for Health Care Systems

A set of Current Procedural Terminology (CPT) codes exists for remote patient monitoring with wearables. Devices and procedures that do not meet existing CPT definitions still present serious challenges in securing reimbursement.   

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Deaths From Excessive Alcohol Use—United States, 2016-2021

Deaths from causes fully attributable to alcohol use (i.e., 100% alcohol-attributable causes, such as alcoholic liver disease and alcohol use disorder) have increased during the past two decades in the United States. Rates were particularly elevated from 2019 to 2020, concurrent with the onset of the COVID-19 pandemic. According to data furnished in the February 29, 2024 issue of the Morbidity And Mortality Weekly Report, average annual number of deaths from excessive alcohol use, including partially and fully alcohol-attributable conditions, increased approximately 29% from 137,927 during 2016–2017 to 178,307 during 2020–2021, and age-standardized death rates increased from approximately 38 to 48 per 100,000 population. During this time, deaths from excessive drinking among males increased approximately 27%, from 94,362 per year to 119,606, and among females increased approximately 35%, from 43,565 per year to 58,701.

Cancer Statistics, 2024

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes using incidence data collected by central cancer registries (through 2020) and mortality data collected by the National Center for Health Statistics (through 2021). According to the January/February 2024 issue of CA, A Cancer Journal for Clinicians, in 2024, 2,001,140 new cancer cases and 611,720 cancer deaths are projected to occur in the United States. Cancer mortality continued to decline through 2021, averting over four million deaths since 1991 because of reductions in smoking, earlier detection for some cancers, and improved treatment options in both the adjuvant and metastatic settings. These gains are threatened, however, by increasing incidence for six of the top 10 cancers (e.g., breast, pancreas, uterine corpus cancers, prostate, liver (female), and kidney). 

HEALTH TECHNOLOGY CORNER 

Ant’s Biting System And Surgical Needle Holders

Over the millennia, humans have benefited from learning about the use of medications and other kinds of health interventions by observing animal behavior. As described in the February 27, 2024 issue of the Proceedings of the National Academies of Science of the USA, researchers at the University of California, Berkeley noted that the grasping and holding tools of robotics, microassembly, or endoscopic surgery operate in confined spaces. This fact limits their maximum size and performance. The investigators studied one of nature’s solutions for this problem: the ant’s mandibles, which combine strong biting performance with elaborate maneuverability of objects. Their mandibles are characterized by gliding joints, tilting axes, and changing power transmission during the opening and closing process. These three design principles then were transferred to a commercially available surgical needle holder. The result is that the grasping performance of the needle holder is improved substantially. 

Robotic Surgery For Gall Bladder Cancer

Surgery is the most promising curative treatment for patients diagnosed with gall bladder cancer, Although there has been increasing adoption of minimally invasive surgical techniques in gastrointestinal malignancies, including utilization of laparoscopic and robotic surgery, there are reservations in utilizing minimally invasive surgery for gallbladder cancer. Published on February 27, 2004 in The American Journal of Surgery, researchers at the Boston University School of Medicine found that robotic-assisted surgery for this kind of cancer is as effective as traditional open and laparoscopic methods, with added benefits in precision and quicker post-operative recovery. Robotic-assisted resection safely and effectively treats gallbladder cancer. This intervention achieves equivalent oncologic outcomes compared to open and laparoscopic approaches. Technical advancements in robotic surgery enhance dexterity and precision during procedures. Further research is warranted to confirm its benefits and establish surgical guidelines.  

DEVELOPMENTS IN HIGHER EDUCATION

The Biden Administration on February 21 announced that it automatically will discharge $1.2 billion in loans for nearly 153,000 borrowers who are eligible for the shortened time to forgiveness benefit under the Saving on a Valuable Education (SAVE) Plan. This action comes as 7.5 million borrowers are enrolled in SAVE, 4.3 million of whom have a $0 monthly payment. The action represents a clear message to borrowers who had low balances, informing them that they have done their part and deserve relief. Previously, the Administration announced in January that the shortened time to forgiveness component of the SAVE Plan would be accelerated nearly six months earlier than anticipated in order to provide these individuals the relief they have earned as quickly as possible. For borrowers to be eligible for this forgiveness they must be enrolled in the SAVE Plan, have been making at least 10 years of payments, and originally have taken out $12,000 or less for college. For every $1,000 borrowed above $12,000, a borrower can receive forgiveness after an additional year of payments. 

All borrowers on SAVE receive forgiveness after 20 or 25 years, depending on whether they have loans for graduate school. The benefit is based upon the original principal balance of all federal loans borrowed to attend school, not what a borrower currently owes or the amount of an individual loan. Individuals who meet the eligibility criteria for forgiveness under the SAVE Plan will have their loans automatically discharged with no action needed on their part. Thus far under the current Administration, the following amounts also have been approved: $56.7 billion for more than 793,000 borrowers through fixes to Public Service Loan Forgiveness (PSLF); $45.6 billion for 930,500 borrowers through improvements to income-driven repayment; $11.7 billion for 513,000 borrowers with a total and permanent disability, including the provision of automatic discharges off a data match with the Social Security Administration; and $22.5 billion for 1.3 million borrowers through closed school discharges, borrower defense, and related court settlements.

Final Negotiated Rulemaking Session Of A USDE Committee On Institutions And Programs

A final negotiated rulemaking session of the U.S. Department of Education’s Institutional Quality and   Program Integrity Committee occurred on March 4 through March 7, 2024. Three of the six topics in the discussion focus on Accreditation, State Authorization, and Distance Education. Following this session, the negotiator’s comments and a draft a Notice of Proposed Rulemaking (NPRM) will be made available. The latter item will be published in the Federal Register, making it possible for interested parties and the public to provide comments. A goal is to publish the final rule by November 1, 2024, with implementation set for July 1, 2025. 

Enhancing Educational And Employment Opportunities In Rural Areas

The many positive aspects of living in a rural area may be partially offset by challenges associated with not having ready access to health resources, higher education institutions, and well-paying jobs. An analysis of this situation is provided in a new report from the Georgetown University Center on Education and the Workforce. Entitled “Small Towns, Unique Opportunities,” the document offers a countervailing view to a popular narrative that rural America has been “left behind.” The rural workforce in the U.S consists of up to 13% of the total 25-to-64-year-old working population and holds 12%, or a roughly proportionate share, of the country’s good jobs. It also provides recommendations to mitigate the region’s high labor-force non-participation rate (26%), low bachelor’s degree attainment rate (25%), and overall population decline. Rural areas have strengths that can be built upon with additional investments. To ensure rural workers have access to good jobs, efforts should be implemented to make education and training more easily available to rural residents, while simultaneously investing more in the skills that these individuals already possess. It also would be beneficial to plan ahead for rural growth. Technology is allowing a larger segment of members of the public to work from wherever they want, while the less-crowded, less-expensive rural lifestyle will continue to be attractive for many individuals.  

HEALTH REFORM DEVELOPMENTS

The U.S. has a lengthy history of government involvement in the health domain. Legislation was enacted in 1798, authorizing the provision of medical care for merchant seamen and for establishing the U.S. Marine Hospital. By 1799, federal state cooperation produced efforts to enforce quarantine laws to stem the spread of infectious diseases, e.g., cholera and yellow fever. The 20th century entailed major achievements including creation of the NIH and efforts to improve the health workforce. The Roosevelt Administration in the 1930s and 1940s reflected efforts to expand health insurance coverage for the entire population of this country. By the early 1990s, it became evident that the major focus should not be only on insurance coverage, but also on improving health care quality and controlling a steady rise in the growth of health care costs. 

Unfortunately, this last item does not always attract the attention it warrants in the policy arena. Overall, the nation has a debt of $34 trillion. It grows each year because revenues are less than expenditures. According to a report issued on February 15, 2024 by the Government Accountability Office (Report GAO-24-106987), when the government spends more than it collects in revenue, it borrows to finance the resulting deficit by issuing debt to the public. The fiscal year 2023 deficit was $1.7 trillion, the fourth year in a row above $1 trillion. The deficit is composed of two parts: the  primary deficit, the gap between program spending and revenue, which was about $1 trillion in fiscal year 2023. Also, net interest spending, primarily the cost to service the debt, was $659 billion that fiscal year. A result is that such money cannot be used for more constructive endeavors. Primary deficits are projected to grow over the long term, in large part because of projected increases in spending for Medicare, other federal health care, and Social Security programs compared to relatively lower projected increases in revenue. Proposed solutions are not pleasant and may involve increasing taxes, eliminating popular features of entitlement programs, and changing program eligibility standards, e.g., raising the age for obtaining benefits. 

Insurance Consequences Of Biomarker Testing

A fascinating aspect of the health care arena is that there is a steady flow of new technologies and services that have a significant influence on expenditures. Some new medications can result in monthly costs of hundreds of thousands of dollars, which are well beyond the ability of patients to pay for them. Even for drugs that are curative and life saving, how will such costs be financed? A related consideration involves diagnostics. Based on a paper by Arias et al in the February 2024 issue of JAMA Neurology, evidence-based and empirical legal research is needed to develop policy solutions that could mitigate the risk for individuals at risk of discrimination based on biomarker status. Privacy, confidentiality, and anti-discrimination protections are not yet equipped to mitigate potential discrimination risks. 

Conscientious Guardian vs. Commercialized Jungle

Apart from the Apple technology product marvels resulting from the work of Steve Wozniak and Steve Jobs in a garage in Redondo Beach, CA, advances in health care have been part of the many changes affecting society. Readers of this newsletter who have grown long in the tooth may recall how common it once was for every neighborhood to have a pharmacy, owned and operated by the individual who served as its founder. The establishment typically bore the name of that person, such as Banville’s Drug Store. When druggist Banville was not in a side room creating a prescription using a mortar and pestle, he might be at the 4-5 stool ice cream section of the store dishing out cones and milk shakes in as many as four different flavors. This individual always could be counted on to assist low income patrons by lancing a boil on a child’s neck at no fee or allowing a grandparent to borrow a cane from the store when that kind of assistance device was needed. Moving ahead to 2024, those establishments have vacated the American scene and been replaced by national chain drug stores that occupy much larger real estate spaces. An article by Richert and Carter in the January 2024 issue of the Journal of the History of Medicine and Allied Sciences focuses on a central debate between pharmacists during the postwar period about how pharmacies were shifting from the role of healer to that of a retailer, from a “conscientious guardian” to a “commercialized jungle,” to highlight how the public health role of pharmacies was undermined by industry pressures for profit. 

TOTTERING, BUT STILL STANDING

As they have performed repeatedly over the years, when it comes to the essential task of passing spending legislation to enable the federal government to continue functioning, members in both congressional chambers realize it may not be in anyone’s best interest to approach too closely to the edge of a metaphorical abyss. To produce 12 spending bills for fiscal year 2024, which began on October 1 last year, Congress recently was able to pass an additional continuing resolution (H.R. 7463) on February 29 with the House approving the measure by a vote of 320-99 and by 77-13 in the Senate. The CR extends fiscal year (FY) 2023 funding for four annual spending bills, including the Military Construction and Veterans Affairs spending bill through March 8, while continuing FY 2023 funding for the other eight spending bills, including the Labor, Health and Human Services, and Education and Defense bills until March 22. 

Daily reports from the National Journal provide good snapshots of what is unfolding. Congress on March 3 released a package of six government bills that would fund a half-dozen agencies for the remainder of the fiscal year through September 30. The next hurdle is passing the package in both chambers ahead of a shutdown looming on March 8 at midnight. The $460 billion package for FY 2024 is the culmination of months of negotiations between congressional leaders that entailed a contentious appropriations process that saw multiple stopgap funding measures, and threatened several near-shutdowns.  

The latest bipartisan package includes funding for the Agriculture, Interior, Energy, Veterans Affairs, Transportation, and Housing and Urban Development departments, the Environmental Protection Agency, and the Food and Drug Administration. Passage is expected. Lawmakers then immediately must pivot and fund the rest of the government by March 22, a new date members secured with the continuing resolution. If they fail to pass all 12 appropriations bills by April 30, a 1%, across-the-board cut to federal discretionary spending, essentially everything but entitlement programs would go into effect. Although the funding bill for the Health and Human Services Department (HHS) was not a part of this deal (its funding runs out March 22), lawmakers managed to include an increase to doctors’ pay under Medicare. Specifically, the agreement would change the pay increase from 1.25% to 2.93%. The arrangement only partially offsets the 3.4% reduction in payment that became effective at the beginning of this year. 

Not to be forgotten is the high drama that preceded attempts to pass all 12 spending bills. Unhappiness with the performance of Rep. Kevin McCarthy (R-CA), who was criticized by members of his party’s  Freedom Caucus for failing to oppose a bipartisan approach to government funding and not being successful in enacting steep budgetary cuts, he lost his position as House speaker. He was succeeded by Michael Johnson, a relatively unknown colleague from Louisiana. Oddly enough, the latter will function in the same manner that affected his predecessor adversely. A single vote to vacate the chair also could end Speaker Johnson’s occupancy of that position.  

WHY WORD PRECISION MATTERS

Periodically, this newsletter serves as a vehicle for discussing how terminology inexactitudes can have a detrimental impact on health care quality. For example, the December 2023-January 2024 issue described how inconsistent use of terms, such as Alzheimer disease and dementia has compromised progress in clinical care, research, and development of therapeutics.  

Also, from a much wider perspective, the October 2024 issue referred to how conceptual opacity characterizes the word “health.” Because of this opaqueness, health tacitly is defined narrowly as the absence of disease. The result is a perpetuation of a biomedical paradigm in health care with a focus on diagnosing and treating disease. This tacit definition yields poor investment in the inherent health potential of individuals relative to drugs and technology, thus fostering a misalignment between the goals of health care and the goals of individuals, communities, public health, and society. 

A more recent example is provided regarding the term pain, a condition familiar to members of the entire human family irrespective of other demographic characteristics that differentiate them from one another. The March 2024 issue of the Journal of Pain includes a focus on the term “pain catastrophizing.” A paper by Sullivan and Tripp discusses how recent reports have pointed to problems with the term “pain catastrophizing.” Critiques of that designation have come from several sources including individuals with chronic pain, advocates for individuals with chronic pain, and pain scholars. Reports indicate that the term has been used to dismiss the medical basis of pain complaints, to question the authenticity of pain complaints, and to blame individuals with pain for their pain condition. These co-authors advance the proposition that problems prompting calls to rename the construct of pain catastrophizing have little to do with the term, and as such, changing it will do little to solve these problems. Moreover, they argue that continued calls for changing or deleting the term pain catastrophizing will only divert attention away from some fundamental flaws in how individuals with pain conditions are assessed and treated.   

Conroy and Webster in their article in that journal issue underscore these views by maintaining that indeed, language does matter. The argument that the term itself is not problematic perhaps reflects an underestimation of the role of language in shaping understandings of the world. They posit that language not merely describes, but in fact shapes how objects become known. A survey they conducted pertaining to pain catastrophizing revealed how the term was understood to be problematic by many individuals living with pain insofar as they perceived it to invalidate their experiences and confer stigma. The issue is not confined to clinician education and the use of patient-centered language in the clinical visit. Rather, it extends to public education; media and press stories about scientific work; and social media visibility of scientific work where patients, scientists, and clinicians communicate in a public and open forum.  

WOMEN’S HEALTH THROUGHOUT THE LIFE COURSE

Acknowledging that women’s health remains underserved by the medical research community, and the impacts of sex differences and sociocultural factors on the health and wellbeing of women are rarely considered, the January 2024 issue of the journal Nature Medicine launched a “Series on Women’s Health.” The first installment by Carcel et al presents a Perspective calling for a life-course approach to the prevention and treatment of non-communicable diseases (NCDs) in women. The authors assert that women’s health has been critically underserved by a failure to look beyond their sexual and reproductive systems to consider their broader health needs adequately. In almost every country in the world, NCDs are the leading causes of death for women. Among these conditions, cardiovascular disease (including heart disease and stroke) and cancer are the major causes of mortality. Risks for these diseases exist at each stage of women’s lives, but recognition of the unique needs of women for the prevention and management of NCDs is relatively recent and still emerging.  

Once diagnosed, treatments for these maladies often are costly and noncurative. Hence, there is a call for a strategic, innovative life-course approach to identifying disease triggers and instigating cost-effective measures to minimize exposure in a timely manner. Prohibitive barriers to implementing this holistic effort regarding women’s health exist in both the social arena and the medical arena. Recognizing these impediments and implementing practical approaches to surmounting them is a rational way to advancing health equity for women, with ultimate benefits for society. Although the impact of NCDs is greatest in older women, there is increasing evidence that across all life stages, women are susceptible to risk factors that ultimately contribute to those ailments. The authors contend that early education, timely initiation of preventive measures and consistent risk factor management over the course of a woman’s life represent a strategic approach to prevent or delay the progression of many NCDs. When opportunities for such interventions are overlooked in health systems, there can be substantial socioeconomic implications, as preventive interventions over the life course generally are more cost-effective than treating diseases after onset. 

TREATING PATIENTS WHO KVETCH

Not every day in the life of clinicians is full of joy and self-fulfillment. Apart from stresses and strains associated with providing effective patient care, some individuals on the receiving end of treatment warrant special attention. Welcome to the kvetching arena. The verb kvetch is a Yiddish term defined in the Oxford English Dictionary as “To criticize or complain a great deal.” A paper by Yager and Kay in the January 2024 issue of the Journal of Nervous & Mental Disease indicates that clinicians often encounter patients whose presentations are characterized by long lists of complaints about their biological, psychological, interpersonal, and social conditions. The problems on which complaints are based are variably reality-based and variably modifiable. Some patients display chronic complaining as a core, distinguishing feature. Based on clinical observations enhanced by selective narrative literature review, the authors delineate and differentiate four groups of patients: 1) situational complainers; 2) chronic complainers due to unidentified medical problems; 3) mood-induced chronic complainers; and 4) personality-driven pan-dimensional chronic complainers.  

An example is provided of a perplexing 60-year-old patient who responded to a request for a chief complaint by unleashing a litany of sufferings beginning with a mournful recitation of numerous aches and pains that encompass an area from the top of the head down to the toes. The mix included psychological agonies-anxieties, worries, insomnia, depression, tearfulness, regrets, resentments, grudges, envies, and hurt feelings. Numerous problems were enumerated concerning ungrateful sons, back-biting daughters-in-law who poisoned grandchildren's minds, and a passive-aggressive landlord. The most bitter tirade was reserved for a late spouse who died five years previously, leaving the patient ill-equipped to handle many demands of daily living. All woes were compounded by financial insecurities and frustrations with doctors, pharmacies, and insurance companies. The overall affect varied from bitterness to whimpering to hopeless resignation. Strategies for managing those four groups of patients begin with careful, detailed assessments, including ascertaining reality-based and patient contributions to their complaints. Management approaches that can call upon an array of specific tactics should be formulated according to patient-centered particulars. Sources of countertransference reactions should be identified and addressed. Multiple questions remain and merit further research. 

OBTAINABLE RESOURCES

THE FUTURE OF REMOTE PATIENT MONITORING

Digital health advocates believe remote monitoring, the use of digital technologies to collect and relay patient data to health care professionals, has the potential to transform disease management, health outcomes, and patient care, especially for individuals with multiple chronic conditions who lack convenient access to providers. Medicare, most state Medicaid agencies, and many private health insurance plans cover remote monitoring services. For the purposes of a report from the Bipartisan Policy Center, remote monitoring is defined as an umbrella term for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM). RPM refers to the monitoring of physiologic data, such as weight, blood glucose, or blood pressure, while RTM refers to the monitoring of patients’ self-reported nonphysiologic data, such as pain levels or medication adherence. Currently, the Centers for Medicare & Medicaid Services (CMS) limits RTM reimbursement to cases involving the respiratory system, musculoskeletal system, and cognitive behavioral therapy. Although the percentage of patients using RPM remains relatively low (594 monthly claims per 100,000 Medicare enrollees in 2021), the use of RPM increased among Medicare beneficiaries more than sixfold from 2018-2021. In part, this increase was due to CMS’ expanded coverage rules during the COVID-19 public health emergency. The  Report looks broadly at ways to improve the use of remote monitoring services, ensure equitable access to these services across populations, and enhance data security and privacy standards. It can be obtained at https://bipartisanpolicy.org/download/?file=/wp-content/uploads/2024/01/BPC_Health_FutureOfRemoteMonitoring.pdf. 

HEALTH CARE WORKERS’ DISCRIMINATION AGAINST PATIENTS 

Discrimination against patients in health care settings on the basis of race, ethnicity, or language can have a negative impact on quality of care and health outcomes. Workers on the front line of care delivery can provide insights about the nature of this discrimination, helping to inform opportunities to address bias and unequal treatment. About half of U.S. health care workers have witnessed racial discrimination against patients and say discrimination against patients is a crisis or major problem, according to a survey released on February 15, 2024 from the Commonwealth Fund and African American Research Collaborative. Six focus groups of health care workers were followed by a survey of 3,000 health care workers across a variety of care settings. Surveyed workers, across all races, ethnicities, ages, genders, and care settings, personally witnessed discrimination against patients and consider it to be a serious problem. Younger health care workers and health care workers of color were more likely than their older or white counterparts to acknowledge witnessing this discrimination. Just under half of all health care workers indicated the discrimination causes them stress. The report is at https://www.commonwealthfund.org/publications/issue-briefs/2024/feb/revealing-disparities-health-care-workers-observations. 

WEARABLE TECHNOLOGIES IN THE WORKPLACE 

A Spotlight released on March 4, 2024 by the Government Accountability Office (GAO ) discusses how companies are deploying technologies worn on the body to try to improve safety and productivity. These items vary in size and function. Technologies such as exoskeletons, which can provide physical support to the user's body during repetitive overhead work, already are used in industrial workplaces. Yet, there are concerns about data privacy, cost, ease of use, and being tracked by the devices. Industrial uses are in four general categories: (1) supporting devices to assist workers with tasks like lifting (e.g., exoskeletons). (2) monitoring devices to alert workers to specific changes in vital signs (e.g., smart helmets); (3) training devices provide feedback on movements to help improve worker performance (e.g., augmented reality glasses); and (4) tracking devices observe the location of employees on a worksite (e.g., GPS trackers). The report is accessible at https://www.gao.gov/assets/d24107303.pdf.