Healthcare

Unregulated Healthcare – Supplements and Technology

By Brendan Moore

Half of all Americans regularly take at least one multivitamin. But despite such high prevalence in today’s society, the health supplements industry goes largely unregulated by the FDA.

So, on Tuesday, March 31st, the Roosevelt Institute met to discuss this critical policy issue in a discussion moderated by Leah Reiss and Allie O’Keefe. The discussion’s two focal points revolved around supplement regulation and the burgeoning mobile medical application industry.

 

Concerning supplement regulation, the multivitamins and health supplements that can be obtained without a doctor’s prescription are subject to insufficient regulation by the Food and Drug Administration (FDA) or are otherwise not regulated at all. In fact, a 2015 investigation by the New York State Attorney General into herbal health supplements sold at major retailers revealed that 80% of tested products did not contain any of the herbs stated on their label. The major deregulation of the supplements industry took place in 1994, when a lobbying campaign funded by drug companies convinced hundreds of thousands of Americans to urge their Congressmen to support the Dietary Supplement Health and Education Act, which grants firms rather than the FDA, responsibility for determining the safety and effectiveness of their products. This inherent bias in which companies act as their own regulatory agencies has led to many instances of falsely-marketed supplements.

There was virtually unanimity among Roosevelt members that increased oversight and regulation of the supplement industry was needed. However, there appeared to be an even split between those who advocated for the ends of regulation to simply prevent harm to the consumers and those who believed regulation should ensure not only safety but also effectiveness. Many members pointed out that reform in this sector of the healthcare industry is essential simply because of the vast number of people it affects. While there was one proposal for government to absorb all production of drugs and vitamins, most attendees were in favor of a more strictly regulated private sector for supplements in conjunction with increased education and awareness on the actual effectiveness of drugs. There was also general agreement that many supplements are not effective – yet there was dispute over reasons people continue to consume them at record amounts (i.e. placebo, advertisements). This was another impetus for many members to advocate for education on multivitamins and supplements towards the end of the discussion.

Regarding mobile application regulation, although there exists thousands of health and lifestyle related apps (i.e. MyFitnessPal, FitBit, etc.), only about 100 have been approved by the FDA. Moreover, it is estimated that 50% of the world’s 3.4 billion app users will be using a health-related app by 2018. It’s likely that insufficient app regulation has repercussions worldwide, as opposed to nuclear United States with supplement regulation (most countries have tighter regulation for supplements).

Many members of Roosevelt agreed that regulating and verifying the accuracy of these countless mobile apps would be a burdensome task not worth the labor intensive effort, especially when such efforts could be better channelled towards regulating the multivitamin industry. There was debate about websites such as webmd.com, where normal citizens are sometimes prone to inaccurate self-diagnosing. However, it was pointed out that because of the Affordable Care Act, where 16 million more Americans have access to healthcare than before 2013, possibly unreliable apps and websites will pose less of a threat to public health than in previous years. Moreover, members emphasized that most people know to take these apps “with a grain of salt,” and that if a possible medical issue arises, doctor consultation is traditionally the next step anyway.

Thank you for all of those who came out to the discussion!!

Vaccination and Personal Liberty

By Leah Reiss

On Tuesday, February 9th Roosevelt met to discuss vaccines and personal liberty. The United States is currently suffering from the worst measles outbreak in almost 20 years. Measles were declared to be eradicated in the United States in 2000, but in recent years has been on the rise. Last year saw 664 cases, the highest in decades, but since the start of 2015 107 cases of measles have been reported in California, with over three dozen additional cases reported in 19 other states and Mexico. The epicenter of the virus is believed to be an unvaccinated eight-year-old who visited Disneyland and infected other unvaccinated children. This follows a break out of whooping cough in California in 2010 that infected 9,120 people and killed 10 babies, who are too young to receive vaccinations. The resurgence of essentially wiped-out diseases is largely attributed to anti-vaccination movements, which encourage people not to vaccinate their children because of the harmful health effects of vaccines or mistrust for the government and the “true purpose” of large-scale vaccinations.

There are two main demographic groups of anti-vaxxers, distinguished from each other by factors such as geography and income. One anti-vaccination movement is associated with not wanting to “pollute” their children’s bodies with diseases or “harmful chemicals” such as mercury or formaldehyde. This occurs mainly in high income areas, particularly Marin County, California, and may be associated with a resurgence of natural approaches in certain upper class parenting circles, such as organic food and homeopathic medicine. The other anti-vaxxing group is socially conservative and concentrated in the Deep South, where not vaccinating has been linked to a general mistrust of government and unwillingness to comply with state-mandated health measures.

During our discussion we unanimously agreed that all members of society who are able to should get vaccinated as children to protect themselves and others from diseases like mumps, measles, and whooping cough. However, the more contentious question that emerged was whether or not parents who do not vaccinate their child should face some kind of penalty. Some participants thought that these parents should be fined. Others believed that penalties should only be applied to parents if disease outbreaks could be traced to their children. And some thought that parental rights should trump the government’s, so though parents should vaccinate their children, there should not be any legal consequences for parents who do not. Several policy ideas were proposed including imposing a standard for the required percentage of vaccinated residents in each county in accordance with herd immunity and imposing a fine on parents if they choose not to vaccinate their children.

HIV/AIDS Domestic Policies and Stigma

This week’s discussion on HIV/AIDS domestic policies and stigma was hosted by the Equal Justice center and the Healthcare center.

The discussion covered a variety of angles from education policies, to the effect of socio-economic status on HIV medicine access. One of the most important points brought up in the discussion was the need for better mechanisms of education to groups with high-levels of untreated HIV. Alongside multifaceted education for those with HIV as well as preventative and awareness programs for all others, subsidized treatment plans were discussed. HIV treatment is very expensive and many cannot afford it — especially minority groups and those of lower socioeconomic class, which are the groups most disproportionately affected by HIV/AIDS. On a very different point, the question of knowledge was brought up. What should a person do if they have contracted HIV from a partner who did not disclose the information prior to intercourse? Should they sue? Should they only sue if the other person did not know they HIV? Should there be a database for HIV positive people that lists other people of the same status? These are just some questions and points discussed in a very involved conversation about the possible future of HIV/AIDS in the US.

Potent Heroin

At this week’s meeting, the healthcare center led a discussion on potent heroin and what the rise in deaths from overdoses tell us about the state of stigma, and preventive drug use programs in the United States.

People raised several sides of the issue of how to address the larger question of drug abuse in the United States. Many voiced the opinion that mental health must be de-stigmatized as asking for help should be socially acceptable. This is in light of the fact that many drug users also have preexisting mental health issues. On another angle, culture was examined; both how a culture of glamour that surrounds drugs promotes use and how the criminalization of drug use in culture has led to decreased access to rehabilitation clinics and help for drug addicts. Health insurance limits access by denying extended coverage of time in rehabilitation and methadone clinics leading people to go back to abusing drugs.  Education was one of the solutions proposed; that education in schools would address the negative effects of drugs,  and the benefits of asking for help both as a drug addict and as someone with mental health issues. Other ideas brought up were the establishment of clinics in central communal locations so that everyone could have easy access to help. The majority came to an agreement that the first step in addressing the increasing rates of drug abuse and over doses that the recent potent heroin problem has brought to light would be de-stigmatizing mental health.