December 5, 2020

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Health Eclipses

The Health 202: Health care was first up in last night’s caustic presidential debate

President Trump incessantly interrupted and insulted his opponent Joe Biden and both men repeatedly talked over each other, in a debate severely lacking in civility even by today’s standards. 

The candidates spent the first half hour tangling over the coronavirus pandemic, the Obamacare challenge before the Supreme Court, differences over expanding health insurance and abortion rights . But much of the debate couldn’t be heard clearly and the candidates jumped quickly between topics to lob accusations and even insults at each other.

Here are seven takeaways from the debate.

Trump mocked Biden for wearing a mask and limiting campaign crowd sizes.

The  coronavirus pandemic – and Trump’s response to it – got plenty of air time during the debate’s first half. Biden came prepared with a list of the president’s repeated blunders: his confusing and inaccurate claims about how the virus behaves, his delays on acting on the pandemic last winter and spring and his refusal to accept vaccine timelines laid out by his own advisers.

When Biden noted Trump’s long resistance to wearing masks, despite advice by the director of the Centers for Disease Control, the president mocked Biden for adhering to the public health guidance.

“I wear masks….I don’t wear a mask like him,” Trump said. “Every time you see him, he’s got a mask. He could be speaking 200 feet away…and he shows up with the biggest mask I’ve ever seen.”

From a writer for The Dispatch, which describes itself as “fact based conservative news”:

When moderator Chris Wallace noted Biden is holding much smaller events than Trump, Trump said that’s “because nobody will show up.”

Questioned by Wallace on the large rallies he continues to hold, the president claimed “we have had no problem whatsoever.”

“We do them outside, we have tremendous crowds, as you see, and literally on 24 hours notice,” Trump said. “And Joe does the circles and has three people someplace.”

Trump steamrolled not only Biden but also the moderator.

He repeatedly disregarded rules of the debate, refusing even to let Biden speak for two minutes without interruption when each new debate topic was introduced. Several times he earned rebukes from Wallace, who warned the president he was violating procedures his own campaign had agreed to.

“Mr. President, your campaign agreed to both sides would get two-minute answers, uninterrupted,” Wallace said. “Well, your side agreed to it and why don’t you observe what your campaign agreed to as a ground rule. Okay, sir?”

“Gentlemen, you realize if you’re both speaking at the same time,” Wallace said at another point.

Rodney Whitlock, former health-care staffer for Sen. Chuck Grassley (R-Iowa):

Derek Thompson, a writer at The Atlantic:

Casey Mattox, a vice president at the conservative group Americans for Prosperity:

Libertarian podcaster Ben Shapiro:

Biden didn’t hold back with insults.

He called Trump “a clown,” a “liar” (Trump quickly returned the insult) and told him to “shut up.”

Biden also got sarcastic after a discussion of whether he’d support adding more Supreme Court justices or eliminating the Senate filibuster – two questions the former vice president didn’t answer. Trump kept jabbing Biden over his refusal to answer the question directly, accusing him of seeking to pack the court with “radical left” justices.

“That was really a productive segment, wasn’t it? Keep yapping, man,” Biden retorted.

Megan McArdle, columnist for The Post:

Biden tried to talk directly to Americans.

On several occasions Biden peered directly into the camera and talked directly to viewers, even as Trump tried to talk over him.

“Do you believe for a moment what he’s telling you in light of all the lies he’s told you about the whole issue relating to covid?,” Biden said. “He still hasn’t even acknowledged that he knew this was happening, knew how dangerous it was going to be back in February, and he didn’t even tell you.”

Biden cited the nation’s immense death toll from covid-19, which now exceeds 200,000 – a tragedy the president has rarely acknowledged.

“How many of you got up this morning and had an empty chair at the kitchen table because someone died of covid?” Biden said, looking into the camera.

“How many of you are in a situation where you lost your mom or dad and you couldn’t even speak to them, you had a nurse holding a phone up so you could in fact say goodbye?”

Chris Megerian, White House reporter for the LA Times:

Trump claimed insulin has become “as cheap as water.”

“Insulin, it was destroying families, destroying people, the cost,” the president said. “I’m getting it for so cheap it’s like water, you want to know the truth. So cheap.”

The administration has capped co-pays for insulin at $35 a month in some Medicare prescription drug plans. But insulin remains expensive for millions of Americans with private health coverage or no coverage at all, often adding up to hundreds or thousands of dollars in monthly costs for them.

Trump’s claim about insulin was hardly the only way he misrepresented his record on health policy. Just minutes into the debate, the two candidates clashed over his approach to the Affordable Care Act. Biden noted the president’s failure to repeal and replace the law and his administration’s refusal to defend the law before the Supreme Court. Trump continually interrupted him, loudly countering that the law’s penalty for being uninsured was repealed.

“There are 20 million people getting healthcare through Obamacare now that he wants to take it away,” Biden said. “He won’t ever look you in the eye and say that’s what he wants to do. Take it away.”

“No, I want to give them better healthcare at a much lower price, because Obamacare is no good,” Trump returned

Sarah Kliff, of the New York Times:

Biden exaggerated the number of Americans with preexisting conditions. 

Biden claimed there are “a hundred million people who have preexisting conditions” who could lose their coverage if the Supreme Court strikes the law – to which Trump retorted “there aren’t a hundred million people with preexisting conditions.”

Trump was correct that Biden overstated the number. The Kaiser Family Foundation has estimated almost 54 million people – 27 percent of all adults under age 65 – have a condition that would likely have made them uninsurable in the individual market before the ACA. Seniors wouldn’t be affected because they are eligible for Medicare regardless of health status.

Biden didn’t accurately describe his own health-care plan.

His signature proposal is to create a government-run, “public option” plan which would be available for any American to purchase on the individual ACA marketplaces, alongside the existing private options. 

But Biden claimed the public option would be available only to low-income Americans already eligible for the Medicaid program. He was responding to a question from Wallace about whether a public option would essentially cause private plans to shutter.

“It’s only for those people who are so poor they qualify for Medicaid they can get that free in most states, except governors who want to deny people who are poor Medicaid,” Biden said. “Anyone who qualifies for Medicaid would automatically be enrolled in the public option. The vast majority of the American people would still not be in that option.”

Several reporters and health-policy experts noted Biden’s blunder:

Jennifer Haberkorn, a congressional reporter for the LA Times:

Michael Cannon, director of health-policy studies at the Cato Institute:

Eliot Fishman, senior director of health policy for Families USA:

Ahh, oof and ouch

AHH: HHS is struggling to put together an unusual ad blitz.

The agency’s $300 million ad campaign meant to “defeat despair” in the midst of the pandemic has struggled to meet deadlines and gain support, as celebrities express lukewarm interest in participating, Politico’s Dan Diamond reports.

“Interviews with participants and others in the Health and Human Services Department paint a picture of a chaotic effort, scrambling to meet an unofficial Election Day deadline, floundering in the wake of the medical leave of its architect, Michael Caputo, and running up against increasing resistance among career staff,” Diamond writes.

The health department made a list of 30 celebrities who might participate in a series of public service announcements alongside government health officials, but they ended up with only three: singers CeCe Winans and Shelem Lemmer and actor Dennis Quaid. Quaid recently said he wanted to drop out of the campaign after a Politico story last week traced the origin of the ad blitz and highlighted concerns from critics that it could be used as a political stunt for the Trump administration.

A video firm involved in organizing the campaign has also failed consistently to meet deadlines. DD&T is led by a filmmaker who has no prior experience with public health campaigns and who is also the business partner of Caputo, Diamond reports.

OOF: Seven former FDA commissioners condemned political interference from the Trump administration.

The commissioners argued that actions by the White House and political appointees in Health and Human Services are eroding public trust in a potential coronavirus vaccine.

“If the FDA makes available a safe and effective vaccine that people trust, we could expect to meaningfully reduce covid-19 risk as soon as next spring or summer. Without that trust, our health and economy could lag for years,” the commissioners wrote in an op-ed published in The Washington Post.

The former commissioners pointed to White House statements questioning tougher guidelines that the FDA put out for emergency use of any experimental coronavirus vaccine. Trump called the new guidelines a “political move” and indicated the administration might not approve them.

 The commissioners also cited HHS overruling the FDA on regulation of covid-19 laboratory tests, a recent move by HHS Secretary Alex Azar to rescind FDA’s authority to independently establish rules for food and drug safety, and misstatements from leaders in the Trump administration about the benefits of hydroxychloroquine and convalescent plasma.

The rebuke focused on the public perception of a vaccine, rather than on a concern the vaccine itself would be compromised. The authors write they have “confidence in the integrity and high-quality scientific work of the FDA staff” and that these professionals will not recommend a vaccine unless it meets strict standards. Drugmakers have also promised to follow the scientific standards set forward by the FDA, the authors note.

The rollout of the Trump administration’s rapid coronavirus tests has been plagued by confusion.

“President Trump heralded new rapid coronavirus tests on Monday as game changers — fast, cheap and easy to use. But his administration’s deployment of the new tests to nursing homes has been plagued by poor communication, false results and a frustrating lack of planning, state leaders say,” The Post’s William Wan and Lena H. Sun reports.

State health officials have said that they often don’t know until the last minute which nursing homes will receive tests and that many facilities receiving tests have not had training on how to use them. Overarching all of this is the fact that the federal government has not outlined a clear strategy on testing.

“The lack of federal planning also has left states with no standardized way to capture results from the new tests and include them in daily counts of infections and tests. Consequently, as the rapid tests become more widely distributed, the data and dashboards being used each day to guide the nation’s coronavirus response are becoming more inaccurate,” Wan and Sun write.

Many public health experts have welcomed the mass production of antigen tests, which are less reliable than lab-based tests but also much faster and cheaper. Some researchers, however, are concerned about reports that facilities are finding rates of false positives beyond what is expected. There’s also conflicting advice: the FDA recommends testing only symptomatic people with antigen tests, while the Trump administration has deployed them more widely for screening in nursing homes and schools.

The Trump administration has defended its rollout of the tests, saying that the lack of a standardized reporting system is the result of urgency in getting tests to as many people as quickly as possible. The administration has also indicated that it will give governors more control over where future shipments of tests go.

Race for a vaccine

A new study suggests Moderna vaccine is safe in older adults.

“Results from an early safety study of Moderna Inc’s coronavirus vaccine candidate in older adults showed that it produced virus-neutralizing antibodies at levels similar to those seen in younger adults, with side effects roughly on par with high-dose flu shots,” Reuters’s Julie Steenhuysen reports.

A study published in the New England Journal of Medicine on Tuesday showed that older adults who received two injections of Moderna’s vaccine had roughly the same immune response as younger adults and that most side effects were mild.

The findings are important because immunity can weaken with age, and older adults are also at increased risk of severe complications from covid-19.

The study was an extension of Moderna’s Phase 1 safety trial, which was first conducted in people between the ages of 18 and 55. The new study tested the vaccine in 40 adults over the age of 56. Moderna is already testing its vaccine in a large Phase 3 trial.

Elsewhere in health care

  • Several private health insurers are set to end benefits in which they covered the full cost of telehealth visits during the pandemic. Anthem and UnitedHealthcare will stop waiving the cost of copays or other costs to the patients for virtual visits in some circumstances starting Oct. 1, Stat News reports.
  • Senate Minority Leader Charles Schumer (D-N.Y.) made a rare procedural move on Tuesday to force a vote on a bill that would ban the Department of Justice from supporting litigation to overturn the Affordable Care Act. Democrats are unlikely to get the 60 votes needed to move the legislation forward, but it could put pressure on Republicans at a time when Democrats are making the ACA a key issue in the presidential election and in arguments against the confirmation of Judge Amy Coney Barrett to the Supreme Court, the Hill reports.
  • The Food and Drug Administration approved opioid-based drugs on the basis of short-term, narrowly focused trials that often excluded patients who had negative reactions to drugs, according to a new study published Monday in the journal Annals of Internal Medicine. The study, by researchers at Johns Hopkins, reviewed 48 drug approvals between 1997 and 2018, Courthouse News Service reports.
  • The House Oversight Committee will hold hearings this week with six drug company CEOs as part of a drug pricing probe launched by the late Rep. Elijah Cummings in January 2019, Stat News reports.

Sugar rush