Tag: Arc Health

A Missed Opportunity for Universal Healthcare

Jun 11, 2020

By PHUOC LE, MD and CONNIE CHAN

The United States is known for healthcare spending accounting for a large portion of its Gross Domestic Product (GDP) without yielding the corresponding health returns. According to the Center for Medicare and Medicaid Services (CMS), healthcare spending made up 17.7% ($3.6 trillion) of the GDP in the U.S. in 2018 – yet, poor health outcomes, including overall mortality, remain higher compared to other Organization for Economic Cooperation and Development (OECD) countries. According to The Lancet, enacting a single-payer UHC system would likely result in $450 billion in savings in national healthcare and save more than 68,000 lives.

Figure 1. Mortality rate in the US versus other OECD countries.

The expansion of Medicaid under the Patient Protection and Affordable Care Act (ACA or Obamacare) was not the first attempt the United States government made to increase the number of people with health insurance. In 1945, the Truman administration introduced a Universal Health Care (UHC) plan. Many Americans with insurance insecurity, most notably Black Americans and poor white Americans, would benefit from this healthcare plan. During this time, health insurance was only guaranteed for those with certain jobs, many of which Blacks and poor white Americans were unable to secure at the time, which resulted in them having to pay out-of-pocket for any wanted healthcare services. This reality pushed Truman to propose UHC within the United States because it would allow “all people and communities [to] use the promotive, preventative, curative, rehabilitative and palliative health services they need of sufficient quality…, while also ensuring that the use of these services does not expose the user to financial hardship.”

The Legacy of Forced Sterilizations

Feb 19, 2020

By PHUOC LE, MD and BROOKE WARREN

In the 1970s, Jean Whitehorse, a member of the Navajo Nation, went to a hospital in New Mexico for acute appendicitis. Years later, she found out the procedure performed was not just an appendectomy – she had been sterilized via tubal ligation. Around the same time, a Northern Cheyenne woman was told by a doctor that a hysterectomy would cure her headaches. After the procedure, her headaches persisted. Later, she found out a brain tumor was causing her pain, not a uterine problem. Like Whitehorse and the Northern Cheyenne woman, thousands of Native American women have suffered irreversible changes to their bodies and psychological trauma that continues to this day. Most medical providers are unaware of our own profession’s role in implementing these racists policies that have direct links to the Eugenics movement.

Eugenics was a “movement that is aimed at improving the genetic composition of the human race” through breeding. From its origin in 1883, eugenics became the driving rationale behind using sterilization as a tool to breed out unwanted members of society in the United States. With the 1927 Supreme Court case Buck v. Bell permitting eugenic sterilization, 32 states followed suit and passed eugenic-sterilization laws. Although the outward use of sterilization declined after World War II because of its association with Nazi practices, sterilization rates in poor communities of color remained high throughout the United States.

A System that Fails Migrant and Seasonal Agricultural Workers

Dec 23, 2019• 1

By PHUOC LE, MD, CONNIE CHAN, and BROOKE WARREN

I recently took care of Rosaria[1], a cheerful 60-year-old woman who came in for chronic joint pain. She grew up in rural Mexico, but came to the US thirty years ago to work in the strawberry fields of California. After examining her, I recommended a few blood tests and x-rays as next steps. “Lo siento pero no voy a tener seguro hasta el primavera — Sorry but I won’t have insurance again until the Spring.” Rosaria, who is a seasonal farmworker, told me she only gets access to health care during the strawberry season. Her medical care will have to wait, and in the meantime, her joints continue to deteriorate.

Migrant and seasonal agricultural workers (MSAW) are people who work “temporarily or seasonally in farm fields, orchards, canneries, plant nurseries, fish/seafood packing plants, and more.”[2] MSAW are more than temporary laborers, though— they are individuals and families who have time and time again helped the US in its greatest time of need. During WWI, Congress passed the Immigration and Nationality Act of 1917 ^[3] because of the extreme shortage of US workers. This allowed farmers to bring about 73,000 Mexican workers into the US. During WWII, the US once again called upon Mexican laborers to fill the vacancies in the US workforce under the Bracero Program in 1943. Over the 23 years the Bracero Program was in place, the US employed 4.6 million Mexican laborers. Despite the US being indebted to the Mexican laborers, who helped the economy from collapsing in the gravest of times, the US deported 400,000 Mexican immigrants and Mexican-American citizens during the Great Depression.

Indigenous Medicine– From Illegal to Integral

Sep 25, 2019• 4

By PHUOC LE, MD and BROOKE WARREN

In the 2020 Summer Olympics, we will undoubtedly see large, red circles down the arms and backs of many Olympians. These spots are a side-effect of cupping, a treatment originating from traditional Chinese medicine (TCM) to reduce pain. TCM is a globally used Complementary and Alternative Medicine (CAM), but it still battles its critics who think it is only a belief system, rather than a legitimate medical practice. Even so, the usage of TCM continues to grow. This led the National Institute of Health (NIH) to sponsor a meeting in 1997 to determine the efficacy of acupuncture, paving the way in CAM research. Today, there are now over 50 schools dedicated to teaching Chinese acupuncture in the US under the Accreditation Commission for Acupuncture & Oriental Medicine.

Image of Michael Phelps swimming in 2016 Rio Olympics after using TCM cupping. (Al Bello/Getty Images)

While TCM has seen immense growth and integration around the globe throughout the last twenty years, other forms of CAM continue to struggle for acceptance in the U.S. In this article we will focus on Native American/Indigenous traditional medical practices. Indigenous and non-Indigenous patients should not have to choose between traditional and allopathic medicine, but rather have them working harmoniously from prevention to diagnosis to treatment plan.

It was not until August of 1978 that federally recognized tribal members were officially able to openly practice their Indigenous traditional medicine (the knowledge and practices of Indigenous people that prevent or eliminate physical, mental and social diseases) when the American Indian Religious Freedom Act (AIRFA) was passed. Prior to 1978, the federal government’s Department of Interior could convict a medicine man to a minimum of 10 days in prison if he encouraged others to follow traditional practices.

It is difficult to comprehend that tribes throughout the U.S. were only given the ability to openly exercise their medicinal practices 41 years ago when the “healing traditions of indigenous Native Americans have been practiced on this continent for 12,000 years ago and possibly for more than 40,000 years.”[1]

Since the passage of AIRFA, many tribally run clinics and hospitals are finding ways to incorporate Indigenous traditional healing into their treatment plans, when requested by patients.

How Maunakea Teaches Us to Practice Medicine

Aug 22, 2019• 2

By PHUOC LE, MD and BROOKE WARREN

For over a month, Kānaka ‘Ōiwi (Native Hawaiian) elders and community members have stood in solidarity at Maunakea in Hawai’i. They seek to protect their land, sovereignty, and culture from those who want to build the Thirty Meter Telescope (TMT) on Maunakea. Maunakea holds both cultural and spiritual meaning to the Kānaka ‘Ōiwi. Unfortunately, many astrophysicists and TMT investors see Maunakea primarily as a means to make scientific discoveries. The frequent narrative where Indigenous people need to defend the value of their traditional knowledge^[1], beliefs and culture to Western scientists is a very familiar story that is often replicated in healthcare, both at home in the U.S., and abroad.

Kānaka ‘Ōiwi elders blocking road to prevent TMT construction (Photo: Caleb Jones/AP)

Traditional medicine, as defined by the World Health Organization, is the “knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, used in the maintenance of health and in the prevention, diagnosis, improvement or treatment of physical and mental illness”. Looking at this definition, it is clear that traditional medicine practiced by Indigenous people has equivalent goals to modern Western medicine. Therefore, are we harming our patients when we do not incorporate traditional approaches harmoniously to the practice of healing, and instead value Western medicine over traditional medicine?

The arguments for putting TMT on Maunakea follow a similar reflex to reject knowledge that is different from our own. Thankfully, letters and activism rallying against the construction of TMT on Maunakea, from both Indigenous communities and scientists, are highlighting how Indigenous people are not anti-Western science. In fact, they are beginning to envision how collaboration between Traditional Knowledge and Western science is possible, and potentially even synergistic. Similarly, Western healthcare, too, must foster an approach that centers Traditional Knowledge for Indigenous communities.

How can current and future healthcare providers promote the value of both Traditional Knowledge and Western science, and thus promote trust and collaboration between providers and patients?