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Tapeworms, man-eating amoebas, and other parasites

 How the Worm Gets in Your Brain? (Dana G. Smith and Dani Blum, NY Times, 5-8-24). The title may creep you out, but once it's asked, don't you want to know? This led me to other postings about parasites, which I (anxiously) share below.

    For example, Robert F. Kennedy Jr.'s disclosure that a doctor apparently found a dead worm in his brain has sparked questions about what brain parasites are, the damage they can cause and how, exactly, they get there. How do parasites turn up in people? And what can they do to the brain? Warning: Many of the following pieces are from the New York Times, for which you need a subscription. If you're not a subscriber, see if you can get access to them in your public library.


See especially this excellent resource:
Parasitic Diseases: A–Z Index: More information about specific parasites (CDC, or Centers for Disease Control and Prevention) After a few general articles there's a wonderful A to Z directory to information about specific parasites and diseases (in four alphabetic groups).

About Parasites (CDC)


•  R.F.K. Jr. Says Doctors Found a Dead Worm in His Brain (Susanne Craig, NY Times, 5-8-24) In 2010, Robert F. Kennedy Jr. was experiencing memory loss and mental fogginess so severe that a friend grew concerned he might have a brain tumor. Mr. Kennedy said he consulted several of the country’s top neurologists, many of whom had either treated or spoken to his uncle, Senator Edward M. Kennedy, before his death the previous year of brain cancer. About the same time he learned of the parasite, he said, he was also diagnosed with mercury poisoning, most likely from ingesting too much fish containing the dangerous heavy metal, which can cause serious neurological issues....Doctors who have treated parasitic infections and mercury poisoning said both conditions can sometimes permanently damage brain function, but patients also can have temporary symptoms and mount a full recovery."
     "Hours after this article was published, Mr. Kennedy posted a comment on his X profile. “I offer to eat 5 more brain worms and still beat President Trump and President Biden in a debate,” the post read. “I feel confident in the result even with a six-worm handicap.”


A Silver Bullet Against the Brain-Eating Amoeba? (Emily Baumgaertner, NY Times, 1-14-19) "Brain-eating monsters are real enough — they lurk in freshwater ponds in much of the United States. Now scientists may have discovered a new way to kill them. Minuscule silver particles coated with anti-seizure drugs one day may be adapted to halt Naegleria fowleri, an exceptionally lethal microbe that invades through the sinuses and feeds on human brain tissue."

---Brain-Eating Amoeba Caused Nebraska Child’s Death, Health Officials Say (Eduardo Medina, NY Times, 8-18-22) Such infections are rare. From 2012 to 2021, only 31 cases were reported in the U.S., according to federal data.

---Man Dies of ‘Brain-Eating’ Amoeba After Swimming in Lake ( Jacey Fortin, NY Times, 7-25-19) Naegleria fowleri, a single-celled organism found in warm freshwater, can be fatal if it enters the body through the nose. The amoeba is typically found in warm freshwater, and the majority of cases in the United States have occurred in Florida and Texas. According to the North Carolina health department, Naegleria fowleri “does not cause illness if swallowed but can be fatal if forced up the nose, as can occur during diving, water-skiing or other water activities.”

---A Man Died After Being Infected With a Brain-Eating Amoeba. Here Are the Facts. (Christine Hauser, NY Times, 10-1-18) Naegleria fowleri is a single-celled organism that can cause a rare infection of the brain called primary amoebic meningoencephalitis, also known as PAM, which is usually fatal. The CDC reports that in 123 known cases from 1962 to 2011 in the United States, only one person has survived.

Rare Infection Prompts Neti Pot Warning (Tara Parker-Pope NY Times, 9-3-12)

     The water is the problem, not the pots.

     Neti pots — those odd teapotlike vessels used to wash out the nasal passage — have won legions of fans who rely on them for relief from allergies, congestion and colds. But now, after two cases of a deadly brain infection were linked to neti pots, government health officials have issued new warnings about using them safely: Use distilled or filtered water in a neti pot. You can use bottled water, or you can boil water and let it cool before using.

Pork Tapeworm (taeniasis and cysticercosis) Taeniasis and cysticercosis are diseases of humans caused by a tapeworm (Taenia solium) that normally infects pigs. Taeniasis is an intestinal infection with the adult stage of the tapeworm. Cysticercosis is a tissue infection with the larval stage cysts of the tapeworm.
      "People get taeniasis [pork tapeworm] from eating raw or undercooked pork that contains larval cysts. Once in the person’s intestine, the larval cysts develop into adult tapeworms and produce a large number of eggs.
    "People and pigs develop cysticercosis from swallowing the tapeworm eggs in the feces from an infected human. The eggs hatch in the small intestine and larvae migrate throughout the body before forming cysts. Cysts can form in a variety of tissues, including the brain where the condition is called neurocysticercosis."  [This is one reason they invented housecleaning.]

---Taeniasis FAQs (CDC) Eating raw or undercooked contaminated beef or pork is the primary risk factor for acquiring taeniasis. Because of this, certain groups with dietary restrictions for these meats may have a lower risk of taeniasis. Cook to at least 145° F (63° C) as measured with a food thermometer placed in the thickest part of the meat, then allow the meat to rest* for three minutes before carving or consuming.
   According to USDA, “A ‘rest time’ is the amount of time the product remains at the final temperature, after it has been removed from a grill, oven, or other heat source. During the three minutes after meat is removed from the heat source, its temperature remains constant or continues to rise, which destroys pathogens.”

How Fat Cells Help Kick Parasites Out of Mice: Study (Natalia Mesa, The Scientist, 10-14-22) Immune cells get a lot of shine when it comes to fighting infection, but it turns out that fat might be just as important for removing parasitic invaders.
Lose the Fat and Curb Parasitic Infection (Mariella Bodemeier Loayza Careaga, The Scientist, 3-1-24) Trypanosoma brucei (T. brucei) enters its host’s body through the painful bite of infected tsetse flies, causing sleeping sickness, which can be fatal if left untreated. In her laboratory at the University of Lisbon, parasitologist Luísa Figueiredo studies the mechanisms underlying T. brucei infections.
     “It had often been thought that the wasting associated with these infections was a consequence of high parasitemia,” said Monica Mugnier, a T. brucei researcher at Johns Hopkins University who was not involved in the research. “This result shows that the fat loss may actually be a protective mechanism during the infection.”

• What other parasites are there?  Check out History of Human Parasitology (F. E. G. Cox, Clinical Microbiology Reviews, 10-15-02)

Long, detailed, academic, and not easy reading, but briefly covers Ascaris and Ascariasis (roundworms), Hookworms and Hookworm Disease, Trichinella and Trichinosis, Strongyloides and Strongyloidiasis, Dracunculus and Dracunculiasis (Guinea Worm Disease), Filarial Worms and Lymphatic Filariasis (Elephantiasis), Loa and Loiasis (Eye Worm) and Onchocerca and Onchocerciasis (River Blindness), Schistosomes and Schistosomiasis, Liver and Lung Fluke Diseases, Cestodiasis (Tapeworm Infections),


(for those requiring study under a microscope), THE PARASITIC PROTOZOA: Amoebae and Amoebiasis, Giardia and Giardiasis, African Trypanosomes and Sleeping Sickness, South American Trypanosomiasis: Chagas' Disease, Leishmania and Leishmaniasis, Malaria, Toxoplasma, Toxoplasmosis, and Infections Caused by Related Organisms, Microsporidians.


If you want to post a link to another article, please include the full URL

(such as https://www.cdc.gov/parasites/ for Parasitic Diseases: A–Z Index: More information about specific parasites).

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Chronic Wasting Disease (CWD) strikes free-ranging wildlife. What hunters should know.

"Chronic Wasting Disease (CWD) is an emerging infectious disease that primarily affects deer, elk, reindeer, sika deer, and moose. It belongs to a family of diseases called transmissible spongiform encephalopathies (TSEs).

1. Unlike vector-borne diseases, which are transmitted by vectors like mosquitoes or ticks, CWD is not spread through vectors. Instead, it is thought to be caused by prions, abnormal proteins that lead to neurological degeneration.

2. CWD is the only TSE known to affect free-ranging wildlife. Although it does not directly impact humans, there are concerns about potential mutations and the risk of transmission to other animals or livestock

3. So, while it’s not a vector-borne disease, it remains a significant concern for wildlife health and management."

Chronic wasting disease (Wikipedia) is a highly contagious disease that develops very slowly in the lymph nodes, spinal tissue and brains of deer and similar animals like reindeer and elk. It is an emerging infectious disease that is fatal to free-ranging and captive animals in Cervidae, the deer family. CWD is one member of a family of diseases called transmissible spongiform encephalopathies (TSEs), and is thought to be caused by prions. CWD is the only TSE known to affect free-ranging wildlife.

Mad Deer Disease (Susan Milius, Science News, 11-26-02) "So-called chronic wasting disease strikes mule deer, white-tailed deer, and elk. It riddles the brain with tiny holes as the victim slowly withers and dies. Once found in the wild only in an area intersecting Colorado, Wyoming, and Nebraska, the disease appears to be spreading. In 2002 it turned up in wild herds in South Dakota, New Mexico, and Canada and jumped all the way to Wisconsin and Illinois... This disease belongs to the same class of maladies as mad cow disease, which appeared in Britain in 1986 and about a decade later, showed up in people who had eaten tainted meat.... Similar spongy-brain diseases have appeared in at least 10 animal species, so far.

What Hunters Can Do to Stop Chronic Wasting Disease (Bill Moritz and Matt Dunfee, Wildlife Management Institute, 12-15-17) Hunters are one of conservation’s greatest tool for wildlife management, and particularly so to the management of CWD. Samples collected from hunter-harvested cervids (deer elk or moose) are the key to understanding and controlling the spread of CWD. What should hunters do?
    1 (of 7). Know the status of CWD regulations where you hunt, as well as the states you will travel back through with your harvested animal, and follow them carefully. Do not move carcasses or carcass parts from one area to another. Transportation of live animals, infected harvested animals or parts of infected animals is an easy way for CWD to arrive in your neighborhood. Please check with your state fish and wildlife agency on what parts of your harvested animal you are allowed to bring back to your home.
    2.If the state you’re hunting in is testing for CWD in cervids, then you can help by submitting your harvested animals for testing. Since the odds of finding an infected animal are low, obtaining high numbers of samples is necessary to learn if the disease is present. Testing for CWD will also allow you to avoid eating infected animals. Although no linkage between CWD and human infection has been made, scientists recommend against eating CWD-positive game.
    3.Dispose of the remains of all harvested animals in a way that reduces the chance of spreading CWD. Burning or chemical treatment will not destroy the infective prions, and throwing a carcass or remains out in a back field for scavengers will only contaminate the site if the animal was CWD positive. Check with your state fish and wildlife agency on the proper method of disposal. Go here for four more tips.

What Does a Deer with CWD Look Like? (Staff, National Deer Association,10-2-19) 'Whitetails carry CWD for an average of one to two years before outward visible symptoms begin to appear. During this incubation period, they appear completely healthy to an observer like a hunter, but they are capable of spreading the disease to other deer. Only in the final “clinical” stages of the disease will deer begin to appear bony, weak or disoriented."
     Photos of deer "in the final, sickly stages of CWD has led many hunters to believe that all CWD-positive deer look extremely sick." The truth is "You cannot look at a deer, whether alive in the woods or on the ground after harvest, and tell if it has CWD. Therefore, NDA urges all hunters who will be hunting this fall in a CWD zone to submit every harvested deer to the state wildlife agency for CWD testing. Then, wait for clean results before eating venison from those deer."

Stopping the Latest Outbreak Threat: Chronic Wasting Disease (Jim Robbins, Scientific American and KFF Health News, 2-1-24) A spillover of the neurological disease to humans from deer, elk, and other animals could be devastating. Recent research shows that the barrier to a spillover into humans is less formidable than previously believed and that the prions causing the disease may be evolving to become more able to infect humans.
     “The bottom-line message is we are quite unprepared,” said Michael Osterholm, an expert in infectious disease and a leading authority on CWD.“If we saw a spillover right at the University of Minnesota now, we would be in free fall. There are no contingency plans for what to do or how to follow up.”

Transmission (CDC) Scientists believe CWD proteins (prions) likely spread between animals through body fluids like feces, saliva, blood, or urine, either through direct contact or indirectly through environmental contamination of soil, food or water. Once introduced into an area or farm, the CWD protein is contagious within deer and elk populations and can spread quickly. Experts believe CWD prions can remain in the environment for a long time, so other animals can contract CWD from the environment even after an infected deer or elk has died....
    "To date, there is no strong evidence for the occurrence of CWD in people, and it is not known if people can get infected with CWD prions. Nevertheless, these experimental studies raise the concern that CWD may pose a risk to people and suggest that it is important to prevent human exposures to CWD.
     "Additional studies are under way to identify if any prion diseases could be occurring at a higher rate in people who are at increased risk for contact with potentially CWD-infected deer or elk meat. Because of the long time it takes before any symptoms of disease appear, scientists expect the study to take many years before they will determine what the risk, if any, of CWD is to people.

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The High Cost of Dying

Desperate Families Search for Affordable Home Care (Reed Abelson, The New York Times and KFF Health News, The High Cost of Dying DYING BROKE series, 12-4-23) Facing a severe shortage of aides and high costs, people trying to keep aging loved ones at home often cobble together a patchwork of family and friends to help.
Dying Can Cost Loved Ones $20,000 Before Lost Wages And Worse Health, New Report Says (Deb Gordon, Forbes, 1-16-23)

"On average, survey respondents reported that they paid $3,584 to the funeral home (lower than the 2021 national median cost of $7,848 reported by the National Funeral Directors Association). Burial plots cost respondents an average of $1,841. Smaller expenses, such as catering, officiants, flowers, music, and invitations can add more than $1,700 combined, making the funeral the single biggest expense associated with a loved one's death.

    "But the costs don't end with the funeral. Survey respondents reported paying an average of $4,384 to deal with financial matters, such as hiring accountants and paying bills.

Respondents spent nearly $5,000 on legal matters, including lawyer fees and costs associated with selling off assets. Disposing of real estate can add another $4,000."

“The High Cost of Dying”: What Do the Data Show? Anne A Scitovsky, Milbank Quarterly, 12-2005) It is not surprising that “the high cost of dying” has led some people to question whether resources are being “wasted” on the dying (especially if the latter are very elderly) and could (or should) be more productively allocated to other patients, or even to other socially desirable ends such as education or housing. High medical care costs at the end of life become “the high cost of dying” and the source of concern over “wasting” scarce resources on the care of hopelessly ill patients. The policy implications of this interpretation of the data, though rarely stated explicitly, are clear: If we want to stem the rise in medical care costs, medical care expenditures at the end of life provide an excellent target for cost-containment efforts. A consensus has gradually developed about the ethics of forgoing treatment for such patients for whom care is, in some real way, futile. But no such consensus exists for patients who, although very sick, might still be helped by various diagnostic or therapeutic procedures and whose days might be prolonged. Thus, if we ask whether the costs of care for this group are excessive, we face new ethical problems of major proportions.

The Cost of Dying (Empathy, 2024) Get the report here
The Cost of Dying: Average Cost of Funerals and Cremation Fees (Self) This detailed piece is about the true cost of dying across the U.S. based on official data. Funerals and cremations are expensive--often surprisingly so. How much do people have to spend to say goodbye to their loved ones (by state). Which states cost the most to die in? Which cost the least? What are the most expensive states for funerals,for cremation? What were costs of burials and cremations in 2020 vs. 2022. What is the average cost of a funeral service? The average cost of dying in the U.S. in 2022 was $7,028 based on a blended average cost of burials and cremation services, calculated by the percentage of these end-of-life services performed across the country. Across all states, funerals cost an average of $8,526, while cremations cost $7,573. Hawaii is the most expensive state for funerals ($13,439) and cremations ($11,212). Mississippi is the most affordable state for funerals ($6,144) but Wyoming has the lowest cost for cremations ($5,219). 

     "Average service fees alone are a staggering $2,195 to start, however, the casket fee is what drives the price of funerals much higher than cremations. The average price of a casket according to the NFDA is $2,500, compared with $295 for an urn for those who choose to be cremated." 

What to Know About Home Care Services (Reed Abelson, NY Times, 12-4-23) Finding an aide to help an older person stay at home safely takes work. Here’s a guide.
The Hidden Costs of Dying in America (Kendra Madsen, Tincture, 7-2-19) The National Funeral Director’s Association estimates median funeral costs, such as viewing services and cremation, hover at $7,360. While cremation is generally less expensive than burial, the Consumer Price Index indicates that over the last thirty years, all funeral expenses have risen more than 200%. Being armed with information about costs can help you and your loved ones make the best, most-compassionate decisions for your family. It can also ultimately save you money. In this case, knowledge isn’t only power — it’s also the peace of mind that comes with knowing you won’t leave financial burdens behind.
The Economics of Dying -- The Illusion of Cost Savings at the End of Life (Ezekiel J. Emanuel, and Linda L. Emanuel, New England Journal of Medicine, 2-24-94) The unlikeliness of substantial savings in health care costs does not mean, however, that there are no good reasons to use advance directives, fund hospice care, and employ less aggressive life-sustaining treatments for dying patients....Our alternatives for achieving substantial savings seem limited to major changes in the financing and delivery of health care, difficult choices in the allocation of services, or both. Whatever we choose, we must stop deluding ourselves that advance directives and less aggressive care at the end of life will solve the financial problems of our health care system.
Advance Directives: What You Need To Know (Jennifer Lagemann, Forbes, 10-25-22) Only one in three U.S. adults has an official plan in place for end-of-life care. Formalizing these details when you’re able to do so can make a world of difference for you and your loved ones down the line. Research shows advance directives can “get prematurely misinterpreted as a DNR order, and DNR orders can get misinterpreted as do-not-treat orders.” The goal is for the health care team to make decisions that honor what a person says they want. Each type of advance directive serves a unique purpose and is implemented in certain situations.
    POLSTs (aka MOLSTS) are implemented once both the patient and their health care provider agree and sign off on a medical treatment plan as it relates to the person’s current health status.
    Living wills go into effect when the person enters any of the conditions listed in their living will document. At this point, the document becomes operative and is followed by all care team members, explains Dr. Mirarchi.
    Meanwhile, a health care power of attorney can be utilized at any point in a person’s life when they aren’t able to make a health decision for themselves, be it due to an acute health emergency or progression of a chronic illness.
    And DNR orders become active when a person stops breathing or their heart stops beating, at which time the care team isn’t allowed to perform CPR to resuscitate them. See website section on Advance directives and living wills for more information on those options.


Death and Covid
Statistics about death, mortality, long-term care, hospice care, and palliative care
Having a "good" death
Practical aspects of end of life care

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Being trans in America

In three sections:

Being trans in America (Washington Post/KFF survey and series)

Whistleblower in a small gender clinic

More information, articles



The excellent Washington Post/KFF survey and series (2023)

Contributors: Casey Parks, Emily Guskin, Scott Clement, Annys Shin, Fenit Nirappil, Hannah Natanson, Tara Bahrampour, Laura Meckler, Anne Branigin.


Understanding Trans Identity in the U.S.

  Gender identity differs from sexual orientation.

    Many trans adults don't identify as a man or a woman.

     Most trans adults say transitioning helped them.

  Nearly 8 in 10 trans adults  (78%) say that living as a gender different from the one assigned to them at birth has made them "more satisfied" with their life, including 45% who say they are "a lot more satisfied."
Most trans adults say transitioning made them more satisfied with their lives 

The Washington Post and KFF surveyed one of the largest randomized samples of U.S. transgender adults to date about their childhoods, feelings and lives 
Voices of trans people in America: ‘I’ve always known I was different’

     Four trans people share their stories. With photos.

How historians are documenting the lives of transgender people (Erin Blakemore, National Geographic, 6-24-22) "The term “transgender” wasn’t coined until the 1960s—but people have always challenged the gender binary. Here’s a look at their history, from ancient civilizations to the modern rights movement. "In 1999, trans activist Monica Helms designed a symbol that would come to define a movement: the transgender pride flag. Using blue and pink stripes—colors with deep connections to gender assignment—the flag also featured a white stripe to represent people who are intersex, transitioning, or nonbinary."
•  6 key takeaways from the Post-KFF survey of transgender Americans

      Among them,

        1. Whether a trans person is out to family and friends depends on their age.

        4. Many transgender people knew they were trans from a young age.

        6. Most transgender adults say living as a gender different from the one assigned to them at birth improved their lives.

For trans people, medical visits can be more traumatizing than healing

        Trans patients share stories of subtle discrimination, outright hostility and ill-informed medical professionals

School is a ‘nightmare’ for trans and nonbinary kids. Here’s why.

      In a sweeping Washington Post-KFF poll, 45% of trans adults said school made them feel unsafe
Trans people have never been so visible — or so vulnerable
Six works that capture the complexity of being trans in America:

     'Both Sides Now' by Peyton Thomas; 'One From the Vaults'; 'Veneno'; 'Femme Queen Chronicles';'Big Dad Energy: A Trans-Masculine Comedy Showcase'; and 'Framing Agnes'
Most Americans support anti-trans policies favored by GOP

    Most adults say gender is based on sex assigned at birth. Most Americans say trans women and girls should not be allowed to compete in sports with other women and girls. Etc.
Trans lawmaker Brianna Titone tried not to stand out. Then a gunman killed 5 at Club Q

     This session, she wanted to do more than outvote the Republicans. She wanted to win them over, too.
Trans kids crave acceptance at school in a nation that often resists it

     They had sensed already that something was different about their own gender identity but didn't know what. "I didn't have the words for 'transgender' or 'nonbinary' or any of this."
In middle age, they realized they were trans: ‘A lightbulb went off’

     Roughly one-fifth of trans adults 45 and older have not told anyone they are trans, a Washington Post-KFF poll conducted late last year found
1 in 4 Transgender Adults Say They’ve Been Physically Attacked, New KFF/Washington Post Partnership Survey Finds

[Back to Top]

Whistleblower in a small gender clinic

How a Small Gender Clinic Landed in a Political Storm (Azeen Ghorayshi, NY Times, 8-23-23) Washington University’s youth gender clinic in St. Louis, like others around the world, was overwhelmed by new patients and struggled to provide them with mental health care. "But as the number of these patients soared, the clinic became overwhelmed — and soon found itself at the center of a political storm. In February, Jamie Reed, a former case manager, went public with explosive allegations, claiming in a whistle-blower complaint that doctors at the clinic had hastily prescribed hormones with lasting effects to adolescents with pressing psychiatric problems."
      "The reality was more complex than what was portrayed by either side of the political battle, according to interviews with dozens of patients, parents, former employees and local health providers, as well as more than 300 pages of documents shared by Ms. Reed.

     "Some of Ms. Reed’s claims could not be confirmed, and at least one included factual inaccuracies. But others were corroborated, offering a rare glimpse into one of the 100 or so clinics in the United States that have been at the center of an intensifying fight over transgender rights.

     "The turmoil in St. Louis underscores one of the most challenging questions in gender care for young people today: How much psychological screening should adolescents receive before they begin gender treatments?"  This story about the controversy came out after The Free Press first broke the news.

I Thought I Was Saving Trans Kids. Now I’m Blowing the Whistle (Jamie Reed, The Free Press/TFP, 2-9-23)

[In 2018 Reed was a case manager at The Washington University Transgender Center at St. Louis Children's Hospital, which had been established a year earlier.]

      "There are more than 100 pediatric gender clinics across the U.S. I worked at one. What’s happening to children is morally and medically appalling. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.”
      "At first, the patient population was tipped toward what used to be the 'traditional' instance of a child with gender dysphoria: a boy, often quite young, who wanted to present as—who wanted to be—a girl. Until 2015 or so, a very small number of these boys comprised the population of pediatric gender dysphoria cases. Then, across the Western world, there began to be a dramatic increase in a new population: Teenage girls, many with no previous history of gender distress, suddenly declared they were transgender and demanded immediate treatment with testosterone.
      "As the center’s website said, 'Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.'   "There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are."
      "So many critics and media outlets tried to paint not just me but the entire issue of transgender youth as a showdown between the right and left. As a lifelong member of the left, a queer woman married to a transman, I’d clearly been brainwashed or paid off—or probably even both—by conservatives."

     Many of the following articles are linked to in this article.

Jamie Reed's letter to the Missouri Attorney General (1-26-23) 

Missouri AG officially probing ‘disturbing’ whistleblower claim that transgender clinic ‘harming hundreds’ of kids (Lee Brown, NY Post, 2-10-23)

Missouri Anti-trans "Whistleblower" Story Is a Manufactured Controversy - Point By Point (Erin Reed, Erin in the Morning, 2-10-23)

    Disputes Reed's points, one by one, concluding, "In fact, the findings around gender affirming care are so stunningly in favor of proceeding with that care that 29 major medical organizations representing hundreds of thousands of physicians have signed off to that care" (and lists them).

The Courage to Admit You’re Wrong (Jamie Reed, The Free Press, 12-31-23) Jamie Reed became a lightning rod in TFP after she blew the whistle about the mistreatment of minors at The Washington University Transgender Center at St. Louis Children’s Hospital, where she’d worked as a case manager for four years. Her revelations sparked an investigation of the clinic by the Missouri Attorney General, and this helped lead lawmakers in Missouri and other states to pass bans on gender transition of minors.

    "When I blew the whistle on a transgender clinic, some suggested I had been 'brainwashed by the right.'   "As a lifelong member of the left, a queer woman married to a transman, I'd clearly been brainwashed or paid off—or probably even both—by conservatives. I had a 'clear ideological bias.' No. I'm a progressive who follows science.

The Bigger Picture Continues – Denver, Colorado (Genspect, 7-11-23) Jamie Reed spoke at the first U.S. conference for Genspect, an organization that discourages gender transitioning of minors. See YouTube videos from that conference here



[Back to Top]

More information, articles
What do I need to know about transitioning? (AARP fact sheet)
The Experiences, Challenges and Hopes of Transgender and Nonbinary U.S. Adults (Anna Brown, Juliana Menasce Horowitz, Kim Parker and Rachel Minkinn, Pew Research Center, 6-7-22) Findings from Pew Research Center focus groups.
Bathroom Bills Are Back — Broader and Stricter — In Several States (Jazmin Orozco Rodriguez, KFF Health News, 2-29-24) State lawmakers — predominantly in conservative, rural states — are resurrecting and expanding efforts to prohibit transgender people from using public restrooms and other spaces that match their gender. Some have sought to ban trans people from “sex-designated spaces,” including domestic violence shelters and crisis centers, which experts say could violate anti-discrimination laws and jeopardize federal funding.
This is me, as I am’: A photographer documents her own gender transition (Allison Lippy, National Geographic, 6-24-22) In 2015, Allison Lippy realized who she had always been—and turned her camera on herself to understand her journey as a transgender woman. Excellent photographs.
How historians are documenting the lives of transgender people(Erin Blakemore, National Geographic, 6-24-22)The term “transgender” wasn’t coined until the 1960s—but people have always challenged the gender binary. Here’s a look at their history, from ancient civilizations to the modern rights movement.
Transgender rights in the United States (Wikipedia entry, full of information and links) Marriage, parental rights, reproductive rights, identity documents (name change, birth certificates, cases, driver's licenses, passports, persons not born in the United States, third gender option, US jurisdictions with "gender X" driver's licences, death certificates), housing, genocide, government list of trans people, physical violence, sexual violence, displacement and sanctuary states, discrimination protections (employment, laws--federal, state and local, chart), cases, education (Main article: Gender identity under Title IX) (local school boards), employment, public factors (social media, politicians, media involvement, grooming conspiracy theory); restroom access (indecent exposure charges for restroom use, schools, workplace); Hate crimes legislation; Healthcare (treatment for adults, treatment for children, bans of gender-affirming healthcare for people under 18--chart, by states ), awareness of providers, discrimination, Catholic hospitals, "trans broken arm syndrome" (common form of discrimination), medical privacy, insurance; Prisoners' rights, V-coding; immigration; military; taxes; sports; Biden administration rule change; references.
What Is Gender Transitioning? (S. Nicole Lane, VeryWellHealth, 7-2-23) Gender transitioning, known more commonly today as gender affirmation, not only involves aesthetic appearances but may also involve changes in social roles, legal recognitions, or physical aspects of the body. Gender transitioning is often described as a binary (male or female) but can also be non-binary, meaning a person is neither strictly male nor female.
Transition Roadmap (UCSF Transgender Care)
Breaking the Silence: The Reality of De-Transitioning (YouTube video, NBCNews Spotlight, 9-11-23)
'I regret trusting' the doctors who pushed me to transition gender (YouTube video, Times Radio, 6-4-23)
Interim Report (The Cass Review, UK, Feb 2022) Children and young people with gender incongruence or dysphoria must receive the same standards of clinical care, assessment and treatment as every other child or young person accessing health services. 
       "The care of this group of children and young people is everyone’s business. Our initial work indicates that clinicians at all levels feel they have the transferable skills and commitment to support these children and young people, but there needs to be agreement and guidance about the appropriate clinical assessment process that should take place at primary, secondary and tertiary level, underpinned by better data and evidence.  At this stage the Review is not able to provide advice on the use of hormone treatments due to gaps in the evidence base. Recommendations will be developed as our research programme progresses."

Youth Access to Gender Affirming Care: The Federal and State Policy Landscape (Lindsey Dawson, Jennifer Kates, and MaryBeth Musumeci, KFF, 3-24-23)

     "Numerous states have implemented or considered actions aimed at limiting LGBTQ+ youth access to gender affirming health care. Four states (Alabama, Arkansas, Texas, and Arizona) have recently enacted such restrictions (though the AL, AR, and TX laws all have been temporarily blocked by court rulings) and in 2022, 15 states are considering 25 similar pieces of legislation. At the same time, other states have adopted broad nondiscrimination health protections based on gender identity and sexual orientation. Separately, the Biden administration, which has been working to eliminate barriers and expand access to health care for LGBTQ+ people more generally, has come out against restrictive state policies. This analysis explores the current state and federal policy landscape regarding gender affirming services for youth and the implications of restrictive state laws."

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Stories about wrongful conviction and related issues

First articles, then books. Updated from an earlier version.


• See below a list of books about wrongful convictions and related issues, recommended by the highly valued Innocence Project, which works nationwide to free the innocent and reform our criminal justice system. See The Innocence Project: A Short History Since 1983 (Black Past). "DNA testing has exonerated more than 345 innocent people in the United States – and others are still waiting for justice."
• Also of interest: The Equal Justice Initiative (EJI), based in Montgomery, Alabama, "provides legal representation to prisoners who may have been wrongly convicted of crimes, poor prisoners without effective representation, and others who may have been denied a fair trial." Read about it in the bestseller Just Mercy: A Story of Justice and Redemption by Bryan Stevenson.  On EJI's website (with links to material on racial justice, children in prison, mass incarceration, the death penalty, and "just mercy"): "Since 1973, 166 people have been released from death row after evidence of their innocence was uncovered. A shocking rate of error has emerged: for every nine people executed in this country, one innocent person has been exonerated."


Articles about wrongful convictions (and exonerations)

Crime victims form unlikely bonds with wrongfully convicted men (Leslie Stahl, 60 Minutes, 3-17-24)
Capturing the emotional journey of Healing Justice (Will Croxton, 60 Minutes, 3-17-24)
Why rape survivors and exonerees went on a retreat together (Lesley Stahl, Aliza Chasan, Shari Finkelstein, Collette Richards, 60 Minutes Overtime, 3-17-24) A rape survivor, guilt ridden after learning that an innocent man had been sent to prison in her case, brings together crime victims and exonerees to help heal those impacted by wrongful convictions.
Finally, Justice (Jake Tapper, The Atlantic, 3-24) Two years ago, he wrote an Atlantic cover story about the case of C. J. Rice, a Philadelphia teenager convicted of attempted homicide. Today, Rice was exonerated. C. J. Rice is now a free man.
---C. J. Rice’s Conviction Is Overturned (Andrew Aoyama, The Atlantic, 11-28-23) After a cover story in The Atlantic, a man convicted of a crime he insists he did not commit now has a chance to be freed from prison.
Sentenced to death, but innocent: These are stories of justice gone wrong. (Phillip Morris, National Geographic, 2-18-21) Since 1973, more than 8,700 people in the U.S. have been sent to death row. At least 182 weren’t guilty—their lives upended by a system that nearly killed them.
More than half of all wrongful criminal convictions are caused by government misconduct, study finds (Tom Jackman, Washington Post, 9-16-20) Misconduct can be intentional or unintentional, but either way innocent people are found guilty
Government Misconduct and Convicting the Innocent:The Role of Prosecutors, Police and Other Law Enforcement (Samuel R. Gross, Maurice J. Possley, Kaitlin Jackson Roll, Klara Huber Stephens,National Registry of Exonerations, 9-1-20) The study cites five types of misconduct that lead to wrongful convictions: witness tampering, misconduct in interrogations, fabricating evidence, concealing exculpatory evidence and misconduct at trial. It found that Black defendants were slightly more likely than White defendants to be victims of misconduct, 57 percent to 52 percent, but that the racial difference was much larger for drug crimes — 47 to 22 percent — and in murder cases, 78 to 64 percent. In some instances, authorities purposefully sought to improperly influence a case; other times their missteps were unintentional or based on flawed techniques.
National Registry of Exonerations (a project of the Newkirk Center for Science & Society at University of California Irvine, the University of Michigan Law School and Michigan State University College of Law) See Registry tallies over 2,000 wrongful convictions since 1989 ( David G. Savage, Washington Bureau, Los Angeles Times, 5-20-12) More than 2,000 people have been freed from prison in the U.S. since 1989 after they were found to have been wrongly convicted of serious crimes, according to a new National Registry of Exonerations compiled by University of Michigan Law School and Northwestern University. Follow Exoneration Registry.

% Exonerations by Contributing Factor (National Registry of Exonerations) Factors: Mistaken Witness ID, Perjury or False Accusation, False Confession, False or Misleading Forensic Evidence, Official Misconduct.
Wrongful conviction podcasts
Wrongful Convictions (National Institute of Justice) Articles and other resources on such topics as DNA testing,forensic science, erroneous identification.
Causes of wrongful conviction (Innocence Clinic, Michigan Law, University of MIchigan)

List of Wrongful Convictions (Wikipedia)
New Docuseries Highlights the Impact of Wrong Convictions (Sameer Rao, ColorLines, 10-30-18) The first episode of Vice’s “Innocence Ignored” explores the many drawbacks of Alford pleas, which prevent compensation for the wrongfully convicted.
Wrongful Convictions: A New Exoneration Registry Tests Stubborn Judges (Andrew Cohen, The Atlantic, 5-21-12)
Righting Wrongful Convictions of Youth: What You Can Do (Terry Keleher, ColorLines, 10-4-09) Each year in the US, millions of young people interact with juvenile and criminal courts where they often face unfair treatment and racial discrimination.
The Neighbors Who Destroyed Their Lives (Robert Kolker, The Atlantic, 12-22-23) Murder and lies in small-town Hawaii. "Wrongful convictions can result from any number of cascading errors, blatant oversights, and outright slipups—some conscious and deliberate, some structural and circumstantial. Over 32 years, the investigation and prosecutions of the Schweitzers seem to have incorporated every possible one of them. There was intense media attention putting pressure on police to make an arrest—the “dead white girl” phenomenon. There was cultural bias against Native Hawaiians like the Schweitzers—the legacy, well known to Hawaiians, of lynchings of native men for alleged attacks on white women. There was investigative tunnel vision—going after the Schweitzer brothers even after the facts failed to support that case. There was blind faith in jailhouse informants—a slew of them, all hoping for special favors from prosecutors in return for their testimony. There was junk science—about teeth marks, and tire treads. There even may have been prosecutorial misconduct—a state lawyer misleading a judge about the outcome of one of the brothers’ polygraph tests."
Articles about wrongful convictions (ColorLines)


Books about wrongful conviction and related issues

*DISCLOSURE: Buy anything from Amazon after clicking on a link here and I get a minuscule referral fee for your purchases, with no additional cost to you. Even better, encourage your library to buy these books from the publisher, and check them out of the library.


Actual Innocence: When Justice Goes Wrong and How to Make it Right by Barry Scheck, Peter Neufeld, and Jim Dwyer (2000)
Adams vs. Texas: The True Story Made Famous by the Highly Acclaimed Film The Thin Blue Line by Randall Adams, with William Hoffer and . Read More 

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Life with Alzheimer's: Bonnie Estridge's compelling series in The Mail on Sunday

Here's Bonnie Estridge's amazing series on Life with Alzheimer's, published in The Mail on Sunday (the Daily Mail, UK)

Alzheimer's won't defeat me, I have so much to look forward to: One sufferer's defiant message as dementia rates in Britain soar (The Mail on Sunday, 11-11-17)

Bonnie Estridge can remember seeing Bob Dylan at the Isle of Wight Festival in 1969 but forgets simple words she uses on a daily basis. Doctors in London fear she has Alzheimer's.

'So what if I lose my keys - they'll turn up': BONNIE ESTRIDGE on not letting Alzheimer's get in the way of her life (Bonnie Estridge for The Mail on Sunday, Daily Mail UK, 7-21-18) Journalist Bonnie Estridge, 66, from London, offers a refreshingly upbeat approach to living life with the illness that she refers to as 'the A-word'.

The A-word: Bonnie Estridge has Alzheimer's... but life goes on (8-18-18)

Bonnie Estridge, 67, was diagnosed with Alzheimer’s disease last year. Here she gives her undeniably upbeat take on life with the illness she calls ‘the A-word’.

The real agony of going to the dentist? Getting lost on the way! (9-15-18)

BONNIE, 67, was diagnosed with Alzheimer’s disease last year. Here, her undeniably upbeat take on life with the illness she calls ‘the A-word’.

Helping hand from Downton creator on my luvvie night out: BONNIE ESTRIDGE on how Alzheimer’s is portrayed in the media (10-13-18)

Bonnie Estridge describes stepping out of her comfort zone by agreeing to give a speech at a Channel 4 event in London, organised in conjunction with the Alzheimer’s Society.

The unbearable question: How long will I live? (11-24-18)

How long am I going to live? I’m not normally introspective, but the question was sparked a few weeks ago when I visited my friend Melanie’s mum, who is in the local care home. 

My gravy meltdown and how it led to my Alzheimer's diagnosis: on how Christmas is the best time to spot dementia (12-17-18)

Two years ago, the stress of Christmas prompted something serious: One of the first clear signs of something that would change our family Christmases, and our lives, for ever.

BONNIE ESTRIDGE: This year the girls are coming over for Christmas Day, and my husband Chris will work his magic with a small turkey. Seeing them is what it's all about for me.


Should I give up shopping in case I become a thief? (1-26-19)

A recent study found eight per cent of dementia patients ended up committing crimes, including theft.


Friends reunited on a trip back to the summer of '69 (2-16-19)

The other day, BONNIE ESTRIDGE read a quote somewhere online that said ‘adult friendships are two people saying, “I haven’t seen you in ages – we should hang out more until one of you dies’.


Don't laugh, but I've watched Bohemian Rhapsody 12 times (4-14-19)

I don’t really remember a lot of it, so it’s just as enjoyable every time. Watching the film over and over is a comforting routine.


I keep forgetting that I've got this horrible illness (5-11-19)

I am writing this column from my hotel room in Barcelona, sporting a large plaster on my left knee. Chris and I are on holiday to see an old friend and explore the city.


A bus stop in my dementia ward? It's just the ticket (6-15-19)

A few weeks ago, a bus stop appeared slap bang in the middle of the dementia ward at my local hospital, St George's in London. There it was, complete with the iconic red circle.


Do you forget your passwords? Imagine what it's like being me, says BONNIE ESTRIDGE in her latest despatch on life with Alzheimer's (7-20-19)

Anything I can actually remember is labelled 'weak'. Eventually, in frustration, I'll put something in so complex it has to be written down.


Why, with huge reluctance, I'm off the booze: (8-24-19)

I have given up booze. Completely, on doctor's orders. I haven't touched a drop for more than a month and I'd be lying if I said I didn't miss it.


When I played the beautiful game – in Biba high heels (9-28-19)

I went to Wembley to watch England play in the 1966 World Cup. And my first taste of playing came - yes, I did! - when I was about 20, while working for Vanity Fair magazine.

'It might sound strange... but life's still good': BONNIE ESTRIDGE reflects on how having Alzheimer's means she's no longer one of life's worriers (11-9-19)

I don't rake over the events of the day in my head. I don't worry or ruminate. I suppose it's all to do with the fact that my short-term memory is bad.

BONNIE ESTRIDGE on life with Alzheimer's: They've banned me from the kitchen… and I'm delighted! (12-21-19)

This year the girls are coming over for Christmas Day, and my husband Chris will work his magic with a small turkey. Seeing them is what it's all about for me.

A new test for my illness… sniffing peanut butter! (7-18-20)

Have you heard of the peanut butter test for Alzheimer's? If you can't smell it, it could be an early-warning sign of the disease.

I can tell the time but can't draw a clock... that's scary 8-15-20)

When it comes to clocks, I had a bit of a horrible realisation recently when my husband asked me to draw one on a blank piece of paper, and, as hard as I tried, I just couldn't. 

Don’t call Monika my carer... she’s my friend and personal shopper!

(Bonnie Estridge, Daily Mail UK, 7-31-21)

I bought a bottle of elderflower cordial while I was pottering around the shops the other day with my new friend Monika. I say she's my friend. In fact, she's my carer.


Here's a link to the whole series (I hope it still works!)

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Food to donate to a Food Bank over the holidays

Tricia Anne Meyer posted this on Facebook (with a helpful illustration and many practical comments).  I am reposting the list here, because it is so helpful!


So, I spoke to people getting food at a food bank and here are some things I learned from those in need:
1. Everyone donates Kraft Mac and Cheese in the box. They can rarely use it because it needs milk and butter which is hard to get from regular food banks.
2. Boxed milk is a treasure, as kids need it for cereal which they also get a lot of.
3. Everyone donates pasta sauce and spaghetti noodles.
4. They cannot eat all the awesome canned veggies and soup unless you put a can opener in too or buy pop tops.
5. Oil is a luxury but needed for Rice a-Roni which they also get a lot of.
6. Spices or salt and pepper would be a real Christmas gift.
7. Tea bags and coffee make them feel like you care.
8. Sugar and flour are treats.
9. They fawn over fresh produce donated by farmers and grocery stores.
10. Seeds are cool in Spring and Summer because growing can be easy for some.
11. They rarely get fresh meat.
12. Tuna and crackers make a good lunch.
13. Hamburger Helper goes nowhere without ground beef.
14. They get lots of peanut butter and jelly but usually not sandwich bread.
15. Butter or margarine is nice too.
16. Eggs are a real commodity.
17. Cake mix and frosting makes it possible to make a child's birthday cake.
18. Dishwashing detergent is very expensive and is always appreciated.
19. Feminine hygiene products are a luxury and women will cry over that.
20. Everyone loves Stove Top Stuffing.

In all the years I have donated food at the Holidays, I bought what I thought they wanted, but have never asked. I am glad I did. If you are helping a Family this Christmas, maybe this can help you tailor it more. It does for me! ~ Tricia Anne Meyer

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Are ring cameras (door cameras) for security legal in Maryland

******AUDIO RECORDING without two party consent IS ILLEGAL in the State of MD. But private security cameras are not.


My Neighbor’s Door Camera Faces My Apartment. Is That Legal? (Ronda Kaysen, NY Times, 8-28-21) Rental tenants typically cannot install cameras — or anything else — in common hallways. But landlords can.

    “The courts have held that the landlord has a right to put a camera in the hallway and even disguise it,” Mr. Frazer said.


Is it Legal to Record Audio or Video In Maryland without Consent? (Jeffrey M. Bernstein for Greater Baltimore Board of Realtors, 3-27-19) It is legal in Maryland to record surveillance video with a camera in your home, including the front porch, without the consent of the person(s) you are recording. Maryland does forbid audio recording of private conversations without the consent of all parties.


Maryland State Laws on Video Camera Surveillance Recording on Private Property (Mobile VideoGuard.com, 6-8-20) Presents the state laws in Maryland regarding surveillance recording, and who may be recorded.

      "When you post these cameras that are only video surveillance, make sure that they are only pointed in the direction of public or community areas. Having these video surveillance cameras posted in areas where privacy is expected by guests, customers, or patrons is illegal....While you are able to disguise cameras, do not attempt to record any audio surveillance without the knowledge and consent of those speaking in the conversation."

Is Your Ring Doorbell Invading Other People's Privacy? (Kinza Yasar, MakeUseOf, 10-22-21) "Drawing a line between privacy and security is not always easy. While the Federal law in the United States forbids people from installing recording devices in private areas such as a locker room, there are no stringent legalities in place for homeowners wishing to install smart doorbells on their properties.
       However, in the wake of growing criticism and legal debates, Amazon recently issued a statement saying: “We strongly encourage our customers to respect their neighbors’ privacy and comply with any applicable laws when using their Ring product.”
       "As a Ring doorbell owner, there will be times when you might end up recording something that falls under the gray zone of legality. But as long as your doorbell is in plain sight, is installed correctly, and not pointing at your neighbor's property, you should have little to worry about." [One apartment dweller we know points their device toward the hallway but not toward the door of the neighbor across the hall.]


BILL 14-22: POLICE – PRIVATE SECURITY CAMERA INCENTIVE PROGRAM – ESTABLISHED (Racial Equity and Social Justice (RESJ) Impact Statement Office of Legislative Oversight)

        The purpose of Bill 14-22 is to increase police surveillance in communities that the Montgomery County Police Department (MCPD) deems to be high crime areas. Toward this end, Bill 14-22 authorizes the establishment of a program that incentivizes residents and businesses in “priority areas” to install private security cameras. MCPD encourages current residents and business owners with private security cameras to join the Nextdoor platform to “provide real-time crime updates.”

        Presumably, the intent of Bill 14-22 is to encourage more residences and businesses to join Nextdoor by offsetting the cost of private security cameras in areas where they are less ubiquitous.


• Montgomery County resident Brian Curtis points out: "Cameras ARE legal and actually encouraged by [Montgomery County MD] Council Member Jwando & County Executive Elrich. "The entity [condo organization etc.]  is entitled to almost a full rebate.

      *Individual owners do not receive a rebate. See preceding link to bill and resolution: Mont. Co.Bill 14-22, Police – Private Security Camera Incentive Program.


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The Trouble with Prior Authorization (for Medical Care)

Today, instead of providing a guardrail against useless, expensive treatment, pre-authorization prevents patients from getting the vital care they need.

Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients (Lauren Sausser, KHN, 3-13-23) Few things about the American health care system infuriate patients and doctors more than prior authorization, a common tool whose use by insurers has exploded in recent years. Prior authorization, or pre-certification, was designed decades ago to prevent doctors from ordering expensive tests or procedures that are not indicated or needed, with the aim of delivering cost-effective care. Originally focused on the costliest types of care, such as cancer treatment, insurers now commonly require prior authorization for many mundane medical encounters, including basic imaging and prescription refills.
      So today, instead of providing a guardrail against useless, expensive treatment, pre-authorization prevents patients from getting the vital care they need, researchers and doctors say. It’s not just patients who are confused and frustrated by the process. Doctors said they find the system convoluted and time-consuming, and feel as if their expertise is being challenged.

I Write About America’s Absurd Health Care System. Then I Got Caught Up in It. (Bram Sable-Smith, KHN, 1-25-22) The insurance industry defends "prior authorization" as protecting patient safety and saving money. It feels like a lot of paperwork to confirm something we already know: Without insulin, I will die. The time wasted by me, the pharmacists, the nurses and probably some insurance functionaries is astounding and likely both a cause and a symptom of the high cost of medical care. The problem is also much bigger than that.

What are the downsides to Medicare Advantage? (Explainer NY Times, 11-20-22) One big downside [to Medicare Advantage alternatives to Medicare] is that these insurers require "prior authorization," or approval in advance, for many procedures, drugs or facilities. Advantage participants who are denied care can appeal, and those who do so see the denials reversed 75 percent of the time, but only about 1 percent of beneficiaries or providers file appeals. Before signing up for a Medicare Advantage plan, understand that anytime you want care other than an emergency, the plan has to approve it. So "think very carefully before you switch out of traditional Medicare, which lets you see just about any doctor or go to any hospital." One topic under Which to Choose: Medicare or Medicare Advantage?

Prior authorization rules: Yet another way the health insurance system frustrates physicians and patients (Joseph Burns, Covering Health, Association of Health Care Journalists, 8-9-18) "For patients and physicians, many aspects of the health care and health insurance systems are frustrating and appear to be needlessly complex.
      One of the most frustrating processes is prior authorization, the mother-may-I approach health insurers use to ensure that procedures, medications and even certain care processes are appropriate and worthy of coverage. AHCJ members can access a tip sheet on covering this topic.

Why So Slow? Legislators Take on Insurers’ Delays in Approving Prescribed Treatments (Michelle Andrews, KHN,5-17-22) Insurers say prior authorization requirements are intended to reduce wasteful and inappropriate health care spending. But getting that approval can take as many as three weeks, and patients sometimes run out of insulin before it comes through. Doctors say that insurers have yet to follow through on commitments to improve the process.
      Prior authorizations take up on average almost two business days—14.9 hours—each week to complete. This leads to hiring staff who are dedicated solely to processing prior authorizations.

Pros and Cons of Prior Authorization for Value-Based Contracting (Kelsey Waddill, Health Payer Intelligence) Prior authorizations seem to also enforce the evidence-based care goals of value-based care. One of the major goals of value-based contracts and systems is to reduce unnecessary paperwork so that providers can dedicate more time to high-quality patient care. However, providers have found that prior authorizations often stand in the way of this aim.

       Also, recent research demonstrated that in some cases prior authorizations may be weaponized as tools for discrimination. instead of serving the patient population as designed. In the South, some qualified health plans on the Affordable Care Act have been shown to place prior authorizations on PrEP therapy for HIV patients.
       Plans in the South were 16 times more likely to place a prior authorization on the HIV therapy than plans in the Northeast where prior authorizations for these therapies were lowest. Yet prior authorizations are typically only applied when there are multiple drugs to choose from for a particular condition, and until recently there was only one medication option for HIV patients.

The Shocking Truth about Prior Authorization Process in Healthcare (GetReferralMD) Around 66% of prescriptions that get rejected at the pharmacy require prior authorization. When a PA requirement is imposed, only 29% of patients end up with the originally prescribed product—and 40% end up abandoning therapy altogether! Prior authorization is designed to control costs, but in practice it requires a lot of administrative time, phone calls, and recurring paperwork by both pharmacies and doctors. In 2009, one study estimated that on average, prior authorization requests consumed about 20 hours a week per medical practice: one hour of the doctor’s time, nearly six hours of clerical time, plus 13 hours of nurses’ time. No authorization means no payment. PA problems can create a huge interruption for patients, who have to figure out whether the process is stalled out by the doctor, the insurance company, or the pharmacy.
Insurance companies can deny a request for prior authorization for reasons such as:
---The doctor or pharmacist didn’t complete the steps necessary
---Filling in the wrong paperwork or missing information such as service code or date of birth
---The physician’s office neglected to contact the insurance company due to a lack of time
---The pharmacy didn’t bill the insurance company properly
---Outdated information – claims can be denied due to outdated insurance information, such as sending the claim to the wrong insurance company
---The insurer failed to notify the pharmacy
---The approval expired after a limited time (normally 30 days)


A different kind of prior authorization:
 • Can health care providers invite or arrange for members of the media, including film crews, to enter treatment areas of their facilities without prior written authorization? (HHS.gov) Answer: Health care providers cannot invite or allow media personnel, including film crews, into treatment or other areas of their facilities where patients’ protected health information (PHI) will be accessible in written, electronic, oral, or other visual or audio form, or otherwise make PHI accessible to the media, without prior written authorization from each individual who is or will be in the area or whose PHI otherwise will be accessible to the media. Only in very limited circumstances, as set forth on this website page, does the HIPAA Privacy Rule permit health care providers to disclose protected health information to members of the media without a prior authorization signed by the individual.

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