Health equality and equity, health effects of mass incarceration, and more

April 13, 2017

In order to bring you more of the news you want to read, Right Care Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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This week, The Lancet features a series on equality and equity in American health care. In the first article, Samuel Dickman, MD, David Himmelstein, MD, and Steffie Woolhandler, MD explain how health disparities and income inequality go hand in hand. Unequal access to medical services—due to uninsurance, geographic barriers, and high cost sharing—increases health inequalities. At the same time, rising premiums for private insurance erode incomes for the middle class, and the high cost of care puts many into debt or bankruptcy. The authors advocate “a non-market financing scheme that treats health care as a human right” to move toward health and income equality.

Another article in the Lancet series on equality and equity by Christopher Wildeman, PhD and Emily Wang, MD explores the effects of mass incarceration on health in America. Reviewing the literature, Wildeman and Wang find that previously incarcerated individuals are disproportionately uninsured and are at higher risk for hepatitis, tuberculosis, and depression. In a related piece from the National Institute of Justice, Eric Martin discusses health effects on the children of incarcerated parents, including increased risk of severe depression, substance abuse, and sexually transmitted diseases later in life. Martin calls for additional research and support to improve the well-being of these “hidden victims” of mass incarceration.

Although average physician income has increased steadily since 2011, there remain significant income gaps between physicians based on specialty, location, and race, according to Medscape’s 2017 Physician Compensation Report. Despite efforts to bolster primary care, specialists make 45.6% more on average, a difference of nearly $100,000.  Physicians in rural states make more on average because there are fewer physicians and greater demand. African American physicians earn 15% less than white physicians on average, possibly because a greater proportion are primary care doctors, and many serve low-income communities. Regardless of such disparities, the average income of physicians of all specialties is still in the top 5% of incomes.

The Food and Drug Administration announced last week that they will allow 23andMe, a genetic testing company, to sell tests for disease risk directly to consumers, The New York Times reports. In a press release, the company said these tests will help consumers “know their genetic health risks and be more proactive about their health.” However, genetic testing for most conditions still leaves a lot of uncertainty about the risk of actually getting the disease. And knowing one’s genetic disease risk without getting genetic counseling could simply increase anxiety, especially since some of the conditions that can be tested for, such as Alzheimer’s, do not have a cure.

In this week’s Conference Preview, read a real-world example of what can happen when doctors and hospitals put profits over patients. Ralph Weiss’s surgeon told him he needed immediate spine surgery and recommended a bone morphogenetic protein (BMP) for the procedure. What the surgeon did not tell his patient was that he was using the product off-label, while receiving hundreds of thousands of dollars in payments from the company that manufactured it. Weiss will be telling his story at the Lown Institute Conference, to raise awareness about the consequences of conflicts of interest. “I’d like to think my experience was the exception,” said Weiss, “But regrettably, my story is not an isolated incident.”



Register now for the Lown Institute Conference, May 5-7 in Boston, MA for the chance to hear inspiring keynotes and presentations of new research, participate in hands-on workshops, and collaborate and strategize with others in the Right Care Alliance. This activity has been approved for AMA PRA Category 1 CreditTM. This activity is awarded ANCC credit. See registration page for details.

Join the Right Care Alliance on Earth Day, April 22, to march in defense of science and evidence! See the Facebook page to sign up for the march in your city, or email to start a new local march site. If you are attending the March for Science and still need a Bad Science Makes Bad Medicine T-shirt, please contact to buy a shirt (or two or three).





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