Trump’s Impact on American Health Goes Well Beyond Obamacare

In his slim 1976 treatise, The Role of Medicine: Dream, Mirage, or Nemesis?, the British medical historian Thomas McKeown carefully chronicles the decline in mortality in England and Wales over much of the 19th and 20th centuries—charting death rates for infectious diseases ranging from diphtheria to pneumonia. Particularly striking is the mortality trend line for tuberculosis, which falls precipitously from 1838 onward—decades before the bacterium responsible for the disease was identified (1882), and long before the advent of the first effective antibiotic therapy, streptomycin.

McKeown’s controversial thesis was that it wasn’t medical interventions that were most responsible for the decline in mortality (and subsequent flourishing of the population) in that region, but instead better sanitation, nutrition, and other “external influences.” “Society’s investment in health is not well used,” he said, if we focus our attention only on medical intervention.

When the UK reviewed its national health investment in the late 1990s, it was clear that McKeown’s thinking, for all the controversy, was alive and well. The 1998 Acheson Report, a government effort to reduce health disparities, offered 39 policy recommendations, from improved housing and education to maternal nutrition programs. Only three pertained specifically to traditional health care efforts. Worth reading on the same topic is Steven Schroeder’s terrific 2007 Shattuck Lecture in the New England Journal of Medicine.

I bring all of this up because my colleague Sy Mukherjee has written an important post this morning on Fortune.com. As Sy explains, the President-elect’s picks for various cabinet posts—apart from his selection of Rep. Tom Price to head the Department of Health and Human Services—could well have a significant effect on Americans’ health and well-being over the next several years.

For anyone who thinks the healthcare stakes in the coming months are limited to the fate of Obamacare, read Sy’s eye-opening piece.

More news below.

Clifton Leaf

@CliftonLeaf

clifton.leaf@fortune.com

DIGITAL HEALTH

A massive cyber attack on Quest Diagnostics breaches 34,000 customers' records. In what may turn out to be the final major cyber attack of 2016, the blood testing and diagnostics giant Quest announced that hackers attacked the firm in a breach affecting about 34,000 people. Names, personal lab results, and even telephone numbers were stolen—but not, according to Quest, social security numbers or credit card information. The source of the hack? A vulnerability in a mobile app called MyQuest by Care360. IT security experts have been warning that health care data breaches will continue to be a source of consternation for the medical industry in 2017, especially as many organizations remain unprepared to confront digital thieves.(Fortune)

Spinal stimulation helped a man with a spinal cord injury regain movement. An experimental device that delivers electrical impulses in order to create alternate communication pathways between the brain and lower limbs is showing promise. Patient Brian Gomez, who has a spinal cord injury, had the device implanted last year and is beginning to regain some movement, according to researchers at the Ronald Reagan UCLA Medical Center. "The spinal cord contains alternate pathways that it can use to bypass the injury and get messages from the brain to the limbs,” said Dr. Daniel Lu in a statement. "Electrical stimulation trains the spinal cord to find and use these pathways." Lu went on to compare the spine to a highway for biological communication. "If there is an accident on the freeway, traffic comes to a standstill, but there are any number of side streets you can use to detour the accident and get where you are going. It’s the same with the spinal cord," he said.(MassDevice)

INDICATIONS

Pfizer wants your ideas for how to help breast cancer patients lead better lives. Pharma giant Pfizer is offering up a $250,000 prize for innovative thinkers who can come up with tech-based strategies to improve the lives of metastatic breast cancer patients. The Advancing mBC Patient Care Challenge is open to health care professionals, entrepreneurs, designers, and others around the globe, and is being hosted in collaboration with Health 2.0. Interested in submitting an idea? The deadline is January 20, 2017, and the grand prize winner can nab $100,000.(Fortune)

J&J walks away from Actelion deal, leaving room for Sanofi. Johnson & Johnson has been jockeying to snap up Actelion, Europe's largest biotech and a maker of drugs for the deadly heart and lung condition pulmonary arterial hypertension (PAH). But it appears that CEO and founder Jean-Paul Clozel just isn't too keen on selling the company he's built, leading the U.S. pharma giant to walk away from the negotiating table and its $20 billion offer. "It wasn’t about price, he simply doesn’t want to give up control," said a source familiar with the proceedings. Clozel's apprehensions notwithstanding, other companies are still in the hunt—including France's Sanofi, which has been trying to fill its portfolio with better-selling and higher-margin products in the wake of struggles in its flagship diabetes unit.(Fortune)

Survey: A whole lot of payers are revolting against Sarepta's Duchenne drug. The FDA's most controversial drug approval of the year, for Sarepta's Exondys 51, continues to face major headwinds among insurers, benefits managers, and other health care payers, according to a new Jeffries survey. The treatment was approved for the devastating rare disease Duchenne muscular dystrophy but created major divisions within the FDA because it simply hadn't demonstrated a whole lot of efficacy, meaning the pricey therapy is essentially being subjected to a real-world clinical test. But payers are highly reluctant to cover the $300,000 drug without a record of proven effectiveness. "Based on available data, 3/5 national and 8/15 regional managed care organizations (MCOs) have denied/restricted coverage for Exondys 51, in line with our expectation of pushback from private payers," said Jeffries analyst Gena Wang.(Endpoints)

THE BIG PICTURE

Trump's other Cabinet picks will affect American health care, too. As Cliff notes in his essay today, President-elect Donald Trump's Cabinet picks will affect Americans' health well beyond Obamacare. That's because, as a new study notes, meeting patients' basic social needs—including for heating, electricity, food access, and medicines—can actually have a significant effect on basic health indicators like blood pressure and cholesterol levels. And that means important, non-medical federal programs like food stamps and heating assistance could impact wellness right alongside insurance coverage. Check out my write-up on the issue.(Fortune)

Ohio governor Kasich vetoes "heartbeat" abortion bill, but signs 20-week ban. Women's health advocates got a partial win on Tuesday as Ohio Governor John Kasich, a devoutly religious social conservative, vetoed a controversial "fetal heartbeat" bill that would have outlawed abortions as early as six weeks into a pregnancy. But Kasich did sign into law a measure banning abortions after 20 weeks—another controversial regulation that could potentially brush up against previous court rulings, even though Kasich cited Supreme Court precedent for his veto of the "heartbeat" legislation.(Washington Post)