Brainstorm Health: Royal Baby Costs, VA Secretary Under Fire, Human DNA Structure

On Monday morning, Kate Middleton, the Duchess of Cambridge and wife of Prince William, gave birth to her third child. The baby boy was safely delivered in the Lindo Wing of St. Mary’s Hospital in London, the kind of private, luxurious medical facility one might expect would welcome to this world the fifth in line to the British crown. But everyday American women face even greater costs for giving birth at average U.S. hospitals—and don’t even receive better prenatal care or maternal services for their financial troubles.

In 2015, delivering a baby without a C-section at the Lindo Wing cost about $8,900 for a 24 hour stay in the sort of deluxe room that Middleton likely used, according the Economist. That’s a far cry from the prices American women must grapple with throughout the country (although admittedly those statistics are highly variable and hard to gather given the disparate and opaque nature of U.S. health care).

The average cost of a traditional, non-C-Section delivery at an American hospital is $10,808, according to the most recent survey data from the International Federation of Health Plans. (On the upper range, that can actually reach $18,383, and even some of the lowest-cost options exceed $8,000.) That means American women are charged 21% more on average than more wealthy patrons of the Lindo Wing where Middleton gave birth.

And what do these new and expectant mothers get in exchange for the extra charges? In many cases, objectively poorer health outcomes (particularly for women of color and minorities). The maternal mortality rate in the U.S. is higher than that in most similarly wealthy nations—and it’s actually been on the rise over the past two decades.

There are myriad factors that are likely feeding into this public health gap, including big geographic and socioeconomic disparities in access to medical care and the sky-high cost of American medicine. But the ultimate result is that the very first stages of motherhood are a bigger budgetary burden, for worse results and in far more humble settings, for everyday American families than they are for literal princes and princesses.

Read on for the day’s news.

DIGITAL HEALTH

The double helix has company. The concept of DNA structured as a double helix has long been etched into our collective minds. But maybe it's time to add another kind of genetic architecture to the list: the "i-motif." Scientists have uncovered this DNA structure, shaped like a twisted knot, in human cells for the first time. And it may actually be surprisingly common. As for why these structures appear, the answer isn't quite as clear, though theories include a part in the gene expression process. But it could prove a significant discovery down the line in an age of gene-based medical therapies. (Nature)

INDICATIONS

Is change coming to the drug price chain? Pharmacy benefits mangers (PBM), the middlemen who haggle on drug prices with pharmaceutical companies, have been getting a lot more scrutiny in recent years for what critics say is their substantial role in keeping treatment prices high. On Tuesday, one of the biggest players in the space, Express Scripts—which is currently in the process of being purchased by health insurance giant Cigna—said it wants to change the dynamic a bit (albeit while laying the blame for high prices at the feet of drug makers). To start with, Scripts wants to push companies making migraine drugs to take on more financial risk if they don't work and reconsider setting high list prices that would then be negotiated down by PBMs like Express Scripts—discounts which wouldn't necessarily reach consumers with high deductible insurance plans. (Reuters)

THE BIG PICTURE

VA Secretary nominee faces "serious allegations." President Donald Trump's nominee to lead the Department of Veterans Affairs just hit what may become a buzzsaw for his confirmation. White House physician and Rear Admiral Ronny Jackson, already an unconventional choice given his lack of government and leadership experience, has had a hearing on his confirmation postponed in light of new information presented to Senate leaders that include "serious allegations." Lawmakers cautioned that the allegations, which include allowing a hostile work environment to flourish and drinking on the job while overprescribing drugs, are unsubstantiated but warrant looking into. Trump said Tuesday it's Jackson's "choice" whether or not he wants to withdraw his nomination. (Fortune)

REQUIRED READING

Retail Reckoning: How Private Equity Is Boosting Some Brands and Crushing Others, by Phil Wahba

Inside Uber's 2nd Annual Diversity Report, by Polina Marinova and Grace Donnelly

YouTube Took Down More Than 8 Million Videos in One Quarter, Thanks to AI, by David Meyer

Apple Will Start Paying Billions in Back Taxes to Ireland, by Don Reisinger