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In today’s AMA Update, Leana Wen, MD, MSc, shares her opinions on what health policy issues to watch in 2023. Dr. Wen, an emergency physician and professor of health policy and management at George Washington University, weighs in on vaccine hesitancy around routine childhood immunizations (polio, measles, etc.), the overdose epidemic, marijuana and adolescent development—as well as making contact sports safer to reduce severe brain injuries like CTE and concussions in youth sports. AMA Chief Experience Officer Todd Unger hosts.
Dr. Wen is also a CNN medical analyst and op-ed columnist for The Washington Post, where she writes a weekly column and anchors the Post newsletter, "The Checkup with Dr. Wen". Find her latest articles.
- Leana Wen, MD, MSc, emergency physician and professor of health policy and management, George Washington University
Unger: Hello and welcome to the AMA Update video and podcast. Today we're discussing the big health policy issues to watch in 2023. And I'm joined by Dr. Leana Wen, an emergency physician and professor of health policy and management at George Washington University.
She's also a CNN medical analyst and op-ed columnist for The Washington Post, where she writes a weekly column and anchors The Post newsletter "The Checkup with Dr. Wen." I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Wen, welcome back.
Dr. Wen: Thank you so much, Todd. Happy new year. Great to be with you again.
Unger: Excellent. It's good to see you. It's been a year since we last talked. And in the meantime, and very recently, you just authored an opinion piece about the top 10 health policy issues for 2023. These are issues that you're tracking and plan to write about in future columns, and are also issues that should be on physicians' radar.
And while we don't have time to discuss all 10 here, we're going to go through a bunch of them. People can find your full article at the washingtonpost.com. COVID, of course, is at the top of your list. And while much of the country has decided to move on, in some respects, the immunocompromised and those that are suffering from long COVID are still fighting uphill battles. Where does the focus need to be with COVID for 2023?
Dr. Wen: Yeah, I think it's exactly what you said, Todd, which is that we have to remember that as much as so many people have moved on and have resumed pre-pandemic activities, there are millions of Americans who have not. We need to develop better vaccines, better treatments.
Now we know with new variants emerging that the treatments that we have may not be as effective. And so we need to really put our emphasis on helping those who are the most vulnerable. There's a lot of attention, too, that needs to be placed on long-COVID, including how to characterize it, what to treat long-COVID with.
And then I'll add one more, which is that the state of public health emergency around COVID is probably going to end in the near future. And along with it, there are going to be a lot of changes, including flexibilities around telemedicine. Some of them might not be there anymore.
Redetermination, Medicaid eligibility—we might have a lot of people who could lose their health insurance. And so I think the policy implications of what happens when that state of public health emergency ending is something that all of us will be impacted by and should pay close attention to.
Unger: Yeah, that's very interesting. I mean, we just got another extension. But I think you're right. It's not going to last forever. And a lot of implications there.
Now, you've had a good view of the public health discussion here and particularly around infrastructure. And we're several years into this obviously. Do you see the infrastructure that it's taken to deal with this pandemic is getting stronger or not where it needs to be at this point to prepare for what the future might hold?
Dr. Wen: Yeah. That's a great question and I think it's twofold. On the one hand, there is a lot more attention to public health in a way that we have not had for really ever, in the sense that people now understand the difference between their local and state health department.
They're seeing what we say in public health, which is that public health saved your life today, you just don't know it. That there is generally no face of public health. But now there is a face of public health and it's played out during COVID.
And I think there is, for a lot of places, they're seeing the impacts of additional funding, to try to build their public health infrastructure, to try to sustain their health workforce. So I think, in some ways, that's good.
But actually, I'm really worried about this overall. We're seeing that routine childhood immunizations have decreased. We've seen vaccine-hesitancy increase. We've seen that because people have equated public health with COVID, and because COVID has become so polarized and politicized, unfortunately, but that, I think, has also made public health now in the crosshairs of our political culture wars. And so I do worry about what this means for public health going forward.
We have a lot of state legislatures—more than half of state legislatures have specifically passed legislation that limits the authority of public health officials going forward. And so in many ways, I think we're less prepared for the next pandemic.
Not because of science—the science has really delivered in the case of COVID. I mean, we have these amazing vaccines. We have great treatments and so forth. But I worry that whatever politicization around COVID has now bled into other aspects of public health, making it even harder for us to respond as a society to future public health threats.
Unger: Yeah. The news on the broader issue of childhood immunizations is really troubling. We talked about that earlier this week with our head of science and public health. And you mentioned, basically, it could be a byproduct of equating public health and COVID. I mean, given what you're seeing right now, what can physicians out there do in 2023 to help reverse this very, very troubling trend?
Dr. Wen: Yeah. It's a great question. And I think it begins with acknowledging that this has happened. I mean, the data are there. The CDC just published, as you mentioned, the quite dramatic decline in terms of percentages of children who have gotten their routine immunizations.
It's due to a variety of factors, including disruptions in health care, disruptions in school, vaccine-hesitancy. We have to acknowledge that that's there. Kaiser Family Foundation, back in December, did a poll that found that more than a third of parents opposed mandating childhood vaccinations for school, even if there are health risks to other children.
That's substantially increased from 2019, when a similar Pew Research study found that it was less than a quarter of parents oppose those types of requirements. And so I do think that the opposition against the COVID vaccines have really bled into opposition to the routine childhood immunizations that we have long accepted.
And I actually think that one thing we can do—so first is having the conversation with parents, opening the door to a non-judgmental way, making sure that we are talking about this the same way that we would have pre-pandemic. I also think that we need to not have vaccine equivalency.
The COVID vaccines are not equivalent to the other vaccines. The polio vaccine is more than 99% effective at preventing paralytic polio. Measles vaccine is more than 97% at preventing measles infection and transmission. The COVID vaccines are very effective at preventing severe disease, but they're not that degree of effective that I think we should be pushing them the same way that we're pushing the measles and polio and other vaccines.
And so I think recognizing that what has happened with COVID is really unfortunate. I really wish that COVID were not politicized in this way. But recognizing that it has been. I think it's time for us to try to separate out the administration of routine childhood immunizations from COVID vaccines.
Unger: Well, Dr. Wen, mental health is another big area of concern. We're seeing skyrocketing rates of burnout at record levels. It's one of the reasons the AMA has been continuing to address mental health issues among physicians. What areas do you see needing attention in 2023? And what's your take on the use of novel therapies to treat mental health issues?
Dr. Wen: Well, we have a long way to go when it comes to any kind of mental health parity. I would love to see us being able to treat mental health the same way that we treat any physical health issues. That if somebody is coming in with depression, we would treat them just as if they have diabetes, recognizing that these are complex issues, but that we need to get people the treatment that they need when they need it.
We need to work on insurance issues and insurance reimbursement. We need to work on access and making sure that we have the providers that people need. There needs to be, specifically, attention to youth. We have seen that rates of depression, anxiety, suicidality, et cetera, among youth have really increased during the pandemic and we have to be attentive to that.
Closely related to mental health also are addiction issues as well. And increasing treatment for opioid addiction, treating addiction as a disease that it is also needs to be top of our agenda as well.
Now, you mentioned the use of novel treatments. I think it's a good thing for us to have more data. I would just be careful about some of this. And specifically—I know this is not exactly on the topic necessarily of mental health, but related to this is I wrote a column recently about the dangers of marijuana use in young people.
And specifically, that two things could be true at once. That it could both be true that decriminalizing marijuana use may be important, because we know that the policies around incarceration have put Black and Brown people at disproportionate rates in jail for marijuana possession.
But at the same time, we should not be normalizing marijuana use in young people, because there are substantial detrimental impacts on the developing brain. And the developing brain, including high school-age, adolescents, college-age students, too. And so I think we just need to be careful as things like psychedelics get rolled out. Yes, we need to be studying them in a rigorous manner. But let's not try to normalize their use in recreational ways.
Unger: Absolutely. Another big one on your list is maternal health. And you've said that this issue is near and dear to your heart. Why do you think this is one to watch in 2023?
Dr. Wen: Well, it was one to watch in 2018. It was one to watch in 2019. And then took a back seat, because, understandably, everything took a backseat during COVID. But we still have a situation where women today who are pregnant are more likely to die in pregnancy than our mothers.
We have a situation where Black women—there are huge disparities that exist, in particular, for Black women. And Black maternal health is something that we have to pay attention to. And I think this sheds light on the fact that it's not just about health during the pregnancy. It's also about health before and after pregnancy as well.
And so there are policies that various states, for example, or community organizations have implemented that have been successful in making a dent in maternal mortality. And I think it's important that we study those policies and I'm looking forward to writing about it.
Unger: Well, chronic disease continues to be a challenge for the country. And as you point out, heart disease and cancer are the leading causes of death in the U.S. What do you see happening on this front end 2023? And has the Biden administration's Cancer Moonshot, which aims to cut the death rate from cancer by 50% over the next 25 years, made any progress?
Dr. Wen: Well, there's a lot on tobacco regulation that the Biden administration, the FDA is proposing. And if they're able to make a dent in tobacco regulation, because smoking is the number one preventable cause of disease, we will be able to make a huge dent in cancer just through tobacco regulation alone. So I definitely think that there's good promise there.
And we also have to look at the number two cause of preventable deaths, which is obesity. Childhood obesity is a major issue. Obesity is another one of the issues that was an epidemic prior to COVID and has gotten worse since then. And so I think we also need to pay attention to these underlying conditions, if you will, that COVID has highlighted and has worsened, but that existed before. And all of chronic diseases would fall into that category.
And so I think this is something that we as physicians are very much attentive to. And there are things that can be done, whether it's on the policy level or whether it's interventions in the clinical setting, for example, screening on social determinants of health, better connection with community resources around food and housing and so forth, and pay attention to population health metrics. Those are all the types of things that can make a difference and I would expect that the Biden administration is also looking to highlight through their policy changes as well.
Unger: Well, the last one we're going to talk about today has certainly been on everybody's mind in the wake of Damar Hamlin's collapse on the football field and that's injury prevention. You've been vocal about how to make contact sports safer. What needs to be heard on this topic in 2023? And how do physicians help here?
Dr. Wen: Yeah, so two things here, Todd. The first is that with Damar Hamlin, I wrote a column for The Washington Post on how as dangerous as football is, as violent of a sport as that is, this is not the situation to be pointing to to say, there's a problem with football.
And in fact, the situation specifically with Damar Hamlin, I think there is a lesson to draw from that, which is the importance of having people being trained in CPR, of having AEDs be widely available. But that aside, I've also been writing a separate series on, as you mentioned, how to make football and other contact sports safer.
And it's interesting, because when you look at pro sports, including the NFL, they've actually taken a number of steps that youth sports has not. And one of those steps is to limit tackling—full life tackling during practice.
In football, just like in other sports, you are playing games a lot less than you're practicing. And if you're able to cut out the blows to the head, basically, you're also able to reduce your lifetime likelihood of having severe brain injury, including CTE, Chronic Traumatic Encephalopathy, which is not just due to concussions but also to subconcussive hits to the head.
And so I had written about, for example, how Dartmouth College, their football team actually cut out all live tackling during practice. There's a group also called Practice Like Pros, P-R-O-S, Practice Like Pros, which is urging youth and high school football to cut out live tackling during their practices. And I think of this as harm reduction.
We're not going to be—we're not trying to get people to not play any sports or to never do head in soccer or hockey or football. But rather, are there things that we can do to try to make these sports safer? And I think those are the types of things that we as clinicians might get asked about as well.
And looking to these examples of successful interventions that have allowed kids to play sports at a very high level, but have also reduced their likelihood of injuries, specifically of head injury, I think those are the types of examples that we should be looking at.
Unger: Well, it sounds like we have a lot on our plate for 2023. It's going to be a busy year. And again, to see Dr. Wen's complete list of top 10 health policy issues for 2023, take a look at her opinion pieces on washingtonpost.com. That's it for today's episode.
Dr. Wen, thanks for coming by, and we'll see you soon. In the meantime, you can catch all of our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today and please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.