Jim Hurley's Forgotten AIDS Message

Thirty years ago, AIDS was a total mystery to us.

Six years into what CDC already termed an epidemic, 358 AIDS cases in twenty states had been confirmed and 136 people had died.  No one knew why.

Several people I knew were probably already infected with HIV.  I learned this only as they died over the next few years.  One was a popular Connecticut Congressman, Stew McKinney, who was a moving force behind federal funding for services for homeless people.  Another was a lawyer named Jim Hurley.

I first met Jim when we were high school debaters. 

His school debated against my school at several local and regional debate tournaments.  I remembered him as bright, easy-going, and friendly.

We reintroduced ourselves during our first year in college, when we crossed paths in his dormitory one day.  He hadn’t changed much.  He was personable, still friendly, and happy to exchange a few stories about Catholic high schools and debating.

I transferred to Wesleyan and lost track of him after that.  I became active in Connecticut politics and government after college, and Jim went to law school.  With his skill set, he must have been a very good lawyer.

Our paths crossed just one more time, but not in person. 

The next time I saw him, it was years later on a videotape that was played in 1987 at an AIDS conference at Central Connecticut State University.  On tape, he still looked pretty much the same as I remembered him.  But he was 34 years old and dying of AIDS.    

One of the points Jim made on that videotape stayed with me.  He said that it didn’t really matter how he got AIDS.  What mattered was what we would do to prevent others from getting it in the future.

By that simple standard, there are now well over a million reasons why we haven’t done enough.

There was a time when the Centers for Disease Control and Prevention tracked and reported on AIDS cases every single week.  Now we have to wait years to find data about how many people have HIV and die from AIDS.

In 2009 – the year for which most recent data are available – there were 48,100 new HIV infections in the United States, and 17,774 people died as a result of AIDS.

Last year, CDC also reported that in 2009:

• New HIV infection was as common in men as salmonella poisoning and as common in women as pertussis.
• Among all people between 15 and 24, new HIV infection was twice as common as Valley Fever – a disease well-known and frequently diagnosed in the southwest.
• Among men between 40 and 64 – the population most likely to have been directly affected by AIDS over the years – new HIV infection was more common than Lyme Disease – a disease well-known and frequently diagnosed in the northeast.

AIDS-related deaths declined dramatically when drug cocktails were introduced during the 1990s, and so we began to forget about how serious it is.  People are living longer with HIV infection than they ever did before, but HIV still shaves up to 30 years from life expectancy, and still accounts for more deaths in the under 45 population than diabetes and stroke.

The AIDS epidemic isn’t nearly as under control as we might think.

And it is worse in some places than others.  Connecticut, for example, has more new HIV infections than any other state in New England. 

But for the most part, the HIV/AIDS epidemic has moved south.

Florida leads the nation in new HIV infections, with over 5,400 in 2009 alone – nearly as many as New York City and the entire State of California, two other “ports of entry,” combined. 

HIV death rates are also highest in Florida, Louisiana and Maryland.  New York, New Jersey, Delaware, Tennessee, Mississippi, Georgia, and South Carolina are all in the next tier. 

The half million Americans who have died and the 1.2 million who are living with HIV are also evidence that Jim’s Hurley’s message was poorly heeded. 

Nearly all of them got it after he made his videotape and was featured by Newsweek Magazine in its August 1987 “Faces of AIDs” issue.

We can do better than this.  Even since the most recent HIV data were published, over 100,000 more American men, women, and children have been infected.

April is STD awareness month.  In memory of our lost friends and to save lives in the future, we must do more to eradicate this relentless and deadly disease.

April is STD Awareness Month.  To increase awareness about AIDS, please consider sharing this column with friends and colleagues.  If you have questions about this column or would like to receive an email notifying you when new Our Health Policy Matters columns are published, please email gionfriddopaul@gmail.com.

Mental Health Cuts Will Lead to Increased Health Costs

On December 8, 2010, Jack Dalrymple, a Republican Governor in the safely Republican state of North Dakota, sent a budget to the state Legislative Assembly calling for an $8 million increase in funding for mental health services.

His transmittal message accompanying his FY2011-2013 proposed budget was simple. “We… need to make investments that help take care of people.  We have all been alarmed recently about teen suicide rates, especially on our Native American reservations.  These highlight the need to make more resources available for critical mental health services for our citizens.”

So, in a $3.3 billion general fund budget, he proposed over $6 million for new inpatient services, community crisis stabilization, and drug dependency treatment.  He also proposed $1 million for suicide prevention, another million dollars for mental health services on college and high school campuses, and a rate increase for mental health providers. 

He summed up these requests by saying that “the physical and mental health of our citizens is always a top priority.”

The North Dakota Legislature apparently agrees.  According to a recent report of the National Alliance on Mental Illness, the state has made up for historically low spending on mental health services over the past three years by topping the nation in increasing spending for mental health. 

As overall state mental health spending in the nation declined by $1.6 billion, North Dakota increased spending for mental health by 48.1%.

In the same time frame, South Carolina, Alabama, Alaska, and Illinois all cut mental health spending by over 30%, and Nevada, the District of Columbia, and California all cut it by over 20%.  In fact, most of the rest of the country is clearly out of step with North Dakota.

A Bloomberg News article headline this past week made clear what cuts to mental health mean: “Mental Health Cuts by U.S. States Risk Boosting Health Costs.”  The reason, as one Illinois emergency room physician pointed out, is that sick patients don’t just disappear when they are denied one set of services.  They seek out another, often more costly, alternative.

In the case of people denied mental health care, it is usually the hospital.

According to the Centers for Disease Control and Prevention (CDC), there were 2.4 million primary diagnoses of mental illness in general hospitals in 2006. In the same year, state mental health spending totaled $104 per capita, according to Kaiser Family Foundation State Health Facts data. 

CDC recently released new data for 2009.  In that year, the number of primary mental illness diagnoses decreased to under 1.6 million.  But the State Health facts data reported that state mental health spending had increased by then to $123 per capita.

In other words, during a time frame when state mental health agency funding increased by 18%, mental health diagnoses in general hospitals decreasedby 35%.

These are the facts, and there is an association here, at least for the most recent three-year period for which we have data. When states spend more on mental health as they did in 2009, fewer people with mental illness need hospitals for care.  And when states spend less on mental health, as they did in 2006, hospital use goes up.

Now that they have the facts, what are states proposing this year?

• The Florida Senate has proposed to reduce adult mental health services funding by 34%.  The House saved Florida from such a spending disaster last year; it will have to do so again this year.
• Connecticut’s Governor has proposed a $12 million cut to the Department of Mental Health and Addiction Services from the state’s already-approved FY2013 budget.
• Alabama last week announced plans to close 4 psychiatric hospitals.
• Illinois has proposed cuttingtwo psychiatric hospitals and a host of community health centers throughout Chicago.
• Mississippi is proposing a 5% cut to mental health that could result in the closing of six mental health facilities throughout the state.
• The Pennsylvania Governor’s newly proposed budget will cut Philadelphia by $42 million in mostly mental health and addiction services funding, according to information provided by the Mental Health Association in Pennsylvania.

Do you detect a pattern here?

Proponents argue that these cuts are being made in the name of fiscal responsibility, but they don't have the vision to see the forest beyond the trees.  Every one of them will make people sicker, state costs higher, and an already bad situation worse.

If you have questions about this column or wish to receive an email notifying you when new Our Health Policy Matters columns are published, please email gionfriddopaul@gmail.com.

Why Research Matters

A few weeks ago, we were tantalized by the news that a new treatment for leukemia might be on the horizon. 

Three very sick patients were injected with a new drug.  It was made from – of all things – a modified version of the virus that causes AIDS.  After a year, two were disease-free and the third had a 70% reduction in disease tissue.  One researcher was quoted as saying that the results “exceeded our wildest expectations.”

But the rest of the story pointed out that the discovery almost didn’t happen.  There wasn’t enough research money for a full trial.  Neither the National Cancer Institute nor pharmaceutical companies had funding for the research.  A family foundation stepped up, but that’s why there were only enough funds for three patients to participate initially.

The National Institutes of Health (NIH) is the largest funder of biomedical research in the United States.  In requesting a budget of $32 billion for FY2012, it noted that research that it funded has reduced death rates from stroke by 70% and deaths from coronary heart disease by 60% since 1970.  It has also contributed to the amazing results that have been achieved over the last twenty years in HIV/AIDS management, and to a significant reduction in cancer deaths as well.

We spend $2.4 trillion on health care in America.  Shortly after NIH made this request for just over 1% of that, Congress cut its funding to $250 million below 2010 levels. 

On its cover, the AARP Magazine for September/October 2011 trumpets “Amazing Medical Discoveries That Will Change Your Life.”  These discoveries were the result of funded research.  They include artificial retinas, prostate cancer vaccines, and magnets for depression relief – all currently available.  AARP sees new breast cancer drugs and adult stem cells for coronary artery disease treatment in just a few years, and even more exotic treatments down the road.

These discoveries will all make a huge difference in how we live.

Research isn’t just the work of scientists in labs, and doesn’t just result in new drugs and treatments.  Sometimes, it results in safer medical procedures that not only preserve life, but also lower costs at the same time.

NIH says that research advances have saved trillions of dollars.

Here’s one story of money-saving research advances.  Jeffrey B. Cooper, a biomedical engineer at Massachusetts General Hospital, has made patient safety his life’s work.  Though he has labored in relative obscurity – I doubt that more than a thimble full of policy leaders outside of the Greater Boston area have ever heard of him – he played a key role in the development of modern anesthesia “standard of practice” guidelines, developed technology to manage the use of anesthesia in operating rooms, and facilitated the development of simulation training to ensure patient safety.

The bottom line results of his work suggest that there is more than one way to achieve tort reform.  As training and practice standards evolved and improved, there were fewer adverse patient reactions to anesthesia and fewer deaths.  This resulted in lower costs to insurers, which led to lower malpractice rates for physicians.

Research brings about medical advances, improved training, and better patient treatment.  But that’s not all.

The Framingham Heart Study was recently in the news because it released some new research linking poor health habits in middle age to brain shrinkage.  What makes this Study remarkable is that it has been ongoing since 1948. NIH is a partner, along with a number of other public and private institutions.  It is following its third generation of individuals now, and has participated in some of the most important advances in our understanding of cardiac disease risk factors.

We have another federal agency devoted to disease prevention, the CDC.  Its total budget of $11 billion is less than one half of one percent of our annual health care expenditures.

Most of us take for granted or devalue these agencies, and the many hundreds of researchers who have developed cures or treatments for disease, procedures and training that save patient lives, and strategies for preventing chronic conditions. 

The people who settled Jamestown did not yet know that blood circulated in the body, and those who prepared to declare our freedom from England still did not even know what oxygen was.

But our nation’s founders were scientists as well as public officials.  Modern health care is the result of their embrace of the miracle of modern science.

But in today’s United States, not everyone has equal access to advanced prevention and treatments.  Our health care safety net no longer catches everyone.

And we’re forgetting the value of research – that because of it we now live longer, healthier lives.

Research requires funding, and a willingness to embrace the legacy of our parents and grandparents.

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