DOJ blocks United Health
In this week we lost Dr. Farmer and Ukraine is being invaded. However, there is some good news. For one, the DOJ stepped up their game.
A transformative figure in global public health passed this Monday
Dr. Paul Farmer passed away in Rwanda at the age of 62 this past Monday. His death comes as a shock to many because he was still full of life. Known for his efforts to improve health in the developing world and for founding Partners In Health, Dr. Farmer is considered by many as a once in a generation transformative figure in public health.
Rather than paraphrasing his words, we’ve decided to share a quote from a piece he co-authored with Alicia Yamin in a 2021 commentary about the COVID-19 vaccine inequities. They wrote:
"[I]f we recognize that global health has colonial origins, we must also acknowledge that it remains deeply embedded in, and shaped by, interlocking systems of power—patriarchy, racism, coloniality, neoliberalism, and exploitative commerce, among others. These systems are reflected in laws and policies, as well as in research, programming, and clinical practices, and they breed a pervasive nihilism about our capacity to effect rapid and meaningful change. Even now, well over a year since COVID-19 was declared a global pandemic, the greatest obstacles to health justice stem not from a novel pathogen, but from the pathogenic forces of apathy, cynicism, marginalization, and historical amnesia that drive us to accept the suffering of the poor as inevitable misfortunes to be endured, as opposed to injustices to be cured......Today, COVID-19 reveals that we must do more than just build vertical programs to mitigate HIV or any other single condition. We must insist on robust health systems (public health and care) capable of attending to the complete burden of disease and of fulfilling their functions as core democratic institutions, including progressive public financing of health and social protection."
DOJ Suit Blocks United Health’s $8 Billion Acquisition of Change Healthcare
On Thursday, the US Department of Justice filed an antitrust lawsuit blocking the acquisition of Change Healthcare by health insurer UnitedHealth Group. Last year, the world’s largest insurance company, UnitedHealth, announced an agreement to purchase Change Healthcare for nearly $8 billion in cash. Change Healthcare’s billing and payment process services were expected to bolster UnitedHealth’s growing OptumInsight division. Providing data, software, and services to insurers and providers, Optum accounts for more than half of UnitedHealth’s revenue.
Why did UnitedHealth want to acquire Change Healthcare?
Change Healthcare provides a number of healthcare IT services, but its software falls in two main categories. Change provides clearinghouse services, which transmit claims and payment information between insurers and providers, and first-pass claims editing solutions, which review claims under the health insurer’s policies and relevant treatment protocols.
UnitedHealth provides similar services, but under the umbrella of a much larger company. By acquiring Change Healthcare, UnitedHealth hopes to eliminate competition and become more vertically integrated in healthcare. By growing its OptumInsight division, UnitedHealth would increase their control over the entire healthcare insurance claims process, with greater leverage over providers.
Why does the DOJ want to block this acquisition?
The best way to think about the problematic aspect of this acquisition is through the relationships each company has. UnitedHealth is an insurer. While its healthcare services segment is growing, it has to work with companies like Change Healthcare in the payment process. Change Healthcare works as a linkage between insurers and providers, as what the DOJ describes as a “neutral player” that provides balance. If a health insurance company like UnitedHealth controls this process, more power is placed in the hands of the insurer.
UnitedHealth’s acquisition of Change also would harm competition on the health insurance side. Because Change processes claims and provides services for multiple insurers, it has a huge amount of data on insurers that are UnitedHealth’s competitors. Access to this data would give UnitedHealth an unfair advantage over other insurers.
By blocking this acquisition, the DOJ also sends a message to healthcare conglomerates. If successful, the Change Healthcare deal would have been a portender of other acquisitions, both by UnitedHealth and other insurance companies.
Read more:
Original announcement of acquisition:
Stem Cell Therapy Treats HIV?
In a surprising turn of events, a woman being treated for leukemia using a stem cell therapy was also ‘cured’ of HIV. She is the second person to have her HIV successfully treated this way after the Berlin patient in 2007.
In these stem cell therapies for leukemia, typically bone marrow stem cells are transplanted from a donor to replace the bone marrow of the patient. Normally not all of the bone marrow is replaced and it is important to point out that resistance does not mean the same thing as the ability to cure or prevent the disease at all. Since a lot of immune cells and red blood cells are made in the bone marrow, this transplant may explain how it happened.
The stem cell treatment that was used here consisted of stem cells from two donors, an adult and cells from the placenta that were stored after a fetus was born. The reason this was done was to have the adult stem cells handle the bone marrow cell production initially and eventually have the fetal cells mature and take over in the long term.
However, this is not a feasible way to cure HIV for the 38 million people that are currently living with it. The question of whether a treatment is worth it comes down to how much benefit it can provide versus the risk and costs of the treatments as well as access to facilities that are able to provide the treatment. In the case of bone marrow transplant surgery, the high risks and invasiveness of the procedure make it hard to justify given that people with HIV are now able to live a close to normal life with the help of medications. Therefore this case is unlikely to halt the development of other treatment plans.
Overall, this is an extremely interesting case. While this may not provide a feasible treatment to a terrible disease, it still goes to show how stem cell therapies could potentially treat diseases in addition to myeloid leukemia and the limited set of diseases the therapy is currently focusing on. If one day it were to be less dangerous and easier than medications, we might switch to it.
Featured Fake News
The CDC is not collecting your DNA in a giant databank when you get nose swabs.
This past week on twitter, the CDC sent this out:
The intention was to explain the process of PCR and the purpose of nasal swabs as well as what happens to them.
Then people started commenting about how this was a conspiracy theory to get everyone’s DNA and even congresswoman Marjorie Taylor Greene of Georgia’s 14th district got in the conversation.
This all stems from a misunderstanding of the science of PCR.
PCR is a molecular biology method used to multiply a copy of genetic material. In the case of covid, this is a positive strand of RNA.
The way PCR works is you have a primer sequence, i.e. the complementary sequence to one end of the single stranded RNA or DNA (which you would separate into single strands) that will bind to it, and then you have proteins that will attach to that primer sequence and copy the rest of the RNA or DNA by matching the pre-existing sequence with free nucleotides or dNTPs. Afterwards, you will separate the newly formed double strand into 2 single strands and then repeat the process, doubling the amount of that specific genetic material every cycle. See the diagram below for a graphical explanation.
When covid researchers take your nasal swab, in order to test if you’re positive for the virus or not, they use specific primers that match the RNA from Sars-Cov-2, NOT your human DNA.
Look at it this way, when they get a nasal swab from you, most of the DNA in that sample is your DNA. If they tried to see if there was any viral RNA in there, it could take them years to find it. So instead, they put all that genetic material into a PCR. The PCR that is specifically only going to replicate the SARS-Cov-2 RNA. It’s going to replicate it so many times that when they test the sample after PCR, if there was any SARS-Cov-2 RNA they would see it immediately.
Amplifying your DNA would be pointless for the test because it would just cover up the SARS-Cov-2 RNA. Most importantly, this would be extremely inefficient and really costly. We know, because all 3 of us that work to write this newsletter are researchers and have performed several PCRs before.
More importantly, the samples that are collected from you are never identified as yours. You are given a code which matches your samples. The scientists have no idea who you are. They will only know that a sample with Code X is positive. From there, the email you receive is automated. Even your doctor wouldn’t know your covid test results unless you released them.
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