EPtalk by Dr. Jayne 11/2/23

The state of public health in the US continues to decline, and I’m worried about the potential lack of available data for COVID surveillance. Now that many people with COVID are either testing at home or just not testing at all, it’s more important than ever that we use wastewater surveillance to help predict rising cases.

Politico reported on a contract dispute between the Centers for Disease Control and Prevention and one of its surveillance contractors, resulting in a quarter of testing sites being shut down. The situation might not be resolved until early 2024, which is concerning local officials across the country. Wastewater can also be used to monitor Mpox and changes in opioid use with only passive public involvement in the process. Let’s hope CDC can get the situation resolved so that communities aren’t going into a potential COVID surge blind.

Yet another company is wading into the telehealth space, and this time it’s GNC, the vitamin and supplement company. Their press release lists three tiers of service, with graduated annual fees relative to the services offered. The offerings include not only physician visits, but also a list of up to 400 prescription medications that are shipped directly to the patient with a $0 copay, along with discounts on other medications at retail pharmacies.

I’m still struggling to figure out how the economics of some of these offerings work. The Basic offering for individuals costs $34.99 per year and provides free virtual urgent care, virtual “lifestyle” care, and a list of 100 free prescriptions. Plenty of physicians are airing their dirty laundry on Facebook these days, reporting that the typical payment for physicians for a virtual urgent care visit is $25 to $30 depending on whether the visit is audio or video. Even if you’re mailing out a dirt cheap generic medication, adding in the postage for that one visit and its associated treatment will break the budget for that $34.99 annual subscription.

How are they making their money, you ask? We can only guess at this point, but I suspect that they are going to push all kinds of nutritional supplements and vitamins. If not during the visit, I’m sure the patient will receive marketing emails and text messages. I would bet that they’re also monetizing the patient information to outside firms as well.

Looking at the other plan options, the Plus option is monthly ($9.99 for individuals and $29.99 for families of up to six people) and gets you the benefits of the Basic tier plus free virtual primary care and zero dollar access to the full 400 medication formulary. The premier option jumps to $39.99 per month for individuals and $59.99 for families, and adds free virtual mental health care and virtual physical therapy. Looking at GNC Health’s website, there’s no mention of how they will coordinate care with your existing care team, or what they will do if you need care beyond what they offer.

I also found a likely untruth in their FAQs, which state that “Only the medical professionals in our provider partner’s network can access your personal identifiable health data.” I suspect personnel in quality assurance, customer service, and others will have access to the data. Most people don’t consider a customer service agent or call center rep to be a medical professional, and since I doubt GNC is going to have medical assistants or nurses fielding patient complaints, they might want to update their verbiage.

I found it interesting that their text refers to “medical doctors,” so I wonder if they are excluding doctors of osteopathy? It’s more likely that they just need a better copy editor.

Digging deeper on their menu of services, they leave the door wide open for urgent care with mention of “other individual medical concerns.” I was pleasantly surprised to see they offer emergency contraception since that’s such a charged area of practice in many states. The medication list for Basic members is pretty decent, too. I didn’t have a lot of time to try to figure out what provider group they’re using, and I doubt they have built their own, so if anyone knows, please share with the rest of us. Good luck to GNC as they wade into this, and I hope they engage the help of a solid physician copy editor soon.

Speaking of copy editing, I’ve been using Grammarly for the last couple of years, mostly because my employer pays for it and I’ve found it to be a handy tool. While I was traveling over the last couple of weeks, I was using a different laptop and didn’t realize that it wasn’t connecting with Grammarly. The service perceived that as inactivity and ended my 110-week streak. Gamification is a big thing for encouraging some people to stay persistent, and I have to say that I enjoyed earning the different badges from time to time. I consulted the internet to see if there was any way to reinstate the streak, and it doesn’t seem there is a remedy. It also sounds like there isn’t a way to pause your participation, which is really a negative for people who want to take an actual vacation and not write for a while. It sounds like there have been a number of requests from users to Grammarly for that kind of feature, but they haven’t created it yet. Come on, folks, let’s help enable some work-life balance here.

Earlier this week, Mr. H made mention of a survey that indicated that 25% of medical students in the US are considering leaving the field or selecting careers that don’t involve treating patients. Globally, students’ main concerns include mental health (60%), clinician shortages (60%), burnout (63%), and income (69%), and 12% of students worldwide are considering stepping away from medicine. This is not a new phenomenon. When I graduated more than two decades ago, fully 10% of my medical school class did not go on to residency training. They chose PhD programs, MBAs, law school, or business careers.

Students in the US often graduate with huge student loan debt, which often leads them to avoid pursuing lower-paying specialties such as pediatrics and family medicine, both of which we need desperately. Over the last three years, students undoubtedly had the chance to see that resident and attending physicians were treated as expendable and were subjected to crushing workloads in many fields, including emergency medicine as well as the two specialties previously mentioned. As in any high-pressure scenario, something has to give. In the face of untenable work expectations, loss of privacy, increasing violence, and economic pressures, the fact that people are opting out is not surprising.

I stumbled upon this chap during my recent travels, and I had no idea what it was until I Googled it. Spokane’s famed Garbage Goat has been helping clean up the city since the World’s Fair was held there in 1974. The goat connects to a vacuum that helps it “eat” pieces of trash and was built by the late Sister Paula Mary Turnbull, famous in the area as “the welding nun.” I love finding wacky things when I travel, so couldn’t resist sharing. It’s just over the hill from a giant Radio Flyer red wagon, so if you’re in the area, be sure to catch them both.

What’s the most interesting piece of public art you’ve seen? Leave a comment or email me.

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