One of my favorite sections of this course was the dietary/herbal supplements (DS) section. DS is a broad range of substances that have an interesting legal background in the United States. DS and other aspects of self-care are what I get asked about the most by friends and family. I do my best to answer these questions, but due to the broad nature of DS, it can be difficult to give a concise answer. The herbal supplement presentations were a great way to get a primer of the more common supplements. One of the most helpful aspects I learned about was the role of USP in the vitamins and dietary supplements verification. It was alluded to during class but I was able to read more into the verification during my research for the presentation. To me, it is important for pharmacists to be aware of this seal and how dietary supplements become verified as well as the limitations of this verification. At least in the community setting, it is helpful to inform patients about the role of USP and how they can use this seal quickly and easily aid their dietary supplement choices. The USP began in 1820 with its Dietary Supplement Verification Program starting in 2001. USP’s dietary supplement program was then expanded in 2004 and then again in 2006 in order to meet consumer demands for quality in their dietary supplements. In 2013, the USP created the Herbal Medicines Compendium, a free online resource that provides monographs about available herbal supplements. Curious, I began exploring this resource. Although it isn’t particularly consumer friendly, it is helpful that standards are being established for herbal ingredients. The crux of the problem is enforcing these standards across the board since herbal supplements are not regulated the way the prescription or over the counter medications are. Pharmacists as educators is an aspect that comes up again and again in our therapeutic courses as well as this elective. Overwhelming, we are presented with evidence that DS are not well-regulated and some even make outlandish false claims that results in their removal from market. The DS industry is a difficult one to navigate and it would be easiest for us as pharmacists to try not to engage with DS. However, patients, family, and friends overwhelmingly demand supplements. What is a good middle ground? I feel that having a decent working knowledge of dietary supplements is necessary to understand our patient's needs and concerns and that staying current with the evolving legality of dietary supplements will be necessary as we enter the profession.
Cultural competency is so important not only for patients but also for employees and healthcare workers. As the United States becomes more diverse, the need for diversity in employment also increases because it allows for effective communication and care, resulting in increased positive patient outcomes. I feel that cultural competency is an issue for America more so than other countries because of our diversity. The majority of other countries are more homogenous in terms of race and ethnicity, thus cultural competency is not as much of an issue. A major player in lack of cultural competency is exposure. Certain geographical populations in the United States are more diverse than others, therefore the healthcare providers in those areas are more exposed to diverse populations and are well-equipped to handle various patients. I don’t believe that cultural competency applies only to patients though but also between employers, employees, and colleagues. I, unfortunately experienced the effects of such a lack firsthand. Several months ago while working at a pharmacy, the pharmacy manager called me over to speak to a patient “in my native language,” believing that I would be able to “communicate with her better” and basing it solely on the fact that we were both of Asian descent. The unfortunate part of this was that it happened on multiple occasions. It did not end there though, as he kept asking me about whether or not Asians knew what numbers were and if they take so long to speak English because they have to translate characters to words and numbers in their heads, and these things were only the tip of the iceberg of more ignorance that spanned to other patient populations. I wondered to myself, “How would I react if I were a patient?” Would I want to come back? Probably not. What would that mean for my health? For me, it wouldn’t change much; I would just find a different pharmacist. But what about for the patients’ that don’t have as much of an understanding of healthcare? For the patients that don’t understand that some chronic disease states need consistent intervention? For patients that are too afraid to go seek help because they cannot communicate what they need? This narrow way of thinking affects so much more than merely just being offensive. Cultural competency is being able to interact with someone of a different cultural, background, or opinions. There is actually NO harm in being exposed to different cultures or backgrounds; if anything, you end up broadening your worldview and grow not only as a professional but also as individuals. Without understanding and working with differing ideas, there is no room for growth because you end up staying in your own bubble. Great minds may think alike, but small minds seldom differ.
One topic from this class that I enjoyed and got new information on was healthcare systems. Until recently I used to feel that it was something that didn’t need to be universal and even resented the idea of being fined for not enrolling in it. I did, however, relent and one February night in 2014 I enrolled in it, I wanted to give it the benefit of the doubt. I’m glad I challenged my current beliefs and gave it a try, for the first time in years I had health insurance again. While it hasn’t been without it’s glitches and frustrations it has allowed me to get care at a reasonable cost. That experience and what I have been learning in this class coupled with P1 year health systems class has changed my opinion on the matter. In this class I learned how the U.S. has the highest costs, spends the most, but has surprisingly does not have the outcomes to match. I enjoyed reading about my country of choice(Sweden) for the global health care project and learning about what is covered in their system and how it is funded. Doing this project made me optimistic about the U.S being able to adopt a similar system. Sweden’s system isn’t centralized but divided up by regions, something I feel could possibly be implemented over here and may be more readily accepted by those who have reservations about big government and government control. When learning about Sweden’s health system and listening to other students present on theirs, one aspect of many countries healthcare that I like was the emphasis placed on prevention. I feel like here in the U.S preventative care isn’t as valued as it should be. There is lots of attention centered around treatment after a patient develops a disease but little incentive or support to prevent it in the first place. I think implementing a universal health care system will be very expensive initially but will save in the long run and then overall, be more cost effective than what healthcare we have now. Universal health care can help place more emphasis on preventive care to keep costs down and ensure better patient outcomes.
The portion of class that I found most interesting was the Affordable Care Act, and American opinions about the bill and health care reform in general. I found it interesting that the majority of the country thought that health care was the most pressing issue facing the country, and that the population (in polls) were split fairly down the middle in terms of keeping/expanding the ACA and repealing/scaling back the bill. Additionally, the population seemed to oscillate between thinking that health care was or was not the governments responsibility. These divisions led me to look further into the American population’s opinions about universal healthcare and the ACA.
In 2017, the Kaiser Family Foundation conducted a series of polls to analyze the U.S. population opinion with regards to health care reform which produced some interesting results. The polls found that the majority of those polled (67% total, 70% democrat, and 64% republican) felt that reducing the out-of-pocket costs for individuals was the most critical issue to them, while a minority (35% total, 26% democrat, and 50% republican) felt that decreasing the role of the federal government in health care was a top priority. While the general population in years past has seemed to have a negative view of universal health care for reasons discussed in class, this data seems to imply that the majority of Americans would not be opposed to the government playing a larger role in regulating health care.
The results I thought were perhaps the most interesting revolved around asking people about their opinion regarding individual components of the Affordable Care Act. The results indicated that the population polled had a favorable opinion of the majority of components, while only a few sections had major opposition. For example, the majority of those polled from all parties viewed allowing people to stay on their parents’ insurance until age 26, creating a health insurance exchange, giving the states the option to expand Medicaid, and prohibiting insurance companies from denying coverage based on pre-existing conditions favorably. The only issues where more than 50% of any party viewed a component negatively were requiring employers to pay a fine if they do not provide health insurance and requiring all Americans to have health insurance. These results would imply that the majority of Americans are in favor of expanding medical coverage and services in the US, but the real point of contention is requiring citizens and businesses to become enrolled. I feel this provides interesting information in terms of pursuing a universal or single-payer system in this country; in that, the population likely would not be opposed to a universal or government-run option, they would only resent being forced to become enrolled in the program. I think this type of information will become critical in years to come as the US health care system continues to grow increasingly expensive, and more pressure is placed upon elected officials to reform how health care is conducted and paid for in America.
One of the topics we discussed that interested me most is the philosophy of bioethics and professional ethics. Each person operates based on their own personal morality and that is part of what makes people unique. It feels as though the progressive societal belief is to let each person be who they are. Everyone should be allowed to make their own decisions, if it aligns with the general belief. Morality is fluid. It changes with setting and is not unanimously sorted as right or wrong. Group mentality will define the accepted moralities. Just as people of different backgrounds will develop different perspectives, groups of different backgrounds will form their standards of acceptability. In an area like Ann Arbor, the community is leaned further towards the liberal perspective. Therefore, it more closely follows the progressive ideology that all moralities and personalities are accepted given that each of them is not physically, mentally, or emotionally hurt. Everyone is allowed their autonomy and can act as they wish within a wide set of limits. On another viewpoint, a group such as the Ku Klux Klan would set the acceptable range of perspectives at different beliefs. They may believe that harming certain groups of people to be justified because it is serving a greater good. One group is superior to another and so the better group should be in power and in majority. In that setting, those moralities are correct, and the ones commonly seen on campus are incorrect. To tie that in with healthcare, in class the scenario of pro-life vs pro-choice in pharmacy was brought up. A pharmacist that believes oral contraceptives are morally wrong would ultimately have to provide the patient the medication, largely due to professional ethics. I view professional ethics as the undocumented group morality of the vocation, which requires a suppression of personal morality to serve for a positive effect. Holding onto one’s beliefs in an opposing environment will create conflict, forcing one of the parties to hide, escape, or adapt. I would agree that a person should not pursue a career, in this case pharmacy, if they are unwilling to follow the professional ethics. However, I can understand the frustration of the limitation due to one single aspect of something greater. Each of us are allowed our beliefs, but we will face resistance if too vastly differs within our local sphere of existence. If the community around you disagree, you need to resolve it in some way. Everyone makes their own decisions, and by extension their own mistakes. Parents, mentors, and advisors take the role to teach us, bypassing the mistakes. If moralities within the group should clash, the stronger conviction would win. But should it? How much should one entity of morality push on another? That may also be defined by the group.
Throughout our class, one of the scenarios we talked about that stood out to me was regarding the success of the mass vaccination movement against smallpox. As pharmacy students, it is very easy to get caught up in the technical aspects of pharmacy, such as which agent is most efficacious, which agent has the most tolerable side effects, and what to monitor for while taking certain medications. As such, it is not surprising that we can often overlook the practical and logistical aspects of applying our scientific knowledge to the world. In the case of the smallpox eradication movement, we learned that even when well-intentioned vaccinators went around the world to offer free vaccinations to the citizens of each country, some were met with a low turnout to their events. When I first heard about this scenario, I couldn’t help but continually ask myself “Why? Vaccinations are good preventative care, and given the nasty symptoms of smallpox, wouldn’t people WANT to prevent getting the disease?” Then we learned that it was only after the incorporation of citizens who could speak the local language, into the vaccination efforts, did the turnout grow dramatically. Upon hearing about this, the importance of reaching out through integrative methods such as being endorsed by individuals of these villages and rural areas, who were respected and believed, was made clear. Immediately, I thought about how, at home, a majority of my family members could not speak English very well, but still went to Western health systems such as Kaiser Permanente for check-ups and diagnoses. However, they had also previously mentioned to me that they always needed to hear the information repeated by a Cantonese healthcare professional or translator, largely because that’s what my family members were comfortable with. In my case, since my family knows I am in pharmacy school, they have started asking me for confirmation about different medication regimens, such as antibiotics for acne, and UTI prophylaxis with probiotics. In their eyes, although I may not have an official PharmD. Degree quite yet, my family members still trusted my judgment because they believed in my education, and also because I was able to relay the information I found for them, to them in their mother tongue.
In addition, as I later learned, this example also touched on the concept of cultural competence, in which the social, cultural and linguistic needs of patients must be taken into consideration to deliver healthcare services effectively. In the case of the smallpox eradication effort, as the vaccination teams visited different countries, they were faced with a cultural barrier. Despite having convincing scientific evidence of the efficacy of the vaccination, and its positive implications for global health, citizens of third world countries were still very hesitant to be vaccinated. It was only after the incorporation of local citizens into the effort, that the vaccinations were able to be conducted on a large scale. In our case, especially since the United States in particular is a melting pot of different cultures, ethnicities and races, I believe it is important for aspiring healthcare professionals to strive to improve their cultural competence. As mentioned earlier, we all go to pharmacy school for the didactic aspect of learning in preparation for our careers in the field – however, in practice, there are often many barriers that we as healthcare professionals need to navigate past to help the patient. These barriers may include cultural differences, but may also encompass such factors as access to the medications, educational discrepancies, and difficult life circumstances. These realizations helped me temporarily break out of the “pharmacy bubble mentality”, and really think about how the broad concept of healthcare is undoubtedly a team effort. Moving forward, I definitely want to continue to embody an open-minded mentality towards working with others, and not get bogged down with strictly pharmacy-related information.
I enjoyed learning about the dietary supplements in this class as I have always been interested in traditional Chinese medicine and I am curious on how they are regulated in the US. One of the projects I did in undergrad involved looking into the claimed cardiac effects of a mixed herbal supplement from Japan that is available for sale on the Internet and OTC in a few Asian countries. It was very interesting to look up each ingredient and find out their effects and how they interact together; but it was also scary to see how little information we know about it and there were barely any research done for the combination use of these dietary supplements when they have contradicting effects. Currently, the FDA only serves a surveillance role on these dietary supplements, which is reasonable in my opinion since there are a lot of them and most of the supplements have been tested through time. However, I would like to see in the future better regulation on the labeling of the supplements. My LEPE partner takes various supplements and there are very ambiguous labeling on the bottles, which causes trouble when the patient forgets or misunderstands the use of the supplements. It also makes it harder for healthcare professionals to have a complete medication profile since the levels of ingredients involved in the supplements varies greatly between brands even though they can be advertised with having the same main active ingredient. Ideally, I would like to see more research done on the supplements. However, I think this is unlikely to happen without any penalties or incentives for these studies.
My favorite section of the class is the herb medication section. Nowadays, more and more patients start to use herbal medication as supportive care or to prevent health problems. Based on a survey in 2007, about 16% to 22% of Americans use one or more herb products and the percentage of users can be even higher today. Even though many of these medications are available as OTC or supplement, they are not as “safe” or nature as they seem to be. Some of these medications also exist serious drug-drug interaction or drug-food interaction, like St. John's Wort that need patient consulting. However, this kind of medication or health approach is seldom talked about in the pharmacy schools. 96% of community pharmacists felt they lacked knowledge about drug-herb interactions in herb medications. It is possible that herb medication users will come to your pharmacy or hospital in the future, asking questions these herb medications and you may have no idea about that. More importantly, many PCPs are not aware that their patients are taking herb medications. A survey in 2002 shows that less than 40% of the CAM therapy are disclosed to physicians. Therefore, I think it could be a great chance to introducing some principles and common herb medications in an elective course, so that pharmacist could give advices on these medications or least understand where to find information for these medications. It is really a great experience for me to do some research about specific herbs and present it in the class. To be well-prepared, I need to do a lot of research about herbs, knowing their indications, side effect, clinical trials and side effects, which greatly enrich my own knowledge about these medications. I feel much more confident about giving consulting point about herbs in the futures. Also, based on this project, I found a lot of useful resources to looking for information about herbs which can be very helpful if I have any questions about these medications in the future.
One of my personal favorite topics in this class is the herbal medicine and complementary alternative medicine. I was born in a family with a lot of my family members working with traditional Chinese medicine which develops based on a lot of herbal medicine. One example I would like to share about my family is that my grandma who got end-stage stomach cancer. The average life expectancy for the cancer is about 5 years after diagnosis and the 5 years observe survival is about 18% according to the American Cancer Society. Since my family including grandma believe in herbal medicine, we decided to treat her with Traditional Chinese Medicine. To our surprise, my grandma has lived for 10 years and has a relatively good life quality with these herbals. I know, without a randomized controlled trial, one patient case does not have enough statistical power to prove whether it is effective or not. However, I have the feeling that they hold some magic powers to be effective since those formulations have been designed, prescribed, and recorded for thousands of years before the western evidence-based medicine. Today, even though we kind of know the etiologies of majority diseases, half of them are incurable. Generally, we do not have enough weapon to fight against those mutable viruses, super resistant bacteria, and fungi. I sincerely hope we could devote more research on those “effective” herbal and identify the mechanism behind them. The 2015 noble prize winner in physiology or medicine Youyou Tu is a good example. Sweet wormwood which was used to effectively treat fever, a hallmark of malaria. In the handbook of prescription of emergency treatments, written in 340, states that a handful the herbal immersed with two liters of water, wring out the juice and drink it all. After reading the recipe, Youyou used a low-temperature ether to extract the effective compound and get the active ingredient artemisinin. She studied the chemical structure and pharmacology of artemisinin and won the Nobel prize. The lesson we should learn from her experience is that some of our herbals are indeed effective and we should review those ancient records and research on the mechanism of them. It will be no surprise we can find next effective active compounds from those “old paper”. So, as a pharmacist, when patients are using a herbal medicine, please honor patients reasons for usage, be honest about what we know, avoid criticism, encourage open communication and list them in the patient chart.
One of my favorite topics that we covered in class this semester was the dietary supplements section. Being someone who has always had a high interest in sports and professional athletics, I had always found it astounding how many athletes would get suspended or banned from professional sports for testing positive for a banned substance. Whether is was Olympic athletes or professional players in the NFL, NBA, or MLB, players get caught all the time testing positive for a banned substance and they always claim that they had no idea that whatever they were taking included things that were part of the banned substances list. I used to take whatever excuse that they came up with as a lie, just trying to remain innocent in the eyes of their fans and sponsors. But as I have learned so far in pharmacy school and researching about dietary supplements and over the counter drugs, is that often they indeed do not contain all that the label includes. This makes it extremely difficult for athletes to take any kind of dietary supplement without running the risk for unknowingly taking a banned substance. For example, the NFL does not include a list of approved substances, just a list of banned substances that are not allowed. So it is up to the athlete themself and team doctors/medical team to know if what they are taking is legal. If professional athletes, who have so many resources and people around them, cannot know exactly what they are putting into their bodies, it really makes me wonder how an average person who takes dietary supplements can know what they are actually taking. Athletes usually take supplements to try to achieve peak performance and keep their bodies healthy for training, while regular patients usually take supplements to help treat or manage acute/chronic conditions. Although intent may be different, the concerning thing is the underlying lack of knowledge that patients have about dietary supplements. Being pharmacists, as the drug experts, we are expected to know everything possible about over the counter dietary supplements. Just as a pharmacy student, I get asked often about what dietary supplements are the most beneficial and should be taken, and are safe to take. Relating back to professional athletics, I believe it would be very beneficial for sports teams to have on staff pharmacists added to their medical team to be the experts on all drug related aspects. Overall, I think that more regulation needs to be done regarding dietary supplements, especially in regards to overall content and efficacy.
One topic that really interested me this year was our discussion on the influence of the pharmaceutical industry on American healthcare. We are a part of a society that relies very heavily on medications. On one hand, we have the pharmaceutical industry which we know is responsible for developing, manufacturing, and marketing drugs for use to help people get better. Then, we have Big Pharma, the colloquial term to describe these faceless corporation that aggressively push unnecessarily overpriced drugs onto desperate consumers. It was also surprising to me to hear that the United States is one of four countries that allows direct-to-consumer advertising. While I feel that most patients believe their healthcare providers are there to help them receive the best care possible, I also believe that there are a handful of patients who are weary that their physicians are influenced by particular drug companies. And rightfully so, these big pharmaceutical companies spend billions of dollars on marketing for their drugs. And some companies spend much more on marketing than they do on research and development. But it works- a statistics says that for every 1 dollar spent on advertising, 4 dollars are gained from retail sales. Customers often come into doctors offices and pharmacies requesting drugs that they see on TV and additionally doctors and other prescribing healthcare providers receive lofty bonuses for promoting certain manufacturers. In my opinion, one of the biggest and perhaps most serious effect Big Pharma and direct-to-consumer advertising has on American healthcare is the opioids epidemic. I came across an article on how OxyContin came to market and one pharmaceutical company’s impact on the epidemic. A 2011 survey from the Kaiser Family Foundation revealed that the US only makes about 5% of the world’s population but consumes 80% of the overall painkillers in the world. A great amount of those painkillers can be attributed to one pharmaceutical company. In 1995, the FDA have Purdue pharma, a private, family-owned company in Connecticut to produce OxyContin. In one year, OxyContin generated $45 million in sales. In the next 10 years, the sales based $1 billion and in the 10 years following that, sales passed $3 billion. But to get to that point, the company employed over 300 sales representatives and those sales reps received yearly bonuses on an average of $70,000 some ranging as high as $250,000. Based on prescribing patterns, the company even created a list of doctors who were likely to prescribe OxyContin and other pain medications to their patients and actively pursued those individuals and practices. In addition, Purdue pharma hosted 40 “pain conferences” in resorts that targeted PCPs and doctors who specialized in cancer treatment where the company arranged over 2,000 physicians to deliver paid speeches and presentations. As a result OxyContin prescription in 2002, were ten times higher than those in 1997. Also, to keep up with demand, the FDA approved Purdue Pharma to increase the dosage per pill increasing the dosage from 80 mg to 160 mg. Currently, the Slacker family which privately owns Purdue Pharma is worth $14 billion and happens to be the 16th largest fortune the US. Thus, it’s undeniable that Big Pharma has a giant influence on what type of drugs are getting prescribed in the US. I believe that as future healthcare professions, we have the knowledge and the awareness of this epidemic that can halt overprescribing that is happening. It’s always good to double check where funding is coming from and the different sponsors, whether it be on a drug product, service, or a scientific journal online. While I don’t think the biases and politics of pharmaceutics will cease any time soon, we always have a choice to provide the best, effective care for our patients.
In this course, it was interesting to learn about the different health systems of different countries. I enjoyed learning about how healthcare was paid for and delivered. With a wide variety of systems covered, there were many examples that had more efficient systems in terms of outcomes and cost, but also other systems that had major issues in outcomes and disparities. I wondered which aspects could the United States healthcare system adopt to improve the healthcare system. Efficiency and cost are larger drivers for the news surrounding healthcare today. Several pharmacies and healthcare companies now entering agreements as mergers or acquisitions: CVS and Aetna, Express Scripts and Cigna, Walmart and Humana. News also broke earlier this year of Amazon’s intent to enter the pharmacy business and collaboration with Berkshire Hathaway and JPMorgan Chase to form a health care company. Further, the health-systems of Intermountain Healthcare, Ascension, SSM Health, and Trinity Health intend to start a non-profit company to produce generic drugs with the prospect of addressing drug shortages. The large activity in the world of healthcare reflects the need to address efficiency and costs. Vertical integration of health plans and pharmacies and of health plans and pharmacy benefit managers aim to decrease costs. Their goal is to contain costs and care by establishing networks in which their patients seek healthcare. Rising costs of healthcare and prescription medications, especially specialty pharmaceuticals, have lead employers to band together to address this issue. Outside of costs, the inefficiency and inconsistency of drug shortages have health-systems working together. The endless news of mergers, acquisitions, and collaborations in the healthcare field makes it seem like a single-payer system may help in containing costs. By integrating and consolidating, companies perceive it will benefit. Still, while there is much support of a single-payer system, there are many obstacles associated with the concept. The multi-payer system allows for freedom of choice in which health plan to purchase, which may disappear with a single-payer system. Additionally, the administrative aspect of managing healthcare for the population of the United States must be addressed. Either a national program will be responsible or individual states may be delegated this task. While there is much popularity in supporting a single-payer system, there are important aspects to consider. Still, inefficiencies and cost have lead several companies to merge or collaborate, and these are issues we should definitely address in our current healthcare system.
Among the topics we covered in class this semester, the one that stood out for me was on the subject of the US healthcare system. Is healthcare a commodity or a right? This question, with the majority of the developed world unanimously agreeing on the latter, is still debated in this country. US spending on healthcare is significantly greater in comparison to other countries that have adopted a single payer system, yet our health outcomes do not reflect the amount spent on healthcare. A 2017 poll published by the Pew Research Center reports that support for a single payer system has risen since 2014, with over 58% of the public stating that the government is responsible for providing healthcare. Despite the upward trend of support for universal health-care, there is a roughly even number of people (38%) that believe that the government is not responsible. With millions of people unable to access health care needs due to overwhelming costs, I’ve been curious as to why people in the US are opposed to a single payer system. In class, we saw a video where Rand Paul compared health care as a human right to slavery. The comparison is outlandish, but I realized that there are many Americans who reflect this sentiment. Although the term “healthcare” is not explicitly stated in the constitution, health care should be implied because it’s a necessity to be able to achieve “life, liberty, and the pursuit of happiness.” This phrase can also be translated to “freedom to pursue life, liberty, and happiness,” which is why opponents of a single payer system argue that implementing a universal health care system is a violation of his/or her freedom. I believe the reason why healthcare reforms is still widely debated is because it has yet to address concerns on both sides of the political views. However, it’s important to understand that certain reforms on healthcare, such as the Medicare program, was widely opposed by many people when first introduced. Current polls show that the majority of Americans from both sides of the political spectrum believe that the Medicare program should remain. Whether or not the US decides to adopt a single-payer system remains to be seen. As it stands, I believe that differing political ideologies among Americans is one of the main reasons why healthcare reforms have not been as progressive in comparison to other countries. Furthermore, any reforms on health care will be met with opposition from people on both side of the political spectrum. However, with the cost of health care rising and the number of uninsured patients grow, I believe that there is more pressure towards innovating our current healthcare system.
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DeleteOne of my favorite sections of this course was the dietary/herbal supplements (DS) section. DS is a broad range of substances that have an interesting legal background in the United States. DS and other aspects of self-care are what I get asked about the most by friends and family. I do my best to answer these questions, but due to the broad nature of DS, it can be difficult to give a concise answer. The herbal supplement presentations were a great way to get a primer of the more common supplements.
ReplyDeleteOne of the most helpful aspects I learned about was the role of USP in the vitamins and dietary supplements verification. It was alluded to during class but I was able to read more into the verification during my research for the presentation. To me, it is important for pharmacists to be aware of this seal and how dietary supplements become verified as well as the limitations of this verification. At least in the community setting, it is helpful to inform patients about the role of USP and how they can use this seal quickly and easily aid their dietary supplement choices.
The USP began in 1820 with its Dietary Supplement Verification Program starting in 2001. USP’s dietary supplement program was then expanded in 2004 and then again in 2006 in order to meet consumer demands for quality in their dietary supplements. In 2013, the USP created the Herbal Medicines Compendium, a free online resource that provides monographs about available herbal supplements. Curious, I began exploring this resource. Although it isn’t particularly consumer friendly, it is helpful that standards are being established for herbal ingredients. The crux of the problem is enforcing these standards across the board since herbal supplements are not regulated the way the prescription or over the counter medications are.
Pharmacists as educators is an aspect that comes up again and again in our therapeutic courses as well as this elective. Overwhelming, we are presented with evidence that DS are not well-regulated and some even make outlandish false claims that results in their removal from market. The DS industry is a difficult one to navigate and it would be easiest for us as pharmacists to try not to engage with DS. However, patients, family, and friends overwhelmingly demand supplements. What is a good middle ground? I feel that having a decent working knowledge of dietary supplements is necessary to understand our patient's needs and concerns and that staying current with the evolving legality of dietary supplements will be necessary as we enter the profession.
Sources:
usp.org
Hmc.usp.org
ftc.gov
Cultural competency is so important not only for patients but also for employees and healthcare workers. As the United States becomes more diverse, the need for diversity in employment also increases because it allows for effective communication and care, resulting in increased positive patient outcomes. I feel that cultural competency is an issue for America more so than other countries because of our diversity. The majority of other countries are more homogenous in terms of race and ethnicity, thus cultural competency is not as much of an issue.
ReplyDeleteA major player in lack of cultural competency is exposure. Certain geographical populations in the United States are more diverse than others, therefore the healthcare providers in those areas are more exposed to diverse populations and are well-equipped to handle various patients. I don’t believe that cultural competency applies only to patients though but also between employers, employees, and colleagues. I, unfortunately experienced the effects of such a lack firsthand. Several months ago while working at a pharmacy, the pharmacy manager called me over to speak to a patient “in my native language,” believing that I would be able to “communicate with her better” and basing it solely on the fact that we were both of Asian descent. The unfortunate part of this was that it happened on multiple occasions. It did not end there though, as he kept asking me about whether or not Asians knew what numbers were and if they take so long to speak English because they have to translate characters to words and numbers in their heads, and these things were only the tip of the iceberg of more ignorance that spanned to other patient populations.
I wondered to myself, “How would I react if I were a patient?” Would I want to come back? Probably not. What would that mean for my health? For me, it wouldn’t change much; I would just find a different pharmacist. But what about for the patients’ that don’t have as much of an understanding of healthcare? For the patients that don’t understand that some chronic disease states need consistent intervention? For patients that are too afraid to go seek help because they cannot communicate what they need? This narrow way of thinking affects so much more than merely just being offensive.
Cultural competency is being able to interact with someone of a different cultural, background, or opinions. There is actually NO harm in being exposed to different cultures or backgrounds; if anything, you end up broadening your worldview and grow not only as a professional but also as individuals. Without understanding and working with differing ideas, there is no room for growth because you end up staying in your own bubble. Great minds may think alike, but small minds seldom differ.
One topic from this class that I enjoyed and got new information on was healthcare systems. Until recently I used to feel that it was something that didn’t need to be universal and even resented the idea of being fined for not enrolling in it. I did, however, relent and one February night in 2014 I enrolled in it, I wanted to give it the benefit of the doubt. I’m glad I challenged my current beliefs and gave it a try, for the first time in years I had health insurance again. While it hasn’t been without it’s glitches and frustrations it has allowed me to get care at a reasonable cost. That experience and what I have been learning in this class coupled with P1 year health systems class has changed my opinion on the matter. In this class I learned how the U.S. has the highest costs, spends the most, but has surprisingly does not have the outcomes to match. I enjoyed reading about my country of choice(Sweden) for the global health care project and learning about what is covered in their system and how it is funded. Doing this project made me optimistic about the U.S being able to adopt a similar system. Sweden’s system isn’t centralized but divided up by regions, something I feel could possibly be implemented over here and may be more readily accepted by those who have reservations about big government and government control. When learning about Sweden’s health system and listening to other students present on theirs, one aspect of many countries healthcare that I like was the emphasis placed on prevention. I feel like here in the U.S preventative care isn’t as valued as it should be. There is lots of attention centered around treatment after a patient develops a disease but little incentive or support to prevent it in the first place. I think implementing a universal health care system will be very expensive initially but will save in the long run and then overall, be more cost effective than what healthcare we have now. Universal health care can help place more emphasis on preventive care to keep costs down and ensure better patient outcomes.
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ReplyDeleteThe portion of class that I found most interesting was the Affordable Care Act, and American opinions about the bill and health care reform in general. I found it interesting that the majority of the country thought that health care was the most pressing issue facing the country, and that the population (in polls) were split fairly down the middle in terms of keeping/expanding the ACA and repealing/scaling back the bill. Additionally, the population seemed to oscillate between thinking that health care was or was not the governments responsibility. These divisions led me to look further into the American population’s opinions about universal healthcare and the ACA.
ReplyDeleteIn 2017, the Kaiser Family Foundation conducted a series of polls to analyze the U.S. population opinion with regards to health care reform which produced some interesting results. The polls found that the majority of those polled (67% total, 70% democrat, and 64% republican) felt that reducing the out-of-pocket costs for individuals was the most critical issue to them, while a minority (35% total, 26% democrat, and 50% republican) felt that decreasing the role of the federal government in health care was a top priority. While the general population in years past has seemed to have a negative view of universal health care for reasons discussed in class, this data seems to imply that the majority of Americans would not be opposed to the government playing a larger role in regulating health care.
The results I thought were perhaps the most interesting revolved around asking people about their opinion regarding individual components of the Affordable Care Act. The results indicated that the population polled had a favorable opinion of the majority of components, while only a few sections had major opposition. For example, the majority of those polled from all parties viewed allowing people to stay on their parents’ insurance until age 26, creating a health insurance exchange, giving the states the option to expand Medicaid, and prohibiting insurance companies from denying coverage based on pre-existing conditions favorably. The only issues where more than 50% of any party viewed a component negatively were requiring employers to pay a fine if they do not provide health insurance and requiring all Americans to have health insurance. These results would imply that the majority of Americans are in favor of expanding medical coverage and services in the US, but the real point of contention is requiring citizens and businesses to become enrolled. I feel this provides interesting information in terms of pursuing a universal or single-payer system in this country; in that, the population likely would not be opposed to a universal or government-run option, they would only resent being forced to become enrolled in the program. I think this type of information will become critical in years to come as the US health care system continues to grow increasingly expensive, and more pressure is placed upon elected officials to reform how health care is conducted and paid for in America.
One of the topics we discussed that interested me most is the philosophy of bioethics and professional ethics. Each person operates based on their own personal morality and that is part of what makes people unique. It feels as though the progressive societal belief is to let each person be who they are. Everyone should be allowed to make their own decisions, if it aligns with the general belief. Morality is fluid. It changes with setting and is not unanimously sorted as right or wrong. Group mentality will define the accepted moralities. Just as people of different backgrounds will develop different perspectives, groups of different backgrounds will form their standards of acceptability.
ReplyDeleteIn an area like Ann Arbor, the community is leaned further towards the liberal perspective. Therefore, it more closely follows the progressive ideology that all moralities and personalities are accepted given that each of them is not physically, mentally, or emotionally hurt. Everyone is allowed their autonomy and can act as they wish within a wide set of limits. On another viewpoint, a group such as the Ku Klux Klan would set the acceptable range of perspectives at different beliefs. They may believe that harming certain groups of people to be justified because it is serving a greater good. One group is superior to another and so the better group should be in power and in majority. In that setting, those moralities are correct, and the ones commonly seen on campus are incorrect.
To tie that in with healthcare, in class the scenario of pro-life vs pro-choice in pharmacy was brought up. A pharmacist that believes oral contraceptives are morally wrong would ultimately have to provide the patient the medication, largely due to professional ethics. I view professional ethics as the undocumented group morality of the vocation, which requires a suppression of personal morality to serve for a positive effect. Holding onto one’s beliefs in an opposing environment will create conflict, forcing one of the parties to hide, escape, or adapt. I would agree that a person should not pursue a career, in this case pharmacy, if they are unwilling to follow the professional ethics. However, I can understand the frustration of the limitation due to one single aspect of something greater.
Each of us are allowed our beliefs, but we will face resistance if too vastly differs within our local sphere of existence. If the community around you disagree, you need to resolve it in some way. Everyone makes their own decisions, and by extension their own mistakes. Parents, mentors, and advisors take the role to teach us, bypassing the mistakes. If moralities within the group should clash, the stronger conviction would win. But should it? How much should one entity of morality push on another? That may also be defined by the group.
ReplyDeleteThroughout our class, one of the scenarios we talked about that stood out to me was regarding the success of the mass vaccination movement against smallpox. As pharmacy students, it is very easy to get caught up in the technical aspects of pharmacy, such as which agent is most efficacious, which agent has the most tolerable side effects, and what to monitor for while taking certain medications. As such, it is not surprising that we can often overlook the practical and logistical aspects of applying our scientific knowledge to the world. In the case of the smallpox eradication movement, we learned that even when well-intentioned vaccinators went around the world to offer free vaccinations to the citizens of each country, some were met with a low turnout to their events. When I first heard about this scenario, I couldn’t help but continually ask myself “Why? Vaccinations are good preventative care, and given the nasty symptoms of smallpox, wouldn’t people WANT to prevent getting the disease?” Then we learned that it was only after the incorporation of citizens who could speak the local language, into the vaccination efforts, did the turnout grow dramatically. Upon hearing about this, the importance of reaching out through integrative methods such as being endorsed by individuals of these villages and rural areas, who were respected and believed, was made clear. Immediately, I thought about how, at home, a majority of my family members could not speak English very well, but still went to Western health systems such as Kaiser Permanente for check-ups and diagnoses. However, they had also previously mentioned to me that they always needed to hear the information repeated by a Cantonese healthcare professional or translator, largely because that’s what my family members were comfortable with. In my case, since my family knows I am in pharmacy school, they have started asking me for confirmation about different medication regimens, such as antibiotics for acne, and UTI prophylaxis with probiotics. In their eyes, although I may not have an official PharmD. Degree quite yet, my family members still trusted my judgment because they believed in my education, and also because I was able to relay the information I found for them, to them in their mother tongue.
In addition, as I later learned, this example also touched on the concept of cultural competence, in which the social, cultural and linguistic needs of patients must be taken into consideration to deliver healthcare services effectively. In the case of the smallpox eradication effort, as the vaccination teams visited different countries, they were faced with a cultural barrier. Despite having convincing scientific evidence of the efficacy of the vaccination, and its positive implications for global health, citizens of third world countries were still very hesitant to be vaccinated. It was only after the incorporation of local citizens into the effort, that the vaccinations were able to be conducted on a large scale. In our case, especially since the United States in particular is a melting pot of different cultures, ethnicities and races, I believe it is important for aspiring healthcare professionals to strive to improve their cultural competence. As mentioned earlier, we all go to pharmacy school for the didactic aspect of learning in preparation for our careers in the field – however, in practice, there are often many barriers that we as healthcare professionals need to navigate past to help the patient. These barriers may include cultural differences, but may also encompass such factors as access to the medications, educational discrepancies, and difficult life circumstances. These realizations helped me temporarily break out of the “pharmacy bubble mentality”, and really think about how the broad concept of healthcare is undoubtedly a team effort. Moving forward, I definitely want to continue to embody an open-minded mentality towards working with others, and not get bogged down with strictly pharmacy-related information.
I enjoyed learning about the dietary supplements in this class as I have always been interested in traditional Chinese medicine and I am curious on how they are regulated in the US. One of the projects I did in undergrad involved looking into the claimed cardiac effects of a mixed herbal supplement from Japan that is available for sale on the Internet and OTC in a few Asian countries. It was very interesting to look up each ingredient and find out their effects and how they interact together; but it was also scary to see how little information we know about it and there were barely any research done for the combination use of these dietary supplements when they have contradicting effects. Currently, the FDA only serves a surveillance role on these dietary supplements, which is reasonable in my opinion since there are a lot of them and most of the supplements have been tested through time. However, I would like to see in the future better regulation on the labeling of the supplements. My LEPE partner takes various supplements and there are very ambiguous labeling on the bottles, which causes trouble when the patient forgets or misunderstands the use of the supplements. It also makes it harder for healthcare professionals to have a complete medication profile since the levels of ingredients involved in the supplements varies greatly between brands even though they can be advertised with having the same main active ingredient. Ideally, I would like to see more research done on the supplements. However, I think this is unlikely to happen without any penalties or incentives for these studies.
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ReplyDeleteMy favorite section of the class is the herb medication section. Nowadays, more and more patients start to use herbal medication as supportive care or to prevent health problems. Based on a survey in 2007, about 16% to 22% of Americans use one or more herb products and the percentage of users can be even higher today. Even though many of these medications are available as OTC or supplement, they are not as “safe” or nature as they seem to be. Some of these medications also exist serious drug-drug interaction or drug-food interaction, like St. John's Wort that need patient consulting. However, this kind of medication or health approach is seldom talked about in the pharmacy schools. 96% of community pharmacists felt they lacked knowledge about drug-herb interactions in herb medications. It is possible that herb medication users will come to your pharmacy or hospital in the future, asking questions these herb medications and you may have no idea about that.
ReplyDeleteMore importantly, many PCPs are not aware that their patients are taking herb medications. A survey in 2002 shows that less than 40% of the CAM therapy are disclosed to physicians. Therefore, I think it could be a great chance to introducing some principles and common herb medications in an elective course, so that pharmacist could give advices on these medications or least understand where to find information for these medications.
It is really a great experience for me to do some research about specific herbs and present it in the class. To be well-prepared, I need to do a lot of research about herbs, knowing their indications, side effect, clinical trials and side effects, which greatly enrich my own knowledge about these medications. I feel much more confident about giving consulting point about herbs in the futures. Also, based on this project, I found a lot of useful resources to looking for information about herbs which can be very helpful if I have any questions about these medications in the future.
One of my personal favorite topics in this class is the herbal medicine and complementary alternative medicine.
ReplyDeleteI was born in a family with a lot of my family members working with traditional Chinese medicine which develops based on a lot of herbal medicine. One example I would like to share about my family is that my grandma who got end-stage stomach cancer. The average life expectancy for the cancer is about 5 years after diagnosis and the 5 years observe survival is about 18% according to the American Cancer Society. Since my family including grandma believe in herbal medicine, we decided to treat her with Traditional Chinese Medicine. To our surprise, my grandma has lived for 10 years and has a relatively good life quality with these herbals. I know, without a randomized controlled trial, one patient case does not have enough statistical power to prove whether it is effective or not. However, I have the feeling that they hold some magic powers to be effective since those formulations have been designed, prescribed, and recorded for thousands of years before the western evidence-based medicine. Today, even though we kind of know the etiologies of majority diseases, half of them are incurable. Generally, we do not have enough weapon to fight against those mutable viruses, super resistant bacteria, and fungi. I sincerely hope we could devote more research on those “effective” herbal and identify the mechanism behind them. The 2015 noble prize winner in physiology or medicine Youyou Tu is a good example. Sweet wormwood which was used to effectively treat fever, a hallmark of malaria. In the handbook of prescription of emergency treatments, written in 340, states that a handful the herbal immersed with two liters of water, wring out the juice and drink it all. After reading the recipe, Youyou used a low-temperature ether to extract the effective compound and get the active ingredient artemisinin. She studied the chemical structure and pharmacology of artemisinin and won the Nobel prize. The lesson we should learn from her experience is that some of our herbals are indeed effective and we should review those ancient records and research on the mechanism of them. It will be no surprise we can find next effective active compounds from those “old paper”.
So, as a pharmacist, when patients are using a herbal medicine, please honor patients reasons for usage, be honest about what we know, avoid criticism, encourage open communication and list them in the patient chart.
One of my favorite topics that we covered in class this semester was the dietary supplements section. Being someone who has always had a high interest in sports and professional athletics, I had always found it astounding how many athletes would get suspended or banned from professional sports for testing positive for a banned substance. Whether is was Olympic athletes or professional players in the NFL, NBA, or MLB, players get caught all the time testing positive for a banned substance and they always claim that they had no idea that whatever they were taking included things that were part of the banned substances list. I used to take whatever excuse that they came up with as a lie, just trying to remain innocent in the eyes of their fans and sponsors. But as I have learned so far in pharmacy school and researching about dietary supplements and over the counter drugs, is that often they indeed do not contain all that the label includes. This makes it extremely difficult for athletes to take any kind of dietary supplement without running the risk for unknowingly taking a banned substance. For example, the NFL does not include a list of approved substances, just a list of banned substances that are not allowed. So it is up to the athlete themself and team doctors/medical team to know if what they are taking is legal. If professional athletes, who have so many resources and people around them, cannot know exactly what they are putting into their bodies, it really makes me wonder how an average person who takes dietary supplements can know what they are actually taking. Athletes usually take supplements to try to achieve peak performance and keep their bodies healthy for training, while regular patients usually take supplements to help treat or manage acute/chronic conditions. Although intent may be different, the concerning thing is the underlying lack of knowledge that patients have about dietary supplements. Being pharmacists, as the drug experts, we are expected to know everything possible about over the counter dietary supplements. Just as a pharmacy student, I get asked often about what dietary supplements are the most beneficial and should be taken, and are safe to take. Relating back to professional athletics, I believe it would be very beneficial for sports teams to have on staff pharmacists added to their medical team to be the experts on all drug related aspects. Overall, I think that more regulation needs to be done regarding dietary supplements, especially in regards to overall content and efficacy.
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ReplyDeleteOne topic that really interested me this year was our discussion on the influence of the pharmaceutical industry on American healthcare. We are a part of a society that relies very heavily on medications. On one hand, we have the pharmaceutical industry which we know is responsible for developing, manufacturing, and marketing drugs for use to help people get better. Then, we have Big Pharma, the colloquial term to describe these faceless corporation that aggressively push unnecessarily overpriced drugs onto desperate consumers. It was also surprising to me to hear that the United States is one of four countries that allows direct-to-consumer advertising. While I feel that most patients believe their healthcare providers are there to help them receive the best care possible, I also believe that there are a handful of patients who are weary that their physicians are influenced by particular drug companies. And rightfully so, these big pharmaceutical companies spend billions of dollars on marketing for their drugs. And some companies spend much more on marketing than they do on research and development. But it works- a statistics says that for every 1 dollar spent on advertising, 4 dollars are gained from retail sales. Customers often come into doctors offices and pharmacies requesting drugs that they see on TV and additionally doctors and other prescribing healthcare providers receive lofty bonuses for promoting certain manufacturers.
In my opinion, one of the biggest and perhaps most serious effect Big Pharma and direct-to-consumer advertising has on American healthcare is the opioids epidemic. I came across an article on how OxyContin came to market and one pharmaceutical company’s impact on the epidemic. A 2011 survey from the Kaiser Family Foundation revealed that the US only makes about 5% of the world’s population but consumes 80% of the overall painkillers in the world. A great amount of those painkillers can be attributed to one pharmaceutical company. In 1995, the FDA have Purdue pharma, a private, family-owned company in Connecticut to produce OxyContin. In one year, OxyContin generated $45 million in sales. In the next 10 years, the sales based $1 billion and in the 10 years following that, sales passed $3 billion. But to get to that point, the company employed over 300 sales representatives and those sales reps received yearly bonuses on an average of $70,000 some ranging as high as $250,000. Based on prescribing patterns, the company even created a list of doctors who were likely to prescribe OxyContin and other pain medications to their patients and actively pursued those individuals and practices. In addition, Purdue pharma hosted 40 “pain conferences” in resorts that targeted PCPs and doctors who specialized in cancer treatment where the company arranged over 2,000 physicians to deliver paid speeches and presentations. As a result OxyContin prescription in 2002, were ten times higher than those in 1997. Also, to keep up with demand, the FDA approved Purdue Pharma to increase the dosage per pill increasing the dosage from 80 mg to 160 mg. Currently, the Slacker family which privately owns Purdue Pharma is worth $14 billion and happens to be the 16th largest fortune the US.
Thus, it’s undeniable that Big Pharma has a giant influence on what type of drugs are getting prescribed in the US. I believe that as future healthcare professions, we have the knowledge and the awareness of this epidemic that can halt overprescribing that is happening. It’s always good to double check where funding is coming from and the different sponsors, whether it be on a drug product, service, or a scientific journal online. While I don’t think the biases and politics of pharmaceutics will cease any time soon, we always have a choice to provide the best, effective care for our patients.
Resources:
https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain
In this course, it was interesting to learn about the different health systems of different countries. I enjoyed learning about how healthcare was paid for and delivered. With a wide variety of systems covered, there were many examples that had more efficient systems in terms of outcomes and cost, but also other systems that had major issues in outcomes and disparities. I wondered which aspects could the United States healthcare system adopt to improve the healthcare system.
ReplyDeleteEfficiency and cost are larger drivers for the news surrounding healthcare today. Several pharmacies and healthcare companies now entering agreements as mergers or acquisitions: CVS and Aetna, Express Scripts and Cigna, Walmart and Humana. News also broke earlier this year of Amazon’s intent to enter the pharmacy business and collaboration with Berkshire Hathaway and JPMorgan Chase to form a health care company. Further, the health-systems of Intermountain Healthcare, Ascension, SSM Health, and Trinity Health intend to start a non-profit company to produce generic drugs with the prospect of addressing drug shortages.
The large activity in the world of healthcare reflects the need to address efficiency and costs. Vertical integration of health plans and pharmacies and of health plans and pharmacy benefit managers aim to decrease costs. Their goal is to contain costs and care by establishing networks in which their patients seek healthcare. Rising costs of healthcare and prescription medications, especially specialty pharmaceuticals, have lead employers to band together to address this issue. Outside of costs, the inefficiency and inconsistency of drug shortages have health-systems working together.
The endless news of mergers, acquisitions, and collaborations in the healthcare field makes it seem like a single-payer system may help in containing costs. By integrating and consolidating, companies perceive it will benefit. Still, while there is much support of a single-payer system, there are many obstacles associated with the concept. The multi-payer system allows for freedom of choice in which health plan to purchase, which may disappear with a single-payer system. Additionally, the administrative aspect of managing healthcare for the population of the United States must be addressed. Either a national program will be responsible or individual states may be delegated this task. While there is much popularity in supporting a single-payer system, there are important aspects to consider. Still, inefficiencies and cost have lead several companies to merge or collaborate, and these are issues we should definitely address in our current healthcare system.
Among the topics we covered in class this semester, the one that stood out for me was on the subject of the US healthcare system. Is healthcare a commodity or a right? This question, with the majority of the developed world unanimously agreeing on the latter, is still debated in this country. US spending on healthcare is significantly greater in comparison to other countries that have adopted a single payer system, yet our health outcomes do not reflect the amount spent on healthcare. A 2017 poll published by the Pew Research Center reports that support for a single payer system has risen since 2014, with over 58% of the public stating that the government is responsible for providing healthcare. Despite the upward trend of support for universal health-care, there is a roughly even number of people (38%) that believe that the government is not responsible. With millions of people unable to access health care needs due to overwhelming costs, I’ve been curious as to why people in the US are opposed to a single payer system.
ReplyDeleteIn class, we saw a video where Rand Paul compared health care as a human right to slavery. The comparison is outlandish, but I realized that there are many Americans who reflect this sentiment. Although the term “healthcare” is not explicitly stated in the constitution, health care should be implied because it’s a necessity to be able to achieve “life, liberty, and the pursuit of happiness.” This phrase can also be translated to “freedom to pursue life, liberty, and happiness,” which is why opponents of a single payer system argue that implementing a universal health care system is a violation of his/or her freedom. I believe the reason why healthcare reforms is still widely debated is because it has yet to address concerns on both sides of the political views. However, it’s important to understand that certain reforms on healthcare, such as the Medicare program, was widely opposed by many people when first introduced. Current polls show that the majority of Americans from both sides of the political spectrum believe that the Medicare program should remain.
Whether or not the US decides to adopt a single-payer system remains to be seen. As it stands, I believe that differing political ideologies among Americans is one of the main reasons why healthcare reforms have not been as progressive in comparison to other countries. Furthermore, any reforms on health care will be met with opposition from people on both side of the political spectrum. However, with the cost of health care rising and the number of uninsured patients grow, I believe that there is more pressure towards innovating our current healthcare system.