Telehealth will save lives—for as long as it has funding
The federal government and private insurers greatly increased Americans' telehealth access during the pandemic. Will these changes be permanent?
Stephen Johnson is a St. Louis-based writer whose work has been published by outlets including PBS Digital Studios, HuffPost, MSN, U.S. News & World Report, Eleven Magazine and The Missourian.
- When telehealth visits began skyrocketing after the pandemic began, hospitals had to increase their number of virtual appointments by magnitudes. Most did it seamlessly.
- Big Think spoke to Dr. Martin Doerfler, senior vice president of clinical strategy and development at Northwell Health, about this transition and how it benefited patients.
- Telehealth has proven its value during the pandemic, but it might stop evolving unless the federal government redesigns the regulatory framework so that insurers cover it and patients can afford it.
When COVID-19 began spreading across the U.S. in early 2020, the nation's telehealth infrastructure entered a trial by fire.
It was paramount for hospitals to minimize in-person care—not only to limit the spread of the virus, but also to ensure hospitals wouldn't become overwhelmed, like they had in Italy. That's a key reason why, in March, Medicare and most private insurers sought to increase access to telehealth by relaxing restrictions, waiving fees, and reimbursing practitioners for virtual visits at the same rate as in-person visits.
Soon after the establishment of these temporary measures, telehealth visits skyrocketed. A report from the U.S. Department of Health and Human Services found, for example, that about 43 percent of primary care visits were conducted through telehealth in April, compared to just 0.1 percent in February.
How did that transition go? Despite having just weeks to prepare, most U.S. health care organizations managed to massively increase their virtual caseload with astounding seamlessness. Dr. Martin Doerfler, senior vice president of clinical strategy and development at Northwell Health, was one of the thousands of health care professionals who witnessed the transition.
"We went from the proverbial 'zero to 60' over a matter of weeks, and provided good care with very high degrees of patient satisfaction," Doerfler said.
Prior to the pandemic, Northwell Health—the largest hospital system in New York—was conducting about 150 telehealth visits per month between 20 to 40 physicians. But in May alone, Northwell had conducted approximately 65,000 visits with roughly 8,000 health care professionals across the health system.
Doerfler cited an example of a single mother whose young child had chronic illnesses, including respiratory problems, which made in-person visits especially dangerous during the pandemic. The pediatrician was able to evaluate the child, speak to the mother through a telehealth translation service, and provide the family with the necessary steps to keep the child healthy. The mother was happy to avoid having to take her child on public transportation to visit a hospital in person and still receive the care she needed.
Three hours to drive 200 miles is no different than three hours to take two trains, two buses and a cab.
Clinicians at Northwell have used telehealth to adapt to the pandemic in many ways, from sending phlebotomists to elderly patients' homes after virtual visits, to connecting new mothers with lactation specialists via secure, encrypted telehealth channels.
"There are all sorts of examples throughout health care where this technology, and the willingness of patients and clinicians to embrace it, allowed for care of the type of issues that are normally done face-to-face," Doerfler said.
Telehealth programs that existed before the pandemic also helped to keep both patients and hospital staff safe by minimizing in-person visits. For example, Northwell's TelePsychiatry Department connects people in crisis, who might typically go to the emergency department, with a behavioral health specialist in about 45 minutes, any time of day or week. That is a considerable improvement since emergency department staffing typically does not include psychiatrists or other specialists who can help someone experiencing a behavioral health emergency.
The success of telehealth during the pandemic begs the question: Why hasn't US health care already embraced virtual care?
What are the obstacles facing telehealth?
One of the biggest obstacles to widespread adoption of telehealth has been a lack of national legislation providing financial incentive for health centers to adopt it.
States laws vary on how practitioners are paid for telehealth visits. In some states, laws require insurance providers to cover telehealth visits at parity—at the same rate as in-person visits. But in states without parity laws, there's little incentive for health care organizations to invest in telehealth infrastructure and training.
Access is also a major obstacle. The Centers for Medicare and Medicaid Services (CMS) generally reimburse practitioners for telehealth visits only when patients live in "designated rural underserved areas."
But not all underserved areas are in small, remote places. After all, a single parent living in Brooklyn, New York, might also have trouble accessing quality health care.
"Three hours to drive 200 miles is no different than three hours to take two trains, two buses and a cab," Doerfler said. "So access is almost certainly going to be improved by the greater availability of telehealth in that direct-to-patient, in-their-home-or-office, setting."
Lack of internet access is also a problem. A paper published by the JAMA Network in August found that 41 percent of Medicare beneficiaries don't have a computer at home with access to high-speed internet, and roughly the same number don't have a smartphone with an unlimited data plan.
What is the future of telehealth?
Credit: Daniilvolkov via AdobeStock
Lawmakers in both parties and health care professionals have indicated a desire to make permanent some of the regulatory changes to telehealth enacted during the pandemic. That's key, because without the financial incentives to continue expanding telehealth, health care providers may revert to the pre-pandemic approach.
"One issue, which is important for health care and non-health-care folks to know, is that telehealth will continue to expand dramatically as long as there's funding and reimbursement for it," said Michael Dowling, Northwell's president and CEO. "If the insurance companies and government decide, 'We don't want to pay for telehealth going forward or virtual visits,' then it's going to slow down. If there is no delivery system, no health care system, hospital, or doctor is going to continue to expand telehealth if they don't get reimbursed for it."
Yet some of the nation's biggest insurers have already stopped waiving telehealth deductibles and copays for some customers, even though there's no clear end in sight for the pandemic.
The long-term solution, Doerfler said, is for CMS to start paying for telehealth services, at parity, up and down the chain, and passing federal legislation that requires self-insured health care plans to pay for telehealth services as they would in-person visits.
Telehealth is proven to work for urgent care, primary care and some specialty care, and it clearly expands access to behavioral health care, according to Doerfler. "Some have said that costs of providing telehealth are lower than face-to-face care, but most of the costs are unchanged, and new ones are added with technology requirements. When the patient receives a very specific service there are billing codes used to define that service. If the service is less, the code represents that. If the service is the same, the code will represent that and needs to be paid at parity."
Doerfler added that, while telehealth can't replace all traditional health care services, it should be "in the toolbox" for patients and physicians.
"In the modern world, where this type of technology is being used for all sorts of personal and business uses, excluding something as personal as your care between you and your doctor from fitting into that modern paradigm makes no sense," Doerfler said.
This storm rained electrons, shifted energy from the sun's rays to the magnetosphere, and went unnoticed for a long time.
- An international team of scientists has confirmed the existence of a "space hurricane" seven years ago.
- The storm formed in the magnetosphere above the North magnetic pole.
- The storm posed to risk to life on Earth, though it might have interfered with some electronics.
What do you call that kind of storm when it forms over the Arctic ocean?<iframe width="730" height="430" src="https://www.youtube.com/embed/8GqnzBJkWcw" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> Many objects in space, like Earth, the Sun, most of the planets, and even some large moons, have magnetic fields. The area around these objects which is affected by these fields is known as the magnetosphere.</p><p>For us Earthlings, the magnetosphere is what protects us from the most intense cosmic radiation and keeps the solar wind from affecting our atmosphere. When charged particles interact with it, we see the aurora. Its fluctuations lead to changes in what is known as "space weather," which can impact electronics. </p><p>This "space hurricane," as the scientists are calling it, was formed by the interactions between Earth's magnetosphere and the <a href="https://en.wikipedia.org/wiki/Interplanetary_magnetic_field" target="_blank" rel="noopener noreferrer">interplanetary magnetic field,</a> the part of the sun's magnetosphere that goes out into the solar system. It took on the familiar shape of a cyclone as it followed magnetic fields. For example, the study's authors note that the numerous arms traced out the "footprints of the reconnected magnetic field lines." It rotated counter-clockwise with a speed of nearly 7,000 feet per second. The eye, of course, was still and <a href="https://www.sciencealert.com/for-the-first-time-a-plasma-hurricane-has-been-detected-in-space" target="_blank" rel="noopener noreferrer">calm</a>.</p><p>The storm, which was invisible to the naked eye, rained electrons and shifted energy from space into the ionosphere. It seems as though such a thing can only form under calm situations when large amounts of energy are moving between the solar wind and the upper <a href="https://www.reading.ac.uk/news-and-events/releases/PR854520.aspx" target="_blank">atmosphere</a>. These conditions were modeled by the scientists using 3-D <a href="https://www.nature.com/articles/s41467-021-21459-y#Sec10" target="_blank">imaging</a>.<br><br>Co-author Larry Lyons of UCLA explained the process of putting the data together to form the models to <a href="https://www.nbcnews.com/science/space/space-hurricane-rained-electrons-observed-first-time-rcna328" target="_blank">NBC</a>:<br><br>"We had various instruments measuring various things at different times, so it wasn't like we took a big picture and could see it. The really fun thing about this type of work is that we had to piece together bits of information and put together the whole picture."<br><br>He further mentioned that these findings were completely unexpected and that nobody that even theorized a thing like this could exist. <br></p><p>While this storm wasn't a threat to any life on Earth, a storm like this could have noticeable effects on space weather. This study suggests that this could have several effects, including "increased satellite drag, disturbances in High Frequency (HF) radio communications, and increased errors in over-the-horizon radar location, satellite navigation, and communication systems."</p><p>The authors <a href="https://www.nature.com/articles/s41467-021-21459-y#Sec8" target="_blank" rel="noopener noreferrer">speculate</a> that these "space hurricanes" could also exist in the magnetospheres of other planets.</p><p>Lead author Professor Qing-He Zhang of Shandong University discussed how these findings will influence our understanding of the magnetosphere and its changes with <a href="https://www.eurekalert.org/pub_releases/2021-03/uor-sho030221.php" target="_blank" rel="noopener noreferrer">EurekaAlert</a>:</p><p>"This study suggests that there are still existing local intense geomagnetic disturbance and energy depositions which is comparable to that during super storms. This will update our understanding of the solar wind-magnetosphere-ionosphere coupling process under extremely quiet geomagnetic conditions."</p>
The chariot survived ancient eruptions and modern-day looters to become a part of the world heritage site.
- Archeologists recently discovered a first-of-its-kind chariot in Pompeii.
- The ceremonial chariot is decorated with bronze and tin medallions, while the sides sport bronzesheets and red-and-black paintings.
- Given looting activity in the area, it's lucky the 2,000-year-old treasure wasn't lost to the world heritage site.
One dope Pompeian whip<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTcxOTUzNS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY2MjU3Nzk5MH0.M3HW5tPe17JuKMhLtKgbOlqK4sMbspqYskR_jz6t9sg/img.jpg?width=1245&coordinates=0%2C70%2C0%2C230&height=700" id="497f9" class="rm-shortcode" data-rm-shortcode-id="1bda1a9c489b85c8a56c189eb21706d1" data-rm-shortcode-name="rebelmouse-image" data-width="1245" data-height="700" />
Researchers carefully extract the chariot from the sedimentary rock encasing it.
(Photo: Archaeological Park of Pompeii)<p>In a recent discovery, researchers unearthed a first-of-its-kind chariot at Civita Giuliana, an excavation site north of Pompeii's ancient walls. In Roman times, the site served as a getaway for Rome's elite and wealthy citizens, a serene countryside brimming with villas and Mediterranean farms. So, it's understandable why such an exquisite chariot was found here.</p><p>"I was astounded," Eric Poehler, a professor at the University of Massachusetts Amherst, who specializes in Pompeii traffic, <a href="https://www.npr.org/2021/02/27/972118983/a-lamborghini-of-chariots-is-discovered-at-pompeii-archaeologists-are-wowed?ft=nprml&f=1001" target="_blank">told <em>NPR</em></a>. "Many of the vehicles I'd written about before ... are your standard station wagon or vehicle for taking the kids to soccer. This is a Lamborghini. This is an outright fancy, fancy car."</p><p>Located in a double-level portico, the chariot is a far cry from anything Ben-Hur would have been seen cruising around in. It sports four iron wheels and a high seat complete with arm- and backrest. The sides are adorned with engraved bronze and wooden panels painted with red-and-black figures. And the rear bumps with a register of bronze and tin medallion depicting Eros-inspired scenes of satyrs, nymphs, and cupids. In short, this chariot is slab.</p><p>"It is an extraordinary discovery for the advancement of our knowledge of the ancient world," Massimo Osanna, the director of the archaeological park, <a href="http://pompeiisites.org/en/comunicati/the-four-wheeled-processional-chariot-the-last-discovery-of-pompeii/" target="_blank" rel="noopener noreferrer">said in a statement</a>. "At Pompeii vehicles used for transport have been found in the past, […] but nothing like the Civita Giuliana chariot."</p><p>But unlike a Lamborghini—which serves only to show the owner has more money than sense—this chariot served a social and cultural role. Likely a <em>pilentum</em>, it would have been rolled out in times of ceremony, potentially during festivals, processions, or weddings.</p><p>While similar chariots have been uncovered in northern Greece, this is the first such chariot to be discovered in Italy. Its presence in Pompeii will further help historians understand the people who called the city home, as well as their relation to the Mediterranean world.</p><p>As Poehler added, "This is precisely the kind of find that one wants to find at Pompeii, the really well-articulated, very well-preserved moments in time. And it happens to be in this case an object that is relatively rare despite its ubiquity in the past."</p>
It belongs in a museum (not the black market)<p>Beyond its gilded appeal, the chariot is also special because it survived so we could learn from it. The area where the vehicle was found has been favored in recent years by looters, and illicit tunnels had been dug precariously close to the chariot's resting place. For this reason, the archeological park has teamed up with the Public Prosecutor's Office of Torre Annunziata to protect Pompeii's history and excavate its treasures before they become lost or stolen.</p><p>"The collaboration between the Public Prosecutor's Office of Torre Annunziata and the Archaeological Park of Pompeii has proved itself to be a formidable instrument, not only for bringing finds of exceptional historical and artistic value to light, but also for halting the criminal actions of individuals who for years have been the protagonists in a systematic looting of the priceless archaeological heritage preserved in the vast area of the Civita Giuliana villa, which is still largely buried and to which the recent exceptional findings bear witness," Nunzio Fragliasso, chief prosecutor of Torre Annunziata, said in his joint statement with Osanna.</p><p>Nor is everything that glitters historic gold. Even Pompeii's everyday ephemera can have an outsized impact on history. Pompeian citizens, for example, viewed street walls as a type of "<a href="https://www.thegreatcoursesdaily.com/how-pompeii-graffiti-preserved-the-ordinary-voices-of-ancient-rome/" target="_blank">public advertisement space</a>" and so painted them thick with graffiti. As historians must often rely on the written works of the literate elite, this graffiti gives the ordinary Pompeians their voice back. <a href="https://www.sciencemag.org/news/2018/10/ancient-graffiti-shifts-date-pompeii-s-destruction-back-2-months" target="_blank" rel="noopener noreferrer">One such charcoal tag</a> even corrected the record of Vesuvius's eruption by two months, from August to October, contradicting the traditionally accepted date set by Pliny the Younger.</p><p>"Today, archaeologists try to understand ancient societies by studying the entire material record -- not just the beautiful or luxurious objects, but also the broken bits of cooking pottery, the animal bones thrown into the trash, the microscopic grains of pollen in the soil, and much more," Caitlín Barrett, associate professor at Cornell University, <a href="https://www.cnn.com/travel/article/pompeii-new-excavations-looting/index.html" target="_blank" rel="noopener noreferrer">told <em>CNN</em></a>.</p><p>This ephemera is also at risk. Looters looking for eye-catching treasure and artwork will often destroy everyday objects in their pursuit. And after centuries encased in protective sedimentary rock, the city has again been exposed to the rains, winds, and human blunders that erode. The goal now isn't just to excavate fantastic treasures, but to preserve the world heritage site and learn from it for as long as time (<a href="http://volcano.oregonstate.edu/what%E2%80%99s-most-recent-eruption-vesuvius-and-will-it-erupt-again" target="_blank" rel="noopener noreferrer">and maybe Vesuvius</a>) will allow.</p>
New study suggests the placebo effect can be as powerful as microdosing LSD.
- New research from Imperial College London investigated the psychological effects of microdosing LSD in 191 volunteers.
- While microdosers experienced beneficial mental health effects, the placebo group performed statistically similar to those who took LSD.
- Researchers believe the expectation of a trip could produce some of the same sensations as actually ingesting psychedelics.
Psychedelics: The scientific renaissance of mind-altering drugs | Sam Harris, Michael Pollan & more<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="92360c805fe66c11de38a75b0967f417"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/5T0LmbWROKY?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Published in <em>eLife</em>, the team recruited 191 citizen cosmonauts to microdose either LSD or a placebo over the course of several weeks and note the psychological effects. Volunteers were already microdosing LSD, so there was no true control. Each volunteer was given instructions on creating their own low-dose gel capsules, some containing LSD, others not. Then they mixed the capsules in envelopes so they didn't know if they were taking the real thing or not.</p><p>The trial design was ingenious: each capsule featured a QR code that was scanned after the addition of ingredients but before they were placed in the envelope so that researchers knew what they were ingesting.</p><p>The problem: volunteers sourced their own LSD. Lack of quality control could have had a profound effect on the results. </p><p>The results: LSD microdosers reported feeling more mindful, satisfied with life, and better overall; they also noticed a reduction in feelings of paranoia. </p><p>The catch: the control group felt the same thing, with no statistical difference between the groups. </p><p>Lead author Balázs Szigeti comments on the findings: "This suggests that the improvements may not be due to the pharmacological action of the drug but can instead be explained by the placebo effect." </p>
Photo: Alexander / Adobe Stock<p>Psychedelics are notoriously difficult to control for given the intensity of the experience. Yet there is precedent for the above findings. A <a href="https://link.springer.com/article/10.1007/s00213-020-05464-5" target="_blank">2019 study</a> found that 61 percent of volunteers that took a placebo instead of psilocybin felt some psychedelic effects, with a few volunteers experiencing full-on trips.</p><p style="margin-left: 20px;">"Several stated that they saw the paintings on the walls 'move' or 'reshape' themselves, others felt 'heavy. . . as if gravity [had] a stronger hold', and one had a 'come down' before another 'wave' hit her."</p><p>The Imperial team believes the expectation of a trip might have been enough to produce similar results. Senior author David Erritzoe is excited for future studies on the topic, believing they tapped into a new wave of citizen science that could push forward our knowledge of psychedelic substances.</p><p style="margin-left: 20px;">"Accounting for the placebo effect is important when assessing trends such as the use of cannabidiol oils, fad diets or supplements where social pressure or users' expectations can lead to a strong placebo response. Self-blinding citizen science initiatives could be used as an inexpensive, initial screening tool before launching expensive clinical studies."</p><p>As investments into the psychedelics market explode, with one company <a href="https://www.bloomberg.com/news/articles/2021-03-03/thiel-backed-magic-mushroom-firm-atai-hits-2-billion-valuation" target="_blank">reaching a $2 billion valuation</a>, a recurring irony appears in the long arc of psychedelics and research: the power of our minds might be enough to feel greater life satisfaction and a deeper sense of mindfulness. If that's possible with a placebo, we have to question why the rush to create more pharmacology is necessary. </p><p>This is, mind you, a separate conversation over the role of psychedelics and rituals for group bonding. The function of group cohesion around consciousness-altering substances will continue to play an important role in many communities. </p><p>Of course, we should continue to explore the efficacy of psychedelics on anxiety, depression, suicidal ideation, PTSD, and addiction. <a href="https://bigthink.com/surprising-science/antidepressant-effects" target="_self">Pharmacological dependence</a> is a stain on the psychiatry industry. Whether or not psychedelics can be prescribed for daily use remains to be seen, but we know a moneyed interest is expecting a return on investment—the above company, ATAI Life Sciences, raised $157 million in its Series D round. </p><p>When it comes to wellbeing, some things money just can't buy. How we navigate the tricky terrain of mainstreaming psychedelics remains to be seen. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank" rel="noopener noreferrer">Facebook</a>. His most recent book is</em> "<em><a href="https://www.amazon.com/gp/product/B08KRVMP2M?pf_rd_r=MDJW43337675SZ0X00FH&pf_rd_p=edaba0ee-c2fe-4124-9f5d-b31d6b1bfbee" target="_blank" rel="noopener noreferrer">Hero's Dose: The Case For Psychedelics in Ritual and Therapy</a>."</em></p>
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