DETROIT (AP) — Dr. Starling Tolliver knew she wanted to become a doctor. Yet, as a Black girl growing up in Akron, Ohio, it was a dream that felt out of reach.

She rarely saw doctors who looked like her. As a child, she experienced severe hair loss, and struggled to find a dermatologist who could help.

Tolliver made a pact with two childhood best friends to become doctors who would care for Black and underserved communities like their own. Now 30, she is in her final year of dermatology residency at Wayne State University in Detroit.

She plans to spend her career caring for the body’s largest organ, where differences in melanin give humans the skin colors underpinning the construct of race. In dermatology, only 3% of U.S. doctors are Black.

Despite her success, the girls’ pact remains unfulfilled. While her friend Charmaine became a nurse, Maria, who wanted to become a pediatrician, was killed in their hometown at the age of 19.

Her friend’s death only strengthened her resolve.

“I’m going to continue to go on this path of medicine,” Tolliver said. “Not only for myself, but for Maria, and to potentially help others in the future from similar backgrounds as mine know that they can do it as well.”

But more than two months after the Supreme Court struck down affirmative action in college admissions, concerns have arisen that a path into medicine may become much harder for students of color. Heightening the alarm: the medical field’s reckoning with longstanding health inequities.

Black Americans represent 13% of the U.S. population, yet just 6% of U.S. physicians are Black. Increasing representation among doctors is one solution experts believe could help disrupt health inequities.

The disparities stretch from birth to death, often beginning before Black babies take their first breath, a recent Associated Press series showed. Over and over, patients said their concerns were brushed aside or ignored, in part because of unchecked bias and racism within the medical system and a lack of representative care.

A UCLA study found the percentage of Black doctors had increased just 4% from 1900 to 2018.

But the affirmative action ruling dealt a “serious blow” to the medical field’s goals of improving that figure, the American Medical Association said, by prohibiting medical schools from considering race among many factors in admissions. The ruling, the AMA said, “will reverse gains made in the battle against health inequities.”

The consequences could affect Black health for generations to come, said Dr. Uché Blackstock, a New York emergency room physician and author of “LEGACY: A Black Physician Reckons with Racism in Medicine.”

“It’s really about holding these larger organizations, institutions accountable and saying: ‘Right now, we’re in a crisis — a crisis of humanity,’” Blackstock said.

With affirmative action off the table at predominantly white institutions, historically Black colleges and universities may see an increase in applications, said Dr. Valerie Montgomery Rice, president and CEO of Morehouse School of Medicine in Atlanta.

The college, which typically has 115 openings for new medical students, receives between 7,000 and 9,000 applications per year, a number Rice said she believes will increase in light of the Supreme Court ruling. HBCUs have long served as a direct pipeline of Black doctors.

Experts say diversity is especially needed within specialty medicine. In dermatology, just 65 of the 796 applicants for residencies in 2020 were Black, data from the Association of American Medical Colleges shows. Only 39 were Latino.

For a field focusing on the skin, the unequal access among patients of color is stark: Patients of color are half as likely as white patients to see a dermatologist for the same conditions.

The consequences can be devastating.

“The skin is a window to the rest of your health,” said Dr. Ginette Okoye, professor and chair of dermatology at Howard University, who is a programming lead for the American Academy of Dermatology’s Pathways program.

“If you have kidney disease, if you have cancer, sometimes those clues show up on the skin first. We are able to preemptively diagnose cancer sometimes just by the way a specific rash shows up on the skin,” Okoye said. “That’s pretty impactful.”

Black men are more likely to die of melanoma, compared with men of other races, according to a study co-authored last month by dermatologist Dr. Ashley Wysong in the Journal of the American Academy of Dermatology. They also are more likely to be diagnosed at a later stage, when the condition is more difficult to treat. Melanoma is the most invasive and serious form of skin cancer.

The reasons for the different cancer rates are unclear, and more research is needed to understand in particular how economic and social conditions impact the cancer rates, Wysong said. The study found survival rates in men with melanoma were highest among white men, 75%, while the survival rates were lowest among Black men at only 52%.

“As medical professionals, any time we see disparities in care or outcomes of any kind, we have to look at the systems in which we are delivering care and we have to look at ways that we are falling short,” Wysong said.

Without affirmative action as a tool, career programs focused on engaging people of color could grow in importance.

For instance, the Pathways initiative engages students from Black, Latino and Indigenous communities from high school through medical school.

The program starts with building interest in dermatology as a career and continues to scholarships, workshops and mentorship programs. The goal: Increase the number of underrepresented dermatology residents from about 100 in 2022 to 250 by 2027, and grow the share of dermatology faculty who are members of color by 2%.

Tolliver credits her success in becoming a dermatologist in part to a scholarship she received through Ohio State University’s Young Scholars Program, which helps talented, first-generation Ohio students with financial need. The scholarship helped pave the way for medical school, but her involvement in the Pathways residency program also was central.

Azariah Providence, a 17-year-old rising high school senior who lives in the U.S. Virgin Islands, participated in the high school Pathways program last month. She wants to become a dermatologist because of her own scalp psoriasis diagnosis, which is a skin disease causing a rash with itchy, scaly patches.

Her condition hampered her self-esteem as a 9-year-old girl. The dermatologist she saw, one of very few on the island, prescribed medication causing Providence’s skin to burn and her hair to fall out.

“It was a difficult experience because as a little girl, your hair is very important to you,” Providence recalled. “After going through that, I wanted to help little girls who have similar conditions that I have. I want to be that person for them that I didn’t have when I was younger.”

Providence, who would be a first-generation medical student, said the program exposed her to college students and doctors of color, something she had never before seen.

“I think it’s important for more Black people to get into the field of dermatology for the simple reason that some conditions may appear differently on Black skin,” Providence said. “I want to enter the field so that people who look like me can have their skin understood and fully studied so that when they come to get diagnosed, it’s a correct diagnosis and they could get the correct treatment.”

Dermatology also is working to diversify its textbooks to help improve the spectrum of skin colors so doctors can be better equipped to diagnose and provide equitable care, said Dr. Adam Friedman, chair of dermatology at George Washington School of Medicine and Health Sciences in Washington, D.C.

But targeted programs to diversify the pipeline of talent are crucial for the future of medicine, Friedman said.

As Tolliver prepares to leave residency, she hopes to be one of the people pushing for better outcomes, especially for Black women.

“Our patients are looking for us, and that kind of pushed forward my love for this field,” Tolliver said. “And that really has been my goal ongoing from when I was a little girl: for Black women to see the beauty of themselves, within themselves.”

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My years of reporting on the dialysis industry taught me many things. Besides learning more about arcane Medicare regulations than I ever thought possible, I also learned about what it was like to need dialysis. 

Someone with kidney failure, also known as End Stage Renal Disease or ESRD, has strict limits on how much fluid they can drink and the types of food they can eat. They are told when to show up at medical appointments and when to sit in their chairs for their treatments. ESRD patients are also disproportionately from poor and historically marginalized groups, giving them even less of a voice.

While I knew quite a bit about the dialysis industry, I knew less about what it was like to be someone on dialysis. These experiences, I knew, shaped everything about a person’s life, including the challenges they faced and how they communicated with their care team. My project as a 2022 National Fellow at the Center for Health Journalism investigated the practice of involuntary discharge of dialysis patients, in which they were kicked out from their clinics and had to wait until they were at death’s door to receive emergency dialysis at the hospital. I also received a second grant to do community engagement and center the experiences of those with kidney failure.

For my work on the engagement grant, I initially planned on convening several focus groups of patients to learn more about what their concerns were and what they knew about involuntary discharge. Then, after I had completed my reporting, I would help develop a set of worksheets and help guides for patients to help them address involuntary discharge with their treatment team, documents that I would publish online alongside my piece in Mother Jones magazine. This would help guide my reporting as I dove deeper into the issue and would give me the chance to understand involuntary discharge from the perspective of patients. Using several social media groups for dialysis patients, I was able to recruit 15 individuals to participate in two sets of focus groups.

As I continued my reporting and talked with a broader swath of patients, however, I learned that the factors contributing to involuntary discharge were often unique to each individual. And with such different issues at the heart of the phenomenon, I began to realize that cookie-cutter guides weren’t going to be very helpful. As a reporter, I’ve found myself in similar situations before: the story I thought I was going to find ended up being very different from the one that was actually there. Rather than try and force the topic to conform to my project, I would have to adapt my engagement project to fit the needs of the dialysis community.

Working with my mentors at the Center for Health Journalism, we decided instead to create two virtual webinars on the topic of involuntary discharge. I partnered with the Medical Education Institute, which specializes in creating informational materials for dialysis patients and providers. One webinar would be created for patients, to help them learn more about how to communicate with their medical team and what to do if they were being threatened with involuntary discharge. The second webinar was created for dialysis nurses, technicians, and social workers to help them reframe challenging patient behaviors and respond constructively and with more compassion. 

With World Kidney Day on March 9, both webinars were broadcast live that day. The contents are also archived on MEI’s website so they can be rewatched. Both webinars brought in people from across the United States and enabled a wide discussion on the topic.

Being able to pivot my engagement project partway through was a key component of my ultimate success. It’s not always possible to predict what type of events and information will be useful to a community until you go in there and ask. By being flexible, I was able to adapt to the needs of the dialysis community and provide the kind of content that would provide the most benefit.

DISCLAIMER: The opinions, beliefs and viewpoints expressed by the various author’s articles on this Opinion piece or elsewhere online or in the newspaper where we have articles with the header “COLUMN/EDITORIAL & OPINION” do not necessarily reflect the opinions, beliefs and viewpoints or official policies of the Publisher, Editor, Reporters or anybody else in the Staff of the Hemet and San Jacinto Chronicle Newspaper.

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Samuel Lovett | Contributed

Thousands of people unable to work because of the effects of long Covid are feared to be missing out on financial support, with patients struggling to access and apply for the government ’s disability benefits scheme.

More than 300,000 people in the UK have been left with debilitating, persistent symptoms after catching the virus – but figures show only a tiny fraction of these have successfully claimed benefits.

Politicians and campaign groups warn not enough has been done to remove barriers to applying for financial aid.

“A vast number of severely impaired people are simply not getting the help they need and are entitled to,” said Dr Jo House, a spokesperson for Long Covid Support, which has around 50,000 members, the majority of whom are in the UK.

Latest figures show that in January just 937 individuals with the condition had successfully claimed Personal Independence Payment (PIP), which entitles them to up to £150 a week.

But figures for last month show that 322,000 people in the UK were reporting that their ability to undertake day-to-day activities had been limited “a lot” by long Covid, according to the Office for National Statistics. Some 172,000 of these said they had struggled every day for the past 12 months.

Jenny Ceolta-Smith, of Long Covid Support’s employment group, said there were “multiple barriers in place” when applying for the disability benefit.

She said the assessment process failed to take into account the episodic and fluctuating nature of the condition. “They might be able to perform a one-off activity, but then not do so later in the day,” she said.

Ms Ceolta-Smith, who waited eight months to receive PIP after first making a claim in July 2021, said the application process was also complicated by the need to provide medical evidence to support a claim of mental or physical impairment.

“My assessment was via the phone. When I reported having mental health issues, they said I wasn’t receiving treatment or medication for this. But many people have lengthy delays in accessing mental health services, so don’t have the written evidence to support their claim.

“The same applies for fatigue, breathing or other physical conditions related to Covid. If people haven’t been able to visit a long Covid clinic or referred elsewhere, there’s a lack of medical evidence. GPs will have some data, but it’s going to be a challenge.”

Coupled with the extensive paperwork and general poor health of those seeking PIP, the application process “can be very arduous”, Ms Ceolta-Smith added, with many patients “weighing up whether to bother if they’re only going to get rejected”.

Labour’s Jonathan Ashworth, the shadow secretary for work and pensions, said the right to statutory sick pay for long Covid sufferers should be reinstated, adding that the number of people successfully claiming PIP was “just the tip of the iceberg when it comes to those who need financial support to live with the condition”.

The Department for Work and Pensions (DWP) said it was unable to provide a figure for how many people with long Covid had applied for PIP. The number has risen month on month since March 2021, when the benefits scheme first acknowledged the condition as a disability.

PIP provides help with living costs for people with a long-term physical or mental health condition who have difficulty carrying out everyday tasks. The payment can be awarded to these individuals even if they’re continuing to work.

The payment is split into two, providing financial aid for daily living and for mobility-related needs. Depending on the severity of their condition, a long Covid sufferer could receive up to £89.60 for the former and up to £62.55 for the latter, amounting to £152.15 in total. Patients are eligible for assessment if they’ve had persistent symptoms for more than three months.

But since March 2021, just 1,584 people with long Covid have been assessed by the PIP programme. Out of these, 937 are currently receiving benefits, while the remaining 647 are awaiting final clearance from the government, have been rejected, or are appealing against the outcome of their application.

The DWP said award lengths and rates depend on individual circumstances. Payments for other long-term conditions are typically provided for many months, even years.

Layla Moran MP, chair of the all-party parliamentary group on coronavirus , said the low number of successful claimants over the past 12 months “suggests the government is failing to address the impact of long Covid both on people’s health and the UK workforce”.

She called on ministers to “review current financial support available to people who are, as a result [of long Covid], losing their jobs and income”.

The DWP said that the true number of people receiving PIP is likely to be higher than 937. This is because the programme was amended in March 2021 to acknowledge and record long Covid claimants. Before then, awardees suffering from long-term symptoms were classified according to the main disabling condition identified at the time, such as respiratory illness or fatigue, rather than Covid.

A government spokesperson said: “For anyone with a disability or long-term health condition, including long Covid, there is a strong financial safety net, including statutory sick pay, ESA and universal credit.

“PIP is available to people with long-term health conditions or disabilities and is assessed on the basis of someone’s needs and not a diagnosis or condition.”

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NORFOLK, Va. (AP) — COVID-19 hospitalization numbers have plunged to their lowest levels since the early days of the pandemic, offering a much needed break to health care workers and patients alike following the omicron surge.

The number of patients hospitalized with the coronavirus has fallen more than 90% in more than two months, and some hospitals are going days without a single COVID-19 patient in the ICU for the first time since early 2020.

The freed up beds are expected to help U.S. hospitals retain exhausted staff, treat non-COVID-19 patients more quickly and cut down on inflated costs. More family members can visit loved ones. And doctors hope to see a correction to the slide in pediatric visits, yearly checkups and cancer screenings.

“We should all be smiling that the number of people sitting in the hospital right now with COVID, and people in intensive care units with COVID, are at this low point,” said University of South Florida epidemiologist Jason Salemi.

But, he said, the nation “paid a steep price to get to this stage. … A lot of people got sick and a lot of people died.”

Hospitalizations are now at their lowest point since summer 2020, when comprehensive national data first became available. The average number of people hospitalized with COVID-19 in the last week nationwide dropped to 11,860, the lowest since 2020 and a steep decline from the peak of more than 145,000 set in mid-January. The previous low was 12,041 last June, before the delta variant took hold.

The optimistic trend is also clear in ICU patient numbers, which have dipped to fewer than 2,000, according to the U.S. Department of Health and Human Services.

“We’re beginning to be able to take a breath,” said Dr. Jeffrey Weinstein, the patient safety officer for the Kettering Health hospital system in western Ohio.

COVID-19 patients had filled 30% of Kettering Health’s nearly 1,600 hospital beds back in January, Weinstein said. Kettering’s eight hospitals now average two to three COVID-19 admissions a day — and sometimes zero.

And while Salemi agreed this is a good time for an exhausted health care system to take a breath, he warned that the public health community needs to keep an eye on the BA.2 subvariant of omicron. It’s driving increases in hospitalizations in Britain, and is now estimated to make up more than half of U.S. infections.

“We’re probably under-detecting true infections now more than at any other time during the pandemic,” Salemi said.

For now at least, many hospitals are noting the low numbers.

In California on Thursday, UC Davis Health tweeted that its intensive care unit had no COVID-19 patients for two consecutive days for the first time in two years.

“The first COVID-19 patient to arrive in our ICU did so in February 2020, and the unit treated at least one positive individual every day since, for at least 761 consecutive days,” the hospital system said.

Toby Marsh, the chief nursing and patient care services officer, said in a statement that they hope the numbers “are indicative of a sustained change.”

In Philadelphia, patients are spending less time in the Temple University Health System because there are no longer backlogs for MRIs, CT scans and lab tests, said Dr. Tony Reed, the chief medical officer.

Temple Health’s three hospitals had six adult COVID-19 patients on Thursday, likely its lowest patient count since March 2020, Reed said.

During the omicron surge, patients waited as long as 22 hours for a routine MRI, which is normally done within 12 hours. Longer waits affected those who came in with trouble walking — and in a lot of pain — for example, because of a herniated disc pinching their sciatic nerve.

“Nobody wants to stay in the hospital a day longer than they have to,” Reed said.

The emptying of beds is also helping patients in rural areas, said Jay Anderson, the chief operating officer for Ohio State’s Wexner Medical Center in Columbus. During the surges, the hospital faced challenges accepting people from community hospitals who needed elevated care for brain tumors, advanced cancer and stroke. That burden is now being lifted.

Visitors also will return in higher numbers, starting Tuesday. Ohio State will no longer restrict patients to two designated guests, who could only stop by separately.

“Patients heal better when they have access to their family and loved ones,” Anderson said.

Doctors, nurses and respiratory therapists are also getting a much needed break in some areas.

In Colorado, Dr. Michelle Barron said the consistently low COVID-19 hospitalizations prompted smiles among staff, even as she double-checks the numbers to make sure they’re actually correct.

“I had one of these moments like, oh this is amazing,” said Barron, medical director of infection prevention and control at UCHealth University of Colorado Hospital. “It feels unreal.”

UCHealth loosened some restrictions, including dropping testing requirements for anyone who entered a facility. And while that produced some anxiety among staffers, Barron says the numbers haven’t spiked.

“I think some people have started to take vacations and not feel guilty,” she said. “I had spring break with my kids and it was a level of happiness where I went, oh my god, this is actually normal.”

The omicron surge had stretched staff at work — but also at home, said Dr. Mike Hooper, chief medical officer for Sentara Norfolk General Hospital in southeastern Virginia.

“It was stressful to be at the store … to visit your family,” Hooper said. “We’re all hoping that some ‘return to normalcy’ will help people deal with the inherent stresses of being part of the health care team.”

But just because hospitalizations are down does not mean hospitals are empty, said Dr. Frank Johnson, chief medical officer for St. Luke’s Health System in Idaho.

Some measures — like wearing masks in certain settings — will remain in place.

“I don’t know when we may go back to old practices regarding mask wearing in our clinical areas,” Johnson said. “We’ve seen some benefits of that in terms of reduction in the number of other viral infections.”

In the meantime, the public health community is keeping an eye on the BA.2 subvariant of omicron.

Salemi, the University of South Florida epidemiologist, said the increase in at-home testing means that more results are not being included in official coronavirus case counts. Therefore, wastewater surveillance will be the early warning signal to watch, he said.

“BA.2 is here,” he said. “We don’t have to look that far in the rear-view mirror to know things can change very rapidly. We saw what happened with delta. We saw what happened with omicron…. We don’t want to wait until we see a lot of people hospitalized before we take action.”

___

Kruesi reported from Nashville, Tennessee. AP Medical writer Carla K. Johnson in Washington state contributed to this report.

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As the coronavirus takes hold in the United States and front-line health care providers are hard-pressed to treat those who are sick, pharmacy benefit managers (PBMs), along with health insurers, are working to help patients weather the pandemic.

PBMs across the board are helping patients obtain their essential medications, and supporting plan sponsors who want to waive treatment costs associated with COVID-19 care. A number of PBMs are doing more. For example, one PBM and health plan are offering an early intervention screening tool to help customers and members understand their personal risks for COVID-19.

Beyond these efforts, PBMs are collaborating with health plans and pharmacies to remove potential barriers to getting prescriptions filled by people staying at home and social distancing. Specifically, PBMs are encouraging early prescription drug refills, helping patients sign up for home delivery, and adjusting utilization management programs to minimize potential access delays. PBMs are also advising patients to adhere to guidelines issued by the Centers for Disease Control and Prevention.

This global pandemic raises the possibility of prescription drug shortages, as drugs normally used by only a few people may suddenly be needed by many, or manufacturing centers may be sidelined by virus outbreaks. PBMs, along with drug manufacturers, wholesalers and pharmacies, are integral to identifying and managing drug shortages to reduce the prospects of patients being without their prescribed medications. PBMs are closely monitoring the global manufacturing environment and using analytics to gauge patients’ prescription drug usage trends to anticipate possible disruptions to the supply chain. Then, working in concert with others, PBMs are working to help spread the existing drug supply as equitably as possible among patients who need those drugs.

Indeed, it’s vitally important during the public health crisis that all patients continue receiving access to medications, particularly those treating chronic illnesses, such as asthma and rheumatoid arthritis. As the public increasingly demands off-label use of some medications to treat COVID-19, PBMs are implementing measures that balance off-label usage with the ongoing needs of patients using on-label prescriptions for chronic illnesses. Here, for example, is how one PBM approaches this balancing act:

Decades ago, PBMs perfected home delivery of medicines for patients. While the service has always been a convenient and lower-cost option for patients to access their prescription drugs, home delivery has never been as important as it is right now. That’s why PBMs are enhancing home delivery services, as well as working with network pharmacies to provide local delivery options for consumers.

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