Govind Persad

Now up at Health Affairs Forefront, Kristi Martin and I analyze the drugs selected for the 2028 cycle of the Medicare drug price negotiation program. We focus on what will be new this cycle, but also what didn't (but could have) happened this year. www.healthaffairs.org/content/fore...

Fair Allocation of GLP-1 and Dual GLP-1–GIP Receptor Agonists | NEJM A shortage of GLP-1 receptor agonists and other drugs raises questions about how limited supplies should be allocated. A proposed framework could guide governments, professional societies, and ...

"Fair Allocation of GLP-1 and Dual GLP-1–GIP Receptor Agonists" is now out in NEJM (w/Zeke Emanuel, Johan Dellgren, Matt McCoy).

We propose a #bioethics framework to guide gov'ts, professional societies, & docs in allocation choices about drugs like semaglutide (Ozempic/Wegovy) when demand > supply

www.wsj.com/articles/for...

See if this is unlocked and works

Cities with soda taxes saw sales of sugary drinks fall as prices rose, study finds Soda taxes are meant to discourage people from drinking too much sugar, which is linked to a host of bad health outcomes. Cities that imposed the taxes saw a 33% decrease in the sale of sugary drinks.

Last, while trade-offs in drug spending are inevitable, a creative strategy--#Pigouvian taxes--could lessen their sharpness

States could raise revenues for covering GLP-1s, while mitigating the need for them, by taxing sodas and other obesogenic foods

Value-Based Pricing of Prescription Drugs Benefits Patients and Promotes Innovation Value-based pricing aligns prescription drug prices to their clinical benefits, leading to lower spending and better health outcomes.

Instead, we must honestly and fairly consider trade-offs.

States need to compare drugs- including across different medical conditions- based on value, not just refuse to cover later-arriving drugs like GLP-1s

Value comparisons can help negotiate prices & create incentives for effective drugs

4/5

The much-maligned ‘quality-adjusted life year’ is a vital tool for health care policy A new bill that would ban government use of quality-adjusted life years is misguided.

Would the House's proposed ban on cost-effectiveness analysis (CEA) techniques improve GLP-1 access?

No. It will make things worse.

CEA bans make refusals to cover GLP-1s, like NC’s, that only consider cost & unethically ignore value for money more likely, not less

#bioethics

3/5

Hepatitis C can be cured. So why aren't more people getting treatment? A new CDC report finds that just a third of those diagnosed with hepatitis C have cleared the virus — a decade after a cure was made available.

Blanket refusal to cover GLP-1s for obesity is wrong because GLP-1s are more cost-effective than many other drugs North Carolina covers.

States made the same mistake when they initially refused to pay for new Hepatitis C drugs

2/5

Opinion | For Obese Patients, Wegovy Is Worth the Cost North Carolina is wrong to deny coverage. Breakthrough treatments curb additional health risks.

North Carolina & other health systems are being unethical when they categorically refuse to cover GLP-1 receptor agonists (e.g. Ozempic, Mounjaro) for obesity.

So I & Zeke Emanuel argue in our Wall Street Journal op-ed.

I highlight some of our points below in replies

#bioethics

I mostly know ethics/political ones: Crooked Timber, PEA Soup, and lots of defunct ones (Public Reason, Ethics Etc, my personal fave Left2Right).

I was so looking forward to posting to Public Reason when I finished my PhD, but instead we just have social media

This piece made me think about how structural problems with fragmentation of support programs exacerbate disadvantage, even though the piece sometimes took a frustratingly “blame the hospital” lens.

Would’ve loved to hear more in the piece about reforms that would help undo this fragmentation

…of a paper that determines my judgement of the paper. But the assumptions and starting points of the argument should be reasonable to anyone. In that sense I can offer a fair review of a paper even if the conclusion is something that I deeply disagree with.

No, I think value judgements are inevitable, even in the sciences ppl make (epistemic) value judgements all the time - though often implicitly. On top of that It seems impossible to do (and review in) ethics in a morally neutral way. But it should not be my own moral perspective on the conclusion…

Venture capital fund defends grants for Black women in US appeals court A venture capital fund on Wednesday urged a U.S. appeals court to allow it to resume a grant program that awards funding to businesses run by Black women and reject an anti-affirmative action group's claim that it discriminates based on race.

Some of the litigation I discuss that challenges consideration of race in health grantmaking is patterned on litigation against non-health grantmakers (e.g. Atlanta's Fearless Fund) being brought by the same organization and attorneys that litigated the Harvard/UNC affirmative action cases

Suit challenges required minority appointments to Louisiana medical licensing board A law requiring that some members appointed to the board that licenses and regulates physicians in Louisiana be from minority groups is being challenged in federal court.

Litigation has targeted consideration of individuals’ race in:

-grants to health trainees www.ualrpublicradio.org/local-region...

- physician recruitment litigationtracker.law.georgetown.edu/litigation/d...

-medical board composition litigationtracker.law.georgetown.edu/litigation/d...

Antiracist Medicine in Colorblind Courts This Article considers how health professionals' efforts to combat racial health inequities interact with legal restrictions constraining their ability to consider race. In light of the Roberts Court's recent invalidation of two university admissions programs, intensifying a "colorblind" judicial shift, the collision between antiracist medicine and colorblind law is a pressing concern. This Article anticipates the implications of this collision and explores how health professionals and systems can design programs that survive judicial examination. In Part I, the Article examines the frameworks that will apply if antiracist medicine faces legal challenges. These include the Equal Protection Clause and federal statutes like Title VI and Section 1981. Part II systematically outlines three reasons why medicine might consider race: the enhancement of individual and population health through beneficent consideration . . .

Revised draft of “Antiracist Medicine in Colorblind Courts,” forthcoming in the Michigan Law Review papers.ssrn.com/sol3/papers....

Added material on new §1981, §1557, & Equal Protection litigation against health & other programs that consider individuals’ race

New TX & UT laws are also discussed

Congress’s Misguided Plan to Ban QALYs This Viewpoint discusses the flawed assumptions and potential negative impacts of a proposed federal bill that would ban government health care programs from us

Leah Rand & @akesselheim.bsky.social have a couple of nice papers explaining the problems with QALY bans and evaluating ethical critiques of cost-effectiveness analysis:

"Congress’ Misguided Plan to Ban QALYs" (JAMA)

Review of ethical critiques of QALYs: www.healthaffairs.org/doi/abs/10.1...

QALYs are an imperfect measure of the value of a drug

But often (certainly w/Congress' QALY ban) critics aren't suggesting a better alternative--they want the US, unlike everywhere else, to pay for drugs without measuring or comparing their value

Result: no accountability for pharma, just $$$

What Makes American Healthcare (Un)affordable? | University of Denver University of Denver

Thanks to the University of Denver's #RadioEd podcast for featuring my research on healthcare affordability!

I analyze health affordability in depth in my "Defining Health Affordability," published (open access) in the Iowa Law Review: ilr.law.uiowa.edu/volume-109-i...

#healthlaw #bioethics

I was today years old when I learned that Philippa Foot (of trolley problem/virtue ethics fame) was Grover Cleveland’s granddaughter

Just listened to interesting Philosophy Bites on transformative experience. Do people really think decisions about whether to become a parent are arational, as opposed to just characterized by imperfect info & value change?

Imperfect info, likelihood of change in values ≠ arationality.

I listened to your episode over the holidays! Really enjoyed hearing more about ways of measuring potential benefits of #IRB .

The Biounethical podcast with Sophie Gibert & @leahpierson.bsky.social has been great listening material for my New Year’s resolution to walk more.

Just finished episode w/Danielle Allen on #bioethics & public participation & now in the middle of one with Jeff Sebo on the circle of moral concern

Is Vaccination Approaching a Dangerous Tipping Point? This Viewpoint discusses declining vaccination rates in the US, specifically against COVID-19, and the ways in which clinicians and the Food and Drug Administra

I appreciated Robert Califf & Peter Marks at FDA writing on undervaccination and dangers to population immunity

But surprised to see not one mention of politics or partisanship as a cause of undervaccination. Curious if they can't say it, or if they don't think it's a cause.

Friday Fave #6: David DeGrazia, Moral Status as a Matter of Degree? Southern J. Phil. 2008

"Many people hold views implying that sentient animals have moral status but less than that of persons. These positions suggest that moral status admits of degrees. Does it?"

TIL: some believe that if research participants respond regularly & at a high rate to text-message surveys because of:

- a motivation to improve the quality of the research output
- a desire to be thought well of by the researchers

this might be . . . ethically concerning coercion

Friday Fave #5(?): Peter Ubel & George Loewenstein, Distributing scarce livers: the moral reasoning of the general public, Soc. Sci. & Med., 1996, www.cmu.edu/dietrich/sds...

"Many people in the general public are interested in goals other than merely maximizing measurable health outcomes..."

Friday Fave #1: Amy Gutmann, For and against equal access to health care, Milbank Qtrly, 1981

"We need to find some principle or procedure by which to draw a line at an appropriate level of access to health care short of what is socially and technologically possible..."

As a fun post-tenure thing, I'm going to try to post favorite health law/policy/bioethics articles on Fridays. Not always ones I perfectly agree with, but ones I've gotten something from.

Rules:
- Before 2018
- Ideally, not already super famous
- Not hard-paywalled

Antiracist Medicine in Colorblind Courts Michigan Law Review, Forthcoming 53 Pages Posted: 16 Aug 2023 Govind Persad University of Denver Sturm College of Law Date Written: August 3, 2023 Abstract This Article considers how health professionals’ efforts to combat racial health inequities must navigate legal constraints on their ability to consider race. In light of the Roberts Court’s recent invalidation of two university admissions programs, intensifying a “colorblind” judicial shift, the collision between antiracist medicine and colorblind law is a pressing concern. It seeks to anticipate the implications of this collision and explore how health professionals and systems can design programs that survive judicial examination. In Part I, the Article examines the frameworks that will apply if antiracist medicine faces legal challenges. These include the Equal Protection Clause, federal statutes like Title VI and Section 1981, and state law provisions.

Curious (or worried) about how #SCOTUS affirmative action decisions may hamper antiracist efforts in medicine?

Happy to share that “Antiracist Medicine in Colorblind Courts” is forthcoming in the Michigan Law Review.
Comments welcome!

Draft: https://tinyurl.com/AntiracistMedicine
Abstract ⬇

[crossposting]

I am pleased to share that I’m now (as of Aug. 1) Associate Professor with Tenure at the University of Denver Sturm College of Law.

. I’m grateful to the external and internal mentors who supported me through this process, to all my collaborators, and to the outside reviewers.