Running a Health Care System: As Natural As Mother’s Milk?

Posted on | April 9, 2019 | Comments Off on Running a Health Care System: As Natural As Mother’s Milk?

Mike Magee

The latest recorded U.S. birth rate dropped for the second year in a row, down 3% from the prior year. In 2017, there were just under 4 million births, 500,000 fewer than in 2007. Even though there has been a 7% increase in women 20 to 39, women are delaying child birth. Over the past 10 years, women in their 30’s are now having more babies than women in their 20’s.

If you look at US health care outcomes, women can hardly be criticized for being cautious. Moms giving birth in the U.S. are three times as likely to die in the process as moms in Canada or the U.K. But that’s not the worst of it. For every woman who does die, 70 more (an estimated 50,000 moms) come close to dying.

The Obama administration recognized that lack of access to health insurance was a large factor, and targeted women for coverage. As a result, uninsured women under age 65 dropped from 20% to 11% overall, and for poor women uninsured declined from 34% to 18%.

For all interested in national health reform in the U.S., the measures of maternal-fetal health, safety, and care should be ground zero. That our performance – in 3rd world ratings for morbidity and mortality of both mothers and children – reflects the total absence of a national health plan let alone a national health system should be a national scandal.

We fail on every measure, even those most believe are our strong suits – like medical research. Case in point: Is the breast milk we’re feeding our children safe? This is the question raised in a New England Journal of Medicine article this week. It notes that 8 in 10 American women breast feed (at in least in part) during the first six months of their children’s lives. But we also know that over half (over 1.5 million lactating women) take one or more prescription drugs during that period. And these mothers often ask, is the milk safe?

You would think their doctors would know, but they don’t. After two decades of badgering, in 2006, the National Library of Medicine created a voluntary database called LactMed. Twelve years later, in 2018, there were 1408 products in the database. But only 2% had strong, evidence based data to support conclusions of safety.

This was consistent with an FDA analysis of 575 drugs in 2018 which included data on human lactation in only 15%. Research on breast-feeding, lactation, and breast milk garnered only .3% of the NIH budget in 2017. If you want to rise quickly in academic medicine, cancer or diabetes research if a far more lucrative and productive pathway.

But what if you’re a new mom trying to do right by your baby, and you’re on anti-hypertensive meds, is that OK? We don’t know. How about if you’re having trouble getting your milk to come in, and your doctor tells you to take the GI drug, metoclopramide, said to have an off-label benefit of increasing milk supply. Is that safe for your baby? We don’t know.

Bottom line is, when it comes to running a health care system, our priorities are all screwed up. And as health industry profiteers pursue their wildest genomic dreams, moms are left to wonder why they always seem to get the short end of the stick. I mean really – Is this any way to run a health care system?