2018: A year in review in health policy

The holiday season is filled with both nostalgia and foresight – we look back at the year that was and await the start of a new beginning. We ethics and policy wonks are no different.

This year challenged us to think differently about the interplay between providers and patients and technology and data. It posed questions about enhancement vs. treatment, regulation vs. free will, and how we integrate technology into our lives.

Before we close the books on 2018, let’s reflect on the various stories that had the greatest health policy impact ranked by our faculty and staff.

1. A new chapter of gene-editing: CRISPR-Cas9 has continued to gain popularity and this year was taken to new heights with the first gene-edited baby and a growing community of biohackers who attempted to re-engineer DNA. Society is in an uproar about these developments and it’s likely we’ll see more efforts in 2019 to regulate gene-editing, especially in human embryos.

2. #ThisIsOurLane: A tweet from the NRA caused a viral response from healthcare professionals who shared their stories, photos and policy perspectives. We anticipate more funding, partnerships, research and policies focused on gun control in 2019.

3. Addressing addiction: Overdose deaths are at a record high. With a heighted awareness about the ethics of prescribing painkillers, new legislation and charities stepping in, we’re hopeful 2019 will bring new approaches to effectively tackle the opioid epidemic.

4. Right-to-Try bill becomes law: The controversial right-to-try bill allowing terminally ill patients to seek access to experimental medicine was signed into law, though not yet fully approved by the FDA. The law dramatically expands the scope of the existing compassionate use program, yet many argue it’s poorly imagined and a danger to patients.

5. The explosion of at-home genetic testing: Direct-to-consumer genetic testing has gone mainstream and this year, its impact became even clearer. It’s changing how law enforcement catches criminals, the physician-patient dialogue and the modern definition of family.

6. Immigration and health: A proposal to strengthen the “public charge” rule would make it harder for legal immigrants to get green cards. This proposal could change the face of legal immigration, and impact public health and the healthcare system at large. It’s also important that we focus not only on what is being proposed, but also how such issues are discussed.

7. #MeToo in medicine: Gender inequalities were brought to the forefront with articles spotlighting unfair treatment in hospitals and operating rooms, “healthcare gaslighting” and the life or death crisis of America’s black mothers and babies. Coupled with an election year dubbed, “The Year of the Woman,” we anticipate seeing more legislation, policies and interventions to address these issues.

8. AI, big data and health: The connection between the tech industry and healthcare was actualized in 2018 with Alphabet, Amazon, Apple, and Microsoft entering the space. The role of artificial intelligence will continue to evolve and influence patient care, privacy policies and costs.

9. Vaccines and re-emerging diseases: In the news, we saw anti-vaccine hot spots on the rise , reports that more children aren’t receiving vaccines from their doctors, and the rise of neglected tropical diseases. As surveillance expands, there will be more data about disease control and prevention; but also there’s an increasingly likelihood of additional outbreaks without stronger advocacy and regulations.

10. Limiting tobacco availability: We saw the explosion of vaping among our youth coupled with sweeping anti-tobacco legislation from the FDA. Will we see these types of polices studied more and subsequent copycat legislation, similar to what we’ve seen with soda or alcohol?
    

11. Midterm mania: Health care took center stage this election. With a divided Congress, it is likely key issues like the Affordable Care Act and Medicaid expansion will be a focus in 2019.

12. Spotlighting mental health: The Centers for Medicare and Medicaid Services introduced expanded mental health treatment opportunities for states, scientists took a step toward building a computer model of the brain’s genome, and psychiatric advanced directives became more popular. The importance of neuroethics will continue to grow as we are able to interface and understand our brains with machinery in completely new ways.

13. Trust in medicine: Healthcare headlines continued to highlight the distrust of providers, scientists, and healthcare agencies. Expect 2019 to include more rigorous disclosure policies and efforts to improve transparency.

14. New orientation of the Supreme Court: Changes on the highest court in the land may have important effects on healthcare cases.

15. Re-evaluating physician-assisted suicide (PAS): The AMA revisited its policy, ultimately leaving it intact, declaring PAS “fundamentally incompatible with the physician’s role as healer.” On the contrary, AAFP opted for a “neutral position” regarding whether individual states should allow medical aid in dying; and a California court reinstated doctor-assisted suicide. As boomers continue to age, might we see more states legalizing euthanasia?

And that’s a wrap! We hope you’ll continue reading PolicyWise in 2019 to see how these stories evolve and get our perspective on what the future holds. Happy New Year!

 -By Clarice Jacobson, health policy and communications program manager in the Center for Medical Ethics and Health Policy at Baylor College of Medicine