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Samaan F, Mendes Á, Carnut L. Privatization and Oligopolies of the Renal Replacement Therapy Sector on Contemporary Capitalism: A Systematic Review and the Brazilian Scenario. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:417-435. [PMID: 38765895 PMCID: PMC11100955 DOI: 10.2147/ceor.s464120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024] Open
Abstract
Worldwide the assistance on renal replacement therapy (RRT) is carried out mainly by private for-profit services and in a market with increase in mergers and acquisitions. The aim of this study was to conduct an integrative systematic review on privatization and oligopolies in the RRT sector in the context of contemporary capitalism. The inclusion criteria were scientific articles without language restrictions and that addressed the themes of oligopoly or privatization of RRT market. Studies published before 1990 were excluded. The exploratory search for publications was carried out on February 13, 2024 on the Virtual Health Library Regional Portal (VHL). Using the step-by-step of PRISMA flowchart, 34 articles were retrieved, of which 31 addressed the RRT sector in the United States and 26 compared for-profit dialysis units or those belonging to large organizations with non-profit or public ones. The main effects of privatization and oligopolies, evaluated by the studies, were: mortality, hospitalization, use of peritoneal dialysis and registration for kidney transplantation. When considering these outcomes, 19 (73%) articles showed worse results in private units or those belonging to large organizations, six (23%) studies were in favor of privatization or oligopolies and one study was neutral (4%). In summary, most of the articles included in this systematic review showed deleterious effects of oligopolization and privatization of the RRT sector on the patients served. Possible explanations for this result could be the presence of conflicts of interest in the RRT sector and the lack of incentive to implement the chronic kidney disease care line. The predominance of articles from a single nation may suggest that few countries have transparent mechanisms to monitor the quality of care and outcomes of patients on chronic dialysis.
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Affiliation(s)
- Farid Samaan
- Planning and Evaluation Group, São Paulo State Health Department, São Paulo, SP, Brazil
- Research Division, Dante Pazzanese Cardiology Institute, São Paulo, SP, Brazil
| | - Áquilas Mendes
- Public Health School, University of São Paulo, São Paulo, SP, Brazil
- Postgraduate Program, Pontifícia Universidade Católica, São Paulo, SP, Brazil
| | - Leonardo Carnut
- Center for the Development of Higher Education in Health, Federal University of São Paulo, São Paulo, SP, Brazil
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Perry T, Bernasek A. Profits over care? An analysis of the relationship between corporate capitalism in the healthcare industry and cancer mortality in the United States. Soc Sci Med 2024; 349:116851. [PMID: 38642520 DOI: 10.1016/j.socscimed.2024.116851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/22/2024]
Abstract
The characteristic features of 21st-century corporate capitalism - monopoly and financialization - are increasingly being recognized by public health scholars as undermining the foundations of human health. While the "vectors" through which this is occurring are well known - poverty, inequality, climate change among others - locating the root cause of this process in the nature and institutions of contemporary capitalism is relatively new. Researchers have been somewhat slow to study the relationship between contemporary capitalism and human health. In this paper, we focus on one of the leading causes of death in the United States; cancer, and empirically estimate the relationship between various measures of financialization and monopoly in the US healthcare system and cancer mortality. The measures we focus on are for the hospital industry, the health insurance industry, and the pharmaceutical industry. Using a fixed effects model with different specifications and control variables, our analysis is at the state level for the years 2012-2019. These variables include data on population demographic controls, social and economic factors, and health behavior and clinical care. We compare Medicaid expansion states with non-Medicaid expansion states to investigate variations in state-level funded health insurance coverage. The results show a statistically significant positive correlation between the HHI index in the individual healthcare market and cancer mortality and the opioid dispensing rate and cancer mortality.
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Affiliation(s)
- Teresa Perry
- California State University- San Bernardino, CA, USA.
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Ku E, McCulloch CE, Bicki A, Lin F, Lopez I, Furth SL, Warady BA, Grimes BA, Amaral S. Association Between Dialysis Facility Ownership and Mortality Risk in Children With Kidney Failure. JAMA Pediatr 2023; 177:1065-1072. [PMID: 37669042 PMCID: PMC10481326 DOI: 10.1001/jamapediatrics.2023.3414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/13/2023] [Indexed: 09/06/2023]
Abstract
Importance In adults, treatment at profit dialysis facilities has been associated with a higher risk of death. Objective To determine whether profit status of dialysis facilities is associated with the risk of death in children with kidney failure treated with dialysis and whether any such association is mediated by differences in access to transplant. Design, Setting, and Participants This retrospective cohort study reviewed US Renal Data System records of 15 359 children who began receiving dialysis for kidney failure between January 1, 2000, and December 31, 2019, in US dialysis facilities. The data analysis was performed between May 2, 2022, and June 15, 2023. Exposure Time-updated profit status of dialysis facilities. Main Outcomes and Measures Adjusted Fine-Gray models were used to determine the association of time-updated profit status of dialysis facilities with risk of death, treating kidney transplant as a competing risk. Cox proportional hazards regression models were also used to determine time-updated profit status with risk of death regardless of transplant status. Results The final cohort included 8465 boys (55.3%) and 6832 girls (44.7%) (median [IQR] age, 12 [3-15] years). During a median follow-up of 1.4 (IQR, 0.6-2.7) years, with censoring at transplant, the incidence of death was higher at profit vs nonprofit facilities (7.03 vs 4.06 per 100 person-years, respectively). Children treated at profit facilities had a 2.07-fold (95% CI, 1.83-2.35) higher risk of death compared with children at nonprofit facilities in adjusted analyses accounting for the competing risk of transplant. When follow-up was extended regardless of transplant status, the risk of death remained higher for children treated in profit facilities (hazard ratio, 1.47; 95% CI, 1.35-1.61). Lower access to transplant in profit facilities mediated 67% of the association between facility profit status and risk of death (95% CI, 45%-100%). Conclusions and Relevance Given the higher risk of death associated with profit dialysis facilities that is partially mediated by lower access to transplant, the study's findings indicate a need to identify root causes and targeted interventions that can improve mortality outcomes for children treated in these facilities.
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Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine and Pediatrics, University of California, San Francisco, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Alexandra Bicki
- Division of Nephrology, Department of Medicine and Pediatrics, University of California, San Francisco, San Francisco
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Isabelle Lopez
- Division of Nephrology, Department of Medicine and Pediatrics, University of California, San Francisco, San Francisco
| | - Susan L. Furth
- Division of Pediatric Nephrology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Bradley A. Warady
- Children’s Mercy Kansas City, Division of Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Barbara A. Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Sandra Amaral
- Division of Pediatric Nephrology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Zhang LY, Amaral S, McCulloch CE, Grimes B, Ku E. Risk of Death among Dialysis Patients Treated at Hospital-Affiliated versus Free-Standing Facilities in the United States. KIDNEY360 2023; 4:e1297-e1301. [PMID: 37357354 PMCID: PMC10547217 DOI: 10.34067/kid.0000000000000199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/10/2023] [Indexed: 06/27/2023]
Abstract
Receipt of dialysis at hospital-affiliated facilities was associated with a higher risk of mortality compared with treatment at free-standing dialysis facilities. The differential mortality risk in free-standing versus hospital-affiliated facilities was more pronounced in non-Hispanic Black and Asian patients compared with other racial/ethnic groups.
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Affiliation(s)
- Lucy Y. Zhang
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Sandra Amaral
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Barbara Grimes
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Elaine Ku
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Department of Medicine and Pediatrics, University of California San Francisco, San Francisco, California
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GAFFNEY ADAM, WOOLHANDLER STEFFIE, HIMMELSTEIN DAVIDU. Century-Long Trends in the Financing and Ownership of American Health Care. Milbank Q 2023; 101:325-348. [PMID: 37093703 PMCID: PMC10262388 DOI: 10.1111/1468-0009.12647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/28/2022] [Accepted: 02/08/2023] [Indexed: 04/25/2023] Open
Abstract
Policy Points Over the past century, the tax-financed share of health care spending has risen from 9% in 1923 to 69% in 2020; a large part of this tax financing is now the subsidization of private health insurance. For-profit ownership of health care facilities has also increased in recent decades and now predominates for many health subsectors. A rising share of physicians are now employees. US health care is, increasingly, publicly financed yet investor owned, a trend that has been accompanied by rising medical costs and, in recent years, stagnating or even worsening population health. A reconsideration of US health care financing and ownership appears warranted. CONTEXT Who pays for health care-and who owns it-determine what care is delivered, who receives it, and who profits from it. We examined trends in health care ownership and financing over a century. METHODS We used multiple historical and current data sources (including data from the American Medical Association, the American Hospital Association, government publications and surveys, and analyses of Medicare Provider of Services files) to classify health care provider ownership as: public, private (for-profit), and private (not-for-profit). We used US Census data to classify physicians' employers as public, not-for-profit, or for-profit entities or "self-employed." We combined estimates from the official National Health Expenditures Accounts with other data sources to determine the public vs. private share of health care spending since 1923; we calculated a "comprehensive" public share metric that accounted for public subsidization of private health expenditures, mostly via the tax exemption for employer-sponsored insurance plans or government purchase of such plans for public employees. FINDINGS For-profit ownership of most health care subsectors has risen in recent decades and now predominates in several (including nursing facilities, ambulatory surgical facilities, dialysis facilities, hospices, and home health agencies). However, most community hospitals remain not-for-profit. Additionally, over the past century, a growing share of physicians identify as employees. Meanwhile, the comprehensive taxpayer-financed share of health care spending has increased dramatically from 9% in 1923 to 69% in 2020, with taxpayer-financed subsidies to private expenditures accounting for much of the recent growth. CONCLUSIONS American health care is increasingly publicly financed yet investor owned, a trend accompanied by rising costs and, recently, worsening population health. A reassessment of the US mode of health care financing and ownership appears warranted.
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Affiliation(s)
| | - STEFFIE WOOLHANDLER
- Cambridge Health Alliance
- Harvard Medical School
- Hunter College, City University of New York
- Public Citizen Health Research Group
| | - DAVID U. HIMMELSTEIN
- Cambridge Health Alliance
- Harvard Medical School
- Hunter College, City University of New York
- Public Citizen Health Research Group
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Erickson KF, Warrier A, Wang V. Market Consolidation and Innovation in US Dialysis. Adv Chronic Kidney Dis 2022; 29:65-75. [PMID: 35690407 DOI: 10.1053/j.ackd.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/06/2022] [Accepted: 01/18/2022] [Indexed: 11/11/2022]
Abstract
While patients with end-stage kidney disease have benefited from innovations in clinical therapeutics and care delivery, these changes have been primarily incremental and have not fundamentally transformed care delivery. Dialysis markets are highly concentrated, which may impede innovation. Unique features of the dialysis industry that have contributed to consolidation can help to explain links between consolidation and innovation. We discuss these unique features and then provide a framework for considering the effects of consolidation on innovation in dialysis that focuses on the following economic considerations: (1) industry characteristics, composition, and stage of consolidation, (2) innovation characteristics and relative profitability, (3) the role of government regulation, and (4) innovation from smaller providers and new entrants. We present examples of how these considerations have influenced the adoption of alternative dialysis technologies such as peritoneal dialysis and erythropoietin-stimulating agents, and we discuss how consolidated markets can both help and hinder recent policy initiatives to transform dialysis care delivery. Only by considering these important drivers of consolidation, future efforts can be successful in transforming end-stage kidney disease care.
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Affiliation(s)
- Kevin F Erickson
- Baylor College of Medicine, Section of Nephrology, Houston, TX; Baker Institute for Public Policy, Rice University, Houston, TX.
| | - Anupama Warrier
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Virginia Wang
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC; Health Services Research and Development Center of Innovation, Durham VA Health Care System, Durham, NC
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Liu SY, Cheng CY, Wu MY, Zheng CM, Hsu CC, Wu MS, Lin YC. Effect of profit status in facilities on the mortality of patients on long-term haemodialysis: a nationwide cohort study. BMJ Open 2021; 11:e045832. [PMID: 34475147 PMCID: PMC8413873 DOI: 10.1136/bmjopen-2020-045832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Over the past two decades, debates on whether the profit status of dialysis facilities influences patient prognosis have been popular in the USA. Taiwan is one of the regions with the highest rate per capita of kidney replacement therapy worldwide, but no similar research has been conducted to date. This is the first study to address this issue. DESIGN This was a nationwide retrospective cohort study based on the Taiwan Renal Registry Data System. SETTING Patients were categorised into two groups based on the profit status (for-profit, not-for-profit (NFP)) of dialysis facilities, with 31 350 patients in each group. The patients were followed up from 2005 to 2012. PARTICIPANTS Patients with uraemia who underwent long-term haemodialysis in private dialysis facilities and public facilities were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES Survival analyses were performed to compare prognosis between the two groups. Adjustments to patients' basic profile, and facilities' geographical distribution, level, and length of ownership were carried out to minimise possible confounding effects. RESULTS Analysis revealed that NFP dialysis facilities had better outcomes (HR=0.91, 95% CI (0.89 to 0.93)). A favourable effect remains with the adjustment of the facilities' level, geographical distribution (HR=0.89, 95% CI (0.86 to 0.93)) or length of ownership (HR=0.95, 95% CI (0.89 to 0.95)). Survival analysis based on the geographical distribution and level of facilities was also conducted, which showed better prognosis in medical centres in the six municipalities, whereas worse prognosis was found in local hospitals not located in these municipalities. CONCLUSION Our findings suggest that in contemporary settings in Taiwan, treatment at NFP dialysis facilities was associated with a better prognosis. The results should be interpreted with caution since the possibility of residual confounding effects and uncertainty of casual relations exist due to the nature of observational studies.
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Affiliation(s)
- Sheng-Yu Liu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chung-Yi Cheng
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Wanfang Hospital, Taipei, Taiwan
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Mei-Yi Wu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Cai-Mei Zheng
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Chih-Cheng Hsu
- National Health Research Institutes, Institute of Population Health Sciences, Zhunan, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Yen-Chung Lin
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
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Himmelstein DU, Woolhandler S. Recovering from Trump: Biden's first 100 days. Lancet 2021; 397:1787-1791. [PMID: 33933187 PMCID: PMC8084352 DOI: 10.1016/s0140-6736(21)00979-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/01/2022]
Affiliation(s)
- David U Himmelstein
- City University of New York at Hunter College, New York, NY 10035, USA; Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA.
| | - Steffie Woolhandler
- City University of New York at Hunter College, New York, NY 10035, USA; Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA
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Woolhandler S, Himmelstein DU, Ahmed S, Bailey Z, Bassett MT, Bird M, Bor J, Bor D, Carrasquillo O, Chowkwanyun M, Dickman SL, Fisher S, Gaffney A, Galea S, Gottfried RN, Grumbach K, Guyatt G, Hansen H, Landrigan PJ, Lighty M, McKee M, McCormick D, McGregor A, Mirza R, Morris JE, Mukherjee JS, Nestle M, Prine L, Saadi A, Schiff D, Shapiro M, Tesema L, Venkataramani A. Public policy and health in the Trump era. Lancet 2021; 397:705-753. [PMID: 33581802 DOI: 10.1016/s0140-6736(20)32545-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/22/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Steffie Woolhandler
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - David U Himmelstein
- School of Urban Public Health, City University of New York at Hunter College, New York, NY, USA; Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Sameer Ahmed
- Harvard Immigration and Refugee Clinical Program, Harvard Law School, Harvard University, Boston, MA, USA
| | - Zinzi Bailey
- Medical Oncology Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mary T Bassett
- Francois-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, MA, USA
| | | | - Jacob Bor
- School of Public Health, Boston University, Boston, MA, USA
| | - David Bor
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Olveen Carrasquillo
- Division of General Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Samantha Fisher
- Program for Global Public Health and the Common Good, Boston College, Chestnut Hill, MA, USA
| | - Adam Gaffney
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | | | - Kevin Grumbach
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence & Impact and Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Helena Hansen
- Research Theme in Translational Social Science and Health Equity, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Philip J Landrigan
- Program for Global Public Health and the Common Good, Boston College, Chestnut Hill, MA, USA
| | | | - Martin McKee
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Danny McCormick
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Alecia McGregor
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Reza Mirza
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Juliana E Morris
- Harvard Medical School, Harvard University, Boston, MA, USA; Department of Medicine and Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Joia S Mukherjee
- Harvard Medical School, Harvard University, Boston, MA, USA; Partners in Health, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marion Nestle
- Department of Nutrition and Food Studies, New York University, New York, NY, USA
| | - Linda Prine
- Department of Family and Community Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Altaf Saadi
- Harvard Medical School, Harvard University, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Davida Schiff
- Harvard Medical School, Harvard University, Boston, MA, USA; Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA
| | - Martin Shapiro
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Lello Tesema
- Department of Public Health, Los Angeles County, Los Angeles, CA, USA
| | - Atheendar Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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