Ivermectin Suit Revived; Curbing Fentanyl Deaths in Kids; Medicare Spending Plateau

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Doctors' Ivermectin Lawsuit Revived

Last week, the 5th U.S. Circuit Court of Appeal in New Orleans revived a lawsuit brought by three doctors alleging that the FDA overstepped in its public statements about ivermectin as a COVID-19 treatment, the Associated Press reported.

The lawsuit argues FDA messaging such as, "I'm not a horse!" interfered with their practice, and in "most of that messaging," left out the human version of ivermectin that the plaintiffs were prescribing.

The lawsuit was originally brought by otolaryngologist Mary Talley Bowden, MD, and critical care doctor Paul E. Marik, MD -- both of whom have faced professional repercussions after touting the anti-parasitic, among other controversies -- and emergency medicine doctor Robert L. Apter, MD.

A district court judge had dismissed the lawsuit in December, but the New Orleans appellate court argued that the FDA exceeded its authority under federal law, though normally government entities have more protections from civil lawsuits because of what's known as "sovereign immunity."

"FDA is not a physician. It has authority to inform, announce, and apprise -- but not to endorse, denounce, or advise," Judge Don Willett, MA, JD, a Trump appointee, wrote for the panel, according to the AP. "The Doctors have plausibly alleged that FDA's Posts fell on the wrong side of the line between telling about and telling to.

State Laws Attempt to Curb Fentanyl Deaths in Kids

The synthetic opioid fentanyl claimed the lives of 1,800 teenagers between July 2019 and December 2021 in the U.S. -- and a number of states are passing legislation geared toward preventing these deaths, according to Politico.

In California, a bill named for a 15-year-old who died in a Hollywood high school would require schools to include responses to overdoses into their safety plans. In Texas, middle and high schoolers learn about the dangers of fentanyl in a new education campaign. Mississippi created a media campaign.

But families of youths that have died from overdoses want more to be done. They cite pandemic-era lockdowns and social media as drivers of declining mental health and easy access to drugs available for purchase. Surprisingly few treatment options are available for adolescents struggling with substance abuse, and naloxone (Narcan) isn't readily available in many overdose situations, according to Politico.

On the national level, members of Congress have introduced a bill that would fund education on fentanyl for children, and provide school employees with naloxone and training for its use. Likewise, Surgeon General Vivek Murthy, MD, MBA, has said he supports age limits for social media use.

Medicare Spending Plateau

Medicare spending per beneficiary has ceased its dramatic trend upward, baffling experts who projected a continued steady climb would strain the federal budget and lead to increasingly difficult spending choices. Spending would have been $3.9 trillion higher since 2011 had it not been for the change, the New York Times reported.

Possible reasons for the relative plateauing at $12,459 per beneficiary per year include the Affordable Care Act, which cut Medicare payments to hospitals and Medicare Advantage insurers. Older Americans are also having fewer heart attacks and strokes because of effective drugs for cholesterol and blood pressure. Some parts of healthcare have become more efficient, with some care shifting out of hospitals into cheaper settings, for example.

However, the shift may also reflect slowing life expectancy for seniors because of a lack of major medical breakthroughs in recent years, the death of many older Americans from COVID-19, and seniors being denied the care of their choice as hospitals contain costs.

Trump tax cuts, a deficit reduction deal, and the recent Medicare drug negotiation policy wouldn't have come close to this magnitude of government savings, according to the New York Times, although Medicare spending is still likely to increase in the coming years. An aging population, and a new development like an Alzheimer's drug or the burden of long COVID, for example, could push spending up again.

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