Citizen Cartwright

Doctors tell accountants: Don’t make our mistakes taking private equity investments

Drs. Bob McNamara and James Keaney, former longtime emergency-room physicians, were early critics of private equity in healthcare who now say such ownership in accounting could shake trust in an industry that investors depend on for trustworthy financial information about companies, The Wall Street Journal recently reported.

“If accounting holds itself out as an ethical profession, which puts the client first, they should have never let private equity in because that’s what we did and it hurt the patients,” says McNamara, a professor and chair of emergency medicine at Temple University. 

Since 2021, about two dozen of the 100 biggest U.S. accounting firms either have sold an ownership stake to private-equity investors or been acquired by a firm that's done so, says the WSJ. Concerns have been raised about the potential threat to the independence of auditors, who are intended to be objective assessors of financial information. And accountants worry that the typical three- to five-year investment window is detrimental to CPA firms’ long-term plans for maintaining service quality and could spur them to accept higher-risk clients. 

Private-equity firms say they provide needed capital that enables accounting firms to boost hiring and improve their services. They say their investment in healthcare has helped hospitals and other medical practices, some of which were in dire financial straits, to continue providing care to patients, especially in regions where medical options are limited. Private-equity sponsors of accounting firms say cost-cutting isn’t part of their mission.

Longtime readers of this blog may recall the extensive KFF series "Patients for profit: How private equity hijacked health care.” The summary of that series of articles says: “Private equity investors are rapidly scooping up thousands of health care businesses, taking over emergency rooms or entire hospitals, and becoming major players in physician practices and patient care, from cradle to grave. But these acquisitions are often invisible to federal regulators. And their profit motives raise concerns about rising prices and the quality of treatment.”

Good news: World’s first personalized gene editing

On this good-news Friday, I’d like to give you this link to our edition of Fix the News and focus my summary here on the world’s first personalized gene editing treatment.

There are 350 million people worldwide with rare diseases, most of which are genetic, says The Associated Press.

And while researchers have developed gene-editing therapies for illnesses that affect millions of people with common genetic mutations, like sickle cell disease, millions of others have genetic diseases with unique mutations that need personalized therapy, says The Wall Street Journal.

KJ Muldoon was a week old when he was diagnosed with a rare genetic disorder, CPS1 deficiency, that affects just one in 1.3 million babies.

Now nine and a half months old, he's the first patient of any age to have a custom gene-editing treatment, The New York Times reports. He's received an infusion made just for him and designed to fix his precise mutation.

The investigators who led the effort to save KJ presented their work Thursday at the annual meeting of the American Society of Gene & Cell Therapy and are publishing it in the New England Journal of Medicine.

The implications of the treatment go far beyond treating KJ, says Dr. Peter Marks, who was the Food and Drug Administration official overseeing gene-therapy regulation until he recently resigned over disagreements with Robert F. Kennedy Jr., secretary of health and human services. 

More than 30 million people in the United States have one of more than 7,000 rare genetic diseases, and most are so rare that no company is willing to spend years developing a gene therapy that so few people would need.

But KJ’s treatment — which built on decades of federally funded research — offers a new way for companies to develop personalized treatments without going through years of expensive development and testing.

Illnesses like KJ’s are the result of a single mutation: an incorrect DNA letter among the three billion in the human genome. 

Correcting it requires pinpoint targeting called base editing. The treatment is wrapped in fatty lipid molecules to protect it from degradation in the blood on its way to the liver, where the edit will be made. Inside the lipids are instructions that tell the cells to produce an enzyme that edits the gene. They also carry a molecular GPS — CRISPR — altered to crawl along a person’s DNA until it finds the exact DNA letter that needs to be changed.

While KJ’s treatment was customized so CRISPR found just his mutation, the same kind of method could be adapted and used over and over to fix mutations in other places on a person’s DNA. Only the CRISPR instructions leading the editor to the spot on the DNA with the mutation would need to be changed. 

Treatments would be cheaper, “by an order of magnitude,” says Dr. Marks. He wrote an editorial accompanying the research paper and says the method “is, to me, one of the most potentially transformational technologies out there.” 

It eventually also could be used for more common genetic disorders such as sickle cell disease, cystic fibrosis, Huntington’s disease and muscular dystrophy.

Dozens of researchers put everything aside for months to work on KJ’s treatment, says the Times. 

David Liu of Harvard, whose lab invented the gene-editing method used to fix KJ’s mutation, says the speed was “astounding. These steps traditionally take the better part of a decade, if not longer.”

The success in treating KJ “is a triumph for the American peoples’ investment in biomedical research,” says Dr. Fyodor Urnov of the University of California at Berkeley.

The work began decades ago with federal funding for basic research on bacterial immune systems. That led eventually, with more federal funding, to the discovery of CRISPR. Federal funding for sequencing the human genome made it possible to identify KJ’s mutation. Federal funding supported Dr. Liu’s lab and its editing discovery. A federal program to study gene editing supported other research. Federally funded work led to an understanding of KJ’s disease.

“I don’t think this could have happened in any country other than the U.S.,” Dr. Urnov says. And “we all said to each other, ‘This is the most significant thing we have ever done.’”

Results of lawmakers’ all-nighters on ‘big, beautiful bill’

I’d love to be able to give you details of the legislation approved Wednesday as three House committees advanced their parts of the bill.

 

But with a gigantic bill like this — intended to make spending cuts to offset the costs of making President Trump’s 2017 tax cuts permanent — it’s routine that important details only emerge after Congress has passed the bill and the president has signed it.

 

There’s also this dynamic: 

 

"The House Energy and Commerce Committee was 16 hours into a nearly 27-hour markup [session to change and approve the bill] when it became clear that top Republicans on the panel weren’t clear on what key Medicaid provisions in the legislation they were actively debating would actually do,” Politico says.

 

The best summary of what’s in the bill that I can find continues to be this one from The Associated Press, published before the three committees finished their work.

 

The legislative package combining all the House committees' work is to be put together by the House Budget Committee on Friday.

 

Here are some details on Energy and Commerce’s health care piece of the bill, from Politico.

 

Here is a rundown on the House Agriculture Committee’s approval of $300 billion in nutrition spending cuts, also from Politico.

Good news on malaria prevention, brain microrobots, violets for a landfill

As usual, I hope you’ll have time to scan the many items of good news that are free in our Fix the News edition for this week.

Among the items behind the paywall:

— Insecticide-treated malaria nets have helped prevent more than 2 billion cases and nearly 13 million deaths since 2000, says the World Health Organization. 

— The French startup Robeauté is developing microrobots the size of a grain of rice that can navigate inside the brain, delivering targeted treatments and collecting samples without invasive surgery, reports the online publication EU-Startups.com. 

— Staten Island's Freshkills Park, once the world's largest landfill, is planting 50,000 native violets to attract monarch butterflies and bees, says SILive.com. 

What Americans can do to avoid authoritarianism

Twenty years ago, Garry Kasparov, world chess champion from 1985-2000, retired from professional chess to help Russia resist what he calls Vladimir Putin’s "budding dictatorship."

Now, he writes in The Atlantic, "Putin is still in the Kremlin, and I’m writing this from New York City — my family has made its home there, as well as in Croatia, since we were forced to leave Russia in 2013."

And "President Donald Trump and his allies in power are trying to erect an authoritarian Mafia state like the one Vladimir Putin and his cronies established in Russia," he says.

"Never lose sight of the fact that the Trump administration’s aim is to weaken and devalue the machinery of government, on one hand, and privatize the levers of power on the other," Kasparov says.

Americans have a "well-stocked toolbox" with which to defend democratic institutions, he says: a free press, strong economy, separation of powers, and federalism (power shared by the national government and the states).

So "political pressure must be brought to bear — through the courts, the press, and the states, but also applied to legislators," he says.

"Americans should invest their time and money fighting in the arena where political power still lies: with the American people and in Washington, D.C., with the handful of Republican representatives who could put a stop to the power grab. Go after the weakest links and call them out. Promise to support them against Musk’s threats to fund primary challenges if they defy him—and to raise millions against them if they don’t."

"Four votes in the Senate. Three votes in the House. That’s all it takes," Kasparov says.

How Americans can take action right now:

The House Energy and Commerce Committee could meet as soon as the week of May 5 to work on making $880 billion in spending cuts from the programs under its jurisdiction — including Medicaid, the joint federal-state safety net program for health care, says Politico.

Twelve House Republicans have sent a letter to the House leadership opposing potential Medicaid cuts. They are, according to the American Hospital Association: Reps. David Valadao, R-Calif., Don Bacon, R-Neb., Jeff Van Drew, R-N.J., Rob Bresnahan Jr., R-Pa., Juan Ciscomani, R-Ariz., Jen Kiggans, R-Va., Young Kim, R-Calif., Robert Wittman, R-Va., Nicole Malliotakis, R-N.Y., Nick LaLota, R-N.Y., Andrew Garbarino, R-N.Y., and Jeff Hurd, R-Colo.

In the Senate, Josh Hawley, R-Mo., says he won’t support any proposal that would lead to cuts in Medicaid benefits for people in his state, Roll Call reports.

Good news on health, energy, planets

It seems you can read the first 15 of this Fix the News edition without a password. And I’ve got tears of exhilaration as I go through them. For example:

"The world has made remarkable progress in reducing child mortality," says UNICEF. Since 2000, the global mortality rate of children under five has dropped by 52 percent. Clicking through to the UNICEF article and seeing the photo of the baby — whose eyes show such excited intelligence — could not be a better way to start my day.

And congratulations, California, on your win-win effort to generate energy while combatting drought. A pilot project is covering canals with solar panels, simultaneously generating clean energy and preventing water evaporation, says PV Magazine. 

Among the 28 items behind Fix the News’ paywall:

— A tiny magnetic robot that can take 3D scans deep inside the body could revolutionize early cancer detection. Researchers at Britain’s University of Leeds say they’ve generated the first high-resolution three-dimensional ultrasound images taken by a probe moving through the colon. 

— In 1990, there wasn’t a single planet known beyond our solar system. We’ve now discovered nearly 6,000 confirmed exoplanets. And a proposed telescope could find Earth-like exoplanets using just one pixel of data, says BigThink.

— California, Illinois, Maryland, Michigan, Minnesota, New York and Pennsylvania have joined in a Clean Rides Network. The group is working on environmentally friendly transportation projects it says the federal government has abandoned, The Associated Press reports.

Atul Gawande on USAID: ‘This was America at its best’

“As a surgeon, Gawande had long been in a position to save one life at a time. More recently, and all too briefly, he was part of a vast collective responsible for untold good around the world,” says David Remnick, editor of The New Yorker. 

 

Gawande, author of three best-selling books and a writer for The New Yorker, was assistant administrator for the Bureau of Global Health at the U.S. Agency for International Development from 2021 until the end of the Biden administration. 

 

“When we spoke recently for The New Yorker Radio Hour, Gawande, usually a wry, high-spirited presence, was in a grave mood. There were flashes of anger and despair in his voice,” says Remnick.

 

That’s certainly understandable; the news has been full of the effects of the Trump administration’s dismantling of USAID on people around the world and on the employees of the agency.

 

But let’s focus here on a few excerpts from Remnick’s interview with Gawande on his personal reactions and hope for the future:

 

“I did not expect that going into government would be as meaningful to me as it was,” Gawande says.

 

“I describe it as the best job in medicine that people have never heard of. It is at a level of scale I could never imagine experiencing.

 

“I had twenty-five hundred people, between D.C. and sixty-five countries around the world, working on advancing health and protecting Americans from diseases and outbreaks abroad. The aim was to work with countries to build their systems so that we protected global health security and improved global outcomes — from reducing HIV/AIDS and other infectious diseases like malaria and TB, to strengthening primary health-care systems, so that those countries would move on from depending on aid from donors. In three years, we documented saving more than 1.2 million lives after COVID alone.

 

“In the end, professionally organized bureaucracies — that need to have political oversight, need to have some controls in place, but a balance that allows decision-making to happen — those have been a key engine of the prosperity of the country. Their destruction will have repercussions that I think will make the administration very unpopular, and likely cause a backlash that balances things out.”

Good news on AI, philanthropy, health

Fix the News’ Feb. 27 issue has nearly 20 good news items that are free to read and 35 that are behind the paywall.

 

Among the items that require a subscription:

 

— A problem that took microbiologists a decade to get to the bottom of was solved in two days by a new artificial intelligence tool, the BBC reports. 

 

Professor José Penadés and his team at Imperial College London had spent years figuring out and proving why some superbugs are immune to antibiotics. The Google AI tool "co-scientist” reached the same conclusion in 48 hours.

 

— Mackenzie Scott, philanthropist and ex-wife of Amazon founder Jeff Bezos, has pioneered a new kind of giving that’s been transformative for nonprofit organizations, says CBS News.

 

Since 2019, Scott, whose net worth is estimated by Forbes to be more than $32 billion, has given $19 billion in no-strings-attached gifts to more than 2,000 nonprofits, meaning the recipients of the donations were permitted to spend the funds however they saw fit. The median gift size was about $5 million.

 

New research from the Center for Effective Philanthropy found that the size and lack of restrictions of Scott's charitable gifts have not only helped those nonprofits become more financially stable but has enabled them to increase the scope of their impact.

 

Scott says she believes the people closest to the work are best positioned to identify the organization's needs. 

 

— The World Health Organization and St. Jude Children’s Research Hospital have started distribution of free childhood cancer medicines in Mongolia and Uzbekistan, with shipments planned for Ecuador, Jordan, Nepal and Zambia, through the Global Platform for Access to Childhood Cancer Medicines.  

 

The goal is to reach 50 low- and middle-income countries in the next five to seven years. Childhood cancer survival rates are often 30 percent lower in these countries than in high-income countries, the WHO says.

House passes ‘big, beautiful’ budget bill Trump wants

The president spent hours lobbying Republican holdouts on Tuesday to pass the fiscal 2025 budget blueprint, on a 217-215 vote, with one Republican voting no, Roll Call reports.

 

It’s just the first step toward passing the reconciliation bill, with $4.5 trillion in tax breaks and $2 trillion in spending cuts, that House Republicans are seeking to enact Trump’s agenda. The plan is at odds with Senate Republicans, who are pursuing their own budget blueprint focused on border security and defense, while deferring tax legislation until later in the year.

 

The House budget resolution had gotten criticism from both wings of the Republican Conference. 

 

Ultraconservatives, mainly from the Freedom Caucus, said an initial draft calling for $1.5 trillion in spending cuts was insufficient. 

 

And GOP moderates expressed concern about the impact spending cuts could have on Medicaid, the health insurance program for low-income families. The budget would instruct the Energy and Commerce Committee to find $880 billion in savings over a decade, and Medicaid is the likeliest target for cuts in that panel’s jurisdiction. 

 

But they got assurances from House leaders after a late-night meeting Monday that cost-cutting would focus on Medicaid fraud, while not touching benefits for people eligible for the program.

 

Rep. Mike Lawler, R-N.Y., noted that Trump has promised he wouldn't allow Medicaid to be cut.

“The president was clear about that. I was clear about that,” Lawler said. “We will work through this, but the objective today is to begin the process.”

Good news on recycling, ocean protection, health care

Australia’s Fix the News begins this week’s issue saying, “The best thing we can do at this point is to remind all of our readers that the madness going down in Washington DC right now is not the only news story in the world.” 

Well, I’m ready; how about you?!

 

I believe the first 19 items are accessible without a subscription. So I’ll leave those to you to scroll through yourself and will note three of the remaining 30 items that are available only to subscribers:

 

— Fast fashion is causing a big increase in textile waste, but textile recycling mostly has been limited to re-using old clothes as cleaning cloths or turning them into upholstery fillers, says the nonprofit online magazine Reasons to be Cheerful. But now a Swedish company has found a way to process old textiles and fabric to produce a material that can be used to manufacture brand new clothing.

 

Reasons to be Cheerful was founded by musician David Byrne to provide “news for when you’ve had too much news.”

 

— Researchers have engineered a miniaturized version of the CRISPR gene-editing tool that may be able to reach more of the body's tissues to treat more diseases, reports Science.

 

— The first marine sanctuary has been announced for the Marshall Islands in the central Pacific Ocean, reports Oceanographic Magazine. 

 

Enric Sala, National Geographic's explorer in residence, says the coral reefs around the two northernmost islands “are a time machine, like diving in the ocean of 1,000 years ago. They are our best baselines for what the ocean could look like if we truly let it be.”