My Juneteenth federal holiday didn’t turn out the way I hoped. It was even better!

By Sally Greenberg, NCL Executive Director

This week we celebrated the Juneteenth federal holiday and one that the National Consumers League will continue to honor into the future.

Juneteenth marks the date in 1865 when a union general and his soldiers rode into Galveston, Texas to tell the enslaved community that they had been emancipated from slavery; the plantation owners didn’t bother to give them the news.

At last, these Texans were free human beings.

Sadly, this happened two years after the 1863 signing of the Emancipation Proclamation by President Abraham Lincoln.

Fast forward to June 20, 2022. While watching the Today Show, I saw a 95-year-old inspiration named Miss Opal Lee, appropriately from Texas, who made it her life’s work to make Juneteenth a federal holiday. The piece featured Miss Opal’s photos from her childhood when she had celebrated Juneteenth in Texas.

Most of the U.S. didn’t know about the importance of this date, but, in Texas, the black community has been honoring Juneteenth for decades – with parades and music and traditional foods. The Today Show clip featured Miss Opal in 2021 when President Joe Biden signed the bill creating the federal holiday; she is standing next to him surrounded by members of Congress.

This heroic former schoolteacher was nominated for a Nobel Prize. Not only did she march to Washington with more than one million signatures to get Juneteenth recognized, but she created a food bank out of her kitchen that has grown into a huge warehouse. She launched a farm to feed thousands in the community.

I was in awe of this incredible woman and was so grateful to learn about her role in the adoption of this federal holiday.

Later that day, I was looking forward to celebrating local events around D.C., and headed down to the National Museum of African American of History and Culture. Sadly, I couldn’t get in because the museum had sold out of timed passes. I was so disappointed.

On the ride home from the museum, I happened to see horses being put back into a trailer by African American men dressed as union soldiers. I stopped and got out to see what was happening; they told me this was the end of a parade from 14th street down to Howard University.

Then they said, “Miss Opal came too.”

“Miss Opal?”, I asked. Was this Miss Opal the same amazing lady who made it her life’s work to make Juneteenth a federal holiday?

“That is her over there,” they told me.  I asked if I could meet her – it turned out she was in a car near the food trucks. She rolled down her window and we talked for a few minutes about how she made Juneteenth happen. I shook her hand and thanked her for being a true American hero; for finally getting this most important federal holiday on the calendar; for teaching school and; for her incredibly uplifting spirit. She was just as inspiring in person. I hope I have her energy and spirit when I’m 95 years old!  She invited me to come down and see her in Fort Worth, which I might just do!

Serendipity in Washington, D.C.

Juneteenth didn’t turn out like I thought it would, but I feel so honored to have met this towering figure in American history. Go Miss Opal Lee!

Dispatches from Durban: May 15-20, 2022

Reflections on the 5th Global Conference on the elimination of child labour in Durban, South Africa: May 15-20, 2022

Reid Maki is the director of child labor advocacy at the National Consumers League and he coordinates the Child Labor Coalition.

The recently-concluded week-long “5th Global Conference on the Elimination of Child Labour” in Durban, South Africa was convened against the backdrop of the announcement last July of an alarming rise in child labor numbers after two decades of steady and significant declines in global child labor totals.

The global conference, which typically comes about every four years, brought together an estimated 1,000 delegates from foreign governments and small number of representatives of NGOs. It also brought together for the first time at one of the quadrennial child labor conferences dozens of participant youth advocates as well as a number of child labor victims and survivors.

The conference had the difficult mission of righting the ship and trying to reverse the rising child labor numbers, which seem destined to rise further as the COVID pandemic’s impact will continue to be felt for years. Sadly, the pandemic threw 1.6 million children out of school, often for prolonged periods and some of those children entered work and may never return to school.

We would first like to thank the South Africa government for the herculean task of organizing a global conference during a still raging pandemic, all against a backdrop of devastating floods in April that savaged the provinces of KwaZulu-Natal and Easter Cape and killed nearly 500 people, destroyed 4,000 homes and displaced 40,000 people.

As the conference opened, Guy Ryder, the Director General of the International Labour Organization, which helped advise the government of South Africa on the organization of the conference, suggested that the rise in 8 million child laborers from 152 million to 160 million likely represented complacency and a loss of focus by global governments on the child labor problem and must be rectified. He noted increases in child labor impacting children under age 11 and urged delegates to redouble their efforts. “We need to increase our efforts, and pay particular attention to child labor in agriculture,” said Ryder, who added that child labor advocacy is threatened by a “perfect storm” created by COVID’s enduring impact, rising food insecurity, and debt crises that are expected to impact 60 nations in the coming years.

South Africa’s president Cyril Ramamphosa delivered a stirring welcome. He noted that his country’s embrace of child rights is not just a matter of principle. “The assertion of the rights of children was a direct response to the deprivation, discrimination and deliberate neglect that had been visited on the black children of this county by successive colonial apartheid administrations,” said Ramamphosa. “Child labor perpetuate the cycle of poverty, denying young people the education they need to improve their circumstances. It condemns communities to forms of economic activity and labor that limit any prospect of advancement or progress.”

Nobel Peace Prize laureate Kailash Satyarthi noted the particular challenge that the sub-Saharan African region is facing with the highest rates of child labor and one in five children are in child labor.

Satyarthi urged listeners to embrace the idea that every single child can be protected from child labor. “Let us march from exploitation to education,” he urged, calling for children to have a “fair share” of resources. The amount needed to ensure all children have access to needed resources is only $53 billion – not much considering the wealth of many nations, said Satyarthi who also noted that the G7, which is about to meet on June 26th, has never focused attention collectively on child labor. “This needs to change,” he urged.

The conference opened with a pledge by European Union (EU) Commissioner Jutta Urpilainen that the EU will create a new $10 million euro initiative to reduce child labor in agriculture. Child labor must return to the political agenda, she urged.

The six-day conference, attended by 1,0000 delegates in person and an estimated 7,000 online, according to organizers, featured workshops and side events, and included three meetings every other day by separate groups of employers, workers, and governments. Readers can find a conference agenda here with video links to many sessions.

Twenty-four side events focused on many related topics including child labor in supply chains, a decent work agenda, youth-led activism, small-scale mining, livelihoods skills development, African priorities, partnership in Latin America to end child labor, due diligence legislation, data and research needs, labor inspections, artisanal fisheries and aquaculture, and a child-labor-free zone in Ghana. For a complete list and to view specific side events, please go to agenda, scroll each day’s offerings and click links to the videos.

Attendees learned a lot about specific intervention efforts, and the struggles many nations are engaged in, including Malawi, which has recently been hit by two cyclones and where there is a shortage of 50,000 schools – less than half of the children have access to education, said the nation’s Education Minister Agnes Nyalongje. She pleaded for international help, noting that 12 years of sustained aid could create generational change in Malawi and fix its troubled education system.

It’s difficult to summarize the hundreds of hours of content but readers may get a sense from the CLC’s twitter stream which included four to five dozen original tweets at @ChildLaborCLC.

The conference’s concluding “Call to Action” document emphasizes the need for urgent action, because “the consequences of the COVID-19 pandemic, armed conflicts, and food, humanitarian and environmental crises threaten to reverse years of progress against child labour”. The document includes commitments in six different areas:

  • Make decent work a reality for adults and youth above the minimum age for work by accelerating multi-stakeholder efforts to eliminate child labour, with priority given to the worst forms of child labour.
  • End child labour in agriculture.
  • Strengthen the prevention and elimination of child labour, including its worst forms, forced labour, modern slavery and trafficking in persons, and the protection of survivors through data-driven and survivor-informed policy and programmatic responses.
  • Realize children’s right to education and ensuring universal access to free, compulsory, quality, equitable and inclusive education and training.
  • Achieving universal access to social protection.
  • Increasing financing and international cooperation for the elimination of child labour and forced labour.

As is often the case at conferences, many of the side conversations are of great interest. We had many great conversations with Simon Steyne, who recently retired from the International Labour Organization but continues his child labor advocacy. Simon is campaigning to bring about a child-labor-in-agriculture conference in the coming year. With 70 percent of global child labor in agriculture and rising child labor rates, a focus on agriculture at this time is absolutely essential, Steyne argued.

What might have been improved at the conference? It seems that a relatively small number of Civil Society participants were invited to the conference, included few from the Americas and Asia. The pandemic and travel distances certainly impacted in-person attendance. And we know a lot of NGO participants were able to join online. We hope that a broader spectrum of Civil Society is invited to future global child labor conferences. NGO delegates often possess in-the-field, grass roots knowledge lacked by government and employer groups and NGO presence is a key element in the fight to reverse accelerating incidence of child labor.

The Civil Society advocates and experts who were there enhanced the conference greatly, mostly through the two dozen side events. We were delighted to be joined at the conference by CLC members Bank Information Center and GoodWeave, which organized the side event “Child Labour Free Supply Chains: Tackling Root Causes from Maker to Market” — included panelist Thea Lee, the deputy undersecretary for International Affairs at the U.S. Department of Labor, who was ubiquitous at the conference. CLC-member Action Against Child Exploitation (ACE) also presented a side event: “Promoting an Integrated Area-based Approach to the Elimination of Child Labour: A Case of the Child Labour Free Zone in Ghana,” with Yuka Iwatsuki, president of ACE among the panelists.

In addition to thanking our gracious South African hosts and the ILO for its organizing role, the CLC also wishes to express appreciation to our valued partners the Global March Against Child Labour and the Kailash Satyarthi Children’s Foundation for enhancing the conference significantly through organizing side events and bringing the voices of youth advocates to Durban.

Tara Banjara. 17, was among the youth advocates who appeared as a panelist. Tara said she is from a community in India where there are no schools and “no one had an idea about what education is.” She was four and half when she went to work on roads with her mother. They cleaned garbage and rubble out of potholes. The work was exhausting and difficult and went on till she was rescued by Bachpan Bachao Andolan’s Bal Ashram.

Today, Tara is the first girl to complete grade 12 exams in her entire family. She asked attendance participants gathered in Durban and the thousands on line: “Is this our fault that if we are born in a small village, we do not have the right to live our childhood with freedom?” She asked.

“We want freedom. We want the right to education,” Tara said, sharing her dream of becoming a police officer some day and working at the grassroots level to ensure that all children have equal rights and freedom. In one of the conference’s emotional high points, Tara asked attendees to stand and make a pledge: “Let us all pledge to create a world where every child is free from slavery; every child gets an education and an opportunity to fulfill their dreams.”

Jeanette Contreras portrait

Leaders in Congress support safe OTC hearing aid standards

By NCL Director of Health Policy Jeanette Contreras

Mild to moderate hearing loss is a difficult reality that millions of Americans struggle with, which is why the availability of over-the-counter (OTC) hearing aids is exciting for those who are impacted by hearing loss. While making OTC hearing aids more accessible is a promising step for consumers, we at NCL would be remiss if we didn’t underscore our concerns around the Food and Drug Administration’s (FDA) proposed OTC hearing regulations as they currently exist.

In December of last year, NCL was one of hundreds of organizations who submitted a comment to FDA’s public docket on the issue; and last month we submitted a letter voicing our concerns to the FDA that was supported by 29 not-for-profit, public health organizations across the country. These organizations collectively represent the concerns of millions of consumers, patients, and individuals impacted by hearing loss.

We want to reiterate our enthusiasm for OTC hearing aids, but as the gold standard of safety in our country, it is imperative that the FDA make sure these devices are safe for consumers and do not worsen a problem they are intended to mitigate. As written, the draft regulations would allow for a maximum sound output level of 120 dBA – equivalent to the volume of a chainsaw or fire engine siren. This is concerning, as exposure to sounds at 120 dB can be dangerous in as little as nine seconds according to the CDC. This is why NCL, along with other leading consumer and healthcare voices, encourage the FDA to follow the recommendations of hearing care professionals, including the American Academy of Otolaryngology–Head and Neck Surgery that recommend a maximum output of 110 dB and a gain limit of 25 dB. Without a limit on gain, OTC hearing aids users will be able to amplify sounds to dangerous levels, and far beyond what Congress authorized when it said these devices must be limited to adults with moderate hearing loss or less.

The safety parameters we are recommending would in no way compromise the efficacy of OTC hearing aids intended for individuals with perceived mild to moderate hearing loss. In fact, a recent study concluded that commercially-available hearing aids programmed according to parameters typical of those used for individuals with mild to moderate hearing loss yield effective output and gain levels and are within the recommended limits specified by leading hearing care organizations and medical experts.

Importantly, the FDA has already cleared several hearing aids for adults with perceived mild to moderate hearing loss that were found to be safe and highly effective during clinical trials. While these devices were authorized under a different category of hearing aids, these devices limit the maximum output to 115 dB or below and gain to 30 dB or less, lower than the amplification limits currently proposed by the FDA. At the very least, the FDA should incorporate these amplification limits in the final OTC hearing aid regulation.

Finally, as we await finalized guidance from the FDA, we applaud leaders in Congress who are standing behind consumers in supporting safe and effective amplification limits. Last month, Congresswoman Betty McCollum (D-MN) and Congresswoman Rosa DeLauro (D-CT) sent a letter to the FDA echoing their safety concerns. The letter states, “[The proposed rule] hurts consumers and patients in two ways. First, it means individuals suffering from greater levels of hearing loss could put off a needed visit with a licensed hearing professional. Doing so could lead to worsening their existing symptoms, delaying an accurate diagnosis and treatment, and even creating irreparable damage to their hearing. Secondly, it means those with perceived mild-to-moderate hearing loss would be exposed to harmful levels of noise that could result in further damage to their long-term hearing. In order to avoid these concerns, FDA should impose a gain limit of 25 dB and an overall output limit of 110 dB.”

Similar to the countless other experts that have also weighed in, we believe that establishing safe amplification limits would not reduce the efficacy of these devices or limit the advancement of innovative technologies. We thank Congresswomen McCollum and DeLauro for being a voice for consumers and patients on this important issue. To learn more about gain and output and how to protect yourself from hearing loss, check out our infographic.

Jeanette Contreras portrait

How to protect consumers from PBM greed

By NCL Director of Health Policy Jeanette Contreras

The rising cost of health care is a sore point for all consumers and nowhere is it more glaring than at the pharmacy counter. However, consumers are largely unaware that Pharmacy Benefit Managers – or PBMs – are the middlemen working behind the scenes with very little competition and accountability. There are now just three PBMs that account for about 77% of all equivalent prescription claims. This lack of competition allows PBMs to easily manipulate the price and make it impossible for consumers to get a fair deal.

There is plenty of blame to go around when it comes to the rising cost of prescription drugs. But PBMs ultimately control which medicines we get (and don’t get) and how much we pay out of pocket for them. That’s exactly why the Federal Trade Commission (FTC)– whose mission is to protect consumers and competition – has requested public comments on the ways these large, middlemen companies are affecting drug affordability and access.

I recently led a discussion with key experts to discuss this issue. NCL’s Executive Director Sally Greenberg, Former FTC Policy Director David Balto, and HIV + Hepatitis Policy Institute Executive Director Carl Schmid, shared their insights with us.

David Balto explained, “There are three things needed for a market to really function effectively – you need to have choice (competition); second, transparency – that is you know what you’re getting and what the benefit of the bargain is; and third, that there’s no conflict of interest. In the PBM market, PBMs fail on all three grounds.”

PBMs initially came into existence to streamline how consumers get their medicines and were intended to lower costs. However, as Sally Greenberg pointed out, “The fact that PBMs have the influence and decision-making authority they do should be concerning for all consumers. PBMs have the power to negotiate discounts with drug manufacturers, they work with insurance companies to determine which drugs will ultimately be covered, and they work with pharmacists to reimburse them for dispensing drugs. All along the way, they’ve found ways to profit – and all along the way this impedes the savings that should be going to consumers.”

Carl Schmid shared more about how this impacts patients, “We’re now seeing the creation of specialty drugs or specialty tier (on formularies). This is a term created totally by the PBMs…now it’s just any new drug – all HIV drugs, all Hepatitis drugs, all cancer drugs – they’re all specialty drugs these days and they put them in the highest tier. And this not only creates higher out-of-pocket costs for patients, but it’s also discriminatory.”

These unfair PBM practices lead to unnecessarily high out-of-pocket costs for prescriptions while PBMs continue to find ways to game the system to their benefit. The FTC wants to hear from consumers and patients who have been negatively impacted by these PBM practices.

Watch the full discussion here to learn more about the PBM problem. Then share your story with the FTC here.

NCL Briefing: measuring the 340B program’s impact on charitable care and operating profits for covered entities

Join the National Consumers League for a panel discussion with experts from Health Capital Group, the Community Oncology Alliance, and Johns Hopkins on this new white paper, which analyzes 340B’s impact on hospital profit margins and charitable care spending and attempts to quantify the amount of program benefits accruing to covered entities, contract pharmacies and patients.

Breyault and Amazon’s Alyssa Betz discuss policing fake reviews and counterfeits

 

By NCL Staff

 

This week, John Breyault, our Vice President of Public Policy, Telecommunications, and Fraud, sat down with Amazon’s Director of Public Policy, Alyssa Betz. On this episode of NCL’s We Can Do This! podcast, Alyssa and John discussed fake reviews, Amazon’s product liability, and more. This has been the latest collaboration between Amazon and NCL in our partnership towards improving consumer safety and online experiences.  

Fake Reviews 

With users increasingly relying on user reviews to make buying decisions, having access to trustworthy reviews is critical for consumers. Last month, Amazon sued a group of review brokers who were allegedly paying for fake reviews at large scale. In addition to discussing the suit, Betz outlined some of the steps they have taken to ensure that user reviews are trustworthy and accurately reflect consumers’ experiences. 

Counterfeits 

Given the vast number of products sold through nearly two million sellers worldwide, Amazon has an enormous responsibility to ensure consumer safety. Alyssa discussed some of the measures Amazon has taken to reduce criminals’ ability to operate on their platform, including investing over $700 million and employing more than ten thousand people to protect its store from fraud and abuse, including counterfeit products.

To hear the full episode, including John and Alyssa’s conversation about product liability and how to spot those phony Amazon delivery phishing texts, click here. 

If you have received suspicious communications or packages claiming to be from Amazon, you can find Amazon’s support page here. 

Nancy Glick

Consumers need accurate product names and labeling of plant-based meat products

Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

With mounting information that plant-based diets are generally better for people’s health and the environment, many consumers are giving “meatless meats” a try.

About two-thirds of Americans consumed “plant-based meat alternatives” – or PBMAs – in the past year, with 20 percent eating them at least weekly, according to an August 2021 survey from the International Food Information Council (IFIC).[1] As a result, current estimates put the market for PBMAs at $1.4 billion – up from $962 million in 2019[2] –and a Bloomberg Intelligence Report predicts a 500 percent increase in global sales of plant-based foods globally by 2030.[3]

It is easy to understand consumers’ excitement about meatless products that closely resemble the look, feel and taste of burgers, sausages, deli meat and other products made from beef, pork, chicken, eggs and seafood. Polling shows consumers’ top reason for buying these products is the perceived healthfulness of PBMAs. The most sought-after benefits consumers cite are heart health and a good source of high quality and complete protein.

Yet, the reality is that plant-based meat products vary in their formulations, nutritional content and can be high in saturated fat and sodium. These products are often packaged in the same way as their animal protein counterparts and routinely sold next to the meat section in supermarkets. Thus, consumers need clarity in labeling to ensure product names, descriptions and packaging are not misleading and consumers have the qualifying terms to make informed decisions.

As the agency that regulates plant-based foods in the US, the Food and Drug Administration shares this viewpoint. Later this year, FDA will issue draft guidance on the labeling of plant-based milks and plant-based alternatives to “animal-derived foods” (meats) under the umbrella of the agency’s Nutrition Innovation Strategy. The strategy addresses the need for FDA to modernize its regulatory approach for new categories of foods, like PBMAs, developed through the latest technologies.

In developing its draft labeling guidance, FDA has sought information on a range of issues related to labeling, including whether consumers understand terms like “milk” when used in the name of plant-based alternatives and are aware of the nutritional differences between traditional meat and dairy products and their plant-based substitutes. In response, the agency has received thousands of comments from industry groups, manufacturers, academic institutions and professional societies offering their viewpoints. However, the National Consumers League contends that the consumer’s voice must be articulated and heard. Unless the information needs of consumers are clearly defined, FDA’s goal of labeling for transparency and clarity will not be realized.

To provide the consumer perspective, especially regarding decisions about plant-based meat alternatives, in November 2021 NCL and the Academy of Nutrition and Dietetics (AND) convened a panel of experts to assess consumers’ needs for accurate naming, labeling and claims on the package of PBMAs. Comprising regulatory specialists, market researchers, consumer advocates and food industry leaders, the panel also addressed how some key principles laid out in FDA’s Nutrition Innovation Strategy – a common nomenclature, accurate naming and labeling, and elements that assure honesty and fair dealing — can be applied to improve consumer understanding, perception, and decision-making of PBMA products.

In the near future, NCL will issue a full report of the findings of the expert panel and the implications for consumer education efforts and public policy. However, the need to articulate the consumer perspective on labeling PBMAs shouldn’t wait. Therefore, NCL has translated the consensus from the expert panel into a blueprint for FDA and the food industry.

The following are the seven priorities for labeling, naming and marketing plant-based meats alternatives that are in the best interest of consumers:

  1. Establish a definition for the category of “plant-based meat alternatives” that will unite all stakeholders
    Today, many brands, companies and organizations define the term “plant-based” differently and there is not collective agreement on definition of a “meat alternative.” Since these terms represent an entire class of food products, FDA guidance should define what constitutes a “plant-based meat alternative” to promote consistency in labeling across the category.
  2. Ensure brand names are not deceptive
    NCL’s position is it is a deceptive practice to use brand names for PBMAs that suggest a product contains meat, seafood or eggs when none is present or is better/healthier than the traditional animal protein product. Even when the label states the product contains no meat or eggs, consumers are influenced by the brand name, especially if the packaging and content on the website, social media platforms and in ads shows pictures and iconography of animals or the type of meat. 
  3. Require that labels on PBMAs are standardized and clarify the protein source

For labels of PBMAs to be transparent, the naming and labeling of PBMAs must be uniform and consistent and ensure that consumers can readily identify the protein source. Accordingly, FDA should require that all labels and advertisements for PBMAs must:

  • Use a common name that links the protein source and the form, such as “soy burger.”
  • Make clear that the product contains some animal protein in addition to plant-based proteins like soy. Qualifying terms can include “plant-based” and “made from plants.”
  • Make clear when the PBMA contains no meat. These terms can include vegan,” “meatless,” “vegetarian,” “veggie,” and “veggie-based” as well as “plant-based” and “made from plants.”
  • Place the phrase “contains no meat,” “contains no poultry,” or “contains no eggs” on the principal display panel of vegan PBMAs near the common name and in letters at least the same size and prominence as shown in the product’s common name.
  • Not use pictures, icons or vignettes on the packaging, in marketing materials or in advertising that suggests nutrition superiority or that the product is the same as the comparable meat product.
  1. Regulate health/nutrition claims for PBMAs
    Consistent with how FDA regulates the health claims allowed on traditional food products, FDA must make clear in its guidance that nutrition/health claims must undergo review by the FDA through a petition process and there must be significant scientific agreement that the claim is supported by available scientific evidence.
  2. Ensure website, social media, and advertising content for PBMAs conforms to what is on the product label

The guidance must make clear that FDA considers websites and social media to be an extension of the product label, meaning the claims and information that PBMA manufacturers put online must conform what FDA allows on the label.

  1. Address the nutritional composition of the PBMAs in FDA guidance
    In Canada, regulation of PBMAs includes nutritionally required amounts of vitamins and mineral nutrients that must be added to the PBMA product and a minimum limit of total protein content, among other requirements. While NCL supports this approach, FDA should at least recommend levels of key vitamins and nutrients in its guidance and address concerns, such as allergenicity with labeling requirements to flag known allergens, such as soy.
  2. Educate consumers about the nutritional composition of plant-based protein alternatives

It is in the public interest for FDA and the US Department of Agriculture – along with nutrition societies – to conduct education programs that explain the nutritional composition of plant-based protein food products. This will allow consumers to make informed decisions based on science-based information.

Plant-based meat alternatives are a popular and valued part of our food supply. That is why the public needs regulatory policies that ensure the labels on these products are accurate, complete, and provide the qualifiers necessary for consumers to understand what they are purchasing.


[1] International Food Information Council. “Consumption Trends, Preferred Names and Perceptions of Plant-Based Meat Alternatives. November 3, 2021.

[2] Good Food Institute. US retail market data for the plant-based industry. Accessible at: https://gfi.org/marketresearch/

[3] Fortune. Plant-based food sales are expected to increase fivefold by 2030. August 11, 2021. Accessible at: https://fortune.com/2021/08/11/plant-based-food-sales-meat-dairy-alternatives-increase-by-2030/

Why we need more Black health professionals in the workforce

By NCL Health Policy Associate Milena Berhane

A lack of diversity in the health care workforce has been a persistent issue in the United States, posing significant implications to health equity, particularly for the Black or African American community.

An estimated five percent of physicians identify as Black, despite making up 13 percent of the U.S. population. A recent study utilizing U.S. Census Bureau information found that the proportion of Black physicians in the United States has only increased by four percent in more than a century — from 1900-2018. This study also reported that the percent of Black male physicians has remained relatively stagnant since 1940. Diversity issues also exist in other health care professions, with an estimated 7.8 percent of nurses, 3.8 percent of dentists, and 2.5 percent of physical therapists being Black.

The education, testing, application, and interviewing process required to pursue a career in health care is rigorous and costly. In addition to a four-year degree, candidates are also required to take standardized exams, pay expensive application fees, and pay for travel to interview. Most medical students expect to spend up to $10,000 for the application process. Once accepted to a health professional program, the tremendous monetary and time costs of schooling are immense obstacles for many. Medical school attendees accumulate an average $200,000 of student loans by the time they are finished with their programs.

Due to generations of systemic racism in our country, Black Americans are less resourced — financially and in terms of social capital — than their white counterparts. The rigorous process of applying to and remaining in health professional programs creates a pipeline that excludes disadvantaged students from the ability to pursue careers in clinical care.

The barriers to enter the workforce have further negative impact on communities and health equity. Black patients face a variety of issues that can influence their ability to access medical care, including medical mistrust caused by historical unethical medical mistreatment faced by Black Americans, dismissal of health concerns that Black patients express to health care providers, and others. Time and time again, Black patients have shared their experiences of medical providers ignoring their health concerns, and therefore being undertreated and going undiagnosed for their conditions. In addition, research indicates that Black patients report poorer patient-provider communication and shared decision-making. These issues lead to Black patients receiving lower quality care from medical providers, further worsening health conditions that could be treated.

Racial bias and a lack of culturally competent medical care in the healthcare system has led to poorer health outcomes for Black patients. Black Americans of all ages already face higher rates of hypertension, asthma, diabetes, and other health issues due to systemic racism and how it has affected the environments they live in, the food they have access to, their education prospects, income, etc. These inequities compiled with a culturally incompetent and bias medical system leaves Black Americans with little ability to receive proper medical treatment and improve their health and well-being. Although medical schools are attempting to teach the importance of culturally competent care, it is crucial that Black patients are also able to access healthcare providers that look like them and come from their communities.

Clearly, the current make up of racial diversity of the health care workforce has failed to keep up with the demographic shifts in the United States. Although public health efforts are important in addressing and improving health equity, inequities within the medical system must be addressed simultaneously. The COVID-19 pandemic has only highlighted and exacerbated health inequities. Increasing the amount of Black health professionals across the United States is a critical step in ensuring better health outcomes for Black patients and their overall well-being.

Annual fraud report highlights crypto insecurity

By Eden Iscil, Public Policy Associate

Earlier this month, NCL’s Fraud.org project released its annual Top Ten Scams report. After collecting thousands of consumer complaints, we sorted through the data to share the major trends from the past year. We saw some interesting trends! 

As the pandemic has entered its third calendar year, notable patterns included median dollar losses from fraud reaching a 10-year high and investment-related scams increasing by almost 170 percent, likely due to the rising popularity of cryptocurrency. So, consumers who lose money to scams are losing more of it. And cryptocurrency-related scams are something we all need to start paying attention to. 

These are the top ten scams reported to Fraud.org in 2021: 

  1. Prizes/Sweepstakes/Free Gifts  
  2. Internet: General Merchandise  
  3. Phishing/Spoofing  
  4. Fake Check Scams  
  5. Friendship & Sweetheart Swindles  
  6. Investment: Other (incl. cryptocurrency scams)  
  7. Advance Fee Loans, Credit Arrangers  
  8. Family/Friend Imposter  
  9. Computers: Equipment/Software (incl. tech support scams)  
  10. Scholarships/Grants 

The categories with the highest median losses were fake check scams at $2,000 and investment scams at $1,750. 

Focus: Cryptocurrency driving investment fraud 

Fake check scams have often scored near the top on our annual trend reports, but investment scams jumped several ranks, more than doubling their share of consumer complaints. Given the explosive growth of cryptocurrency usage in 2021, the emerging market likely provided an opening for fraudsters to take advantage of still-developing regulations and a lack of consumer knowledge about these new forms of investing.  

Fraud.org’s data appears to take the same shape as trends from the Federal Trade Commission (FTC), which had reported a ten-fold increase in cryptocurrency fraud. The FTC’s data spotlight on cryptocurrency scams also included a median loss of $1,900, a figure further demonstrating the heightened risk that consumers face within this sphere. Unfortunately, consumer protections in cryptocurrency usage are largely a patchwork of state-by-state rules, with some trading regulated by the Securities and Exchange Commission (SEC). 

Notably, Bitcoin and Ethereum (the two most popular cryptocurrencies) have so far been exempt from the SEC’s strictest oversight requirements, as it is considered a commodity rather than a security. The lack of comprehensive, nationwide protections coupled with the fact that these coins exist to be anonymous, instant, and irreversible creates an unsafe environment for consumers—especially ones who may be entering this space for the first time.  

Although media buzz has generated a lot of interest in crypto, with reports often centered on the potential for eye-popping returns, these articles do a disservice to readers if they don’t include the risks involved. Market volatility, a lack of consumer protections, and environmental damage only scratch the surface when it comes to hazards related to virtual currencies. These liabilities can be minimized by sticking with traditional forms of payment and investment—pending comprehensive regulation of digital coins. 

The full Top Ten Scams Report for 2021 can be found here. Additionally, Fraud.org’s February Fraud Alert includes great tips to help consumers better protect themselves against 2021’s top scams. 

Illicit drugs and the digital marketplace

By NCL Health Policy Associate Milena Berhane

Technology has brought into the homes of millions of consumers many wonderful tools for accessing the drugs and medical products we need. We, as consumers — at the touch of a few buttons — have access to drugs and devices that would have required far more time and effort to acquire in the past. But with that ease of access, we also have millions of tainted or suspect products peddled to consumers, including counterfeit drugs.

At any one time, there are 35,000 active pharmacies online, according to ASOP Global. Ninety-five percent of them do not comply with applicable laws and pharmacy standards. Counterfeit products sold by this 95 percent are manufactured in often unsafe conditions and contain little or no active ingredients.

Those in charge of online registries could better control this. These registries control the websites that can be set up on the Internet, managing domain name extensions such as .com, .gov, and .org, and .pharmacy. It is critical that Internet registries and registrars monitor the activity on their domains and ensure that illegal activity is prevented.

Consumers look for drugs online for both cost and convenience reasons. It’s understandable that consumers are turning to the Internet for cheaper options when the cost of many prescription drug costs is so high. Those who do undoubtedly don’t understand the risk of illegal online pharmacies; research shows only an estimated 37 percent see little danger in ordering from such a pharmacy. In addition, 7 in 10 Americans incorrectly believe that appearing at or near the top of Internet search results legitimizes such a website.

The COVID-19 pandemic has also played a role in these risks, with an increased sale of online goods, including prescription drugs. About 31 percent of consumers who bought prescription medication online did so for the first time in 2020 because of the pandemic. As a result, now more than ever, we need to ensure that illegitimate online pharmacies are far better regulated, and frankly, put out of business.

The examples are stark. In 2021, the Drug Enforcement Administration (DEA) seized more than 9.5 million counterfeit pills, which is more than what was seized in 2020 and 2019 combined. Due to these high numbers, in late 2021, the DEA warned that “fake prescription pills are widely accessible and often sold on social media and e-commerce platforms — making them available to anyone with a smartphone, including minors.”

We believe that online platforms have the responsibility to enforce their terms and conditions. These registries and registrars are choosing profit over safety by allowing online pharmacies to sell fake drugs and products.

For this reason, the National Consumers League is supporting the DRUGS Act (H.R. 6352/S.3399) which aims to holds Internet registries and registrars responsible for any illegal and illegitimate drugs being sold through their online platforms. Modeled after a pilot “trusted notifier” program, this bill would require registries to suspend a website, conduct an investigation, and then shut the platform down if it is found to be selling illegal substances.

In the meantime, NCL will continue to educate consumers about the dangers of counterfeit drugs. NCL’s FakeRx Action Center provides consumers with the tools to protect themselves from fake drugs and illegal online pharmacies — as well as a place to report counterfeits. Consumers have a duty to do their homework, but we have to make it far harder for fakes and counterfeits to be peddled to unwitting consumers. The DRUGS Act will go a long way to make that a reality.