From Health and Fitness

How to Follow the News in a Political Age of Anxiety

Another day and, for many, another worrisome news alert out of Washington — or two, or three. Travel bans. Policy reversals. Wire taps.

In October, during the buildup to Election Day, we heard from therapists about how their patients were feeling fearful, angry and distrustful in reaction to the contentious presidential race. Now, these same therapists report that many of their patients are even more upset as they struggle to make sense of the direction in which the country is heading. And many can’t tear themselves away from the news.

“So much is coming at us,” said Sue Elias, a psychotherapist in New York City. “There’s a chronic sense of anxiety among my patients that I have never seen before.”

Indeed, Americans are reporting even higher levels of stress than they did before the election, according to a report from the American Psychological Association released in February. And like so many issues these days, the stress appears to be partisan.

The report, called Stress in America: Coping with Change, was based on a Harris Poll of more than 3,500 American adults in August, with a follow-up of more than 1,000 men and women in January. While 26 percent of Republicans polled after the election said the political climate was a source of stress, 72 percent of Democrats said they felt that way. The report also found that 86 percent of adults constantly or often check their email, texts and social media accounts, and that those who are constant checkers are more likely to experience stress.

The cycle of vigilance can be insidious. “The election results caused feelings of uncertainty,” which leads many people to check the news and search for information to help them cope, said Dr. Eric Hollander, a professor of psychiatry and the director of the Autism and Obsessive-Compulsive Spectrum program at Einstein — Montefiore Medical Center in the Bronx. If people see a tweet about wiretapping or deportations, for example, and try to look up news articles about it, what they find often “only heightens the worry and perpetuates the cycle,” he said.

“Many of my patients are frightened and on edge. They wonder, Could the next news alert report that missiles are flying through the air?” said Dr. Robert Bright, a psychiatrist at the Mayo Clinic in Phoenix. “Almost all my patients report having insomnia.” He tells clients who are feeling overwhelmed to turn off news alerts on their phones and instead tune into the news just once a day. If social media feels as if it’s making your blood pressure rise, limit the number of times per week you log on.

“A couple of patients told me they were incredibly stressed and embarrassed to tell friends they had voted for Trump, as they felt they would lose their friendship,” said Elaine Ducharme, a licensed clinical psychologist in Glastonbury, Conn. “The country was already divided, but the election has made it feel more so.”

She advises patients to talk to people on the other side of the political divide, in order to understand their point of view. She also reminds them that big changes will not happen instantly and counsels them to do something fun and engaging. “I’ve been playing Words With Friends online in French,” she says. “It’s been wonderful.”

Dr. Steven C. Hayes, a psychology professor at the University of Nevada in Reno, likewise advises reaching out to others on the opposing political side. “Have a conversation, not to convince, but to be curious,” he said. “Practicing empathy for different points of view can help you feel less distressed.” You might find that you have more in common than you imagined.

“I’m surrounded by Democrats,” said Abe McCallum, a software product architect in San Francisco who is a Trump supporter. “But I talk to them. I find that there is a lot of common ground between us. Talking things out lowers my stress level. If you just move across the aisle, it relieves a lot of pressure.”

Dr. Hayes agreed. “Use your anxiety to motivate you,” he said. “Think about what you value most and take action.” Taking action can help to instill the sense that you have some control over your environment — what psychologists call perceived self-efficacy — and leave you feeling less stressed.

Action might take the form of old-fashioned letter writing. Dan Shaw, a freelance writer based in Falls Village, Conn., sent a postcard to Chief Justice John G. Roberts Jr. saying: “If we have a constitutional crisis, please protect our democracy and our freedom.” He also writes regularly to his senator.

Volunteering is another option. A study from BMJ Open that analyzed data from a large, longitudinal study in England found that those who volunteered their time scored higher on tests measuring mental health than those who did not; the results were particularly robust for those over 40. Even a “minimal amount of participation” in volunteer activities boosted mental well-being. The authors theorize that volunteering may provide people with a “sense of purpose” and help “maintain social networks.”

After the election, Robin Marshall, a brand strategist in Brooklyn, wanted to channel her “rage” productively. She and a few friends now organize fund-raisers at local restaurants for groups such as Planned Parenthood and the National Immigration Law Center. “In addition to raising money, the events bring members of the community together and provide others with a way to help, too,” says Ms. Marshall.

Identifying those issues that are most important to you, then connecting with watchdog organizations that can be vigilant on your behalf, is another way to keep the anxiety in check. If climate change is a top concern, for instance, periodically check in with an environment group like the Natural Resources Defense Council that follows that issue closely and offers tips about how to make your voice heard.

Laura Fishman, a speech pathologist in Westin, Fla., says she was never a “political person,” but after the election, she grieved for a few weeks, then joined the group South Florida Women Rise Up, a progressive political group focused on education and action, which meets the first Monday of the month. “When I attend these meetings I feel more hopeful,” she said.

For some, simply taking the time to be a better person is calming. “I consciously try to be nice to everyone,” says Leslie Koren, a content consultant in New York City. “Being polite and kind helps to counteract a lot of the feelings of helplessness and all the negativity in the air.”

Walk, Stretch or Dance? Dancing May Be Best for the Brain

By GRETCHEN REYNOLDS

Could learning to dance the minuet or fandango help to protect our brains from aging?

A new study that compared the neurological effects of country dancing with those of walking and other activities suggests that there may be something unique about learning a social dance. The demands it places on the mind and body could make it unusually potent at slowing some of the changes inside our skulls that seem otherwise inevitable with aging.

Neuroscientists and those in middle age or beyond know that brains alter and slow as we grow older. Processing speed, which is a measure of how rapidly our brains can absorb, assess and respond to new information, seems to be particularly hard hit. Most people who are older than about 40 perform worse on tests of processing speed than those who are younger, with the effects accelerating as the decades pass.

Scientists suspect that this decline is due in large part to a concomitant fraying of our brain’s white matter, which is its wiring. White matter consists of specialized cells and their offshoots that pass messages between neurons and from one part of the brain to another. In young brains, these messages whip from neuron to neuron with boggling speed. But in older people, brain scans show, the white matter can be skimpier and less efficient. Messages stutter and slow.

Whether this age-related decline in white matter is inexorable, however, or might instead be changeable has been unclear.

So for the new study, which was published this month in Frontiers in Aging Neuroscience, researchers from the University of Illinois in Urbana and other schools decided to look at the effects of several different types of exercise on the wiring and the function of older people’s brain.

They began by recruiting 174 healthy people in their 60s and 70s with no signs of cognitive impairment. Most were sedentary, although some occasionally exercised.

Then they invited the men and women to a university lab for tests of their aerobic fitness and mental capacities, including processing speed and a brain scan with a sophisticated M.R.I. machine.

Finally, the researchers randomly divided the volunteers into several groups. One began a supervised program of brisk walking for an hour three times a week. Another started a regimen of supervised gentle stretching and balance training three times a week.

The last group was assigned to learn to dance. These men and women showed up to a studio three times a week for an hour and practiced increasingly intricate country-dance choreography, with the group shaping itself into fluid lines and squares and each person moving from partner to partner.

After six months, the volunteers returned to the lab to repeat the tests and the brain scans from the study’s start.

The differences now proved to be both promising and worrisome.

By and large, everyone’s brain showed some signs of what the scientists termed “degeneration” of the white matter. The changes were subtle, involving slight thinning of the size and number of connections between neurons.

But the effects were surprisingly widespread throughout people’s brains, given that only six months had elapsed since the first scans, says Agnieszka Burzynska, the study’s lead author and a professor of exercise and neuroscience at Colorado State University in Fort Collins. (She was previously a postdoctoral researcher at the University of Illinois.)

The degeneration was especially noticeable in the oldest volunteers and those who had been the most sedentary before joining the study.

However, one group showed an actual improvement in the health of some of the white matter in their brains, compared to six months before. The dancers now had denser white matter in their fornix, a part of the brain involved with processing speed and memory.

It seems likely that the cognitive demands of the dancing, which required people to learn and master new choreography throughout the six months of the study, affected the biochemistry of the brain tissue in the fornix, Dr. Burzynska says, prompting increases in the thickness and quantity of the wiring there.

Interestingly, none of the changes in the volunteers’ white matter were obviously reflected in their cognitive performance. Almost everyone performed better now on thinking tests than at the study’s start, including tests of their processing speed, even if their white matter was skimpier.

These results indicate that there could be a time lag between when the brain changes structurally and when we start having trouble thinking and remembering, Dr. Burzynska says.

But, more encouraging, she says, they also suggest that engaging in “any activities involving moving and socializing,” as each of these group programs did, might perk up mental abilities in aging brains.

“The message is that we should try not to be sedentary,” she says. “The people who came into our study already exercising showed the least decline” in white matter health, she points out, and those who took up dancing showed white-matter gains.

Of course, this study was relatively short-term. Dr. Burzynska hopes in the future to study the brains of people engaging in different types of exercise over the course of several years.

But for now, she says the data provide another rationale for moving — and perhaps also learning to contra dance and sashay.

How to Be Mindful on a Hike

Meditation for Real Life
By DAVID GELLES

“Hiking in nature provides an opportunity to tune in — both to our own experience and to the world around us. While it can be easy to get lost in thought or daydreams while hiking, the simple practices of mindfulness can draw us more closely into our experience of the natural world.” — Khalila Archer, program director at Inward Bound Mindfulness Education.

Start by paying attention to each step. Simply notice each time your foot makes contact with the ground.

Notice your body, moving through space. Feel the contact of air against your skin. Is it hot, cool, heavy, light?

Bring your awareness to your senses.

Touch: What do you feel in your body as you hike?

Smell: What scents do you pick up as you move?

See: What do you notice? Pay attention to both what is below and above you.

Hear: What sounds do you hear?

Allow each sensation to wash over you, not holding on to any one, but gently receiving each as you notice it.

When hiking uphill, take your time. Let your weight come fully into each step before you take the next one, and find a pace that allows your breathing to have a steady rhythm.

Find moments to stop and receive the experience, at the top of a hill, looking over a view, at a junction in the trail or in front of a beautiful flower or tree.

Feel your feet on the ground, your body in space and notice the movement of the environment around you.

First Edition: March 29, 2017

Mar 29 2017

Today’s early morning highlights from the major news organizations.

Kaiser Health News: Justice Department Joins Lawsuit Alleging Massive Medicare Fraud By UnitedHealth
Fred Schulte reports: “The Justice Department has joined a California whistleblower’s lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans. Justice officials filed legal papers to intervene in the suit, first brought by whistleblower James Swoben in 2009, on Friday in federal court in Los Angeles. On Monday, they sought a court order to combine Swoben’s case with that of another whistleblower.” (Schulte, 3/29)

Kaiser Health News: March Madness Vasectomies Encourage Guys To Take One For The Team
KQED’s April Dembosky reports: “Doctors say it all started eight years ago, when a urology clinic in Oregon ran an ad promoting the benefits of scheduling a vasectomy in March. “You go in for a little snip, snip and come out with doctor’s orders to sit back and watch nonstop basketball,” the voice-over promised. “If you miss out on this, you’ll end up recovering during a weekend marathon of ‘Desperate Housewives’!” (Dembosky, 3/28)

Kaiser Health News: Lead Poisoning’s Lifelong Toll Includes Lowering Social Mobility, Researchers Find
Shefali Luthra reports: “Findings published Tuesday in JAMA break new ground by suggesting the effects of childhood lead exposure continue to play out until adulthood, not only harming an individual’s lifelong cognitive development, but also potentially limiting socioeconomic advancement. Specifically, Duke University researchers tracked a generation of kids based on data collected through a nearly 30-year, New Zealand-based investigation known as the Dunedin Multidisciplinary Health and Development Study.” (Luthra, 3/28)

Kaiser Health News: On The Air With KHN: What’s Next For The Affordable Care Act?
On Friday, House Republican leaders failed to secure enough support to pass their plan to repeal and replace the Affordable Care Act. Reporters with Kaiser Health News and California Healthline (produced by KHN) have appeared on numerous radio and television shows in recent days to assess what’s next for the health law. Listen to what they had to say below. (3/28)

The New York Times: Repeal Of Affordable Care Act Is Back On Agenda, Republicans Say
Under extreme pressure from conservative activists, House Republican leaders and the White House have restarted negotiations on legislation to repeal the Affordable Care Act. But efforts to revive the legislation in the House could take weeks, lawmakers conceded, as Congress moves forward with a full plate of other time-consuming issues. And the renewed push did not meet with much enthusiasm from Senate Republicans, who said they had other priorities at the moment. (Pear and Peters, 3/28)

The Associated Press: Ryan Says House To Revisit Health Care, Offers No Details
Speaker Paul Ryan said Tuesday he’s going to give battered House Republicans another crack at a health care overhaul. But he offered no timeline, and leaders haven’t resolved how to overcome the deep GOP divisions that crumpled their legislation last week in a humiliating retreat for themselves and President Donald Trump. (3/28)

USA Today: House Republicans Say They Are Still Negotiating Obamacare Repeal
After the failure of the bill and some weekend reflection, Freedom Caucus Chairman Mark Meadows, R-N.C., and his caucus are trying to do things differently. The group is working with leadership and moderate Republicans to try to bring back the bill in a different form. Meadows had a meeting with Ryan on Tuesday, which was unusual because the Freedom Caucus had largely gone around leadership during the negotiation process and dealt directly with the White House. (Collins, 3/28)

The Associated Press: Senate, White House Pass On House Push To Revive Health Bill
Senate Majority Leader Mitch McConnell, R-Ky., made his views clear after a closed-door lunch with fellow Senate Republicans and Vice President Mike Pence. “It’s pretty obvious we were not able, in the House, to pass a replacement. Our Democratic friends ought to be pretty happy about that because we have the existing law in place, and I think we’re just going to have to see how that works out,” McConnell said. “We believe it will not work out well, but we’ll see.” (3/28)

Politico: GOP On Reviving Obamacare Repeal: Lots Of Talk, No Action
[L]awmakers and aides acknowledge the odds are not in their favor. The conference is still deeply divided, and members are seething over the demise of their replacement bill — with most fingers pointing at members of the arch-conservative Freedom Caucus. During a meeting with several dozen whips Monday night, Republican allies of leadership vented about how they want to punish members of the conservative group who “don’t play with the team.” (Bade, Cheney and Bresnahan, 3/28)

Politico: Roskam Rejects Bid To Revive Failed GOP Obamacare Repeal Bill
Rep. Peter Roskam (R-Ill.), a former member of House Republican leadership, is leading a charge to bury Speaker Paul Ryan’s Obamacare replacement once and for all and start over, multiple sources told POLITICO. The move by the senior House Republican who sits on the Ways and Means committee could complicate any GOP leadership attempt to resurrect the bill that Ryan pulled from the floor Friday. (Bade and Bresnahan, 3/28)

Politico: Trump Tells Senators: We Can Deal On Health Care ‘Very Quickly’
President Donald Trump still sees a deal on health care. In fact, he told senators he has “no doubt that that’s going to happen very quickly.” Speaking in brief remarks at a White House reception for senators and their spouses, Trump brushed off the recent collapse of a House-led bill to repeal and replace Obamacare. (Jackson, 3/28)

The Washington Post: Here’s When We’ll Know The Future Of Obamacare
President Trump and his fellow Republicans have failed, at least for now, in their bid to repeal Obamacare entirely, but they still have plenty of ways to cripple the law without pulling it off the books. By blocking funding for subsidies or refusing to enforce the individual mandate, the administration and congressional Republicans could undermine the law’s insurance exchanges — government-established marketplaces where individuals can buy health insurance from private companies, often with the help of federal subsidies. The exchanges and an expanded Medicaid program are the main programs in Obamacare, officially known as the Affordable Care Act, aimed at expanding coverage to the uninsured. (Johnson, 3/28)

Politico: Trump Could Blow Up Obamacare With One Move
President Trump says that Obamacare is going to explode. But if that happens, it is likely because his administration supplies the spark that detonates the marketplaces. The White House could decide at any time to eliminate subsidies relied upon by insurers to lower costs for Obamacare’s poorest customers, as a result of a court win by House Republicans last spring. (Demko, 3/29)

The Associated Press: Hillary Clinton Calls Defeat Of GOP Health Care Bill ‘A Victory For All Americans’
A spirited Hillary Clinton took on the Trump administration Tuesday in one of her first public speeches since she lost the presidential election, criticizing the country’s Republican leaders on everything from health care to the shortage of women appointees in top administration positions. Cracking jokes about her November defeat and her months out of the limelight since, Clinton spoke to thousands of businesswomen in San Francisco, joking there was no place she’d rather be, “other than the White House.” (Knickmeyer, 3/28)

The Washington Post: Kansas Moves To Expand Medicaid As GOP Legislatures Face Pressure After ‘Trumpcare’ Failure
State lawmakers in this deep-red state on Tuesday did what a year ago would have been unthinkable: They voted to expand Medicaid under the health-care law that Republicans here have railed against for years. … The abrupt reversal in Kansas could be the front edge of a larger shift nationally, as state lawmakers absorb the repercussions of congressional Republicans’ failed attempt to repeal and replace elements of the Affordable Care Act. (DelReal and Somashekhar, 3/28)

Reuters: Kansas Passes Medicaid Expansion Bill Despite Governor’s Objection
The Kansas Senate gave final approval on Tuesday to a bill expanding eligibility for Medicaid under the federal Affordable Care Act (ACA) even though the measure faces a likely veto by Republican Governor Sam Brownback. The 25-14 Senate vote followed the House’s 81-44 passage of the bill last month, with the vote totals falling short of veto-proof margins in both Republican-controlled chambers. (Pierog, 3/28)

The Wall Street Journal: Kansas GOP-Led Legislature Approves Medicaid Expansion
Legislators said it appears likely Mr. Brownback would veto the bill. “To expand Obamacare when the program is in a death spiral is not responsible policy,” Melika Willoughby, the communications director for Mr. Brownback, said in an emailed statement after the vote Tuesday. “Kansas must prioritize the care and service of vulnerable Kansans, addressing their health care needs in a sustainable way, not expanding a failing entitlement program to able-bodied adults.” (Levitz and Mahtani, 3/28)

The Associated Press: Felony Charges For 2 Who Secretly Filmed Planned Parenthood
California prosecutors on Tuesday charged two anti-abortion activists who made undercover videos of themselves trying to buy fetal tissue from Planned Parenthood with 15 felonies, saying they invaded the privacy of medical providers by filming without consent. The charges against David Daleiden and Sandra Merritt of the Center for Medical Progress come eight months after similar charges were dropped in Texas. (Dalton, 3/29)

The Washington Post: Two Activists Who Filmed Undercover Videos Of Planned Parenthood Charged With 15 Felonies
In announcing the charges against David Robert Daleiden and Sandra Merritt on Tuesday, California Attorney General Xavier Becerra said the duo used manufactured identities and a fictitious bioresearch company to meet medical officials and covertly record the private discussions they initiated. “The right to privacy is a cornerstone of California’s Constitution, and a right that is foundational in a free democratic society,” Becerra said. “We will not tolerate the criminal recording of confidential conversations.” (Schmidt, 3/29)

Los Angeles Times: Antiabortion Activists Face 15 Felony Charges Over Undercover Videos That Targeted Planned Parenthood
An affidavit filed in San Francisco Superior Court alleges that Daleiden and Merritt used phony California driver’s licenses and a fabricated medical research company, BioMax Procurement Services, to attend the National Abortion Federation’s 2014 conference in San Francisco. At the conference, the pair posed as BioMax representatives, offered fake names and surreptitiously recorded eight attendees and speakers, according to court papers. (Hamilton, 3/28)

Politico: California Charges Creators Of Planned Parenthood Undercover Videos
Daleiden’s sting videos, released two years ago through the Center for Medical Progress, accused Planned Parenthood clinics of profiting from the sale of fetal tissue. Planned Parenthood has strongly denied the accusations, and numerous investigations into the organization since the videos were released haven’t found any wrongdoing. The videos strengthened efforts in Congress to cut off federal funding to Planned Parenthood — efforts that are still underway. (3/28)

The Associated Press: Iowa Republicans Back ‘Fetal Heartbeat’ Abortion Legislation
Republicans in the Iowa Legislature are backing newly filed legislation that would ban abortions once a fetal heartbeat is detected, which would be the strictest ban in the country if enacted. A GOP-led House committee had been set to vote on the provision Tuesday night but lawmakers later adjourned without a decision. It’s expected to be taken up again Wednesday. (3/28)

The New York Times: Severe Eczema Drug Is Approved By F.D.A.; Price Tag Is $37,000 A Year
The Food and Drug Administration on Tuesday approved a drug to treat people with a serious form of eczema, a potential breakthrough for people who have suffered for years without relief. But it will not come cheap. The drug, to be called Dupixent, will carry a list price of $37,000 a year, a hefty price tag for patients who are increasingly being asked to pay a larger share of the drugs they take. (Thomas, 3/28)

The Associated Press: FDA Approves 1st Drug For Moderate & Severe Eczema Cases
The drug is an antibody that patients inject just under the skin every two weeks. It binds to a specific protein to inhibit the immune system’s inflammatory response. That’s why in many study participants, Dupixent also improved the asthma and hayfever common in eczema patients. It’s now in late-stage patient testing as an allergy treatment. (Johnson, 3/28)

The New York Times: F.D.A. Approves First Drug To Treat Severe Multiple Sclerosis
The Food and Drug Administration approved on Tuesday the first drug to treat a severe form of multiple sclerosis, offering hope to patients who previously had no other options to combat a relentless disease that leads to paralysis and cognitive decline. The federal agency also cleared the drug to treat people with the more common, relapsing form of the disease. (Thomas, 3/28)

The Wall Street Journal: FDA Approves Drug For Primary Progressive Multiple Sclerosis
“This is an historic day for the MS community with the approval of the first-ever treatment for people living with primary progressive MS. This is a real game-changer,” said Cyndi Zagieboylo, president and chief executive of the National MS Society. “The National MS Society hopes this is just the beginning of the development of the next generation of treatments for MS.” (Burton, 3/28)

The Wall Street Journal: FDA Nominee Plans Recusals From Decisions On Many Drug Firms
The Trump administration’s nominee to lead the Food and Drug Administration plans to recuse himself for a year from FDA decisions on more than 20 companies, including some drug giants. Scott Gottlieb in recent years has held positions and received millions of dollars in income as adviser, executive, paid speaker or consultant to the companies, according to financial-disclosure documents he has filed with government ethics officials. (Burton, 3/29)

The Wall Street Journal: Senator McCaskill Begins Probe Of Prescription Opioid Marketing
An influential Democratic lawmaker has begun a probe into the marketing of opioid drugs, sending letters to Purdue Pharma LP, Johnson & Johnson and other big sellers of the pain medicines for materials detailing sales practices. Sen. Claire McCaskill (D.-Mo.), the top-ranking Democrat on the Senate Homeland Security and Governmental Affairs Committee, said she aims to clarify “the challenges industry practices pose to efforts to curb opioid addiction.” (Rockoff, 3/28)

The Washington Post: Opioid Crisis: McCaskill Demands Documents From Manufacturers
Sen. Claire McCaskill of Missouri demanded information Tuesday from five top opioid manufacturers, saying she would investigate their alleged role in the drug epidemic responsible for more than 200,000 overdose deaths since 2000. “This epidemic is the direct result of a calculated sales and marketing strategy major opioid manufacturers have allegedly pursued over the past 20 years to expand their market share and increase dependency on powerful — and often deadly — painkillers,” McCaskill, who is the ranking Democrat of the Homeland Security and Governmental Affairs Committee, wrote to company executives. (Bernstein and Higham, 3/28)

USA Today: Suburban Drug Overdoses Fuel Spike In Premature Death Rate
Premature deaths among those aged 25-44 were way up in 2015, due in large part to a surge of drug overdoses in suburban areas, a report out Wednesday shows. Drug deaths are also accelerating among 15- to 24-year-olds, but almost three times as many people in this age group died by homicide, suicide or in motor vehicle crashes, according to the new report from the Robert Wood Johnson Foundation (RWJF). A rural and urban divide, along with racial differences, were also evident in the data. Young white adults in rural areas were more likely to die by suicide or overdose, while homicides by firearms were much more common for young black victims. (O’Donnell, Gluck and Carter, 3/29)

The New York Times: In School Nurse’s Room: Tylenol, Band-Aids And An Antidote To Heroin
At every school in New Rochelle, just north of the Bronx, in Westchester, there is a locked medicine cabinet in the nurse’s office, stocked with things like EpiPens for allergic reactions, inhalers for asthma, Tylenol for aches and pains. Now, those cabinets also include naloxone, an antidote for people who are overdosing on opioids like heroin. Given as an injection or a nasal spray, naloxone can quickly revive someone who is not breathing. The city keeps it in every nurse’s office, including in its elementary schools. (Harris, 3/29)

NPR: Lead Exposure In Childhood May Blunt Thinking Skills For Decades
“It’s toxic to many parts of the body, but in particular in can accumulate in the bloodstream and pass through the blood brain barrier to reach the brain,” says the study’s first author, Aaron Reuben, a graduate student in clinical psychology at Duke University. (Bichell, 3/28)

The New York Times: Costly Doctors Don’t Provide Better Care
Doctors who tend to spend more in treating hospitalized patients do not get better results than those who spend less, a new study has found. Researchers examined spending records of 72,042 physicians at more than 3,000 acute care hospitals. The patients were fee-for-service Medicare beneficiaries 65 and older treated between January 2011 and the end of 2014. (Bakalar, 3/28)

The Washington Post: This Woman Is Growing A Second Skeleton — And It’s Locking Her Inside Her Own Body
Jasmin Floyd was on her way to kindergarten in northeastern Connecticut, buckled into the back seat of her mother’s car. On the way, she called out, “Mommy, my neck hurts,” her mother, RoJeanne Doege, recently recalled. Doege said she peered through the rearview mirror and tried to reassure her, “Honey, it’s probably just how you slept. ”But it wasn’t — and, not long after that, Floyd’s father noticed that their 5-year-old’s neck was tilted ever so slightly to the side. (Bever, 3/28)

The Washington Post: Should ‘Morning-After’ Pills Be Available On College Campuses Around The Clock?
Sarah Riback doesn’t have personal experience with getting the pills on campus. But the 19-year-old at the University of Maryland knows peers who have needed them. “This is a common thing that a lot of other female students have had to do,” she said. She’s talking about emergency contraception. Riback and other advocates say morning-after pills should be available on college campuses at all hours. At U-Md., they’re available at a student health center pharmacy that is open 36 hours a week, Monday through Friday. (Larimer, 3/28)

Los Angeles Times: Hepatitis B And C Can Be Wiped Out In The U.S. By 2030. Here’s How
Health experts have devised an aggressive plan to stamp out a viral disease that is fueling a sharp rise in liver cancer in the United States and killing 20,000 Americans per year. Their national strategy for eliminating two types of hepatitis by 2030 hinges on persuading the federal government to purchase the rights to one or more of the costly new medications that can essentially cure hepatitis C. (Healy, 3/28)

Los Angeles Times: California GOP Lawmakers Introduce Bills To Boost Healthcare And Jobs For Veterans
Republican state lawmakers unveiled a package of six bills Tuesday aimed at improving job training and healthcare services for California veterans. “Our veterans have served this country bravely and it is only right for us to recognize their contribution and see that when they do come home they receive the care and assistance they deserve,” said state Sen. Janet Nguyen of Garden Grove, who authored three of the measures. (Dillon, 3/28)

NPR: Scientists Replicate Female Reproductive System In A Dish To Aid Research
Scientists say they’ve made a device in the lab that can mimic the human female reproductive cycle. The researchers hope the device, assembled from living tissue, will lead to new treatments for many medical problems that plague some women, ranging from fibroids and endometriosis to infertility, miscarriages and gynecologic cancers. (Stein, 3/28)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

March Madness Vasectomies Encourage Guys To Take One For The Team

Doctors say it all started eight years ago, when a urology clinic in Oregon ran an ad promoting the benefits of scheduling a vasectomy in March.

“You go in for a little snip, snip and come out with doctor’s orders to sit back and watch nonstop basketball,” the voice-over promised. “If you miss out on this, you’ll end up recovering during a weekend marathon of ‘Desperate Housewives’!”

Copycat ads followed. Now a sports radio show in Washington, D.C., has an annual Vasectomy Madness contest, where the prize is a free vasectomy.

Here’s how it works: Three guys come on the air to make their cases for getting snipped. The announcers ruthlessly roast them, and then listeners vote on their favorite.

“All right, let’s bring in our next contestant,” a host said. “I believe it’s Abe from Warrenton, Va. So tell us your story. Why are you here?”

Abe has three kids, ages 9, 6 and 3.

“Another one — surprise! Due in July,” Abe said. “I was shopping after the third for a vasectomy and, like a dope, dragged my feet.”

There’s Mike, also expecting his fourth child — also a surprise.

“My wife and I have had enough,” he pleaded. “We need help to stop the flow.”

And then there’s Charles.

“Four kids. Three different women,” Charles said, inspiring a roar of jeers from the hosts.

Procrastination can be so common with the “Big V” that it takes a panel of sports jocks offering a free procedure for some guys to finally let a doctor take a scalpel to their nether regions.

That may be one reason vasectomy rates are low: About 5 percent of women rely on their partner’s vasectomy for contraception, unchanged from a decade ago. The Centers for Disease Control and Prevention’s National Survey of Family Growth compares that to 20 percent of women who have had a sterilization procedure, even though women’s surgery is more invasive and more expensive.

“Men are culturally the providers. It’s hard for them to seek care,” said Dr. Paul Turek, a California urologist. “They don’t know how to be a patient.”

Turek has clinics in San Francisco and Beverly Hills. He sees an uptick in vasectomy visits during March Madness, and he’s also noticed more guys coming in together.

“One group came in from a tech company in a limousine,” he said.

Last year, five college buddies scheduled a group vasectomy in March. They live all over the U.S. now, and one of them had an idea to reunite in San Francisco and undergo the outpatient procedure together.

“I gave ’em a deal,” Turek said. “I closed the doors. We had sports TV on. They were having fun.”

As each guy returned to the waiting room, he was greeted with fist bumps and high-fives. Then the men hobbled back to their hotel to bet on the games and yell at the television together.

Turek made an interesting observation during that bro basketball weekend: The friends seemed to recover faster than his typical patients.

“They had no complaints,” he said. “They were back at work sooner. They took fewer pain pills. It was the best anesthesia, having their buddies with them.”

Turek gives all his vasectomy patients a certificate of honor for “uncommon bravery and meritorious performance.”

There is another theory about why vasectomies aren’t more popular: the cost. The Affordable Care Act requires insurers to cover contraceptives without charging out-of-pocket costs. But vasectomies weren’t included in the rule. The procedure costs about $500, but some doctors charge up to $1,000.

That’s why Charles subjected himself to the free vasectomy contest at the D.C. radio station. His insurance covers a portion of the procedure, “but I’d still have to pay my deductible, which is, like, a thousand bucks.”

Vasectomy was overlooked in Obamacare because, under the law, birth control was considered a women’s health service.

“Right now the policy says to a couple: Your insurance will cover birth control without any out-of-pocket costs on your end, as long as it’s the woman who’s using it,” says Adam Sonfield, senior policy manager at the Guttmacher Institute.

Last year, 12,000 people signed a petition asking regulators to cover vasectomy without cost sharing. Doctors’ groups even drafted language to this effect to add to the regulations.

But when the Trump administration took over, it told the groups to stop trying, according to Aaron Hamlin, executive director of the Male Contraception Initiative.

“The birth control benefit has been under pretty much continual political attack since the ACA was enacted,” said Sonfield.

So for now that leaves guys like Charles, Mike and Abe vying for a free March Madness vasectomy. The winner in the end?

Abe — one of the guys expecting his fourth child.

His prize came with a catch, though. He will have to let one of the sportscasters come to his appointment, to broadcast a “play-by-play.”

This story is part of a partnership that includes KQED, NPR and Kaiser Health News.

Categories: Cost and Quality, Health Industry, Public Health, The Health Law

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On The Air With KHN: What’s Next For The Affordable Care Act?

On Friday, House Republican leaders failed to secure enough support to pass their plan to repeal and replace the Affordable Care Act. Reporters with Kaiser Health News and California Healthline (produced by KHN) have appeared on numerous radio and television shows in recent days to assess what’s next for the health law. Listen to what they had to say below.

National Media

NPR’s All Things Considered with Mary Agnes Carey (March 25):


CNN’s Smerconish with Mary Agnes Carey (March 25):


WBUR’s On Point with Mary Agnes Carey (March 27):

https://kaiserhealthnews.files.wordpress.com/2017/03/032717-on-point_carey.mp3


WAMU’s 1A with Julie Rovner (March 27):

Click here to listen to the segment.


WBUR’s Here & Now with Julie Rovner (March 27):

https://kaiserhealthnews.files.wordpress.com/2017/03/032717-here-now_rovner.mp3


PBS NewsHour with Mary Agnes Carey (March 27):

[embedded content]


California Media

KCRW’s The Mixer with Anna Gorman (March 24):

https://kaiserhealthnews.files.wordpress.com/2017/03/032417-kcrw_gorman.mp3


KQED’s The California Report with Pauline Bartolone (March 27):

https://kaiserhealthnews.files.wordpress.com/2017/03/032717-kqed_bartolone.mp3


KPCC’s Air Talk with Chad Terhune (March 27):

https://kaiserhealthnews.files.wordpress.com/2017/03/032717-kpcc_terhune.mp3

Categories: Multimedia, Repeal And Replace Watch, The Health Law

The Real Reason I Work Out? Because I Want to Live in Leggings

The woman I want to be looks something like the woman I saw in a recent Athleta catalog. She’s effortlessly jumping across a babbling brook in a verdant forest—while wearing sleek slate-gray workout tights and a quilted jewel-toned hoodie. Or wait: Maybe I’m the lady doing yoga on the beach in a slouchy pale-pink tank top, who I saw pictured in the window at Lululemon. While I definitely admire both of their strong bodies and what looks like adventurous spirits (as well as their choice of vacation spots)—I also really, really want those clothes.

Confession: I’ve never met a pair of leggings I didn’t love. As far as I’m concerned, if I could spend 90 percent of my life in slimming, strategically seamed workout wear that makes me feel ready to leap and bound, I would.

But it comes with a catch. If I want a piece of new gear, I’ve got to earn it. I have to be out there logging miles, slogging through spin class, grimacing through the ridiculously hard thigh portion of barre workouts. I need to be using the stuff so much that occasionally the items actually wear out and have to be replaced! It’s simple: The more consistent I am with my exercise regimen, the more justified I feel bringing home a new goodie.

RELATED: 8 Mesh-Paneled Leggings We’re Obsessed With Right Now

Judging from what I wear the majority of the time—note that I work from home—you’d think I was pretty much always coming from or going to the gym. But that’s the point. The last person I want to be is the lady who looks like she is suited up for the gym but whose main cardio is gabbing at school drop-off. Oh, and my little sweat-for-spandex bargain also works once the gear has come home with me. On a day when I’m short on motivation, a cute new top is often what gets me out the door.

Look, I’m not aiming to be the best in the class, the fastest in the park, or even a seven-days-a-week exerciser. I’m only trying to keep myself on track when it comes to my spending, my sweating, and my style. Some people need a prize at the finish line. Me? I need something dangling at the starting gate—something just within reach and preferably ankle-length.

Justice Department Joins Lawsuit Alleging Massive Medicare Fraud By UnitedHealth

The Justice Department has joined a California whistleblower’s lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans.

Justice officials filed legal papers to intervene in the suit, first brought by whistleblower James Swoben in 2009, on Friday in federal court in Los Angeles. On Monday, they sought a court order to combine Swoben’s case with that of another whistleblower.

Swoben has accused the insurer of “gaming” the Medicare Advantage payment system by “making patients look sicker than they are,” said his attorney, William K. Hanagami. Hanagami said the combined cases could prove to be among the “larger frauds” ever against Medicare, with damages that he speculates could top $1 billion.

UnitedHealth spokesman Matt Burns denied any wrongdoing by the company. “We are honored to serve millions of seniors through Medicare Advantage, proud of the access to quality health care we provided, and confident we complied with program rules,” he wrote in an email.

Burns also said that “litigating against Medicare Advantage plans to create new rules through the courts will not fix widely acknowledged government policy shortcomings or help Medicare Advantage members and is wrong.”

Medicare Advantage is a popular alternative to traditional Medicare. The privately run health plans have enrolled more than 18 million elderly and people with disabilities — about a third of those eligible for Medicare — at a cost to taxpayers of more than $150 billion a year.

Although the plans generally enjoy strong support in Congress, they have been the target of at least a half-dozen whistleblower lawsuits alleging patterns of overbilling and fraud. In most of the prior cases, Justice Department officials have decided not to intervene, which often limits the financial recovery by the government and also by whistleblowers, who can be awarded a portion of recovered funds. A decision to intervene means that the Justice Department is taking over investigating the case, greatly raising the stakes.

“This is a very big development and sends a strong signal that the Trump administration is very serious when it comes to fighting fraud in the health care arena,” said Patrick Burns, associate director of Taxpayers Against Fraud in Washington, a nonprofit supported by whistleblowers and their lawyers. Burns said the “winners here are going to be American taxpayers.”

Burns also contends that the cases against UnitedHealth could potentially exceed $1 billion in damages, which would place them among the top two or three whistleblower-prompted cases on record.

“This is not one company engaged in episodic bad behavior, but a lucrative business plan that appears to be national in scope,” Burns said.

On Monday, the government said it wants to consolidate the Swoben case with another whistleblower action filed in 2011 by former UnitedHealth executive Benjamin Poehling and unsealed in March by a federal judge. Poehling also has alleged that the insurer generated hundreds of millions of dollars or more in overpayments.

When Congress created the current Medicare Advantage program in 2003, it expected to pay higher rates for sicker patients than for people in good health using a formula called a risk score.

But overspending tied to inflated risk scores has repeatedly been cited by government auditors, including the Government Accountability Office. A series of articles published in 2014 by the Center for Public Integrity found that these improper payments have cost taxpayers tens of billions of dollars.

“If the goal of fraud is to artificially increase risk scores and you do that wholesale, that results in some rather significant dollars,” Hanagami said.

David Lipschutz, senior policy attorney for the Center for Medicare Advocacy, a nonprofit offering legal assistance and other resources for those eligible for Medicare, said his group is “deeply concerned by ongoing improper payments” to Medicare Advantage health plans.

These overpayments “undermine the finances of the overall Medicare program,” he said in an emailed statement. He said his group supports “more rigorous oversight” of payments made to the health plans.

The two whistleblower complaints allege that UnitedHealth has had a practice of asking the government to reimburse it for underpayments, but did not report claims for which it had received too much money, despite knowing some these claims had inflated risk scores.

The federal Centers for Medicare & Medicaid Services said in draft regulations issued in January 2014 that it would begin requiring that Medicare Advantage plans report any improper payment — either too much or too little.

These reviews “cannot be designed only to identify diagnoses that would trigger additional payments,” the proposal stated.

But CMS backed off the regulation’s reporting requirements in the face of opposition from the insurance industry. The agency didn’t say why it did so.

The Justice Department said in an April 2016 amicus brief in the Swoben case that the CMS decision not to move ahead with the reporting regulation “does not relieve defendants of the broad obligation to exercise due diligence in ensuring the accuracy” of claims submitted for payment.

The Justice Department concluded in the brief that the insurers “chose not to connect the dots,” even though they knew of both overpayments and underpayments. Instead, the insurers “acted in a deliberately ignorant or reckless manner in falsely certifying the accuracy, completeness and truthfulness of submitted data,” the 2016 brief states.

The Justice Department has said it also is investigating risk-score payments to other Medicare Advantage insurers, but has not said whether it plans to take action against any of them.

Categories: Cost and Quality, Courts, Health Industry, Medicare

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Lead Poisoning’s Lifelong Toll Includes Lowering Social Mobility, Researchers Find

Cynthia Brownfield was lucky. When her daughter, then 2 years old, tested for high levels of lead in her blood, she could do something.

Brownfield, a pediatrician in St. Joseph, Miss., got her home inspected and found lead in the windows. She got them replaced and had her pipes fixed, too. Her daughter, now 12, was probably affected, says Brownfield. But quick action minimized the exposure. Her daughter is now a healthy, fully-functioning preteen.

“We were in the financial position where we could hire a plumber and change the windows,” she said. But others — even her own patients — may not be so fortunate. This reality may have implications even more far-reaching than generally accepted.

Findings published Tuesday in JAMA break new ground by suggesting the effects of childhood lead exposure continue to play out until adulthood, not only harming an individual’s lifelong cognitive development, but also potentially limiting socioeconomic advancement. Specifically, Duke University researchers tracked a generation of kids based on data collected through a nearly 30-year, New Zealand-based investigation known as the Dunedin Multidisciplinary Health and Development Study.

They studied the development of more than 1,000 New Zealanders born between April 1972 and March 1973. Because at that time gasoline still contained lead, exposure was common, creating a sizeable sample that included people across class and gender. More than half in that data set had been tested for lead-exposure at age 11, and the study tracked brain development and socio-economic status over the years — making for “a natural time” to use them to study lead’s health effects, said Aaron Reuben, a PhD candidate in neuropsychology at Duke University, and the study’s first author.

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By the time study participants reached age 38, a pattern emerged: Children who were exposed to lead early in life had worse cognitive abilities, based on how their exposure level. The difference was statistically significant. They were also more likely to be worse off, socioeconomically, than those who had not been exposed to lead. The study found that no matter what the child’s IQ, the mother’s IQ, or the family’s social status, lead poisoning resulted in downward social mobility. That was largely thanks to cognitive decline, according to the research.

“Regardless of where you start out in life, exposure to lead in childhood exerts a downward pull to your trajectory,” Reuben said.

Though this research was set in New Zealand, it offers insight into a problem experts said is fairly ubiquitous in the United States and across the globe. The CDC estimates that as many as half a million children between ages 1 and 5 had blood lead levels high enough to cause concern: 5 micrograms per deciliter and up. At least 4 million households across the country have children experiencing significant lead exposure.

Last year’s water crisis in Flint, Mich., brought lead exposure front and center as a public health concern. Meanwhile, a Reuters investigation published this winter found elevated lead levels in almost 3,000 communities around the country. The Centers of Disease Control and Prevention recently changed its guidelines to suggest that any childhood exposure to the chemical is harmful, and is pushing to get rid of lead poisoning in kids by 2020.

In the U.S., children at risk are typically poorer and racial minorities — in part because they more often live in older houses with lead paint. This is a stark difference from the research population, which tended to be white. However, because the study spanned a period of time in which lead was still used in gasoline, the lead exposure measured in the study spanned a wider class spectrum.

That adds greater consequence to these findings, many said.

“Kids who are poor, or who have some of these other social determinants of health that are negative — they end up with a double whammy. Whatever health consequences they have from being poor, those are added to the additional consequences of being exposed to lead,” said Jerome Paulson, an emeritus professor and pediatrician at George Washington University. Paulson has researched lead’s effects on children, although he wasn’t involved with this study.

“If you want to talk about ‘breaking out of poverty,’ kids who have lead exposure are probably going to have more difficulties,” he added.

That said, these conclusions aren’t perfect. For instance, the research doesn’t account any variation in how the children who were tested may have been previously exposed to lead, or how their continued lead exposure through adulthood may have differed. Those who worked in jobs like construction, for instance, may have had greater lead exposure than those in white-collar jobs, Paulson noted. But on the whole, he said, it makes a strong case for the long-term impact of childhood lead exposure.

Pennsylvania, Maryland and Massachusetts, which all have cities with concentrated areas of older housing, have identified lead poisoning as a major child health hazard. The CDC has also embraced “primary prevention” — testing homes for lead and removing it before people move in and risk exposure. But securing resources for lead testing, screening and abatement poses its own set of challenges.

The JAMA study illustrates, in part, one such difficulty. Lead poisoning happens over years, not overnight. So illustrating the impact, even if it’s ultimately significant, is hard to do.

“Prevention doesn’t have a lot of pizzazz. If you prevent something from happening, it’s a wonderful thing, but it’s hard to measure and take credit for,” said David Bellinger, a neurology professor at Harvard Medical School and a professor in the environmental health department of the university’s public health school, who wrote a commentary that ran alongside the JAMA paper.

And funding for such programs is often unreliable, said Donna Cooper, the executive director of Public Citizens for Children and Youth, a Pennsylvania-based nonprofit that advocates on behalf of young people. For instance, the White House’s initial budget plans would boost some lead abatement funds but slash other grants used for similar purposes. And for many states, she said, even what’s long been available isn’t enough to meet the scope of the concern.

“We have very clear CDC guidance on what should be done, and no money to back it up,” Cooper said. “It ebbs and flows with the headlines.”

Categories: Public Health

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Costly Doctors Don’t Provide Better Care

Doctors who tend to spend more in treating hospitalized patients do not get better results than those who spend less, a new study has found.

Researchers examined spending records of 72,042 physicians at more than 3,000 acute care hospitals. The patients were fee-for-service Medicare beneficiaries 65 and older treated between January 2011 and the end of 2014.

The investigators calculated spending in the first two years, and tracked outcomes in the last two. They concentrated on the types of spending controlled by doctor choice — tests, procedures, imaging studies and so on. The study is in JAMA Internal Medicine.

After adjusting for the varying characteristics of the hospitals, they found that spending among physicians varied by as much as 10.5 percent.

But there was no association over all between higher physician spending and 30-day mortality, or between spending and readmissions. In other words, more spending did not yield better results.

“Even when you go to the same hospital, you’re going to get a different bill — as much as 40 percent higher — depending on who treats you,” said the lead author, Dr. Yusuke Tsugawa, a researcher at the Harvard T.H. Chan School of Public Health. “And you’re not getting better care from a doctor who submits a higher bill.”

How Kickboxing Can Change Your Body and Your Life

This article originally appeared on Time.com. 

To get better balance, power and agility, kickboxing is king among workouts. Experts who have studied the sport say nearly everyone—even older people who might shy away from such things—can benefit from throwing a punch.

Unlike most other types of exercise, kickboxing emphasizes powerful movements. Power is different from strength, and for older adults, it’s an even better predictor of mobility and their risk for falls, says Kurt Jackson, an associate professor of neurology and rehab science at the University of Dayton in Ohio. “Pure strength is what a weightlifter uses, but producing power is about both force and speed,” he says.

Kickboxing training tends to involve shorts bouts, two to three minutes long, of intense, repetitive movement—like hitting a punching bag over and over again and kicking and kneeing a pad someone else is holding. “If you look at the research on high-intensity interval training [HIIT], you see these short, intense periods of activity can have big benefits,” he says. Some research shows that even very brief stretches—just 60 seconds—of HIIT can offer the same gains in heart and lung health as 45 minutes of less-intense exercise.

Kickboxing has been shown to improve fitness, power, flexibility and agility, according to a study of healthy men in their twenties who trained three days a week for five weeks. The men in the study improved their upper and lower body power by about 7%, while shaving off more than a second from their time in a 50-meter dash.

It also torches a lot of calories. One study from the American Council on Exercise (ACE) found that the kind of punching-and-kicking combinations used in Tae Bo or “cardio kickboxing” classes burn more than eight calories per minute—about the same amount you’d burn while swimming.

RELATED: Torch Calories With This Total-Body Circuit Workout

The sport can also improve coordination, even in the most extreme cases. Jackson studies the neuromuscular benefits of kickboxing training for people with multiple sclerosis (MS), a condition in which poor communication between the brain and muscles can lead to falls or problems with activities that rely on multitasking, like walking and talking. Kickboxing helps strengthen neuromuscular control in people with the disease in ways that improve balance, mobility and dual-tasking activities, he found.

The benefits likely apply to older adults as well. Kickboxing improves both types of balance that the body requires—anticipatory and reactive—and better balance reduces risk of falls or muscle weakness. “Anticipatory balance is something you use when you can see a need coming, like when you’re stabilizing yourself to reach up into a cupboard,” Jackson says. Reactive balance is the type of mind-muscle coordination you need to catch your balance when you trip, or when life throws some unexpected object your way.

Those skills are useful before you hit old age. If your workout routine relies on lifting weights, running or yoga, your neuromuscular system may not be tuned to handle the kind of dynamic motion required for sports—even the ones you do just a few times a year, like skiing or pickup basketball. “You see these people step or twist wrong and suffer major tears,” Jackson says. “Kickboxing training is a great way to avoid those types of injuries.”

However, the swift whole-body movements required in kickboxing could also cause injuries. Back, knee, hip and shoulder strains are all common among kickboxers, found a study in the Journal of Strength and Conditioning Research.

As with most other forms of vigorous exercise, if you’re a newbie, it’s important to ease into kickboxing gradually. “If you have a bad knee or some other limitation, it’s important to have a coach or physical therapist who knows how to adapt a kickboxing program to your needs, and who will introduce it in a controlled, systematic manner,” Jackson says. Start slow, and you’ll get the most benefits in the end.

Viewpoints: Short Shrift For Mental Health Coverage; Medicare’s Firewall From ‘Harmful’ Changes

A collection of opinions on health care from around the country.

Boston Globe: Changing Attitudes Is Harder Than Changing The Law 
Someone trying to access mental health care is twice as likely to be denied coverage by a private insurer than someone seeking surgical or other medical care, according to a survey of 84 insurance plans in 15 states by the National Alliance on Mental Illness. Matt Selig, executive director of Health Law Advocates, a Boston-based nonprofit group that represents low-income residents, said that last year alone his agency opened cases for 158 people who were denied coverage for mental health or substance use treatment, nearly half of them children. (Kevin Cullen, 3/27)

Arizona Republic: McCain Can Stop Cuts To Seniors’ Health Care
The future of Medicare and Medicaid may depend on John McCain. He is one of a handful of Senate Republicans who could serve as a firewall against harmful changes to this crucial program that Arizona seniors rely upon. … Looking down the road, the majority in Congress has also proposed to privatize Medicare and raise the eligibility age from 65 to 67. These actions could reduce health care coverage and increase out-of-pocket costs for Arizona’s 1,134,000 seniors and people with disabilities. (Max Richtman, 3/27)

Los Angeles Times: Note To Republicans: Drop The Crusade Against Planned Parenthood
Millions of Americans who rely on the Affordable Care Act for their insurance coverage dodged a bullet last week when Republican infighting killed a bill by the House GOP leadership to repeal and replace the healthcare law. So, thankfully, did Planned Parenthood. Embedded in the bill was a provision to bar federal funding temporarily for this well-regarded and crucial healthcare provider, which the GOP has tried, obsessively, to dismantle for years. (3/28)

St. Louis Post-Dispatch: Saluting Our Doctors: The Calm Within The Storm
For many, the role of physicians in hospice is especially important — as they attend to patients and families at this most vulnerable time, guiding and comforting them through the toughest decisions they will ever make. What kind of quality of life does the patient want? What side effects can be expected from chemo or certain medications? What’s the best way to deal with pain? It’s a role hospice doctors readily accept. (Dr. Hashim Raza, 3/28)

The New York Times: Training Your Brain So That You Don’t Need Reading Glasses
By middle age, the lenses in your eyes harden, becoming less flexible. Your eye muscles increasingly struggle to bend them to focus on this print. But a new form of training — brain retraining, really — may delay the inevitable age-related loss of close-range visual focus so that you won’t need reading glasses. Various studies say it works, though no treatment of any kind works for everybody. (Austin Frakt, 3/27)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Perspectives On What Happens Now: Can Obamacare Be Fixed Or Will It Be Left To ‘Explode’?

Opinion writers offer their thoughts on this question, outline ways the health law can be spared and examine the direction in which the political winds could send the ongoing debate.

The Washington Post: Obamacare Is The Law Of The Land. But It’s Still Vulnerable.
House Speaker Paul D. Ryan’s (R-Wis.) decision to pull legislation to reconfigure the nation’s health-care system is a major setback to President Trump and the GOP. For seven years, Republicans promised to repeal and replace Obamacare. Their failure to deliver on this promise exposes intraparty divisions that will not be easily healed. (Eric Patashnik and Jonathan Oberlander, 3/27)

Los Angeles Times: Can Trump Be Stopped From Making Obamacare ‘Explode’?
Supporters of the Affordable Care Act may have celebrated prematurely at the demise last week of the House Republicans’ proposal for its repeal. Yes, the most immediate threat to the future of Obamacare is dead, for now. And in the wake of the House fiasco, President Trump as well as some Senate Republicans have made noises about reaching out to Democrats to shore up the health insurance program. But the Trump White House and congressional Republicans still have it within their power to damage the prospects of health coverage for millions of Americans, whether by actively undermining the Affordable Care Act by administrative fiat or by letting it wither by neglect. (Michael Hiltzik, 3/27)

The Atlantic: Obamacare Won’t Explode Unless Trump Wants It To
The scope of Obamacare’s problems is small, but significant. While health-care costs have been going up less than normal in recent years and premiums for people insured by their employers have also been fairly stable, people who buy their own insurance through the Obamacare marketplaces saw premiums spike by an average of about 25 percent this year. Also, several insurers pulled out of the Obamacare exchanges in the past year, leaving 21 percent of exchange enrollees with just one insurance option and people in Knoxville, Tennessee with potentially no insurers at all. (Olga Khazan, 3/28)

The New York Times: Pushing Obamacare Over The Cliff 
After Republicans pulled their legislation to repeal and replace the Affordable Care Act last Friday, President Trump told The Washington Post, “The best thing politically is to let Obamacare explode.” Or he could light a match. Republicans may have conceded defeat in their legislative effort to get rid of Obamacare, but their guerrilla war to achieve its demise remains underway. (Steven Rattner, 3/28)

The Washington Post: Why Trump Won’t ‘Let Obamacare Explode’
As President Trump licked his wounded ego Friday, he told The Post in an interview, “The best thing politically is to let Obamacare explode.” His Office of Management and Budget director, Mick Mulvaney, echoed that sentiment on “Meet the Press.” (Jennifer Rubin, 3/27)

The Des Moines Register: It’s Time To Embrace And Fix Affordable Care Act
“I have to tell you, it’s an unbelievably complex subject,” President Donald Trump told governors during a meeting last month. “Nobody knew that health care could be so complicated.” Nobody except everyone else. That is why the 2009 Democratic-controlled Congress spent a year debating and ironing out the details of what eventually became the Affordable Care Act. The two-part law and regulations total thousands of pages. Before passage, lawmakers met with insurers, hospitals, physicians and patient advocacy groups to build a consensus for what they all understood was a labyrinthine endeavor. (3/27)

The New York Times: Republicans For Single-Payer Health Care
Without a viable health care agenda of their own, Republicans now face a choice between two options: Obamacare and a gradual shift toward a single-payer system. The early signs suggest they will choose single payer. That would be the height of political irony, of course. Donald Trump, Paul Ryan and Tom Price may succeed where left-wing dreamers have long failed and move the country toward socialized medicine. And they would do it unwittingly, by undermining the most conservative health care system that Americans are willing to accept. (David Leonhardt, 3/28)

Atlanta Journal-Constitution: Post-AHCA, How Health Reform Can Move Forward In Georgia
When Roswell’s Tom Price moved from Congress to the executive branch as secretary of health and human services, he instantly gained the power to reshape much of the way health care works in this country, regardless of what becomes of Obamacare. Ironically, it’s Obamacare that gives him that ability… It also gives Price’s department the authority to grant the states waivers to the law’s requirements for health plans offered on their insurance exchanges, and that’s where this gets interesting. (Kyle Wingfield, 3/27)

WBUR: Can Gov. Charlie Baker Fix Health Care In America?
Republicans have long hyped the need for a replacement bill by sowing the fear that Obamacare is imploding. Yet they hypocritically ignore their own complicity in creating the conditions for failure. Now that their bill has collapsed, the new mantra is to practice saying “I told you so,” in the event their self-fulfilling prophecy comes to fruition. (Lauren Stiller Rikleen, 3/28)

The Washington Post: Why Trump And The GOP Could Fail On Tax Reform, Too
There are many lessons to be learned from the failure of the GOP health-care effort. An important one is that being a businessman, even a successful one, does not prepare you for the complexities of governing, any more than being a successful software engineer means you could easily become a great carpenter. (Paul Waldman, 3/27)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Different Takes On Who’s To Blame For The Demise Of The House GOP Health Plan

Editorial pages across the country offer their thoughts on the blame game as well as the policies and politics that led to last week’s dramatic outcome.

Los Angeles Times: Healthcare Debacle Results From Republicans Believing Their Own Myths
Donald Trump and congressional Republicans created a political debacle for themselves by believing a set of scare stories about Obamacare that came back to haunt them. It is an object lesson in how false realities ultimately pop like soap bubbles when pricked by plain old truth. There are five fatal fibs the GOP sold to supporters and to themselves. (David Horsey, 3/27)

Boston Globe: In Donald Trump’s Oval Office, The Buck Stops Elsewhere
Since US House Speaker Paul Ryan scrapped last week’s vote on the Republican proposal to replace Obamacare, Trump has blamed different people for its demise, depending on the day. From the Oval Office on Friday, Trump blamed Democrats. On Saturday, Trump asked people to watch a Fox News Channel show on which the host proclaimed, “Paul Ryan needs to step down as speaker of the House.” (Pindell, 3/27)

The Wichita Eagle: Trump’s Ego Costs Him Opportunity On Health Care
When President Trump’s first major governing challenge unexpectedly crystallized last week, his failure to meet it was preordained by his personality. Because he considers himself the center of every universe, an opportunity to step toward greatness was invisible to him. His primary failure wasn’t his inability to persuade the hard-liners in his party to go along with a cobbled-together, cynical and desperate attempt to repeal and replace the Affordable Care Act. Solomon could not have salvaged that wreck. (Davis Merritt, 3/28)

Los Angeles Times: Who’s To Blame For Trump’s Failures? Must Be Paul Ryan
Paul Ryan did it. That’s the argument many of the louder voices on the right are shouting. In the story they tell, the speaker of the House is fully responsible for the GOP’s failure to pass an Obamacare repeal-and-replace bill last week. President Trump should walk across a Havana ballroom like Michael Corleone in “The Godfather Part II,” kiss Ryan on the mouth and say, “I know it was you, Paul. You broke my heart.” (Jonah Goldberg, 3/27)

The Washington Post: This Is Why The Freedom Caucus Called The Shots On Trump’s Health-Care Bill
The Republicans’ failed strategy to repeal and replace the Affordable Care Act is puzzling. Knowing that a more conservative health-care bill would be dead on arrival in the Senate, why did President Trump and House Speaker Paul D. Ryan (R-Wis.) seek the votes of the House Freedom Caucus (HFC), a group of about 30 of the chamber’s most conservative members? Desperate to secure a majority, the White House offered significant last-minute policy concessions to the group — turning off the more centrist members of the Tuesday Group, failing to secure Freedom Caucus votes and dooming the bill. (Ruth Bloch Rubin, 3/27)

The Wall Street Journal: The GOP Entitlement Caucus
The full dimensions of the GOP’s self-defeat on health care will emerge over time, but one immediate consequence is giving up block grants for Medicaid. This transformation would have put the program on a budget for the first time since it was created in 1965, and the bill’s opponents ought to be held accountable for the rising spending that they could have prevented. (3/27)

The Washington Post: The Freedom Caucus Blows Its Chance To Govern
A few days before the House Freedom Caucus brought down the American Health Care Act, Rep. Mark Meadows laid out the stakes for his group: “This is a defining moment for our nation, but it’s also a defining moment for the Freedom Caucus.” The North Carolina Republican was right. The vote was indeed a defining moment — a test in which the Freedom Caucus had to decide: Would it remain a minoritarian opposition bloc whose only role was to defend truth without compromise? Or could it become something bigger, transforming itself into a majoritarian governing force that could lead Congress toward achievable conservative victories and have a lasting impact on the direction of our country? (Marc A. Thiessen, 3/27)

Huffington Post: The Death Of Trumpcare Is The Ultimate Proof Of Obamacare’s Historic Accomplishment
Somehow, despite the intense political forces arrayed against it, and the mind-boggling policy problems it tries to solve, the 2010 health care law keeps defying efforts to wipe it out. That says something about the people who wrote it ― and what they have achieved. Obamacare has never been hugely popular, and it has never worked as well as its architects hoped. Millions of Americans don’t like it and, even now, there are parts of the country where the markets are struggling to survive. But the program has provided security and access to care for millions of others. More importantly, it has shifted the expectations of what government should do ― and of what a decent society looks like. (Jonathan Cohn, 3/26)

Los Angeles Times: The Original Mistake That Distorted The Health Insurance System In America
A World War II-era mistake distorted the U.S. health insurance system. Reformers tried to fix the problem with patchwork solutions until Obamacare dumped yet another layer of misguided policy onto what was already a mess. Now the tangle is so perplexing that a Republican Congress, under a Republican president, could not even bring a health-insurance reform bill to a vote last week. But legislators will no doubt try to tackle the issue again, and when they do, they should consider erasing the original error instead of merely papering it over. (Myron Magnet, 3/28)

RealClear Health: Five Lessons From The AHCA’s Demise
While the keyhole of history has had insufficient time to bring the failed launch of the American Health Care Act (AHCA) into focus, it’s not too soon to begin learning some of the lessons it can teach us. Legislative efforts have a lifespan but our health care system does not. So whether we are still rejoicing or recriminating, let’s take a look at some timeless principles we can apply to the ongoing effort to improve health care in the United States. (Billy Wynne, 3/27)

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State Highlights: Once-Grand D.C. Hospital Serving African-American Patients Beset By Troubles; Colo. City Bucks Free-Standing ER Trend

Media outlets report on news from D.C., California, Missouri, Colorado, New Jersey and Pennsylvania.

The Washington Post: Howard University Hospital Shows Symptoms Of A Severe Crisis
But over the past decade, the once-grand hospital that was the go-to place for the city’s middle-class black patients has been beset by financial troubles, empty beds and an exodus of respected physicians and administrators, many of whom said they are fed up with the way it is run. The facility has faced layoffs, accreditation issues, and sexual harassment and discrimination lawsuits, and it has paid out at least $27 million in malpractice or wrongful-death settlements since 2007, a Washington Post examination has found. (Thompson, 3/25)

Denver Post: Wheat Ridge Stands Firm On Its Prohibition Of Free-Standing ERs
Free-standing emergency rooms may be on a growth streak in Colorado — there are around three dozen facilities today from just a handful a few years ago — but not everyone is rolling out the welcome mat. On Monday night, the Wheat Ridge City Council voted to extend a year-long moratorium it had placed on free-standing ERs in 2016 for another year as it comes up with regulations for the medically advanced, emergency care centers before the first sets up shop in the city. (Aguilar, 3/27)

Des Moines Register: Branstad Defends Pledge To Help Medicaid Firms Cover Losses
Gov. Terry Branstad on Monday defended his administration’s decision to help private Medicaid managed care organizations shoulder huge financial losses, and he said it doesn’t mean the project is in trouble. … The three companies have complained they’ve lost hundreds of millions of dollars in Iowa in the year since they began running the state’s $4 billion Medicaid program. The Des Moines Register reported Friday that the Department of Human Services has signed contract amendments under which the state agreed to help the companies cover some of those losses. (Leys,3/27)

St. Louis Post Dispatch: St. Louis County Home Health Worker Admits Defrauding Elderly Of $30,000 
A home health care worker from St. Louis County pleaded guilty to federal charges Monday and admitted defrauding elderly people in the area, the U.S. Attorney’s office said. De’Janay Noldon, 27, worked as a certified nurse’s assistant caregiver at a Webster Groves company that provides home health care for the elderly, prosecutors said. She used a nursing home resident’s personal information to open lines of credit that she used to pay her own bills, make purchases in stores and online and pay bills for relatives and friends, prosecutors said. (Patrick, 3/27)

NJ Spotlight: NJ Spotlight Helps Plan For Healthcare Future As GOP Bill Melts Down 
Hours before the Republican plan to replace Obamacare died in Congress Friday without a vote, healthcare experts in New Jersey gathered to discuss how the state’s healthcare system can withstand the major changes under consideration in Washington, D.C., and ensure gains made in recent years aren’t entirely lost. Several speakers said that regardless of the fate of the Republican bill, the state needed to prepare for potential changes. Some suggested creating a state-run insurance plan that would essentially extend the existing Medicaid proposal, which now covers one-in-five New Jersey residents, or finding other ways to reduce the cost of care so more can afford to purchase commercial plans. (Stainton, 3/27)

The Philadelphia Inquirer/Philly.com: In Fight Over EMS, Virtua Hospital Blasts Camden County’s ‘Political Machine’
Virtua Hospital executives on Monday accused Camden County freeholders of fear-mongering, saying the board is attacking Virtua’s emergency response times to clear the way for rival Cooper University Hospital to take over as the county’s emergency response provider. The remarks came after Virtua executives learned that freeholders were to host a forum Tuesday morning with mayors from around the county whose agenda would include improvements to advanced life support services. Virtua, which provides such services to municipalities throughout Camden County, was not invited to the meeting, which was described in a letter to mayors as an opportunity to address concerns about response times that are “woefully inadequate” in some areas. (Steele, 3/27)

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Clinic Seeks To Turn Marijuana From ‘Gateway Drug’ To Gateway To Treatment

A small but growing number of pain doctors and addiction specialists are overseeing the use of marijuana as a substitute for more potent and dangerous drugs. In other public health news: the opioid epidemic, lead standards, childhood trauma, multiple sclerosis, Zika, HPV vaccines and concussions.

The New York Times: Addiction Specialists Ponder A Potential Aid: Pot
Nine days after Nikolas Michaud’s latest heroin relapse, the skinny 27-year-old sat on a roof deck at a new drug rehabilitation clinic here. He picked up a bong, filled it with a pinch of marijuana, lit the leaves and inhaled. All this took place in plain view of the clinic’s director. … The new clinic is experimenting with a concept made possible by the growing legalization of marijuana: that pot, rather than being a gateway into drugs, could be a gateway out. (Richtel, 3/27)

Stat: EPA Sidestepped Decision To Tighten Standards For Lead Levels
The 750,000-ton stack is a mix of lead, arsenic, and other toxic metals, blended with sand and abandoned by the businesses that once employed most of the town, about 100 miles southwest of Chicago, in the Illinois River Valley. When the wind blows, specks of toxic metals sail off the slag heap and land on the town’s modest houses and gardens, in school playgrounds, on church steps and, sometimes, in the water…It is the lead — a toxin that can damage children’s brains at even low levels of exposure — that worries most people here. (Kaplan, 3/28)

Milwaukee Journal Sentinel: An Intractable Problem
Public health experts in Milwaukee and around the nation now see a direct link between childhood trauma and an incapacitated workforce. Improving the latter is impossible without addressing the former. Children exposed to abuse, violence and neglect may not be able to concentrate in school, much less job training programs. (Schmid and Crowe, 3/27)

Columbus Dispatch: Multiple Sclerosis Drug Offers Hope Of Halting Disease
In multiple sclerosis, an abnormal immune-system response leads to an attack of nerve fibers and the fatty myelin that surrounds them in the central nervous system… Ocrelizumab works by depleting B cells, which are immune cells that participate in the attack on myelin, Racke said. The drug represents a transformation in MS care, said Dr. Aaron Boster, director of the MS center at OhioHealth, where he also serves as systems medical chief of neuroimmunology. (Viviano, 3/28)

Miami Herald: Zika Virus: Rick Scott Visits Miami Prepare Mosquito Season 
South Florida’s battle plan for Zika, expected to rebound with the rainy season, includes more boots on the ground to inspect and fumigate for mosquitoes, more lab resources to speed up test turnaround times and the promise of a more collegial collaboration between the federal and state governments. (Chang, 3/27)

Kaiser Health News: New Vaccine Recommendation Cuts Number Of HPV Shots Children Need
You’d think that a vaccine that protects people against more than a half-dozen types of cancer would have people lining up to get it. But the human papillomavirus (HPV) vaccine, which can prevent roughly 90 percent of all cervical cancers as well as other cancers and sexually transmitted infections caused by the virus, has faced an uphill climb since its introduction more than a decade ago. Now, with a new dosing schedule that requires fewer shots and a more effective vaccine, clinicians and public health advocates hope they may move the needle on preventing these virus-related cancers. (Andrews, 3/28)

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White House Shies Away From Planned Parenthood Defunding Talk

Press secretary Sean Spicer says the Trump administration won’t commit to including the hot-button issue in the upcoming spending bill. In other women’s health news, some states are still moving to protect access to contraception and Democrats try to reconcile their platform with a need to include anti-abortion voters.

The Hill: WH Won’t Commit To Defunding Planned Parenthood In Spending Bill
The White House refused to commit Monday to defunding Planned Parenthood in an upcoming must-pass spending bill, a sign it’s looking to avoid a government shutdown over the hot-button issue. President Trump viewed the now-dead Republican healthcare bill as “an opportunity to defund” Planned Parenthood, according to press secretary Sean Spicer, who wouldn’t say whether the president would demand defunding in future legislation. (Fabian, 3/27)

Roll Call: Abortion Opponents Look For A Home In Democratic Party
For supporters of abortion rights, the Democratic Party has become the only real option. But as the party struggles to make inroads in red states, where its economic message may resonate more than its social values, some Democrats think there needs to be more flexibility on that issue. … But there’s no easy answer for the Democratic Party. The platform’s narrow focus on abortion rights is borne of a commitment to protect the rights of women to control their own bodies — a self-determination issue from which few Democratic lawmakers in Congress want to back away. (Pathé, 3/28)

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McAuliffe Says Health Bill’s Collapse In Congress Signals Need For Virginia To Expand Medicaid

But the state’s Republican lawmakers, who have consistently opposed such a move, appear unlikely to accept the governor’s suggestion. News outlets also examine a proposal in Georgia to revamp Medicaid, a look at how the program for low-income Americans has evolved since the 1960s and a request from Wisconsin to add drug tests for eligibility.

The Washington Post: McAuliffe: If Obamacare Is Here To Stay, Then It’s Time To Expand Medicaid
The failure of Congress to repeal and replace Obamacare has emboldened Gov. Terry McAuliffe (D) to renew his stalled crusade to expand Medi­caid in Virginia. On Monday, he proposed an amendment to state budget language to give him power to set an expansion in motion, and called on the Republican-controlled General Assembly to immediately begin making plans. But Republican legislators were unmoved by the plea, saying they would reject the amendment and that they stood firm against expanding Medicaid. (Schneider, 3/27)

CNN: McAuliffe Pushes Virginia Medicaid Expansion After GOP’s Failure To Repeal Obamacare
Virginia’s Democratic governor is using President Donald Trump’s failure to repeal Obamacare to heap pressure on Republican state lawmakers to expand Medicaid. Gov. Terry McAuliffe — who has long supported the Affordable Care Act’s Medicaid expansion, but has been stymied by GOP legislators in extending the coverage to more than 400,000 Virginians — announced the push Monday. (Bradner, 3/27)

Atlanta Journal-Constitution: Georgia Eyes New Medicaid Options After Trump Health Bill Fails 
Gov. Nathan Deal said Monday his administration is exploring changes to Georgia’s Medicaid program after a sweeping Republican overhaul of the Affordable Care Act was scuttled in a stunning rebuke to Donald Trump and Congressional leaders. The Republican governor said there are limits to what the state can request “as long as mandates under the basic Obamacare legislation stand in place.” But he said the state would review healthcare options that could include changes to “mandated minimum coverage” provisions that require the state Medicaid program to cover a range of health services to recipients. (Bluestein, 3/27)

The Associated Press: Georgia Governor Says State Will Explore Health Care Changes
Trump’s administration has signaled a willingness to let states experiment with Medicaid funds using waivers. Former Georgia congressman Tom Price now leads the Department of Health and Human Services under Trump. Deal said Monday that he wants the state to look into the options but didn’t discuss details. He also added that his administration hasn’t developed a proposal so far. (Foody, 3/27)

The New York Times: In Health Bill’s Defeat, Medicaid Comes Of Age
When it was created more than a half century ago, Medicaid almost escaped notice. Front-page stories hailed the bigger, more controversial part of the law that President Lyndon B. Johnson signed that July day in 1965 — health insurance for elderly people, or Medicare, which the American Medical Association had bitterly denounced as socialized medicine. The New York Times did not even mention Medicaid, conceived as a small program to cover poor people’s medical bills. (Zernike, Goodnough and Belluck, 3/27)

Milwaukee Journal Sentinel: With Congress Gridlocked, Scott Walker Wants Trump To OK Drug Tests For State Health Coverage
With the GOP’s repeal of Obamacare stymied in Congress, Gov. Scott Walker is still rejecting the federal law and instead asking the Trump administration to let Wisconsin drug test applicants for state coverage. Even though federal money remains available for providing health care to more Wisconsin residents, the GOP governor says he’s not reconsidering his decision to skip that and forgo hundreds of millions of dollars from federal taxpayers. (Stein, 3/27)

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Kansas Senate Gives Preliminary Approval To Medicaid Expansion Bill

Moderate Republicans join with Democrats to easily push through the legislation. But Gov. Sam Brownback has criticized the measure and may veto it.

KCUR: KanCare Expansion Bill Now Just One Step Away 
Buoyed by the failure of Republicans in Congress to repeal the Affordable Care Act, the Kansas Senate on Monday gave tentative approval to a Medicaid expansion bill after debating it for nearly three hours. A bipartisan group of 25 senators voted for the bill. All 13 “no” votes were cast by Republicans concerned about the cost of expansion and opposed to covering low-income, non-disabled adults. If it survives a final-action vote Tuesday, the bill would go to Republican Gov. Sam Brownback, whose spokeswoman reaffirmed his opposition to expansion in tweets during the debate but did not say whether he would veto it. (McLean, 3/27)

Wichita (Kan.) Eagle: Kansas Senate Votes To Expand Medicaid
The legislation in the Senate would expand eligibility for the program for people with incomes of up to 133 percent of the federal poverty line, which is $24,600 for a family of four. The federal government covers 90 percent of the cost of expansion, while the states pay the remaining 10 percent. (Shorman, 3/27)

Kansas City Star: Kansas Senate Votes To Expand Medicaid As Gov. Sam Brownback Doubles Down On Opposition
Opponents of the bill have spent much of the 2017 session downplaying the legislation’s chances because of uncertainty over how health care would change under President Donald Trump’s administration. … But the opponents’ argument faded slightly after U.S. House Speaker Paul Ryan, a Wisconsin Republican, canceled a vote on a bill that would have repealed the Affordable Care Act and effectively barred states from expanding Medicaid beyond March 1, due to a lack of GOP support. (Woodall and Lowry, 3/27)

The Associated Press: GOP Failure In Congress Boosts Medicaid Effort In Kansas
Legislators and advocates in Kansas pushing to expand the state’s health coverage for the poor to thousands of adults are buoyed by the failure of Republicans in Washington to repeal former President Barack Obama’s signature health care law. … The effort in Kansas could prove largely symbolic because Republican legislators remain deeply divided and Brownback is a longstanding critic of health care policies championed by Obama, a Democrat. Yet supporters have scored a significant gain by getting a bill so close to passage. (Hanna, 3/27)

Topeka Capital Journal: Senators Back Medicaid Expansion To Aid Vulnerable Hospitals
Financially fragile hospitals in Kansas — especially facilities in rural areas of the state — have a lot to lose in the Kansas Legislature’s debate about expanding Medicaid services. The Alliance for a Healthy Kansas reported 31 of the state’s 107 hospitals are financially vulnerable because each must grapple with costs of providing care to people who are uninsured. The Senate voted 25-13 on Monday to send the Medicaid expansion bill, House Bill 2044, to final action on Tuesday. Expansion would deliver Medicaid services to about 150,000 more Kansans. (Harford, 3/27)

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Federal Government Takes In $22 Billion In Fines Paid By Health Companies Since 2010

Stat looked at data from 39 agencies to analyze which segments of the health care industry have settled with the government. It found that pharmaceutical companies paid the most, accounting for almost 80 percent of penalties.

Stat: Who Paid The Biggest Fines In Health Care?
When you think of business expenses in the health care industry, you probably don’t think about this mostly hidden cost: settlements made with government agencies. From 2010 to 2017, pharmaceutical companies, health care service providers, and producers of medical equipment and supplies paid the federal government more than $22 billion to settle legal cases. STAT analyzed data from 39 federal regulatory agencies that initiated legal actions against health care companies. In some instances, the companies settled cases without acknowledging any wrongdoing. (Bronshtein, 3/27)

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Price, A Fierce Opponent Of ACA, Now Stuck Holding The Reins On Administering It

Many expect new HHS Secretary Tom Price to shift the regulations onto a more conservative path, but don’t expect him to try to sabotage it completely.

The Hill: Price Faces Unwanted Task Of Administering ObamaCare 
Secretary of Health and Human Services Tom Price came into office last month ready to lead the charge on repealing ObamaCare. Now, that effort has run into a brick wall, leaving him to oversee a law he fiercely opposes. President Trump last week predicted that ObamaCare “soon will explode,” stirring speculation that the administration could seek to undermine the law. Yet there are also signs that Price and the Department of Health and Human Services (HHS) will take a more pragmatic approach. (Sullivan, 3/28)

WBUR: The Origins Of A Complex American Health Care System
The problems with the health care system in the United States may seem like they’re new, but they’re not. Historian Nancy Tomes explains to Here & Now’s Jeremy Hobson how our uneven, expensive and complicated system came to be. (Hobson, 3/27)

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WITS Program Teaches Healthy Cooking in Schools

On a recent Tuesday, the airy rooftop greenhouse at P.S. 333 on the Upper West Side of Manhattan was a hive of purposeful activity as students massaged olive oil into kale and ground spices for a salad they were preparing to serve at lunch.

“Could we spread this out and make it look edible,” Yadira Garcia urged, as the children drizzled balsamic dressing over a mass of spiralized zucchini and garnished the tray with cherry tomatoes plucked from a sprawling vine growing a few feet away.

Ms. Garcia, a graduate of the Natural Gourmet Institute in Manhattan, is one of a growing number of professional chefs assigned to the city’s schools. As part of a program called Wellness in the Schools (WITS), she is spending three years at P.S. 333, teaching cooking and nutrition classes to children and organizing educational events for their parents after school hours.

The program, which aims to teach public school students about healthful eating and fitness, partners with chefs like Ms. Garcia and Bill Telepan of the restaurant Oceana to develop nutritious recipes children are excited about trying. It’s a modern take on the home ec class. The goal is not to try to make kids eat food that they won’t like but to make things they already like healthier, and to instill an interest in cooking fresh, healthy food that carries over to the way the children eat at home.

WITS, now a national nonprofit reaching 50,000 children in four states, is the brainchild of Nancy Easton, who spent 25 years as a teacher, mentor and administrator in the New York school system. Ms. Easton was appalled to see overweight students unable to walk up a flight of stairs without stopping to catch their breath at the school she directed on the Lower East Side in the 1990s. That was long before the childhood obesity epidemic became big news. Of public school children in New York City, 40 percent are either overweight or obese, which is higher than the state average of 32 percent.

“Schools are examples for reading, writing and arithmetic, examples for how to behave,” Ms. Easton said. “They need to become examples for healthy living.”

She started by cooking wholesome meals for a handful of her own students. Gradually, a formal program to combat obesity took shape and eventually spread to more than 100 schools (87 of which are in New York). WITS recently added a program called Coach for Kids, in which trained fitness professionals lead children in activities at recess and after school. Ms. Easton says her goal is to be in all of the city’s elementary schools within 10 years.

WITS, which is based in Harlem, prioritizes working in underprivileged neighborhoods. The program is financed through grants and private donations. Schools contribute part of the cost from their supplementary budget on a sliding scale calibrated to the income level of the students’ families.

WITS introduced its alternative menu in partnership with the city’s Department of Education. For many lower-income children, school lunch is the only cooked meal of the day, supplying them with over half of their daily nutrition. Although the WITS program does not depend on government funding, some school nutrition advocates are concerned about efforts to weaken or defund federal initiatives, including a bill introduced by Representative Steve King, Republican of Iowa, in January, which would repeal nutrition standards for the national school lunch and breakfast programs.

Claire Lowenstein, the principal at P.S. 333, says the WITS program has been an excellent investment. “More of our students are eating the school lunch and fewer are bringing their food from home than ever before,” she said.

Gone is the usual kid-bait like fried mozzarella sticks and chicken fingers. In their place are a daily salad bar, wraps and main dishes like the Caribbean specialty chicken guisado and vegetarian dumplings, created whenever possible with unprocessed, seasonal and locally farmed ingredients.

Judging from the children’s plates in the lunchroom heaped with salad and bowls of vegetarian chili, the healthy new fare is a success.

“It’s insane how much they love salads,” said Mr. Telepan, who was at the school recently to help with the meal for a wellness event. “It is a known fact that it takes kids between eight and 15 times of trying something before they like it,” he said, adding, “It can take adults 30 times.”

Mr. Telepan, who joined the WITS team in 2008, recalled how students at a school in the Bronx took instantly to the celery root soup and baked rutabaga fries with cranberry relish he cooked for them, although none had ever tried these vegetables before.

“You’ll rarely find a kid who won’t eat something that they themselves have made,” Ms. Garcia said. “They turn into the best salespeople. They are like ‘you’ve got to try this,’ with their friends. It’s contagious!” Kale chips were a recent hit, and so was the black bean brownie, in which beans, oats and honey stand in for flour and processed sugar. “Sounds kind of gross,” one of the young salad makers said, but it turned out to be creamy and delicious.

Like other WITS chefs, Ms. Garcia helps train the kitchen workers to prepare healthy food. That can be a challenge. Many school kitchens are lacking in even basic equipment, and cafeteria staff members are not accustomed to cooking from scratch with fresh ingredients. There are also financial constraints: Nutritious meals can be hard to create on food budgets that can be as low as a dollar a day per student served.

Some argue that processed foods offers inexpensive calories, and that the fresh fruits and vegetables championed by WITS are beyond the budget of many low-income families. Ms. Garcia acknowledges that quality ingredients don’t always come cheaply. But she points to initiatives like the city’s Health Bucks program which helps home cooks stretch food stamp dollars by paying bonuses for healthy purchases.

Ultimately, she said, “we either pay the farmer or the pharmacist.” In the neighborhood of the South Bronx where Ms. Garcia grew up, there were high rates of preventable and reversible diseases like high blood pressure, high cholesterol and Type 2 diabetes — all illnesses that research links to poor diet. Her own parents have cardiovascular conditions that she attributes to their diets.

While adults like to talk about the health benefits of eating well, for the kids the reason is often simply that it tastes great.

Ike Shaw, age 10, tried vegetable sushi for the first time in Ms. Garcia’s food lab and became a big fan. He now makes it for his family at least twice a month.

“I was like, how can something be so healthy and so good at the same time,” Ike said as he chopped carrots, cucumbers and orange bell peppers in his family kitchen together with his 11-year-old sister, Sai.

She has introduced the family to new salad dressings and soups, which she also learned to make at the food lab. Their mother, Amy Shaw, a lawyer, says that whatever they try in Ms. Garcia’s class, they insist on recreating at home — and she stays out of the kitchen.

Ms. Shaw admits that she is not much of a cook, but says her children’s enthusiasm has been infectious. Cooking is now a family affair that has brought them closer. “I love that they are so passionate about it,” Ms. Shaw said. “Seeing how confident they are around cooking helps me relax around it too.”

————————-

Fudgey Black Bean Brownies

by Chef Yadira Garcia, adapted from Natural Gourmet Institute

Ingredients

1½ cups black beans (1 15-oz. can, drained and rinsed very well)

2 tablespoons cocoa powder

½ cup quick oats

¼ teaspoon salt

⅓ cup pure maple syrup or honey

½ tablespoon stevia

¼ cup coconut oil, at room temperature (liquid)

2 teaspoons pure vanilla extract

½ teaspoon baking powder

½ cup to ⅔ cup organic semisweet chocolate chips (more if desired)

Preparation

1. Heat oven to 350 degrees Fahrenheit. Grease an 8-inch-by-8-inch pan.

2. Combine all ingredients except chocolate chips in food processor and blend until completely smooth.

3. Stir in the chips and pour into prepared pan. (Optional: sprinkle additional chocolate chips on top)

4. Bake 15-18 minutes, then remove from the oven and let cool for at least 15 minutes. Cut and serve.

First Edition: March 28, 2017

Mar 28 2017

Today’s early morning highlights from the major news organizations.

Kaiser Health News: New Vaccine Recommendation Cuts Number Of HPV Shots Children Need
You’d think that a vaccine that protects people against more than a half-dozen types of cancer would have people lining up to get it. But the human papillomavirus (HPV) vaccine, which can prevent roughly 90 percent of all cervical cancers as well as other cancers and sexually transmitted infections caused by the virus, has faced an uphill climb since its introduction more than a decade ago. Now, with a new dosing schedule that requires fewer shots and a more effective vaccine, clinicians and public health advocates hope they may move the needle on preventing these virus-related cancers. (Andrews, 3/28)

California Healthline: Repeal And Replace Hits A Roadblock. What’s Next For California?
California embraced the Affordable Care Act and in many ways became a national model for how it could work — driving uninsured rates down from about 17 percent to 7 percent since the law rolled out. The state added 3.7 million people to the rolls under its Medicaid expansion, and 1.5 million joined its state-run marketplace, Covered California. Compared to other states, the exchange’s premium increases have remained low, though they have risen substantially this year. (3/28)

The Wall Street Journal: After GOP Bill’s Failure, Health-Law Lawsuit Takes Center Stage
President Donald Trump and GOP lawmakers, seeking to regroup following the collapse of the effort to repeal the Affordable Care Act, have an option for gutting the health law relatively quickly: They could halt billions in payments insurers get under the law. House Republicans were already challenging those payments in court as invalid. Their lawsuit to stop the payments, which they call illegal, was suspended as Republicans pushed to replace the ACA, but it could now resume—or the Trump administration could decline to contest it and simply drop the payments. Mr. Trump could unilaterally end the payments regardless of the lawsuit. (Armour, 3/27)

The Washington Post: Paul Ryan: House Republicans Will Continue Their Push For Health-Care Reform This Year
House Speaker Paul D. Ryan told Republican donors Monday that he intends to continue pushing for an overhaul of the nation’s health-care system by working “on two tracks” as he also pursues other elements of President Trump’s agenda. “We are going to keep getting at this thing,” Ryan said three days after intraparty opposition forced him to pull the American Health Care Act after it became clear it did not have enough Republican votes to pass. (DeBonis, 3/27)

The New York Times: 2018 Dilemma For Republicans: Which Way Now On Obamacare? 
As they come to terms with their humiliating failure to undo the Affordable Care Act, Republicans eyeing next year’s congressional campaign are grappling with a new dilemma: Do they risk depressing their conservative base by abandoning the repeal effort or anger a broader set of voters by reviving a deeply unpopular bill even closer to the midterm elections? (Martin, 3/28)

The New York Times: The Republicans In Power: From ‘We Got This’ To ‘What Now?’
The new Republican government is in deep trouble.President Trump and his majorities in the House and Senate had hoped to head out for their spring break celebrating the chest-thumping accomplishments of finally gutting President Barack Obama’s health care law and installing a conservative Supreme Court justice. They were determined to show the American public: We got this. (Hulse, 3/27)

The Wall Street Journal: Hospital Stocks Rise Amid Broader Slump
Monday’s climb in hospital stocks continues a rally that began last week, as the Trump administration and House Republicans failed to win support for a bill to dismantle the ACA. House Speaker Paul Ryan on Friday canceled a vote on the legislation, conceding it lacked enough Republican backing. Hospitals benefited from more paying patients under the Affordable Care Act, most notably in states that expanded Medicaid. (Evans, 3/27)

NPR Fact Check: Trump Says Obamacare Is ‘Exploding.’ That’s Not Quite True
President Trump is doing his best to put a good face on defeat in his party’s attempt to replace the Affordable Care Act, also known as Obamacare. His strategy is simple: declare that the law is failing. And he is selling that message in his own distinctly Trumpian way: concocting it out of simple, bold words and then hammering that message home, over and over: Obamacare, in his words, will “explode.” (Kurtzleben and Kodjak, 3/27)

Politico: Gallup: Trump Hits New Low After Health Care Flop
President Donald Trump’s approval rating slipped to a new low Monday in the Gallup daily tracking poll, the first measure of Trump’s job performance following his administration’s failure to move a new health care law through Congress. Only 36 percent of Americans approve of the way Trump is handling his job as president in interviews conducted last Friday through Sunday, a time period entirely after Republicans abandoned their bill to replace the 2010 Affordable Care Act. (Shepard, 3/27)

The Washington Post: McAuliffe: If Obamacare Is Here To Stay, Then It’s Time To Expand Medicaid
The failure of Congress to repeal and replace Obamacare has emboldened Gov. Terry McAuliffe (D) to renew his stalled crusade to expand Medi­caid in Virginia. On Monday, he proposed an amendment to state budget language to give him power to set an expansion in motion, and called on the Republican-controlled General Assembly to immediately begin making plans. But Republican legislators were unmoved by the plea, saying they would reject the amendment and that they stood firm against expanding Medicaid. (Schneider, 3/27)

USA Today/Milwaukee Journal Sentinel: With Congress Gridlocked, Scott Walker Wants Trump To OK Drug Tests For State Health Coverage
With the GOP’s repeal of Obamacare stymied in Congress, Gov. Scott Walker is still rejecting the federal law and instead asking the Trump administration to let Wisconsin drug test applicants for state coverage. Even though federal money remains available for providing health care to more Wisconsin residents, the GOP governor says he’s not reconsidering his decision to skip that and forgo hundreds of millions of dollars from federal taxpayers. (Stein, 3/27)

The New York Times: In Health Bill’s Defeat, Medicaid Comes Of Age
When it was created more than a half century ago, Medicaid almost escaped notice. Front-page stories hailed the bigger, more controversial part of the law that President Lyndon B. Johnson signed that July day in 1965 — health insurance for elderly people, or Medicare, which the American Medical Association had bitterly denounced as socialized medicine. The New York Times did not even mention Medicaid, conceived as a small program to cover poor people’s medical bills. (Zernike, Goodnough and Belluck, 3/27)

The Associated Press: GOP Divided Over New Course After House Health Care Debacle
Still reeling from last week’s House health care debacle, Republicans are pivoting to tax cuts and other issues but remain riven into factions and all over the map about how and when to return to their marquee pledge to eviscerate former President Barack Obama’s 2010 overhaul. House Republicans are gathering Tuesday to discuss their agenda, their first meeting since House Speaker Paul Ryan, R-Wis., suddenly abandoned plans last Friday for a vote on the GOP legislation. The retreat on the party’s top legislative priority so far this year was a jarring defeat for President Donald Trump and Republican leaders and raised questions about whether the GOP could muster the unity it will need on other issues. (Fram, 3/28)

The Associated Press: Bitter GOP Finger-Pointing Clouds Path For Trump Agenda
President Donald Trump is hoping to drive his priorities forward following the crumbling of the Republican health care bill but GOP finger-pointing is rampant, underscoring how tough it will be to produce the unity the party will need. Rep. Ted Poe, R-Texas, criticized the contrarian House Freedom Caucus on Monday, a day after resigning from the hard-right group because it helped sink the Republican health care effort. “You can have your principles and then when it comes to voting, you have to compromise to get something passed,” Poe said of the caucus, which has roughly three dozen members. (Yen, 3/27)

The Associated Press: High Court Struggles Over Hospital Pension Dispute
The Supreme Court seemed to struggle on Monday over whether some of the nation’s largest hospitals should be allowed to sidestep federal laws protecting pension benefits for workers. Justices considered the cases of three church-affiliated nonprofit hospital systems being sued for underfunding pension plans covering about 100,000 employees. But the outcome ultimately could affect the retirement benefits of roughly a million employees around the country. (3/27)

The New York Times: Addiction Specialists Ponder A Potential Aid: Pot
Nine days after Nikolas Michaud’s latest heroin relapse, the skinny 27-year-old sat on a roof deck at a new drug rehabilitation clinic here. He picked up a bong, filled it with a pinch of marijuana, lit the leaves and inhaled. All this took place in plain view of the clinic’s director. … The new clinic is experimenting with a concept made possible by the growing legalization of marijuana: that pot, rather than being a gateway into drugs, could be a gateway out. (Richtel, 3/27)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

New Vaccine Recommendation Cuts Number Of HPV Shots Children Need

You’d think that a vaccine that protects people against more than a half-dozen types of cancer would have people lining up to get it. But the human papillomavirus (HPV) vaccine, which can prevent roughly 90 percent of all cervical cancers as well as other cancers and sexually transmitted infections caused by the virus, has faced an uphill climb since its introduction more than a decade ago.

Now, with a new dosing schedule that requires fewer shots and a more effective vaccine, clinicians and public health advocates hope they may move the needle on preventing these virus-related cancers.

In December, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommended reducing the number of shots in the HPV vaccine from three to two for girls and boys between the ages of 9 and 14. The recommendation was based on clinical trial data that showed two doses was just as effective as a three-dose regimen for this age group. (Children older than 14 still require three shots.)

Michelle AndrewsInsuring Your Health

The study was conducted using Gardasil 9, a version of the vaccine approved by the Food and Drug Administration in late 2014. It protects against nine types of HPV: seven that are responsible for 90 percent of cervical cancers and two that account for 90 percent of genital warts.

In addition, the new version of Gardasil improved protection against HPV-related cancers in the vagina, vulva, penis, anus, rectum and oropharynx — the tongue and tonsil area at the back of the throat.

An earlier version protected against four types of HPV.

From the start, clinicians have run into some parental and political roadblocks because the vaccine, which is recommended for preteens, protects against genital human papillomavirus — a virus transmitted through sexual contact. Many physicians are also reluctant about discussing the need for the vaccine, and for many parents, the vaccine’s cancer-prevention benefits were overshadowed by concerns about discussing sexual matters with such young kids. Yet for maximum protection, the immunizations should be given before girls and boys become sexually active.

The focus should not have been on sexually transmitted infections, some say. “You only get one chance to make a first impression,” said Dr. H. Cody Meissner, a professor of pediatrics at Tufts University School of Medicine and a member of the American Academy of Pediatrics’ committee on infectious diseases. “This vaccine should have been introduced as a vaccine that will prevent cancer, not sexually transmitted infections.”

The HPV virus is incredibly common. At any given time, nearly 80 million Americans are infected, and most people can expect to contract HPV at some point in their lives. Most never know they’ve been infected and have no symptoms. Some develop genital warts, but the infection generally goes away on its own and many people never have health problems.

However, others may develop problems years later. There are approximately 39,000 HPV-related cancers every year, nearly two-thirds of them in women. In addition to cervical cancer, more than 90 percent of anal cancers and 70 percent of vaginal and vulvar cancers are thought to be caused by the HPV virus. Recent studies show that about 70 percent of cancers in the oropharynx may also be linked to HPV.

A 2015 study published in the Journal of the National Cancer Institute estimated that earlier versions of the HPV vaccine could reduce the number of HPV-related cancers by nearly 25,000 annually, and the new version of the vaccine could further reduce the number of such cancers by about 4,000.

The vaccine is estimated to prevent 5,000 cancer deaths annually, said Dr. Paul Offit, professor of pediatrics and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.

But compliance is an ongoing problem. “They’re not getting the one vaccine that protects against diseases from which they’re most likely to suffer and die,” Offit said, noting that deaths from pertussis and meningococcal disease, for which adolescents are also vaccinated at that age, are minuscule compared with HPV-related cancers.

In 2015, 87 percent of 13-year-olds were up-to-date with the Tdap vaccine that protects against tetanus, diphtheria and pertussis, and 80 percent had received the meningococcal vaccine, according to the Centers for Disease Control and Prevention. But just 30 percent of girls and 25 percent of boys at that age had received all three doses of the HPV vaccine. In contrast to other vaccines, however, the HPV vaccine is required only in a few states for secondary school.

Public health advocates say they think the shift to a two-dose regimen could make a big difference in the number of adolescents who get all the necessary doses of the HPV vaccine. For one thing, the fewer shots the better, in general, they say.

In addition, because the second HPV shot is supposed to be given anywhere from six months to a year after the first one, “parents can fit it into a routine regimen when people go in for their 12-year-old’s regularly scheduled visit,” said Dr. Joseph Bocchini Jr., chairman of pediatrics at Louisiana State University Health in Shreveport who is president-elect at the National Foundation for Infectious Diseases.

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Testosterone Therapy Is Popular, but Studies Are Mixed

Television ads for “low T” have sparked a rise in the use of testosterone gels, patches and injections by older men in recent years, according to a new report. But anyone hoping that a dose of testosterone will provide an easy antidote for sagging muscles, flagging energy and a retiring sex drive may find the results of recent government studies of the sex hormone sobering.

The latest clinical trials, published over the past year, are the first rigorous ones to assess the potential beneficial effects of testosterone treatment for older men with abnormally low levels of the hormone. Scientists followed 790 men age 65 and older who had blood testosterone levels below 275 nanograms per deciliter of blood, well below the average for healthy young men and lower than would be expected with normal aging. The men also had symptoms reflecting their low hormone levels, like loss of sex drive. Half the participants were treated with testosterone gel, and half were given a placebo gel.

The studies reported mixed results, finding that over the yearlong study period, testosterone therapy corrected anemia, or low levels of red blood cells, which can cause fatigue, and increased bone density. But a study to see if testosterone improved memory or cognitive function found no effects.

Meanwhile, a red flag warning of possible risks to the heart emerged from the studies: Imaging tests found a greater buildup of noncalcified plaque in the coronary arteries of men treated with testosterone for a year, an indicator of cardiac risk, compared with those who were given a placebo gel.

The findings of plaque were not a complete surprise; many reports have tied testosterone use to an increase in heart attacks, and the Food and Drug Administration already requires testosterone products to carry warnings of an increased risk of heart attacks and stroke (men at high risk of cardiovascular disease were not allowed to participate in the latest trials). But observational studies, which are weaker, have yielded mixed results over all, with one study published last month finding that men taking testosterone actually had fewer heart problems.

Only about 15 percent of men 65 and over have the low testosterone levels studied in the recent trials. Most men experience only slight declines in testosterone as they age, so the trial results are not necessarily applicable to the general population of older men.

The findings are a follow-up to an earlier report from last year that found testosterone improved sexual function in older men with low levels of the hormone, though the bump was modest and waned over time. The researchers even noted that for erectile function, drugs like Viagra are more effective. Testosterone didn’t help older men walk farther, they found, and it didn’t temper fatigue or increase men’s sense of vitality, though it did improve mood slightly.

“Testosterone is clearly not a panacea,” said Dr. Thomas Gill, a geriatrician at Yale School of Medicine who was one of the study’s authors and ran one of the clinical trial sites. “It’s not an agent that’s going to restore the fountain of youth. The benefits are modest, even when they are favorable.”

Dr. David J. Handelsman, director of the Anzac Research Institute in Sydney, Australia, who wrote an editorial accompanying the publication of the latest trials and who was not involved in them, was more somber in his assessment.

“What you see in these testosterone trials is an ominous portent of cardiovascular disease, although it remains a prediction, not a fact,” Dr. Handelsman said in an interview. He noted that older men with low testosterone levels often have other chronic health conditions, like obesity, that can affect hormone levels but that can be managed by lifestyle factors like diet and exercise.

Testosterone has been available as a drug for so long that it was never subjected to clinical trials of safety and efficacy as most new drugs are today. Nor has it been tested in large government-sponsored trials lasting many years, like the one of hormone replacement therapy for older women that found hormones did not prevent heart disease in postmenopausal women and actually posed serious risks.

Larger and longer-term studies would be needed to further assess testosterone’s safety, because the latest studies, called the T trials, followed men for only a year, too short a time to determine whether testosterone increases the risk of problems like heart disease or prostate cancer.

The T trials “didn’t answer the question of risk,” said Dr. Evan Hadley, director of the division of geriatrics and clinical gerontology at the National Institute on Aging. “We’ve gotten a lot more data on benefits, but benefit trials alone would not answer all the questions about use of testosterone therapy. It’s very important to get definitive data on risk so we have the whole picture of risk and benefit.”

But the results do not support the promise implied by advertisements for testosterone that using it “will make you stronger and fitter,” he said, though many men said they simply “felt better” while on the drug, and some improvements in walking could be seen when the findings were analyzed differently.

Testosterone prescriptions in the United States nearly doubled in recent years to 2.2 million in 2013, up from 1.2 million three years earlier, as more and more healthy middle-aged and older men started taking it. Many of them did not have the kind of medical conditions, like genetic defects, chemotherapy or problems with the hypothalamus and pituitary glands in the brain, that make men unable to produce sufficient hormone on their own. Many younger men also take the hormone for bodybuilding purposes.

Using testosterone for bodybuilding or for normal age-related declines in hormones is not approved by the F.D.A., but physicians are allowed to prescribe drugs for nonapproved reasons, a practice called “off-label use.”

The F.D.A. has told drug manufacturers that sell testosterone that any larger studies must be carried out at their own expense. A spokeswoman for AbbVie, which makes AndroGel and provided the testosterone gel for the latest trials, said manufacturers are working with the agency to design such a trial.

“I think these results are more than sufficient to warrant a longer trial,” said Dr. Peter Snyder, an endocrinologist and professor of medicine in the Perelman School of Medicine at the University of Pennsylvania and principal investigator of the T trials.