From Health and Fitness

State Highlights: New Progressive Use-Of-Force Policy In Camden, N.J., Aims To Reduce Police Shootings; N.Y. Medical Ethicists Cite Invasion Of Privacy In Releasing Info On Fetus Burials

Media outlets report on news from New Jersey, New York, Connecticut, Florida, Colorado, Wisconsin, Louisiana, California, Texas, District of Columbia, Georgia, Missouri and Wyoming.

Maryland’s Pilot Program To Offer Dental Coverage To Some Medicaid Recipients Brings Smiles To Desperate Patients

The program is aiming to catch dangerous dental problems before they can result in costly emergency room visits for the Medicaid recipients. Experts were muted in their praise. “It’s a very primitive first step for people who don’t have dental care,” said Dr. Louis DePaola, the associate dean at the University of Maryland’s School of Dentistry. Medicaid news comes out of Minnesota as well.

Patient Privacy Continues To Be A Priority When Working On Increasing Access To Health Data, Federal Official Says

Dr. Donald Rucker, the chief of the Office of the National Coordinator for Health Information Technology, said balancing privacy and patients’ rights is a “delicate balancing act.” In other news at the intersection of health and technology: robotic nurses and artificial intelligence’s role in drug development.

Scores Of People Born Through Artificial Insemination Are Finding Out Their Fathers Are The Doctors Who Performed Procedure

With the growing use of consumer DNA tests, many have been left reeling by the news that the sperm donors that their mothers selected are not their fathers. “You build your whole life on your genetic identity, and that’s the foundation,” said one woman. “But when those bottom bricks have been removed or altered, it can be devastating.” In other public health news: Lyme disease, gene editing, a blood test for Alzheimer’s, employee wellness programs and more.

Sky-High Diabetes Costs Are Forcing Patients To Ration Drugs, Ask For Lower-Cost Prescriptions

Stories of the fatal decision to skip or ration insulin have filled headlines in recent months, but new government data shows just how many people are taking those dangerous measures because of high costs. In other pharmaceutical news: Gilead’s stand-off with the government over Truvada, tips for shopping abroad for cheaper meds, and more.

Planned Parenthood Braces For Fallout From Title X Decision With Fundraisers, New Fees And Warnings

Clinics across the country are expecting to lose millions in federal funding after Planned Parenthood rejected money that came with a condition the organization deemed a “gag rule.” The women’s reproductive health care provider plans to lean heavily on donors to make up the funding gap while staff members assess how they’ll cope. Other news on abortion comes out of Ohio and Tennessee, as well.

Lung Illnesses Among Vapers Is Growing: FDA Joins CDC’s Investigation As 153 Cases In 16 States Are Identified

Federal and state officials say it does not appear that an infectious disease is responsible for the illnesses, while noting numerous ingredients in e-cigarette aerosol could harm the lungs. News on e-cigarettes also looks at bans against vaping in public places, a new industry probe over health concerns and more.

Feds Pave The Way To Expand Home Dialysis — But Patients Hit Roadblocks

Home dialysis for older adults will become more common in the years ahead, experts predict — but not without overcoming significant challenges.

By 2025, the Trump administration wants 80% of people newly diagnosed with kidney failure to receive home dialysis or kidney transplants, according to an executive order issued in July. Currently, more than 85% of such patients are treated at dialysis centers.

In a notable move, retail health giant CVS Health has said it will enter the dialysis business, while the companies that dominate this market — Fresenius Medical Care and DaVita — have confirmed plans to expand their home dialysis offerings.

“We think there’s definitely an opportunity to get more of our patients home,” said Dr. Dinesh Chatoth, associate chief medical officer at Fresenius, which this year bought NxStage Medical, a leading provider of home dialysis technology. (About 12% of Fresenius’ 208,000 U.S. dialysis patients are on home therapies.)

“I think it’s realistic to expect 40% to 50% of patients to be able to do home dialysis,” said Dr. Martin Schreiber, chief medical officer for DaVita home modalities. (About 13% of DaVita’s 203,000 U.S. dialysis patients now receive home therapies.)

Other experts think that’s optimistic. “I think 25% to 30% of patients is more realistic,” said Dr. Thomas Golper, a professor of medicine at Vanderbilt University, whose home dialysis program is among the largest in country.

Home dialysis has several advantages over dialysis in treatment centers: Patients can get therapy more frequently, which puts less stress on their bodies; it’s more convenient; it’s less expensive; and patients’ quality of life is generally better, according to numerous studies. On the downside, doing this therapy at home can be isolating, fraught with anxiety, technologically challenging and burdensome for patients and caregivers.

What changes are needed to bring home dialysis to more patients — especially older adults, the fastest-growing group of patients with serious, irreversible kidney disease? We asked nephrologists, patient advocates and dialysis company officials for their thoughts.

Better patient education. Medicare pays for “pre-dialysis education” that informs patients about treatment options before their kidneys fail. Yet, fewer than 2% of Medicare members with advanced kidney disease receive this benefit, according to a U.S. Government Accountability Office report.

“We need to improve the education of patients regarding their [dialysis] modality choices,” said Schreiber of DaVita. Patients who attend that company’s Kidney Smart education classes are six times more likely to select home dialysis as a treatment option, according to materials supplied by DaVita.

Ongoing education about how to handle issues that arise during home dialysis is also needed. In a recent survey of caregivers providing complex care at home, 60% of caregivers assisting with home dialysis said they needed “more/better instruction” while 18% called for “more help from others.”

“Right now, patients are educated on the mechanics of the treatment,” said Nieltje Gedney, treasurer of Home Dialyzors United, a patient group that has been testing an education curriculum. “But in order to be successful at home, patients also have to learn much more about how to manage their treatment.”

More personal assistance. In Canada, Australia and other countries where home dialysis is much more common than in the U.S., patients can get assistance from health workers who help them set up for a dialysis treatment and wind things down when treatment is over. On each end, tasks required can take half an hour or longer.

Medicare doesn’t pay for this kind of assistance, but it should — especially for older adults, several experts suggest.

“Imagine trying to move someone 75 or older who’s socioeconomically disadvantaged onto home dialysis,” said Dr. Holly Mattix-Kramer, president of the National Kidney Foundation and a professor of medicine at Loyola University Medical Center in Chicago. “Maybe they feel insecure and kind of afraid. Maybe they need some extra time going over skills. Maybe they need some extra support the first few months before they feel comfortable with the routine.”

Home health aides or community health workers could provide help of this kind. Dori Schatell, executive director of the Medical Education Institute, which specializes in serving people with kidney disease, called for a demonstration project of paid home dialysis helpers.

“Assisted dialysis in the home would have tremendous advantages, I believe, especially for the elderly,” Schreiber said, and DaVita has been talking to the Centers for Medicare & Medicaid Services about how this might work.

New technologies. In the next several years, Chatoth of Fresenius envisions that new technologies will allow people on home dialysis to be monitored much more closely, day by day. Two-way portals would allow data to flow back and forth between patients and clinicians. Telehealth would allow physicians, nurses, social workers and dietitians to interact with patients remotely and provide more ongoing support.

This kind of connectivity is especially important for older adults with multiple medical conditions who need extra oversight and may have difficulty traveling to a dialysis center.

Fresenius is doing a telehealth pilot, and “we think by the end of the year we should have this rolled out across most of our [home dialysis] programs,” Chatoth said.

Dr. Eric Wallace, an associate professor of nephrology at the University of Alabama at Birmingham and a pioneer in the use of telehealth for home dialysis, thinks telehealth has considerable potential but voiced concerns.

For instance, poor patients and patients in rural areas often don’t have enough internet bandwidth to support videoconferencing. While physicians rely on laboratory tests to evaluate dialysis patients, “there aren’t mechanisms in place to do labs inside a patient’s home,” Wallace said. And some older patients may become even more isolated without regular face-to-face visits to medical providers.

“Telehealth is going to open up new ways to connect with patients,” he said. “But I don’t think it’s quite as easy as people want to make it sound.”

Also, several companies are developing technologies that could make home dialysis safer and easier, including NxStage, CVS, Outset Medical of San Jose, Calif., Quanta Dialysis Technologies of the United Kingdom, and Physidia, out of France.

“They each have their own specific angle, but the general theme with all of them is the ‘Apple-fication’ of dialysis machines,” said Dr. Frank Liu, director of home hemodialysis at the Rogosin Institute in New York City.

Altering physician practices. A precondition for change is educating physicians about home dialysis and persuading them to offer it to more patients, experts suggest.

Only one-third of patients who need to start dialysis are told peritoneal dialysis at home is an option, while only 12% are offered home hemodialysis, research has shown.

Dr. Matthew Rivara, a nephrologist and investigator at the University of Washington Kidney Research Institute, faults “inadequate training in home dialysis” in nephrology fellowship programs, as do several other leading nephrologists.

“There’s almost nothing on board examinations that tests physicians’ knowledge about home dialysis; nephrologists can pass with flying colors and know very little about these therapies,” said Golper of Vanderbilt who’s helped launch a training program for physicians, Home Dialysis University.

Easing transitions. When patients learn they have potentially fatal kidney disease, “you’re literally blinded with fear. There’s no way you can think about your options until you get past that,” said Gedney of Shepherdstown, W.Va., who has relied on home hemodialysis since 2014.

Transitional programs that help people adjust to the need for dialysis and understand what it entails should become more widely available, she said.

Fresenius has nearly 40 programs of this kind across the U.S., and more are starting up. Over four to six weeks, people start receiving dialysis at a center and learn about specifics such as what they can eat, who’s going to pay for dialysis, how their lives might change and how much support they’ll need.

The goal is to help patients “cope with the diagnosis,” Chatoth said. After going through transitional programs, he added, more than half of patients choose home dialysis.

 

Shopping Abroad For Cheaper Medication? Here’s What You Need To Know

In its effort to temper the sky-high prices Americans pay for many vital medications, the Trump administration last month unveiled a plan that would legalize the importation of selected prescription drugs from countries where they sell for far less. But the plan addresses imports only at the wholesale level; it is silent about the transactions by millions of Americans who already buy their medications outside the United States.

Americans routinely skirt federal law by crossing into Canada and Mexico or tapping online pharmacies abroad to buy prescription medications at a fraction of the price they would pay at home.

In some cases, they do it out of desperation. It’s the only way they can afford the drugs they need to stay healthy — or alive. And they do it despite warnings from the Food and Drug Administration, echoed by the pharmaceutical industry, about the risk of contaminated or counterfeit products.

“The reality is that literally millions of people get their medications this way each year, and they are either saving a lot of money or they are getting a drug they wouldn’t have been able to get because prices are too high here,” says Gabriel Levitt, president of PharmacyChecker.com, an online company that allows people to compare prescription drug prices among international and U.S. pharmacies.

For people with diabetes, the inability to pay U.S. prices for insulin can be a matter of life and death, which is why so many families look to Canada or Mexico to meet their needs.

Robin Cressman, who was diagnosed with Type 1 diabetes in 2012 and has become a vocal advocate for lower drug prices, says that even with insurance she was paying $7,000 a year out-of-pocket for the two insulin drugs she needs: Lantus and Humalog. At one point, her credit card debt hit $30,000, says Cressman, 34, of Thousand Oaks, Calif.

While on an outing in Tijuana, Mexico, last year, she popped into a few pharmacies to see if they stocked her medications. With little fanfare, she says, she was able to buy both drugs over the counter for less than 10% of what they cost her north of the border.

“I left Tijuana that day absolutely trembling because I could not believe how easy it was for me to get my insulin,” she says, “but also how little money it cost and how badly I was being extorted in the U.S.”

If you are planning to cross the border for your medications, or get them through an online pharmacy abroad, here are two things you should know. First: It is technically illegal. Second: It is unlikely you will be prosecuted.

Despite the official prohibition, FDA guidelines allow federal agents to refrain from enforcement “when the quantity and purpose are clearly for personal use, and the product does not present an unreasonable risk to the user.”

Personal use generally means no more than a 90-day supply. You should think twice before bringing in quantities larger than that, because if authorities suspect you have commercial intentions, you could land in legal jeopardy — and lose the drugs.

People familiar with the practice say you generally can pass through customs without much hassle if you have no more than three months’ worth of a medication, you declare it to customs agents and you show them a doctor’s prescription or a personal note attesting it is for personal use, along with contact information for your physician.

Even in the worst-case scenario, an unsympathetic agent might confiscate the drugs — but not arrest you.

Ordering drugs online from foreign pharmacies also tends to go largely unchallenged. Legally, the FDA can refuse entry of the package at an international mail facility. “That does happen from time to time,” but not often, says Levitt.

It is more common for shipments that do get through to be detained for several days pending FDA inspection. So, if you need to take your medication every day, be sure to build in a sufficient margin for potential delays.

A far bigger risk if you’re shopping abroad for medications is that you might not get what you paid for — and it might not be safe. “There’s a lot of junk in the pharmaceutical world,” says Dr. Ken Croen, a primary care physician at the Scarsdale Medical Group in Westchester County, N.Y., who advises many of his patients on how to buy drugs safely in Canada.

And there are plenty of rogue operators, especially in the world of online pharmacies. You will need to do a little vetting.

Before doing business with an online pharmacy, confirm it is licensed in its country of origin and that the country has strong pharmacy regulations, says Dr. Aaron S. Kesselheim, a professor of medicine at Brigham & Women’s Hospital and Harvard Medical School. (Read below for websites that can help with that.)

Countries with well-regulated pharmacies include Canada, New Zealand, Australia, much of Western Europe and Turkey.

Also, check to make sure the pharmacy posts an address and phone number on its website. Experts advise against using online pharmacies that don’t require a doctor’s prescription: They are more likely to cut other corners, as well.

A couple of websites do the vetting for you, using these and other criteria.

The Canadian International Pharmacy Association runs a site (cipa.com) that allows you to compare drug prices among dozens of pharmacies whose legitimacy it has certified. Its customers “tend to be people who live in the U.S., are on fixed income or low income and can’t afford the medications where they live,” says Tim Smith, the association’s general manager.

To buy through one of CIPA’s certified pharmacies, you must have a valid prescription and submit a medical profile to help guard against adverse drug interactions. The site also maintains a list of “rogue” online pharmacies.

PharmacyChecker.com offers a similar service, linking customers to a broader range of online pharmacies abroad and in the U.S.

Levitt, its president, notes that while importing drugs from overseas is a “critical lifeline” for many people, it is still possible to buy many medications affordably in the U.S. He and others suggest you take the time to comparison shop in the U.S. because prices can vary significantly from pharmacy to pharmacy.

Santa Monica, Calif.-based GoodRx tracks prescription drug prices at over 70,000 pharmacies across the U.S. and offers coupons.

Levitt also recommends asking your doctor if there is a viable therapeutic alternative or a lower-cost generic drug. Recent research from PharmacyChecker shows that 88% of the most commonly prescribed generic drugs can be purchased more cheaply in the U.S. than from Canadian pharmacies.

“Many times there is no reason to go international,” Levitt says. “The drug will actually be cheaper here.”


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Texas Touch Football Group Requires All Players Wear Soft-Shell Helmets After Serious Head Injuries Occur

Researchers have found that flag football players receive many smaller hits to the head than those playing contact football, and they’re falling down on nearly every play. “This idea that there is no contact at all is fairly naïve,” said Robert C. Lynall, co-author of a study done at Georgia. Public health stories focus on artificial intelligence, vaping, PTSD treatments, a dehydration patch, e-cig TV ads, state fairs and cannabis research, as well.

FDA Officials: Stakes Were Too High In Novartis Data Manipulation Case To Do Anything But Publicly Drop The Hammer

The FDA came down hard on Novartis, subjecting the company to a public flogging over the data manipulation that, at the end of the day, didn’t effect patients’ safety. But the issue is too important to give anyone a pass, officials say. “It may sound like we’re kind of bureaucratic paper-pushers, but it’s more than that,” said FDA’s Dr. Peter Marks. “It’s making sure that the whole ecosystem understands that when people are working on these things that are highly technically complex, that they have to work truthfully and accurately.”

Alaska Governor Vetoes Bill To Restore Sharp Medicaid Cuts

Following the move by Gov. Mike Dunleavy and earlier action by the Alaska’s legislature, the state’s Medicaid program is expected to be cut by about 22%. Those state spending cuts mean Alaska will receive at least $127 million less in federal Medicaid matching funds. Medicaid news comes out of Oklahoma and Ohio, as well.

Former FDA Chief Urges Agency To Loosen Restrictions On Drugs To End Early Pregnancy

Former FDA Commissioner Dr. Jane Henney says Mifepristone is still heavily regulated despite having been proven safe and effective. “I think the FDA has shown a willingness to … take action,” Henney said. “I believe it’s important for them to do another review in light of the safety information we know about this drug.” In other news, clinics react to the Planned Parenthood’s decision to forgo Title X funds and ousted Planned Parenthood head Leana Wen announces her new job.

Cigna Explores Sale Of Its Group Benefits Insurance Business In Sign Insurer Intends To Focus On Health Care

Reuters reports that the division Cigna is looking to shed involves disability and life insurance. The move echoes ones made by other insurers looking to focus on health care. In other health industry news: a slew of departures from Apple’s health team, price transparency, hospital chains and purchases, and more.

Government Was On Cusp Of Alerting Public About Opioid Crisis 13 Years Ago. Why It Didn’t Remains A Mystery.

Top government officials flagged “disturbing” data around opioids and addiction back in 2006 and requested urgent action be taken. Then-U.S. Surgeon General Richard Carmona agreed to issue a call to action. But then the momentum fizzled after a new surgeon general came on and 13 years later, the crisis continues to grip the country.