Tagged Children’s Health

Does It Make Sense To Delay Children’s Vaccines?

When Elyse Imamura’s son was an infant, she and her husband, Robert, chose to spread out his vaccinations at a more gradual pace than the official schedule recommended.

“I was thinking, ‘OK, we’re going to do this,’” says Imamura, 39, of Torrance, Calif. “‘But we’re going to do it slower so your body gets acclimated and doesn’t face six different things all of a sudden.’”

Seven years later, Imamura says her son, Amaru, is a “very healthy,” active boy who loves to play sports.

But delaying vaccines is risky. Many pediatricians will tell you a more gradual approach to vaccinations is better than no vaccinations at all, but they offer some hard advice to parents who are considering it.

“Every day you are eligible to get a vaccine that you don’t get one, the chance of an invasive disease remains,” says Dr. Charles Golden, executive medical director of the Primary Care Network at Children’s Hospital of Orange County.

Recent outbreaks of measles, mumps and whooping cough have once again reignited a war of words over vaccinations.

The squabble is often painted as two-sided: in one camp, the medical establishment, backed by science, strongly promoting the vaccination of children against 14 childhood diseases by age 2. In the other, a small but vocal minority — the so-called anti-vaxxers — shunning the shots, believing the risks of vaccines outweigh the dangers of the diseases.

The notion that there are two opposing sides obscures a large middle ground occupied by up to one-quarter of parents, who believe in vaccinating their children but, like the Imamuras, choose to do so more gradually. They worry about the health impact of so many shots in so short a period, and in some cases they forgo certain vaccines entirely.

Alternative vaccine schedules have been around for years, promoted by a few doctors and touted by celebrities such as Jenny McCarthy. Donald Trump endorsed the idea during a 2015 Republican presidential debate.

The concept gained a large following more than a decade ago, when Robert W. Sears, an Orange County, Calif., pediatrician, published “The Vaccine Book,” in which he included two alternative schedules. Both delay vaccines, and one of them also allows parents to skip shots for measles, mumps and rubella (MMR), chickenpox, hepatitis A and polio.

Sears’ book became the vaccination bible for thousands of parents, who visited their pediatricians with it in tow. But his ideas have been widely rejected by the medical establishment and he was punished by the Medical Board of California last year after it accused him of improperly exempting a 2-year-old from all future vaccinations. He declined to be interviewed for this column.

Imamura, who describes herself as “definitely not an anti-vaxxer,” says she and her husband “followed Sears to a T.” They limited the number of vaccines for their son to no more than two per appointment, compared with up to six in the official schedule. And they skipped the shot for chickenpox.

She concedes, however: “If there’d been outbreaks like now, it would have affected my thinking about delaying vaccines.”

Elyse and Robert Imamura with their son, Amaru (Courtesy of Elyse Imamura)

The ideas promoted by Sears and others have contributed to parents’ worries that front-loading shots could overwhelm their babies’ immune systems or expose them to toxic levels of chemicals such as mercury, aluminum and formaldehyde.

But scientific evidence does not support that. Infectious-disease doctors and public health officials say everyday life presents far greater challenges to children’s immune systems.

“Touching another human being, crawling around the house, they are exposed to so many things all the time on a daily basis, so these vaccines don’t add much to that,” says Dr. Pia Pannaraj, a pediatric infectious-diseases specialist at Children’s Hospital Los Angeles.

The same is true of some of the metals and chemicals contained in vaccines, which vaccination skeptics blame for autism despite numerous studies finding no link — the most recent published earlier this month.

In the first six months of life, babies get far more aluminum from breast milk and infant formula than from vaccines, public health experts say.

“When you look at babies that have received aluminum-containing vaccines, you can’t even tell the level has gone up,” says Paul Offit, professor of pediatrics at Children’s Hospital of Philadelphia (CHOP) and director of the hospital’s Vaccine Education Center. The same is true of formaldehyde and mercury, he adds.

(Offit co-invented Merck’s RotaTeq vaccine for rotavirus, and CHOP sold the royalty rights to it for $182 million in 2008. CHOP declined to comment on what Offit’s share was.)

Parents who are concerned about mercury, aluminum or other vaccine ingredients should avoid information shared on social media, which can be misleading. Instead, check out the Vaccine Education Center on CHOP’s website at www.chop.edu by clicking on the “Departments” tab.

The Centers for Disease Control and Prevention also provides a detailed breakdown of the ingredients in every vaccine at http://www.cdc.gov/vaccines.

If your child has a condition you fear might be incompatible with vaccinations, discuss it with your pediatrician. The CDC gives very specific guidelines on who should not receive vaccines, including kids who have immune system deficiencies or are getting chemotherapy or taking certain medications.

If your children are not among them, vaccinate them. That will help prevent outbreaks, protecting those who, for medical reasons, have not received the shots.

When parents resist, Pannaraj says, she emphasizes that the potential harm from infections is far more severe than the risks of the vaccines. She notes, for example, that the risk of getting encephalitis from the measles is about 1,000 times greater than from the vaccine.

Still, side effects do occur. Most are mild, but severe cases — though rare — are not unheard of. To learn about the potential side effects of vaccines, look on the CDC website or discuss it with your pediatrician.

Emily Lawrence Mendoza, 35, says that after her second child, Elsie, got her first measles, mumps and rubella (MMR) shot at 12 months of age, she spiked a fever and developed a full body rash that looked like a mild version of the disease.

It took three visits to urgent care before a doctor acknowledged that Elsie, now almost 5, could have had a mild reaction to the vaccine. After that, Mendoza, of Orange, Calif., decided to adopt a more gradual vaccination schedule for her third child.

Yet Mendoza says Elsie’s adverse reaction made her realize the importance of vaccinations: “What if she’d been exposed to a full-blown case of the measles?”


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

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Has everyone recovered from their daylight saving time jet lag? Every year we get a whole host of articles about why changing the clocks is outdated, terrible and really quite bad for our health, and yet! Here were are, still grumpy and tired. But it’s almost the weekend, so let’s soldier on.

Here’s what you may have missed in your spring-forward daze.

President Donald Trump released his $4.75 trillion budget plan this week, which included a big increase in military funding and deep cuts to other domestic spending. Although the proposal will be dead on arrival in Congress, it still serves as a good road map for the administration’s priorities and Trump’s re-election campaign.

There were some health care wins, but there were also some blows, as well. At the heart of it all, critics say, are contradictions that undercut Trump’s talk about supporting certain public health causes. Take the $291 million budgeted for HIV, for example. Trump’s proposal allocates hundreds of millions toward the cause domestically, but then cuts global aid and chips away at programs like Medicaid, which HIV patients rely on.

Some of the health care highlights in the budget:

• Shaving $818 billion from projected spending on Medicare over 10 years and calling for belt-tightening within the popular program to combat “waste, fraud and abuse”;

• Cutting nearly $1.5 trillion from projected spending on Medicaid and transforming the program into a block grant system (a controversial idea that has received a lot of criticism in the past, even from Republican governors);

• Slashing spending on the National Institutes of Health, a longtime favorite of lawmakers of both parties, by $4.5 billion, with the National Cancer Institute absorbing the largest chunk of that cut;

• Increasing funding for pediatric cancer research by $50 million;

• Cutting HHS funding to $87.1 billion, which would be 12 percent less than in the spending plan Congress adopted for this fiscal year;

• Charging the e-cigarette industry $100 million a year in user fees that would go toward the FDA and its oversight efforts;

• And raising funding for VA medical care by nearly 10 percent.

Another interesting tidbit comes out of Politico’s reporting: HHS would be directed to steer $20 million toward a small children’s health program sought by one of Trump’s golfing buddies, Jack Nicklaus.

The New York Times: Trump Proposes a Record $4.75 Trillion Budget

The Washington Post: Springing Forward to Daylight Saving Time Is Obsolete, Confusing and Unhealthy, Critics Say

The Washington Post: Trump Pledges Support for Health Programs but His Budget Takes ‘Legs Out From Underneath the System’

Politico: Trump’s Budget Would Steer $20M to Jack Nicklaus-Backed Hospital Project

Democrats were less than pleased with the suggested budget. Lawmakers warned HHS Secretary Alex Azar — who bore the brunt of their ire at a hearing on Tuesday — that if Medicaid were transformed into a block grant system the change would face “a firestorm” of opposition.

The New York Times: Congress Warns Against Medicaid Cuts: ‘You Just Wait for the Firestorm’

Meanwhile, the “Mediscare” game went another round with Democrats saying that the “unbelievable” cuts fulfill long-standing Republican ambitions “to make Medicare wither on the vine.” If the accusations sound familiar to ones you’ve heard in the past, you’re not mistaken. They just might have been coming from Republicans. The Washington Post Fact Checker untangles it all to show that everyone is guilty of playing this particular scare game.

The Washington Post Fact Checker: Democrats Engage in ‘Mediscare’ Spin on the Trump Budget


Following FDA Commissioner Scott Gottlieb’s surprise resignation announcement, Dr. Ned Sharpless has been named as the acting chief of the agency. Sharpless’ current work as the director of the National Cancer Institute has focused on the relationship between aging and cancer, and the development of new treatments for melanoma, lung cancer and breast cancer.

The appointment was a bit of a curveball for some agency watchers. Some Republicans had been chafing at the way Gottlieb embraced his pro-regulation side as commissioner and were hoping for a sea change. But Sharpless is a Democrat who has spoken out before about how his worries over the e-cigarette industry keep him up at night, so the direction of the agency may not be changing soon. (HHS Secretary Alex Azar has said this is a temporary appointment and the search for a permanent commissioner is underway, but there are also hints that Sharpless could step into the role.)

Colleagues were quick to praise the cancer doctor and research veteran for his breadth of experience and his “approachable, objective” demeanor.

Stat: How Ned Sharpless, Biotech Veteran, Vaulted to the Top of the FDA

No one can accuse Gottlieb of getting whatever the professional version of “senioritis” is, despite the fact that he’ll be departing in a few weeks. The FDA has issued a proposal that would sequester flavored e-cigarettes to areas off-limits to anyone under age 18. The stores can still sell tobacco, mint and menthol e-cigarettes, which the FDA says are more popular among adults than minors.

The New York Times: F.D.A. Moves to Restrict Flavored E-Cigarette Sales to Teenagers


Beto O’Rourke is the latest Democrat to throw his hat in the ring for 2020, but can the moderate Texan overcome his baggage when it comes to his past opposition to the Affordable Care Act? In terms of his current stance, he has said that he supports universal health care, but has, like other moderates in the race, taken pains not to name “Medicare-for-all” in particular.

The Wall Street Journal: Beto O’Rourke’s Past GOP Ties Could Complicate Primary Run


The Connecticut Supreme Court has now cleared the way for Sandy Hook families to sue gunmakers over wrongful marketing. In the lawsuit, the families pointed out ads with slogans like “Consider your man card reissued,” which they say is specifically targeted for troubled young men like Adam Lanza. The ruling is fairly narrow and limited to marketing — the justices dismissed other aspects of the lawsuits — but could have far-reaching ramifications because it strips away some of the blanket immunity offered to gun manufacturers by Congress.

The New York Times: Sandy Hook Massacre: Remington and Other Gun Companies Lose Major Ruling Over Liability


Lawyers are starting to warn their clients who have filed disability claims with the government to clean up their social media because Uncle Sam might start snooping for fraud. “You don’t want anything on there that shows you out playing Frisbee,” one said. Advocates for people with disabilities say using social media sites in such a way would be irresponsible, as it’s impossible to gauge just from the pictures people post if they need disability aid.

The New York Times: On Disability and on Facebook? Uncle Sam Wants to Watch What You Post


In the miscellaneous file for the week:

• Calls for a worldwide moratorium on gene-editing human embryos expose the ethical divide over the research, which has been thrust into the spotlight following a Chinese scientist’s shocking and unexpected revelation that he successfully accomplished the feat.

Reuters: Experts Call for Halt to Gene Editing That Results in ‘Designer Babies’

• An entrenched culture of sexism at VA facilities has led female veterans to forgo needed care in order to avoid harassment. “It’s like a construction site,” said Rep. John Carter (R-Texas).

The New York Times: Treated Like a ‘Piece Of Meat’: Female Veterans Endure Harassment at the V.A.

• Court filings detail Johnson & Johnson’s role in the opioid epidemic, including accusations that the company operated like a drug “kingpin … profiting at every stage.’’

Bloomberg: US Opioid Drug Epidemic: J&J Called ‘Kingpin’ by Oklahoma

• The cost of this Oregon child not getting vaccinations? $800,000 in medical bills and 57 days in the hospital. The terrifying ordeal shows how quickly a small cut can spiral into a devastating emergency.

The New York Times: An Unvaccinated Boy Got Tetanus. His Oregon Hospital Stay: 57 Days and $800,000.

• Medical ethicists were given a lot to think about this week: In this case, it’s examining the tough decisions that come from deciding to extract sperm from a deceased loved one. While some support the choice if it’s a spouse, what happens if it’s the parents who are making the call?

Stat: Efforts to Save the Sperm of the Dead Bring Heartache and Tough Questions

• Is there a chilling effect on disease research when social media activists engage in thought-policing? Scientists say yes, and that, ultimately, the patients are the ones getting hurt.

Reuters: Special Report: Online Activists Are Silencing Us, Scientists Say


Doctors say our oversanitized culture does no favors to our immune system. (I have been pounding this drum for years, so I had to include this story.) The next time you drop some food on the floor, apparently the right move is to embrace the three-second rule and eat it. Have a great weekend!

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Has everyone recovered from their daylight saving time jet lag? Every year we get a whole host of articles about why changing the clocks is outdated, terrible and really quite bad for our health, and yet! Here were are, still grumpy and tired. But it’s almost the weekend, so let’s soldier on.

Here’s what you may have missed in your spring-forward daze.

President Donald Trump released his $4.75 trillion budget plan this week, which included a big increase in military funding and deep cuts to other domestic spending. Although the proposal will be dead on arrival in Congress, it still serves as a good road map for the administration’s priorities and Trump’s re-election campaign.

There were some health care wins, but there were also some blows, as well. At the heart of it all, critics say, are contradictions that undercut Trump’s talk about supporting certain public health causes. Take the $291 million budgeted for HIV, for example. Trump’s proposal allocates hundreds of millions toward the cause domestically, but then cuts global aid and chips away at programs like Medicaid, which HIV patients rely on.

Some of the health care highlights in the budget:

• Shaving $818 billion from projected spending on Medicare over 10 years and calling for belt-tightening within the popular program to combat “waste, fraud and abuse”;

• Cutting nearly $1.5 trillion from projected spending on Medicaid and transforming the program into a block grant system (a controversial idea that has received a lot of criticism in the past, even from Republican governors);

• Slashing spending on the National Institutes of Health, a longtime favorite of lawmakers of both parties, by $4.5 billion, with the National Cancer Institute absorbing the largest chunk of that cut;

• Increasing funding for pediatric cancer research by $50 million;

• Cutting HHS funding to $87.1 billion, which would be 12 percent less than in the spending plan Congress adopted for this fiscal year;

• Charging the e-cigarette industry $100 million a year in user fees that would go toward the FDA and its oversight efforts;

• And raising funding for VA medical care by nearly 10 percent.

Another interesting tidbit comes out of Politico’s reporting: HHS would be directed to steer $20 million toward a small children’s health program sought by one of Trump’s golfing buddies, Jack Nicklaus.

The New York Times: Trump Proposes a Record $4.75 Trillion Budget

The Washington Post: Springing Forward to Daylight Saving Time Is Obsolete, Confusing and Unhealthy, Critics Say

The Washington Post: Trump Pledges Support for Health Programs but His Budget Takes ‘Legs Out From Underneath the System’

Politico: Trump’s Budget Would Steer $20M to Jack Nicklaus-Backed Hospital Project

Democrats were less than pleased with the suggested budget. Lawmakers warned HHS Secretary Alex Azar — who bore the brunt of their ire at a hearing on Tuesday — that if Medicaid were transformed into a block grant system the change would face “a firestorm” of opposition.

The New York Times: Congress Warns Against Medicaid Cuts: ‘You Just Wait for the Firestorm’

Meanwhile, the “Mediscare” game went another round with Democrats saying that the “unbelievable” cuts fulfill long-standing Republican ambitions “to make Medicare wither on the vine.” If the accusations sound familiar to ones you’ve heard in the past, you’re not mistaken. They just might have been coming from Republicans. The Washington Post Fact Checker untangles it all to show that everyone is guilty of playing this particular scare game.

The Washington Post Fact Checker: Democrats Engage in ‘Mediscare’ Spin on the Trump Budget


Following FDA Commissioner Scott Gottlieb’s surprise resignation announcement, Dr. Ned Sharpless has been named as the acting chief of the agency. Sharpless’ current work as the director of the National Cancer Institute has focused on the relationship between aging and cancer, and the development of new treatments for melanoma, lung cancer and breast cancer.

The appointment was a bit of a curveball for some agency watchers. Some Republicans had been chafing at the way Gottlieb embraced his pro-regulation side as commissioner and were hoping for a sea change. But Sharpless is a Democrat who has spoken out before about how his worries over the e-cigarette industry keep him up at night, so the direction of the agency may not be changing soon. (HHS Secretary Alex Azar has said this is a temporary appointment and the search for a permanent commissioner is underway, but there are also hints that Sharpless could step into the role.)

Colleagues were quick to praise the cancer doctor and research veteran for his breadth of experience and his “approachable, objective” demeanor.

Stat: How Ned Sharpless, Biotech Veteran, Vaulted to the Top of the FDA

No one can accuse Gottlieb of getting whatever the professional version of “senioritis” is, despite the fact that he’ll be departing in a few weeks. The FDA has issued a proposal that would sequester flavored e-cigarettes to areas off-limits to anyone under age 18. The stores can still sell tobacco, mint and menthol e-cigarettes, which the FDA says are more popular among adults than minors.

The New York Times: F.D.A. Moves to Restrict Flavored E-Cigarette Sales to Teenagers


Beto O’Rourke is the latest Democrat to throw his hat in the ring for 2020, but can the moderate Texan overcome his baggage when it comes to his past opposition to the Affordable Care Act? In terms of his current stance, he has said that he supports universal health care, but has, like other moderates in the race, taken pains not to name “Medicare-for-all” in particular.

The Wall Street Journal: Beto O’Rourke’s Past GOP Ties Could Complicate Primary Run


The Connecticut Supreme Court has now cleared the way for Sandy Hook families to sue gunmakers over wrongful marketing. In the lawsuit, the families pointed out ads with slogans like “Consider your man card reissued,” which they say is specifically targeted for troubled young men like Adam Lanza. The ruling is fairly narrow and limited to marketing — the justices dismissed other aspects of the lawsuits — but could have far-reaching ramifications because it strips away some of the blanket immunity offered to gun manufacturers by Congress.

The New York Times: Sandy Hook Massacre: Remington and Other Gun Companies Lose Major Ruling Over Liability


Lawyers are starting to warn their clients who have filed disability claims with the government to clean up their social media because Uncle Sam might start snooping for fraud. “You don’t want anything on there that shows you out playing Frisbee,” one said. Advocates for people with disabilities say using social media sites in such a way would be irresponsible, as it’s impossible to gauge just from the pictures people post if they need disability aid.

The New York Times: On Disability and on Facebook? Uncle Sam Wants to Watch What You Post


In the miscellaneous file for the week:

• Calls for a worldwide moratorium on gene-editing human embryos expose the ethical divide over the research, which has been thrust into the spotlight following a Chinese scientist’s shocking and unexpected revelation that he successfully accomplished the feat.

Reuters: Experts Call for Halt to Gene Editing That Results in ‘Designer Babies’

• An entrenched culture of sexism at VA facilities has led female veterans to forgo needed care in order to avoid harassment. “It’s like a construction site,” said Rep. John Carter (R-Texas).

The New York Times: Treated Like a ‘Piece Of Meat’: Female Veterans Endure Harassment at the V.A.

• Court filings detail Johnson & Johnson’s role in the opioid epidemic, including accusations that the company operated like a drug “kingpin … profiting at every stage.’’

Bloomberg: US Opioid Drug Epidemic: J&J Called ‘Kingpin’ by Oklahoma

• The cost of this Oregon child not getting vaccinations? $800,000 in medical bills and 57 days in the hospital. The terrifying ordeal shows how quickly a small cut can spiral into a devastating emergency.

The New York Times: An Unvaccinated Boy Got Tetanus. His Oregon Hospital Stay: 57 Days and $800,000.

• Medical ethicists were given a lot to think about this week: In this case, it’s examining the tough decisions that come from deciding to extract sperm from a deceased loved one. While some support the choice if it’s a spouse, what happens if it’s the parents who are making the call?

Stat: Efforts to Save the Sperm of the Dead Bring Heartache and Tough Questions

• Is there a chilling effect on disease research when social media activists engage in thought-policing? Scientists say yes, and that, ultimately, the patients are the ones getting hurt.

Reuters: Special Report: Online Activists Are Silencing Us, Scientists Say


Doctors say our oversanitized culture does no favors to our immune system. (I have been pounding this drum for years, so I had to include this story.) The next time you drop some food on the floor, apparently the right move is to embrace the three-second rule and eat it. Have a great weekend!

Podcast: KHN’s ‘What The Health?’ The Karma Of Cutting Medicare

Like those of his recent predecessors, President Donald Trump’s proposed budget for the fiscal year that starts in October will not be adopted by Congress. Still, a presidential budget plan is an important indicator of the administration’s priorities.

The Trump administration’s priority for health is for the federal government to spend less. In some cases much less, as evidenced by its proposed funding for the National Institutes of Health and Centers for Disease Control and Prevention.

Also this week, a federal district judge in Washington, D.C., heard arguments in a case challenging work requirements for some Medicaid enrollees in Arkansas and Kentucky. This is the same judge who struck down an earlier version of Kentucky’s proposal.

Meanwhile, Food and Drug Administration chief Scott Gottlieb is stepping down, but this week he issued more rules intended to prevent minors from purchasing flavored e-cigarette products.

This week’s panelists are Julie Rovner of Kaiser Health News, Stephanie Armour of The Wall Street Journal, Alice Ollstein of Politico and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • Trump’s budget may turn the tables on the Republican Party. It calls for more than $500 billion in reductions to Medicare, much of that in payments to providers. That is similar to what Democrats proposed to help fund the Affordable Care Act — a tactic that Republicans used to whip up widespread opposition to the law and gain control of the House of Representatives. Count on Democrats to return the favor in coming campaigns.
  • Some Republicans, including Rep. Tom Cole of Oklahoma, a key Republican on the House Appropriations Committee, signaled concerns about budget cuts recommended by the administration, especially for NIH.
  • On Medicaid, the budget suggests that states be allowed to administer many parts of the program as they see fit. But opponents are likely to ask courts to stop any efforts to weaken federal requirements for coverage.
  • House Democrats have begun an investigation of the marketing and benefits of short-term insurance plans to see if they are denying promised coverage to consumers. The lawmakers are concerned that what they call “junk plans” are confusing consumers who would be better off with policies from the ACA’s marketplace. But any efforts to rein in the plans — which have the blessing of the Trump administration — could run into opposition from Republicans.
  • A federal appeals court this week ruled that Ohio may exclude Planned Parenthood from participating in several small federal health programs that provide money to the state to distribute. The case does not involve either Medicaid or the federal family planning program, but the participation of four judges appointed by Trump could signal a judicial trend.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: Buzz Feed News’ “Military Doctors Told Them It Was Just ‘Female Problems.’ Weeks Later, They Were In The Hospital,” by Ema O’Connor and Vera Bergengruen.

AND

The New York Times’ “Treated Like a ‘Piece of Meat’: Female Veterans Endure Harassment at the V.A.,” by Jennifer Steinhauer.

Rebecca Adams: Kaiser Health News’ “’Medicare-For-All Gets Buzzy In Unexpected Locales,” by Shefali Luthra.

Stephanie Armour: Kaiser Health News’ “Understanding Loneliness In Older Adults – And Tailoring A Solution,” by Judith Graham.

Alice Ollstein: HuffPost’s “These Citizen Activists Fought Hard to Expand Health Care. Then Their Lawmakers Rebuked Them,” by Jeffrey Young.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Podcast: KHN’s ‘What The Health?’ The Karma Of Cutting Medicare

Like those of his recent predecessors, President Donald Trump’s proposed budget for the fiscal year that starts in October will not be adopted by Congress. Still, a presidential budget plan is an important indicator of the administration’s priorities.

The Trump administration’s priority for health is for the federal government to spend less. In some cases much less, as evidenced by its proposed funding for the National Institutes of Health and Centers for Disease Control and Prevention.

Also this week, a federal district judge in Washington, D.C., heard arguments in a case challenging work requirements for some Medicaid enrollees in Arkansas and Kentucky. This is the same judge who struck down an earlier version of Kentucky’s proposal.

Meanwhile, Food and Drug Administration chief Scott Gottlieb is stepping down, but this week he issued more rules intended to prevent minors from purchasing flavored e-cigarette products.

This week’s panelists are Julie Rovner of Kaiser Health News, Stephanie Armour of The Wall Street Journal, Alice Ollstein of Politico and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • Trump’s budget may turn the tables on the Republican Party. It calls for more than $500 billion in reductions to Medicare, much of that in payments to providers. That is similar to what Democrats proposed to help fund the Affordable Care Act — a tactic that Republicans used to whip up widespread opposition to the law and gain control of the House of Representatives. Count on Democrats to return the favor in coming campaigns.
  • Some Republicans, including Rep. Tom Cole of Oklahoma, a key Republican on the House Appropriations Committee, signaled concerns about budget cuts recommended by the administration, especially for NIH.
  • On Medicaid, the budget suggests that states be allowed to administer many parts of the program as they see fit. But opponents are likely to ask courts to stop any efforts to weaken federal requirements for coverage.
  • House Democrats have begun an investigation of the marketing and benefits of short-term insurance plans to see if they are denying promised coverage to consumers. The lawmakers are concerned that what they call “junk plans” are confusing consumers who would be better off with policies from the ACA’s marketplace. But any efforts to rein in the plans — which have the blessing of the Trump administration — could run into opposition from Republicans.
  • A federal appeals court this week ruled that Ohio may exclude Planned Parenthood from participating in several small federal health programs that provide money to the state to distribute. The case does not involve either Medicaid or the federal family planning program, but the participation of four judges appointed by Trump could signal a judicial trend.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: Buzz Feed News’ “Military Doctors Told Them It Was Just ‘Female Problems.’ Weeks Later, They Were In The Hospital,” by Ema O’Connor and Vera Bergengruen.

AND

The New York Times’ “Treated Like a ‘Piece of Meat’: Female Veterans Endure Harassment at the V.A.,” by Jennifer Steinhauer.

Rebecca Adams: Kaiser Health News’ “’Medicare-For-All Gets Buzzy In Unexpected Locales,” by Shefali Luthra.

Stephanie Armour: Kaiser Health News’ “Understanding Loneliness In Older Adults – And Tailoring A Solution,” by Judith Graham.

Alice Ollstein: HuffPost’s “These Citizen Activists Fought Hard to Expand Health Care. Then Their Lawmakers Rebuked Them,” by Jeffrey Young.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Students With Disabilities Call College Admissions Cheating ‘Big Slap In The Face’

For Savannah Treviño-Casias, this week’s news about the college admissions cheating scandal was galling, considering how much red tape the Arizona State University senior went through to get disability accommodations when she took the SAT.

“It felt like such a big slap in the face,” said Treviño-Casias, 23, who was diagnosed in sixth grade with dyscalculia, a disability that makes it more difficult to learn and do math. “I was pretty disgusted. It just makes it harder for people who actually have a diagnosed learning disability to be believed.”

Federal prosecutors have charged 50 people, including actresses Felicity Huffman and Lori Loughlin, in a nationwide bribery and fraud scheme to admit underperforming students to elite colleges. Some of the parents charged, the FBI said, paid to have their children diagnosed with bogus learning disabilities so they could get special accommodations on the SAT and ACT college entrance exams. Such accommodations can include giving students extra time on the tests or allowing them to take their exam in a room alone with a proctor to limit distractions. Prosecutors allege ringleaders in the scandal arranged for proctors in on the scam to correct students’ answers during or after the exam, or had someone else take the test for them.

Now, families and advocates are worried about a backlash that could make it harder for students with legitimate disabilities to get the accommodations they need to succeed.

“There are already too many hoops and hurdles disabled students must navigate in order to vindicate their civil right to higher education,” said Matthew Cortland, a lawyer and disability activist based in Boston. “My fear is that these celebrity fraudsters will incite a crackdown on accommodations. Schools and testing companies will make it even more burdensome for disabled students to get the accommodations that allow them to realize their civil right to access higher education.”

Federal law requires colleges and college testing companies to provide accommodations for students with documented disabilities, including learning disabilities. But in practice, it can be difficult for students — particularly low-income students — to get those accommodations. Students diagnosed in grade school may have to provide updated evaluations documenting their need for special accommodations — testing that can cost thousands of dollars.

Students with legitimate disabilities constantly have to fight the perception that they’re gaming the system, said Lindsay Jones, CEO of the National Center for Learning Disabilities.

Savannah Treviño-Casias, a senior at Arizona State University, worries about the backlash against educational accommodations for students with legitimate learning disabilities. She was diagnosed in sixth grade with dyscalculia, a math learning disability. (Courtesy of Savannah Treviño-Casias)

“Many people in our society assume accommodations give you an advantage. They assume, ‘I, too, would have done better,’ which is a fundamental misunderstanding,” Jones said. “But these individuals are already facing skepticism. The college admissions scandal is incredibly damaging to a population that’s already fighting to prove that they are amazing and can achieve incredible things.”

The FBI did not charge any medical professionals who might have provided a fraudulent diagnosis.

Diane Blair-Sherlock, a real estate attorney in the Chicago suburb of Villa Park, didn’t have any trouble getting entrance exam accommodations for her daughter, who is deaf, although it took three months for the College Board, which administers the SAT, to approve a sign-language interpreter.

Her son, diagnosed with Asperger’s syndrome, a form of autism, was another story. Blair-Sherlock said the College Board turned down her son’s application for accommodations on the SAT despite his having provided documentation of his disability. She finally succeeded after appealing the denial, and her son was granted extra time, breaks and an isolated area in which to take the test. He is now a student at the University of Illinois-Chicago — getting A’s and B’s, she said proudly — and Blair-Sherlock helps other parents facing similar difficulties.

“I’m looking for a level playing field,” Blair-Sherlock said. “You’re playing with kids’ lives here.”

The College Board, which also administers Advanced Placement (AP) tests, has said that requests for accommodations have increased in recent years as more students opt to take the exams, but didn’t respond to questions about specifics from KHN. Such requests rose from 80,000 in 2010-11 to 160,000 in 2015-16, and about 85 percent of requests for accommodation were approved, according to recent news reports.

In 2017, under pressure from disability advocates and amid inquiries from the U.S. Department of Justice, the company said it would streamline applications for accommodations; students who had been granted existing accommodations at their high schools — extra time on tests, for example — would have the same accommodations automatically approved for exams such as the SAT.

When documentation is requested, the College Board requires that a diagnosis be made by “someone with appropriate professional credentials” and that a diagnosis be current. For example, for students with a diagnosis of attention deficit hyperactivity disorder, or ADHD, evaluations should be no more than five years old. The College Board said it combats organized cheating by banning cellphones, analyzing test-taker behaviors and enhancing security measures at test centers, among other actions, though it failed in a number of the cases the FBI investigated.

The ACT organization, which administers the test by the same name, also requires students to have a professionally diagnosed disability and generally to already be getting accommodations in their school classrooms. It may require additional documentation, depending on the type of disability. Students reporting mood or anxiety disorders, for example, would have to provide information on the psychological tests used, as well as a history of medication and treatment. Documentation of a psychiatric disorder must be current within the past year. The ACT declined to comment on whether the number of students granted accommodations has gone up in recent years, citing the ongoing investigation.


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

Why Measles Hits So Hard Within N.Y. Orthodox Jewish Community

The Rockland County, N.Y., woman hadn’t told her obstetrician that she had a fever and rash, two key signs of a measles infection. A member of the Orthodox Jewish community there, she went into premature labor at 34 weeks, possibly as a result of the infection. Her baby was born with measles and spent his first 10 days in the neonatal intensive care unit.

The infant is home now, but “we don’t know how this baby will do,” said Dr. Patricia Schnabel Ruppert, the health commissioner for Rockland County. When young children contract measles, they face a heightened risk of complications from the disease, including seizures or hearing and vision problems down the road.

The measles case Ruppert described is just one of many. New York state’s outbreaks, which began last October, have gone on longer and infected more people than any other current outbreak nationwide. More than 275 cases of the disease have been confirmed statewide through the first week of March, primarily in the New York City borough of Brooklyn and in Rockland County towns northwest of the city.

That total makes up about half of the 578 confirmed cases in 11 states that were reported nationwide by the federal Centers for Disease Control and Prevention from January 2018 through the end of last month. Washington state, with 76 cases by the end of February, has the second-highest number of cases.

Measles cases in New York have been concentrated among children from Orthodox Jewish families, many of whom attend religious schools where vaccination rates may have been below the 95 percent threshold considered necessary to maintain immunity. The outbreaks began when unvaccinated travelers returned from Israel, where an outbreak persists, and spread the disease here.

Besides geographic proximity, cultural identity may contribute to an outbreak taking hold in the close-knit Orthodox community — a feeling that their worldview is not in keeping with modern secular society, said Samuel Heilman, a Queens College sociology professor who has authored several books about Orthodox Jews.

“It’s about a view that we have our ways and they have their ways,” he said.

Although some Orthodox Jews claim that vaccinations are against Jewish law, that’s not correct, said Dr. Aaron Glatt, who is also a rabbi and chairman of the department of medicine at South Nassau Communities Hospital on Long Island. “There’s not a single opinion that says vaccination is against Jewish law,” he said.

As public health officials and health care providers battle to get the outbreaks under control, one of their biggest challenges is communicating to people that measles is a menacing disease to be taken seriously.

“People don’t want to get vaccines because they don’t think they need them,” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

The public may have grown complacent. Before the vaccine program began in the United States in 1963, as many as 4 million people became infected every year. Nearly 50,000 were hospitalized and up to 500 people died annually. By 2000, measles was a disease that public health officials said was essentially eradicated in the U.S., thanks to a comprehensive vaccine program that reduced the number of cases by 99 percent.

But measles has crept back in recent years, in part because of fears fanned by anti-vaccine activists who have claimed, without evidence, that vaccines cause a variety of problems, including autism.

The measles virus is still a problem in some other countries, and unvaccinated people may bring the virus back with them and infect others.

The virus is exquisitely contagious. If an infected person coughs or talks, droplets can remain in the air or land on a surface and cause infection for hours. Ninety percent of people who are exposed and susceptible will become infected. While a fever and red rash that spreads from the face down along the body are common symptoms, side effects can be serious and even lethal, especially for young children and people with compromised immune systems.

In an effort to contain New York’s outbreaks, Ruppert initially prohibited 6,000 children at 60 mostly religious schools and day care centers in Rockland County from attending class because they hadn’t been vaccinated. As more children have been vaccinated and the school vaccination rates have reached 95 percent, those numbers have dropped. But about 3,800 students at 35 schools are still excluded from attending.

In Brooklyn, 1,800 students at 140 schools were originally affected, said Dr. Jane Zucker, assistant commissioner for the Bureau of Immunization at the New York City Health Department. Those numbers have declined somewhat as well.

Since the outbreaks began, Rockland County health care providers have administered more than 16,000 vaccines, while New York City has provided more than 7,000 shots.

The measles, mumps and rubella vaccine is given in two doses, the first when a child is between 12 and 15 months old, and the second between ages 4 and 6. It is 97 percent effective in preventing the disease.

In New York and nearly every other state, children may be exempted from vaccination requirements for medical or religious reasons. Seventeen states allow parents not to vaccinate their children for philosophical reasons, according to the National Conference of State Legislatures, but New York is not one of them.

Concerns about contracting measles aren’t limited to people who are part of the Orthodox Jewish community. Heilman said that one of his daughters-in-law likes to shop at a kosher supermarket in Rockland County, not far from her home in suburban White Plains. But with an 11-month-old daughter who hasn’t yet been vaccinated, she doesn’t want to take any risks. As long as the threat of measles continues, his daughter-in-law is shopping elsewhere, Heilman said.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Headline writers across the world (read: yours truly) breathed a sigh of relief this week when the venture formally known as “the health initiative founded by Amazon, Berkshire Hathaway and JPMorgan Chase” finally picked a name. After more than a year of tight-lipped secrecy, they settled on “Haven.” What do you guys think? I’m just thankful it’s short.

On to what you may have missed this week!

FDA Commissioner Scott Gottlieb sent shock waves through Washington and the industry when he announced he’ll be retiring at the end of the month. Gottlieb was a standout in the anti-regulatory, pro-business Trump administration as one of the most activist commissioners in recent years. Over the past two years, he has launched what could be termed a crusade against teen vaping — his most recent action coming just the day before the announcement, when he called out Walgreens and gas stations for selling tobacco products to minors — and cracked down on “miracle cures” and unregulated stem cell clinics and supplements, among other initiatives. Public health advocates are fretting that with him gone, some of the progress they’ve seen will be chipped away.

The departure is also a blow to the administration in that Gottlieb is a highly liked health official who worked well with Congress, winning over even Democratic lawmakers on Capitol Hill. Behind the scenes, he was known as someone who was “accessible,” would field lawmakers’ questions and was actively working on things that would make Congress happy. “I’ve never seen an administration official, Republican or Democrat, that has worked with the Hill so well on a bipartisan basis,” a senior congressional aide told Stat.

That’s not to say he didn’t have his critics. A decision on approving a powerful opioid late last year, in particular, drew fire from many advocates.

Gottlieb said his decision to leave was based on the fact that he missed spending time with his family, and White House officials confirmed that President Donald Trump did not seek the resignation.

Now the big question is: Who is going to replace him?

Stat: With Gottlieb’s Resignation, the Trump Administration Loses Its Backroom Whisperer on Capitol Hill

Politico: ‘Something Very Rare’: FDA’s Gottlieb Aggressively Tackled Difficult Issues

Stat: The Likely, Possible, and Longshot Contenders to Replace Gottlieb at FDA


As expected, legal challenges to the administration’s changes to the family planning rules came not in a trickle but a flood. California Attorney General Xavier Becerra, in his 47th lawsuit against the administration, said the rules restricting abortion referrals were like something out of 1920 and not 2019. Apart from California’s case, 20 states and D.C. announced they will be filing suits. Then came the announcement that Planned Parenthood Federation of America and the American Medical Association will also challenge the restrictions, deeming the changes a “domestic gag rule” and an overreach from the administration.

The New York Times: California Sues Trump Administration to Block Restrictions to Family Planning Program

The Washington Post: Planned Parenthood, American Medical Association Sue Trump Administration Over Abortion ‘Gag Rule’


Facing increasingly intense outrage over insulin prices, Eli Lilly has decided to offer an authorized generic version of its drug for half the cost. Stories of people dying after they rationed newly pricey insulin have been circulating with ever-increasing frequency, and lawmakers have made it their priority to specifically rout out answers about insulin price hikes. In that context, Eli Lilly’s move here seems more damage control than charitable, but it also puts them in good company with drugmakers who have been hotfooting it to avoid whatever worse would come out of Congress if they don’t make some changes.

Stat: Lilly Will Sell a Half-Price Version of Its Insulin. Will It Appease Critics?


Former Colorado Gov. John Hickenlooper officially threw his hat into the narrowing 2020 field this week. Hickenlooper seems to gravitate more toward the moderate wing of the Democratic Party, saying he supports universal health care in principle but refusing to get behind a “Medicare-for-all” plan. His evolution on gun control (as a governor who oversaw a mass shooting in the state where Columbine occurred) is also worth checking out.

The New York Times: John Hickenlooper on the Issues


There has always been a gap swallowing people who make too much for health law subsidies or Medicaid but not enough to comfortably afford insurance through the exchanges. A new county-by-county analysis looks at just how tough it is for the people who fall into the holes created by the ACA. A particularly striking figure? In almost all of Nebraska, a 60-year-old with a $50,000 income would pay from 30 to 50 percent of that income in premiums for the least expensive ACA health plan.

The Washington Post: ACA Premiums Rising Beyond Reach of Older, Middle-Class Consumers

Meanwhile, the Trump administration is interested in bolstering interstate insurance sales despite there being little appetite for it in the past and experts saying it wouldn’t lower premiums. In fact, the practice is already allowed under the health law, and no one does it because insurers think it’s just not worth it.

The Wall Street Journal: Trump Administration Looks to Jump Start Interstate Health-Insurance Sales


A teenager who got vaccinated against his mother’s wishes was the star witness at a hearing this week sparked in part by the measles outbreak. Ethan Lindenberger, a high school senior, hoisted the blame for his mother’s deeply rooted beliefs squarely on Facebook’s shoulders.

The anti-vaccination movement has long flourished on Facebook, partly because of the site’s search results and “suggested groups” feature. On Thursday, the company announced it has developed a policy to try to curb that culture of misinformation on vaccines, saying it will rank pages and groups that spread that kind of information lower and will keep them out of recommendations or predictions in search.

The Washington Post: Ethan Lindenberger: Facebook’s Anti-Vax Problem Intensified in Congressional Testimony

The New York Times: Facebook Announces Plan to Curb Vaccine Misinformation


After 12 long years, scientists finally announced that a second patient appears to have been cured of HIV. While the news was well-welcomed around the world — “This will inspire people that cure is not a dream,” said Dr. Annemarie Wensing, a virologist — there are some practical obstacles to consider. For example, bone marrow transplants (which is how both patients were cured) are extremely risky, especially since there are drugs that exist that can control HIV fairly well.

The New York Times: H.I.V. Is Reported Cured in a Second Patient, a Milestone in the Global AIDS Epidemic


In a scathing ruling that could have wide-reaching ramifications for the insurance industry, a judge blasted UnitedHealth Group for policies that he says were aimed at effectively discriminating against patients with mental health and substance abuse disorders to save money. The decision is part of a larger debate over parity in relation to coverage for mental health services versus other illnesses like diabetes. Insurance companies have been getting around parity requirements with internal rules, but advocates are viewing the judge’s ruling as a warning shot that those loopholes will no longer be tolerated.

The New York Times: Mental Health Treatment Denied to Customers by Giant Insurer’s Policies, Judge Rules

The FDA this week approved a cousin of party drug “Special K” to help people with severe cases of depression, marking a shift away from traditional antidepressant medications. While many said the news would give hope to desperate patients, others are worried about the potential for abuse.

The New York Times: Fast-Acting Depression Drug, Newly Approved, Could Help Millions


Honorable mention for International Women’s Day: A veritable “tsunami wave of women veterans” over the past several years is forcing the VA to step up in terms of meeting female-specific health care needs. Among basic issues are seeing to it that doctors are trained to deal with gynecological matters and ensuring that VA facilities have child care services available when female veterans come in for appointments.

The Wall Street Journal: As More Military Women Seek Health Care, VA Pursues Improvements


In the miscellaneous file for the week:

• Nearly 600,000 children have dropped off of states’ Medicaid and CHIP rolls over a one-year span. While states rush to assure anyone asking that it’s because the economy is improving, public health experts are alarmed at the disturbing trend.

Stateline: Child Enrollment in Public Health Programs Fell by 600K Last Year

• In a “craning your neck at the car wreck” sort of way, this profile on disgraced pharma bro Martin Shkreli is a wild read. Through the help of a contraband smartphone, Shkreli is, from his prison cell, still pulling the strings at his old company, schmoozing up his prison friends “Krispy” and “D-Block,” and planning his big comeback.

The Wall Street Journal: Martin Shkreli Steers His Old Company From Prison — With Contraband Cellphone

• Last year, doctors burst onto the gun-debate scene through the help of a viral tweet that directed them to “stay in their lane.” But a new analysis provides an interesting look at which lawmakers are getting the most money from physician-related PACs. (Hint: It’s overwhelming ones who are against tighter gun regulations.)

The Wall Street Journal: Doctors’ PACs Favored Candidates Opposing Gun Background Checks

• In slightly terrifying news, research that was halted over concerns it could create deadly flu viruses that could be used by terrorists was just given the green light again —without any explanation as to why. *Gulp*

The New York Times: Studies of Deadly Flu Virus, Once Banned, Are Set to Resume

• Everyone is expecting a big settlement in the sweeping opioid case against Purdue Pharma. But what happens if the opioid maker declares bankruptcy first?

Stat: If Purdue Pharma Declares Bankruptcy, What Happens to the Opioid Cases?

• Luke Perry’s early death from a stroke this week has many middle-aged Americans worried.

The New York Times: Here’s How Strokes Happen When You’re As Young As Luke Perry

• Drug companies and doctors are in a dirty war over fetal transplants. It may seem click-baity at first, but the issue is highly revealing of how the health industry works when it comes to something that could make people lots of money.

The New York Times: Drug Companies and Doctors Battle Over the Future of Fecal Transplants


That’s it from me! Have a great weekend!