Tagged Health Industry

Cause Of Polio-Like Illness In Children Continues To Stump Experts Even As Dozens Of More Cases Emerge

“What we do know is that these patients had fever and respiratory symptoms three to 10 days before their limb weakness,” CDC’s Dr. Nancy Messonnier told The Associated Press. “And we know that it’s the season where lots of people have fever and respiratory symptoms. What we need to sort out is what is the trigger for the [acute flaccid myelitis].”

New Guidelines Say Any Kind Of Exercise In Small Doses And Less Sitting Improve Health Starting As Early As Age 3

Getting a sedentary nation off the sofa — only 20 percent of us get the recommended amount of exercise a day — is a big concern for the government, which updated its guidelines Monday for the first time in 10 years. Since the first guidelines were issued, research has expanded the recognized benefits of movement, including reducing the risk of cancer, anxiety and depression and improving cognitive function and sleep.

An Underused Strategy For Surge In STDs: Treat Patients’ Partners Without A Doctor Visit

If patients return to Dr. Crystal Bowe soon after taking medication for a sexually transmitted infection, she usually knows the reason: Their partners have re-infected them.

“While you tell people not to have sex until both folks are treated, they just don’t wait,” she said. “So they are passing the infection back and forth.”

That’s when Bowe, who practices on both sides of the North and South Carolina border, does something doctors are often reluctant to do: She prescribes the partners antibiotics without meeting them.

Federal health officials have recommended this practice, known as expedited partner therapy, for chlamydia and gonorrhea since 2006. It allows doctors to prescribe medication to their patients’ partners without examining them. The idea is to prevent the kind of reinfections described by Bowe — and stop the transmission of STDs to others.

However, many physicians aren’t taking the federal government’s advice because of entrenched ethical and legal concerns.

“Health care providers have a long tradition of being hesitant to prescribe to people they haven’t seen,” said Edward Hook, professor at the University of Alabama’s medical school in Birmingham. “There is a certain skepticism.”

A nationwide surge of sexually transmitted diseases in recent years, however, has created a sense of urgency for doctors to embrace the practice. STD rates have hit an all-time high, according to the Centers for Diseases Control and Prevention. In 2017, the rate of reported gonorrhea cases increased nearly 19 percent from a year earlier to 555,608. The rate of chlamydia cases rose almost 7 percent to 1.7 million.

“STDs are everywhere,” said Dr. Cornelius Jamison, a lecturer at the University of Michigan Medical School. “We have to figure out how to … prevent the spread of these infections. And it’s necessary to be able to treat multiple people at once.”

A majority of states allow expedited partner therapy. Two states — South Carolina and Kentucky — prohibit it, and six others plus Puerto Rico lack clear guidance for physicians.

A 2014 study showed that patients were as much as 29 percent less likely to be re-infected when their physicians prescribed medication to their partners. The study also showed that partners who got those prescriptions were more likely to take the drugs than ones who were simply referred to a doctor.

Yet only about half of providers reported ever having prescribed drugs to the partners of patients with chlamydia, and only 10 percent said they always did so, according to a different study. Chlamydia rates were higher in states with no law explicitly allowing partner prescriptions, research published earlier this year showed.

Because of increasing antibiotic resistance to gonorrhea, the CDC no longer recommends oral antibiotics alone for the infection. But if patients’ partners can’t go in for the recommended treatment, which includes an injection, the CDC said that oral antibiotics by themselves are better than no treatment at all.

“Increasing resistance plus increasing disease rates is a recipe for disaster,” said David Harvey, executive director of the National Coalition of STD Directors. The partner treatment is important for “combating the rising rates of gonorrhea in the U.S. before it’s too late.”

The CDC recommendations are primarily for heterosexual partners because there is less data on the effectiveness of partner treatment in men who sleep with men, and because of concern about HIV risk.

Bowe said that even though she writes STD prescriptions for her patients’ partners, she still worries about possible drug allergies or side effects.

“I don’t know their medical conditions,” she said. “I may contribute to a problem down the road that I’m going to be held liable for.”

Physician Crystal Bowe, who practices in North and South Carolina, said she occasionally writes prescriptions for her patients’ partners but worries about possible drug allergies or side effects. “I don’t know their medical conditions,” she says. “I may contribute to a problem down the road that I’m going to be held liable for.” (Courtesy of Crystal Bowe)

In many cases, doctors and patients simply do not know about partner therapy. Ulysses Rico, who lives in Coachella, Calif., said he contracted gonorrhea several years ago and was treated by his doctor. He didn’t know at the time that he could have requested medicine for his girlfriend. She was reluctant to go to her doctor and instead got the required antibiotics through a friend who worked at a hospital.

“It would have been so much easier to handle the situation for both of us at the [same] moment,” Rico said.

Several medical associations support partner treatment. But they acknowledge the ethical issues, saying it should be used only if the partners are unable or unwilling to come in for care.

Federal officials are trying to raise awareness of the practice by training doctors and other medical professionals, said Laura Bachmann, chief medical officer of the CDC’s office of STD prevention. The agency posts a map with details about the practice in each state.

Over the past several years, advocates have won battles state-by-state to get partner treatment approved, but implementation is challenging and varies widely, said Harvey, whose National Coalition of STD Directors is a member organization that works to eliminate sexually transmitted diseases.

The fact that some states don’t allow it, or haven’t set clear guidelines for physicians, also creates confusion — and disparities across state lines.

The Planned Parenthood affiliate that serves Indiana and Kentucky sees this firsthand, said clinical services director Emilie Theis. In Indiana, providers can legally write prescriptions for their patients’ partners, but they are prohibited from doing so in Kentucky, even though the clinics are only a short drive apart, she noted. A similar dynamic is at play along the South Carolina-North Carolina border, where Bowe practices.

California started allowing partner treatment for chlamydia in 2001 and for gonorrhea in 2007. The state gives medication to certain safety-net clinics, a program it expanded three years ago. However, “it has been an incredibly difficult sell” because many medical providers think “it’s a little bit outside of the traditional practice of medicine,” said Heidi Bauer, chief of the STD control branch of California’s public health department.

At APLA Health, which runs several health clinics in the Los Angeles area, nurse practitioner Karla Taborga occasionally gives antibiotics to patients for their partners. But she tries to get the partners into the clinic first, because she worries they might also be at risk for other sexually transmitted infections.

“If we are just treating for chlamydia, we could be missing gonorrhea, syphilis or, God forbid, HIV,” Taborga said. But if prescribing the drugs without seeing the patients is the only way to treat them, she said, “it’s better than nothing.”

Edith Torres, a Los Angeles resident, said she pressured her then-husband to go to the doctor after he gave her chlamydia several years ago: She refused to have sex with him until he did. Torres said she wanted him to hear directly from the doctor about the risks of STDs and how they are transmitted.

If he had taken the medication without a doctor visit, he wouldn’t have learned those things, she said. “I was scared, and I didn’t want to get it again.”


KHN’s coverage in California is supported in part by Blue Shield of California Foundation.

‘This Isn’t Just My Lane. It’s My Highway’: Doctors Outraged Over NRA’s Suggestion That They Stay Out Of Gun Debate

The NRA’s tweet saying doctors should “stay in their lane” over the gun control debate sparked furious, and sometimes graphic, responses from physicians who deal with gun shot victims frequently. “Do you have any idea how many bullets I pull out of corpses weekly?” Judy Melinek tweeted. Another doctor posted: “My lane is paved by the broken bodies left behind by your products.” Meanwhile, media outlets examine the widespread mental health effects of mass shootings.

Fish Oil And Vitamin D Pills No Guard Against Cancer Or Serious Heart Trouble

A widely anticipated study has concluded that neither vitamin D nor fish oil supplements prevent cancer or serious heart-related problems in healthy older people, according to research presented Saturday at the American Heart Association Scientific Sessions. Researchers defined serious heart problems as the combined rate of heart attacks, stroke and heart-related deaths.

Although hundreds of studies of these supplements have been published over the years, the new clinical trial — a federally funded project involving nearly 26,000 people — is the strongest and most definitive examination yet, said Dr. Clifford Rosen, a senior scientist at the Maine Medical Center Research Institute who was not involved in the research.

Doctors have been keenly interested in learning the supplements’ true value, given their tremendous popularity with patients. A 2017 study found that 26 percent of Americans age 60 and older take vitamin D supplements, while 22 percent take pills containing omega-3 fatty acids, a key ingredient in fish oil.

The new study also suggests there’s no reason for people to undergo routine blood tests for vitamin D, said Rosen, who co-wrote an accompanying editorial. (Both were published in the New England Journal of Medicine.). That’s because the study found that patients’ vitamin D levels made no difference in their risk of cancer or serious heart issues, Rosen said. Even people who began the study with clear vitamin D deficiency got no benefit from taking the supplements, which provided 2,000 international units a day. This amount is equal to one or two of the vitamin D pills typically sold in stores.

A recent Kaiser Health News story reported that vitamin D testing has become a huge business for commercial labs — and an enormous expense for taxpayers. Doctors ordered more than 10 million vitamin D tests for Medicare patients in 2016 — an increase of 547 percent since 2007 — at a cost of $365 million.

“It’s time to stop it,” said Rosen of vitamin D testing. “There’s no justification.”

Dr. JoAnn Manson, the study’s lead author, agrees that her results don’t support screening healthy people for vitamin D deficiency.

But she doesn’t see her study as entirely negative.

Manson notes that her team found no serious side effects from taking either fish oil or vitamin D supplements.

“If you’re already taking fish oil or vitamin D, our results would not provide a clear reason to stop,” Manson said.

Manson notes that a deeper look into the data suggested possible benefits.

When researchers singled out heart attacks — rather than the rate of all serious heart problems combined — they saw that fish oil appeared to reduce heart attacks by 28 percent, Manson said. As for vitamin D, it appeared to reduce cancer deaths — although not cancer diagnoses — by 25 percent.

But slicing the data into smaller segments — with fewer patients in each group — can produce unreliable results, said Dr. Barnett Kramer, director of the cancer prevention division at the National Cancer Institute. The links between fish oil and heart attacks — and vitamin D and cancer death — could be due to chance, Kramer said.

Experts agree that vitamin D is important for bone health. Researchers didn’t report on its effect on bones in these papers, however. Instead, they looked at areas where vitamin D’s benefits haven’t been definitely proven, such as cancer and heart disease. Although preliminary studies have suggested vitamin D can prevent heart disease and cancer, more rigorous studies have disputed those findings.

Manson and her colleagues plan to publish data on the supplements’ effects on other areas of health in coming months, including diabetes, memory and mental functioning, autoimmune disease, respiratory infections and depression.

Consumers who want to reduce their risk of cancer and heart disease can follow other proven strategies.

“People should continue to focus on known factors to reduce cancer and heart disease: Eat right, exercise, don’t smoke, control high blood pressure, take a statin if you are high risk,” said Dr. Alex Krist, a professor of family medicine and population health at Virginia Commonwealth University.

Fish Oil And Vitamin D Pills No Guard Against Cancer Or Serious Heart Trouble

A widely anticipated study has concluded that neither vitamin D nor fish oil supplements prevent cancer or serious heart-related problems in healthy older people, according to research presented Saturday at the American Heart Association Scientific Sessions. Researchers defined serious heart problems as the combined rate of heart attacks, stroke and heart-related deaths.

Although hundreds of studies of these supplements have been published over the years, the new clinical trial — a federally funded project involving nearly 26,000 people — is the strongest and most definitive examination yet, said Dr. Clifford Rosen, a senior scientist at the Maine Medical Center Research Institute who was not involved in the research.

Doctors have been keenly interested in learning the supplements’ true value, given their tremendous popularity with patients. A 2017 study found that 26 percent of Americans age 60 and older take vitamin D supplements, while 22 percent take pills containing omega-3 fatty acids, a key ingredient in fish oil.

The new study also suggests there’s no reason for people to undergo routine blood tests for vitamin D, said Rosen, who co-wrote an accompanying editorial. (Both were published in the New England Journal of Medicine.). That’s because the study found that patients’ vitamin D levels made no difference in their risk of cancer or serious heart issues, Rosen said. Even people who began the study with clear vitamin D deficiency got no benefit from taking the supplements, which provided 2,000 international units a day. This amount is equal to one or two of the vitamin D pills typically sold in stores.

A recent Kaiser Health News story reported that vitamin D testing has become a huge business for commercial labs — and an enormous expense for taxpayers. Doctors ordered more than 10 million vitamin D tests for Medicare patients in 2016 — an increase of 547 percent since 2007 — at a cost of $365 million.

“It’s time to stop it,” said Rosen of vitamin D testing. “There’s no justification.”

Dr. JoAnn Manson, the study’s lead author, agrees that her results don’t support screening healthy people for vitamin D deficiency.

But she doesn’t see her study as entirely negative.

Manson notes that her team found no serious side effects from taking either fish oil or vitamin D supplements.

“If you’re already taking fish oil or vitamin D, our results would not provide a clear reason to stop,” Manson said.

Manson notes that a deeper look into the data suggested possible benefits.

When researchers singled out heart attacks — rather than the rate of all serious heart problems combined — they saw that fish oil appeared to reduce heart attacks by 28 percent, Manson said. As for vitamin D, it appeared to reduce cancer deaths — although not cancer diagnoses — by 25 percent.

But slicing the data into smaller segments — with fewer patients in each group — can produce unreliable results, said Dr. Barnett Kramer, director of the cancer prevention division at the National Cancer Institute. The links between fish oil and heart attacks — and vitamin D and cancer death — could be due to chance, Kramer said.

Experts agree that vitamin D is important for bone health. Researchers didn’t report on its effect on bones in these papers, however. Instead, they looked at areas where vitamin D’s benefits haven’t been definitely proven, such as cancer and heart disease. Although preliminary studies have suggested vitamin D can prevent heart disease and cancer, more rigorous studies have disputed those findings.

Manson and her colleagues plan to publish data on the supplements’ effects on other areas of health in coming months, including diabetes, memory and mental functioning, autoimmune disease, respiratory infections and depression.

Consumers who want to reduce their risk of cancer and heart disease can follow other proven strategies.

“People should continue to focus on known factors to reduce cancer and heart disease: Eat right, exercise, don’t smoke, control high blood pressure, take a statin if you are high risk,” said Dr. Alex Krist, a professor of family medicine and population health at Virginia Commonwealth University.

As Mass Gun Violence Rises, Debate Intensifies Over Strategy On How To Proceed In Active Shooter Situations

The recent shooting at a bar in California highlights how difficult it is to decide on how emergency responders should handle highly dangerous situations. Meanwhile, The Associated Press looks at California’s gun laws, which are some of the strictest in the country. And a community grieves.

As Part Of Crackdown On Vaping ‘Epidemic,’ FDA To Ban Sales Of Most Flavored E-Cigarettes In Stores, Gas Stations

FDA Commissioner Scott Gottlieb has been trying to cut down on what he’s called an epidemic of teenagers’ increased used of vaping products. The FDA stopped short of including menthol flavors in the vaping sales ban, partly out of concern that some users would switch to traditional menthol-tobacco cigarettes. New York is also considering a ban on flavored e-cigarettes.

Measure To Cap Dialysis Profits Pummeled After Record Spending By Industry

Record-breaking spending by the dialysis industry helped doom a controversial California ballot measure to cap its profits.

The industry, led by DaVita and Fresenius Medical Care, spent nearly $111 million to defeat Proposition 8, which voters trounced, 62 to 38 percent, and appeared to approve in just two of 58 counties. The measure also faced strong opposition from medical organizations, including doctor and hospital associations, which argued it would limit access to dialysis treatment and thus endanger patients.

The opposition presented a powerful message that “if you can’t get dialysis, you will die,” said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research. “If you didn’t know that, the commercials made it clear.”

Despite arguments about the outsize profits of dialysis companies, Kominski said the “Yes on 8” case wasn’t as clear. The measure, sponsored by the Service Employees International Union-United Healthcare Workers West, sought to cap dialysis clinic profits at 115 percent of the costs of patient care. Revenues above that amount would have been rebated primarily to insurance companies. Medicare and other government programs, which pay significantly lower prices for dialysis, wouldn’t have received rebates.

The union raised nearly $18 million — a large sum for most initiatives but about 16 percent of what the opposition mustered.

The proposition also was poorly written and difficult for voters to understand, said Erin Trish, associate director of health policy at the USC Schaeffer Center for Health Policy and Economics. Trish said she wasn’t surprised by the landslide defeat given the widespread ads against the initiative about the potential harms to patients. “The message came through loud and clear,”  she said.

Trish said health care industry groups genuinely viewed Proposition 8 as a poor initiative — but they also didn’t want to see rate regulation. “This is not what most of these associations want to open the door to,” Trish said.

Generally speaking, said Jessica Levinson, a professor at Loyola Law School, voters’ default on initiatives is “no.” In addition, money spent against an initiative is usually more effective than money spent for it. Levinson said people weren’t 100 percent sure what they were voting on with Proposition 8. All of those factors made passage “an uphill battle,” she said.

Kathy Fairbanks, a spokeswoman for the opposition, credited the electorate for properly sorting out the facts. “Voters did their homework and saw who lined up on both sides,” Fairbanks said. “All the leaders of the medical community were against Proposition 8 because of the negative impact it would have had on patients and access to dialysis.”

Proponents of the measure argued that highly profitable dialysis companies don’t invest enough in patient care and that they need to hire more staff and improve clinic safety. Opponents said passage would have forced clinics to cut their hours or close altogether, resulting in more emergency room visits by dialysis patients.

SEIU-UHW said the opponents tried to “scare and mislead” voters. It vowed to continue targeting profitable dialysis companies with another measure on the 2020 ballot, as well as through legislation.

“We exposed problems within the dialysis industry and we put a spotlight on a sector that has operated in the shadow for far too long,” said Sean Wherley, spokesman for the “Yes” campaign. “But we are not finished yet. … The need is still there to hold this industry accountable.

He added that the union is proud to have put a spotlight on “the inflated charges that drive up health care costs for all California.”

Critics say that SEIU-UHW, which represents more than 95,000 workers in California, uses state and local ballot initiatives as a way to pressure legislators and gain bargaining power. They’ve sponsored measures on such topics as hospital and clinic funding, access to affordable insurance and training for in-home caregivers.

The union maintains its goal is simply to improve health care.

Two other Bay Area initiatives sponsored by SEIU, aiming to limit hospital pricing, also were defeated Tuesday, indicating that the ballot box may not be the best place to address concerns about costs in the health care industry.

“This is too complicated to do by ballot proposition,” Trish said.

Dialysis patients participated heavily in both the pro and con sides of the initiative, appearing in dramatic television ads and presenting their personal stories on social media.

Lili Hernandez, 27, who began treatment four years ago, showed up to her appointments at a DaVita clinic in Hollywood with “Yes on Prop. 8” placards even as  the clinic posted “No” signage, she said.

Hernandez supported the initiative because she believes the corporations should be held accountable, she said. “They take advantage of how much money they can charge, but don’t give the best service,” she said. “Too many people are at risk of infection and neglect.”

She woke up Wednesday feeling defeated. “I was awake last night, checked results online, had my cry and went to sleep,” she said, adding that she thinks people were confused about the initiative and believed the “false ads.”

Meanwhile, DeWayne Cox, a dialysis patient from Los Angeles, expressed relief. “This means that voters got the message, they understood,” he said.

Cox, 56, said he comes from a union family and believes in unions, but this was a “terrible” move by SEIU because it could lead to cutbacks in services. “Not only was this scary for me, but they made me angry,” he said, noting concerns about potential cutbacks in services. “If their motive was truly to help patients, they would have written a better, more precise measure.”

The measure became the most expensive race in California this year. Industry giants DaVita and Fresenius Medical Care, which operate nearly three-quarters of the chronic dialysis clinics in California, were responsible for more than 90 percent of the contributions in opposition to the measure

The California Medical Association, the California Hospital Association and the California chapter of the American College of Emergency Physicians all opposed Proposition 8. “Our concern was the impact on patient care,” said hospital association spokeswoman Jan Emerson-Shea. “If dialysis clinics were forced to close and patients needed care, we are the only place within the health care system that is open 24/7.”

Municipal ballot initiatives sponsored by SEIU-UHW targeted Stanford Health Care in Livermore and Palo Alto by attempting to cap prices at 115 percent of the “reasonable” cost of care. Under the initiatives, hospitals and other medical providers would have been required to pay back any charges above the cap each year to private commercial insurers. The initiatives failed dramatically, losing 77 to 23 percent in Palo Alto and in Livermore, 82 to 17 percent.

Voters did approve three statewide health care initiatives Tuesday, however:

  • Proposition 2 won 61 to 39 percent, allowing the state to issue $2 billion in bonds for housing for homeless people in need of mental health services. Bond money will be distributed to counties and repaid with proceeds from the Mental Health Services Act, which levies a 1 percent tax on personal incomes of $1 million and above.
  • Proposition 4, which won by the same margin, allows the state to distribute $1.5 billion in bonds to help the state’s 13 children’s hospitals’ pay for construction and equipment. It was the third time in 14 years that voters had agreed to subsidize the hospitals.
  • Proposition 11, passing with  59 percent of the vote, requires private ambulance employees to remain on call during their breaks — just as firefighters, policemen and other public emergency workers do.

Samantha Young and Harriet Rowan contributed to this report.


KHN’s coverage of these topics is supported by
California Health Care Foundation
and
Blue Shield of California Foundation

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Administration Finalizes Rule Allowing Moral And Religious Exemptions For Health Law’s Birth Control Mandate

The policy change is much more narrow than a previous proposed rule that is now stuck in the courts, and applies mainly to religious organizations, nonprofits and small businesses. Advocates, however, are already vowing to fight the rule in court.