Tagged Mental Health

Viewpoints: Talking About Suicide; Military Life’s Toll On Women; Listening To Patients

Here’s a review of editorials and opinions on a range of public health issues.

The New York Times: Let’s Talk About Suicide
Chester Bennington, the lead singer of the band Linkin Park, was found dead on Thursday in his home near Los Angeles. The coroner’s office has confirmed that the 41-year-old died of suicide. That’s something I — and so many millions of other Americans suffering from mental illness — have considered. … more often than not, we don’t talk about mental health. And shows like Netflix’s “13 Reasons Why” or artists like indie pop singer Lana Del Rey have sensationalized or glamorized mental illness and suicide rather than taking it seriously. Worldwide, 350 million people (that’s 5 percent of the population) suffer from depression every day. And they are suffering – and sometimes dying – in silence because we can’t seem to talk openly about mental health. (Robert Rigo, 7/24)

Stat: Protecting Interns And Other Physicians From Depression And Suicide
This month, more than 25,000 medical school graduates will begin working at hospitals and medical centers across the United States. By the end of September, nearly one-third of these new doctors could become depressed and 24 percent could have thoughts of suicide. First-year interns often move away from family and friends to start the next chapter of intensive training. It is an exciting time, but also a difficult time. A recent study in Academic Medicine confirms that their suicide risk is highest in the early months of training. (George Keepers and Mary Moffit, 7/24)

Los Angeles Times: What Military Recruiters Aren’t Telling Women: You’ll Face Disproportionate Health Risks
Recently, 18 brave women graduated from the U.S. Army Infantry School, pioneers headed for fully gender-integrated “ground close-combat” units. Women have long served valiantly and effectively in almost every military role, but now they are tackling extremely physical combat jobs that, until recently, were designated men-only. … In this push for more female recruits, it’s not at all clear that young women — or the civilian population in general — understand the unique, disproportionate health risks women face in combat roles. The dangers, which have been known for decades, will undoubtedly be exacerbated as women serve in the most physically demanding units. (Julie Pulley and Hugh P. Scott, 7/25)

Bloomberg: Trump’s Quiet Progress On Veterans Affairs
[I]n one area, Veterans Affairs, there actually has been progress. Since the Senate approved his appointment unanimously in February, Secretary David Shulkin has sought to improve accountability at hospitals by publicly posting wait times and care-quality data, and has extended much-needed mental health services to veterans with less-than-honorable discharges. Even Congress has made a contribution, passing a bill to streamline the agency’s hiring and firing processes — legislation that Trump signed and tweeted about three times. (Mark Whitehouse, 7/24)

WBUR: Against Medical Advice: Sometimes, When Patients Defy Accepted Wisdom, So Must Doctors
Keeping the whole patient in view, including the social challenges they will return to after their short stint in a hospital, is as much a part of medical decision-making as the understanding of disease, or selection of the right medication. While this lesson is far from new — you’ll hear it taught to every medical student across the country — it is much harder to apply it in practice than to learn in principle. (Abraar Karan, 7/24)

Cincinnati Enquirer: Heroin Epidemic Must Be A Priority
Currently, human services funding is allocated towards increasing gainful employment, reducing homelessness, and preventing violence, all in need of our attention. Heroin is often a component of these other issues but the acute nature of this crisis demands prioritized attention not secondary. (Amy Murray, 7/24)

RealClear Health: Ending The Opioid Epidemic: Only The US Can Stop China’s Counterfeit Pharmaceutical Trade
The United States is facing an explosion of counterfeit opioids from China. Illegal synthetic opioids like carfentanil and fentanyl are being packaged as legal prescription opioids (like oxycodone) and sold on the black market. The US has dealt with counterfeit drug scandals before, notably in 2008 when 149 Americans died from a counterfeit blood thinner found to have originated in China. Today, counterfeit opioid compounds with carfentanil and fentanyl are blamed for the sudden increase in overdose deaths in the United States, making drug overdoses the current leading cause of death for Americans under age 50. (Emily Foecke Munden, 7/25)

Sacramento Bee: Reparations For Drug War? Consider It California
The same people who went to prison in disproportionate numbers for selling marijuana are on the verge of being cut out of California’s multibillion-dollar legal marijuana industry – and, without help, could even become victims of it. …Together, they are demanding that local governments adopt a reparations strategy that would begin to repair the damage done to communities of color. (Erika Smith, 7/24)

The Kansas City Star: Scrutiny Of Overland Park Pain Doctor Highlights Challenge Of Fighting Opioid Addiction
An Overland Park doctor is in the crosshairs of an expanding investigation into the business practices that are fueling American’s addiction to opioids. The records of Steven Simon of The Pain Management Institute have been seized by the FBI. He earns more than only a handful of other doctors in the U.S. from payments by drug manufacturers to promote both opioids and the medications that treat side effects of the drugs. It’s a revenue stream that can influence doctors to write more prescriptions. (7/23)

USA Today: Trump Budget Would Set Back Global AIDS Fight Just When We’re On Track To Win It
When we started our HIV/AIDS Initiative at Saddleback Church 13 years ago, we reminded our congregation, “If you’re going to be like Jesus, you have to learn to be compassionate toward people when they’re sick.” Even in this time of tight budgets, America’s leaders should show precisely this kind of compassion for our brothers and sisters living with HIV and AIDS in Africa and around the world. (Rick and Kay Warren, 7/25)

The New York Times: Fixes: The Tasmanian Hep C Buyers’ Club
In 2014, when Greg Jefferys’s urine started smelling like dead meat, he knew there was something seriously wrong. For weeks, Jefferys, an Australian then 60 years old, had felt fatigued and noticed that just a slight bump would leave a dark purple bruise on his skin. Blood tests revealed to Jefferys that he had chronic hepatitis C – a disease he’d never heard of. (Sophie Cousins, 7/25)

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

State Highlights: In Special Session, Texas Senate Takes Up Abortion Bills; Ohio’s Cost Transparency Law Stalls Amidst Strong Opposition

Media outlets report on news from Texas, Ohio, Pennsylvania, Minnesota, California, Tennessee, Florida, Maryland and Kansas.

Texas Tribune: Texas Senate Tackles Special Session Abortion Bills
Under state Sen. Donna Campbell’s Senate Bill 10, in procedures where complications occur, physicians would be required, within 72 hours, to submit reports to the state health commission that include detailed information like the patient’s year of birth, race, marital status, state and county of residence, the date of her last menstrual cycle, the number of previous abortions, and the number of previous live births. Physicians who failed to comply with the reporting requirements would face a $500 fine for each day of each violation. (Smith, 7/24)

Texas Tribune: Texas Senate OKs Maternal Mortality Task Force
State senators on Monday tentatively approved a bill that would give a state task force more time to study why an alarming number of Texas mothers are dying less than a year after childbirth. Under Senate Bill 17, the state’s Task Force on Maternal Mortality and Morbidity would be able to continue its work until 2023. (Evans, 7/24)

Kaiser Health News: Price Transparency In Medicine Faces Stiff Opposition — From Hospitals And Doctors
Two years after it passed unanimously in Ohio’s state Legislature, a law meant to inform patients what health care procedures will cost is in a state of suspended animation. One of the most stringent in a group of similar state laws being proposed across the country, Ohio’s Healthcare Price Transparency Law stipulated that providers had to give patients a “good faith” estimate of what non-emergency services would cost individuals after insurance before they commenced treatment. (Bluth, 7/25)

The Philadelphia Inquirer/Philly.com: New Five-Year Contract Between Independence And Jefferson
Independence Blue Cross is pushing for new contracts with area health systems that accelerate the hoped-for transition from paying for volume of services to paying for positive results. But it is not taking a one-size-fits-all approach. “We need to adapt to different providers” because they have “different states of readiness,” Anthony V. Coletta, president of Facilitated Health Networks at Independence, said Monday after the announcement of a contract with Jefferson Health that starts Sept. 1 and will last five years. (Brubaker, 7/24)

The Star Tribune: Minneapolis Proposal To Restrict Menthol Tobacco Sales Sparks Debate
While public health advocates pushed for the restrictions at a packed public hearing — arguing that tobacco companies target black smokers and young people with menthol products — Minneapolis store owners said it’s the latest example of City Hall overreach and would devastate their livelihoods. …The City Council heard from dozens of speakers Monday in crowded council chambers and is expected to vote on the policy in August. (Belz, 7/24)

San Francisco Chronicle: Jahi McMath’s Family Wins Backing For Argument That She’s Alive
It’s been more than three years since 13-year-old Jahi McMath was declared dead after something went terribly wrong following throat surgery at Children’s Hospital Oakland. Her family has never accepted the declaration and has kept her on life support ever since — and in a new twist, a prominent neurologist says recent videos of the girl show she is alive, with a partially functioning brain. (Johnson, 7/24)

The Philadelphia Inquirer/Philly.com: Horizon Blue Cross Ordered To Turn Over Omnia Documents
The New Jersey Supreme Court on Monday ordered Horizon Blue Cross Blue Shield, the state’s largest health insurer, to turn over a McKinsey & Co. report and other documents it used to establish two tiers of health systems for an insurance plan introduced in 2015. Providers in the second tier, including Capital Health System Inc. and St. Peter’s University Hospital Inc., sued, alleging that Horizon treated them unfairly and breached their contracts when it set up the tiers for its Omnia insurance plan. At the seven Tier One health systems in the Omnia Health Alliance consumers have lower out-of-pocket costs. (Brubaker, 7/24)

Texas Tribune: Texas To Lose Galveston And Hill Country Children’s Therapy Providers
Children in the Galveston and Hill Country areas are going to be without state-funded speech, occupational and physical therapy services as two more providers prepare to leave the Early Childhood Intervention program. The Texas Health and Human Services Commission confirmed Monday that the University of Texas Medical Branch and Hill Country MHDD Centers are ending services through the program. (Evans, 7/24)

Nashville Tennessean: Children’s ER At TriStar Centennial Opens
A new children’s emergency room in Nashville — the city’s second — is now seeing patients. The first patient at The Children’s Hospital at TriStar Centennial arrived at 9:21 a.m. on July 24 to the new seven-bed, 6,000-square foot facility on the hospital’s campus in Midtown Nashville. (Fletcher, 7/24)

Columbus Dispatch: Mount Carmel Adding 80 Beds For Mental-Health Treatment
Mount Carmel Health System and Acadia Healthcare announced on Monday that they are teaming up to open an 80-bed inpatient behavioral health hospital in Columbus to replace a 20-bed hospital at Mount Carmel West hospital in Franklinton. Officials say they are still finalizing a site for the $26 million, 64,300-square-foot freestanding facility that will have units for adult and geriatric patients as well as for dual-diagnosis patients — those who are suffering from both mental-health and drug-addiction illnesses. (Viviano, 7/25)

The Baltimore Sun: CVS Opens First Maryland Hearing Center
CVS Pharmacy opened its first Maryland hearing center in an Ellicott City store, as part of the drug store chain’s move to capture more health related business in its retail outlets. The store, which sells and services hearing aids, is staffed by audiologists and can provide hearing screenings and fittings. Insurance is accepted for some services. (Cohn, 7/24)

Cleveland Plain Dealer: Johnson Amends Cleveland ‘Lead Safe’ Law Proposal To Exclude Owner-Occupied Homes
Cleveland City Councilman Jeff Johnson, after hearing from a slew of residents said today he’s changing the ‘Lead Safe’ ordinance he plans to propose next month so that it excludes mandatory compliance and fines for homeowners who live in their properties. The ordinance — which proposes that all city homes built before 1978 be certified safe from lead hazards by 2021 — would still apply to rentals and apartments, which comprise the majority of the city’s homes, as well as child care centers and schools constructed prior to 1978, Johnson said. (Dissell and Zeltner, 7/24)

KCUR: Safety Net Clinic To Reopen Facility In Quindaro Neighborhood 
Southwest Boulevard Family Health Care, a safety net clinic in Kansas City, Kansas, will reopen its Quindaro facility after several years’ hiatus. The satellite clinic will be located in a church building owned by Family Health Care. Initially, it will be open a couple of half-days per week and, depending on demand, may increase its hours of operation. (Margolies, 7/24)

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

Prominent Psychiatry Group Relaxes Stance On Speaking About Mental Health Of Public Figures

The rule against psychiatrists offering their analysis of behaviors, such as ones exhibited by the president robs the public “of our professional judgment and prevents us from communicating our understanding” of the president’s mental state, one psychiatrist said. In other public health news: the next revolution in HIV treatment, Zika testing, ticks and disease, dental services, pollution and more.

Stat: Psychiatry Group Tells Members They Can Discuss Trump’s Mental Health
Aleading psychiatry group has told its members they should not feel bound by a longstanding rule against commenting publicly on the mental state of public figures — even the president. The statement, an email this month from the executive committee of the American Psychoanalytic Association to its 3,500 members, represents the first significant crack in the profession’s decades-old united front aimed at preventing experts from discussing the psychiatric aspects of politicians’ behavior. (Begley, 7/25)

The Washington Post: Monthly Shot Could Be The ‘Next Revolution’ In HIV Therapy, Replacing Daily Pills
HIV/AIDS is no longer the death sentence it once was, but maintaining the strict regimen required to keep the virus at bay — one or more pills daily — still poses a major challenge to many people who are infected. Adherence is low among some populations, given the effort that is required to obtain, keep and store the medications. That may soon change. On Monday, scientists reported an important advance in the development of a long-acting antiretroviral shot. According to an international study involving 309 patients, an injection that combines two drugs, cabotegravir and rilpivirine, appears to be as safe and effective at suppressing HIV as the daily oral regimen. (Cha, 7/24)

The Washington Post: New Zika Testing Recommendation Issued For Pregnant Women
Federal health officials are changing their testing recommendations for pregnant women who may be exposed to the Zika virus through travel or sex or because of where they live. In updated guidance released Monday, the Centers for Disease Control and Prevention is no longer recommending routine testing for pregnant women without any Zika symptoms but who may have been put at risk because they have traveled to a region where Zika is circulating. (Sun, 7/24)

The Washington Post: A New Way To Fulfill The Single Biggest Need Of Poor Patients: Teeth
Larry Bays has seen his share of hard times, but on this day he was blessed. The 71-year-old goat farmer from Gate City, Va., had come to the annual free medical clinic held over the weekend here in coal country so his wife, Joyce, could have her asthma and arthritis checked. When her doctor realized she had no teeth, he sent the couple over to a trailer operated by the Mission of Mercy dental team. (Schneider, 7/24)

ProPublica: Has The Moment For Environmental Justice Been Lost?
Given how President Donald Trump has taken aim at the Environmental Protection Agency with regulatory rollbacks and deep proposed budget cuts, it may come as no surprise that the Office of Environmental Justice is on the chopping block. This tiny corner of the EPA was established 24 years ago to advocate for minorities and the poor, populations most likely to face the consequences of pollution and least able to advocate for themselves. (Buford, 7/24)

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

Physicians, Often In Fear Of Losing License, Know How To Hide Signs Of Addiction To Escape Notice

“Somehow they believe their knowledge is going to be more powerful than addiction,” said Dr. Marvin Seppala, an addiction expert. Meanwhile, FDA Commissioner Scott Gottlieb is looking to tap unlikely sources as allies in the battle against opioids: benefit payers and insurance administrators.

Los Angeles Times: Doctors And Drug Abuse: Why Addictions Can Be So Difficult
Allegations that Dr. Carmen A. Puliafito used methamphetamine and ecstasy while he was dean of USC’s medical school have opened a window into the pervasiveness of drug use and addiction among physicians and the challenges they face when confronting it. Experts say physicians become substance abusers at about the same rate as the general population. But they are often reluctant to seek treatment out of fear of losing their medical licenses and livelihoods. (Karlamangla, 7/24)

Bloomberg: Trump’s FDA Chief Takes Wide Aim At Opioid Addiction Crisis 
The Food and Drug Administration, as part of a sweeping overhaul in how it regulates opioid painkillers, plans to look to some unusual allies to limit the flood of the addictive pills — health insurers and companies that manage prescription drug benefits. Food and Drug Administration Commissioner Scott Gottlieb plans to meet in September with the benefit payers and insurance administrators, groups the FDA hasn’t typically worked with in its role as a drug regulator. The plan, Gottlieb said, is to stem the tide of addiction to the pills by limiting the number of people exposed to them in the first place. (Edney, 7/24)

And in other news on the epidemic —

The New York Times: Economy Needs Workers, But Drug Tests Take A Toll
Just a few miles from where President Trump will address his blue-collar base here Tuesday night, exactly the kind of middle-class factory jobs he has vowed to bring back from overseas are going begging. It’s not that local workers lack the skills for these positions, many of which do not even require a high school diploma but pay $15 to $25 an hour and offer full benefits. Rather, the problem is that too many applicants — nearly half, in some cases — fail a drug test. (Schwartz, 7/24)

Arizona Republic: Hepatitis C: The Public-Health Worry Lurking Behind The Opioid Crisis
Hepatitis C, a blood-borne virus that attacks the liver and causes inflammation, is so infectious it can spread through a few microscopic dots of blood. Intravenous drug users are among the most high-risk populations for infection because they share syringes, cookers, cotton, water, ties and alcohol swabs, according to the Centers for Disease Control and Prevention. (Stanford, 7/24)

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

Opioid Treatment Funds In Senate Bill Would Fall Far Short Of Needs

At a lunch last week, President Trump tried to persuade some reluctant senators to endorse repealing the Affordable Care Act. During the meeting, he mentioned a provision in the Senate Republican proposal that allocates funding for opioid treatment, saying, “We’re committing $45 billion to help combat the opioid epidemic, and some states in particular like that.”

But addiction treatment specialists warn that sum of money is far from enough to address a crisis that has escalated across the United States in recent years, killing tens of thousands of people.

The federal money would be spent over about a decade, and is part of a bill that also dramatically cuts Medicaid, which is helping many people get treatment now. Those cuts will hit people in some states especially hard — those living in states that expanded the Medicaid program under the Affordable Act.

“You’re going to take a lot of people, take away their health care benefit, and basically do just a small grant to each state. It’s going to be real big problem,” said Richard Edley, executive director of the Rehabilitation and Community Providers Association, which includes hundreds of mental health and substance use disorder providers in Pennsylvania. “You hate to say you’re opposing [$45 billion], but it’s packaged with a rollback of benefits to these same individuals.”

In Pennsylvania in 2016, Medicaid expansion helped 124,000 people get treatment for their substance use disorder. Democratic Gov. Tom Wolf has said his state won’t be able to maintain Medicaid expansion if the federal government cuts back its share of spending. Without the program, many of those people would have limited access to help for their addiction.

Edley did some back-of-the-envelope math, and is really concerned at what he found.

If $45 billion is distributed to all 50 states by population, Pennsylvania would get about $1.8 billion, spread out over nine years. Depending on other variables, that could range from somewhere between $1,000 to $2,000 per person per year who might need treatment, based on how many people got treatment under expanded Medicaid in Pennsylvania last year.

By contrast, one year of maintenance treatment with methadone costs about $4,700 per year, according to the National Institute on Drug Abuse. Methadone is an evidence-based treatment that makes it possible for a person with opioid addiction to work and lead a normal life.

But the cuts to Medicaid would amount to billions of lost dollars in Pennsylvania.

The state says it can’t make up the difference. So, many of the people who get opioid treatment through Medicaid could lose coverage and then turn to the grant that’s specifically meant for opioid treatment.

And, like any chronic disease, opioid treatment takes many steps — medication and, perhaps, a lifetime of management.

“Your typical individual doesn’t get treatment right in 10 days on their first try,” said Jennifer Smith, Pennsylvania’s acting secretary for the Department of Drug and Alcohol Programs.

“[The funding] doesn’t even come close. Doesn’t even come close,” Smith added. “We can piece together some solutions that might help get us a little closer to where we had been, but the end result is more people are going to die.”

Every day in Pennsylvania an average of 13 people die from a drug overdose.

And there also would be ripple effects from that drop in funding, Smith said — grandparents taking care of grandkids, bankruptcies because of treatment costs, and more work for each county’s department of children and youth services. Smith also worries that less treatment would mean more people would be desperate to support their habit.

“And they end up with a criminal record,” she said. “Nobody wants to hire them.”

So they drop out of the workforce.

Experts like Smith and Edley are concerned that if the federal government pulls back spending on Medicaid, the costs simply will be shifted somewhere else.

“You stop funding for [treatment and] they don’t go away” said Edley. “People end up in emergency rooms. They end up in uncompensated care, homelessness. You talk to people in the criminal justice system — you see increased incarcerations.”

He expects that if the Senate GOP health bill is approved, lawmakers will have to come back to this issue in six months or a year.

“They’re going to be back at the drawing board,” Edley said, “realizing, ‘All right, that didn’t work, and there are too many people being hurt.’”

Edley and Deb Shoemaker, executive director of the Pennsylvania Psychiatric Society, also see a double standard with how the Senate GOP bill treats people who have a substance use disorder.

Shoemaker is very active on substance use issues in Pennsylvania, and said she often tries to personalize her pitch to lawmakers.

“Would you want to say, ‘Hey, I’m sorry that you have cancer but you can only get treatment once a week,’ or ‘you can only get dialysis once a week,’” she said, pointing to the disparity in the way the proposal treats substance abuse versus other physical conditions.

“So think about it that way,” she said. “Yes, [treatment for substance use disorder] is a cost, but in the long run, they’re healthier. They’re alive.”

Sen. Pat Toomey (R-Pa.) has defended the proposed cuts.

“If it’s not worth it to the state to buy this coverage at 43 cents on the dollar [about what the state contributes to non-expansion Medicaid recipients], then how is it worth it to those very same taxpayers — who, at the end of the day, have to provide the funding for the federal program — why is it worth it to them to pay 90 cents on the dollar? It just doesn’t make sense,” he told NPR in June.

In a written statement, Toomey has said “fighting the scourge of opioid and heroin abuse remains a top priority of mine.” His office also says current Medicaid funding is unsustainable.

An earlier version of the bill included just $2 billion in grants for substance use disorder treatment. Senate GOP leaders included the $45 billion as a concession to moderate Republicans like Sen. Rob Portman of Ohio and Sen. Shelley Moore Capito of West Virginia, who represent states that have been hit particularly hard by the crisis.

This story is part of a reporting partnership with WITF’s Transforming Health, NPR and Kaiser Health News.

Categories: Medicaid, Mental Health, Public Health, Repeal And Replace Watch, States

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Research Roundup: Early Hospice Discharges Turn Profits; Integrating Mental Health Care

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: A Positive Association Between Hospice Profit Margin And The Rate At Which Patients Are Discharged Before Death
Although certain live discharges are consistent with high-quality care, regulators have expressed concern that some hospices’ desire to maximize profits drives them to inappropriately discharge patients… Adjusted analyses showed positive and significant associations between both operating and total margins and hospice-level rates of live discharge: One-unit increases in operating and total margin were associated with increases of 3 percent and 4 percent in expected hospice-level live discharge rates, respectively. (Dolin et. al., 7/1)

Health Affairs: Medicare Advantage Associated With More Racial Disparity Than Traditional Medicare For Hospital Readmissions
We compared racial disparities in thirty-day readmissions between traditional Medicare and Medicare Advantage beneficiaries who underwent one of six major surgeries in New York State in 2013. We found that Medicare Advantage was associated with greater racial disparity, compared to traditional Medicare. After controlling for patient, hospital, and geographic characteristics in a propensity score based approach, we found that in traditional Medicare, black patients were 33 percent more likely than white patients to be readmitted, whereas in Medicare Advantage, black patients were 64 percent more likely than white patients to be readmitted. (Li et. al., 7/1)

RAND: Possible Legal Barriers For PCP Access To Mental Health Treatment Records
Provider and payer groups have endorsed the goal of improving the integration of primary care and behavioral health across a variety of programs and settings… Preliminary investigation found that in almost one third of the states (including large-population states such as Florida, Georgia, Massachusetts, New York, and Texas), primary care physicians (PCPs) may have difficulty accessing mental health treatment records without the patient’s (or his/her guardian/conservator’s) written consent. If a comprehensive legal analysis supports this conclusion, then those advocating integration of behavioral and primary care may need to consider seeking appropriate state legislative solutions. (Rothenberg et. al., 7/19)

New England Journal of Medicine: Implementation Of Medical Homes In Federally Qualified Health Centers 
We examined the achievement of medical-home recognition and used Medicare claims and beneficiary surveys to measure utilization of services, quality of care, patients’ experiences, and Medicare expenditures in demonstration sites versus comparison sites… Demonstration sites had higher rates of medical-home recognition and smaller decreases in the number of patients’ visits to federally qualified health centers than did comparison sites, findings that may reflect better access to primary care relative to comparison sites. (Timbie et. al., 7/20)

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

How D.C. Pulled Itself Back From The Brink Of An AIDS Epidemic

A decade ago, city officials realized they had to take action, and they turned the numbers around. Stateline looks at how they did it. In other public health news: a breakthrough on cancer, mental illness, female homicide victims, antibiotics and birth defects, heart health and more.

Stateline: Fighting AIDS In The Nation’s Capital
Ten years ago, Washington, D.C., was on the verge of a public health disaster: It had the highest reported rates of HIV in the country. And in a city of 588,000, 1,333 people tested positive for HIV in 2007 alone. By the time they were tested, most had full-blown AIDS.Back then, city officials acknowledged that they didn’t have a complete picture of the problem. But they estimated that as many as one in 20 residents were infected with the disease, rivaling rates in sub-Saharan Africa. (Wiltz, 7/21)

Stat: One Cancer Breakthrough Is On Its Way. Here’s What’s Coming Next
CAR-T is having a moment. The Food and Drug Administration looks poised to approve the first hot-wired white blood cell treatment from Novartis, promising to change the lives of patients with a particularly deadly form of cancer and usher in an entirely new definition of the word “drug.” But scientists around the world are hardly standing pat in the glow of this success. Instead, they’re toiling to discover, refine, and re-invent cellular therapies for cancer in hopes of treating more tumor types, improving safety, and pushing the still-nascent field forward. Some of the most promising applications of the technology remain on the horizon — though plenty of challenges stand in the way. (Garde, 7/21)

Stat: This Biotech Aims To Simplify Diagnosis Of Mental Illness. Can It Work?
Asmall Australian biotech has drawn big-name backers — including swimming superstar Michael Phelps — to its audacious goal: to develop a quick, cheap, and objective way to diagnose an array of mental illnesses. The tool would be a stunning breakthrough in the field of mental health —  if it works. And there’s the rub. Researchers have been trying for decades to find reliable biomarkers for mental illness — that is, tangible biological clues that conclusively indicate whether a person has a particular psychiatric disease. Effort after effort has failed, leaving doctors to diagnose such conditions mostly on the basis of screening checklists and conversations with their patients. (Keshavan, 7/21)

The Washington Post: Most Female Homicide Victims Are Killed By Husbands Or Other Intimate Partners, New Report Shows
A report out Thursday by the Centers for Disease Control and Prevention about homicides and women provides some disturbing numbers about just how common this is. Homicide is the fifth leading cause of death for women ages 18 to 44. In 2015 alone, 3,519 women and girls were killed. More than half of these killings were perpetrated by current or former boyfriends, husbands or other intimate partners. (Cha, 7/20)

The New York Times: Certain Antibiotics May Increase Risk Of Birth Defects
A large study published in the British Journal of Clinical Pharmacology found that certain antibiotics taken during pregnancy may increase the risk for birth defects. Canadian researchers followed 139,938 mothers of babies born in Quebec from 1998 to 2008, tracking their antibiotic use in the first trimester, and their babies’ birth defects through the first year of life. (Bakalar, 7/20)

NPR: Just Thinking That You’re Slacking On Exercise Could Boost Risk Of Death
In a fitness-crazed land of spin classes and CrossFit gyms, Octavia Zahrt found it can be tough to feel as though you’re doing enough. “When I was in school in London, I felt really good about my activity. Then I moved to Stanford, and everyone around me seems to be so active and going to the gym every day,” she says. “In the San Francisco Bay Area, it’s like 75 percent of people walk around here wearing exercise clothes all day, every day, all the time, and just looking really fit.” (Chen, 7/20)

The Washington Post: Coffee With Viagra-Like Ingredient Recalled After FDA Discovery
Albert Yee said the coffee is everywhere you look in the densely packed vendor stalls along avenues in Malaysian cities: an instant mix with a natural ingredient similar to what’s found in Viagra that helps men with erectile dysfunction. And he wanted a piece of the action. “There are whole streets of it, like tequila in Mexico,” Yee told The Washington Post by phone Thursday, describing how his one-man import business outside of Dallas is now at the center of a nationwide voluntary recall coordinated by the U.S. Food and Drug Administration. (Horton, 7/20)

The New York Times: Long Workdays May Be Bad For Your Heart
Working long hours may increase the risk for atrial fibrillation, or irregular heartbeats that can lead to serious cardiovascular complications, a new study in the European Heart Journal found. Lengthy work hours have been shown in several previous studies to increase the risk for cardiovascular disease. (Bakalar, 7/20)

The Philadelphia Inquirer/Philly.com: New Transplant Rules Help More African Americans Get Kidneys
UNOS data he presented this month show that in 2016, a third of those on the waiting list (31,830 people) were African American, and just over a third of transplant recipients (4,284) were African American.  The rates at which other racial groups were wait-listed and transplanted were also even. There still aren’t enough kidneys for those in need. But the system no longer unintentionally works against blacks as it did in the 1990s, when UNOS data show they made up more than a third of the wait inglist, but got only about a quarter of kidney transplants. (McCullough, 7/20)

The Philadelphia Inquirer/Philly.com: A Philly Pediatrician Looks At Why Too Many Babies Die Suddenly
Philadelphia, like most major cities, has a team that regularly reviews the most tragic events many of us can imagine: the deaths of children. The goal is to look for any patterns that might help prevent these deaths, and the circumstances that allowed them to occur. A recent report from the city’s Department of Public Health shows that we still have a long way to go, specifically when it comes to the number of infants who die at what should be a safe time, when they are put to sleep. (Taylor, 7/20)

The Baltimore Sun: Civil Unrest Related To Freddie Gray Death Caused Depressive Symptoms Among Mothers In Affected Neighborhoods, Study Finds 
Half of the mothers who lived in the neighborhoods wracked by the civil unrest that followed the death of Freddie Gray in 2015 became so stressed by the circumstances that they suffered from insomnia, loss of appetite and other depressive symptoms, according to new research by the University of Maryland School of Medicine. While the mothers weren’t tested to see if they fit the clinical definition of depression, the researchers said the results found that the sight of burning buildings, looting, and the constant blue lights from police cars was enough to have a major emotional impact in neighborhoods located in the six ZIP codes where the brunt of the unrest took place. (McDaniels, 7/20)

Stat: Forget ‘Shark Week’: 7 Things In The Water Swimmers Should Actually Fear
It’s shark season — primarily on cable TV. As the decades-long tradition of “Shark Week” approaches, you can expect once again to hear of “serial killer” sharks, attacks near major coastal cities, and menacing, massive shark swarms. But, as you probably also know, shark attacks are incredibly unlikely. You’re 75 times more likely to be killed by lightening than by a shark. On average, one person dies of a shark attack every other year in the United States. (Wosen, 7/21)

Orlando Sentinel/Tampa Bay Tribune: Preeclampsia’s Impact On Families, Health Care Costs: Despair In A Time Of Delight
Physicians, researchers, activists and legislators across the U.S. are working to understand why preeclampsia is rising faster than other chronic conditions and prevent it. …And according to Dr. Anupam B. Jena, internal medicine physician and professor at Harvard Medical School, and his colleagues, preeclampisia increased “from 2.4% of pregnancies in 1980 to 3.8% of pregnancies in 2010.” (Cheatham, 7/20)

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Reddit Offers Dark Marketplace For Opioids, But Also Support Groups For Those Struggling To Get Clean

The online forum does not allow users to solicit illegal substances, but those seeking opioids find ways to get around those rules. On the other hand, the forums help some form a community to help get them through the difficult process of getting and staying sober.

The New York Times: On Reddit, Intimate Glimpses Of Addicts In Thrall To Opioids
Every day, thousands of people who are consumed by the nation’s opioid epidemic connect on the popular discussion website Reddit. They swap advice on getting high and offer encouragement to those who have managed to stay clean or are teetering between recovery and relapse. Addicts lament the deaths of fellow users who have suddenly stopped posting. And until last week, buyers and sellers could easily find each other, relying on coded messages that communicated their intent. (Zapler and Harris, 7/20)

In other news on the crisis —

The Washington Post: A 10-Year-Old’s Overdose Death Reveals Miami Neighborhood’s Intense Struggle With Opioids
When 10-year-old Alton Banks left the community swimming pool on the last day of his life, he walked past the elementary school where he had just finished fifth grade. He passed a cheery banner that defined a beaten-down inner-city neighborhood trying to will itself into up-and-comingness: “Experience Overtown. Eat, Live, Work, Play.” He walked past a fancy new apartment building under construction, then a long row of ragged homes and chickens clucking freely on sidewalks littered with crushed tall-boy beer cans in brown paper bags. (Sullivan, 7/20)

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Debate Flares Over Governor’s Drug Monitoring Program In Missouri

Gov. Eric Greitens’ order to create a registry in Missouri — the last state to have one — does not allow doctors to see if a patient has already been prescribed an opioid. Some lawmakers say more legislative action is needed. In other news on the national drug epidemic, Ohio’s board on workers’ compensation wants fewer opioids prescribed for back pain. And a Kansas City doctor is under investigation for prescriber kickbacks and insurer fraud.

Kansas City Star: FBI Seizes Patient Records Of KC-Area Doctor With Ties To Insys Therapeutics
The FBI last week seized patient records of Dr. Steven Simon, an Overland Park pain physician with ties to Insys Therapeutics, an opiate manufacturer at the center of a federal case that alleges prescriber kickbacks and insurance fraud… The owner of the pain clinic, Dr. Srinivas Nalamachu, said FBI agents showed up there with a search warrant for the medical records of every patient whom Simon had prescribed oral forms of fentanyl, a powerful synthetic opioid. (Marso, 7/19)

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Public Health Roundup: Helping Police Cope With Trauma; The National Shortage Of OB-GYN Docs

And other public health stories from today’s news cover depression, obesity and substance abuse driving up death rates, weight loss, AIDS and the world’s youngest double hand-transplant recipient.

Stateline: Cops Get Help To Cope With Trauma
For decades, police have kept silent about the toll trauma takes on them, their families and their careers. One result, according to researchers, is that they have higher suicide rates than the general population. To change that, police departments across the country are turning to nonprofit or state-funded programs that help cops cope by connecting them to their peers and to mental health professionals. (Mindy Fetterman, 7/20)

Stat: These Cities Are On The Front Lines Of A National OB-GYN Shortage
Nearly half of all U.S. counties already lack a practicing OB-GYN. The American Congress of Obstetricians and Gynecologists projects a shortage of up to 8,800 OB-GYNs by 2020. And Pew Trusts predicts the nation could be 22,000 practitioners short in the decades that follow…The Doximity report, which looked data from more than 30,000 OB-GYNs practicing in the nation’s 50 largest metro regions, found the cities with the highest risk of a shortage had a confluence of doctors retiring early and few younger doctors replacing them. (Blau, 7/20)

Bloomberg: This App Tells You — And Maybe Other People — When You’re Depressed
A Facebook message pops up on my phone screen. “What’s going on in your world?” It’s from a robot named Woebot, the brainchild of Stanford University psychologist Alison Darcy. Woebot seems to care about me. The app asks me for a list of my strengths, and remembers my response so it can encourage me later. It helps me set a goal for the week — being more productive at work. It asks me about my moods and my energy levels and makes charts of them. (Chen 7/20)

Denver Post: Obesity, Overdose The Key Factors In Killing White Americans
Despair over economic and social status is likely not to blame for a startling rise in death rates among middle-aged white Americans, according to a new study from researchers at the University of Colorado. After years of decline, mortality rates across the country have begun to increase, and life expectancy in some parts of the country is falling. The new study, though, pushes back on the popular narrative that this trend is the result of a loss of hope among middle-class whites. That narrative suggests despair has led to health problems, self-destructive behavior and earlier deaths. (Ingold, 7/19)

The Associated Press: AIDS Epidemic: For 1st Time, Over Half Taking HIV Drugs
The United Nations says that for the first time in the AIDS epidemic, more than half of all people with HIV are on drugs to treat the virus. AIDS deaths are also now close to half of what they were in 2005, according to the U.N. AIDS agency, although those figures are based on estimates and not actual counts from countries. (7/20)

The Washington Post: Zion, The World’s Youngest Double Hand Transplant Recipient, Can Swing A Baseball Bat
In 2015, Zion Harvey became known to the public as the youngest person in the world to go through a successful bilateral hand transplant. Zion, who was 8 at the time, captured hearts with his upbeat attitude toward life and his wise-beyond-his-years expositions — on everything from losing both of his hands to an infection at age 2 to why he wanted to adopt a dog — in a widely shared video by the Children’s Hospital of Philadelphia. The film documented Zion’s life before the surgery and the complicated, high-risk procedure he underwent to gain a pair of new hands. (Wang, 7/19)

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Will Comprehensive Health, Lifestyle Choices Help Stave Off Dementia? Scientists Want To Find Out

A $20 million study will try to figure out if “life hacks” — like more exercise — can have an effect on protecting from dementia.

Kaiser Health News: These Preventive Measures Might Help Delay Dementia Or Cognitive Decline
In a landmark report, scientists have endorsed three strategies for preventing dementia and cognitive decline associated with normal aging — being physically active, engaging in cognitive training and controlling high blood pressure. This is the first time experts convened by the National Academies of Sciences, Engineering and Medicine have deemed scientific evidence strong enough to suggest that preventing dementia and age-related cognitive decline might be possible. (Graham, 7/20)

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Depression Among Heart Attack Survivors Can Be Deadly, Yet Is Often Ignored

Clyde Boyce has been hospitalized 14 times in the past four years.

Boyce, 61, survived two strokes and five operations to unblock arteries around his heart, including three procedures in which doctors propped open his blood vessels with stents. He takes 18 pills a day and gets injections every two weeks with a powerful drug to lower cholesterol.

Yet the disease that came closest to taking Boyce’s life wasn’t a heart condition. It was depression, which led him to attempt suicide twice in the year after his first surgery.

One in 5 people hospitalized for heart attack or chest pain develop major depression — about four times the rate in the general population, according to the American Heart Association. One in 3 stroke survivors become depressed, along with up to half of those who undergo heart bypass surgery.

Heart disease patients who become depressed are twice as likely to die within the following decade as other patients, according to an unpublished study presented in March at the American College of Cardiology’s annual meeting.

Depression increased the risk of death more than any other risk factor in the study — even smoking, said lead author Heidi May, a cardiovascular epidemiologist at the Intermountain Medical Center Heart Institute in Salt Lake City.

Relatively few heart patients die from suicide.

Most often, depressed heart attack survivors die of physical causes, partly because they’re less motivated to take care of themselves and take medication as directed, said Dr. Martha Gulati, a spokeswoman for the American College of Cardiology.

People suffering from depression are also more likely to smoke but often less likely to exercise and follow a healthy diet than those who are not depressed, Gulati said.

“You may be told to change your diet, but if you’re depressed, you may think, ‘This is too overwhelming. I can’t even process this information right now,’ ” said Kim Smolderen, an assistant professor at the University of Missouri-Kansas City.

The American Heart Association has recommended that cardiologists screen all heart attack patients for depression, using a short questionnaire, since 2008.

Yet nearly a decade later, relatively few cardiologists screen patients for depression, Smolderen said. In May, she published a study in Circulation of younger heart attack survivors, most of whom were women, showing that only 42 percent of depressed heart attack patients received treatment.

Overall, only half of all Americans diagnosed with depression receive care, according to the National Institute of Mental Health.

Many cardiologists say they don’t have the time or the expertise to handle mental health care, Smolderen said. Critics note there’s little to no evidence that depression screening prevents additional heart attacks.

Yet many doctors also fail to refer patients to cardiac rehabilitation — a program of supervised exercise and education — which has been shown to both reduce depression and help prevent heart attacks and deaths, according to a 2015 study in JAMA Internal Medicine.

Although the American Heart Association strongly recommends cardiac rehab, doctors refer only 2 out of 3 heart attack survivors for the program, the study found.

A fraction of patients referred to the program — which involves three sessions a week for 12 weeks — actually show up. Due to cost and other barriers — such as long drives to hospital rehab centers — just 23 percent of patients attended one or more sessions, and 5 percent completed all 36 recommended sessions, the study found.

Cardiac rehab programs include stress management and teach relaxation techniques and coping skills similar to those used in some types of depression therapy. The programs can reduce the risks of heart attack more than standard rehab.

In a three-year study published in Circulation last year, which included heart patients ages 36 to 84, nearly half of patients who didn’t attend cardiac rehab died or had a heart attack, stroke or hospitalization due to chest pain, compared with 33 percent of those who attended rehab.

Among those whose rehab included stress management, only 18 percent suffered one of these heart-related complications, the study found.

Ignoring The Warning Signs

Boyce — who said depression sent him into rages that tested his marriage — said no one screened him for mental illness after his heart procedures, although he had suffered several debilitating depressions since adolescence.

He wasn’t prescribed antidepressants, Boyce said, until after his first suicide attempt.

“The system failed him,” said psychologist Barry Jacobs, a spokesman for the American Heart Association, when he heard Boyce’s story. “What you’re describing is not the way it’s supposed to work.”

After Boyce’s second heart procedure, he stopped taking his heart medications for five days — a move that his doctors viewed as a suicide attempt. His doctor committed him to a state psychiatric hospital for almost a week, prescribed medication and referred him to a psychiatrist.

Yet Boyce’s depression deepened as the bad health news piled up. Doctors diagnosed heart rhythm problems that required a pacemaker; congestive heart failure, caused when weakened heart muscle allows fluid to build up in the lungs; as well as asthmatic bronchitis, which affects the lungs. Boyce began to dread that he would suffer a fate similar to his mother, who died after six months in a coma, brought on by a long battle with heart disease.

A year after his first suicide attempt, Boyce tried to overdose on prescription medication. His wife found him and took him to the hospital, where doctors committed him to a psychiatric ward.

“Everything was happening so fast,” said Boyce, a former advertising executive from Murchison, Texas, who retired due to his health problems. “I was just convinced I was going to die. I thought to myself, ‘I’m going to end up on a ventilator, unconscious, just like my mother.’ ”

Boyce, 61, of Murchison, Texas, shows his smallest and largest pills — two of 18 he takes every day for various conditions. (Sarah A. Miller for KHN)

Boyce received help from a variety of sources: medication; counseling with a psychologist; a “mindfulness” stress reduction program, which borrows techniques used in meditation; and cardiac rehabilitation.

Exercise helped him feel stronger and less disabled, Boyce said.

“I do think the rehab raised my spirits … feeling like I could still do some things,” Boyce said.

What helped Boyce turn the corner, he said, was a conversation with God.

“It was the night before my third or fourth operation, and for some reason, I was sure I was not going to live through it,” Boyce said. “I said, ‘God, all I ask is that you give me one more day, and I will try to be a better man every day.’”

Boyce lost his fear of death. Although he occasionally still gets depressed, Boyce said, he’s able to manage his fears and anxieties better than in the past.

An Expensive Problem To Ignore

Cardiologists are divided about whether to screen heart patients for depression, but many primary care doctors have embraced the idea, said Dr. Ken Duckworth, medical director for the National Alliance on Mental Illness.

Both the American Academy of Family Physicians and the U.S. Preventive Services Task Force, an expert panel that advises Congress on health care, now recommend that doctors screen all adults for depression. The family physician group also singles out heart attack survivors for depression screening.

Studies increasingly suggest that the most effective care comes from addressing physical and mental health conditions together, rather than forcing frail patients to make separate trips to a variety of specialists, Duckworth said.

Successful approaches have involved “packages of care,” rather than individual services, said Dr. Bruce Rollman, a professor at the University of Pittsburgh School of Medicine.

The team approach is key.

A mild decrease in depression led to a big decrease in cost.

Bruce Rollman, University of Pittsburgh School of Medicine

In an approach called collaborative care, mental health nurses or social workers serve as care managers, who reach out directly to patients, often by phone, to educate them about their disease, suggest ways to manage their depression and make sure that treatments are working, said Dr. Mary Whooley, director of cardiac rehabilitation at the San Francisco VA Health Care System.

Care managers work with primary care doctors to quickly adjust patients’ medications or other treatments as needed. They consult with a psychiatrist, often over the phone, Whooley said.

“You can’t stay home and get depressed … they won’t let you,” said Dr. Anita Everett, president of the American Psychiatric Association. “They reach out to you.”

A 2014 study in JAMA Internal Medicine found that collaborative care could be delivered over the phone. Patients in the study had blocked arteries, heart rhythm problems or heart failure.

Even on the phone, care managers “develop a trusted relationship with our patients,” said study co-author Dr. Bruce Rollman, a professor at the University of Pittsburgh School of Medicine.

An earlier study of collaborative care, which focused on patients who had undergone bypass surgery, found that telephone care not only improved depression, quality of life and patients’ physical functioning, it saved over $2,000 a year per patient. Rollman is now studying ways to treat depression and heart failure together.

Keeping depression under control can save money if patients stay healthy and spend less time in the hospital, Rollman said.

Depression costs the U.S. more than $210 billion a year, with much of the cost coming from reduced productivity at work, according to a 2015 study.

“There are very, very few things in health care that save money,” Rollman said. “A mild decrease in depression led to a big decrease in cost.”

Officials at the University of Pittsburgh Medical Center Health Plan were impressed enough by the results to include depression screening as part of a checklist of care for patients who are sent home after a heart attack.

Medicare, the federal health insurance program for Americans age 65 and older, began paying doctors to deliver collaborative care in January. Medicare has covered depression screenings in primary care settings since 2012.

In that time, Medicare payments for depression screening have grown from $1.7 million a year to $9.5 million a year, according to a Kaiser Health News analysis. While those screenings make a small fraction of Medicare’s annual budget of $646.2 billion, Duckworth called the services “a noteworthy trend in the right direction.”

Elizabeth Lucas contributed to this story.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Medicare, Mental Health, Public Health

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Viewpoints: History Offers Lessons In Addressing Opioid Addiction Crisis; Minority Communities And Access To Mental Health Care

Opinion writers offer their thoughts on a range of health issues.

Bloomberg: This Isn’t The First U.S. Opiate-Addiction Crisis
It’s true that there’s an opioid epidemic, a public health disaster. It’s not true that it’s unprecedented. A remarkably similar epidemic beset the U.S. some 150 years ago. The story of that earlier catastrophe offers some sobering lessons as to how to address the problem. (Stephen Mihm, 7/17)

Lexington Herald Leader: Ky.’s New Opioid Law Will Only Result In More Death, Pain
As the death toll from opioid overdoses in Kentucky and the rest of the Midwest continues to soar, it’s truly disconcerting to see that policymakers are taking steps that are not only devoid of medical and common sense, but virtually guaranteed to make matters worse. The recent passage of the ill-conceived House Bill 333, which imposes a three-day limit (with certain exceptions) on opioid prescribing, reflects a fundamental misunderstanding of the reasons behind the addiction epidemic. (Josh Bloom, 7/14)

Miami Herald: Minority Communities Lack Access To Mental Healthcare
Despite the need for mental health services, minorities are not seeking medical care. Even when they do seek treatment, they are less likely to receive adequate mental health care and tend to drop out of treatment two to three times more frequently. (Daniel Jimenez, 7/17)

Lincoln Journal-Star: Nebraska Needs Family Planning Clinics
In our neighboring state of Iowa, 15,000 people lost access to preventive care and contraception as Planned Parenthood clinics shut down earlier this month after Iowa politicians passed a law to stop reimbursing the trusted provider for health services. (Mia Fernandez, 7/18)

Stat: It’s Time To Break Down The Wall Between Dentistry And Medicine
In 1840, dentistry focused on extracting decayed teeth and plugging cavities. Today, dentists use sophisticated methods for prevention, diagnosis, and treatment. We implant teeth, pinpoint oral cancers, use 3-D imaging to reshape a jaw, and can treat some dental decay medically, without a drill. We’ve also discovered much more about the intimate connection between oral health and overall health. Periodontal disease, also known as gum disease, has been linked to the development of diabetes, high blood pressure, and cardiovascular disease. Pregnant women with periodontitis are more likely to develop pre-eclampsia, a potentially serious complication of pregnancy, and deliver low-birth-weight babies. (Bruce Donoff, 7/17)

Austin American-Statesman: Vaccines Protect Texas Children
When kids are vaccinated, there is less concern that they will contract diseases when they go with their friends to the local swimming pool or the playground… Pockets of parents in Texas and other states have become complacent because they don’t regard these diseases as threats to their children, while others don’t believe these diseases exist any longer. (Terry Cook, 7/18)

The Des Moines Register: Postpartum Psychosis Claimed Molly Roth. Her Husband Hopes To Save Others
But two weeks after Gracelyn arrived Jan. 5, Molly encountered her biggest hurdle. A nurse practitioner called it the “baby blues,” a benign term for a sometimes monumental change that affects about one in five new mothers. Normally a whirlwind of energy, the 32-year-old Molly, who used to make sure everyone else was OK, now had to drag herself through the motions of daily life. She would cry uncontrollably and say she had made a mistake. About a month in, she was diagnosed with postpartum depression and put on a handful of medicines, Jamison says. By then she was struggling just to bathe: “I had to show her the simple steps of turning on the water and getting a towel.” She talked of suicide. What she was suffering from, according to Jamison, was actually a rarer, more dangerous perinatal mood disorder called postpartum psychosis, compounding her existing anxieties. (Rekha Basu, 7/17)

Los Angeles Times: Domestic Violence Victims Shouldn’t Have To Choose Between Deportation And Medical Care
When Elena attempted to break up with her abusive boyfriend, he beat her horribly, saying he would leave her with scars by which to remember him. Although badly injured, she did not contact the police to report the domestic violence. Nor did she seek medical care for her open wounds or the ringing in her ear. She had heard news of President Trump’s expanded immigration enforcement policies and stories of immigration agents arresting domestic violence and human trafficking victims inside courthouses. She had also learned that her state, California, requires medical professionals to report domestic violence and sexual assault to the police, and she feared deportation more than she desired medical care. (Jane K. Stoever, 7/17)

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State Highlights: D.C.’s Aid-In-Dying Law Takes Effect, Setting Up Showdown With Congress; N.H.’s Mental Health Services Still Found Lacking

Media outlets report on news from D.C., Massachusetts, Kansas, Iowa, New Hampshire, California, Ohio, Colorado and Michigan.

The Washington Post: Assisted Suicide Is Legal And Available In D.C. — For Now
District officials say doctors in the city may now begin the process of prescribing life-ending drugs to terminally ill patients, setting up a showdown with Republicans in Congress who are trying to void the city’s assisted-suicide law. City officials say the rules and regulations to implement the law took effect Monday, adding the District to six states that authorize the practice. (Nirappil, 7/17)

San Jose Mercury News: End Of Life: Family Sues UCSF For Refusing To Help Woman Die
In what may be the first-of-its-kind lawsuit related to California’s End of Life Option Act, the family of a San Francisco terminally ill cancer patient is suing the UC San Francisco Medical Center alleging that her physician and the system misrepresented that they would help the dying woman use California’s right-to-die law when her time came. Instead, according to the July 7 civil lawsuit filed in San Francisco Superior Court, Judy Dale’s wish for a peaceful death was denied to her by the defendants’ “conscious choice to suppress and conceal’’ their decision that they would not participate in the law, despite Dale’s repeated indications to doctors and social workers that she intended to use its provisions. (Seipel, 7/17)

New Hampshire Public Radio: Outside Review Says State Lagging In Some Key Areas Of Mental Health Reform
Three years after the state reached a major legal settlement meant to reform its mental health system, both the outside reviewer hired to monitor the state’s progress and the advocacy organization that sued on patients’ behalf say there’s still significant work to be done. The state is required to submit to regular outside reviews of its mental health offerings as part of a multi-million dollar settlement reached three years ago, as a result of a class action lawsuit brought by the Disability Rights Center of New Hampshire. (McDermott, 7/17)

The Associated Press: Kansas Board Revokes Doctor’s License Again In Abortion Case
Kansas’ medical board for the third time has revoked the license of a doctor whose second opinions allowed the late Dr. George Tiller to perform late-term abortions more than a decade ago. The State Board of Healing Arts acted against Dr. Ann Kristin Neuhaus over what it previously concluded were her inadequate records for 11 patients aged 10 to 18 who sought abortions in 2003. Kansas law at the time required a second doctor to conclude that continuing a pregnancy would permanently harm a patient’s physical or mental health. (7/17)

Iowa Public Radio: First Day Of Testimony In Abortion Restrictions Trial
The medical director of Iowa’s largest abortion provider took the witness stand today in Polk County District Court. Dr. Jill Meadows of Planned Parenthood of the Heartland and the ACLU of Iowa are suing the state, saying that new restrictions on abortion create an undue burden for women. There’s currently an injunction on the new law which requires a woman to have an ultrasound three days before terminating her pregnancy. (Boden, 7/17)

State House News Service: Baker Vetoes $320 Million, Returns Assessments With MassHealth Reforms
Baker signed a budget for fiscal 2018 on Monday afternoon that includes $39.4 billion in spending after he vetoed $320 million from the plan, and went even further than House and Senate budget negotiators to revise tax revenue projections downward for this year by $749 million. The governor also returned to the Legislature a new assessment on employers that he initially proposed to help pay for growing MassHealth expenses, calling on lawmakers to act quickly to package the $200 million in new employer fees with MassHealth reforms that lawmakers laid aside during budget deliberations. (Murphy, 7/17)

Denver Post: Boulder-Based Techstars And Foundry Invest In “Airbnb Of Health Care”
Armed with Boulder money, a California health insurance startup is trying to make it big. But not by selling plans — just by telling people about them. Impact Health is sort of like a dating service, or maybe an Airbnb. First, put in your preferences and history, then the algorithms find you a match: a health insurance plan. The company serves about 59,000 people, according to chief executive and co-founder Christine Carrillo, but they have lofty goals — and that’s where Techstars Venture Capital Fund and Foundry Group can help. (Douglas, 7/17)

Detroit Free Press: Doctor Claims Mike Morse Demanded Kickbacks
Southfield attorney Mike Morse demanded kickbacks and fudged test results in return for patient referrals, according to claims made by a Clarkston doctor who plead guilty to conspiracy to commit wire fraud. Dr. Ram Gunabalan swore to the accusations in a 49-page affidavit filed in federal court last week. The document lays out a series of allegations of questionable dealings Gunabalan said he had with Morse and others related to the treatment of auto accident patients in lawsuits. (Wisely and Reindl, 7/17)

San Francisco Chronicle: Sonoma County Challenges For Pot Supremacy As Others Turn Away
Craft cannabis is becoming a cousin to craft beer in Sonoma County, and the venture by the founder of the San Francisco Patient and Resource Center, or SPARC, is among several operations awaiting permits to grow and manufacture medical marijuana — and, presumably, recreational pot in the future. Around the state, the mainstreaming and legalization of marijuana is prompting many cities, even liberal ones, to fear trouble and shun the exploding industry. (Fimrite, 7/17)

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Governor’s Order Makes Missouri Last State To Adopt Prescription Drug Database

Republican Gov. Eric Greitens surprises state lawmakers with is executive order creating a drug monitoring program. News outlets also cover efforts in Wisconsin and Massachusetts to combat the opioid epidemic.

The Associated Press: Missouri Becomes Last State To Create Drug-Monitoring Plan
Missouri became the final state to create a prescription drug-monitoring program Monday when Republican Gov. Eric Greitens signed an executive order aimed at combatting a scourge that killed more than 900 residents last year. The announcement surprised lawmakers, many of whom were unaware such a program was under consideration. Almost immediately, Democrats questioned whether the order goes far enough while some Republicans expressed concerns about privacy. (Salter, 7/17)

The Kansas City Star: Missouri Gov. Eric Greitens Issues Order To Create Drug Monitoring Program
Greitens’ order directs the Department of Health and Senior Services to build the database, which will be designed to help identify suspicious patterns of prescriptions of controlled substances, including opioids. The announcement was made at the St. Louis headquarters of Express Scripts, a pharmacy benefits management company. “Like the plague, opioids kill the young, the old, the healthy, the sick, the virtuous and the sinful,” Greitens said in a prepared statement. “There’s not a corner of our state that hasn’t been visited by this curse.” (Hancock and Marso, 7/18)

KCUR: Greitens’ Executive Order Creates Statewide Prescription Drug Monitoring Program For Missouri
Gov. Eric Greitens signed an executive order Monday to set up a statewide prescription drug monitoring program, ending Missouri’s status as the final state in the nation without such a database. The order also bypasses another round of debates in the Missouri legislature, which came close to establishing a broad program during the regular session, but failed. Several cities and counties in the state already have set up their own monitoring program. (Rosenbaum, 7/17)

WBUR: Latest Idea In The Battle Against Opioid Addiction: A ‘Soup To Nuts’ Recovery Campus
By mothership, Fox and Sue Sullivan, who represent 235 area companies through the Newmarket Business Association, envision an addiction treatment and research campus. … On these campuses, patients would find everything they need to manage their addiction, including detox to get them through withdrawal, all varieties of 12-step programs, all types of medication treatment, inpatient facilities, outpatient care and mental health services. (Bebinger, 7/17)

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State Highlights: Minn. Marks New Measles Case; Three Mass. Hospitals Reach Merger Agreement

Media outlets report on news from Minnesota, Massachusetts, Georgia, Missouri, California, Ohio, Michigan, Texas and Florida.

The Star Tribune: New Measles Case In Minnesota Extends Threat
A new measles case in Minnesota, reported just as the recent outbreak seemed to be winding down, has state health officials on alert because it involved a white adult who had visited public places in Hennepin, Ramsey and Carver counties while infectious and who had circulated among several people known to be unvaccinated. Reported Thursday by the Minnesota Department of Health, the case brings the total for the current measles outbreak to 79. (Olson, 7/13)

WBUR: Proposed Beth Israel-Lahey Merger Includes 13 Hospitals
A proposed hospital merger, spearheaded by Beth Israel Deaconess Medical Center and Lahey Health, became formal Thursday with the signing of a definitive agreement and a filing with the state’s Health Policy Commission. If approved, it would be the largest hospital merger in Massachusetts since Partners HealthCare formed in 1994 — and it would include more hospitals. (Bebinger, 7/13)

Atlanta Journal-Constitution: Georgia To Pursue $49 Million For School Nurses
In a joint effort with the Georgia Department of Education, the Department of Community Health board voted to approve a nursing services reimbursement program that would draw an estimated $48.6 million in additional federal dollars, assuming no major changes to Medicaid. There were 1,629 nurses and 307 unlicensed health care and clinic workers in Georgia schools last spring. (Tagami, 7/13)

The Associated Press: Confusion Over How Anti-Abortion Bill Could Affect St. Louis
Missouri lawmakers are at a standstill on broad anti-abortion legislation more than a month after Republican Gov. Eric Greitens called them into a special session to deal with abortion issues. The legislation calls for several new regulations, such as annual state inspections of abortion clinics. But one of the provisions causing the most confusion addresses a St. Louis ordinance that city leaders say is intended to prevent discrimination based on reproductive health decisions, such as pregnancy and abortion. (7/14)

Atlanta Journal-Constitution: Best Hospitals In US: 8 Georgia Hospitals Among Most Advanced In Tech
And according to Hospitals and Health Networks 19th annual “Most Wired Hospitals and Health Systems” survey, eight Georgia hospitals or health systems (including four in metro Atlanta) rely heavily on digital innovation “to improve population health, capitalize on data analytics, boost patient engagement and introduce new efficiencies” …The survey, conducted with the help of the American Hospital Association and health care experts, showed 82 percent of the nation’s hospitals and hospital systems use technological analysis tools to help improve quality and reduce costs, both clinically and administratively. (Pirani, 7/13)

Detroit Free Press: Beaumont Trumpets, Defends New Pricey Proton Beam Cancer Center
Beaumont Health officials showed off their new $40-million cancer-fighting machine on Thursday — the first of its kind in Michigan and purportedly more advanced and less costly to operate than earlier models of the sometimes controversial technology. The proton beam device is the centerpiece of the new Proton Therapy Center on Beaumont’s Royal Oak hospital campus and one of just 25 in the country. (Reindl, 7/13)

Austin American-Statesman: Lawmakers Propose Reining In Health Costs For Texas Retired Teachers
After failing to temper soaring health care costs for retired teachers, state lawmakers are considering giving retired teachers up to $1,200 more a year and pumping $200 million into their health care over the next two years. Starting in January, many retired teachers, particularly those under the age of 65, will see higher premiums and deductibles grow as much as 10 times what they’re paying now. (Chang, 7/13)

Minnesota Public Radio: Crisis Connection Hotline Rescued, As Least Temporarily
A mental health hotline that’s served Minnesotans for nearly 50 years will keep operating thanks to an eleventh-hour infusion of money. Crisis Connection had been scheduled to shut down Friday evening, but a grant from the state health department means the service will continue linking people suffering mental health emergencies to professional counselors. (Sepic, 7/14)

The Star Tribune: Minnesota Mental Health Crisis Line Gets Rescued At The Last Minute
<p class=”Text_Body”>In a last-minute move, the agency agreed late Thursday to provide enough funding, $139,000, to keep the crisis hot line open until late September. Canvas Health, the Oakdale-based nonprofit agency that operates the service, had previously announced the hot line would go dark on Friday, citing financial difficulties and a lack of state funding. The planned closing of Crisis Connection concerned state health officials and mental health advocates, because the line is so widely used and remains the only mental health crisis line that serves the entire state. (Serres, 7/13)</p>

Health News Florida: Federal Judge Dismisses Request To Stop Spraying Pesticide Naled In Miami-Dade County
A federal judge has dismissed a request to stop aerial spraying of the pesticide Naled in Miami-Dade County, describing the plaintiffs’ complaint as “poor” and recommending they get a lawyer before pursuing further legal action. Judge Federico Moreno, of the Southern District of Florida, gave the two Miami Beach residents who filed the complaint 60 days to amend it by clarifying why the case belongs in federal court and which laws they contend are being violated. (Stein, 7/13)

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Longer Looks: The Future Of Repeal; A New ‘War On Drugs’; And IVF Innovations

Each week, KHN’s Shefali Luthra finds interesting reads from around the Web.

The Economist: The Republicans’ Chances Of Replacing Obamacare Are Receding
No Republican senator looms larger in the schemes of left-wing protesters than Susan Collins of Maine. One of the last New England moderates, a once-common Republican species, Ms Collins is considered the likeliest holdout against the draft Republican health-care reform that has overshadowed the week-long Independence Day recess. But on the evidence of her appearance at the Fourth of July parade held in Eastport, Maine, America’s easternmost city, liberals can relax. (7/6)

The New York Times: A Small-Town Police Officer’s War On Drugs
Eric Adams is a handsome, clean-­shaven man, almost 41, with a booming voice and hair clipped short enough for the military, which once was an ambition of his. After high school, he tried to join the Marines but was turned away because of his asthma. He needed three different inhalers then, plus injections. Today he has outgrown the problem. He is 5-foot-10, weighs 215 pounds and can dead lift 350. (Benjamin Rachlin, 7/12)

The Atlantic: Is The Republican Health-Care Bill Dead?
Senate Republican leaders have a new plan to pass the health-care bill their members scuttled late last month: They’ll unveil a revised bill this Thursday, receive an updated analysis from the Congressional Budget Office on Monday, and then rush the proposal across the floor before its critics have a chance to defeat it. (Russell Berman, 7/11)

The Atlantic: INVOcell: Growing Cheaper Embryos For IVF Inside The Vagina
As the number of U.S. babies born as a result of fertility treatment tops 1 million—an all-time high—clinics are under pressure to keep up to date with pricey lab equipment that can create, develop, and test embryos. But some fertility doctors have started to offer a new low-tech device that enables a woman to incubate them in her own body. The catch: She grows them inside her vagina. (Sarah Elizabeth Richards, 7/12)

FiveThirtyEight: The Trump Administration’s Own Data Says Obamacare Isn’t Imploding
President Trump and other Republicans have said repeatedly that one reason they have to repeal and replace the Affordable Care Act is that the law is failing: Healthy people are abandoning the insurance marketplaces set up by the law, driving up costs and leading yet more people to drop insurance — a so-called “death spiral.” Many health insurance experts, however, have argued that those fears are overblown, and they recently got support from an unlikely source: the Trump administration itself. (Anna Maria Barry-Jester, Michelle Cheng and Maggie Koerth-Baker, 7/7)

The New York Times: The Gentler Symptoms Of Dying
The patient’s hair was styled with curls so stiff, they held her head a few inches up from her hospital pillow. She had painted her lips a shade of bright pink that exuded the confidence of age. Just after her colon burst, she was still awake. She looked around, at me, at the monitors. She asked for pain medication. “Am I dying?” she asked. (Sara Manning Peskin, 7/11)

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State Highlights: San Diego Hepatitis A Breakout Claims 5 Lives; Colorado’s ‘Baby Box’ Effort Aimed At Reducing Infant Mortality

Media outlets report on news from California, Colorado, Maryland, Illinois, Florida, Missouri, Wisconsin, New Hampshire and Ohio.

Los Angeles Times: Hepatitis A Outbreak In San Diego County Claims 5th Victim
A fifth person has died in San Diego County’s ongoing hepatitis A outbreak — the state’s largest in two decades, public health officials said Wednesday. The outbreak started in November and has grown among the region’s homeless population. There have been 228 confirmed infections, including 161 people who had to be hospitalized, according to the county’s Health and Human Services Agency. (Sisson, 7/12)

Denver Post: All New Mothers In Colorado Can Receive Baby Boxes, Thanks To New Program
New and expectant mothers across Colorado will soon be eligible to receive a free gift: a cardboard box that health workers hope will reduce infant mortality. The box comes courtesy of The Baby Box Co., a for-profit maker of the kinds of boxes that mothers in Finland have received for decades. The boxes include a basic foam mattress and can serve as a safe sleep space for infants up to about 6 months old. A smattering of other items — such as diapers, wipes and onesies — are also included with the boxes. (Ingold, 7/12)

Sacramento Bee: Single Payer Health Care Still On Wish-List In California
Toni Atkins grew up without health insurance in a “crossroads out in the middle of nowhere. ”The family lived in rural Virginia, where her father worked as a miner and her mother was a seamstress. Her mom broke an arm at one point, reducing the family to one income while medical bills stacked up. “We had to get food stamps. It was excruciating,” Atkins said. (Luna, 7/13)

The Baltimore Sun: University Of Maryland Medical System Board Approves Affiliation With Dimensions Health
The University of Maryland Medical System board of directors executive committee voted Wednesday to bring Dimensions Health Corporation under the UMMS banner. The vote authorizes, Robert A. Chrencik, UMMS president and chief executive officer, to enter into an affiliation agreement with Dimensions in Prince George’s County.The Dimensions board voted last month to allow the merger to go through. (McDaniels, 7/12)

Chicago Tribune: Abbott, Silicon Valley Company Partner To Develop System For Diabetes Patients 
When Jeffrey Brewer’s son was 15, the boy nearly lost his life because he took too much insulin. The diabetic teen took insulin to eat a large bag of chips late at night. But about 20 minutes later, he forgot about that first dose and took another. He spent two days in the hospital, his father said…Now, Bigfoot Biomedical and north suburban-based Abbott Laboratories hope to help prevent such problems — and make life easier for millions of people with diabetes — with a new partnership announced Thursday. The partnership aims to combine several technologies to make it easier for diabetics to monitor their glucose levels and figure out how much insulin to take throughout the day. (Schencker, 7/13)

Health News Florida: More Rain Means More Mosquitoes In Orange County
There’s a downside to the rainy season in Florida: Mosquitoes. Orange County Mosquito Control has seen a tenfold increase to about 100 calls for service every day. The calls are primarily for nuisance mosquitoes, not the mosquitoes that can transmit Zika virus and other diseases. The county urges residents to drain standing water to cut down on mosquito breeding areas. (Aboraya, 7/12)

Health News Florida: Newtown Celebrates New ‘One-Stop-Shop’ Clinic
A new adult-care clinic in Newtown opened this month.  A community-wide partnership aims to make the clinic a ‘one-stop-shop’ for a variety of needs for the community just north of the city of Sarasota, where access to medical care and other services has been a challenge. (Davis, 7/12)

KQED: Is The New Tobacco Tax Causing A Drop In Smoking? Big Time, Indicators Suggest
Last fall, California voters approved the biggest increase in cigarette taxes since the state first began levying tobacco in the 1950s. Advocates for Proposition 56, which passed with a fairly overwhelming 64 percent of the vote, argued that a $2-per-pack tax hike would hurt pocketbooks enough to nudge millions of California smokers to quit, or at least to light up less frequently. (Levin, 7/12)

Modern Healthcare: SSM Health To Acquire Wisconsin Hospitals From The Congregation Of Sisters Of St. Agnes
SSM Health will acquire two Wisconsin-based systems from the Congregation of Sisters of St. Agnes, the Catholic-sponsored providers announced Wednesday. The systems are Agnesian HealthCare and Monroe Clinic. St. Louis-based SSM Health owns St. Mary’s Hospital in Madison, Dean Clinic and hospitals in Baraboo and Janesville. The facilities will likely carry the SSM Health brand. (Kacik, 7/12)

San Francisco Chronicle: Group Seeks Referendum On Flavored Tobacco Ban In S.F.
A San Rafael lawyer has filed a referendum measure to strike down the Board of Supervisors’ ban on flavored tobacco, which passed unanimously in June. … The group represents tobacco manufacturers R.J. Reynolds and Altria, as well as several vaping advocacy groups and the Arab American Grocers Association, whose members opposed the supervisors’ ordinance, saying it hurt immigrant business owners. (Swan, 7/12)

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Study May Provide Road Map For Scientists Searching For Genes Linked To Autism

Researchers found that the way children search out social experiences is connected to genetics. In other public health news: prostate cancer, Zika, food safety and diets, deadly infections and more.

Stat: 15 Percent Of Men Regret Prostate Cancer Treatment Choices Years Later
After years of introspection, about 15 percent of men with localized prostate cancer regretted the decisions they made regarding treatment, a survey of almost 1,000 patients showed. About twice as many men expressed regret after radical prostatectomy or radiation therapy as compared with active surveillance. The single biggest contributor to regret was treatment-associated sexual dysfunction, as reported in the Journal of Clinical Oncology. (Bankhead, 7/12)

Los Angeles Times: Surgery For Early-Stage Prostate Cancer Does Not Lead To Longer Lives, Study Finds
A long-term study of men diagnosed with early-stage prostate cancer has confirmed that patients who forgo immediate surgery have the same odds of living another decade or two as patients who have their tumors surgically removed. The results, published in Thursday’s edition of the New England Journal of Medicine, show that while each approach offers a different mix of benefits and risks, neither is likely to result in death due to prostate cancer. (Abed, 7/12)

USA Today: Why Zika Virus Infections Are Way Down In U.S. This Summer
Zika, the virus that sparked widespread concern last year? It’s on the wane, at least for now. The number of people infected with Zika is down substantially this year in the United States, reflecting a precipitous drop in mosquito-borne virus infections in Puerto Rico and other overseas locations. (Orr, 7/12)

Stat: Changing What You Eat Can Change How Soon You’ll Die
A new study shows that such diet changes are better late than never — as long as those new healthy habits stick. That came from researchers at Harvard’s school of public health who tracked what over 70,000 people have eaten for decades. They found that long-term improvements in diet were associated with a significantly decreased risk of death. (Sheridan, 7/12)

The Baltimore Sun: Genetics Playing A Growing Role In Intersection Of Nutrition And Health 
Dieticians for years have used genetics on a limited basis, looking at mutations in one particular gene that may make patients prone to disease or more likely to have certain health conditions. For example, patients who are lactose intolerant can’t break down the lactose found in dairy products because of a mutation in the lactose gene. So they suffer with gas and other uncomfortable digestive problems after drinking milk or eating cheese or ice cream. The sequencing of the human genome – or the mapping of every gene in the body – has enabled not just dieticians, but all doctors, to use genetics in a more comprehensive way. A doctor can look at a patient’s entire genetic makeup to determine, for instance, if they have multiple gene mutations that would make them more prone to obesity or cardiovascular disease. (McDaniels, 7/13)

The New York Times: The Chemicals In Your Mac And Cheese
Potentially harmful chemicals that were banned from children’s teething rings and rubber duck toys a decade ago may still be present in high concentrations in your child’s favorite meal: macaroni and cheese mixes made with powdered cheese. (Rabin, 7/12)

Kaiser Health News: DNA Links Deadly Germs, Tainted Heart Surgery Devices To German Factory
Contamination at a German factory that makes crucial machines used during open-heart surgery is the likely source of a global outbreak of deadly infections tied to the devices, the largest analysis to date shows. Scientists using whole-genome sequencing matched the DNA fingerprints of samples taken from infected heart-surgery patients from several countries, including the U.S., to samples from the devices, called heater-cooler units, in multiple hospitals — and at the production site. (Aleccia, 7/12)

Stat: Movement Supports People Who Hear Voices, Yet Refuse Medication
Do patients who hear voices — and suffer other symptoms that psychiatrists would consider severe —  have the right to direct their treatment, even if that means rejecting conventional therapies, such as psychiatric medication? Some mainstream psychiatrists have concerns that people who are out of touch with reality and spurn treatment may pose a danger to themselves or others. But the movement, which began in the Netherlands, has spread rapidly in the past three decades; there are now “hearing voices” support groups on all five continents, and over 180 in the U.K., alone, anchored by the Hearing Voices Network. The idea has been slower to take hold in the U.S., which has a strong medical model for treating mental illness, but is gaining steam there, too. (Wang, 7/13)

NPR: Study Finds Mistakes With Medications On The Rise
When people take medicine at home, mistakes happen. Some people end up taking the wrong dose of a medication or the wrong pill. Sometimes, they don’t wait long enough before taking a second dose. Other times, it’s a health professional who’s at fault. A pharmacist might have dispensed a medication at the wrong concentration, for example. (Columbus, 7/12)

The New York Times: Who Needs Hard Drives? Scientists Store Film Clip In DNA
It was one of the very first motion pictures ever made: a galloping mare filmed in 1878 by the British photographer Eadweard Muybridge, who was trying to learn whether horses in motion ever become truly airborne. More than a century later, that clip has rejoined the cutting edge. It is now the first movie ever to be encoded in the DNA of a living cell, where it can be retrieved at will and multiplied indefinitely as the host divides and grows. The advance, reported on Wednesday in the journal Nature by researchers at Harvard Medical School, is the latest and perhaps most astonishing example of the genome’s potential as a vast storage device. (Kolata, 7/12)

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Money, Recognition And Dark Chocolate: How To Sell Doctors On Prescribing Powerful Painkillers

Two former sales reps pleaded guilty to violating the federal anti-kickback law in bribing doctors to prescribe Subsys. A look at the case shows how companies can get doctors to do their bidding.

Stat: Former Insys Reps Plead Guilty To Bribing Docs For Opioid Prescribing; They Wanted ‘Money’ And ‘Dark Chocolate’
Two former sales reps pleaded guilty on Tuesday to bribing doctors in exchange for prescribing the powerful Subsys painkiller sold by Insys Therapeutics, which is under numerous investigations by state and federal authorities for its role in the opioid epidemic. In both instances, the sales reps pleaded guilty to violating the federal anti-kickback law for participating in a speaker program that prosecutors say was used to reward doctors and other medical practitioners for prescribing Subsys, which contains fentanyl and carries a high risk of dependency. (Silverman, 7/12)

In other news on the opioid epidemic —

The Associated Press: Doctor Accused In Deaths Of At Least 7 In Oklahoma, Texas
A Texas doctor wrote unnecessary prescriptions for powerful drugs that contributed to the overdose deaths of at least seven people over a four-year period, according to a federal indictment unsealed Wednesday. Howard Gregg Diamond, 56, was arrested Tuesday on charges that include conspiracy to distribute controlled substances and health care fraud. (7/12)

The Philadelphia Inquirer/Philly.com: Wolf Hails New Program In Opioid Treatment
Gov. Wolf on Wednesday joined Clarion University officials to announce the launch of an online certificate program in opioid treatment, which they said is the first of its kind in Pennsylvania. “Education is a powerful thing,” Wolf said at a news conference at the Capitol. “Armed with facts, health-care providers, drug counselors, EMTs, school counselors, therapists, anyone interested in learning more will be able to take this online course.” In 2015, 3,500 Pennsylvanians died of drug overdoses, Wolf said. He said it appears that the toll in 2016 was even higher. (Langley, 7/12)

The Associated Press: Palm Beach County Considers Suing Drug Companies
At the suggestion of a Palm Beach County Commissioner, the county is looking into suing drug companies whose products are at the heart of the opioid crisis. The Palm Beach Post reports the county attorney will have her staff examine the legal landscape to determine if pharmaceutical companies have been successfully sued, which jurisdictions have been involved and what law firms have taken on the work. (7/12)

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New CDC Director’s Track Record On Public Health Initiatives Worries Some Advocates

Brenda Fitzgerald chose to partner with Coke in an effort to fight obesity, a move that raises some eyebrows. “We hope Dr. Fitzgerald, as head of CDC, avoids partnering with Coke on obesity for the same reason she would avoid partnering with the tobacco industry on lung cancer prevention,” said Jim O’Hara of the Center for Science in the Public Interest.

The Washington Post: New CDC Chief Partnered With Coke In State Obesity Program
As Georgia’s top public health official, Brenda Fitzgerald led the fight against childhood obesity in a state with one of the highest rates in the country. The program there, funded in part by the Coca-Cola Foundation, emphasizes exercise and makes little mention of the problems with sugary soft drinks — putting the effort at odds with research and the positions of many experts. (Sun, 7/12)

In other federal government news —

Nashville Tennessean: VA’s Facility Planning An Obstacle To Modernize Its Care, Report Says
The Department of Veterans Affairs is using an outdated and shortsighted planning process for managing its facilities and it’s an obstacle for the VA’s effort to repurpose or rid itself of old buildings and plan for future of care. That is the finding of the Government Accountability Office, which issued an opinion Wednesday on the VA’s two processes it uses to plan for managing facilities and how they are used to provide medical care for the nation’s veterans. (Lowary, 7/12)

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In Texas, People With Mental Illness Find Work Helping Peers

Recovery coaches and peer mentors — known in Alcoholics Anonymous as “sponsors” — have for decades helped those addicted to alcohol or drugs. Now, peer support for people with serious mental illness is becoming more common. Particularly in places like Texas, where mental health professionals are in short supply, paid peer counselors are filling a gap.

David Woodside, who has lived with bipolar and schizoaffective disorder his whole life, is getting help this way. Not long ago, he wound up in a Dallas County jail for the first time, at age 57. Woodside had gotten upset and kicked his brother.

“Nothing good happens in jail,” he said. “They don’t give you your medication.”

After his brothers, including the one he kicked, bailed him out, Woodside enrolled in an anger management class in Dallas at Metrocare, a nonprofit serving people with mental illness in North Texas.

At Metrocare, Woodside started visiting David Yarborough’s office several times a week. Inside, there’s an American flag on the wall, a popcorn machine in the corner and tissues on the wooden desk.

The two Davids have much in common.

Both are fathers and have worked as electricians, and both are taking the same antipsychotic medicine. That’s because Yarborough also copes with mental illness. He’s not a volunteer — he’s a full-time, paid, peer specialist. Woodside said, for him, seeing Yarborough has been better than seeing a psychiatrist.

David Woodside visits David Yarborough’s office several times a week to get helpful coaching on how to manage the symptoms of his bipolar and schizoaffective disorder. “Dave’s been through a lot of the things I’ve been through — and vice versa,” Woodside says. (Lauren Silverman/KERA)

“[Psychiatrists] see you for about six or seven minutes,” Yarborough said. “They don’t know what’s going on with you. And Dave’s been through a lot of the things I’ve been through — and vice versa.”

Metrocare employs five trained peer specialists, including two who are part of the statewide Military Veteran Peer Network. In Texas, more than 900 people have gone through the statewide certification process provided by the nonprofit organization Via Hope. The training requires 43 hours over five days and covers topics such as ethics, effective listening, the role of peer support in recovery and using your personal story as a recovery tool. The certification is valid for two years, and a person needs to earn continuing education credits to renew their certification.

Dennis Bach, executive director of Via Hope, said most of the certified peer specialists are employed by community mental health clinics and state hospitals.

Jim Zahniser, with The Meadows Mental Health Policy Institute, said the idea of peer services has been around for decades but only recently have research studies shown how powerfully effective the approach can be.

“One of the problems with mental health is we’ve learned how to keep people ‘stable’ on their medications and get them out of the hospital. But recovery is about having a life in the community,” Zahniser said. “And peer services are often focused on those things: How do you get your life back?”

Studies show peer support specialists can do as well as traditional case managers — if not better — in keeping patients with severe mental illnesses out of psychiatric hospitals.

And, Zahniser said, when it comes to persuading people who are suspicious of doctors to seek help, peers are often the ones who can connect fastest, and get them to accept treatment.

Peer counselors historically were volunteers. But as the Centers for Medicare & Medicaid Services recognized their value, and more training programs were established and standardized, it became easier for hospitals and clinics to employ these specialists full time.

Texas is one of more than 35 states that finance peer services through Medicaid. There’s a severe shortage of mental health care providers in the state, so certified peer specialists bridge the treatment gap.

Joanne Spetz, a researcher of workforce issues with the Institute for Health Policy Studies at the University of California-San Francisco, says peers play a critical role in mental health teams — alongside doctors and social workers.

“When [programs] first brought in peers,” Spetz said, “[they] had to spend a lot of time with the social workers, explaining to them that we were not going to take their work and hand it off to a cheaper person — that what the peer did was complimentary, but it was different.”

(Martin Barraud/Getty Images)

Peer specialist Yarborough was offered a job precisely because of his success in coping with his own mental illness and overcoming his past use of methamphetamines. When he works with clients, he can talk openly about how, decades ago, he fell into a very dark place.

“I went from the outdoorsman — fishing, yardwork, just really enjoying all that stuff — to … the guy who wants to lie in bed all day and stare out the window,” Yarborough remembers.

He started having suicidal thoughts.

“I gave my wife the key to my gun safe,” Yarborough said, “because I did not feel comfortable having access to my pistols.”

Eventually, Yarborough was diagnosed with bipolar II disorder. His condition has been stable for seven years and he has been drug- and alcohol-free for 10.

When he trained to become a peer specialist, Yarborough said, he learned to work with others while keeping a close watch on his own mental health. Every week, he helps dozens of people manage their symptoms.

His mantra? “It’s not how you fall, it’s how you get back up,” he said. “And I’ve really stuck to that concept.”

There can be a lot of stumbling with a mental illness, Yarborough noted, and having a shoulder to lean on makes the journey much smoother.

The idea of relying on peer providers in this way isn’t unique to the U.S.

“There are many parts of the world where peer specialists are being deployed in the health care system to provide mental health care interventions,” says Dr. Vikram Patel, a psychiatrist and professor of global health and social medicine at Harvard Medical School.

Patel says nearly 450 million people are affected by mental illness worldwide. In developing countries, the vast majority go untreated, he says, because psychiatrists are in such short supply. Patel has looked at the potential of peer support to help meet mental health needs in India and Pakistan.

“We’ve completed trials showing people affected by schizophrenia can be very effective in supporting other people in their own community by befriending them and giving them social support,” he said.

Patel is completing a trial that trains women in a community to help their neighbors recover — mothers suffering from depression.

He hopes Texas and other states in the U.S. continue to experiment with using peer providers, especially to serve people who are finding it difficult to get access to mental health professionals.

“Many groups experience such difficulties — for example, minorities and those who are homeless,” Patel said. “This model is one that should be adopted and integrated into the mental health care system.”

This story is part of a reporting partnership with KERA, NPR and Kaiser Health News.

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