Tagged Study

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Before we dive in to the harder news, please join me in enjoying this story about scientists dosing a shy breed of octopus with ecstasy to see if the animal became cuddly and friendly while high. (I swear, it relates to health care: More studies are evaluating psychedelic drugs as outside-the-box treatments, especially for post-traumatic stress disorder in veterans.)

Now, here’s what else you may have missed:

Senators were busy bees this week on the Hill. In a rare bipartisan feat, the upper chamber passed a sweeping opioids package … but there’s some fine print. Lawmakers still have to iron out the (harder, more controversial) differences between the Senate and House versions of the legislation, and they probably won’t do that work until November — conveniently, after midterms. Until then, they have a talking point!

And you know that “doughnut hole” change (which forces drugmakers to pay more for medication used by Medicare beneficiaries) that pharma hates and has been pestering lawmakers about for ages? Congress might tuck a measure rolling that back into the opioid package.

The Associated Press: GOP, Dems Unite Behind Senate Bill Fighting Addictive Drugs

Stat: GOP Lawmakers Seeking to Use Opioids Bill to Deliver Drug Industry Major Victory

It’s not all roses for drugmakers, though: A Senate-passed bill would ban “gag clauses,” which currently keep pharmacists from talking to consumers about lower-cost options.

Stat: Senate Passes Bill That Would Ban ‘Gag Clauses’ Limiting Disclosures on Drug Prices

In a sharp divergence from the budget spectacles of years past, the Senate quietly OK’d a measure to avert a government shutdown. The measure included a big, 5 percent boost to the National Institutes of Health, which was the fourth-straight significant increase for the agency.

The Associated Press: Senate Backs Bill to Avert Shutdown, Boost Military Spending

There’s a real fear out there that we’re all one bad accident away from financial ruin. A bipartisan group of senators wants to protect patients from that worry with its proposed measure on surprise bills, otherwise known as “balance billing.” (Bonus: Check out the KHN story that Republican Sen. Bill Cassidy cited in his announcement.)

The Hill: Bipartisan Senators Unveil Proposal to Crack Down on Surprise Medical Bills

As the news continues to evolve over the sexual assault allegations against Supreme Court nominee Brett Kavanaugh, here’s a health tidbit you might have missed if you didn’t scan all the way to the bottom of today’s stories. Gov. Bill Walker of Alaska, an independent, and his lieutenant governor, Byron Mallott, both came out against Kavanaugh’s nomination — not because of the accusations, but because they’re worried he’s going to jeopardize Medicaid coverage. It will be interesting to see if that’s enough to sway Alaska Sen. Lisa Murkowski, a Republican, who is being watched closely as a possible swing vote.

The New York Times: Christine Blasey Ford Opens Negotiations on Testimony Next Week

Attorney general races are rarely the belles of the ball when it comes to elections. But as more of them use their position to try to check President Donald Trump’s policies (especially ones chipping away at the health law), the campaigns are drawing more eyes.

Politico: Obamacare Lawsuit Boosts Democrats in State AG Races

Preexisting conditions have been a bomb Republicans have been trying to defuse for weeks on the campaign trail, but even GOP strategists call it a losing battle. “What you have to do at this point is duck and cover,” said one in Politico’s coverage.

Politico: Republicans ‘Duck and Cover’ on Pre-Existing Conditions

A new, more detailed report has emerged of the slow-moving medical catastrophe that was Hurricane Maria. It’s also a grim insight into why counting a death toll becomes so complicated.

The Associated Press: Maria’s Death Toll Climbed Long After Rain Stopped

Meanwhile, an investigation has been launched into why two mentally ill women who were seeking care were taken from a safe hospital and driven into Florence’s floodwaters, where they both drowned.

The New York Times: They Were Seeking Mental Health Care. Instead They Drowned in a Sheriff’s Van.

In the miscellaneous, must-read file for the week:

  • The U.S. is the most dangerous place to have a baby in the developed world, yet states are doing little to address the issue. And the ones that are, often blame the moms.

USA Today: Maternal Deaths: What States Aren’t Doing to Save New Mothers’ Lives

  • We’re on the precipice of some amazing breakthroughs for cancer treatments, yet Native Americans and black patients are missing out because they’re underrepresented in clinical trials.

ProPublica/Stat: Black Patients Are Being Left Out of Clinical Trials for New Cancer Therapies

  • Personal health aides can be a lifeline for elderly patients. Inviting a stranger into your home, though, is inherently risky and there’s few regulations that exist to weed out predators.

Boston Globe: Stranger in the House

  • And a fascinating Alzheimer’s treatment called “reminiscence therapy” has seen success overseas and is gaining traction here. Check out this one facility that recreated a 1950s town square, complete with Buddy Holly on the jukebox and an old-fashioned diner.

The Wall Street Journal: To Help Alzheimer’s Patients, A Care Center Re-Creates The 1950s

As a newsroom that has a dedicated chocolate drawer and sweet treats brought in by colleagues a few times a week, this article on employers cutting down on sugary snacks sparked a bit of a debate here. To ban or not to ban, that is the question of the week.

Have a great weekend!

Half As Many People Are Trying Heroin, But Marijuana Use Grows

Some good news from the front lines of the heroin crisis: Half as many people tried heroin for the first time in 2017 as in 2016. That’s according to data released Friday from the government’s annual National Survey on Drug Use and Health.

“This is what we were hoping for,” said Dr. Elinore McCance-Katz, who directs the Substance Abuse and Mental Health Services Administration. “It tells us that we are getting the word out to the American people of the risks of heroin,” especially when the drug is tainted with additional powerful opioids, fentanyl or carfentanil.

The survey found that marijuana use, however, increased in 2017, especially among pregnant women and young adults. McCance-Katz said the increase was likely linked to the growing number of states that have legalized marijuana and the misperception that marijuana is harmless.

McCance-Katz attributed the drop in new heroin users to increased government funding for prevention and public messaging on the local, state and federal levels.

Dr. David Kan, president of the California Society of Addiction Medicine, was surprised by the heroin finding. “This report seems to run counter to the common wisdom that everyone is migrating from prescription medications to heroin,” he said. Still, the number of drug overdose deaths continued to climb to a staggering 72,000 in 2017, with the sharpest increase among people who used fentanyl or other synthetic opioids. “All it takes is one exposure to fentanyl to die,” Kan said.

The survey also found a small increase in the number of people with substance use disorders who receive treatment, particularly heroin and opioid users.

“It’s unacceptable,” said Greg Williams, executive vice president of Facing Addiction, a nonprofit group that advocates for people struggling with substance use disorders. “We’ve had a 90 percent treatment gap in America for the two decades we’ve been tracking it, and we have not been able to close it.” Despite all the news coverage of the drug crisis, he said, “the response has been woefully inadequate.”

As for marijuana, it appears that public health messaging has not been as effective as marketing efforts by the burgeoning cannabis industry. “When you have an industry that does nothing but blanket our society with messages about the medicinal value of marijuana, people get the idea this is a safe substance to use. And that’s not true,” said McCance-Katz.

Cannabis does appear to have medical benefits — in June, for example, the FDA approved the first cannabinoid-derived medication for the treatment of epilepsy. But McCance-Katz said there is already ample evidence that the drug can pose serious health risks, particularly for teenagers, young adults and pregnant women.

The survey found that from 2015 to 2017 the percentage of pregnant women who reported marijuana use more than doubled, to 7.1 percent. Often, they use it to combat nausea and pain, believing it is safer than the FDA-approved drugs prescribed by their doctors. Mounting evidence, however, suggests that marijuana can cause preterm birth and long-term neurological problems in the babies of mothers who use it during pregnancy.

“I’m going to talk about it every chance I get,” said McCance-Katz. “Americans have the right to know that marijuana has risks.”

4 Takeaways On Puerto Rico’s Death Toll, In The Wake Of Trump’s Tweet Storm

President Donald Trump took to Twitter on Thursday morning to challenge the official count of the number of people who died in Puerto Rico in the aftermath of Hurricane Maria, which struck nearly a year ago.

“3000 people did not die” in Puerto Rico, the president tweeted.

The death toll from the Sept. 20 storm, a Category 4 hurricane, has been a point of contention between officials and residents who live there. George Washington University (GWU) researchers released the findings of an in-depth investigation commissioned by Puerto Rico’s government. They estimated 2,975 people died as a result of the storm.

The president questioned that report’s credibility, insinuating that the count was a ploy by his political opponents and that it included people who died from causes unrelated to the storm.

“This was done by the Democrats in order to make me look as bad as possible when I was successfully raising Billions of Dollars to help rebuild Puerto Rico,” he tweeted. “If a person died for any reason, like old age, just add them onto the list.”

The tweets prompted a sharp rebuke from Puerto Rico Gov. Ricardo Rosselló, who called for recovery efforts to remain above the political fray.

“The victims and the people of Puerto Rico do not deserve to have their pain questioned,” the governor’s statement said.

Here is a brief look at the issue of casualties and Puerto Rico’s response to Hurricane Maria.

How many people died?

Calculating a death count is not an exact science. Estimates are influenced by a variety of factors including the period analyzed and the definition of a disaster-related death, according to Columbia University professor John Mutter.

The Puerto Rican government accepts GWU’s estimate of 2,975 deaths as the official count. Local officials had originally said 64 people died in Hurricane Maria, counting only fatalities directly attributable to the storm, such as drowning deaths or mortal injuries caused when buildings collapsed. During the summer they acknowledged that toll had risen to more than 1,400.

The GWU researchers calculated their estimated death toll, which is about double that tally, by comparing the number of people who died in the six months after Hurricane Maria to historical averages in previous years.

The university issued a statement Thursday, disputing Trump’s comments. The investigation was “carried out with complete independence and freedom from any kind of interference,” according to the press release.

Prior to the GWU study, other researchers and one newspaper released estimates that also garnered media attention.

One study, published in the New England Journal of Medicine, put the number of excess deaths at 4,645 in the three months following the hurricane. A study by The New York Times used vital records from the government to calculate an excess of 1,052 deaths in the first 42 days after the disaster.

Still, the numbers are important, said Mutter, who researches disaster management and worked on collecting the number of deaths in New Orleans after Hurricane Katrina. These death counts are a key way the public measures a disaster and perception drives donations for relief, he said.

Why was it so confusing getting a death toll?

When Hurricane Maria made landfall in Puerto Rico, it devastated the island’s infrastructure, which can limit access to health care and impact mortality, especially among residents who are frail or dealing with chronic health issues.

The storm knocked out electricity for the entire island, which took nearly a year to restore fully. At least 80 percent of communications towers were not operational, crippling phone services. Medical centers across the island relied on generators for power, which sometimes failed and jeopardized patients. Some medical facilities in Puerto Rico were irreparably damaged, like the only hospital on the island of Vieques, which housed its only dialysis center. Residents must now leave the island three times a week for treatment.

Many roads on the island were impassable because of debris or erosion. Roads near rivers, like those in the mountainous, rural province of Utuado, washed away. Bridges also fell, leaving some communities isolated and unable to access assistance.

Hurricane Maria also cut off drinking water to more than half of Puerto Rico. The lack of electricity meant water pumps could not work. Some people turned to other sources, like natural springs and rivers, for drinking water. At least 26 people died of leptospirosis, a bacterial infection caused by exposure to water or soil contaminated with the urine of infected animals, according to reporting from CNN and the Centro de Periodismo Investigativo, a nonprofit group that promotes investigative journalism.

In addition to the physical disruption, the GWU researchers noted that officials in charge of certifying deaths did not have a process that automatically noted when a death was a consequence of the hurricane or its aftereffects.

How did the federal government do in its response to Hurricane Maria?

According to the federal government, not very well.

A report released earlier this month by the U.S. Government Accountability Office (GAO) details how the Federal Emergency Management Agency (FEMA) struggled to meet the needs of Puerto Rico and the U.S. Virgin Islands after the storms.

The agency didn’t provide adequate staffing to the disasters on the islands, according to the GAO. It faced a 37 percent staffing shortage as of Sept. 1, 2017. Of the personnel deployed to the islands, some “were not physically able to handle the extreme or austere environment of the territories,” the report said. The lack of bilingual employees also led to delays since many Puerto Ricans speak Spanish.

Transporting materials to the island was also an issue for the agency, as both islands are located more than 1,000 nautical miles from the mainland, the report said.

FEMA Administrator Brock Long addressed some of those issues Tuesday in an interview on CNN. “We threw as much as we could towards Puerto Rico,” he said.

He added that FEMA’s prime concern is preventing deaths from natural disasters, but also that “there’s a difference between direct deaths of, you know, the winds, water, collapsed buildings, things that kill people directly versus the indirect deaths. Indirect deaths are always higher than the direct deaths after many events. … But what I really believe is that we have to concentrate on the pre-disaster mitigation, fix the infrastructure that was crumbling before the storms in the commonwealth, so that we prevent this from ever happening again.”

He noted that FEMA is now the largest employer in Puerto Rico as repair efforts continue.

What has the Puerto Rican government done in response to the death counts in Hurricane Maria?

After the GWU findings were released, Gov. Rosselló changed the official death count and accepted responsibility for the territory government’s failure to adequately respond to residents’ needs. He also said he would form a commission to consider the recommendations suggested in the GWU study on how to improve the island’s response to disasters.

However, how many changes the territory’s government can make remains to be seen. Puerto Rico’s purse is under the control of a fiscal oversight board put in place by Congress to address the island’s debt crisis, which stands at more than $70 billion.