Tuesday, November 25, 2014

Chain restaurants, theaters, amusement parks and grocery delis must post calorie counts in a year, to fight obesity

McDonald's already posts calorie content on its menus
In an effort to combat the country's obesity epidemic, the Food and Drug Administration issued final regulations Tuesday that will require chains with 20 or more restaurants, movie theaters and pizza parlors to post calorie counts on menus.

"The rules will have broad implications for public health," Sabrina Tavernise and Stephanie Strom report for The New York Times. "As much as a third of the calories that Americans consume come from outside the home, and many health experts believe that increasingly large portion sizes and unhealthy ingredients have been significant contributors to obesity in the United States."

“This is one of the most important public health nutrition policies ever to be passed nationally,” Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, told the authors. “Right now, you are totally guessing at what you are getting. This rule will change that.”

The numbers "could be a pretty big wake-up call," writes Jason Millman of The Washington Post. "The FDA rules are more comprehensive than expected, given the strong industry pushback since the menu labeling provision was included in the 2010 health-care law." The FDA proposed a rule in 2011, but heavy lobbying has delayed its finalization.

"Do people eat healthier when they can see calorie counts?" Milliman asks. "The evidence so far seems mixed. The impact seems to be greater when the calorie count is much higher than what consumers expect. What does seem clear from past studies is that people really are terrible judges of how many calories they consume when they dine out [and] are especially bad judges of the calorie content of the least healthy foods commonly found of restaurant menus."

The rules also cover food in vending machines, amusement parks, alcohol if it is on the menu or a menu board, and some prepared foods in supermarkets. Chain restaurants are defined as food establishments with 20 or more outlets.

The policy will take effect a year from now, "and seems likely to face legal and political challenges from some parts of the food industry, including grocery and convenience stores that sell prepared foods for takeout," the Times reports.

The National Grocers Association told the paper, “Grocery stores are not chain restaurants, which is why Congress did not initially include them in the law. We are disappointed that the FDA's final rules will capture grocery stores, and impose such a large and costly regulatory burden on our members.”

Daren Bakst, a research fellow in agricultural policy at the conservative Heritage Foundation, told the authors that the FDA interpreted the law too broadly. “If Congress wanted to cover any establishment that sells prepared foods, they would have said that,” he said. “No reasonable person is about to confuse a grocery store, convenience store or movie theater with a restaurant.” But retiring Democratic Sen. Tom Harkin of Iowa, who helped create the labeling requirement, said the rule “closely mirrors congressional intent.”

The FDA offered some concessions to grocers, convenience stores, pizza chains and vending-machine owners. For example, pizzerias can define their serving sizes and list calories by the slice, and vending machine owners have been given an extra year to comply.

Sunday, November 23, 2014

Kynect policyholders get premium notices, are urged to check website to see if a better deal is available

The 80,000-plus Kentuckians who bought private health insurance during the first open enrollment period under the federal health-reform law are getting letters notifying them of their new premium and subsidy amounts. Most policies will cost more, and the overall average increase is expected to be 4.6 percent.

Policyholders will be automatically enrolled in the same plans as last year, but should check the state's Kynect website to see if a better plan is avaialble. The second enrollment under the law is open through Feb. 15.

Kentuckians are showing "brisk interest" in Kynect coverage, according to a news release from Gov. Steve Beshear's office. It said that as of 11 a.m. Friday:
• 72,335 unique visitors to the site had viewed 2.1 million web pages;
• 45,412 people had conducted preliminary screenings;
• 4,180 new accounts had been created;
• 6,471 new applications had been submitted;
• 8,727 people had made changes to existing applications; and
• 3,199 people renewed their enrollment in a private health-insurance plan.
• 908 people newly enrolled in a private plan.

The release said more than 1,800 people had visited the new, federally funded Kynect store at Fayette Mall in Lexington, and 522 of them had completed applications for new coverage.

“We made tremendous headway last year, but we still have thousands of Kentuckians who need insurance for themselves and for their families,” said Carrie Banahan, executive director of Kynect. “Not only do we encourage first-time insurance buyers to check out Kynect online, by phone or in person with an insurance agent or Kynector, we are also strongly encouraging those who enrolled last year to check out the plans available for 2015. You could get a bigger subsidy, a lower monthly cost, or more network options if you shop again.”

Conference focuses attention on importance of patient- and family-centered care, health education, communication

Health education, communicating with physicians, and patient- and family-centered care that empowers patients to be their own best health advocates, were some of the topics discussed at the Health Watch USA conference in Lexington this month.

Joycelyn Elders
“Patient empowerment is the right of the patient to take an active role in decisions about his or her own care,” said former U.S. surgeon general Joycelyn Elders, professor emeritus of pediatric endocrinology at the University of Arkansas. “But you can't make a good decision if you have not been educated. You can't keep an ignorant population healthy.”

Waiting until a person is old and set in their ways and then trying to teach them better health strategies doesn't work, Elders said. For patients to really be involved in their health, health education must start early.

“We must push for comprehensive health education in our school systems from kindergarten through 12th grade,” she said. “It is just as important as teaching reading, writing, and arithmetic. . . . We need to have science-based answers rather than ubiquitous myths. We need to protect people by arming them with correct information.”

Elders offered some practical suggestions to help patients become more empowered during their doctor's visits:
  • Take a trusted person with you.
  • Ask questions if you don't understand.
  • Bring all of your medications with you.
  • Write down questions and concerns before you go.
  • Ask your doctor to write down information and instructions discussed.
  • Make sure to tell your doctor if you have vision or hearing problems.

Elders said health education for physicians could also be improved, by putting more emphasis on preventive care and the treatment of chronic diseases, which are 75 percent of diseases in the United States, rather than acute diseases.

“We spend only 3 percent of our health-care dollars on keeping people well,” Elders said. “We have to do a better job. We haven’t educated our doctors.”

Karen D. Meyers
Karen D. Meyers, a lawyer who works with catastrophic-injury victims and health-care providers, said medical schools must start teaching doctors how to become better collaborators, not only between specialties, but with their patients as we move toward a model of patient and family centered care.

“They must learn to treat patients with dignity and respect, listen and share information with their patients, and allow patients to participate in their care,” said Meyers, who became an advocate for patient- and family-centered care after becoming a health advocate for her mother, who was in a coma for 40 days.

Elders said patient empowerment requires the patient to take some responsibility for his or her care, which requires respectful communication and shared decision-making between the doctor and the patient. The current physician-patient model of care does not support this concept, Elders said: “This has to change.”

Meyers concurred, saying physicians, hospitals and patients must change the attitude of “my patient, my treatment plan, my procedure, my case” to a model that recognizes that “everything about a patient's health belongs to the patient and their family.” She added, “Patients have to understand, because they are responsible for their care.”

Health Watch USA, based in Somerset, was founded by Dr. Kevin Kavanagh to promote health care transparency and patient advocacy, according to its website.

Saturday, November 22, 2014

Deaths from drug overdoses and prescriptions for opiate treatment drugs are both rising, worrying state officials

Despite measures to discourage prescription drug abuse, Kentucky health officials report overdose deaths continue to rise and opioid treatment drugs are being prescribed "at alarming rates," Kevin Wheatley reports for cn|2's "Pure Politics."

A shift to cheaper, readily available heroin is partly to blame, Audrey Haynes, secretary of the Cabinet for Health and Family Services, told the legislature's Interim Joint Committee on Health and Welfare Wednesday.

Haynes told the committee that heroin overdose deaths in Kentucky increased 207 percent from 42 in 2011 to 129 in 2012; Kentucky ranks highest in hospital admissions for heroin abuse among surrounding states and the national average; more women age 18-44 in Kentucky die from drug overdoses than the U.S. average; and the state has shown a 165 percent increase in neonatal abstinence syndrome in newborns from 2008 to 2013.

Another issue, Wheatley writes, is that opiate treatment drugs like buprenorphine, which can be prescribed by physicians, have been seized by police in arrests at higher rates, creating a concern among health officials that it is being used illegally.

The medical director of the Department for Medicaid Services, John Langefeld, told Wheately that data show a 241 percent increase in buprenorphine prescriptions for Medicaid recipients from January 2012 to this May and that police seizures of this drug have increased "threefold" since tougher laws on prescription drug abuse took effect in July 2012.

Study finds electronic cigarettes help people stop smoking

A study has found that electronic cigarettes help people cut back on their use of tobacco, Christopher Ingraham reports for The Washington Post.

The finding was part of a study published in the International Journal of Environmental Research and Public Health, which tracked 48 smokers who were unwilling to quit smoking.

Participants were divided into three groups: two e-cigarette groups and a control group that switched from tobacco to e-cigarettes two months into the eight-month study. During the testing period all three groups were only allowed e-cigarettes. The difference between the groups occurred in between the testing periods.

"At the end of the 8-month study, 21 percent of all participants had stopped smoking tobacco entirely," Ingraham writes. "An additional 23 percent reported cutting the number of tobacco cigarettes they smoked per day by half." Across all three groups, total tobacco consumption fell by 60 percent, and 44 percent of the smokers had reduced or eliminated their tobacco use at the end of the eight months, Ingraham reports.

"The nicotine e-cig offers many smokers a successful alternative for smoking less – or even quitting altogether," write authors Frank Baeyens and Dinska Van Gucht. "E-cig users get the experience of smoking a cigarette and inhale nicotine vapor, but do not suffer the damaging effects of a tobacco cigarette.”

Ingraham lists many of the pros and cons of e-cigs and concludes, "From a public health standpoint, if we're interested in promoting smoking cessation it would seem sensible to encourage studies like this one, which point to new avenues for reducing the harms of smoking and helping people quit altogether."

In some wealthy areas, smoking rates have declined, while smoking rates in working class and rural areas have remained stable. Use of electronic cigarettes among rural teens has also risen in recent years, prompting the U.S. Food and Drug Administration to propose rules to give it authority over e-cigarettes, an industry that accounts for about $2.5 billion in annual sales.

Casey joins Adair and Russell as longtime tobacco counties where schools are going tobacco-free; Clinton defers action

The schools in another longtime tobacco county in Southern Kentucky are going tobacco-free. With only one member in opposition, the Casey County Board of Education recently enacted a tobacco-free school policy beginning with the 2015-16 academic year, Abigail Whitehouse reports for The Casey County News.

Jelaine Harlow, health educator for the Lake Cumberland District Health Department, presented the board with letters from community partners supporting a tobacco-free school policy, and results from surveys that showed 70 percent of school parents in the county school support a tobacco-free school policy, Whitehouse reports.

The surveys included ones given to parents and students across the school district including a ninth-grade student survey, a teacher-opinion survey, and a parent survey. It also included opinion results from attendees at a Casey County basketball game that showed overwhelming support for tobacco-free policy.

Following Harlow’s presentation, Beverly Hoskins, who taught at Casey County High School for 30 years, voiced her support for a tobacco-free campus. She said her father's tobacco crop put her through college, but "has lost the two men she loved the most to smoking, first her father and then her husband," Whitehouse writes.

Board Chairman Ken Coffman first said the issue would be decided later, but member Marilyn Coffey said, “Ken, I believe some of us are ready to vote. I think we’ve had a year to think about this and I’d like to make a motion to pass it and phase it in.” the motion carried, with only Vice Chairman John Cox opposed.  

The school board in Clinton County also heard a similar plea from the same health department, including a report that high-school sophomores' use of smokeless tobacco had increased, but took no action, the Clinton County News reports. The high-school principal noted that many school employees smoke.

The health department noted that school boards in Somerset, Adair County and Russell County had recently enacted tobacco-free policies. Since the end of the federal tobacco program in 2004, tobacco production in the area has sharply and steadily declined, leaving tobacco with little of the political support that once insulated it from government controls.

With school-board elections held this month, and not to be held for another two years, there may be more such votes in the near future.

Kentucky School Boards Association spokesman Brad Hughes said in an e-mail that as of June, 33 of the state's 173 school districts had adopted all-encompassing tobacco-free campus policies; 12 have adopted policies that only affect students and staff, with no restrictions for visitors and groups renting district facilities. Four have adopted tobacco-free policy language with exceptions, such as allowing smoking in personal vehicles or at outdoor events; and four have asked KSBA to draft tobacco-free policy language, but have not yet reported final adoption of those policies. Hughes noted that smoking by underage students is prohibited by law anywhere, including in schools, in buses and anywhere on campus.

Thursday, November 20, 2014

Smoking ban upsets some state workers; entrepreneur starts a van to take some off Human Resources campus to smoke

Cigarettes and all other tobacco products, as well as e-cigarettes, are no longer allowed on most state property, both indoors and outside, and some state workers aren't happy about it, Jack Brammer reports for the Lexington Herald-Leader.

"Under the new rules, employees and visitors to executive branch agencies of state government won't be able to light up or chew tobacco in state-owned or state-leased buildings, in state-owned vehicles or on state property — including parking lots, sidewalks and green space under the control of the executive branch of government," Brammer writes, reporting that state workers "are fuming about it."

Human Resources Building, from main highway entrance
About a dozen people smoking outside the state Human Resources Building last week told Brammer they were not happy with the policy. All but one did not want to be identified for "fear of retribution," he reports, but Andrea Schank of Frankfort told him, "It feels like discrimination against smokers." She and the others said there should be a designated smoking area. State Personnel Secretary Tim Longmeyer told Brammer that wouldn't happen. He said state officials understand how addictive smoking is and they "are helping people to stop."

David Smith, president of the Kentucky Association of State Employees, said "state workers who smoke should have a designated area and called the state's ban on smoking in personal cars on state property 'really invasive,'" Brammer writes.

Schank told Brammer that workers in the building will now have to walk about a half-mile to smoke, but that may not be the case if a new enterprise stays in business. Bill Bryant of WKYT-TV reported on KET's "Comment on Kentucky" Friday night that a van is circulating in and around the huge Human Resources campus, giving smokers a ride to places off the campus during work breaks.

State government is the largest employer in Kentucky, and the tobacco-free rule will affect about 33,000 state workers, plus hundreds of thousands of visitors to state offices and properties. Gov. Steve Beshear makes no apologies for the executive order that put this policy in place, justifying his decision with Kentucky's dismal health statistics. Kentucky ranks first in smoking and cancer deaths.

Kentucky is the fifth state to adopt such a policy. The others are Delaware, Oklahoma, Oregon and South Dakota. Details of the policy can be found at https://tobacco-free.ky.gov.

UK study finds HIV drugs could be repurposed to treat age-related macular degeneration, now untreatable in up to 90% of cases

Drugs that have been used for the last 30 years to treat HIV and AIDS could also be used to treat age-related macular degeneration in the eye and other inflammatory disorders, says a University of Kentucky news release.

The "landmark study" was led by Dr. Jayakrishna Ambati, professor and vice chair of UK's Department of Ophthalmology and Visual Sciences and has been published in the journal Science.

Age-related macular degeneration is a progressive condition that is untreatable in up to 90 percent of patients and is a leading cause of blindness in the elderly worldwide. There are two forms of AMD, wet and dry.  Wet AMD has several therapies available, which are not always successful. Dry AMD has no approved treatments.

The most widely used class of anti-HIV drugs are thought to work as a treatment for HIV/AIDS patients because of how they target a specific enzyme that is critical for the replication of HIV. The drugs are nucleoside reverse transcriptase inhibitors.

The study found "NRTIs prevented retinal degeneration in a mouse model of dry AMD," the release reports. The toxic molecule that causes dry AMD requires the same enzyme to fulfill its life cycle as the enzyme that is responsible for replicating HIV; NTRIs target that enzyme. Surprisingly, the study found that NRTIs target it indirectly, by blocking an immune pathway, says the release.

"Repurposing of NRTIs could be advantageous, for one, because they are very inexpensive," Benjamin Fowler, the lead author and a postdoctoral fellow in the Ambati lab, said in the release. "Moreover, through decades of clinical experience, we know that some of the drugs we tested are incredibly safe. Since these NRTIs are already FDA-approved, they could be rapidly and inexpensively translated into therapies for a variety of untreatable or poorly treatable conditions."

Ky. Rural Health Association backs statewide smoking ban

The Kentucky Rural Health Association is asking Kentuckians to contact their legislators and advocate passage of a statewide smoking ban in the 2015 session of the General Assembly.

KRHA Executive Director Tina McCormick writes, "Smoke-free laws have been unmitigated and popular successes here in Kentucky at the local level and virtually everywhere they have been implemented. Comprehensive laws protect everyone equally, achieve nearly universal compliance, and improve air quality and the health of workers almost immediately." To read McCormick's article, click here.

Broad ban on use of tobacco on state property takes effect, except in Capitol and Annex, where law supersedes policy

"Despite a smoking ban and a tobacco-free campus policy starting Thursday for any of the more than 3,000 state buildings, legislative employees working at the Capitol Annex can still light up without a write-up," Brad Bowman reports for The State Journal in Frankfort.

Gov. Steve Beshear's new policy bans use of tobacco products in all executive branch properties, with a few specific exceptions. The ban took effect Thursday, to coincide with the American Cancer Society’s "Great American Smokeout Day," which encourages smokers to quit.

Beshear can set policy for all such properties except those in the Capitol and Capitol Annex, which are set by law. “The statute prohibits smoking in public areas, such as hallways, offices shared by more than one person, stairwells, restrooms, the cafeteria and conference rooms,” Robert Weber, public information officer for Legislative Research Commission, told Bowman. The state House “prohibits smoking in common areas and office suites,” House Speaker Greg Stumbo said.

The state Supreme Court recently voted to make its Capitol space smoke-free, and “The use of tobacco products is prohibited in all areas of the AOC campus without exception,” Administrative Office of the Courts spokeswoman Jamie Neal told Bowman. “This includes common work areas, conference and meeting rooms, private offices, hallways, break rooms, restrooms, outdoor grassy areas, picnic-table areas and parking lots.”

Beshear's office says about 5,000 executive branch state workers report using tobacco, "raising their health care costs an average of 20 percent higher than those that don’t," Bowman reports.

Exceptions to Beshear's order include state parks, the state fairgrounds, the Frankfort convention center, state-maintained rest areas, military training centers and armories.

Carrie Banahan, director of Kynect, is named one of Governing magazine's nine Public Officials of the Year

Carrie Banahan, executive director of the Kentucky Health Benefit Exchange, has been selected by Governing magazine as one of nine 2014 Public Officials of the Year.

The magazine, for state and local government officials, has presented the awards since 1994 to recognize excellence in state and local government.

The magazine said it chose Banahan "for her tireless work overseeing the creation, development and promotion of Kynect," the brand for the insurance exchange created under the federal health-reform law. Her profile will be featured in the December issue of the publication.

“Lots of things had to go right before Kentucky became the nation’s gold standard for health-care implementation, and the first thing we did right was to name Carrie Banahan as kynect’s executive director,” Gov. Steve Beshear said in a release from his office. “Carrie not only had the perfect mix of experience and technical know-how to direct Kynect, she had the passion for the job."

Over her more than three decades of public service, Banahan has served as deputy commissioner of the Department of Insurance, deputy commissioner of the Department for Medicaid Services and executive director of the Office of Health Policy in the Cabinet for Health and Family Services.

“Carrie was truly the perfect person for this job. It is as if her whole career has been training her for this very opportunity,” Cabinet Secretary Audrey Haynes said in the release. "She is certainly deserving of this prestigious honor.”

Kynect has enrolled more than 521,000 Kentuckians in health care coverage, with three out of every four enrollees reporting they did not have health insurance prior to signing up, says the release. The Gallup Organization found that the percentage of Kentuckians without health insurance fell from 20.4 percent in 2013 to 11.9 percent midway through 2014, second only to Arkansas, the other Southern state that expanded Medicaid.

Wednesday, November 19, 2014

Medicaid expansion has been more popular than expected, but that raises a question of whether it will really pay for itself

Kentucky officials say the state’s Medicaid expansion under the federal health-reform law has enrolled more residents and created more jobs than expected, but a study will see whether the expansion will pay for itself, as an earlier study and Gov. Steve Beshear predicted.

Eric Friedlander, deputy secretary of the Cabinet for Health and Family Services, reported both a larger-than-expected Medicaid enrollment in every county and an increase of 17,000 jobs in Kentucky from Medicaid expansion at Monday's meeting of the legislature's Interim Joint Committee on Appropriations and Revenue.

Friedlander also discussed other benefits of Medicaid expansion, saying Kentucky health-care providers had received $892,973,500 in reimbursements from January to October of 2014, reports Brad Bowman of The State Journal in Frankfort.

Cabinet Secretary Audrey Haynes told Kentucky Health News on Tuesday that on the previous Friday, the cabinet had passed $1 billion in payments of federal money to health-care providers for treatment of people newly eligible for Medicaid: those with household incomes between 69 percent and 138 percent of the federal poverty level. About half the money has gone to hospitals, she said.

Still, many providers, particularly in rural areas, have reported cash-flow problems caused by delays in payment from Medicaid managed-care companies, lower-than-cost reimbursements and increased administrative burdens.

Also, some legislators have expressed concern about the cost of expanding Medicaid rolls, which grew more than predicted by a study that Beshear cited in his expansion decision. As the law outlines, the federal government will pay 100 percent of the costs until Jan. 1, 2017, when the state will begin paying a small share rising to the law's limit of 10 percent in 2020.

Republican Sen. Chris McDaniel of Taylor Mill, who is running for lieutenant governor on the gubernatorial slate headed by Agriculture Commissioner James Comer, asked Friedlander what Kentucky’s financial obligations would be because of the expansion in the next few years. He said that is uncertain.

Under initial estimates, based on the study by PriceWaterhouse Coopers, expansion was expected to cost the state only about $150 million a year when it was paying 10 percent of the cost. But the study only forecast that fewer than 300,000 newly eligible Kentuckians would sign up for Medicaid in the first year, but about 337,419 did.

To get updated cost projections, Beshear has contracted for a second analysis by an independent agency, which Friedlander said should be completed by mid-January, reports Ronnie Ellis of CNHI News Service.

The governor said the new study will speak for itself, reports Tom Loftus of The Courier-Journal. "I was confident after that initial report that we could certainly afford down the road over the next eight years to expand Medicaid and stay within our budget. I'm still confident," Beshear said.