Trump Nominates Indiana Health Commissioner as Surgeon General
http://ift.tt/2tpORiC Dr. Adams also said he believed exchanges were “not a panacea,” and their value should not be overstated. “It’s only going to work if it allows us to connect people to the resources they need to get clean, to get off drugs and get their infectious diseases appropriately diagnosed and treated,” he said. Dr. Adams, who trained as an anesthesiologist, has also been outspoken about the risks of prescription opioid painkillers and the need to address the opioid epidemic. Charles N. Rothberg, president of the Medical Society of the State of New York, said Dr. Adams reminded him of C. Everett Koop, who was surgeon general through much of the 1980s. “Dr. Adams has a proven track record to make public health a priority despite political hurdles,” Dr. Rothberg said in an email. “Dr. Adams is in touch with the public needs.” Dr. Joshua M. Sharfstein, who was at the Food and Drug Administration in the Obama administration, said Dr. Adams was a great choice. “I think it’s great to have a state health officer as surgeon general because it’s a job that really defies politics,” said Dr. Sharfstein, who is now an associate dean at the Johns Hopkins Bloomberg School of Public Health. “From everything I’ve seen, Dr. Adams is a very serious and capable physician and public health official. This is an opportunity to speak to the problems as they are and not as they are viewed through an ideological prism.” Dr. Adams, who is married and has three children, received bachelor’s degrees in biochemistry and biopsychology from the University of Maryland in 1997. He then earned a master’s degree in public health from the University of California at Berkeley, and a medical degree from the Indiana University School of Medicine. His LinkedIn page says he is also an assistant professor of anesthesiology at Indiana University Health, and cares for patients at Eskenazi Health, Indianapolis’s publicly funded hospital. If confirmed by the Senate, Dr. Adams would join another prominent health official in the Trump administration who was brought in from Mr. Pence’s state: Seema Verma, who is now the head of the Centers for Medicare and Medicaid Services. He would replace Sylvia Trent-Adams, who has been acting surgeon general since Mr. Trump ousted Dr. Vivek Murthy, a holdover from the Obama administration. The surgeon general is often called “the nation’s doctor,” and works to improve public health. The surgeon general also oversees the 6,700 public health officers, many of whom work in underserved areas. The post has traditionally served as a bully pulpit, and past surgeons general have used it to campaign against tobacco, obesity and gun violence. It was Dr. Murthy’s stance against gun violence that appeared to have led to his dismissal. Continue reading the main storyHealth via NYT > Health http://ift.tt/2koaaw3 June 29, 2017 at 06:39PM
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Ohio official: Don't send medics for third overdose
http://ift.tt/2ss4JwH Middletown City Council member Dan Picard is proposing to give drug users two chances. Paramedics would respond to an overdose twice, and each time the addict would receive a summons and be required to do community service after being treated. But if they don't show up in court, don't complete the service and then overdose a third time? That's it. No one will come to help them. So far, the proposal is only that -- a proposal. Picard said the city manager is still looking into the legality of the plan before the council can move forward. Picard said his proposal isn't meant to be a solution to opioid abuse. He's concerned that Middletown simply doesn't have the money to keep treating overdoses.
According to the Middletown Fire Department
, EMS units responded to 535 opiate overdoses in 2016, 77 of which resulted in death. Picard said the city spent over $1.2 million responding to those calls. This year, the Middletown city manager estimates that cost will exceed $2 million. At that rate, Picard said, it's inevitable the city will not have sufficient funds to keep responding. He hasn't calculated the cost of implementing his proposal, which would require keeping records of repeat offenders. "Either we go down the road with my plan, or we don't, and we run out of money," Picard said. "In either scenario, they're not going to get treatment." Opioid use is on the rise across the country, and overdose deathsare becoming more common in Ohio. In 2014, the state had the second-largestnumber of opioid-related deaths in the country. It had the fifth-highest rate of overdose. And the next year, overdose deaths in the state rose 11%. One Ohio coroner's officebarely had room for the 145 overdose-related victims it processed in January of this year. And in September, 21 peoplein Akron overdosed in a single night. 'I was trying to scare people'Butler County, where part of Middletown lies, has the fourth-highestoverdose death rate in the state. Even though the intention of the plan isn't to lower the number of overdoses, Picard hopes it will still have that effect. "I was trying to scare people," he said. "I want the drug users out there to know that if you come to Middletown and you overdose, there's a possibility that we're not going to come." Truth Pharm, a national advocacy group focusing on substance addiction and drug policy, wrote an open letter to Picard on the organization's websitecriticizing his approach. "To suggest that you withhold emergency medical response to overdose patients is manslaughter at best and premeditated murder at worse," the letter read. Truth Pharm wrote in the letter that it would provide information for people to sue Picard and "the entire town government" if the policy moves forward. Picard has acknowledged that he's considered people may try to take legal action if the plan moves forward. Picard said there have been a lot of misconceptions about the details of his proposal -- more specifically, the details about exactly when the city would leave an overdosed user without aid. He said that an EMS squad dispatched to the scene of an overdose would never leave a victim to die. Under Picard's rules, if a user overdoses for a third time, the city won't send someone again. If EMS workers are dispatched, he said, they are obligated to treat the patient they were called to help. Health via CNN.com - RSS Channel - Health http://ift.tt/1rsiniF June 29, 2017 at 06:09PM
MDA Named “Best Men’s Health Blog of 2017”
http://ift.tt/2s7610D What can I say…it’s a great way to end the week and head into the holiday weekend. I just got word that Healthline.com has named Mark’s Daily Apple among its “Best Men’s Health Blogs of 2017.” In their words…”We’ve carefully selected these blogs because they are actively working to educate, inspire, and empower their readers with frequent updates and high-quality information.” I’d say that certainly aligns with my vision for Mark’s Daily Apple and for what I hope this blog and community offer reader and visitors every day. But I’m not stopping there. In particular, I’m looking to add more information, more research, more insight for women this coming year. I’ve never called or considered this a men’s blog, but I’m thrilled male readers find solid and relevant information here. I want MDA women readers to feel spoken to with the same regard and depth for health issues and questions affecting them. And you can hold me to that. Gratitude to Healthline.com and to all of you for being part of the Primal movement and the Mark’s Daily Apple community. Grok on, everyone! The post MDA Named “Best Men’s Health Blog of 2017” appeared first on Mark's Daily Apple. Health via Mark's Daily Apple http://ift.tt/zxCBD6 June 29, 2017 at 05:40PM
Dr. Jerome Adams nominated as new surgeon general
http://ift.tt/2uoSP81 Story highlights
Adams is an anesthesiologist who has been outspoken against the opioid epidemic. His brother is an addict, he revealed during a May 2015 testimony (PDF)at the House Energy and Commerce Committee. He began serving as the Indiana State Health Commissionerin 2014 under then-governor Mike Pence and was in that role during the 2015 outbreak of HIV that spread among users of a prescription opioid, Opana. In an area where there were previously few cases of HIV, 219 people have been infected in the Southeast Indiana outbreak, according to the Indiana State Department of Health. A needle exchange programwas ultimately implemented as part of the efforts to slow the epidemic, though some public health experts criticized the response for what they said was a slow and hesitant start. Adams is also an assistant professor of anesthesiology at Indiana University School of Medicine and has sat on committees of various professional organizations. Health via CNN.com - RSS Channel - Health http://ift.tt/1rsiniF June 29, 2017 at 04:51PM
'Hookers for Health Care' refuse to take change lying down
http://ift.tt/2smbZir Licensed prostitutes in Nevada, working in legal brothels, are organizing against legislation they say will devastate them, other prostitutes across the nation and their families. With Obamacare (Affordable Care Act), now under threat of being repealed and replaced, "thousands of prostitutes nationwide were, for the first time, able to obtain affordable health care insurance for themselves and their families," said a press release issued Thursday. So, dubbing itself "Hookers for Health Care," this group plans to go "on a political offensive ... lobbying politicians, protesting in the streets, and waging battle on social media to stop the Republican effort." At the helm is Alice Little, 27, who works near Carson City at Dennis Hof's Sagebrush Ranch brothel. She thinks about the cuts being proposed, the slashes to coverage for things like pregnancies and eating disorders and is outraged by the toll it will take on women. "When I look at the folks that are making decisions, the majority of them are male voices," she said by phone. "They have no idea how they're affecting women's lives." About a hundred women working in Hof's seven brothels have already signed up to be involved with this new movement. She says several dozen women and counting have already agreed to sign onto a petition she's drafting and that many are waiting to have their perspecitves recorded for social media purposes. "These ladies are often stereotyped and I want to bring some humanity to their stories," said Little, whose mother is a cancer survivor. "We are people. We have families. We have the same health concerns as other Americans." As independent contractors, she said, prostitutes are "at the mercy of the health care marketplace to obtain our own insurance" and are often reliant on Medicaid. "I have been fortunate to amass a strong clientele and establish myself as a financially successful businesswoman within Nevada's legal brothel industry, but that can take time," Little said in the release. In fact, she's so successful Hof says she made about $500,000 last year. But even with her success, Little knows plenty of women need a break. "A young woman entering our business, who in some cases may also be a single mother with limited financial means, will also need time," Little said. "Expanded access to Medicaid for her or her child may be the only way that she is able to know that they will be protected in case of medical misfortune." It's not just the prostitutes and their families that stand to lose if this new bill passes, Little adds. Consider the housekeepers, bartenders and cashiers who also work hard to be self-sustaining Nevadans. Also, added to the list of those she hopes to protect: brothel clients. "Under Trumpcare insurers will be able to charge older consumers five times more than young consumers," she said. "People over the age of 65 make up a very large percentage of Nevada brothel clients. If these clients are forced to pay unfairly augmented health care costs, they will not have money on hand to spend on the things that make life worth living in the first place -- like sex." Her advocacy, however, is not mirrored by her employer. Hof describes himself as fiscally conservative, "but don't bother me about abortion, who's having sex with who and weed; it's a personal choice." He is a Trump supporter, though, who'd love to see Obamacare get tossed out. "I believe in people taking responsibility for their own lives, and not asking for these kind of government handouts," he said. "You start giving these working girls free or discounted health care coverage, then what comes next? ... This is definitely not a road we want to go down." But even while Hof disagrees with the politics of "Hookers for Health Care," he supports the involvement of women who work for him. He says there are 540 prostitutes affiliated with his brothels, and "These aren't your daddy's old hookers." By that he says he means, "These aren't street walkers. They're professional working girls that work in a legal environment." In fact, he says half of them have college educations, 20% have master's degrees, a few have doctorate degrees and one, an Ivy League educated professor, picks up hours to help pay off her huge student loans. "I love that they're involved," he said. "These girls are smart, they will be running our country, and they vote." Health via CNN.com - RSS Channel - Health http://ift.tt/1rsiniF June 29, 2017 at 02:27PM
How 4 Americans say Obamacare helped or hurt them
http://ift.tt/2tqnW6a The 2010 health care reform law has long been polarizing: Some 51% of Americans had a favorable opinion of the ACA last month, while 41% had an unfavorable view, according to a Kaiser Family Foundation poll. The public was more sour on Obamacare in November, when Donald Trump was elected President. About 45% had a negative view of it then, against 43% with a positive one, Kaiser says. Here's what some people told CNN about how they say current health care laws affected them: Florida resident Ashley Ruiz is grateful for Obamacare regulations and safety-net spending, not least because of otherwise crushing costs for her special-needs son. A Medicaid-funded program fully covers Jackson, 4, because he is disabled, with a rare skull deformity and adrenal problems. He received more than $250,000 worth of care in his first 6 months, including removal of part of his skull. Another surgery put bone grafts and titanium plates in his head. He sees dozens of specialists on a yearly basis for the deformity alone, and receives therapy for autism. Medicaid insures about two in five children and the same share of the disabled. Medicaid existed long before Obamacare, but as part of potential ACA replacement, lawmakers are considering cutting federal Medicaid support. It's unclear how Medicaid recipients would be affected. But Ruiz, a 29-year-old divorced mother of two, is concerned. "I don't think people understand that when you deal with a special needs child -- once you are able to find a plan that covers you, it's such a precious commodity. I think the fear for me and any parent like me is that there's a potential that would be ripped away." She works at a small business that gives her flexibility to care for Jackson and her older son. But the job offers no insurance, so she has no coverage. Ruiz relied on the ACA itself when Jackson was born. She and her then-husband didn't have access to affordable insurance themselves. But because she was under 26,her stepfather's insurance covered $100,000 in costs including an emergency C-section. Melanie Brightwell: Obamacare failed meMelanie Brightwell says she can't afford individual insurance through the federally run exchange and keeps getting rejected for Medicaid despite making less than $12,000 annually. Brightwell, 52, of Georgia's Peachtree City area, says she had a full-time job and insurance, but received medical services worth more than $1 million in the last two years she was insured, including two major abdominal surgeries. She was laid off in 2015, months after her last operation, from her job as a sales assistant for a media group. She now works part time, not yet able to land something full time. The cheapest monthly premiums for individual insurance she's found, she said, ranged from $250 to $400, which she can't afford. Brightwell shares living expenses with her retired mother. She says Georgia won't explain why it rejects her for Medicaid; she has retirement savings, which she says she's tapped twice for car repairs. She visits discount clinics for occasional checkups, but cannot afford to see specialists recommended for her conditions. "I was promised every American would get coverage, regardless of income," she said of Obamacare. "Didn't happen." She said she hopes to eventually qualify for Social Security disability programs, which would lead to Medicare coverage.She said she believes Obamacare is inefficient and overly regulated, driving up costs putting affordable and effective insurance out of reach for many. Joshua Grubbs: Obamacare protects my toddlerJoshua Grubbs, an assistant professorat Ohio's Bowling Green State University, would have employer-provided insurance with or without the ACA reforms. But Obamacare protections, he says, ensure his son will keep getting the life-sustaining treatment he needs. Grubbs' 2-year-old son, Brantley, has cystic fibrosis. Current respiratory treatments, specialist visits and prescriptions would cost $60,000 a year without insurance, Grubbs said -- but that figure would rise by tens of thousands of dollars should Brantley need hospitalizations or surgeries. Obamacare bans lifetime and annual dollar limitson most benefits, and prevents insurers from refusing coverage or charging more for conditions that exist before new coverage starts. That ensures Brantley gets the kind of quality care that could extend his life, his father says. "We do have insurance -- good insurance -- but we need protections for pre-existing conditions; and because cystic fibrosis is such an expensive disease to treat, we need no lifetime caps," he said. Even with his father's insurance, Brantley gets supplemental coverage from Ohio's Bureau for Children with Medical Handicaps, funded in part by federal grants. The GOP's talk of cuts to systems like Medicaidas part of health care reform makes Grubbs worry about the future of programs like BCMH and greater out-of-pocket expenses. Businessman: Obamacare hurt sales, led to job cutsAndy Furniss says Obamacare hurt his medical equipment business several ways -- and had to cut full-time positions as a result. Ohio-based Furniss Corp. makes knee rehabilitation devices for hospitals and wholesalers. To help pay for Obamacare, the government levied a 2.3% taxon the gross sales of medical devices from 2013 through 2015. That cut deeply into revenue for a company hoping to make 5% net sales profits. To adjust, Furniss reined in bulk discounts, but that may have hurt sales volume. The business operated at a loss in 2014. Furniss also believes demand dropped as customers dealt with rising costs of insuring their own workers. Furniss Corp. itself, which offers health insurance to its 11 current full-time workers, saw its premiums rise faster than in pre-Obamacare years, which Furniss attributes in part to the ACA raising requirementsof what plans must cover. Furniss cut some full-time positions and stopped research and development for a shoulder product, he said. He said his business recovered somewhat after the tax was suspended in 2016. The suspension ends in January, so he hopes for a permanent tax repeal. "You get a helpless feeling. I can deal with competition, but you cannot fight Washington," he said. Health via CNN.com - RSS Channel - Health http://ift.tt/1rsiniF June 29, 2017 at 02:21PM
Paid leave for parents: What's the right amount of time?
http://ift.tt/2ulVeAE Just how much time should be covered will be the subject of political debate in the weeks and months ahead. But how much time is enough? Forget politics for a moment, and how a paid leave system would ultimately be financed. How much time is best for babies, for mothers, for fathers? "In reporting on (paid leave) over the years, everybody looks sort of longingly at Europe. It's like, 'Oh my God, they have months. They have weeks. They have years.' Well how much is enough?" said Schulte, director of the Better Life Labat New America. Anyone who follows this issue knows the United States stands in an embarrassing position as the only high-income nation not to have a national paid leave policy. It is also one of only a few countries around the world without such a plan. (Those others include Papua New Guinea, Suriname and a few small South Pacific Islands.) Schulte wondered if the science would show there was a "sweet spot" for the duration of paid leave for mothers and fathers. After conducting a deep dive project, where Schulte and her New America colleagues reviewed numerous studies and talked to a range of experts, they have a recommendation for the optimal duration of paid leave according to available science: Based on infant health, maternal health, gender equality and female labor force participation, they recommend six months to a year of paid family leave. The timing for such a conversation couldn't be more important, Schulte said, especially as President Donald Trump is calling for six weeks of paid parental leave. Ivanka Trump recently discussed the President's plan with Republican Sen. Marco Rubio of Floridaand other Republican members of Congress. A Democratic alternative calls for 12 weeks of paid parental leave. "If we're the last country to do something like this, we really have the opportunity to learn from what other people have done," said Schulte, author of The New York Times best-selling book "Overwhelmed: Work, Love and Play When No One Has the Time.""The bad news is the United States is so late to the game," said Jody Heymann,dean of the UCLA Fielding School of Public Health, who has been leading teams studying paid leave for 17 years. "The good news is that with 187 countries in the world having paid maternity leave, over 90 having paid paternity leave, actually there's a ton that's already known about what works." Heymann, who is also founding director of the WORLD Policy Analysis Centerat UCLA, is leading a comprehensive review of the literature on paid leave, including the health impact of different durations. That review is expected to be released over the summer or in early fall. Where did we get 6 weeks, 8 weeks, 12 weeks?If you live in the United States and have given birth, you are probably familiar with these three stretches of time: six weeks, eight weeks and 12 weeks. Six weeks is the amount of time you may be eligible for some disability pay after a vaginal delivery and eight weeks after a cesarean section. Twelve weeks is the amount of unpaid leave you may be eligible for under the 1993 Family Medical Leave Act, as long as you're at a company with 50 or more employees, and have worked at that company for at least a year, and at least 1,250 hours during that year. What many people might not realize is that the initial Family Medical Leave proposal, which ultimately got watered down, was six months of paid leave. "Some of the very early hearings, they had pediatricians and medical experts saying if you were to do this, a minimum should be six months paid," said Schulte. In 1978, after the Pregnancy Discrimination Act became law, women were eligible to apply for six to eight weeks of partial disability pay after the birth of a child. The number of weeks was based on an understanding back then of what it would take for the body to heal and for the major reproductive organs to return to a nonreproductive state, said Schulte. "What we were able to find is that there have been a number of international studies since then that have really questioned that six to eight weeks and show that a majority of women at six months are still experiencing one or more symptoms of physical illness, whether it's dizziness, fatigue or urinary incontinence or a host of things," she said. "You are not healed in six months, whereas back in 1978, they thought you were, but again, that was based not so much on science as on what were the typical amounts that you could get under disability insurance programs." Today, one in four US mothers returns to work much earlier -- two weeks after childbirth -- according to Schulte's report. What the science shows"The research is really clear, particularly when you look at infant mortality," said Schulte. Of all advanced economies, the United States has one of the highest rates of infant mortality and sudden infant deaths. A study of 20 low-income and middle-income countries found that for each month of paid maternity leave, there was a 13% decline in infant mortality. The greatest reduction in infant mortality was found with 40 weeks paid leave, according to the report. "From the infant health standpoint, it matters for women to be able to exclusively breastfeed for six months. The best way to guarantee that they can exclusively breastfeed for six months is to have at least six months of paid maternity leave," said Heymann of UCLA. "Why care so much about breastfeeding? Because breastfeeding lowers infant mortality three- to five-fold in high- and low-income countries." The benefits for children can also be long-term, according to the research. Researchers compared the lives of children born in Norway before 1977, when mothers had 12 weeks of unpaid leave, with children born after, when the country offered an additional four months of paid leave. The children whose moms had longer leaves had better cognitive and academic development at age 30 and were more likely to have graduated from college and have higher wages. When it comes to maternal health, an Australian study found that psychological distress was significantly less likely for mothers who took more than 13 weeks of paid leave. The report also noted that leaves shorter than 12 weeks have been connected with higher depression and anxiety, a decline in self-esteem and problems with sensitivity to the baby. "We have one of the highest infant mortality rates of developed countries. We have one of the highest maternal mortality rates of developed countries. I mean higher than Bosnia ... places that have just come from recent conflict. And when you put it all out on a time line, you really start seeing connections about the larger cost of not doing some kind of paid family leave," said Schulte. Schulte and her colleagues did not find a study that backed a particular length of time to get the best results for gender equality, but what they did find is that when men took an adequate amount of leave, there was a huge impact on the gender division of labor. Studies out of Iceland and Quebec showed that three years later, men who had taken paid leave were more likely to share child care and divide up other responsibilities at home. "We found that having some kind of equal bonding would actually disrupt those powerful traditional gender roles and enable families to form their own kind of work and life combination in a way that was best for their family," said Schulte. When it comes to women returning to the workforce after giving birth, a bell curve exists. When leaves are too short, women tend not to go back or they simply can't go back, and if they are too long, they can't easily get back in, according to the report. For example, in the Czech Republic, where with paid leave and home leave, women could be out for three years, women tended to not go back or employers didn't want to hire them back. "The question has been raised whether the very long leaves that some European countries have, meaning two years and over, not a length the United States is considering, do those have any impact on gender equality?" said Heymann, who said her research study is looking into that very issue. "There's absolutely no evidence that there's any negative effect on workplace equality of the durations the United States might consider," she added. "There's this sweet spot that most studies will show it's between nine months to a year where nine months is where it's positive and up to a year. Anything longer than a year tends to be kind of a detrimental effect to women's wages, women's return to work and their career prospects," said Schulte. How do you pay for it?Heymann's research will also look at how paid leave is financed around the world. Does the government pay for it? Does the employer or the employee or some combination? She and her team will then compare those results with impacts on the health of the infant and parents, equality between men and women at work and home and the economy. "The reason we're mapping onto economic outcomes is one of the questions that is often raised is, 'Can countries afford to compete and do this?' " said Heymann. Her team is trying to answer whether there are certain models that are more or less feasible. Schulte's report points to a 2017 survey conducted by Ernst & Young, which found that 90% of companies with paid family leave policies found there was either a positive or neutral impact on productivity, morale and the bottom line. Studies of the three states currently offering paid leave, California, New Jersey and Rhode Island -- New York's plan goes into effect in 2018 -- found that a majority of companies experienced positive or neutral effects on productivity. In the United Kingdom, a survey of more than 2,000 companies found that workplaces with parental leave policies were 60% more likely to report that their financial performance was higher than average as compared to the companies that didn't offer any leave plans. "People like to talk about paid family leave as like a perk or an accommodation or kind of nice to have, but when you look at the totality of all of these studies, it's really an investment in the future," said Schulte. Schulte hopes the report she and her colleagues crafted will help people understand, even before the debate begins, what, let's say, six weeks of paid leave, the President's proposal, means based on the science and the available evidence. "We're not going to be Estonia where they have 166 weeks, but we'll hopefully move beyond zero. It looks like there is movement so what is the right amount of time? Where do we start?" said Schulte. "The whole goal here is to really bring some objective, as much as it can be, neutral scientific data and really inject it in the conversation and to help guide people making the best decisions." Health via CNN.com - RSS Channel - Health http://ift.tt/1rsiniF June 29, 2017 at 01:33PM
Lily's Place: The heart of the heroin epidemic
http://ift.tt/2umAKb0 Lily's Place, in Huntington, West Virginia, treats babies born exposed to drugs. Here, mothers learn to balance their addiction and recovery with motherhood. Health via CNN.com - RSS Channel - Health http://ift.tt/1rsiniF June 29, 2017 at 01:33PM
Melanoma Biopsy Results Can Differ, Worrying Patients
http://ift.tt/2srcLpt By Dennis Thompson HealthDay Reporter THURSDAY, June 29, 2017 (HealthDay News) -- Joann Elmore is a doctor, so when her dermatologist said her skin biopsy indicated possible melanoma, she knew just what to do -- get a follow-up biopsy to verify. But she got two polar-opposite diagnoses, leaving her anxious and uncertain. One pathologist declared it benign, while the other called it suspicious for invasive melanoma, the deadliest form of skin cancer. "It showed me what patients go through," said Elmore, a professor at the University of Washington School of Medicine. "It sort of made me realize that in much of what we do, there is an art and it is subjective." Pathologists can vary widely when assessing skin biopsies for melanoma, particularly when the case is not clear-cut, according to a study led by Elmore. When asked to repeatedly assess the same set of cases, pathologists often disagreed with one another and, sometimes, themselves. Disagreements occurred more often when the skin biopsy fell in the middle ground between clearly benign or definitely melanoma, Elmore said. "It's very hard classifying in those middle diagnostic categories," Elmore explained. "On the two extremes -- if it's totally normal or if it's a high-grade invasive melanoma -- those are easier to identify when you're looking at them under a microscope." The only way to diagnose melanoma at this time is to place a skin sample under a microscope and compare it to textbook examples, Elmore said. The problem is, these examples used for diagnosis have never been organized into one clear standard shared by everyone, she noted. "The pathologists are not the problem," Elmore said. "The problem is we have not developed adequate classification systems." In Elmore's case, it took a leading pathologist who wrote textbooks on the topic to provide a definitive third opinion -- she had an atypical lesion that is harmless but looks a lot like melanoma. For their study, Elmore and her colleagues pulled together 240 different skin biopsies ranging from an ordinary mole to advanced melanoma. The study authors sent off the glass slides, in groups of 36 or 48 slides, to 187 pathologists across the United States. The pathologists reviewed the same slides on two occasions, at least eight months apart. ContinuedElmore's team then compared the pathologists against themselves and a "gold standard" consensus diagnosis for each slide reached by a panel of pathology experts. Pathologists often agreed on their diagnosis in cases at either extreme. But lesions that were not that straightforward produced a lot of disagreement, the investigators found. The pathologists agreed with the consensus diagnosis less than half of the time in these middle-ground cases, with agreement ranging from 25 percent to 43 percent. Agreement with themselves ranged from 35 percent to 63 percent, the findings showed. One slide in particular produced 18 different diagnoses from 36 pathologists, representing the full range from common mole up to invasive and heavily pigmented melanoma, the researchers reported. Dr. Ted Gansler said these results "may be shocking to patients, but should not be surprising to pathologists or dermatologists who have spent time peering at these samples through a microscope." Gansler is a pathology expert. "Most renowned experts in this field sometimes disagree," said Gansler, strategic director of pathology research for the American Cancer Society. The reality, he said, is no other lab test is better than the consensus of these experts in predicting whether a spot on someone's skin is benign, malignant or atypical. "As one would expect, ordinary pathologists are not as accurate as these experts," Gansler added. Elmore said that patients facing one of these uncertain diagnoses need to remain calm, since the great majority of skin biopsies do not wind up diagnosed as melanoma. "Most biopsies are benign. Even if they get one of these diagnoses, it doesn't mean they need to act immediately," she added. "They have time to communicate with one of their doctors and get educated. It's not an emergency that needs to be dealt with within the next five days." Gansler pointed out that in "real world" practice, doctors often share difficult cases with colleagues who have more expertise in assessing skin biopsies, or forward them to recognized experts. At the same time, Elmore said, there's a need for the field of skin cancer to come together and create a clearer classification system. Continued"We're at a point where we need to step back and figure out how to fix this," she concluded. The study was published online June 28 in BMJ. WebMD News from HealthDay SourcesSOURCES: Joann Elmore, M.D., MPH, professor, University of Washington School of Medicine, Seattle; Ted Gansler, M.D., MPH, strategic director, pathology research, American Cancer Society; June 28, 2017, BMJ, online Copyright © 2013-2017 HealthDay. All rights reserved.Health via WebMD Health http://www.webmd.com/ June 29, 2017 at 01:27PM
Opioid addiction rates continue to skyrocket
http://ift.tt/2t5ryIy An analysis from Blue Cross Blue Shieldof its members found that from 2010 to 2016, the number of people diagnosed with an addiction to opioids -- including both legal prescription drugs like oxycodone and hydrocodone, as well as illicit drugs -- climbed 493%. In 2010, there were just 1.4 incidences of opioid use disorder among every 1000 members. By 2016, that rate had climbed to 8.3 incidences for every 1000 members. Yet, at the same time, there was only a 65% increase in the number of people getting medication-assisted treatment to manage their addiction. Medication-assisted treatment, MAT, includes the prescribing of medications like buprenorphine or methadone, along with behavioral therapy. MAT is considered the gold standard of treatment amongst doctors and there are a number of studies to back it up - one found that Suboxone, a combination of buprenorphine and naloxone could at least doublea persons chances of remaining drug free after 18 months; anotherfound that increased buprenorphine use was accompanied by a reduction in the number of overdose deaths. Other treatments may include detox programs such as Narcotics Anonymous. "Opioid use disorder is a complex issue, and there is no single approach to solving it," Dr. Trent Haywood, senior vice president and chief medical officer for BCBSA said in a statement. "It will take a collaborative effort among medical professionals, insurers, employers, communities and all levels of government working together to develop solutions that effectively meet community needs," he added. Addiction climbs, but few get treatmentWhile the rates of opioid addiction treatment have increased more than 6 foldsince 1999, few individuals struggling with addiction actually receive treatment. In fact, a 2016 Surgeon General's Reportfound that only one in 10 people receive any specialized treatment to manage their addiction. At the same time 40% of those who are addicted do not seek treatment. Of the 20 million Americans that had a substance abuse addiction in 2015, about 10% of them were addicted to opioids.In addition to that, few places provide MAT. According to the Pew Charitable Trusts, less than half of private sector treatment programs offered any medications approved by the Food and Drug Administration for substance use disorders, and just 23% of publicly funded treatment centers offered them. More people die from drugs than from gunsThese numbers illustrate the continued difficulty of trying to get control of this public health epidemic. According to the US Centers for Disease Control and Prevention, 91 people die every day from an opioid overdose. In 2015, more than 33,000 lives were lost to opioids. In fact, drug overdoses - most of them from opioids -kill more people than guns or car accidents. The deaths from prescription drugs alone have more than quadrupledsince 1999. Added to that is the threat of heroin and synthetic drugs like illicitly made fentanyl. Deaths from synthetic opioids alone, such as illicit fentanyl, jumped 72%from 2014 to 2015. According to the National Institutes of Health, three in four new heroin usersstart by abusing prescription drugs. Who'e becoming addictedThe BCBS analysis found that longer-duration prescriptions were associated with higher incidences of opioid use disorder. A CDC studyfrom earlier this year found that an opioid prescription lasting for eight or more days increased the likelihood of using the drug a year later to 13.5%. A prescription of 31 days or more increased chances of long-term opioid use to 29.9%. In an effort to reign in the problem, a handful of states-- Connecticut, Massachusetts, Rhode Island, New York, and Maine - have adopted legislation that limits opioid prescriptions to seven days. This year, New Jerseybecame the strictest, limiting painkiller prescriptions to just five days. The BCBS analysis also found that women 45 and older had higher rates of abuse then men. According to the CDC, the overdose deaths for womendue to prescription painkillers have jumped more than 400%, while for men it has increased by 265% Part of that may be due to the fact that women in general are more likely to be diagnosed with chronic pain and be prescribed painkilling narcotics at higher dosages and durations. Finding solutions"BCBS companies are already undertaking initiatives to help families and communities address opioid use disorder by forging partnerships with the medical community to promote best practices in prescribing and providing critical education to the public to raise awareness of the risks of opioid use," said Kim Holland, vice president of state affairs for BCBSA. President Trump has said that the opioid epidemic is a top priority for his administration and established a commission,headed by New Jersey Governor Chris Christieto look at how to combat the epidemic. The commission was set to have their second meeting and provide a draft of recommendations this past Monday, but the meeting was postponed till July. And while the commission has no law making abilities, during the commission's first meetingin June, commission members and panelists alike testified to the need to maintaining Medicaid expansion in the health care proposals. Commission member Bertha Madras, of Harvard Medical School, has said"We need more time because it's a massive task." CNN reached out to Madras - as well as the other members of the commission and the White House for further comment on the status of the draft of recommendations and has not received any comment. Health via CNN.com - RSS Channel - Health http://ift.tt/1rsiniF June 29, 2017 at 01:15PM |
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