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Health care town hall covers Fort Knox changes

A town hall is scheduled Tuesday at American Legion Post 113 on Ring Road in Eliza­bethtown with Ireland Army Health Clinic officials to discuss transitioning retirees’ primary care to the civilian health care network, update attendees on progress of the transition and talk about additional changes.

The two-hour meeting is scheduled to begin at 5 p.m.

The U.S. Army is building a new clinic at Fort Knox to replace its current clinic, which operates out of the former hospital, which opened in 1957. The new clinic is scheduled to open in 2020.

Ireland Army Health Clinic leadership, Humana, the Veterans Administration and area network partners also will discuss how to navigate the network and find a doctor, according to a news release. Additionally, they will explain the services each network partner offers, as well as similarities and differences between military and civilian health care processes such as acquiring and filling certain prescriptions. There also will be an opportunity for attendees to ask questions.

The new military treatment facility will be constructed according to U.S. Army Health Facilities Planning Agency clinic construction guidelines and Title 10 Public Law, which allows room for only current active duty soldiers and their family members.

As a result, the clinic on post will no longer be able to provide primary care and some services for retirees. However, retirees still will have access to the pharmacy, the release said.

The Veterans Admin­istra­tion broke ground last week on its Fort Knox clinic to be constructed alongside the Ireland clinic.

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4 Your Health: Measles risks and complications –

4 Your Health: Measles risks and complicationsCopyright 2018 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

BUFFALO, N.Y. (WIVB) – Erie County residents have been warned about a confirmed measles case in the area. But, how worried should we really be? News 4 sat down with a medical expert to find out.

“If you’re immunized, you should feel good about that. If you’re not immunized, if you don’t know your immunization status, if you have a weak immune system, if you’re pregnant, those are certainly things that you should find out about your immunity status and get it checked, or get the vaccine,” said Dr. Joseph Chow, the president of WNY Immediate Care.

Dr. Chow says measles are something we don’t hear about often, but every few years, they seem to make a comeback.

And when there’s a confirmed case, that get’s people talking.

Measles is a highly contagious virus, spread by coughing and sneezing, that can stay live in room or a closed space for up to two hours.

“Because it’s a virus, there’s no treatment for it. It’s mostly supportive treatment,” Dr. Chow said. “Some of the complications can include diarrhea, pneumonia, and in rare cases, you can get infections in the brain, so it can be fatal.”

Fortunately, the vast majority of us should be protected.

Most Americans receive MMR vaccines as a requirement to start school, so we should be in the clear.

“If you’re immunized, it doesn’t mean you can’t get it, but the likelihood is much lower, and if you do get it, typically the symptoms are not quite as severe,” Dr. Chow pointed out.

Measles symptoms usually start with a fever, then patients may have a cough, runny nose and watery eyes, and then a rash appears.

People are considered infectious from four days before to four days after the appearance of the rash.

It can take 7 to 21 days for symptoms to appear.

Dr. Chow says there are likely several factors that could contribute to the measles popping up now.

For some, he says, immunity can wane over time, leaving a person less protected decades after being immunized.

Other people were never immunized to begin with.

“There may be people from other countries who may not be immunized or didn’t have the resources to get immunized,” Dr. Chow said. “So there always seems to be ways that some of these infections creep their way back.”

We know the most recent case in Erie County involves a person who recently came to the United States.

The Erie County Health Department released a list of places that person went during the time in which they would have been contagious:

  • Catholic Charities,  20 Herkimer Street, Buffalo on 12/4/2018 between 11:00am and 5:00pm
  • Erie County Department of Health Clinic, 608 William Street, Buffalo on 12/4/2018 between 11:30 am and 4:00pm
  • Sweet Home High School, 1909 Sweet Home Road, Amherst on 12/5/2018 between 5:00pm and 10:30pm
  • Erie County Department of Social Services, 158 Pearl Street, Buffalo on 12/6/2018 between 8:00am and 1:00pm
  • Erie County Department of Health Clinic, 608 William Street, Buffalo on 12/6/2018 between 10:30am and 2:00pm
  • Catholic Charities,  20 Herkimer Street, Buffalo on 12/6/2018 between 11:30am and 3:00pm
  • Erie County Department of Social Services, 158 Pearl Street, Buffalo on 12/6/2018 between 12:30pm and 4:30pm
  • Aldi, 4259 Transit Road, Buffalo on 12/6/2018 between 5:00pm and 9:00pm
  • Best Buy, 4401 Transit Road, Williamsville on 12/6/2018 between 6:00pm and 9:15pm
  • Marshalls, 2383 Maple Road, Williamsville on 12/6/2018 between 6:00pm and 10:00pm
  • Millard Fillmore Suburban Hospital Emergency Department, 1540 Maple Road, Williamsville on 12/10/2018 between 9:00am and 5:30pm

Dr. Chow says if you may have been exposed to the measles virus at any of those times, and you have not been vaccinated or do not know your vaccination status, this is something to take seriously.

“Certainly stay vigilant on it,” he said, adding that you should call your doctor before going to a medical facility if you suspect you may have the virus, “because if you do wind up having measles, you don’t want another scenario where you’re infecting other people.”

Anyone with questions or concerns can contact Millard Fillmore Suburban’s Infection Prevention Office at (716) 568-3999, Erie County Department of Health at (716) 858-7697 or their primary care provider.

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Boys need better access to mental health care. Why aren’t they getting it?

Throughout high school, Alexander Sanchez was severely depressed. He thought about suicide, and he didn’t know how to explain what was wrong or ask for help. Instead, Sanchez said that whenever he wasn’t in school, he would lie in bed all day, “not eating, not being happy, being almost not there.”

It wasn’t until Sanchez, who grew up in College Station, Texas, got to college that a friend convinced him to see a psychologist, who diagnosed him with depression. In hindsight, Sanchez said he did not reach out for help sooner because he believed that men should be self-reliant— an idea he believes he picked up from Tom Cruise and other macho characters on TV and in movies.

“I think I had really internalized this emotional stoicism that I know I was supposed to have,” said Sanchez, 21, who is now a senior studying psychology at New York University.

Mental health has become a crisis among America’s youth, and experts say the unique challenges and needs of young men are not receiving enough attention. Doctors, teachers and family members may not recognize the symptoms of depression, which in men can include anger, irritability and aggressiveness, according to the National Institute of Mental Health. Men are also less likely than women to “recognize, talk about and seek treatment” for depression, which is sometimes stereotyped as a women’s problem, the agency said.

While teenage girls attempt suicide more often than teenage boys, according to the American Foundation for Suicide Prevention, boys are more likely to die by suicide. Suicide rates for teenage boys and girls rose steadily from 2007 to 2015. In 2015, there were 1,537 suicides documented for boys ages 15 to 19 and 524 for girls, according for the Centers for Disease Control and Prevention.

Federal judge rules health care overhaul unconstitutional

After a federal judge ruled that the Obama-era health overhaul was “invalid,” President Donald Trump is looking to congressional leaders to come up with a replacement even as the White House says the current law will remain in place for now.

“Get it done!” the president instructed Senate Majority Leader Mitch McConnell, R-Ky., and Rep. Nancy Pelosi, D-Calif., the likely House speaker in January.

Legal appeals are expected to reach the Supreme Court on an issue that helped propel Democrats to their new majority in the House in the recent midterm elections.

In a 55-page opinion Friday, U.S. District Judge Reed O’Connor in Texas ruled that last year’s tax cut bill knocked the constitutional foundation from under the Affordable Care Act by eliminating a penalty for not having coverage. He wrote that the rest of the law cannot be separated from that provision and therefore was invalid.

For the most comprehensive local coverage, subscribe today.


Supporters of the law said they would appeal. “Today’s misguided ruling will not deter us: Our coalition will continue to fight in court for the health and wellbeing of all Americans,” said California Attorney General Xavier Becerra, who is leading a coalition of states defending the overhaul.

The White House applauded the ruling by O’Connor, who was appointed by President George W. Bush, and said that “pending the appeal process, the law remains in place.”

Trump tweeted that “Obamacare has been struck down as an UNCONSTITUTIONAL disaster!” and said it was not up to Congress to “pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions.”

While congressional Republicans held their silence in reaction to the ruling, Democrats said they would test the GOP’s commitment to such popular provisions.

“The GOP spent all last year pretending to support people with pre-existing conditions while quietly trying to remove that support in the courts,” Senate Democratic leader Chuck Schumer of New York said in a tweet Saturday. “Next year, we will force votes to expose their lies.”

Pelosi said the House “will move swiftly to formally intervene in the appeals process to uphold the life-saving protections for people with pre-existing conditions and reject Republicans’ effort to destroy” the law.

But Congress is unlikely to pass a new law while the case remains in the courts. Numerous high-ranking Republican lawmakers have said they did not intend to also strike down provisions such as protection for people with medical conditions when they repealed the law’s fines for people who can afford coverage but remain uninsured.

Legal expert Timothy Jost, a supporter of the health law, said O’Connor’s ruling would have repercussions for nearly all Americans if it stands. If the entire health law is invalidated, popular provisions that benefit Medicare beneficiaries and people with employer coverage would also be scrapped. That could include the section that allows parents to keep young adult children on their coverage until age 26.

About 20 million people have gained health insurance coverage since the law passed in 2010 without a single Republican vote. Currently, about 10 million have subsidized private insurance through the health law’s insurance markets, while an estimated 12 million low-income people are covered through its Medicaid expansion.

Saturday was the sign-up deadline for 2019 private plans through Meanwhile, a number of states are expected to move forward with Medicaid expansion after Democratic victories in the midterm elections.

If the case were to reach the Supreme Court it would mark the third time the justices consider a challenge to fundamental provisions of the law. The law’s opponents lost both the first two cases.

The five justices who upheld the health law in 2012 in the first major case — Chief Justice John Roberts and the court’s four liberals — are all still serving.

Since then, public opinion on the overhaul has shifted from mostly negative to generally favorable.

Preserving the law’s protections for people with medical conditions proved to be a strong argument for Democrats in the November elections. Republicans who tried to undermine those safeguards during their failed effort to repeal the health law last year were forced on the defensive and went on record saying they, too, want to make sure people with health problems can get coverage.

House Democrats are talking about passing legislation that enshrines protections for medical conditions. It’s unclear what form that would take, or if the Republican-majority Senate would go along and Trump would sign it.

The GOP-led states that had sued asked O’Connor to toss out the entire law after Congress repealed the “individual mandate” penalty for going without coverage. The judge had previously ruled against other Obama-era policies.

The Trump administration weighed in, saying the government would no longer defend some core components of the law, but that others could remain, including Medicaid expansion, subsidies for private insurance and health insurance markets.

Along with the requirement to have health insurance, the administration said the parts of the law that should go included:

—the requirement that insurers must take all applicants for comprehensive coverage regardless of prior health history, including existing conditions. That includes a prohibition on insurers writing policies that exclude a particular condition — for example, a recurrence of breast cancer.

—the prohibition on insurers charging higher premiums to people with health problems.

The health insurance industry says doing away with consumer protections will destabilize a market that seems to be finding its footing, with modest premium increases and more plan choices next year.

The American Medical Association called O’Connor’s ruling an “unfortunate step backward for our health system that is contrary to overwhelming public sentiment to preserve pre-existing condition protections.”

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Pennsylvania Holds Naloxone Giveaway : Shots – Health News

David Braithwaite signs a document to get free naloxone from Hayley Eager on Thursday, when Pennsylvania gave away naloxone at almost 80 places across the state.

Brett Sholtis/WITF

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Brett Sholtis/WITF

David Braithwaite signs a document to get free naloxone from Hayley Eager on Thursday, when Pennsylvania gave away naloxone at almost 80 places across the state.

Brett Sholtis/WITF

David Braithwaite was standing next to his pickup truck Thursday in a parking lot outside the Cumberland County health center in Carlisle, Pa.

He’s a chaplain for Carlisle Truck Stop Ministry. His hat even says it.

Braithwaite said he and another chaplain minister to truck drivers, homeless people and anyone else who needs help at the truck stop seven days a week.

Braithwaite was one of a half-dozen people who got to the health center before it opened. On Thursday, the state gave away the opioid reversal drug naloxone at nearly 80 places across Pennsylvania.

The state made the medication available to anyone free of charge — no questions asked. It is part of Democratic Gov. Tom Wolf’s effort to address the opioid crisis.

Pennsylvania has allocated $5 million to the two-year opioid distribution program, part of a multidepartmental effort to curb opioid addiction in a state that lost over 5,400 people to overdoses in 2017.

The 66-year-old retired postal service employee was friendly and talkative, but his cheerful demeanor changed when he started talking about drug addiction. “We have had a number of individuals who have passed away from overdose,” he said. “Young people. It is so frustrating and so heart-wrenching.”

Braithwaite, a self-described conservative pragmatist, said he has mixed feelings about handing out naloxone to revive people who have had a drug overdose. He worries that without requirements for follow-up care, people who aren’t ready to begin recovery will go right back to using heroin.

However, he knows of at least one person at the truck stop who was revived by naloxone. And he said he wants to be ready to save someone’s life if he has to.

By the time he got to the front of the line, at least a dozen people were behind him, some streaming out the health center door.

Some in line knew firsthand how hard it is to beat opioid addiction.

“People have to be alive to get the help that they need,” said Brittney Webster, who got free naloxone at a health center in Carlisle, Pa.

Brett Sholtis/WITF

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Brett Sholtis/WITF

“People have to be alive to get the help that they need,” said Brittney Webster, who got free naloxone at a health center in Carlisle, Pa.

Brett Sholtis/WITF

Brittney Webster, 28, has been in recovery for six years. She spent 30 days at inpatient rehab and has attended 12-step meetings ever since. Now she works as a residential coordinator at the RASE Project, a nonprofit inspired by mental health advocacy groups that aims to help people who are recovering from addictions.

Webster said she plans to give naloxone to people in the recovery community who she meets through the RASE Project.

When asked about why she showed up, she started to tear up, thinking of the people she knew who have died from drug overdoses. It’s been an emotional day, she said.

Scrolling the comments section of Facebook didn’t help. She said too many people don’t understand how addiction works, or how important naloxone is for saving lives.

“People have to be alive to get the help that they need,” she says. “So, that’s what this is. It gives people a chance to choose recovery again.”

By 3 p.m., the state had distributed nearly 4,500 kits of naloxone, according to a news release. At least 42 locations had run out of naloxone.

Pennsylvania Department of Health Secretary Rachel Levine noted that the state’s standing order for naloxone means people are also able to pharmacies to get naloxone — no prescription needed, but they would have to pay or use their health insurance.

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

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Texas Judge Rules ACA Unconstitutional : Shots – Health News

A federal district court judge in Texas has threatened the future of the Affordable Care Act.

Judge Reed C. O’Connor struck down the law, siding with a group of 18 Republican state attorneys general and two GOP governors who brought the case. O’Connor said the tax bill passed by Congress in December 2017 effectively rendered the entire health law unconstitutional.

What's At Stake In The Latest Affordable Care Act Court Battle

That tax measure eliminated the penalty for not having insurance. An earlier Supreme Court decision upheld the ACA based on the view that the penalty was a tax and thus the law was valid because it relied on appropriate power allowed Congress under the Constitution. O’Connor’s decision said that without that penalty, the law no longer met that Constitutional test.

“In some ways, the question before the Court involves the intent of both the 2010 and 2017 Congresses,” O’Connor wrote in his 55-page decision. “The former enacted the ACA. The latter sawed off the last leg it stood on.”

The decision came just hours before the end of open enrollment for ACA plans in most states that use the federal insurance exchange. It is not expected that the ruling will affect the coverage for those people. The final decision isn’t likely to be made until the case reaches the Supreme Court again.

The 16 Democratic state attorneys general who intervened in the case to defend the health law immediately vowed to appeal.

“The ACA has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Supreme Court,” said a statement from Xavier Becerra of California. “Today’s misguided ruling will not deter us: our coalition will continue to fight in court for the health and wellbeing of all Americans.”

It is all but certain the case will become the third time the Supreme Court decides a constitutional question related to the ACA. In addition to upholding the law in 2012, the court rejected another challenge to the law in 2015.

It is hard to overstate what would happen to the nation’s health care system if the decision is ultimately upheld. The Affordable Care Act touched almost every aspect of health care, including Medicare and Medicaid, generic biologic drugs, the Indian Health Service, and public health changes like calorie counts on menus.

The case, Texas v United States, was filed in February. The plaintiffs argued that because the Supreme Court upheld the ACA in 2012 as a constitutional use of its taxing power, the elimination of the tax makes the rest of the law unconstitutional.

In June, the Justice Department announced it would not fully defend the law in court. While the Trump administration said it did not agree with the plaintiffs that the tax law meant the entire ACA was unconstitutional, it said that the provisions of the law guaranteeing that people with preexisting health conditions could purchase coverage at the same price as everyone else were so inextricably linked to the tax penalty that they should be struck.

The administration urged the court to declare those provisions invalid beginning Jan. 1, 2019. That is the day the tax penalty for not having insurance disappears.

The protections for people with preexisting conditions was one of the top health issues in the midterm elections earlier in November. While the issue mostly played to the advantage of Democrats, one of the Republican plaintiffs, Missouri Attorney General Josh Hawley, defeated Democratic incumbent Sen. Claire McCaskill. Another plaintiff, West Virginia Attorney General Patrick Morrisey, lost to Democratic incumbent Sen. Joe Manchin.

President Donald Trump was quick to take a victory lap, and pressed Senate Majority Leader Mitch McConnell, R-Ky., and the presumed incoming House Speaker Nancy Pelosi, D-Calif., to fix the problem. The president tweeted Friday night: “As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!”

But congressional leaders were quick to point out that the suit is far from over.

“The ruling seems to be based on faulty legal reasoning and hopefully it will be overturned,” said a statement from Senate Minority Leader Chuck Schumer, D-N.Y.

Many legal experts agreed with that assessment. “This is insanity in print, and it will not stand up on appeal,” tweeted University of Michigan Law School Professor Nicholas Bagley, an expert in health law.

Even some conservatives were left scratching their heads. “Congress acted last year to repeal the mandate, but leave everything else in place and the courts should have deferred to that,” tweeted former congressional GOP aide Chris Jacobs.

Kaiser Health News, a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation, and not affiliated with Kaiser Permanente.

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5-Star Friday: The obvious and the obscure

The 5-star writing we feature below highlights an interesting contrast: the obvious and the obscure.

5-Star FridayOn the one hand, I’m guessing it’s fairly obvious to many of us that some physicians have ties to industry money; but on the other hand, is it widely known that some doctors and medical journals are blatantly refusing to disclose such ties?

And what about HIV, which seemed to be on everyone’s radar for years, and lately much less so. Now there’s a preventive medicine that, obviously, would be a good thing … or is it?

Then there’s the promise of robotic surgery for cancer patients. Newer and less invasive must be better right? Or is there something less obvious and maybe more important to consider?

Finally, your doctor – if you’re lucky enough to have one you call your own. Seems obvious that the longer that relationship lasts, the better. But is it really that simple?

This 5-Star Friday serves as an important reminder that good reporting thrives on this contrast, and explores not just the obscure, but challenges the obvious.

Gary Schwitzer | Publisher founder
Prominent Doctors Aren’t Disclosing Their Industry Ties in Medical Journal Studies. And Journals Are Doing Little to Enforce Their Rules  • by Charles Ornstein Katie Thomas • ProPublica New York Times

Gary Schwitzer

Often in these 5-Star Friday features we have celebrated high-quality investigative health care journalism efforts. And the ProPublica-New York Times team of Charles Ornstein and Katie Thomas is leading the way very often, as they did earlier this week with another in their occasional series on conflicts of interest. In their sights have been big names: the chief medical officer of Memorial Sloan Kettering Cancer Center in New York; the dean of the Yale School of Medicine; the president-elect of the American Society of Clinical Oncology, and others.

Now they’ve shifted their focus to what leading medical journals are not doing to ensure proper disclosure by authors of manuscripts in their journals. About the editor-in-chief of the Journal of the American Medical Association, they wrote that he said that verifying each author’s disclosures would not be worth the time or effort. They cited studies recently published by the New England Journal of Medicine that omitted disclosures.

They concluded this story with a quote from Dr. Bernard Lo, the chairman of the 2009 Institute of Medicine panel on how conflicts of interest should be reported.  Lo said, “(Journals are) certainly not out in front trying to be trailblazers, let me just say it that way. The fact that it hasn’t been done means that nobody has it on their priority list.”

Kudos to Ornstein and Thomas for putting it on their priority list, and thereby, on their readers’ radar screens.

Jill U. Adams | Associate Editor
The unexpected effects of the HIV prevention pill • by Bryn Nelson • Mosaic

Jill U. Adams

This Mosaic story about the rise of the HIV-prevention medication Truvada, also known as PrEP (pre-exposure prophylaxis), takes the reader from San Francisco’s Castro Street to a London health clinic that caters to gay men.

The piece is deeply reported, which allows writer Bryn Nelson to address the nuanced and sometimes contradictory data and the wide range of interpretations of that evidence. Nelson covers an assortment of opinions and predictions by various activists and doctors; he also dips back in history to show how moral judgments of casual sex hampered AIDS treatment in the 1980s, and how they might do the same today.

For instance, one worry with PrEP is that men who have sex with men will forego other protective measures, such as condoms, putting them at greater risk of other sexually transmitted diseases. Nelson asks: “What if this common narrative isn’t quite right?”

This is the driving question of the article and makes for a rich and informative read.

Michael Joyce | Writer-Producer
Long-term Physician-Patient Relationships — Persevering in a Practice • by Adam Cifu • JAMA

From the article:

“I am a better physician when I care for a patient I know well than when I care for a patient I have only just met.”

Michael Joyce

You may be tempted to file this under “obvious,” but you’d also be justified filing it under “obviously not the norm.” And that’s revealing.

Cifu, an internist and regular contributor to our site, beautifully describes how an organically grown, long-term alliance between patient and doctor fosters much more than just familiarity. He also speculates about improved job (and patient) satisfaction, better outcomes, and improved efficiency.

And he sees disadvantages too, which are much less obvious, but no less compelling. Granted, it’s an opinion piece, but it’s proof that good health care writing does find its way into medical journals.

We’d love to see more articles like this reach the general public.

Joy Victory | Deputy Managing Editor
As surgeons tout robot-assisted breast cancer surgeries, safety remains a question • by Marie McCullough • Philadelphia Inquirer

Joy Victory

As we pointed out earlier this year, too often news outlets have a poor track record when it comes to producing high-quality journalism about robot-assisted surgery. Instead, puff pieces get published (or aired) that never examine the claims being made. That means potential patients come away thinking machines like the da Vinci robot are unquestionably the latest and greatest in modern medicine.

The reality is a lot more muddled, especially for breast cancer patients needing tumor removal, according to the Philadelphia Inquirer. The core problem? “Rigorous clinical trials have not been done to compare the safety of robotic approaches with conventional methods,” reporter Marie McCullough explains.

What we do know, she points out, is that for other types of cancers, evidence reveals that minimally invasive surgery, including robot-assisted surgery, may not be more effective and in some cases may actually be less safe. The article also explores the lack of certainty around using these types of surgeries for prophylactic breast removal or cosmetic reconstruction, the latter of which the University of Pennsylvania medical school recently touted as the “world’s first.”

Instead of merely rehashing Penn’s talking points, McCullough dug deep, surfacing a far richer–and more valuable–story.

Please Note: These stories have not been subject to our rigorous, 10-criteria systematic review for accuracy, balance, and completeness. Rather, they represent pieces of health care journalism and opinion writing that members of our staff found compelling and wanted to share with others.

However, our reviewers did award 5 stars to this HealthDay story: Incontinence Drug May Cut Hot Flashes in Breast Cancer Survivors

Our reviewers noted:

“This story from HealthDay does many things right — it covers costs, side effects, study limitations, and more. This earned it five stars from us. However, we do think the story would have been even stronger if it had better emphasized a key fact: The overall reduction in hot flashes was roughly 28 to 23 in the drug group and 28 to 25 in the placebo group. That’s not much, and raises eyebrows in light of a physician in the story calling it “game-changing.”

You might also like

  • 5-Star

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Population Health News: 2018 Newsletter – Includes Detailed Feature Articles; Thought Leader Insights; Industry Briefs; a Profile of an Industry Leader; and more –

Health News”
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Each issue has 12 pages with detailed feature articles contributed by
leading national experts and executives in the field; Thought Leader
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Subscribers receive issues in print and electronic format, and also
receive exclusive website access to back issues and supplemental content
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stakeholder community.

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Every month, readers will be able to:

  • Get valuable business intelligence, networking and contact information
    regarding issues related to population health
  • Monitor current clinical, quality, care management, analytics, legal,
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Deep in the troubled heart of Texas, health care suffers

AUSTIN, Texas — The booming $1.8 trillion Texas economy rivals that of many countries and puts the state at the top of a host of rankings for its fast-growing cities, low unemployment and job growth.

But the familiar Texas braggadocio disappears when it comes to health care.

Texas has both the largest number (4.7 million) and highest percentage (19 percent) of uninsured residents under age 65 in the country, according to a new Urban Institute analysis. Two-thirds of the uninsured are in families with at least one full- or part-time worker. The state ranks 34th in the 2017 issue of America’s Health Rankings, an annual state-by-state assessment of the nation’s health. Thirty-three percent of adult Texans are obese. The state’s maternal mortality rate is 34.2 per 100,000 live births, a rate that has increased 10 percent since 2016 and is one of the worst in the country. It ranks 47th in the number of primary care doctors per capita.

The state’s “Don’t Mess With Texas” mantra drives much of its politics and policies, as limited government, low taxes and individual rights have prevailed at the statehouse for almost a quarter-century. That freewheeling formula has worked gangbusters for the economy, including the business of medicine, giving rise to some of the nation’s wealthiest hospital systems, as well as hundreds of freestanding emergency rooms and surgery centers.

But it has also left citizens struggling to get care and pay bills in health care’s wild west. It has allowed and supported entrepreneurial health care practices that are illegal in many states, including freestanding emergency rooms, doctor-owned hospitals and balance billing. Texas has more uninsured residents than any other state, in part because its largely Republican state politicians elected not to expand Medicaid.

Don’t sign Chemours consent order, residents tell DEQ

By Greg Barnes

Fran Minshew developed a rash after stepping out of her shower, even after the installation of an expensive filtration system.

The granular activated carbon filtration unit was installed at Minshew’s well, at a point before the water enters her Cumberland County home, which is less than a mile from the Chemours Fayetteville Works plant.

Minshew’s well was among those that tested highest for the possible carcinogen GenX when state regulators took samples earlier this year from Chemours’ neighbors.

a woman stands at a small podium in a room that's obviously an auditorium of some type. She's gesturing to the people behind her.
Calling Chemours “the devil we do know,” activist Beth Markesino urges DEQ to not sign a consent order with the company on what it should pay to clean up GenX contamination until more is known. Photo credit: Greg Barnes

Now, state officials say they may know why GenX is still showing up in Minshew’s tap water.

“It’s in the plumbing,” said Michael Scott, director of the Department of Environmental Quality’s Division of Waste Management.

Alerted to Minshew’s complaint, the state tested the water from her kitchen sink and found GenX as high as 134 parts per trillion, a level slightly under the provisional health goal of 140 parts per trillion set in 2017 by the  Department of Health and Human Services after the fluorchemical was detected in the Cape Fear River. Subsequently, the state has learned that Chemours was releasing the chemical into the river for decades.

GenX was not detected in the tap water from four other homes tested by DEQ that recently got the filtration systems.

Scott said DEQ believes the GenX is trapped in Minshew’s soft-water system, and possibly her hot water heater. More tests will be done to find the source of the contamination before the state decides whether to sample other homes where the GAC filtration systems are being used to filter out GenX and a stew of related chemicals that state officials say came from the industrial facility in Bladen County.

Scott and other DEQ officials spoke at a forum Tuesday at Bladen Community College. During a question-and-answer period at the end of the meeting, residents made it clear they don’t want  DEQ to give final approval to a consent order with Chemours anytime soon.

Residents say consent order is a bad deal

The consent order, signed Nov. 21 by DEQ, Chemours and Cape Fear River Watch, requires the company to pay a $12 million penalty and $1 million in investigative costs to the state. The consent order must undergo a public comment period before it can be given final approval by DEQ and a Bladen County Superior Court judge. The comment period ends Dec. 21.

Although the health effects on humans are not well known, GenX has been found to cause kidney, liver, pancreas and testicular cancer in animals. It is just one of dozens of so-called emerging contaminants detected in private wells surrounding and downstream of the Chemours plant near the Cumberland-Bladen County line. The contamination became public in June 2017, when the Wilmington Star-News reported that GenX had been found in the Cape Fear River and Wilmington’s drinking water supply.

The community forum on Tuesday was the seventh held by DEQ since the contamination became known. During it, Beth Markesino, who believes her young son’s health issues are caused by the contamination, urged state officials to hold off on final approval of the consent order.

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“Chemours and DuPont have been poisoning us for 37 years,” Markesino said, adding that the state doesn’t yet know the full extent of the contamination or the number of people who may be affected.

“Chemours is the devil that we do know,” said Markesino, who lives in Wilmington and is a member of a community activist organization. “We can’t sign this right now. What else is Chemours hiding from us?”

Bruce Skinner said the consent order “must have been written by Chemours.”

“How much more could it have been written in their favor?” he told the DEQ panel. “You need to set an example of what happens if you pollute beautiful North Carolina.”

Activist Mike Watters, who lives about a mile from the plant, wrote a 47-page analysis of the consent order, which he said he plans to present to the judge who will decide whether to approve the order.

Watters argues that the state needs to follow its groundwater rules, known as the practical quantitation limit, which sets the standard at 10 parts per trillion — not the state’s health goal of 140 parts per trillion. Doing so could qualify hundreds more people with well contamination below 140 parts per trillion for bottled water and filtration systems.

“You are allowing Chemours to pay off $12 million to absolve them of all their infractions,” Watters said. “That is absolutely insane.”

Community survey coming

State officials told the gathering of about 60 people that their comments have helped the state identify potential problems, including Minshew’s tap water contamination, low water pressure caused by the GAC filtration systems, and a tanker truck spill during Hurricane Florence that is expected to lead to a notice of violation against Chemours.

Zack Moore, the state epidemiologist, said officials will conduct a community survey in January for residents living within 10 miles of Chemours. The goal, Moore said, is to better understand and respond to community concerns.

Scott said DEQ would be retesting wells that fell below the 140 parts per trillion threshold for GenX. Currently, 172 wells have been detected with contamination above the threshold. Retests will be done on wells with contamination of between 101 and 139 parts per trillion, he said.

Scott emphasized that the focus is not solely on GenX.

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The consent order requires Chemours to make or pay for many improvements, including extending public water lines where economically practical and feasible from an engineering standpoint. Scott said low population density in some areas with well contamination might make it impracticable to extend water lines. In those cases, homeowners could select either GAC or reverse osmosis filtration systems at Chemours expense, he said.

The order also requires Chemours to eliminate at least 99 percent of GenX air emissions, partly by installing a thermal oxidizer by Dec. 31, 2019. The improvements, which are underway, are expected to cost the company an estimated $100 million.

Earlier this month, Chemours Plant Manager Brian Long said the company hopes to one day get a permit to resume discharging wastewater from the plant. Chemours has been trucking the wastewater to an injection site in Texas since the contamination was discovered in the Cape Fear River and state officials began investigating last year.

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