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Can you eat your way to better mental health? Study says yes

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Updated 4:38 AM ET, Mon February 18, 2019

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‘Griddling’ is greatContrary to grilling, which normally involves some sort of charcoal, “griddling” uses a pan with distinctive raised edges and is normally done on the stove or in the oven.

Vegetables such as asparagus, griddled with a tiny bit of olive oil, can develop intense flavor and be quite healthy. It’s also an especially good choice for green beans, broccoli, celery, Swiss chard and onions.

It is well known that eating lots of fruit and vegetables is good for your physical health, but our latest research suggests that it might be good for your mental health too.

      Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.

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State employee health plan changes face legislative scrutiny

By Mark Tosczak

State Treasurer Dale Folwell’s plan to cut more than $300 million in annual spending from the State Health Plan, which covers more than 700,000 state employees, public school teachers, retirees and their families, will be under scrutiny this week at the Legislature.

The House Health Committee on Tuesday is scheduled to hear from Folwell as well as from the North Carolina Healthcare Association, which represents the state’s hospitals and opposes the treasurer’s plan.

Under the new system, the SHP would reimburse health care providers a fixed percentage more than what Medicare pays them. The SHP is already moving to implement the plan, working with Blue Cross and Blue Shield of North Carolina to recruit hospitals, doctors and other providers into a new network. Blue Cross is contracted with the state to administer the health plan.

Meanwhile, NCHA and its hospital members have criticized Folwell’s plan as potentially damaging for state employees and many communities — especially rural communities — across the state.

“What we’re saying is we believe there’s a better path forward for the State Health Plan,” said Julie Henry, a spokeswoman for the NCHA. “If that requires legislative intervention to make that happen, then that’s what we would like to see happen.”

Hospitals push ‘value-based’ care

Hospital executives say they understand Folwell’s concern about rising health care costs, but they argue there are better ways to control those costs.

“I understand the premise that we need to reduce costs and eliminate waste in health care,” said Terry Akin, CEO of Greensboro-based Cone Health. “We’re not going to achieve that through arbitrary cuts in reimbursement.”

Instead, Akin and others argue, the state should embrace methods that the federal Centers for Medicare and Medicaid Services have been pushing for several years, and which are now being adopted even by some private payors. Chiefly, that means shifting to “value-based care,” where providers are reimbursed in part on their ability to keep patients healthy.

This would eventually supplant the system now used by most health insurance plans, including the SHP. That current system is based on fee-for-service reimbursements, where providers are paid based on the service they provide, whether that’s knee surgery, an MRI scan or an annual check-up. Critics of fee-for-service argue that it provides little incentive for providers to keep people healthy, as most doctors and hospitals collect most of their fees when someone is treated for an illness or injury.

Some providers back Folwell

Though hospitals have attacked Folwell’s plan, not all health care providers are opposed to it. Under SHP’s new payment plan, independent physicians, mental health counselors and a few small, rural hospitals that are federally designated as “critical access hospitals” could see their payments go up.

Dr. Dale Owen, a Charlotte cardiologist and CEO of the 88-physician Tryon Medical Partners group, said he’s met with Folwell to discuss the SHP and that he and other Tryon doctors support the move.

“We believe that it is a major step in the right direction,” he said. “Quite frankly, I think that the taxpayers who are paying the state employee health care plan, you know, are paying, they’re paying too much.”

Tryon Medical Group was formed last year after Owen and 87 other doctors who worked for Atrium Health quit the health care system to form their own entity.

“Everywhere hospitals go, the charges and costs go up,” he said. “Wherever they merge, wherever they buy physician groups and so forth, the cost goes up. That is not sustainable.”

The state needs good hospitals, Owen said, but “I don’t think we need to spend as much in all the bureaucracy that goes on in hospital systems.” Some health policy research supports Owen’s contention.

Value-based care being tested

Cone has, for several years, operated an accountable care organization for Medicare patients. Under that system, the hospital has the potential to earn back from the federal government a share of the money saved by delivering higher quality, lower cost care to a group of Medicare patients.

In 2018, Cone’s ACO, the Triad HealthCare Network, earned an extra $13.2 million by meeting benchmarks for quality and cost. The year before, the ACO earned an extra $10.7 million.

Networks like Triad HealthCare are still the exception, rather than the rule. But value-based care is beginning to spread into privately funded health care.

Last month, for example, Blue Cross announced that it had agreed on long-term contracts with five of the state’s biggest hospital systems to move roughly half their payments from fee-for-service to value-based care by 2020.

Though health care that’s cheaper and higher quality is attractive, value-based care can’t deliver the cost cuts that Folwell’s would.

“[The SHP} would be reducing revenue to these hospitals by a very substantial amount,” said Stuart Altman, a Brandeis University health care economist who also teaches part-time at UNC’s Gillings School of Global Public Health. “There is no amount of value-based [care] that would get anywhere close to that, nothing even remotely close.”

Hospitals face tough choices

According to SHP figures, the new payment system would cut overall payments for hospital outpatient services by almost a third. Hospital inpatient services, overall, would see much smaller cuts — from an average of 158 percent of Medicare rates to 155 percent. For large health systems, like Cone, the cuts could total up to tens of millions of dollars a year.

For smaller hospitals, especially rural facilities that are often perilously close to losing money, the cuts could push them into the red, hospital executives say, unless they cut other areas of hospital spending to make up the difference.

“Based on his proposed plan, we would lose 50 percent of our current state employee health plan reimbursements,” said Kathy Bailey, president and CEO of Carolinas Healthcare System Blue Ridge, a 184-bed in Morganton.

That loss — more than $9 million per year — would force Bailey to make some tough decisions, she says.

“Nine million is a lot more than what our operating margin was last year, and more, a lot more, than what it’s expected today, this year,” she said. “If his plan goes into place, we’ll have to make some pretty tough decisions on what services we can continue to offer.”

Potentially on the chopping block, Bailey says, would be free services, such as sports medicine for local high schools and free health screenings. She would also have to evaluate whether Blue Ridge could continue to offer some specialty services that are unusual for a small hospital, such as staffing a special care nursery 24-7 with neonatologists and having an infectious disease physician and gerontologist on the medical staff.

Employers subsidizing Medicaid

Altman says part of the problem that hospitals face has been created by legislative inaction in another area: Medicaid.

After the Affordable Care Act was passed, many states expanded their Medicaid programs to cover a wider swath of low-income residents. But the North Carolina General Assembly didn’t. Plus, in North Carolina, Medicaid is relatively stingy — paying hospitals and other providers significantly less than what it costs to actually deliver care.

Cone Health, for example, earned about $209 million in revenues from Medicaid for the fiscal year ending September 30, 2018, but it still lost about $62 million on those services, according to spokesman Doug Allred.

Between low Medicaid payments and the lack of Medicaid expansion, Altman says, hospitals end up treating more uninsured patients, who frequently can’t pay for the cost of their care. So employer-based health plans make up the difference.

“They then turn around and charge the privately insured substantially — substantially — more than the cost,” he said.

And in North Carolina, the biggest employer-based health plan is the state’s.

Folwell, however, has maintained since announcing the plan last fall that the State Health Plan should be treated like a government payor — similar to Medicaid or Medicare or even the systems set up to pay for prisoner health care — rather than like a private-sector, employer-funded health plan.

North Carolina’s $6 billion Medicaid program, which covers 2.1 million people, is scheduled to shift to managed-care plans this year. But those changes won’t change who’s eligible and aren’t designed to increase overall payments to providers.

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KY Health News: Half of US adults don’t know symptoms of heart attacks; KY high in heart attacks – User

By Melissa Patrick
Kentucky Health News

About 50 percent of American adults don’t know the five common symptoms of a heart attack, even though a heart attack happens about every 40 seconds in the U.S., according to a recent study.

The five common symptoms of heart attack are pain or discomfort in the jaw, neck, or back; feeling weak, lightheaded or faint; chest pain or discomfort; pain or discomfort in the arms or shoulder; and shortness of breath.

Other symptoms include unexplained tiredness and nausea and vomiting.

The study, published in the Centers for Disease Control and Prevention’s Feb. 8 Morbidity and Mortality Weekly Report, found that while the number of U.S. adults who could list all five of these symptoms increased to 50.2 percent in 2017 from 39.6 percent in 2008, half the adults in the study couldn’t name them. Nearly 95 percent knew to call 911 if someone was having a heart attack. The data came from the National Health Interview Survey.

The study found that knowledge about the five heart attack symptoms was lower among men, young adults, racial and ethnic minorities, and persons with less than average education.

Heart attacks happen when part of the heart muscle doesn’t receive adequate blood flow. It’s important to call 911 immediately if you or someone you know is having a heart attack because the more time that passes without treatment to restore blood flow, the greater the risk to the heart.

In Kentucky, 6.5 percent of adults reported having had a heart attack, according to the 2017 Behavioral Risk Factor Surveillance System annual survey. The national average was 4.2 percent. Kentucky ranks second highest for his measure, followed by West Virginia. The CDC reports that every year, about 790,000 Americans have a heart attack.

Click here for an interactive atlas of heart disease and stroke data for each county in Kentucky.

Coronary artery disease, or atherosclerosis, which is sometimes called hardening of the arteries, is the main cause of heart attack, the CDC says. The disease is caused by plaque buildup in the wall of the arteries that supply blood to the heart and other parts of the body, which causes the arteries to narrow over time and can partially or totally block the blood flow.

The CDC offers a list of things you can do to lower your chances of getting heart disease, including: eating a healthy diet, being physically active, maintaining a healthy weight, not smoking, limiting your alcohol intake, checking your cholesterol, controlling your blood pressure, managing your diabetes, having screening tests done that are recommended and taking medications to control your high cholesterol, high blood pressure or diabetes.

It’s also important to find out who in your family has heart disease and to then share it with other family members and your health care providers because having close blood relatives with heart disease can also increase your risk of having a heart attack.

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Ann Angell: It’s time to focus on heart health

Since February is heart month, I thought It would be appropriate to write about heart disease — something that runs deep in my family.

Just because someone has heart disease in their family doesn’t always mean they too will develop heart disease. Heart disease can be caused by the choices we make — the food and drink choices, as well as our all-around lifestyle.

Someone with no heart disease in their family can still get it, and someone with a genetic predisposition for heart disease can avoid getting it.

A book I often use as a reference when I am curious about different health issues is “How Not to Die” by Dr. Michael Greger. The intro to this book sold me. It’s the story of why Greger chose the path of medicine for his own career.

Greger’s grandmother had several heart bypass surgeries and was basically sent home by her doctor in a wheelchair with crushing chest pain at age 65 to die. The doctors could not do any more for her. Basically, a death sentence.

His grandmother happened to see Nathan Pritikin on “60 Minutes” stating that heart disease could be reversed by a plant-based diet, so she decided to go to California to the Pritikin Longevity Center, where she delved into this newfangled way of eating.

Within three weeks, she was up out of her chair and walking miles. After her dramatic lifestyle change, she lived 31 more years — to 96 years old!

Nathan Pritikin himself had heart disease and very high cholesterol. He was able to reverse both by cutting animal products from his diet. When he died, an autopsy revealed his arteries to be completely clean, even though he had suffered from heart disease and high cholesterol prior to the major change in the way he ate. The results of his own autopsy were even published in the New England Journal of Medicine.

We have known for some time that diet and disease are very closely linked, but the go-to cure for most diseases is a pill or three.

Why isn’t our dietary consumption ever analyzed as an option for change? I suspect it has to do with money. You never hear of the Kale and Broccoli Association visiting the doctor’s office to promote their goods. Or the Brown Rice and Legume Society leaving free samples.

Drug companies are ever-present influence in the medical world. And medicine can be a miracle for some. But that does not mean is the only miracle that can happen.

So we must educate ourselves. We cannot always count on others to help us. Raise your hand if you want to try to stay off all meds if possible. We should all want that. We should try to fix the problems that cause the heart disease or the high cholesterol, not just medicate it away.

We tend to give in way too easily. Heart disease and high cholesterol are almost non-existent in many countries where people eat mostly plant-based diets. Japan has a very low rate of heart disease. The Japanese consume a lot of fish and vegetables, eat smaller portions and are very active even into old age.

Dr. Dean Ornish, Dr. T. Colin Campbell and Dr. Caldwell B. Esselstyn are famous experts in the field of heart disease reversal. They all believe that a plant-based diet can change the path of heart disease and in many cases completely reverse it.

Be your own detective and research for yourself all the interesting data that I wish my mother had access to in 1981 when she died of heart disease. I wish my dad had it too, in 1976.

That brings me to exercise. Our heart is a muscle that we need to exercise to keep strong. Stay as active as you can throughout your entire life. Exercise can reduce inflammation in our bodies, which is a great insurance plan against coronary disease.

Things to remember that will help you to be healthier:

•  Control your blood pressure (exercise can do wonders).

• Keep your cholesterol within healthy parameters (diet can do wonders).

• Keep your weight down (diet and exercise can do wonders).

• Don’t smoke.

• Get plenty of sleep.

• Reduce your stress.

• Reduce your alcohol intake.

All familiar advice — but putting all that into motion can be a challenge. If you have been diagnosed with heart disease, consult your physician about where to start. But also be a detective for yourself. Check the facts and alternatives. Commit long-term to exercise and changes in your diet. Take control and make you own decisions through education. And always keep moving.

Ann Angell is a certified instructor and personal trainer. She is fitness director for the YMCA of Calhoun County. Her fitness column appears the third Sunday of each month.



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Glimpsing the future at gargantuan health technology showcase – Herald





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Why conservatives should care about women’s health | Commentary

For too long, conservative thinking on women’s health has selectively overlooked the influence women have on both economic opportunity and social stability. Conservatism is rooted in ideals of individual rights, liberty and the protection of human dignity. But partisanship has caused too many conservatives to look past the moral and even economic reasons to care for the health of women. You would think the ability of half the population to thrive economically would resonate. Yet issues from family planning to access to care are caught up in our contemporary polarization.

Nearly 150 years ago, Republicans were the first major political party to acknowledge and support the rights and representation of women within the party platform. The road to women’s suffrage proved a long and arduous journey. But from the election of Jeannette Rankin to the U.S. House to introduction and ratification of the 19th Amendment, Republicans were influential in women becoming more actively involved in American society.

We have more work to do in the pursuit of full equality, but women have continued to push forward in every facet of American life. Today, women outnumber men on college campuses, with women comprising the majority of medical and law school enrollees. Single women are purchasing homes at twice the rate of single men. And women are more likely to start businesses than their male peers, according to a study by SCORE, equating to an estimated 1,821 new U.S. businesses per day. 

That is all to the good, but too many women in the United States are being left behind. That is creating devastating consequences for their individual welfare and our collective strength and international competiveness.

Compared to women of other high-income countries like Canada, Germany, Australia and the United Kingdom, U.S. women cope with higher instances of chronic disease and are more prone to skipping important medical care because of cost and inability to afford adequate treatment, according to research from the Commonwealth Fund. Yes, infant mortality is at a historic low. But American women are more likely to die in childbirth, with maternal mortality rates doubling since the mid-1980s.

Those realities equate to the deaths of two to three women daily from complications of pregnancy or childbirth. Tragically, that ranks as the highest rate among developed countries in the world. And as NPR and ProPublica reporting notes, “for every American woman who dies from childbirth, 70 more come close.”

Geographic isolation, “medicine as business” models, gender and racial bias, and socioeconomic inequalities further compound these issues. Geographic isolation alone is a major limitation. Half of all counties in the United States are without a single obstetrician and 50 percent of rural counties are without a hospital where women can give birth.

The Texas Organization of Rural and Community Hospitals reports that only 69 of 163 rural hospitals in the state still deliver babies. This naturally creates serious health risks for women in these areas. It also becomes one more way in which low-income communities become separated from the larger American culture, exacerbating the socio-economic divide that is creating such tension across our nation.

The impact of geographic isolation on women’s health care also came through in a groundbreaking assessment on access in the U.S. to feminine hygiene products in low-income areas. Researchers at the Saint Louis University College for Public Health and Social Justice found that nearly half of all participants surveyed could “not afford to buy both food and period-related products during the past year.” Nearly two-thirds of respondents were unable to afford products like tampons and sanitary pads at some point during the previous year. And of the participants in full- or part-time employment, 36 percent reported missing at least one day of work a month due to lack of access to much-needed products.

Economic disparities present their own challenges. Deaths from cervical cancer, which is a preventable and treatable disease with adequate care, are twice as likely in low-income counties than in more affluent areas, according to the American Cancer Society, and twice as likely among African American women than white women.

For too many women, their personal demographics determine how long and how healthy they live. The United Health Foundation pointed out in a study that the mortality rates for women and children vary greatly depending upon the state in which they live. Women who have the means can travel elsewhere for care. For those that don’t, options are limited.

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Two Crises In One: As Drug Use Rises, So Does Syphilis

Public health officials grappling with record-high syphilis rates around the nation have pinpointed what appears to be a major risk factor: drug use.

“Two major public health issues are colliding,” said Dr. Sarah Kidd, a medical officer at the Centers for Disease Control and Prevention and lead author of a new report issued Thursday on the link between drugs and syphilis.

The report shows a large intersection between drug use and syphilis among women and heterosexual men. In those groups, reported use of methamphetamine, heroin and other injection drugs more than doubled from 2013 to 2017.

The data did not reveal the same increases in drug use among gay men with syphilis, the group with the highest rates of the disease.

Researchers said the results suggest that drug use — and the risky sexual behaviors associated with it — may be driving some of the increase in syphilis transmission among heterosexuals.

People who use drugs are more likely to engage in unsafe sexual behaviors, which put them at higher risk for sexually transmitted diseases, experts said. The CDC also saw increases in syphilis among heterosexuals during the crack cocaine epidemic of the 1980s and 1990s, and use of the drug was associated with higher syphilis transmission.

“The addiction takes over,” said Patricia Kissinger, an epidemiology professor at Tulane University School of Public Health and Tropical Medicine.

For example, people using drugs may avoid condoms, have multiple sex partners or exchange sex for drugs or money — all significant risk factors for sexually transmitted diseases, said Dr. Sara Kennedy, medical director of Planned Parenthood Northern California.

“I think it’s impossible to eradicate syphilis and congenital syphilis unless we are simultaneously addressing the meth-use and IV-use epidemic,” Kennedy said.

Syphilis rates are setting records nationally. They jumped by 73 percent overall and 156 percent for women from 2013 to 2017. The highest rates were reported in Nevada, California and Louisiana.

Syphilis — which had been nearly eradicated before its resurgence in recent years — is treatable with antibiotics, but if left untreated it can lead to organ damage and even death. Congenital syphilis, which occurs when a mother passes the disease to her unborn baby, can lead to premature birth and newborn deaths.

The study’s authors analyzed syphilis cases from 2013 to 2017 and determined which patients had also reported using drugs. They discovered methamphetamine was the biggest problem: More than one-third of women and one-quarter of heterosexual men with syphilis reported using methamphetamine within the previous year.

Substance use among both populations was highest in 13 Western states and lowest in the Northeast. In California, methamphetamine use by people with syphilis nearly doubled for women and heterosexual men from 2013 to 2017, according to the California Department of Public Health.

The intersecting epidemics of sexually transmitted infections and substance abuse make it harder to identify and treat people with syphilis because drug use makes people less likely to go to the doctor and to report their sexual partners, Kidd said.

Pregnant women also may be reluctant to seek prenatal care and get syphilis testing and treatment because of concerns their doctor will report the drug use.

To stem the transmission of syphilis, the CDC urges more collaboration between programs that address STDs and programs that treat substances abuse.

Drug use is an “incredibly huge contributing factor” to somebody getting an STD and transmitting it, said Jennifer Howell, sexual health program coordinator for the health district in Washoe County, Nev.

“Everybody needs to see that we are dealing with a lot of the same clients,” she said.

Fresno County has the highest rate of congenital syphilis in California. Its health department analyzed 25 cases of congenital syphilis in 2017 and determined that more than two-thirds of the mothers were using drugs, said Joe Prado, the county’s community health division manager.

The county has started offering STD testing for people entering inpatient drug treatment facilities, Prado said. “That’s our opportunity to get them screened,” he said.

Those who return for the results are offered incentives such as gift cards. The county also gives people in drug treatment a care package that contains condoms and education materials about sexually transmitted infections, Prado said.

The city of Long Beach sends a mobile clinic to drug treatment facilities, where it provides HIV testing, said Dr. Anissa Davis, the city’s health officer. She said Long Beach hopes to expand services to include screening for other sexually transmitted infections.

Although increased collaboration between drug treatment providers and STD clinics is essential, it’s not always easy because they traditionally have not worked together, said Kissinger of Tulane.

“The STI people are hyperfocused on STIs and the substance abuse people are focused on substance abuse,” she said. It is an “opportunity lost” if people in drug treatment aren’t screened for syphilis and other sexually transmitted infections, she added.

Fighting the rising rates of syphilis will also require more resources, said Dr. Jeffrey Klausner, a professor of medicine and public health at UCLA.

“The STD workforce has almost entirely disappeared,” he said. “While policies could be put in place that require syphilis testing, those policies also have to come with resources.”

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Discharged, Dismissed: ERs Often Miss Chance To Set Overdose Survivors On ‘Better Path’

The last time heroin landed Marissa Angerer in a Midland, Texas, emergency room — naked and unconscious — was May 2016. But that wasn’t her first drug-related interaction with the health system. Doctors had treated her a number of times before, either for alcohol poisoning or for ailments related to heavy drug use. Though her immediate, acute health issues were addressed in each episode, doctors and nurses never dealt with her underlying illness: addiction.

Angerer, now 36 and in recovery, had been battling substance use disorder since she started drinking alcohol at age 16. She moved onto prescription pain medication after she broke her ankle and then eventually to street opiates like heroin and fentanyl.

Just two months before that 2016 overdose, doctors replaced an infected heart valve, a byproduct of her drug use. She was discharged from the hospital and began using again the next day, leading to a reinfection that ultimately cost her all 10 toes and eight fingers.

“[The hospital] didn’t have any programs or anything to go to,” Angerer said. “It’s nobody’s fault but my own, but it definitely would have been helpful if I didn’t get brushed off.”

This scenario plays out in emergency departments across the country, where the next step — a means to divert addicted patients into treatment — remains elusive, creating a missed opportunity in the health system.

A recent study of Medicaid claims in West Virginia, which has an opioid overdose rate more than three times the national average and the highest death rate from drug overdoses in the country, documented this disconnect.

Researchers analyzed claims for 301 people who had nonfatal overdoses in 2014 and 2015. By examining hospital codes for opioid poisoning, researchers followed the patients’ treatment, seeing if they were billed in the following months for mental health visits, opioid counseling visits or prescriptions for psychiatric and substance abuse medications.

They found that fewer than 10 percent of people in the study received, per month, medications like naltrexone or buprenorphine to treat their substance use disorder. (Methadone is another option to treat substance use, but it isn’t covered by West Virginia Medicaid and wasn’t included in the study.) In the month of the overdose, about 15 percent received mental health counseling. However, on average, in the year after the overdose, that number fell to fewer than 10 percent per month.

“We expected more … especially given the national news about opioid abuse,” said Neel Koyawala, a second-year medical student at Johns Hopkins School of Medicine in Baltimore, and the lead author on the study, which was published last month in the Journal of General Internal Medicine.

It’s an opportunity that’s being missed in emergency rooms everywhere, said Andrew Kolodny, the co-director of Opioid Policy Research at the Heller School for Social Policy and Management at Brandeis University outside Boston.

“There’s a lot of evidence that we’re failing to take advantage of this low-hanging fruit with individuals who have experienced a nonfatal overdose,” Kolodny said. “We should be focusing resources on that population. We should be doing everything we can to get them plugged into treatment.”

He compared it to someone who came into the emergency room with a heart attack. It’s taken for granted that the patient would leave with heart medication and a referral to a cardiac specialist. Similarly, he wants patients who come in with an overdose to start buprenorphine in the hospital and leave with a referral to other forms of treatment.

Kolodny and Koyawala both noted that a lack of training and understanding among health professionals continues to undermine what happens after the overdose patient is stabilized.

“Our colleagues in emergency rooms are not particularly well trained to be able to help people in a situation like this,” said Dr. Margaret Jarvis, the medical director of a residential addiction treatment center in Pennsylvania.

It was clear, Angerer said, that her doctors were not equipped to deal with her addiction. They didn’t know, for instance, what she was talking about when she said she was “dope sick,” feeling ill while she was going through withdrawal.

“They were completely unaware of so much, and it completely blew my mind,” she said.

When she left the hospital after her toe and finger amputations, Angerer recalls her next stop seemed to be a tent city somewhere in Midland, where she feared she would end up dead. Instead, she persuaded her mother to drive her about 300 miles to a treatment facility in Dallas. She had found it on her own.

“There were a lot of times I could have gone down a better path, and I fell through the cracks,” Angerer said.

The bottom line, Jarvis said, is that when a patient comes into the emergency room with an overdose, they’re feeling sick, uncomfortable and “miserable.” But surviving that episode, she emphasized, doesn’t necessarily change their perilous condition.

“Risk for overdose is just as high the day after as the day before an overdose,” said Dr. Matt Christiansen, an assistant professor in the Department of Family Community Health at the Marshall University Joan C. Edwards School of Medicine in West Virginia.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Facebook may hide anti-vaxx posts after it’s accused of spreading fake health news


A measles outbreak is spreading across a Washington county known for choosing not to vaccinate its children, and health officials have declared a public health emergency.

Facebook says it has ‘taken steps’ to reduce fake health news, anti-vaxx posts amid measles outbreak

Facebook is considering making anti-vaccination content on its site less visible amid a measles outbreak that has reignited a conversation about preventative shots. 

The social media giant that’s been criticized for spreading fake news told USA TODAY it’s “taken steps to reduce the distribution of health-related misinformation on Facebook, but we know we have more to do.”

Facebook has been fighting misinformation on its platform since the 2016 presidential election after fake accounts and news stories aimed at sowing discord among users were discovered.

“We’re currently working with outside experts on additional changes that we’ll be announcing soon,” Andy Stone, a spokesperson for Facebook, said in a statement. Stone couldn’t comment on exactly how soon those changes would be announced. 

Facebook told Bloomberg this might look like “reducing or removing this type of content from recommendations, including Groups You Should Join, and demoting it in search results, while also ensuring that higher quality and more authoritative information is available.”

More: Facebook is investing in local news and there’s nothing fake about it

More: Facebook is judging how trustworthy you are: What you need to know

This response follows a letter from Rep. Adam Schiff (D-Calif.) partly blaming Facebook and Instagram for spreading false information about vaccine safety. 

“As a Member of Congress who is deeply concerned about declining vaccination rates around the nation, I am requesting additional information on the steps that you currently take to provide medically accurate information on vaccinations to your users, and to encourage you to consider additional steps you can take to address this growing problem,” Schiff wrote to Mark Zuckerberg.  

More: Wife of White House official claims measles ‘keep you healthy fight cancer.’ Not quite.

More: Son defies mom, chooses to get vaccinated at 18: ‘God knows how I’m still alive’

Right after the 2016 election, Facebook introduced a series of changes to stop fake information from spreading on its service, including making it easier for people to report hoaxes and fact-checking organizations to flag fake articles.

In August 2018, Facebook introduced reputation scores to users to weed out malicious actors who abuse the system for flagging fake articles. “We developed a process to protect against people indiscriminately flagging news as fake and attempting to game the system,” said the company in a statement.

Last fall, Facebook chief operating officer Sheryl Sandberg and Twitter CEO Jack Dorsey testified before Congress ahead of the 2018 midterm elections on how they planned to keep foreign actors from using their platforms to spread misinformation.

Fears of misinformation have grown as more people use social media to consume news. A survey released in September by the Pew Research Center found two-thirds of Americans get their news on social media platforms.

As of now, health-related information is eligible for fact-checking through Facebook’s partners certified through a non-partisan International Fact-Checking Network.

People choosing not to vaccinate have become a global health threat in 2019, the World Health Organization reported. Also, the CDC recognized that the number of children who aren’t being vaccinated by 24 months old has been gradually increasing.

Some parents opt not to vaccinate because of the discredited belief vaccines are linked to autism. The CDC said that there is no link and that there are no ingredients in vaccines that could cause autism.

Currently, an anti-vaccination hot spot in Washington state is battling a measles outbreak that’s been declared a public health emergency. More than 50 people have  been infected, mostly unvaccinated children. The state is also entertaining a bill that would remove parents’ ability to refuse the measles, mumps and rubella vaccine for their school-age children. 

More: I’m an adult worried about measles. What do I need to know?

More: A quarter of all kindergartners in this county in Washington aren’t immunized. Now there’s a measles crisis

Follow Ashley May and Brett Molina on Twitter: @AshleyMayTweets and @brettmolina23 


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New environmental board gives voice to poor neighborhoods

By Greg Barnes

This story was published in partnership with Coastal Review Online.

Members of a new state panel boarded a church bus Tuesday morning in Wilmington, intent on exploring the environmental atrocities of the past and determined to keep history from repeating itself.

Veronica Carter stood at the front of the bus, serving as a guide on a roughly 25-mile, three-hour tour for the 16-member North Carolina Department of Environmental Quality’s Environmental Justice and Equity Advisory Board.

The board’s primary objective is to protect and provide a voice for people living in underserved and underrepresented communities across the state — communities that are, by and large, poor and black.

Perhaps nowhere else in the state are the reminders of past environmental disasters in these communities more vivid or as shameful as they are near Wilmington.

Shortly after the bus rolled out, Carter, a retired Army major and a board member, called attention to Wilmington’s 1898 Memorial Park, which commemorates blacks who died or were run out of town in November of that year when a white mob overthrew Wilmington’s biracial government.

“African Americans in this city have never recovered,” Carter bellowed in her Army voice before the bus turned onto a paved road lined by trailers and small houses, some still bearing blue tarps and other scars left nearly six months ago by the winds and record-setting rain of Hurricane Florence.

This is the Flemington community, Carter told the group, referring to the poor, largely black community off U.S. 421 in New Hanover County that had unknowingly been drinking well water laced with arsenic, boron, cobalt and other contaminants for decades.

The toxins came from an unlined pit where Duke Energy had stored coal ash, the residue of a coal-fired power plant that operated here from 1954 until 2013, when Duke opened a $600 million natural gas plant nearby.

shows a group of people standing on the shore of a lake looking out. One of the women is speaking.
Veronica Carter, foreground, tells other members of the the N.C. DEQ’s Environmental Justice and Equity Advisory Board that people of little means may be eating contaminated fish caught off this dock at Sutton Lake. Photo credit: Greg Barnes

Duke was fined a record $25.1 million for the contamination, a figure that was later reduced to $7 million in a settlement with the state. Duke also paid more than $3 million to have public water lines run to the Flemington community in 2016. None of the money, Carter told the group, went to pay medical bills for residents who may have been harmed by the contamination.

“These small communities never have a chance,” said Carter, an environmental activist and board member with the North Carolina Coastal Federation.

Duke is now excavating the coal ash and putting it in nearby lined pits that will be capped when the work is complete. A deadline for completion has been set for later this year.

Sutton Lake

Sutton Lake sits a stone’s throw from the Flemington community. The 1,100-acre reservoir was formed by Duke’s predecessor, Carolina Power Light, in 1972 to cool its power plant.

An earthen dam at the lake breached during Hurricane Florence, flooding coal ash pits and spilling some of their toxic contents into the Cape Fear River. State regulators say the spill did not harm the river.

Environmentalists say Sutton Lake is contaminated, too, an opinion backed by science but one that remains up for debate.

A study in 2017 by Duke University found high levels of selenium in fish in Sutton and two other North Carolina lakes that had been receiving coal ash from power plants.

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According to the study, early life exposure to selenium can cause deformities, impaired growth and reproduction, and in extreme cases death in fish and aquatic invertebrates. Because selenium accumulates in the food chain, it also can be toxic to birds that eat aquatic animals containing high levels.

Of the three lakes studied, Sutton had the highest concentration of selenium, with 85 percent of all fish muscle samples containing levels above what the U.S. Environmental Protection Agency considers safe.

Board members departed the bus at Sutton Lake’s public access area, where Carter said a dock is usually thronged by people fishing, not for recreation but for subsistence. For many, Carter told the group, fish from the lake is their primary source of protein.

Some board members asked why there are no signs at the dock or the public boat ramp warning people that the fish may be contaminated.

It’s an old story, responded Dana Sargent, deputy director of Cape Fear River Watch. No one — not the state or local governments — knows who would be responsible for placing the signs.

Contamination in Navassa

Board members asked question after question as the bus headed to its next destination, the town of Navassa, where the majority of its 1,895 residents are black and poor. Many are the descendants of the Gullah Geechee people, who arrived here to work in the town’s rice plantations.

The bus stopped outside Reaves Chapel, a dilapidated clapboard church built after the Civil War that once served as a house of worship for the Gullah-Geechee.

shows a group of people sitting in a charter bus, looking out the right hand window
Members of the N.C. DEQ’s Environmental Justice and Equity Advisory Board on a bus tour of contaminated sites near Wilmington. Photo credit: Greg Barnes

Efforts are underway to restore the church, which sits in woods that are about to give way to two new subdivisions containing 6,000 homes — three times as many homes as Navassa now has people. Board members remarked that the subdivisions could lead to more problems for the Navassa natives, including gentrification, higher property values and a dilution of voting strength.

It’s the cumulative effects of environmental contamination that Carter and other board members worry about most. Navassa is a poster town for those impacts. The town has four inactive brownfield sites, land that cannot be developed because of industrial contamination lying under the surface. Carter told the group that there are more brownfield and federal Superfund sites in Navassa than any other municipality in the state.

The bus rolled past some of the brownfield sites before arriving at the former Kerr-McGee Chemical Corp. plant, which used to preserve wood with creosote in unlined pits from 1936 to 1974. The creosote, a probable carcinogen, has seeped as deep as 100 feet into the ground, Carter told the group.

The EPA deemed the property a Superfund site and added it to its National Priorities List in 2010. Efforts are now underway to turn some of the land into public space, which could include a park with trails and an amphitheater, a river walk and a rice field for demonstration purposes of the town’s heritage. The remainder of the land remains unusable.

Carter, who lives in the neighboring town of Leland, said she has heard from many people living in Navassa whose relatives had died at an early age from cancer. Although there is no way to quantify whether contaminants caused the diseases, Carter said, “you know we think in our heart of hearts that was the problem.”

Board urged to act

The bus arrived back at Cape Fear Community College at about 1 p.m. The tour served as a prelude to the board’s third meeting since it was formed last May.

After concluding the mundane matters of a new board, including the names of subcommittees, the panel heard from two of the DEQ’s top-ranking officials, Sheila Holman, assistant secretary for the environment, and John Nicholson, DEQ’s chief deputy secretary.

shows a woman standing in a room full of people, speaking.
Sheila Holman, DEQ’s assistant secretary for the environment, tells the N.C. DEQ’s Environmental Justice and Equity Board about a new mapping tool. Photo credit: Greg Barnes

Holman unveiled a new mapping tool, which she and other DEQ officials said will enable local planners to better determine the suitability of proposed industrial sites and inform residents of the potential environmental effects those industries could cause. The tool is expected to become available for public use April 1.

The board also approved statements about their concerns over coal ash and industrial-scale animal farms. The statements will be provided to DEQ officials.

But perhaps the most telling part of the board’s mission came during the public comments period at its conclusion. About a dozen speakers stood up, most praising the board for its work and expressing deep concerns about GenX or coal ash.

Frank Holleman, senior attorney with the Southern Environmental Law Center’s Chapel Hill office, urged the board to voice objection to Duke Energy’s plans to excavate coal ash pits from only eight of its 14 coal-fueled power plants. Many of those plants have converted to natural gas.

Holleman noted that South Carolina and Virginia have required energy companies in those states to remove the coal ash and place it in lined and covered landfills. North Carolina needs to do the same, he said.

“This is an opportunity for the state and the governor of this state to do something about it,” Holleman said, urging the board to speak up. “There is no better body to take action than this body.”

The Rev. Gregory Hairston told the board that people are becoming ill from the 12 million tons of coal ash stored in Stokes County, where he lives.

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“I try to encourage you because we feel we are not getting a fair shake,” Hairston said. “It’s time that we had a voice, and we feel that we don’t have a voice in our state … We demand and we request that you be a forceful voice for us.”

Board hears complaints, too

The board also heard complaints from residents.

“You’re understaffed, you’re under budget, I get it,” said Ashley Daniels, a member of Cape Fear River Watch and the North Carolina Environmental Justice Network. “But if you are saying you want to include the community, you have to do better.”

Daniels complained that there is too little notice of board meetings and too little time to prepare for them. Carter agreed. She asked that the next meeting, set for this summer, be held later in the day so more people could attend.

John Wagner of Chatham County complained that the board “is moving too slow.”

“I know you all have lives, but you are the board,” Wagner said. “Our house is on fire.”

Leslie Cohen said that, as a candidate for a state House seat last year, she spoke to thousands of people whose No. 1 concern is contamination of their drinking water. Many people cannot afford to buy bottled water or filtration systems, she said.

“We need you,” Cohen told the board. “Every citizen of North Carolina needs you.”

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