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Glimpsing The Future At Gargantuan Health Tech Showcase

ORLANDO, Fla. — Imagine going to the doctor and finding out before you leave the exam room how much your prescribed drug will cost, avoiding sticker shock at the pharmacy.

Or what if you could wear a tiny device at the top of your back that would gently nudge you to sit up straight whenever you slump.

How about not having to sign by hand a raft of hospital registration papers — instead, doing it all online — and using a laptop computer during your stay for health education purposes?

Innovations like these geared to help consumers were on display here this week at the nation’s largest health technology conference, the Healthcare Information and Management Systems Society meeting — popularly known at HIMSS. More than 40,000 health industry professionals gathered at the Orange County Convention Center, one of only a few in the country large enough to handle the conference.

How big was the meeting?

Attendees could use a 10-minute bus ride to get from one side of the mile-long center to the other. Just touring the exhibit hall was a full-day affair — not counting sitting in on the dozens of educational sessions meant to spur transactions among health businesses.

The exhibit hall had more than 1,300 companies showcasing their latest and greatest products. Traditional technology stalwarts such as IBM and Hewlett Packard Enterprise were on hand, but so were Uber and Lyft. Microsoft, Google and Amazon were selling services amid start-ups, too. Countries — such as Israel — had their own spaces.

Most of the technology on display was geared for the insurers, hospitals and doctors who command more than $3 trillion in annual U.S. health spending.

Terms like artificial intelligence, machine learning and predictive analytics ruled the day here as much as the stuffed animals, candy and other knickknacks attracting visitors. Who knew there were Chrome- and Google-themed socks?

But if you looked closer you could see new devices and systems geared toward changing the consumer experience — whether in the home, doctor’s office or hospital.

“Alexa, I’ve burned my hand what should I do?” asked an exhibitor from the Intelligent Health Association into the Amazon-owned device. “Is it a major burn or minor burn?” Alexa replied, then cited tips on how to treat the hand, such as running the wound under cold water.

A tabletop robot called Pillo showed how consumers could connect to a health coach via video conferencing, submit their latest blood pressure readings electronically to their doctors and dispense that day’s medications.

Around the corner, Surescripts, out of Arlington, Va., was showing how its technology allowed doctors to tap into a patient’s health insurance information to see what the copay would be for medication — and discover if a less expensive alternative existed. Tens of thousands of doctors already make use of the feature, although that represents barely 10 percent of all providers, a Surescripts representative said.

Google had an extensive exhibit showing it could offer a variety of its products, ranging from an indoor map that would help patients navigate through massive medical centers to an online registration tool using Google Cloud that would speed the sign-in process at hospitals. The hospital could then offer a Google Chromebook to provide medical education and other entertainment during a patient’s stay.

One feature being offered by Microsoft would appeal to anyone whose doctor spends more time typing notes into a computer during patients’ visits than listening to their problems. The company was showcasing a new speech-to-text program that could convert the entire patient visit into easily readable medical notes. “This has [the] power to save doctors hours of work — each day,” a Microsoft engineer said.

Nearby, Upright Inc. was one of 20 start-up companies at the Israel booth. For $80, it was selling a 2-inch sensor that people could put on their backs, and it would gently vibrate when the user assumed poor posture. An app can provide daily data on posture — call that the slouch rate?

As happy hours kicked into gear in the exhibit hall — free mimosas, wine and beer to go along with all the free coffee, fruit slushies and cookies — I thought it would be great if only I had the indoor Google app to find my way out of the convention center to my car.

One consumer health benefit from the conference already kicked in. My Fitbit showed I had walked nearly 15,000 steps.

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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Friday, February 15, 2019

The New York Times:
The Instant, Custom, Connected Future Of Medical Devices

When Jeff Dachis suddenly and unexpectedly learned he had Type 1 diabetes at the age of 46 in September 2013, he was stunned. After all, he ran marathons, followed a healthy diet and never had an inkling of any medical troubles during previous annual physicals. “I went to the doctor, got about six minutes with a nurse practitioner, an insulin pen, a prescription and a pat on the back, and I was out the door,” Mr. Dachis said. “I was terrified. I had no idea what this condition was about or how to address it.” Feeling confused and scared, he decided to leverage his expertise in digital marketing, technology and big data analytics to create a company, One Drop, that helps diabetics understand and manage their disease. (Morrissey, 2/14)

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Missouri Foundation for Health and KFF Announce New Long-term Partnership, Establish Kaiser Health News Midwest Bureau in St. Louis

ST. LOUIS, Mo. SAN FRANCISCO, Calif. — Missouri Foundation for Health (MFH) and KFF (the Henry J. Kaiser Family Foundation) have entered into a new long-term partnership to establish a KHN (Kaiser Health News) Midwest Bureau, based in St. Louis, Missouri.  KFF – the trusted source of health policy information – produces health policy analysis, polling, and journalism, and KHN is its national health and health policy newsroom, producing in-depth news coverage of health care policy and politics. An editorially independent program of KFF, KHN’s more than 50 journalists are mostly based in KFF’s Washington, D.C. offices or in California.

With support from MFH, KHN will expand its editorial staff and build a team of journalists based in St. Louis who, working with freelancers, will produce coverage throughout the region. The goal is to bring the same high-quality health and health policy journalism that KHN produces nationally to the region and to bring important stories from the Midwest Bureau to the nation.  As with all its journalism, KHN stories produced from the Midwest Bureau will be made freely available for publication by media outlets throughout the region and the country and will be published on and distributed through KHN’s social media platforms.

“This partnership continues and expands Missouri Foundation for Health’s commitment to health journalism,” said Robert Hughes, president and CEO of Missouri Foundation for Health. “This exciting new venture will provide the local health journalism Missourians need to understand and navigate the changing landscape of health, the health industry, and health politics. I’m looking forward to seeing more stories reported out of the Midwest Bureau receive the national attention they deserve.”

“We are thrilled that Missouri Foundation for Health is making it possible for us to bring KHN to the Midwest and to create a new engine for health journalism based in St. Louis,” said KFF president and CEO Drew Altman, who is also KHN’s founding publisher. “Next we hope to expand in other important regions such as the South and the Mountain states,” Altman added.

“The ongoing crisis in local journalism’s business model has left many communities with few or no trusted sources of news about a wide range of issues, including health,” said KFF vice president and executive director of Media and Technology, David Rousseau, KHN’s Publisher. “We are excited to be working with Missouri Foundation for Health to extend the KHN model of nonprofit journalism to the Midwest and are confident that both the region and the nation will benefit from this increased coverage.”

Media organizations interested in working with KHN should contact KHN at and those interested in joining our efforts to expand and improve health journalism in the Midwest and beyond should contact KFF at  Employment opportunities for the Midwest Bureau will be posted soon at

For more on the partners, visit Missouri Foundation for Health at, Kaiser Family Foundation at, and Kaiser Health News at


Missouri Foundation for Health is a resource for the region, working with communities and nonprofits to generate and accelerate positive changes in health. As a catalyst for change, the Foundation improves the health of Missourians through partnership, experience, knowledge, and funding. To learn more please visit

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Medical wasteland – Health news – Health – February 14, 2019


Dr. Linda Lewis often cringes when she sees health news on the internet. She, like anyone else with a smartphone or computer, encounters a barrage of articles with click-enticing headlines about breakthroughs in research and cutting-edge treatments.

Even after reading to the bottom, she said, “I often wonder, What’s the rest of the story?

She knows to be skeptical. Lewis is a medical professional—epidemiologist for the Butte County Department of Public Health and faculty member in the Health and Community Services Department at Chico State. She studies and tracks how diseases spread; scientific studies are her mental lifeblood.

Most readers lack her training. So, when a report misstates or oversimplifies findings, how many know the difference? Or, know to detect a discrepancy? When the report gets tweeted and retweeted, shared and reshared, blogged about and reposted, misinformation magnifies.

“Fifteen years ago, and before Web 2.0, this information was blurry and difficult to start with,” said Stephen Caldes, a Chico State journalism professor who teaches online media literacy. “Digital media, and social media specifically, has probably made this even more of a cluster.”

The extent to which internet distribution clouds health information got some quantification last week with the release of—shock!—a study that got covered in articles online.

Health Feedback, a group of international scientists who assess the credibility of health coverage from major media organizations, reviewed for accuracy the articles from last year that most engaged people on social media; that is, drew high totals of likes, shares and comments.

Among the top 10, only three proved highly credible. Four had scientific accuracy but misleading elements, and the remaining three had major inaccuracies. Extended to the top 100, the scientists determined 45 percent to be highly credible and 35 percent highly inaccurate.

Health Feedback conducted the study—titled “The Most Popular Health Articles of 2018, a Scientific Credibility Review,” out Feb. 4—in collaboration with an interdisciplinary media literacy group, the Credibility Coalition. They focused on articles about health and wellness as opposed to policy and politics.

Their findings surprised neither Lewis nor Caldes. Both pointed to sensational headlines and head-spinning research results, sometimes in direct contradiction to previous reports. The No. 1 social media story last year had as its headline “Federal Study Finds Marijuana 100X Less Toxic Than Alcohol, Safer Than Tobacco”—courtesy of (now apparently defunct). The review found this article highly suspect.

“Part of the scientific method, we never rely solely on one study,” Lewis said. “Studies have to be replicated. When there’s some new breakthrough—one study—it gets people’s attention, we’re interested, but [in medicine or public health] we’re not going to make changes until that study is replicated in a different institution by different people and the findings are consistent.”

Caldes noted a seesaw phenomenon: “Eggs have gone through ‘they’re good for you, they’re bad for you’; avocado, ‘it’s high in cholesterol, oh but it’s the good type of cholesterol’…

“With health and wellness and fitness and diet, that information is so fickle.”

Distinct from outright inaccuracy, Health Feedback delineated as credibility impacts such issues as lack of detail, absence of context, misinterpretation of findings and overstatement of significance. The study authors wrote, “This illustrates the need for journalists to go beyond simply accurately describing results and research in health news.”

Caldes feels readers also need to take extra steps.

“A well-meaning reporter can still make mistakes,” he said, “and half the articles we’re reading online are by citizen journalists or amateur journalists who are not working with an editorial board, haven’t been trained. So I want to put a lot of the effort on the consumer themselves. It’s your job to check the information; it’s your job to look into this further if it’s piqued your interest.”

Familiarity with the source of the material can serve as a good gauge of its accuracy.

Lewis sticks to sites for institutions she considers reputable. Her go-to resources are the U.S. Centers for Disease Control and Prevention and California Department of Public Health. She also trusts research hospitals such as the Mayo Clinic, Harvard and Johns Hopkins.

In an article, look for hyperlinks. If they connect to the original study, or a report on it from the researchers’ university, check that out. If links lead to a rabbit hole of rehashes, Caldes said, that’s a red flag.

“We’re now a nation of secondary sources,” he said. “We’re talking about articles that are using articles as their source material, rather than looking at studies, looking at statistics, looking at information from peer-reviewed journals.

“People can come up with questions on [the validity of] anything,” Caldes noted. “If something takes you to the CDC, I give that a certain amount of weight—or a Pew Research study, or a study coming out of Stanford. Could there be problems with it? Sure. But it’s not coming from these organizations that are just scouring the internet and writing things.”

Caldes considers Facebook, in particular, “a dumpster fire” of online info-sharing. While he found value in it during the Camp Fire aftermath, with immediate updates and connections to aid, “that was the first bright light I’ve seen in social media in a while.”

His recommendation: “Do not use Facebook to get your news and information. If you post and share, you are part of the problem—you’re just spreading information that was interesting to you that you didn’t do enough work to fully evaluate, but you’re willing to pass that on.”

Lewis, too, sees certain lines of value in the social media sphere. She suggested Twitter feeds from the county public health department and other reputable sources as ways to stay informed. Yet, she well understands the double-edged sword that unsheathes.

“It’s all in the way you use it,” she said of social media. As she tells her students, when going online, “there’s a wealth of information available. It’s a remarkable resource. Like any tool, you have to use it wisely.”

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Vaccine Hesitancy Tied To Community Norms : Shots – Health News

Hesitancy about vaccination in a community has a lot to do with acculturation to its norms.

Karl Tapales/Getty Images

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Karl Tapales/Getty Images

Hesitancy about vaccination in a community has a lot to do with acculturation to its norms.

Karl Tapales/Getty Images

Distrust of vaccines may be almost as contagious as measles, according to medical anthropologist Elisa Sobo.

More than 100 people have been infected with measles this year, according to the Centers for Disease Control. Over 50 of those cases have occurred in southwest Washington state and northwest Oregon in an outbreak that led Washington Gov. Jay Inslee to declare a state of emergency on Jan. 25.

Some public health officials blame the surge of cases on low vaccination rates for this highly infectious disease.

Defying Parents, A Teen Decides To Get Vaccinated

Clark County, Wash. — the center of the current spate of cases — has an overall vaccination rate of 78 percent, but some schools in the county have rates lower than 40 percent.

Washington is one of 17 states that allows a parent to send his or her child to public school not completely vaccinated because of a “philosophical or personal objection to the immunization of the child.”

What makes some families reluctant to vaccinate their children? Sobo, a professor at San Diego State University, says it may be driven in part by the desire to conform in a community where many parents are skeptical of vaccines.

To better understand how parents decide not to vaccinate, Sobo interviewed families at a school with low vaccination rates in California. She found that skepticism of vaccines was “socially cultivated.”

Parents who believe that vaccines are dangerous persuaded other parents to believe the same thing by citing fears of “mainstream medicine” harming their children. Enrolling in the school even seemed to change the beliefs of some parents who had previously followed the state-mandated vaccine schedule: They started to refuse vaccines.

Once A Vaccine Skeptic, This Mom Changed Her Mind

NPR’s Audie Cornish spoke with Sobo on All Things Considered. These interview highlights have been edited for clarity and length.

What are the common ideas that we have about families that don’t believe in vaccination?

One common idea would be that they’re all absolutely looney-tunes, crazy people wearing tinfoil hats and reading all these conspiracy theories on crazy blogs on the Internet. And that is absolutely not the case. What I found was that most of the people who are hesitating to vaccinate … They’re really smart people, and they’re highly, highly educated.

Back in 2012, you actually spoke to some parents in California, in a community where parents had their kids at a fairly progressive school. Half of kindergarteners had gotten exemptions from vaccines. What was going on in this community?

Often, the parents, the family didn’t arrive at the school having any hesitancy about vaccinations … As they acculturated or became part of the community, that’s when these kinds of beliefs and practices would take hold.

The longer the family had been in the community, … this practice of being hesitant about vaccinations evolved and it became part of that family’s medical practice.

[In areas where there are low vaccination rates], there tends to be a more open norm, where not vaccinating is accepted or sometimes even encouraged. When you have people surrounding you that move in that direction, to go in a different direction has social costs.

Number Of Early Childhood Vaccines Not Linked To Autism

It’s not just the facts and the information that you’re going by. It’s: “What are the norms? What are people around me doing? And they seem to be OK, and everything’s working out for them.”

Think about yourself and the clothes that you wear to work. I’m guessing that you probably don’t have a formal dress code, but you kind of look around, and you see: “Oh, OK, this is what we’re expected to wear to work.” And you just do it.

Are you talking about a formal kind of peer pressure?

The peer pressure is not formal.

Informally, there becomes a sort of feeling in the community. It becomes known for not vaccinating.

There are parts of the country where there’s the opposite expectation, where someone who didn’t want to vaccinate their kids might be socially isolated for that decision.

And then their behaviors would be pushed underground. They might not feel comfortable telling other people.

When you see what’s going on in Washington State, what came to mind for you?

What is the media coverage going to do? Are they going to vilify these parents?

That witch hunt aspect is not helpful to have a good discussion about vaccination. It needs to be much more open and much less polarizing.

Are people ready to listen? Can there be convincing?

I think people are very ready to listen — if they’re heard. If you listen to them, and you allow them to say what they think without feeling judged, without pushing them into a corner, they’re absolutely ready.

Mara Gordon is a family physician in Washington, D.C., and a health and media fellow at NPR and Georgetown University School of Medicine.

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Officials hope to change minds amid measles outbreak

Plan a magical wedding day in Vermont, whether ablaze with fall color, capped with snow, or lush with the green of summer. If you’re interested in learning more, click here.

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First Edition: February 13, 2019

The Washington Post:
Three Teen Suicides In Eight Months Have Devastated This Midwest Village

In June, the death of 16-year-old DeAnte Bland jolted the rural village of Kingsley — population 1,600 in northwest Michigan. Four months later, 14-year-old Kayden Stone’s death sent shock waves again through the close-knit community. Then, Shealynn Pobuda, also 14, died in early February and the community met its breaking point. Eight months, three teenagers, three suicides. “Everyone was devastated,” said Keith Smith, the superintendent of Kingsley Area Schools. “This is a small community, and not only do we all know each other, we all know each others’ kids.” (Thebault, 2/13)

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Medicaid changes will become more visible to beneficiaries, providers

By Rose Hoban

Most of North Carolina’s 2.1 million Medicaid recipients are likely unaware  that the program is about to dramatically change. That’s because, for years, most of the activity to make the transformation has taken place in legislative hearings and departmental conference calls.

But no longer. After years of planning, the changes to North Carolina’s Medicaid system are about to get real.

That was the message from state Health and Human Services Sec. Mandy Cohen to a legislative committee in Raleigh on Tuesday.

Last week, DHHS announced which companies won their bids to work with the state for a total of $6 billion in annual contracts. This week, lawmakers from the House Health Committee asked Cohen to explain publicly how her team at the Department of Health and Human Services decided which companies to provide services to the first 1.6 million Medicaid beneficiaries who will be in the first wave of change.

Beneficiaries will start seeing advertising campaigns roll out in early summer. Companies that won bids will start putting up billboards, sending mailings, and running TV and radio ads encouraging those people, who are mostly low-income children, some of their parents and pregnant women, to choose their health insurer.

“The way we’re going to do the start of managed care is going to be in a phased way. That’s to make sure we get as smooth of an implementation as we possibly can,” Cohen told lawmakers.  The regions surrounding the Triangle and Winston-Salem will launch the managed care program on Nov. 1, with the rest of the state following next February.

Preventive health benefits help line NC Dept of Insurance 855-408-1212

Contracts for behavioral health  providers for the most severely disabled will be issued in several years, once the larger populations requiring more basic care are on board.

Locals score poorly

In the 2015 bill that created this new Medicaid regimen, lawmakers made it clear they wanted to have some locally managed “provider-led entities” with majority ownership by health care providers to provide care.

Out of eight bidders, only three such provider-led organizations made bids for contracts. When Cohen displayed the numerical scores given to those bids by members of the DHHS team, it showed the three PLEs had the three worst outcomes. Only one, Carolina Complete Health, a consortium formed by the state medical society, the state community health center association and national managed care giant Centene, won a contract to provide care in two regions despite departmental reservations.

chart showing the evaluation scores for ach of the Medicaid managed care programs
Chart displayed by HHS Sec. Mandy Cohen shows the scores of each of the companies bidding for Medicaid contracts. Chart courtesy: NC DHHS

“We definitely wanted to recognize the fact that a lot of work went into the negotiations around getting to the legislation from 2015 and the contemplation of the provider-led entities. We felt like it was in the service of the intent of the law to include a regional provider-led entity,” Cohen said. “Carolina Complete Health was the only PLE that met minimum expectations.”

“It’s time,” says Cohen.

In recent public appearances, Sec. Mandy Cohen has become vocal about her desire to see the Medicaid program expand to cover people who make too much to qualify for Medicaid, but who earn too little to qualify for insurance subsidies available under the Affordable Care Act.

Many of these people falling into the “coverage gap” are family caregivers, people going to school and other low-income adults who earn less than $34,638 a year for a family of four. The number of people who would qualify range from a recent Kaiser Family Foundation estimate of 208,000 to older estimates generated by state-based researchers that say as many as 500,000 would qualify. Kaiser also estimated about 60 percent of these people are already working.

“If you really want to care about access … we have to think about using Medicaid to get more folks coverage,” Cohen told members of the House Health Committee on Tuesday. “If we’re really going to help folks get access to care in rural areas, having an insurance card and keeping those access points open is going to be really critical.”

While Cohen was more circumspect in front of legislators Tuesday, she offered a more full-throated endorsement of expansion during the recent Mental Health Legislative Breakfast in Chapel Hill in early February.

“It’s the right thing to do for North Carolina,” she told that gathering, to applause. “Think about that insurance card that’s sitting in your wallet that gives you that peace of mind. The fact that we have not done Medicaid expansion here in North Carolina is actually increasing the cost of care for all of us who do have insurance.”

She cited the fact that states that have expanded have lower rates of uninsurance, and that research shows 7 percent lower increases in prices for all health care consumers.

“I’ll say it another way. Our prices are 7 percent higher than they need to be,” she said. “And that is affecting every single one of us.”

When asked after the breakfast if she was taking a political risk by speaking out, Cohen said her message shouldn’t come as a surprise.

“I’ve always said access to care is so critical, we’ve been saying that all along,” she said. “I’ve done the work for two years to get us ready for this moment, to say that it’s time for Medicaid expansion. I didn’t come here two years ago and say, ‘We’re ready,’ I said, ‘Let’s work hard, let’s get the system ready. Let’s move to manage care. Let’s lay all that foundation.’

“Now I’m saying it’s time.”

Cohen explained that she and Medicaid head Dave Richard decided to give the group only two of the state’s six regions, which will be included in the second phase of the managed care rollout, “to give folks the most time to be ready.”

Another consortium, My Health by Health Providers, made up of the state’s hospitals along with a managed care company based in New Mexico, actually received a slightly higher overall score than Carolina Complete Health, but the group had only bid for a statewide contract and scored lower the other statewide bidders.

“Missed opportunity”

Committee chair Rep. Greg Murphy (R-Greenville), a physician who practices at Vidant Medical Center, expressed his disappointment that North Carolina-based PLEs were “locked out” of the contracts. Another member, Hugh Blackwell (R-Valdese) pressed Cohen for details of the decisionmaking process.

Cohen told him that all the bids were rated on 14 points, that were scored in parallel.

“There were very, very, very detailed questions and criteria… and we had a RFP that was nearly [300 or 400] pages long, with an appendix that was even longer, so folks had clear understanding of criteria by which they were going to be scored against,” she explained. “And the evaluation committee needed to use the words on the paper, but they were able to ask clarifying questions, and they did, through the process if things were unclear.”

“It just seemed that the legislative intent …  was to have a good mix between provider-led entities and private managed care orgs. I don’t see a big mix there,” Murphy responded. “I understand the scoring process, but … it’s a missed opportunity.“

It’s expected that some of the organizations not receiving contracts will challenge DHHS’ decision before the close of a 30-day appeals period.

Getting everyone on board

Most beneficiaries will see little difference in the process of getting Medicaid for now: county social service workers will continue to do perform eligibility screening for applicants. Cohen said beneficiaries don’t have to do anything other than to make sure that their contact information is up to date.

Although that sounds like a simple thing, Cohen said that’s hugely important.

“I will say that we haven’t been good about collecting multiple …  ways to communicate with folks. We know most of our Medicaid beneficiaries do have a cell phone, but we don’t systematically collect cell phone numbers,” she said. “We need to start doing that and communicating with folks by text message and not by snail mail all the time.”

But as changes get closer, there will be more public outreach.

Rep. Carla Cunningham, (D-Charlotte), who works as a nurse, said she’s been looking for public outreach since the start of the Medicaid changeover process.

Cohen said, though, that it’s best to wait.

“There’s a fair amount of research that shows that if you actually tell folks too soon when there’s actually not something to ‘do’ you lose them, you want to capture folks at a moment … when you want them to do something,” Cohen said. “So you will see us ramp up a lot of our communications just before and very much during that open enrollment period when there is something for them to do.”

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Tamra Judge Offered an Update on Eddie Judge’s Health: "Not The News We Were Hoping For" Blog

Tamra Judge has offered up a new update on Eddie Judge‘s ongoing heart issues after a check-up this week, telling fans on Instagram that they received “not the news we were hoping for. We will keep fighting this fight. Thank you for all the love. [Eddie] you have my heart.”

On Monday, The Real Housewives of Orange County husband underwent more testing to check on the status of his heart and AFib condition, which he confirmed he had last year. Tamra opened up about the procedure on Instagram prior to confirming what the doctors had discovered:

“Hoping for good news. It’s been 5 months since his last ablation and he’s been feeling so much better. Today the doc will scope his heart to see if his appendage is working properly [and] he can go off medication. If it’s not working the appendage will need to be closed (another procedure) and he stays on meds.[Eddie] must be nervous because his heart is playing all kinds of tricks right now. #AFib,” she wrote.

Photo: @TamraJudge/Instagram Stories

When Tamra and Eddie spoke to The Daily Dish late last month, they previewed their hopes for this next stage in his journey, with Eddie revealing at the time that “as of today I am feeling 99.9 [percent] normal. Yesterday was one of my first days that I have ever felt, since I got diagnosed, that I ever felt normal. I can think clearer, I have energy, I’m getting a lot of things done, I don’t feel lethargic.”

With the news different than the couple initially expected last month, Tamra did thank fans for their ongoing support this week as he continues on his health journey: “Thanks for all the sweet comments[;] he loves reading them.” -Additional reporting by Alice Dubin

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Vaccine Storage Too Often Fails To Meet Standards

By correcting one potential error, the Ventura County (Calif.) Health Care Agency accidentally made another — and jeopardized vaccines given to thousands of people in the process.

In October 2017, county health officials, concerned that vaccines were getting too warm while being transported to clinics, changed their protocol. But a routine audit in November found that the ice packs they were using may have frozen some of the medicines and lowered their effectiveness. The agency then offered to reimmunize everyone who had received a vaccine that was delivered in faulty packaging.

“There’s no way to tell whether or not they were ineffective,” said Jason Arimura, director of pharmacy services for Ventura County Medical Center. Out of an abundance of caution, “we just notified everyone.”

The number of patients affected: 23,000.

Ventura County is far from the only case of vaccines feared to be ineffective reaching patients. In the past 13 months alone, 117 children received possibly compromised vaccines against polio, meningococcal disease and the human papillomavirus at an Indian Health Service clinic in Oklahoma City because of improper refrigeration. Similar issues with temperature control prompted a health clinic in Indianapolis to send letters offering to revaccinate 1,600 people last January, according to local news reports.

On Feb. 1, Kentucky officials announced that potentially ineffective and contaminated vaccines were administered at multiple businesses across Kentucky, Ohio and Indiana. The statement did not disclose how many people were affected.

The federal government sets standards on the storage of vaccines. However, not all health care providers are accountable under those guidelines.

The Vaccines for Children (VFC) program, which offers these drugs at no cost for kids from low-income families, requires clinics, doctors and other providers to undergo annual audits and use top-grade equipment, such as continuous temperature-monitoring devices. It also requires that problems be reported to federal authorities.

More than 44,000 doctors participate in the program and provide vaccines to 90 percent of the children in the country, according to the Centers for Disease Control and Prevention.

But medical facilities outside of the program — like many pharmacies and internists with private practices who are treating adults or children not in the VFC program — have no comparable federal oversight. In fact, storing vaccines and reporting cases of patients receiving ineffective drugs is largely up to their discretion. The vaccines involved in the Ventura County recall were not part of the Vaccines for Children program.

Experts said most hospitals, clinics and doctors are vigilant in properly storing their vaccines. And research suggests that compromised vaccines given to patients are not harmful.

L.J Tan, chief strategy officer for the nonprofit vaccination advocacy group Immunization Action Coalition, said the nation’s vaccine stock is likely one of “the safest in the world.”

But improperly handling these medications means wasting expensive drugs, and using compromised vaccines “could create a pocket of underimmunized individuals,” said Dr. Julie Boom, a pediatrician and director of the immunization project at Texas Children’s Hospital. “And we don’t want that to happen.”

In Ventura County, the temperature problems affected vaccines for flu, tetanus, diphtheria, whooping cough and hepatitis B. County health officials told patients who had received tuberculosis testing and some who had received penicillin to treat syphilis that their medicines also may have been compromised.

Through January, approximately 1,200 have come back to be revaccinated, Arimura said. Revaccinating all 23,000 people would cost $1.3 million, he added.

Vaccines are extremely sensitive to temperature fluctuations. In some cases, exposing a vaccine to the wrong environment once can effectively kill live viruses and harm proteins in the vaccines, said Tan. Generally, temperature problems occur during transportation of medicines.

Without proper monitoring, it is nearly impossible to tell whether vaccines have been exposed to extreme temperatures, said Boom.

A 2012 report by the inspector general at the Department of Health and Human Services found that, in a two-week period, three-quarters of the 45 health care providers who were sampled — all of which participated in the Vaccines for Children program — exposed their vaccines to improper temperatures for at least five cumulative hours.

A separate study by researchers at the federal Centers for Disease Control and Prevention published in 2015 found that 23 percent of the vaccination errors reported to the federal surveillance system from 2000 to 2013 involved improper storage or the use of expired vaccines.

Since these reports, the CDC put in place additional requirements for the children’s program, including recording the minimum and maximum temperature of the vaccine storage unit daily.

Dr. Paul Hunter, associate professor of family medicine and community health at the University of Wisconsin, said the federal oversight is “very good.”

“In the big picture, they do it very consistently,” he said.

For doctors and clinics outside the federal surveillance system, financial concerns often force them to take special care with vaccines and similar medicines. One vaccine dose can cost hundreds of dollars.

Sanford Health, a South Dakota-based health care system with operations across the Midwest, is working to make the federal requirements the standard for vaccines among its health care providers. The system started Vax Champ, a six-month training program for nurses to learn how to store and handle vaccines. The program requires participants to periodically take photos of their vaccine stocks and send in a list of all their inventory for review.

Funding for the program came from the vaccine manufacturer Sanofi Pasteur.

Andrea Polkinghorn, immunization strategy leader for Sanford Health, said vaccine storage systems vary widely among providers. Purchasing pharmaceutical-grade storage equipment is costly, she said, and providers are in different phases of the upgrade.

“But when you compare that to the projected loss of vaccines,” Polkinghorn said, “the end is worth the means.”

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