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Tuesday, 30 June 2015

Princess Health and Know the signs of a heart attack and don't ignore or dismiss them; quick action can be the difference between life and death.Princessiccia

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Many people who have a heart attack initially ignore the symptoms or dismiss them. For the best chance of survival and preserving heart function, you should not ignore these symptoms, and should get help quickly.

Heart disease is the leading cause of death in the U.S. and Kentucky. Nationwide, it causes about one in four deaths. The age-adjusted death rate from heart disease in Kentucky is 208.2 per 100,000 per year, according to the federal Centers for Disease Control and Prevention.

Below are some questions and answers about the symptoms and treatment of heart attacks and narrowed aortic valves, as reported by Gina Kolata for the New York Times.
How do you know if you are having a heart attack? Most people feel pain, pressure or squeezing in their chest and about one-third of people have symptoms in addition to or instead of chest pain that include abdominal pain, heavy sweating, back pain, neck and jaw pain, nausea and vomiting, Kolata reports. WebMD adds pain that radiates down one arm, indigestion or a choking feeling, extreme weakness, anxiety or shortness of breath, and rapid or irregular heartbeats to the list.

How can you decide if symptoms other than chest pain are actually from a heart attack? If your symptoms come on suddenly, or if they worsen over a period of hours or days, call 911 and get to an emergency room. "The best time to treat a heart attack is within one to two hours of the first onset of symptoms," says WebMD. "Waiting longer increases the damage to your heart and reduces your chances of survival."

Do women have different symptoms than men? "Probably not," Dr. Mary Norine Walsh, vice president of the American College of Cardiology, told Kolata. Walsh noted that women, however, are more likely to delay seeking treatment and doctors are more likely to dismiss their symptoms, especially if the woman is younger.

The American Heart Association says women often attribute signs of a heart attack to the flu, acid reflux or the normal aging process, even though it is the number one killer of women. It also noted that symptoms in women can be subtler, like shortness of breath, upper back pressure that feels like squeezing, lightheadedness or actually fainting.

What should you do if you are having heart attack symptoms? Call 911 for an ambulance to take you to the emergency room immediately. Do not drive yourself and do not have a friend or family member drive you unless you have no other choice. Kolata notes that paramedics are trained to treat heart attacks and are less likely to get stuck in traffic.

How can you find out if your local hospital is able to treat heart attacks quickly? Don't waste time fighting with your paramedic when you are having a heart attack, they will know the best place to take you, Kolata writes.

That being said, some hospitals are faster than others in treating heart attacks, but the time to research this information is before you are in the throws of a heart attack, Kolata writes. To find out this information, she suggest you ask each hospital what its "door to balloon time" is, which will tell you how long it takes the hospital to open a blocked coronary artery with a balloon after you arrive at the emergency room. If they don't have this information, ask if they take certain steps to speed up treatment. For example ask: Do paramedics transmit a patient's electrocardiogram to the hospital en route?; Does the ER doctor read the EKG and send out a single call to summon the cardiology team?; And are the team members on call required to be within 30 minutes of the hospital?

What are the symptoms of a severely narrowed aortic valve? There are three classic symptoms of this disease of aging: shortness of breath, a feeling of heaviness and pain in the chest, and fainting, according to cardiologists. They also noted that these symptoms are often mistakenly attributed to the normal process of aging.

How can a doctor know if symptoms are caused by a narrowed aortic valve? The doctor will listen  for a heart murmur in the patient�s chest and can order an echocardiogram, which will reveal the narrowed artery and the extent of the damage.

Should everyone with a severely narrowed artery have it replaced? Not everyone should undergo treatment, Kolata reports, so ask your doctor if you are a good candidate. The latest treatment is a transcatheter aortic valve replacement, or TAVR, which allows doctors to replace valves without doing open-heart surgery. High risk patients who would have been considered at too great a risk of dying from open-heart surgery have a chance to have a valve replacement, but sometimes elderly patients whose health is compromised are not good candidates.

Sunday, 28 June 2015

Princess Health and More dental patients using ERs, showing lack of dental coverage, shortage of dentists and the stepchild status of oral health.Princessiccia

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More patients are going to hospital emergency rooms for dental care, illustrating how oral health remains the stepchild of the health system despite health-care reform.

"An analysis of the most recent federal data by the American Dental Association shows dental ER visits doubled from 1.1 million in 2000 to 2.2 million in 2012, or one visit every 15 seconds, Laura Ungar reports for The Courier-Journal and USA Today.

Christopher Smith of Jeffersonville, Ind., had a dental
infection that put him in a Louisville hospital for a
week. (Courier-Journal photo by Sam Upshaw Jr.)
"This is something I deal with daily," Dr. George Kushner, director of the oral and maxillofacial surgery program at the University of Louisville, told Ungar. "People still die from their teeth in the U.S."

A longstanding federal law requires ERs to treat patients regardless of their ability to pay. "Although they often provide little more than painkillers and antibiotics to dental patients, the visits cost more than three times as much as a routine dental visit, averaging $749 if the patient isn't hospitalized � and costing the U.S. health care system $1.6 billion a year," Ungar reports.

Private dental insurance is not common. "Just over a third of working-age adults nationally, and 64 percent of seniors, lacked dental coverage of any kind in 2012, meaning they had to pay for everything out of pocket," Ungar writes. The Patient Protection and Affordable Care Act "requires health plans to cover dental services for children but not adults," and "Medicare generally doesn't cover dental care at all," she notes.

In Kentucky, the expansion of Medicaid under Obamacare has increased dental visits in the program by 37 percent, but it offers "only a short list of dental services," such as extractions, which patients often choose instead of restorative work, for which they would have to pay.

Another big issue is that many dentists don't accept Medicaid, which pays them only 41 percent of private reimbursement, Ungar reports. Also, Kentucky has a shortage of dentists. "A 2013 workforce study by Deloitte Consulting found the state needs 612 more to meet demand," Ungar notes.

More dentists would encourage more preventive treatment, which dentists say would save a lot of money. "If we were going to the dentist more often, we could avoid a lot of this," Dr. Ruchi Sahota, a California dentist and consumer adviser for the ADA, told Ungar. "Prevention is priceless."

Fewer than 60 percent of Kentuckians saw a dentist in 2013, making their dental-visit frequency 43rd in the nation, according to the Kentucky Health Issues Poll.
Princess Health and CDC says state spends less than 8% of what it should on preventing use of tobacco; companies spend 13 times as much.Princessiccia

Princess Health and CDC says state spends less than 8% of what it should on preventing use of tobacco; companies spend 13 times as much.Princessiccia

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Kentucky spends only 7.6 percent of what it should spend on preventing the use of tobacco, the federal Centers for Disease Control and Prevention says in its latest annual report on the subject.

The state spent $4.33 million on tobacco-control programs in 2011, the year covered by the report. The CDC said spending of $57.2 million was called for, since 29 percent of Kentuckians smoked that year. Tobacco-related illnesses are estimated to cost Kentuckians $3.3 billion a year.

South Carolina and Texas, which spent 6.5 percent and 7 percent of the recommended amounts, were also singled out for criticism by the CDC. Nationally, states spend less than 18 percent of what they should, $3.7 billion, in the agency's view. "Only Alaska and North Dakota funded programs at the CDC-recommended levels, $10.7 million and $9.3 million, respectively," Samantha Ehlinger of McClatchy Newspapers reports.
Read more here: http://www.kentucky.com/2015/06/25/3918046/cdc-says-kentucky-isnt-spending.html#storylink=cpy

"States that made larger investments in tobacco prevention and control have seen larger declines in cigarettes sales than the United States as a whole, and the prevalence of smoking has declined faster as spending for tobacco control programs has increased," the CDC report said. "Evidence suggests that funding tobacco prevention and control efforts at the levels recommended . . . could achieve larger and more rapid reductions in tobacco use and associated morbidity and mortality."

In contrast to the state spending of $658 million on tobacco control, tobacco companies spent more than 13 times as much on advertising and promotion in 2011: $8.8 billion, or $24 million per day, the report noted.

"During the same period, more than 3,200 youth younger than 18 years of age smoked their first cigarette and another 2,100 youth and young adults who are occasional smokers progressed to become daily smokers," the report said. "If current rates continue, 5.6 million Americans younger than 18 years of age who are alive today are projected to die prematurely from smoking-related disease. However, the tobacco-use epidemic can be markedly reduced by implementing interventions that are known to work."

For the CDC's latest comprehensive report on tobacco use in Kentucky, with data from 2012, click here. For county-by-county figures on adults smoking in Kentucky in 2011-13, click here.

Friday, 26 June 2015

Princess Health and Study finds that one dose of HPV vaccine that targets only cervical cancer is as effective as three doses, now recommended.Princessiccia

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By Melissa Patrick
Kentucky Health News

A study has found that one dose of the human papillomavirus vaccine Cervarix appears to be as effective in preventing HPV infections that lead to cervical cancer as do three doses, the recommended course of vaccination. Only 25 percent of Kentucky adolescent women initiate the vaccination, and fewer than one in nine of those who do get three does, according to the Kentucky Cancer Consortium.

"Many women around the world and in the U.S. don't get the full three doses that are recommended, so this is promising news," said Elisia Cohen, an associate professor of communication at the University of Kentucky, who does extensive research on community strategies to improve adolescent and adult vaccinations. However, she cautioned that the drug Cervarix is "only 1 percent of the U.S. market" and that the findings from this study do not apply to Gardasil, the drug most commonly used in the U.S.

Dr. Diane Harper of the University of Louisville, one of the researchers, said in a news release, �Kentucky is one of the states that has not had a program in place to make Cervarix available to all of its citizens, and has very low three-dose completion rates of Gardasil.�

Most health departments and physicians choose Gardasil over Cervarix because it protects against four strains of HPV: two strains that cause 70 percent of all cervical cancers and two strains that cause genital warts and oral and anal cancers, concerns for males as well as females. Cervarix only protects against the two strains that cause cervical cancer. "Generally, the thinking is that protection against four strains is better that two," Cohen said.

She said Gardasil 9, which will protect against 90 percent of HPV strains that cause cervical cancer as well as pre-invasive cervical cancer lesions, has just been approved by the U.S. Food and Drug Administration and is going through its labeling process, and will be recommended for both boys and girls.

HPV is the most common sexually transmitted infection in the U.S., affecting an estimated 79 million individuals, according to the federal Centers for Disease Control and Prevention.

The study, published in The Lancet Oncology, analyzed data from two large trials of Cervarix. In the trials, women were randomly chosen to receive three doses of Cervarix or a control vaccine. All of the women were evaluated, regardless of how many doses of the vaccine they received, for the effectiveness of the vaccine for a period of four years. The analysis found that the protection from one dose was similar to that achieved by three doses of the vaccine.

�Knowing that Cervarix offers protection in one dose reassures public health agencies that they are not wasting money when most of their vaccines are given to those who never complete the three-dose series,� the researchers wrote.

The CDC recommends HPV vaccination for girls 11 and 12 years old, and catch-up vaccination for females from 13 to 26. The second dose should be given one to two months after the first injection; the third dose should be administered six months after the first dose.
Princess Health and How Institutional Conflicts of Interest Exacerbate the Anechoic Effect - the Example of ASCO Fearing "Biting the Hand that Feeds You". Princessiccia

Princess Health and How Institutional Conflicts of Interest Exacerbate the Anechoic Effect - the Example of ASCO Fearing "Biting the Hand that Feeds You". Princessiccia

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As we recently discussed (here, here, here and here), in May, 2015, the New England Journal of Medicine, arguably the world's foremost medical journal, published an editorial and a three-part commentary arguing that current concerns about the effects of financial conflicts of interest (COI) on health care are overblown(1-4).  On June 1, the Wall Street Journal published a report on the 2015 meeting of the American Society of Clinical Oncology (ASCO) that provided a vivid example of why these concerns should not be dismissed.

Questioning Drug Prices at the ASCO Meeting

The main issue in the article was:

In a sign of growing frustration with rising drug prices, a prominent cancer specialist on Sunday sharply criticized the costs of new cancer treatments in a high-profile speech at one of the largest annual medical meetings in the U.S.

'These drugs cost too much,' Leonard Saltz, chief of gastrointestinal oncology at Memorial Sloan Kettering Cancer Center, said in a speech heard by thousands of doctors here for the annual meeting of the American Society of Clinical Oncology.

The notion that health care prices are high and are rising continuously in the US should hardly be novel for regular Health Care Renewal readers.  We have been writing about it for a while, starting in 2005.

We first posted about high drug prices in July, 2005, with the example of BilDil.  This was a brand-name combination drug that included two compounds that were already cheaply available in generic form, advertised as a uniquely convenient therapy for congestive heart failure.  We were aghast that the price of the combination drug might be $5.40 - $10.80 a day (in 2005 dollars), over three times the cost of the two drugs in generic form.

But only a few days later we noted that three cancer costs had yearly costs in the five figures, and one, Erbitux, cost as much as $100,000.  Most amazingly we noted that Thalidomid was priced at $25,000  a year.  Yet it was just the infamous thalidomide, the drug initially marketed as a tranquilizer that caused severe birth defects after it was initially sold in Europe.  The drug was still available in generic form in South America for about seven cents a pill.

Since then, the ridiculously high prices of many tests and treatments, but most notably new drugs and devices, has been so widely covered our discussion has been limited to special cases.   For example, consider just a few headlines from April to May, 2015.

How Much Would You Pay for an Old Drug? If You Have MS, a Fortune (Bloomberg)

Pharmaceutical Companies Buy Rivals' Drugs, Then Jack Up the Prices (WSJ)

How Marketing Exclusivity Led to Higher Drug Costs and Questionable Benefits (WSJ)

Runaway Drug Prices (NY Times)


Drug Prices as a Taboo Topic

However, despite this wide attention to the problem, the speech at ASCO was notable.  Back to the WSJ...

Dr. Saltz�s speech was unusual because it was made at the meeting�s plenary session, where the field�s most significant scientific research is presented and which all meeting participants are expected to attend. An estimated 25,000 doctors and scientists attended this year�s meeting.


One would think that the high price of drugs, especially cancer drugs, would be a fit subject for discussion at a plenary session of ASCO, however,

It is unprecedented for plenary speeches, which typically address scientific and medical issues, to substantially take on the topic of drug costs, said Alan Venook, a professor of medicine at the University of California San Francisco who planned the meeting�s scientific session and invited Dr. Saltz to speak.

The prominent venue for the speech was also unusual because, like many medical meetings, ASCO is sponsored by pharmaceutical companies and often focuses on highlighting advancements in drug development, said Dr. Venook. He said discussing drug prices there is 'uncomfortable' because it could be seen as 'biting the hand that feeds you.'

Doctors are also reluctant to antagonize the drug industry because they need pharmaceutical firms to invest in developing new medicines for patients, he said.

'It�s a tough balancing act for ASCO where the meeting is largely funded by pharma,' Dr. Venook said in an interview. 'You can�t have a [plenary] talk trashing pharma, but you can have a talk by a respected person questioning it.'

So because pharma gives ASCO a lot of money, at best, only the most distinguished ASCO members can gently question pharma, but cannot criticize, much less "trash" the source of their mammon.


This is thus a succinct example of why financial conflicts of interest in medicine and health care can be bad.  The incredibly high prices of cancer drugs should be a fit topic for discussion at a meeting run by a society of medical oncologists.  But those in charge of the meeting and the society are afraid to initiate such a discussion, and even more afraid of appearing to criticize the companies that charge these prices, because the society has become dependent on money from these very same companies.  So this is further an example of how conflicts of interest can create the anechoic effect - the notion that certain topics in medicine and health care are taboo, because discussing them might trouble the powers that be, and particularly the moneyed interests that now dominate medicine and health care. 

In a succinct response to the NEJM series (1-4) soft pedaling concerns about conflicts of interest, the British Medical Journal ran a commentary by a former NEJM national correspondent, and two former NEJM editors.(5)  It stated,

The NEJM has now sought to reinterpret and downplay the importance of conflicts of interest in medicine by publishing articles that show little understanding of the meaning of the term. The concern is not whether physicians and researchers who receive industry money have been bought by the drug companies, as Drazen writes, or whether members of guideline panels or advisory committees to the US Food and Drug Administration with ties to industry make recommendations that are motivated by a desire for financial gain, as Rosenbaum writes. The essential issue is that it is impossible for editors and readers to know one way or the other.

In this case, we seem not to be talking about the possibility that health care professionals "have been bought by the drug companies,"  but how drug companies essentially "buying" a professional organization has apparently heretofore prevented medical professionals from discussing a vital issue that could have major effects on patients.

Following the Money

In case there is any question about the money involved and its sources, one only needs to go to some publicly available in formation supplied by ASCO (mostly because of reporting requirements imposed on all US non-profit organizations of a certain size).  

The latest (2014) annual report from ASCO reveals that the organization only gets 16.1% of its revenue from member dues.  Thus a ostensible membership organization gets only about a sixth of its funding from members' dues.

Yet the organization has become quite wealthy.  Its most recent (2013) US Internal Revenue Service 990 Form reveals that it owns over $55 million in real estate, and has over $104 million in investments (presumably as an endowment.)  The organizations' leaders are also doing very well. Its CEO, Allen Lichter MD, got $804,775 in total compensation in 2012.  Eleven other managers, of which three are health care professionals (one MD, one RN, one PharmD), got at least $220,000 in total compensation.  Five of them got more than $300,000. 

The source of all that money seems mainly to be pharmaceutical and other health care corporations that sell goods and services for cancer care.  US non-profit organizations are not forced by law to reveal the details of their financial support.  However, the ASCO annual report does list 23 pharmaceutical and biotechnology companies, and one for-profit cancer hospital chain as contributing at least $1 million each in total to the non-profit over time.  The report lists 37 pharmaceutical, biotechnology, and medical device companies as current corporate donors, and also 10 other for-profit health care related corporations as current corporate donors.

In addition to these apparently marked institutional conflicts of interest, ASCO leaders may have their own individual conflicts of interest.  I do not have the resources to search all relationships affecting meeting organizers and ASCO officers and trustees, and the organization does not post conflicts of interest affecting its leadership and governance in a prominent place. However, Dr Alan Venook, who confessed to his discomfort about inviting a talk that might be perceived as biting the hand that feeds the finances of ASCO, is or has been on advisory boards for Thershold Pharmaceuticals,  Mirna Therapeutics, and GlobeImmune.  For a 2014 presentation, he gave the following disclosures: "Research support from Genentech/Roche, BMS, Lilly, Novartis; H. Lenz: Consulting, advisory boards and research support from Genentech/Roche, BMS and Merck."  Furthermore, the current chair of the ASCO Board of Directors, Julie M Vose, MD, is also on the Medical Advisory Board of EmergingMed Inc, and the Clinical Advisory Board of Bullet Biotechnology.

Summary

The New England Journal of Medicine recently launched a counter-attack against the "pharmascolds" who are allegedly slowing the pace of medical progress by their excessive and puritanical concerns about financial conflicts of interest.  Yet the arguments that COIs could be bad for health care are logical, and based on at least some reasonably good evidence.  (See the article by Steinbrook et al in the BMJ mentioned above[4], the accompanying BMJ editorial[5] just to start and then the 2009 Institute of Medicine report.)

Moreover, we have encountered a lot of vivid cases suggesting that conflicts of interest can have adverse influences on health care.  In this most recent one, we see at least one prominent if conflicted organizational insider admitting that institutional, and perhaps individual conflicts of interest have made discussion of at least one big health care and health care policy topic taboo.  This seems to corroborate our previous discussion that the anechoic effect - that certain topics in health care are taboo - may be generated by conflicts of interest of the people who ought to discuss them, or of those to whom those people may have to answer.

True health care reform requires full disclosure of conflicts of interest for honesty's sake, and marked reduction of conflicts affecting those who make health care decisions on behalf of individual patients, and health care policy decisions that affect patients' and the public's health.  If we allow conflicts of interest to continue, we will have difficulty even discussing the most severe problems affecting health care, because those generating the topics are benefiting from the circumstances that enable such problems.

ADDENDUM (1 July, 2015) - This post was republished on 28 June, 2015, on the Naked Capitalism blog. 

ADDENDUM (20 July, 2015 ) - This post was republished on July 12, 2015 in OpenHealth News.

References

  1.Drazen JM.  Revisiting the commercial-academic interface.  N Eng J Med 2015; ; 372:1853-1854. Link here.
2. Rosenbaum L.  Reconnecting the dots - reinterpreting industry-physician relations.  N Eng J Med 2015; 372:1860-1864.  Link here.
3. Rosenbaum L. Understanding bias - the case for careful study.  N Engl J Med 2015;  372:1959-1963.  Link here.
4.  Rosenbaum L.  Beyond moral outrage - weighing the trade-offs of COI regulation. N Engl J Med 2015; 372: 2064-2068.  Link here.
5. Steinbrook R, Kassirer JP, Angell M.  Justifying conflicts of interest in medical journals: a very bad idea.  Brit Med J 2015; 350: h2942.  Link here. 
6. Loder E. Revisiting the commercial-academic interface in medical journals.  Brit Med J 2015; 350: h2957.  Link here.
Princess Health and Study outlines historical barriers to tobacco prevention in Kentucky and other tobacco-growing states.Princessiccia

Princess Health and Study outlines historical barriers to tobacco prevention in Kentucky and other tobacco-growing states.Princessiccia

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A University of Kentucky College of Nursing study published in The Milbank Quarterly has shown that five major tobacco-growing states�Kentucky, North Carolina, Virginia, South Carolina and Tennessee�fall behind the rest of the states in enacting laws to reduce tobacco use.

Tobacco and the diseases it causes affect those five states more than others across the nation, and tobacco is the leading cause of preventable death in the U.S. Those states also have fewer smoke-free laws and lower tobacco taxes, which are two evidence-based policies that help reduce tobacco use, write the authors, Amanda Fallin and Stanton A. Glantz.

The researchers used five case studies chronicling the history of tobacco-control policy "based on public records, key informant interviews, media articles and previously secret internal tobacco industry documents available in the Legacy Tobacco Documents Library," they write.

They found that beginning in the late 1960s, tobacco companies focused on creating a pro-tobacco culture to block tobacco-control policies. However, since 2003, tobacco-growing states have seen passage of more state ad local smoking bans, partly because the alliance between tobacco companies and the tobacco farmers dissolved and hospitality organizations stopped objecting to such bans. National Cancer Institute research projects also built infrastructure that led to tobacco-control coalitions. "Although tobacco production has dramatically fallen in these states, pro-tobacco sentiment still hinders tobacco-control policies in the major tobacco-growing states," the researchers write.

To continue the progress, health advocates need to teach the public as well as policymakers about "the changing reality in the tobacco-growing states, notably the great reduction in the number of tobacco farmers as well as in the volume of tobacco produced," Fallin and Glantz write. Kentucky once had about 50,000 tobacco farmers; today it has about 5,000, and production is dominated by large farmers. The study is behind a paywall; to read its abstract, click here.

Princess Health and Half again as many Kentucky newborns were hospitalized for drug dependency last year as the year before.Princessiccia

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Mother Samantha Adams and her newborn Leopoldo Bautista,
10 days old, spend quality time inside the Louisville Norton
Healthcare child care center for children experiencing drug
withdrawal. (Photo by Alton Strupp, The Courier-Journal)
Increasing drug abuse drove up hospitalizations of drug-dependent newborns in Kentucky by 48 percent last year, to 1,409 from 955 in 2013. "The latest numbers represent a 50-fold increase from only 28 hospitalizations in 2000," reports Laura Ungar of The Courier-Journal.

"The seemingly never-ending increase every year is so frustrating to see," Van Ingram, executive director of the state Office of Drug Control Policy, told Ungar. "It's a horrible thing to spend the first days of your life in agony."

"These infants are born into suffering," Ungar writes. "They cry piercingly and often. They suffer vomiting, diarrhea, feeding difficulties, low-grade fevers, seizures � and even respiratory distress if they're born prematurely."

Drug-dependent newborns are becoming more common nationwide, Ungar notes, but "Vanderbilt University researchers publishing in the Journal of Perinatology [a subspecialty of obstetrics concerned with the care of the fetus and complicated, high-risk pregnancies] say rates are highest in a region encompassing Tennessee, Mississippi, Alabama and Kentucky."

While the increase is blamed mostly on illegal drug use, the Vanderbilt study found that 28 percent of pregnant Medicaid recipients in Tennessee filled at least one painkiller prescription, Ungar writes: "Legitimate use not only raises the risk of having a drug-dependent baby, it can sometimes lead to abuse and addiction."

While Medicaid now pays for behavioral-health and substance-abuse treatment, "Drug treatment for pregnant women is sorely lacking," Ungar reports. In Kentucky, only 71 of the 286 treatment facilities listed by the U.S. Substance Abuse and Mental Health Services Administration treat pregnant women. 

Thursday, 25 June 2015

Princess Health and Supreme Court upholds Obamacare subsides in all states; ruling has no direct effect on Kentucky, but focuses political debate.Princessiccia

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By Molly Burchett
Kentucky Health News

The U.S. Supreme Court ruled Thursday that the tax subsidies provided under the Patient Protection and Affordable Care Act are legal in every state.

While the ruling has no effect on Kentucky, and would have had no direct effect if it had gone the other way, it sets the table for continued political debate about health policy in Congress and in Kentucky's race for governor.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Chief Justice John Roberts wrote in the 6-3 majority opinion. "If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter."

The law says the federal government can pay subsidies to help people afford insurance bought through �an Exchange established by the State.� The lawsuit argued that Americans in the 34 states using the federal exchanges were not eligible for the subsidies, which are crucial to the law's success, helping to make health insurance more affordable, reducing the number of uninsured Americans. Proponents of the law say not providing subsidies to individuals in those 34 states relying on the federal exchange would have upended the law, notes CNN.

President Obama called on critics to accept the law as permanent, saying after the ruling, "The Affordable Care Act is here to stay."

But Senate Majority Leader Mitch McConnell, R-Ky., called Obamacare �a rolling disaster for the American people,� with a �multitude of broken promises, including the one that resulted in millions of Americans losing the coverage they had and wanted to keep. Today�s ruling won�t change the skyrocketing costs in premiums, deductibles, and co-pays that have hit the middle class so hard over the last few years.�

Maps: Percentage uninsured in 2012, above, and 2014, below
Obama countered, "The setbacks I remember clearly. But as the dust has settled, there can be no doubt that this law is working. It has changed, and in some cases saved, American lives. It set this country on a smarter, stronger course." He added, "The law has helped hold the price of health care to its slowest growth in 50 years" and "Nearly one in three Americans who was uninsured a few years ago is insured today. The uninsured rate in America is the lowest since we began to keep records."

A White House fact sheet noted that the law also expanded "access to preventive care, including immunizations, well-child visits, certain cancer screenings, and contraceptive services, with no additional out-of-pocket costs as well as no more annual caps on essential benefit coverage and new annual limits on out-of-pocket costs."

Since Kentucky established its own exchange, Kynect, for buying subsidized health insurance or signing up for Medicaid, the ruling may seem moot for Kentuckians. However, it establishes some of the facts for a health-care policy debate in the governor's race between Republican Matt Bevin and Democratic Attorney General Jack Conway.

The exchanges and the expansion of the federal-state Medicaid program are choices for the states, and Bevin has said that if elected he would shut down Kynect and end the Medicaid expansion, which has covered about 430,000 Kentuckians. The federal government is paying their entire cost through next year; in 2017 the state would start picking up a small share, rising to the law's limit of 10 percent in 2020.

Conway has acknowledged questions about whether the state can afford to pay its share, but to �say you�re going to kick a half a million people off of health insurance based on what we may or may not be able to afford in 2021 is irresponsible.� A Conway spokesman said he "appreciates the court's careful consideration of this case and agrees with today's decision," reports the Lexington Herald-Leader.

The Herald-Leader's Mary Meehan interviewed officials and experts for a package of questions and answers about the law and Kentucky. It is published at http://www.kentucky.com/2015/06/25/3917832_in-light-of-the-supreme-court.html.

Outgoing Gov. Steve Beshear, a Democrat who expanded Medicaid, said in a statement that the decision �reaffirms that, from the very start, we did the right thing for the more than 500,000 Kentuckians who have qualified for health-care coverage through Kynect since January 1, 2014.�

Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, said in a release, "While many have been awaiting this important decision, we must remember that much remains to be done to assure that all Kentuckians � and all Americans � have timely access to safe, effective and affordable quality care." Zepeda said Kentuckians continue to work on ways to improve and protect Kentuckians' health, such as reforming the way we pay for care and making health care cost and pricing more transparent.

"As people who have forgone care too long because of its expense now gain access to care, it will place a larger short-term burden on the health-care system, which approaches like these can help to address," said Zepeda. "The Affordable Care Act permits � and incentivizes � local health care innovation. We can and must shape Kentucky solutions to Kentucky�s health challenges."

Princess Health and The Homeplace at Midway opens, with cottages for nursing, assisted living, memory care; first 'Green House' facility in Ky..Princessiccia

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By Kacie Kelly and Al Cross
University of Kentucky School of Journalism and Telecommunications

The Homeplace at Midway was formally opened Thursday, June 25, bringing to fruition a 16-year campaign for a nursing home in the Woodford County town of 1,700. For photos from its June 28 open house, click here.

Construction this spring (Christian Care Communities photo)
The Homeplace, which has four residential buildings that look like single-family homes, is more than a nursing home. Two of the buildings are for skilled nursing, but one is for assisted living and the other is for "memory care" or personal care of patients with dementia and other cognitive impairments.

�The Homeplace at Midway represents a new beginning for older adults in Kentucky and for communities across the commonwealth to embrace them as living treasures, not a burden or a challenge,� Dr. Keith Knapp, president and chief executive officer of Christian Care Communities, which built the Homeplace and will operate it, said at the ribbon-cutting ceremony.

Assisted living cottage (Photo by Kacie Kelly)
�We are extremely grateful to the City of Midway, the Midway Nursing Home Task Force, Midway College, state and local government agencies, our capital campaign�s Leadership Council and all our friends and supporters who championed this new direction and envisioned with us a new day when older adults would receive the highest quality care and support, without feeling their lives are being disrupted or overtaken,� Knapp said. �We trust that it will inspire other senior living providers to move in a similar direction.�

The Homeplace is the first facility in Kentucky built with The Green House model, which includes home-like environments and strong relationships with caregivers, with the goal of meaningful lives for residents. Dr. William Thomas, creator of the model, told the crowd at the event, �The Homeplace, with its emphasis on home, shows how care can be made more loving, community centered and effective.�

One of the two skilled-care cottages (Photo by Kacie Kelly)
Patients have been moving in all month. The staff at The Homeplace is trained to use the �best friend approach,� Laurie Dorough, the facility's community-relations manager, said in an interview. Staff and volunteers are to treat residents as they would treat a best friend.

Knapp said at the ribbon-cutting, �Each resident will have a private bedroom and bath and share, just as people do in any home, the kitchen, living room, den and porch areas. It�s all designed to give residents the freedom to set their own daily routines and to live life to its fullest, while receiving the individual care they need � within each cottage.

The assisted-living cottage is larger than the others, to provide room for more activities and �the potential for spouses to live there,� said Laurie Dorough. �It�s kind of the first step out of independent living,� she said. The cottage has an open kitchen where residents can get involved with meal preparation or �come out and see what�s cooking.�

Skilled-care cottage bathroom lift system (Photo by Kacie Kelly)
The skilled-nursing cottages have bedrooms with medicine cupboards rather than medical carts, and a bathroom lift system (photo at right) that takes the resident straight to their own bathroom. The bedrooms are relatively small, an incentive for residents to spend more time in the communal living space.

The Homeplace campus, across Weisenberger Mill Road from Midway College, also includes an administrative cottage and the Lucy Simms Lloyd Gathering House for special gatherings, worship services and activities.

Between the cottages is the courtyard, with lighted walking paths from building to building, a gazebo, and space for outdoor activities. �Our hope is to maybe start a community garden,� said Dorough.

The long campaign for a nursing home, led by the Midway Nursing Home Task Force, began to see success in 2010 when Louisville-based Christian Care agreed to be the developer. Christian Care has facilities in 11 Kentucky cities, and a church-outreach program with more than 230 churches as partners.

The Homeplace will have a partnership with Midway College, which becomes Midway University July 1. �We are excited to work with Midway College to not only provide learning opportunities for students but also for the residents of The Homeplace,� said Tonya Cox, the facility's executive director.

The Homeplace will be offering internships and other learning opportunities for students. This partnership will also benefit residents, Cox said: �Our residents will also have the opportunity to attend events and classes to foster their lifelong learning.�

Cox said The Homeplace aims to provide �unique long-term care in a way that honors their preferences and desires to be home.� More information is on the facility's website. It will host an open house from 1 to 3 p.m. Sunday, June 28.

Princess Health and Aetna is close to a deal to buy Humana, Bloomberg reports.Princessiccia

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Getty Images, via CNBC
Health insurer Aetna "is said to be closing in on a deal to buy" Louisville-based Humana Inc., Julie Hyman reports for Bloomberg News, "and a deal could come "as soon as this weekend."

Humana is also expecting an offer from Cigna Inc., but Humana's board of directors "prefers the Aetna offer," Hyman reports, citing unnamed people familiar with the negotiations. The deal has been discussed for weeks, but Aetna didn't make a formal proposal until this week.

The last major obstacle to a deal may have been the Supreme Court's ruling today that people in all states are entitled to tax subsidies for health insurance under the Patient Protection and Affordable Care Act, Hyman suggests, noting higher stock prices for health-insurance companies.

"Shares of Humana rallied more than 8 percent after trading was briefly halted for volatility," Reem Nasr of CNBC reports.

Humana is an attractive buy because "a great deal of its business � 73 percent of its premiums revenue � comes from contracts with the federal government," David Mann reports for Louisville Business First. "That means Humana is flush with Medicare business, which is a fast-growing category in the industry as many baby boomers are reaching the eligibility age. Its competitors, including Aetna, don't have nearly as much of this business."

"Consolidation among the country's top insurers follows a massive consolidation among providers in pharmacy, hospital and patient care, which has increased the leverage against insurers like Humana and Aetna," Grace Schneider reports for The Courier-Journal.

Princess Health and Childish, petty and vindictive: UPMC hospitals ban sale of Post-Gazette from their gift shops. Princessiccia

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Here's a new angle on how a healthcare organization might react to unfavorable press:

Ban the sale of the newspaper in question from their territory:

UPMC hospitals ban sale of Post-Gazette from their gift shops
June 24, 2015 12:00 AM
http://www.post-gazette.com/business/pittsburgh-company-news/2015/06/24/UPMC-hospitals-ban-sale-of-Post-Gazette-from-their-gift-shops/stories/201506240066

By Steve Twedt / Pittsburgh Post-Gazette

Some UPMC hospitals are banning the Post-Gazette from sale in their gift shops, a move UPMC spokesman Paul Wood said was precipitated by �fairness issues� in the newspaper�s coverage of the health system.

At least three UPMC hospitals -- UPMC Shadyside, UPMC Mercy and Children�s Hospital of Pittsburgh of UPMC -- say they will no longer sell the newspaper.

This seems simply retaliatory and in fact silly, as (at least hopefully) the newspaper will remain on sale in the rest of the city, as well as available online.  That is, assuming UPMC does not go on a vendetta against the newspaper, in its own in-house PR campaigns and mailings, in other media, or in the courts.

Twice in recent years, UPMC executives have canceled the health giant�s advertising in the PG, citing dissatisfaction with the way UPMC was covered in the news pages and how it was portrayed in editorials and editorial cartoons.

One wonders if UPMC has specifically identified false and inaccurate reporting.  Editorial cartoons are also standard fare for newspapers, and if they are not liked, the answer is written response, not banning IMO.

''The Post-Gazette is edited without regard to any special interest, and our news columns are not for sale, at any price,'' said John Robinson Block, publisher of the newspaper. ''We have been here since 1786, and have as our purpose the same goal that UPMC was established for -- to serve the public's interest, not a narrow purpose.''

As pointed out many times at Healthcare Renewal, the purpose of healthcare systems may not entirely be for serving the public's interests anymore.  Rather, they are serving the private interests of a small executive group who reward themselves handsomely for all being such uniformly superb, excellent and deserving managers.

As Roy Poses wrote at http://hcrenewal.blogspot.com/2015/02/outsize-compensation-for-teflon-coated.html, and elsewhere:

... As we have said before, in US health care, the top managers/ administrators/ bureaucrats/ executives - whatever they should be called - continue to prosper ever more mightily as the people who actually take care of patients seem to work harder and harder for less and less. This is the health care version of the rising income inequality that the US public is starting to notice.

Thus, like hired managers in the larger economy, non-profit hospital managers have become "value extractors."  The opportunity to extract value has become a major driver of managerial decision making.  And this decision making is probably the major reason our health care system is so expensive and inaccessible, and why it provides such mediocre care for so much money. 

Back to the newspaper:

... UPMC officials did not respond Tuesday to questions asking which specific stories they found objectionable.

Perhaps anything that does not read like PR from a large advertising firm painting the organization in the finest light, and editorial cartoons showing executive halos....

''We believe that our coverage of UPMC has been fair-minded in every respect,'' said David M. Shribman, the newspaper's executive editor. ''Every entity in every town feels aggrieved at some point by what a good newspaper writes. It's part of living in a free society where the exchange of news and information is prized, not punished.''

It's sad when newspapers have to state the obvious.

But health system officials have often criticized stories, editorials, and editorial cartoons published in the Post-Gazette in recent years, most frequently in its coverage of the ongoing contract battle with insurer Highmark and, in years past, about the health giant's real-estate holdings and its business practices.

The answer to free speech is more free speech.  Colleges and universities are painfully learning this lesson (e.g., see the website of the Foundation for Individual Rights in Eduction, FIRE, at https://www.thefire.org/).

I actually think a ban on selling the newspaper at UPMC facilities is childish.  UPMC executives seem a bunch of petty, vindictive crybabies for banning sale of the paper from their shops.




-- SS

Wednesday, 24 June 2015

Princess Health and Doctor discusses myths about sun exposure and sunburn.Princessiccia

Princess Health and Doctor discusses myths about sun exposure and sunburn.Princessiccia

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As the weather grows warmer and more people spend longer periods of time outside in the sun, it's important to understand the dangers of sun exposure. "Ultraviolet radiation is a known carcinogen, which means, similar to cigarette smoking, it can cause lasting damage to the body," said Dr. Holly Kanavy, assistant professor of medicine at the Albert Einstein College of Medicine and director of pharmacology at Montefiore Health System. Kanavy discussed five myths people often believe about sun damage:

Myth 1: Some people believe they only need to protect themselves from the sun during peak hours. Although extra precautions should be taken between the hours of 10 a.m. and 4 p.m., people are susceptible to damage from the sun anytime it's out.

Myth 2: Some people think if children do not get burned, they must be wearing enough sunblock. However, young children are particularly susceptible to sun damage and should wear and reapply SPF 30 or higher sunblock. Hats and sunglasses as well as clothing are also helpful, but wet clothes don't offer much protection from the sun.

Myth 3: Some individuals think sun exposure is required to obtain vitamin D. In truth, it only takes 10-15 minutes of sun exposure several times per week. Some people do not wear sunscreen because they're trying to get vitamin D. However, that isn't necessary because it takes sunscreen about 20 minutes to start working, and people can get their vitamin D intake during that time. Also the vitamin can be acquired through certain foods.

Myth 4: Some people believe that the only important factor to look for in sunscreen is the SPF. However, people should make sure their sunblock protects against both UVA and UVB rays. UVA rays age the skin and can cause skin cancer. To make sure a sunblock protects against both kinds of rays, look for the words "broad spectrum" and ingredients like avobenzone, oxybenzone, zinc oxide and/or titanium oxide.

Myth 5: Some people think sun protection is unnecessary indoors or on cold days. However, temperature doesn't affect radiation, and UVA rays can go through clouds and glass. UVA rays don't cause tanning, but can cause damage.

Kanavy also recommended steps to take after getting sunburn. "Immediately after a burn, take a cool shower and keep the burn moisturized," he said. "Ingredients like vitamin C and vitamin E can help control damage."

Tuesday, 23 June 2015

Princess Health and Annual health policy forum set Sept. 28 in Bowling Green.Princessiccia

Princess Health and Annual health policy forum set Sept. 28 in Bowling Green.Princessiccia

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This year's annual Howard L. Bost Health Policy Forum "will offer new insights and opportunities from a range of civic sectors for a shared vision, policies, and actions for community health," says its lead sponsor, the Foundation for a Healthy Kentucky.

"Local, regional, and national speakers will share their knowledge and experiences in building healthy communities, with a focus on transportation and housing, education, food systems and policy, and employers and workplaces," the foundation says. "TED style" speakers will make presentations on each of the forum's four focus areas: education, food systems and policy, employer/workplace, and transportation/housing.

The forum will be held at the Sloan Convention Center in Bowling Green on Monday, Sept. 28. For the registration website, click here.

Sunday, 21 June 2015

Princess Health and Race Weekend: June 20-21st, 2015.Princessiccia

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The Waterloo Classic wasn't our only race this weekend, we were also in action on the trails, in ultras, and in the multisport world!  Here's how the team did:

Guelph Lake 1 Sprint Triathlon

Tracy Urquhart had a break through performance.  She dominated her AG, winning by 7 minutes,
with a final time of 1:22!

Jan had a great performance as well.  In his first triathlon since being hit by a car 4 years ago, he completed his epic comeback to place 5th in his AG.  Nicely done Jan!

Guelph Lake 1 Sprint Duathlon

Steve Schmidt had a great season debut, placing 4th OA and 1st in his AG!


Guelph Lake 1 Olympic Triathlon

Adam Dixon had one of his best performances ever- he managed a great time of 2:20, finishing 4th in his very competitive AG. 

TTF

Lucas Shwed had an outstanding Olympic triathlon debut in Toronto.  He posted an amazing time of 2:16:59, winning his AG.

NOTL

Dave Rutherford posted an outstanding new personal best of 1:22:03, good enough for the OA win.

Jordan Schmidt also had a great race- treating it 100% as a long run training day, he still managed 5th OA in 1:27.

In the 50K, Vicki Zandbergen had an outstanding day, finishing 5th OA for females with a time of 4:26!
Charlotte finished her training run with a great time of just over 5 hours, placing 60th OA. 

Andrew ran just over 5 hours, placing 54th OA!


5-Peaks Rattlesnake Point
In the 5.3K, Jonathan Fugelsang ran a solid 25:04, winning his AG and placing 11th OA!
Justin hit the technical 12.7K, finishing in 1:12:24 coming in 9th in his AG.

 IM Syracuse
Graham Dunn had a very solid performance finishing in 5:17:02.  This placed him 33rd in his very competitive AG.

 Tour de Waterloo
Bill Frier had a very solid performance, managing to finish well inside the top 100, placing 77th OA!

Outstanding work team!  As always, please let us know if we missed your results.

#cantwontstop





























Princess Health and 2015 Waterloo Classic.Princessiccia














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This is our 4th consecutive year doing the Waterloo Classic.  It has been a staple for the team since our inception, and has always been a great way to start summer off on the right track.  We were excited to try a new course on the West end of Waterloo this year, and it did not disappoint.  Here is how the team did:







5K










Dave Rutherford, just 1 day removed from his 1:22 half marathon PB, was in first for the team with a 





great time of 18:31, placing 2nd in his AG and 7th OA.







Steph Hortian came in 2nd OA and 1st in her AG.



Aidan Rutherford ran an outstanding PB of 19:19, good enough for 10th OA and 4th in his AG!







Mike Piazza showed that his fitness is coming along nicely with a solid 19:43, placing him 2nd in his AG.







Coming off a stress fracture, Gillian decided last minute to follow Sean and surprise him with a sprint finish at the line, finishing in 20:07, placing 4th OA and 2nd in her AG.







Coach Sean ran 20:08, placing 3rd in his AG, and emotionally crushed from Gill's ruthless sprint. 







Dan Nakluski ran 23:35, good enough for 3rd in his AG!







Derek Hergott ran a very solid 25:05 WHILE pushing Miles in a stroller!







Samara ran a great time of 36:22, placing 7th in her AG.







Olivia came in just behind 38:36, placing 8th in her AG!







10K










Johana made an outstanding return to the team running a very solid sub-34, winning the race OA. 



RunnerRob was in next for the team with an outstanding time on a hot day of 34:32, placing 2nd 





OA.



Chris Goldsworthy had, quite honestly, the most ridiculous come from behind finish ever, barely taking 3rd place OA at the line, completing the podium sweep for H+P!



Nick was in next for the team in 39 minutes, placing 3rd OA and well inside the top 10.



Andrea Sweny was our first female to finish, running an excellent new PB of 42:22, placing 2nd OA and winning her AG!



Eric came in right after Andrea with a great time just over 43 minutes, placing 2nd in his AG.



Don MacLeod was in right after Eric with an outstanding new personal best of 43:10, bringing him in 3rd in his AG.



Emily was in next for the team with a very solid 10K of 43:52, placing 1st in her AG and 4th OA!



Paul pushed a solid pace on a training day, running just under 46 minutes and placing 4th in his AG.



Howie was in next for the team with a time of 48:51, just under a minute ahead of his rival Manny!  The epic HowieVsManny battle will continue at the ENDURrun in August!



Kristin Marks, Kim Chan and Tracey Kuchma were in next for the team all with times very close to 53 minutes.  Kristin placed 3rd in her AG, Kim got 4th, and Tracey got 2nd!  Nice work girls!



Juan had a solid 10K of 56 minutes placing just within the top 10 of his AG.



Heidi was in next for the team with a very solid time well under 59 minutes.  This allowed her to comfortably win her AG!









Up next for the team is the H+P SummerTT and the ENDURrun!







#cantwontstop 





























Princess Health and Kentucky is cracking down on Suboxone, a heroin substitute that has become a big part of the illegal trade in painkillers.Princessiccia





























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A drug that was supposed to help people get off heroin has "created a new cash-for-pills market and a street trade" that state officials are trying to stop, Mary Meehan reports for the Lexington Herald-Leader.



The drug is buprenorphine, the active ingredient in the brand-name drugs Suboxone and Subutex, which became more popular in 2012, when the state cracked down on "pill mills" that were freely handing out prescriptions for painkillers. "A lot of the pill mills morphed into facilities that dispense these  prescriptions," Dr. John Langefeld, medical director for the state's Medicaid program, told Meehan.



Also, Meehan writes, the Patient Protection and Affordable Care Act required insurance plans to cover treatment for substance abuse, and "as more Medicaid patients and others got health-insurance coverage, more  people obtained prescriptions for buprenorphine, Langefeld said. . . . According to a state report, one user obtained prescriptions from nine doctors."



Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy



Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy








Lexington Herald-Leader chart by Chris Ware from state data



Use of the drug in Kentucky "has increased 241  percent since 2012," Meehan reports. "And 80 percent of the prescriptions for it were  being written by 20 percent of the state's 470 certified prescribers,  said Dr. Allen Brenzel, medical director of the state's Department of Behavioral Health. . . . Since 2011, 10 doctors have been sanctioned by the Kentucky Board of  Medical Licensure because of problems prescribing Suboxone."



Suboxone is supposed to be taken in conjunction with therapy and drug testing. "a patient receives a controlled dose of a legal drug as the dose is tapered by a physician for a safe and effective withdrawal," Meehan notes. However, "doctors started to see Suboxone patients on a cash basis, asking for  as much as $300 for an office visit that included a prescription for the  maximum allowable amount of Suboxone. Patients often received no therapy or drug testing. Some patients were on the maximum dose indefinitely, Brenzel said." Some doctors prescribed the drug with other painkillers, creating an illegal market.



To prevent such abuse by unscrupulous doctors, the medical-licensure board has issued regulations that require "more physician education and the requirement that the drug be  prescribed only for medically supervised withdrawal and not be given to  pregnant women," Meehan writes. "Patients should also be closely monitored and drug  tested. If those rules are not followed, a doctor can face sanctions or restrictions to his medical license."



Suboxone was in the national news recently because the accused killer in the Charleston, S.C., shootings was arrested for illegal possession of it four months ago at a South Carolina shopping mall, the Herald-Leader notes.



Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy





Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

















            

          

          

        

Saturday, 20 June 2015


          

        













Princess Health and Lake Cumberland District Health Department using polls in an effort to get school boards to make campuses tobacco-free.Princessiccia



























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Countywide smoking bans are unlikely to pass anytime soon in most of rural Kentucky, but more county school districts are making their campuses tobacco-free. Now a multi-county health department is trying to get rural school boards to do that, with public-opinion polls showing that county residents overwhelmingly favor the move.








Department logo has been altered to
show Clinton County in yellow.



The Lake Cumberland District Health Department conducted the poll in Clinton County, and said it found that 86.55 percent were in favor and 7.16 percent were opposed. The rest had no opinion.



Making a campus tobacco-free means that members of the public are not free to smoke at school athletic events, so the poll also asked, �Would you like to see our school become tobacco-free at all events?� The results were virtually the same: 85.3 percent answered yes and 8.7 percent answered no, even though one-fourth to one-fifth of the county's residents smoke and it has a long history of raising tobacco.



"The results are perhaps surprising to some, considering the rate of tobacco usage in the county," reports the Clinton County News. The poll of 749 residents has an error margin of plus or minus 3.6 percentage points.



The department also surveyed 100 teachers in the school system and found that 77 percent would "definitely" support making the schools 100 percent tobacco-free.



The health department presented the survey and other findings to the Clinton County Board of Education June 15, but the board took no action. The department noted that a recent survey found that 28 percent of the county's students in eighth through 12th grades had used smokeless tobacco in the previous 30  days. "That level was the highest in the Lake Cumberland District," the Clinton County News reports.



The Casey County Board of Education adopted a smoke-free policy after a poll by the health department showed 70 percent of the county's residents favored it, the Casey County News reported.























Princess Health and Merger mania: Aetna bids for Humana; Cigna may want it too; Anthem has bid for Cigna; UnitedHealth makes a play for Aetna.Princessiccia





Princess Health and Merger mania: Aetna bids for Humana; Cigna may want it too; Anthem has bid for Cigna; UnitedHealth makes a play for Aetna.Princessiccia



















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Aetna Inc. has made a bid to buy Louisville-based Humana Inc.,"one of a number of recent moves by big health insurers to find merger partners," Dana Mattioli and Liz Hoffman report for The Wall Street Journal.



The proposal was made in "the last few days," the Journal reports. "It isn�t clear how much Aetna indicated it would pay. Humana has a market value of $30 billion. The company hired Goldman Sachs Group Inc. to help it field takeover interest, people familiar with the matter have said."



Meanwhile, Aetna has been approached by another big insurer, UnitedHealth Group. "It isn�t clear what, if any, Aetna�s response was," the Journal reports. "News of the Aetna proposal comes the same day Anthem Inc., another of the five big managed-care companies, said it boosted its takeover offer for Cigna Corp.,"offering $47.5 billion. "Anthem went public with the bid after the two sides failed to reach agreement, and is seeking to put pressure on Cigna through Cigna shareholders."



"Cigna itself is eyeing Humana, people familiar with the matter have said. The five big managed-care companies are jockeying for deals that will enable them to get more efficient and better respond to changes in the health care landscape in the U.S.," the Journal reports.



"Humana, which has an estimated 12,000 employees and roughly 2,000 contractors in Louisville and the immediate region, has been seen as an attractive target in the health-insurance industry because of its well-run business running Medicare Advantage programs," Grace Schneider reports for The Courier-Journal. The company is valued at $30 billion.



"The company's membership rolls have surged to more than 3 million in the last year," Schneider writes. "That growth comes when health care reform has forced providers � hospitals, doctors, pharmacies, among them � to consolidate to increase their leverage and clout in an increasingly competitive health care segment. For the same reason, health insurers are now looking to consolidate."























Princess Health and Biotech firm buys UK professor's anti-overdose nasal spray.Princessiccia





Princess Health and Biotech firm buys UK professor's anti-overdose nasal spray.Princessiccia




















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Pharmacy Professor Daniel Wermeling at the University of Kentucky invented a nasal spray to fight heroin overdoses, and a biotech firm has bought the product, which may be on the market within six months, pending approval by the U.S. Food and Drug Administration. The device "contains a single dose of a mist form of naloxone and delivers the drug in a way similar to how Flonase is used to treat allergies," Mary Meehan reports for the Lexington Herald-Leader.



The product is on a fast track for approval because of the rising rates of heroin overdoses across the country, said UK Provost Tim Tracy, former dean of UK's pharmacy school. Wermeling doesn't know exactly when his product will be on the market, but he said the FDA approved another fast-track, anti-overdose therapy after only 14 weeks. The fast-track program speeds development of drugs to treat serious or life-threatening conditions. "Last year, 233 people [in Kentucky] died with heroin in their systems, according to the state medical examiner's office," Meehan notes.



Wermeling has been developing the project at UK since 2009 with the help of more than $5 million in federal and state tax dollars. Tracy said Indivior PLC, the spinoff pharmaceutical company that bought the nasal spray, will be able to manufacture, market and distribute the product. Right now, emergency responders and hospitals must draw naloxone, branded as Narcan, in a syringe to provide the correct dose.



























Princess Health and Three doctors, nine others in western half of Kentucky are indicted in the largest-ever federal 'takedown' of Medicaid fraud.Princessiccia






























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Former Dr. Fred Gott of Bowling Green was arrested.

(Photo: Miranda Pederson, Bowling Green Daily News)



Twelve people in the western half of Kentucky, including three doctors, have been charged with Medicaid fraud in what the federal government calls its biggest-ever "takedown" of the problem, Andrew Wolfson of The Courier-Journal reports.



The indictments allege "a half-dozen schemes involving nearly $8 million in alleged fraudulent billings," Wolfson writes. "The offenses include $5 million in false billings for muscle-relaxant injections that were never delivered to patients, as well as a staged car wreck in which three people allegedly conspired to get controlled substances and fraudulent reimbursements."



In another case, Wolfson reports, "a medical practice that treated car wreck patients is accused of using the DEA numbers of nurse practitioners to order hydrocodone for herself and falsely billing it to an insurance company. Nationally, the sweep resulted in charges against 243 people, including 46 doctors, nurses and other licensed medical professionals."



John Kuhn, acting U.S. attorney for the Western District of Kentucky, told Wolfson that about $1 billion of annual Medicare and Medicaid expenses are fraudulent. Medicare is the federal health-insurance program for people over 65; Medicaid is the federal-state program for the poor and disabled.



Former Dr. Fred Gott of Bowling Green, a 63-year-old cardiologist, was charged with "conspiracy to dispense controlled substances, health care fraud and money laundering," Deborah Highland reports for the Bowling Green Daily News. "The Bowling Green-Warren County Drug Task Force opened an investigation into Gott�s practices after Warren County Coroner Kevin Kirby alerted the task force about drug overdose deaths involving Gott�s patients, task force director Tommy Loving said."















        

      










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