Princess Health and Effects of new vaping regulations won't be felt immediately; American and British researchers have differing views of e-cigs. Princessiccia

Princess Health and Effects of new vaping regulations won't be felt immediately; American and British researchers have differing views of e-cigs. Princessiccia

cancer federal regulation lung disease research smoking tobacco vaping

Gusty 13:40 Add Comment

By Danielle Ray
Kentucky Health News

A long time coming, the U.S. Food and Drug Administration released new regulations this month for all tobacco products, including electronic cigarettes, vape pens, hookahs, dissolvables, and pipes. But the effects might not be felt for as long as two years.

Photo: excusemyvapes.com

The regulations require health warnings on packages and advertisements and ban sales to minors. Other regulations include reporting ingredients to the FDA, requiring photo identification to buy, banning free samples and banning the labeling of products as moderate, with words such as "light" or "mild,"

The FDA called the regulations a milestone in consumer protection. It believes the new rules will help prevent misleading claims by manufacturers moving forward and allow for review of new products not yet on the market. The agency already regulated traditional cigarettes, smokeless tobacco, and roll-your-own tobacco prior to the decision.

The new rules will take effect in stages. The ban on sales to minors begins Aug. 8, but according to Phil Galewitz of The Washington Post, the ban will primarily affect Michigan and Pennsylvania, as the other 48 states already ban sales of e-cigarettes to minors. Warning labels will take effect May 2018. The labels will read: �WARNING: This product contains nicotine. Nicotine is an addictive chemical.�

Don't expect changes overnight. Manufacturers have two years to submit products for review and another year for the agency to perform evaluations.

Why did the FDA take on vaping? For one thing, because the market has so far been unregulated, the ingredients in vaping liquid are largely a mystery. However, a 2015 Harvard University study found several dangerous chemicals present in these liquids. The chemicals can destroy tiny passageways in lungs, leading to scar tissue buildup and eventually respiratory disease, according to the study.

For another thing, adolescents and teenagers are vaping at unprecedented rates. More than 3 million middle and high school students used e-cigarettes in 2015, up more than 500,000 from the year before, according to the FDA.

E-cigarettes have been the most commonly used tobacco products among youth for two consecutive years. Sixteen percent of high schoolers and about 5 percent of middle schoolers were vapers of e-cigarettes in 2015, according to the FDA. More than 80 percent of them cited appealing flavors, which include "gummy bear" and "cotton candy," as their primary reason for use.

The science is still out on whether the harmful qualities of vaping negate any potential benefits. Some studies have found e-cigarettes to be less harmful than traditional cigarettes. For example, a 2015 Public Health England review concluded that e-cigarettes are about 95 percent less harmful than traditional cigarettes.

"E-cigarettes are not completely risk free but when compared to smoking, evidence shows they carry just a fraction of the harm," said Professor Kevin Fenton, director of health and well-being at PHE, said in a news release. "The problem is people increasingly think they are at least as harmful and this may be keeping millions of smokers from quitting."

As noted in the Harvard study, e-cigarettes are not harmless. The question remains if vaping can be a tool to help current smokers quit, if they lure in kids who otherwise would not become smokers or if it's a little of both.

According to the British study, there is no evidence that vaping attracts non-smokers. Fewer than 1 percent of either adults or young people who have never smoked are becoming regular e-cigarette users, the study noted.

As for fears that vaping leads to traditional smoking, Linda Bauld, a cancer prevention expert at Cancer Research United Kingdom, said in a news release that those claims are unfounded.

"Fears that e-cigarettes have made smoking seem normal again or even led to people taking up tobacco smoking are not so far being realized," Bauld said. "In fact, the overall evidence points to e-cigarettes actually helping people to give up smoking tobacco."

Attitudes toward vaping have been much more favorable overall in the UK. Public health officials there seem more willing to accept e-cigarettes as a safer alternative and even a stop smoking tool than do U.S. officials.

For more background information on the FDA's new regulations, click here.

Princess Health and Health-care consumers get little help resolving complaints, columnist says, citing some horrific examples. Princessiccia

Princess Health and Health-care consumers get little help resolving complaints, columnist says, citing some horrific examples. Princessiccia

consumers health care costs health insurance hospitals lung disease Medicare politics state governments

Gusty 18:08 Add Comment

By Trudy Lieberman
Rural Health News Service

Who protects consumers of health care?

Two recent emails from readers got me thinking about that question. I don�t mean consumers in their role as patients whose medical well-being is looked after by state medical boards and health departments that police doctors and hospitals. Those organizations don�t always do a perfect job protecting patients from harm, but at least they are in place.

But who protects patients when things go wrong on health care�s financial side? What happens when you receive a bill you didn�t expect and can�t afford to pay? What happens when insurers send unintelligible explanations of benefits you can�t understand? What about questionable loan arrangements to avoid medical bankruptcy? Consumers of health care are pretty much on their own.

From the 1960s though the 1980s when people complained, they got action from consumer organizations, government and even businesses that set up departments to handle complaints. That consumer movement is now but a flicker.

�We don�t have as many public-interest minded regulators, and officials who try to grab these issues by the horns and deal with them,� says Chuck Bell, director of programs for Consumers Union.

The emails I received show that although it�s an uphill battle to get redress, fighting back as an individual can get attention and may ultimately lead to better protections for everyone.

John Rutledge, a retiree, got snared in Medicare�s three-day rule by a hospital near his hometown Wheaton, Ill. At the end of March he took his wife, who was having breathing problems, to the hospital where she was held for three nights of �observation.� Patients must be in a hospital for three days as an in-patient before they are entitled to Medicare benefits for 100 days of skilled nursing home care, as I noted in a recent column.

Thousands of families have been caught when hospitals decide their loved ones are admitted for �observation,� a tactic that allows them to avoid repaying Medicare if government auditors find patients should not have been classified as �in-patients.� Playing the �observational� game is worth millions to hospitals but costs families tens of thousands of dollars when someone doesn�t qualify for Medicare-covered skilled nursing care.

Rutledge knew about the three-day rule. Both his doctor and a pulmonologist at the same medical practice recommended an in-patient stay, and Rutledge refused to sign a hospital document saying his wife was admitted for observation. Still, the hospital prevailed, claiming a consultant made the decision to keep her for �observation.�

Rutledge was stuck with a bill that, so far, totals over $15,000 for the skilled nursing care his wife did need. He said he had been a �significant donor� to the hospital foundation, and �I have told the foundation that what I spend as a result of �observation� will come out of what I planned to give them, starting with the annual gift.�

The second email came from Kathryn Green, a college history professor who lives in Greenwood, Miss. Green is fighting an air-ambulance company, which transported her late husband to a Jackson hospital after he suffered a fatal fall in their home. This �nightmare,� as she calls it, is a bill from the transport company that claims it�s outside her insurance network, and says she owes them $50,950.

�I am 63 and will have a devastated retirement if this is upheld,� Green told me.

Blue Cross & Blue Shield of Mississippi, the administrator for her insurance carrier the State and School Employees� Health Insurance Plan, paid $7,192 of the $58,142 the transport company billed. Blue Cross has told Green that she should be held harmless and should not be charged for the �balance after payment of the Allowable Charge has been made directly to that provider.�

Green is raising a ruckus and has taken her case to state and national media, members of Congress, the state attorney general, and the Mississippi Health Advocacy Program. The company has told her it will begin collection efforts.

In both cases there�s a legislative solution. The three-day rule can be fixed by counting all the time a patient spends in the hospital whether they�re classified as an �in� or as an �observational� patient. The ambulance problem can be fixed by changing the 1978 airline deregulation law that prevents states from interfering with fares, services, and routes. But money and politics block the federal changes that would help people like Rutledge and Green.

�It�s like playing a game of health-insurance roulette,� Bell says. �Your coverage exposes you to these gaps that have been normalized. It�s become the way of doing business.� A resurgent consumer movement could change all that.

What consumer problems have you had with balance billing? Write to trudy.lieberman@gmail.com.

Princess Health and Even nicotine-free electronic cigarettes can damage lungs; parents urged to warn teens about dangers of e-cig smoking.Princessiccia

Princess Health and Even nicotine-free electronic cigarettes can damage lungs; parents urged to warn teens about dangers of e-cig smoking.Princessiccia

e-cigarettes heart disease hypertension lung disease parenting smoking teens

Gusty 13:52 Add Comment

Kentucky has one of the nation's highest smoking rates, but electronic cigarettes, or e-cigs, are becoming more popular. These battery-powered vaporizers produce a vapor that usually does not contain nicotine. Some have claimed that e-cigs can help people quit smoking because the amount of nicotine can be reduced until it isn't present in the vapor. However, new research shows that other substances in e-cigs may damage the lungs.

Research has found that nicotine in any form damages the endothelial cells that line the lungs, and can cause them to become inflamed or injured. The new research has found that e-cigarette solutions without nicotine contain other substances like acrolein, which damage the lungs in other ways.

"This research reports that components found in commercially available e-cigarette solutions and vapors generated by heating them may cause lung inflammation," said lead researcher Irina Petrache. Long-term effects haven't yet been studied, but the results of this study warn that e-cig inhalation may involve adverse effects on lung health, she said.

Centers for Disease Control and Prevention research shows that e-cigarette use among middle and high school students has tripled. "The development and marketing of e-cigarettes has the potential of hooking a whole new generation on nicotine," Garry Sigman, director of the Loyola University Health System Adolescent Medicine Program, said. It's very addictive and can lead to health issues such as lung disease, heart disease, hypertension and nervous system problems, he said.

Sigman said parents need to made sure their children understand that e-cigarettes are just as addictive as other substances. "Nicotine is so addictive that with only a few inhales, it can create an addiction," he said. Because adolescents enjoy and use technology so much, the modern qualities of the e-cigs might make them seem cool. "Setting rules and monitoring behavior is essential to keeping our teens safe," Sigman said.

Princess Health andPlight of woman needing lung transplant, who has fallen through the cracks of the health-care system, gets attention from CNN.Princessiccia

Princess Health andPlight of woman needing lung transplant, who has fallen through the cracks of the health-care system, gets attention from CNN.Princessiccia

health care access lung disease lung transplant Medicaid Medicare

Gusty 19:12 Add Comment

Update: CNN reports that Kentucky issued a Medicaid provider number to the University of Pittsburgh Medical Center, and the hospital confirmed that they now have enrolled in Kentucky Medicaid and are working to complete the enrollment of some of their physicians, all of which helps clear the way for Katie Prager to get her lung transplant.  "Kentucky Medicaid executives are helping us to get this done in a streamlined fashion that overcomes previous administrative hurdles and misunderstandings in this complex case," Wendy Zellner, a spokeswoman for UPMC, told CNN. Dalton, Katie's husband, has since been discharged from the Pittsburgh hospital where he received his lung transplants in November and has returned to Kentucky. CNN reports Katie and Dalton were only able to communicate through the doorway of her University of Kentucky hospital room because of his risk of getting Katie's infection, which could kill him.

A 24-year-old Kentucky woman with cystic fibrosis who needs a lung transplant to live is caught in the middle of a financial and policy battle among Medicare, Medicaid, a state agency and the University of Pittsburgh Medical Center, one of only two hospitals in the United States qualified to do lung transplants on patients with her specialized condition.

Prager at University of Kentucky hospital (Image from CNN)

"I feel like they're putting a dollar sign on my life," Katie Prager of Ewing, in Fleming County, told CNN. "I don't want to die because of money. That's stupid. Nobody should have to do that." Katie's story was first reported by The Ledger Independent of Maysville and excerpted in Kentucky Health News.

Katie longs to be with her husband, Dalton Prager, but can't until she gets her lung transplant because in addition to cystic fibrosis, she has an infection, Burkholderia cepacia, that is "horribly dangerous" to him, Elizabeth Cohen and John Bonifield report for CNN. Dalton, who also has cystic fibrosis, received his lung transplants Nov. 17 at the Pittsburgh hospital, and the immunity-suppressing drugs he takes for the transplants make him highly vulnerable to infection.

"I just want to make it to see our four-year anniversary in July and be able to hold hands and just hug. That's all I really want -- to be able to hug my husband on our fourth anniversary," Katie told CNN.

Katie and Dalton met on Facebook in 2009 when they were 18 and Dalton lived in Missouri and Katie in Kentucky. And though Katie's doctors had warned her many times that it was dangerous to be around other CF patients because of the risk of shared infections, Katie decided to meet Dalton, even after he had told her he had Burkholderia cepacia, CNN reports. They married two years later.

Photo from CNN

"I told Dalton I'd rather be happy -- like really, really happy -- for five years of my life and die sooner than be mediocre happy and live for 20 years," she told CNN. "That was definitely something I had to think about, but when you have those feelings, you just know."

Their health "quickly deteriorated, and within months, they went on oxygen full time" and had to quit work, CNN reports. They entered the Pittsburgh hospital together in August 2014 to wait for new lungs. Dalton got his in November; Katie is still waiting.

One month after Dalton got his transplants, UPMC discharged Katie because they told her "It would be psychologically good for her to get out for a while," she told CNN. After only three days out she began to have "serious trouble breathing" and tried to go back into the hospital, but was told she could not return because "she had used up her supply of Medicare days."

Medicare wouldn't pay for another hospitalization until Katie had been out of the hospital for 60 days. She is too sick to do that, and has since been a patient at the University of Kentucky, where she relies on the federal-state Medicaid program for the poor and disabled to pay for her care, and doctors have predicted that she won't live a year without new lungs, CNN reports.

Medicaid cannot pay the Pittsburgh hospital because it is not in the state's network of health-care providers. CNN reports that Katie's doctor wrote a letter to Medicaid begging them to make an exception, but the state denied his plea. In a statement to CNN, a spokeswoman for the state Cabinet for Health and Family Services said the hospital had declined to enroll as a Kentucky Medicaid provider. "Medicaid policies allow for a simplified enrollment process for out-of-state providers in such situations," Gwenda Bond, spokeswoman for the cabinet wrote, offering to expedite their application when they choose to sign up.

Hospital officials counter that Kentucky officials said they would have to "sign up hundreds of their doctors to accept Kentucky Medicaid patients," which hospital spokeswoman Wendy Zellner said is "an unusually restrictive approach and contrary to single-case agreements that we have signed with other state Medicaid programs. . . . It is up to Kentucky Medicaid to address this situation."

Katie has also since had a discussion with a federal Centers for Medicare and Medicaid Services caseworker that "didn't go very well," CNN reports. Katie told CNN that the caller was "rude, mean, and angry" and "acted like it was just a pain to have to be talking to me," but said "she would look into her situation." On April 1, CMS spokesman Aaron Albright told CNN that the federal agency was "reaching out to the state agency," and later in the day Zellner said the state agency "has reached out to us to talk. So stay tuned."

The news cheered the Pragers, who continued to talk via Skype and work on their fundraising Facebook page, while dreaming of a future together, CNN reports.

Princess Health andWoman needing lung transplant falls through cracks of health-care system, says she's treated as nothing more than a 'price tag'.Princessiccia

Princess Health andWoman needing lung transplant falls through cracks of health-care system, says she's treated as nothing more than a 'price tag'.Princessiccia

health insurance lung disease lung transplant Medicaid Medicare

Gusty 09:57 Add Comment

Katie Prager, a 24-year-old cystic fibrosis patient from Ewing in Fleming County, needs a lung transplant, but has been denied one because she has met her lifetime maximum on Medicare, Christy Hoots reports for The Ledger Independent in Maysville.

Photo from The Ledger Independent

"They've put a price tag on my name. That's all I am to these people right now," Prager told Hoots from her hospital bed at the University of Kentucky's Chandler Medical Center.

Prager has had cystic fibrosis her entire life, but it was a diagnosis of an infection called burkholderia cepacia in 2009 that caused her lung function to rapidly decline and caused the need for a lung transplant. She was told in 2013 that the UK Center for Cystic Fibrosis does not do transplants on cystic fibrosis patients with this infection, so she was sent to the University of Cincinnati hospital, Hoots reports.

She and her husband Dalton Prager, who also has cystic fibrosis, were then sent to the University of Pittsburgh Medical Center because it is only one of two hospitals that will transplant a lung into a patient with this infection. They began evaluations in January 2013.

Dalton Prager was quickly approved and successfully received a double lung transplant in November 2013. Katie Prager wasn't approved until June 2013. While waiting for a donor lung, she was discharged to spend Christmas with her family, only to hear from the hospital that she could not return there because the Medicare maximum had been reached.

"At first, I thought I might be able to use Medicaid, but was told that it wouldn't cover my transplant due to UPMC being out of network," Katie Prager told Hoots. "After explaining to Medicaid that there are only two places in the country who would operate, due to cepacia, they still refused to work together to help me. In January 2015 I filed an appeal with Medicaid to have them reconsider. The appeal was denied."

She was recently told she would never be eligible to return to UPMC for a transplant and there was nothing else they could do for her, Hoots reports.

"They told me to basically stop wasting my time," she told Hoots. "These are people who we're trusting with our lives and they say that. Most people have no problems when they have to have medical treatments or transplants, and I'm being given the runaround. I'm not trying to be a burden on the system -- that isn't what I want. If I could work and get my own insurance, I would. All I want is a normal chance at life. I want to get my bachelor's degree, get up every day and go to work, run a 5K and have a normal life with my husband. I want to do all the things that young people in love get to do. Is that so much to ask?"

Princess Health and Princess Health andSmoking increases risk of getting lung cancer by up to 20%, but add other carcinogens and it can go up as much as 300%.Princessiccia

Princess Health and Princess Health andSmoking increases risk of getting lung cancer by up to 20%, but add other carcinogens and it can go up as much as 300%.Princessiccia

cancer environmental health lung cancer lung disease research smoking tobacco tobacco prevention

Gusty 19:19 Add Comment

If you smoke, your risk of getting lung cancer is as much as 20 times greater than if you don't. But if you smoke and are exposed to other carcinogens such as radon, asbestos, arsenic or chromium, your risk could be 300 times greater, according to "a growing body of research, including two studies under way at the University of Kentucky," reports Laura Ungar of The Courier-Journal.

See below for example of how to use interactive version of map

"The studies help explain why Kentucky�s lung-cancer and death rates are so much higher than for the rest of the nation," Ungar writes, citing experts. The state leads the nation in lung cancer, "and some Appalachian counties� rates are more than double the national average. While Kentucky�s adult smoking rate of 28 percent is the highest in the nation, it�s not enough to account for the state�s sky-high lung-cancer rates."

Here are two possible causes: Appalachian counties are high in arsenic and chromium, and Central Kentucky has high potential for radon gas, which can accumulate under buildings. "The National Cancer Institute says radon by itself is the second-leading cause of lung cancer in the United States, and most radon-related deaths occur among smokers," Ungar notes. "Kentucky has no laws requiring radon testing for single- or multi-family homes, schools or businesses; and no laws mandating radon-resistant construction of new homes," according to Ellen Hahn, a UK professor of nursing and public health.

"While doctors aren�t sure how smoking interacts with such carcinogens in the body," Ungar writes, "some theorize that when smoking damages lung cells� DNA, the lungs become more susceptible to damage from other toxins." (Read more) The map above is interactive on the Kentucky Cancer Registry website. Here's an example of how to display county data, which also shows the beginning of the county list ranked by lung-cancer rate; a map of county lung cancer death rates is also available:

Princess Health and New treatment first offered in Louisville is helping asthma sufferers.Princessiccia

Princess Health and New treatment first offered in Louisville is helping asthma sufferers.Princessiccia

asthma lung disease research

Gusty 06:27 Add Comment

Shannon Denson, who has severe asthma, gets bronchial
thermoplasty. Courier-Journal photo.

Asthma sufferers can now benefit from an innovative treatment that was first offered at University Hospital in Louisville.

Patients like Shannon Denson are seeing improvement thanks to bronchial thermoplasty, "a minimally invasive, three-step procedure using heat to open airways in adults with severe asthma so they can breathe more easily," reports Laura Ungar of The Courier-Journal.

"Over the years, airways become very narrow. This opens them up," said Dr. Tanya Wiese, an interventional pulmonologist with University of Louisville Physicians, which partnered with UH to offer the treatment.

The treatment is not a cure but it does improve the condition of the lungs, which is good news since asthma rates are high in Kentucky. In the Ohio Valley, almost 15 percent of Kentucky adults said they had asthma, making it the seventh-highest rate in 2010, a survey by the U.S. Centers for Disease Control and Prevention found. (Read more)