Thursday, 6 March 2014

Princess Health and Princess Health andSenate OKs bill to regulate e-cigarettes just like tobacco products.Princessiccia

Princess Health and Princess Health andSenate OKs bill to regulate e-cigarettes just like tobacco products.Princessiccia

A bill to limit the sale of electronic cigarettes in the same way as sales of tobacco products passed the state Senate on Thursday, March 6. Senate Bill 109, sponsored by Sen. Paul Hornback, R-Shelbyville, would prohibit the sale of e-cigarettes and vaporized nicotine to minors. The vote was 36-2.

The bill now goes to the House. House Bill 309, which would regulate e-cigarettes as tobacco products, was approved by a House committee last month but has been awaiting action on the floor for several weeks.
Princess Health and Princess Health andHouse passes bill creating new type of order for end-of-life care, to be signed by patient and physician.Princessiccia

Princess Health and Princess Health andHouse passes bill creating new type of order for end-of-life care, to be signed by patient and physician.Princessiccia

An end-of-life order known as �medical order for scope of treatment� would be allowed in Kentucky under a bill that passed the Kentucky House on an 86-7 vote Thursday, March 6.

Unlike advance directives, such orders spell out a patient�s wishes for end-of-life care are also signed by the patient�s physician. A standard form for the orders would be developed by the Kentucky Board of Medical Licensure for use statewide.

�As a physician, I want to help people live and have a quality of life as long as they can,� said Rep. David Watkins, D-Henderson, the sponsor of House Bill 145. �But I sure don�t want to prolong suffering and agony � It�s our duty to make sure we keep our people in the final hours and final days of their life as comfortable as possible, and also to follow their wishes as close to the letter of the law as we can.�

The House defeated, 18-69, an amendment by Rep. Joe Fischer, R-Fort Thomas, that would have prohibited such orders from allowing food and water to be withheld from a patient unless death was �inevitable and imminent.� The bill now goes to the Senate.

Princess Health and Princess Health andPrimary care, a big focus of health reform, faces challenges as Kentucky doctors deal with change.Princessiccia

Craig Dooley, newly covered by Medicaid under health
reform, got an X-ray in Dr. Sven Jonsson's Baptist Health
office. (Photo by Luke Sharrett for The New York Times)
Primary-care doctors are key to the nation's health by providing preventive care to people who haven't been getting it but are now under federal health reform. However, some independent physicians in Kentucky and other states are struggling to run their businesses due to "flat or dropping reimbursement rates and new federal rules," many related to reform, Abby Goodnough writes for The New York Times. Goodnough's story is the latest in a series lookine at health reform through Kentucky examples.

Dr. Sven Jonsson joined Kentucky's Baptist Health System two years ago after leaving private practice in Louisville, fearing the law's often-expensive requirements. Now he is treating more patients, in the rural exurb of Taylorsville, and Baptist is handling all the details of the transition into the new health-care system.  "This is just a much saner place for me right now," he said. Primary care is more in demand because many states used it to expand Medicaid to people earning up to 138 percent of the poverty line.

Conversely, Dr. Tracy Ragland owns a small private practice in the wealthy suburb of Crestwood, and is concerned about the rules and payments associated with the new system. "The possibility of not being able to survive in a private practice, especially primary care, is very real," she said.

According to the American Medical Association, 40 percent of family doctors and pediatricians are independent. Ragland supports the idea of providing health coverage to more Americans, but says Medicaid and some private plans offered through Kentucky's health-insurance exchange don't pay enough, so she does not treat those patients. She says she values the flexibility of her private practice and the ability to spend as much time with patients as they need.

However, Ragland did join an "accountable care organization," a group of independent physicians who arrange care for a number of patients. "These networks, encouraged by the new law, reap financial rewards if they improve patients' health and spend less doing it," Goodnough notes. Ragland and her associates know that primary-care doctors can receive higher, Medicare-level reimbursements for seeing Medicaid patients, but this only lasts through 2014 and they didn't take the bait.

Doctors who have joined hospitals, like Jonsson, receive a baseline salary with bonuses for extra productivity, but that will probably change because the reform law will base payments on results. When Jonsson owned his own practice, he didn't accept Medicaid. At his new workplace at Baptist Medical Associates, he can treat Medicaid patients because the practice has space to grow, said Donna Ghobadi, an assistant vice president at the hospital.

Recently Kentucky passed a bill that will "give experienced nurse practitioners more leeway to practice independently," Goodnough reports. Ragland went to the state Capitol to ask legislators to give scholarships to medical and nursing students who will practice in under-served areas. "I don't get the emphasis on primary care is so important, but primary care physicians aren't," she said. Lawmakers said they will consider her ideas next year. (Read more)

Here's a video version of Goodnough's story:

Princess Health and The Ultimate Detox: Your Kidneys. Princessiccia

The specter of unseen, unspecified toxins eroding our health is worth many millions of dollars in the United States and abroad.  Companies offer "detox" supplements, beverages, and creams that supposedly rid us of supposed toxins, despite a complete lack of evidence that these products do anything at all*.  This comes from an industry that excels at creating boogeymen and offering costly solutions for them.

If your wallet needs to lose weight, then these products are highly effective, otherwise it's probably best to save your money.  Here's why.

The body is equipped with an extremely advanced system for excreting toxins.  The kidneys are part of this system, and their design is genius.  The basic functional unit of the kidney is the nephron, and the average kidney contains about a million of them.  Nephrons have two major parts: a renal corpuscle and a renal tubule

A nephron.  In this image, the Bowman's capsule and glomerulus make up the renal corpuscle, and the proximal/distal tubules and the loop of Henle (#1-3) make up the renal tubule.  Note the network of blood vessels (capillaries) that allow the transfer of water and other goodies from the tubule back into the blood.  Image source.
The renal corpuscle is the interface between the blood and the fluid that will eventually become urine.  Blood is filtered by a fine "sieve" of cells that prevents everything larger than a small protein from passing into the renal tubule.  Red blood cells, platelets, and most proteins stay on the blood side, while small proteins such as albumin, minerals, urea, glucose, water, and almost anything that would be considered a toxin** are allowed through into the renal tubule.

The renal tubule is a long tube that re-absorbs everything in this filtered blood that the body wants to keep.  Water, minerals, albumin, glucose, amino acids, and other useful molecules are re-absorbed.  Everything else ends up as urine and is excreted. 

Can you see the genius of this design?  Urine is blood, minus all the good stuff.  Everything that isn't specifically recognized by the body as useful is excreted by default, no matter what it is.  The body doesn't have to recognize each of the thousands of foreign compounds that make their way into our circulation each day.  These substances are all out the door, by default.

Are you impressed by your kidneys yet?  If not, consider this.  Your kidneys filter your entire blood volume roughly 70 times per day.  The reason you don't have to pee a liter a minute is that urine volume is reduced by 99 percent due to water reabsorption in the renal tubules.

This is why most drugs have to be taken on a regular basis, often several times per day.  In concert with the detoxification enzymes of the liver, which tend to make drugs easier for the kidneys to excrete, the kidneys rapidly reduce the circulating concentration of drugs simply by excreting everything they don't recognize as useful.

Can a detox product improve upon 500 million years of kidney evolution***?  I have my doubts.


* Exception: chelation therapy offered by a licensed medical practitioner for actual, diagnosed heavy metal poisoning.  Second exception: strategies that use the word "detox" loosely to refer to removing unhealthy foods from the diet.

** Toxins tend to be very small-- either small organic molecules or minerals such as arsenic.  Larger toxins such as proteins are uncommon in the circulation because proteins are generally not absorbed by the digestive tract.  Toxic proteins have to be injected or otherwise directly introduced into the circulation, e.g. by a snake bite or a bacterial infection.  But if you're bitten by a rattlesnake, I hope your first line of treatment won't be a detox kit from your local supplement store.

*** Kidneys are present in hagfish and lampreys, the most "primitive" living vertebrates.

Tuesday, 4 March 2014

Princess Health and Princess Health andWear blue on Friday, March 7 to mark Colorectal Cancer Awareness Month and encourage screening and colonoscopies.Princessiccia

Princess Health and Princess Health andWear blue on Friday, March 7 to mark Colorectal Cancer Awareness Month and encourage screening and colonoscopies.Princessiccia

Friday, March 7 will be "Dress in Blue Day" to mark National Colorectal Cancer Awareness Month and to help raise awareness about colon cancer in Kentucky, according to Madeline Abramson, wife of Lt. Gov. Jerry Abramson.

�Kentucky has one the highest mortality rates of colorectal cancer in the nation,� she said in a news release.  �The good news is that through preventative screenings, this deadly disease can be detected early and treated successfully. I ask Kentuckians to join me in wearing blue on March 7 to help spread the word about the risks of colon cancer and the importance of getting screened.�

The American Cancer Society estimates that about 2,200 Kentuckians will be newly diagnosed with colon cancer this year and nearly 900 of them will die from it.  Those over 50, or who have a family history of colon cancer, are at the greatest risk and should get regular colonoscopies, doctors say.

To help raise awareness in Frankfort, the State Capitol dome will be lit blue until March 7. Hospitals, businesses, churches, schools, banks, health departments and other organizations are planning and hosting special activities to commemorate the month and promote screening.  

For more information on Colorectal Cancer Month and Dress in Blue Day, visit Madeline Abramson�s website at http://1.usa.gov/NrsMriand the Colon Cancer Prevention Project site at http://bit.ly/1i3q98G. The Kentucky Cancer Program website at www.kycancerprogram.org has information about cancer prevention, awareness and treatment.

Monday, 3 March 2014

Princess Health and Princess Health andKentucky Health Cooperative, a new kind of insurer, claims most of the business on the state insurance exchange.Princessiccia

This story was updated Tuesday, March 4.
The Kentucky Health Cooperative, a non-profit, consumer-governed health plan, says it has captured 61 75 percent of the business on Kentucky's health-insurance exchange, according to the latest figures from the exchange.

The co-op competes on Louisville-based Humana's home turf and came out ahead of the insurance company that has $41 billion in annual revenues, CEO Janie Miller reminded Jay Hancock of Kaiser Health News as she told him how the co-op had beaten Humana and Anthem.

Unlike Humana, Anthem is offering exchange policies statewide -- but through a relatively narrow network of health-care providers, which may discourage enrollment. Anthem has sold 13 percent of exchange policies, and Humana is close behind at 12 percent despite not selling statewide.

Janie Miller (AP photo)
�They have a few more employees than I do,� Miller said of Humana. �We believe we're the health insurance plan of the people.� Hancock interviewed the former state Cabinet for Health and Family Services secretary at the recent National Alliance of State Health Co-ops meeting in Washington, D.C.

The Kentucky co-op is planning to expand into West Virginia next year. The co-op in Maine did even better than Kentucky, getting 80 percent of the exchange market in competition with Anthem, Hancock reports.

John Morrison, former president of the co-op alliance, estimated that co-ops have between 15 and 20 percent of the national enrollment through exchanges, Hancock reports. Open enrollment for 2014 ends March 31.

Morrison also told Hancock that co-ops will save billions for the consumers and taxpayers paying for insurance because of the added competition and lower prices. Premiums are 8.5 percent lower on average in states with co-ops than in states without them. He acknowledged that cause and effect hasn't been proven, but said �Nobody's offered another explanation for why that might be true.�

The 23 co-ops were created under federal health reform as non-profit, consumer-governed health plans. They must use any extra revenue to lower premiums and improve benefits, or refund the federal loans that funded them. They are designed to give for-profit companies more competition and hold down rates.

The co-ops have signed up nearly 300,000 members this year and two others are set to expand into new states next year, Montana Health Co-op to Idaho and Minuteman Health in Massachusetts to New Hampshire, officials said at the Washington meeting.

The reform law prohibits co-ops from using federal funds for marketing and advertising, but still requires them to do education and outreach. This creates "big challenge as they try to build their businesses from the ground up while expanding access to care and caring for the chronically ill, Hancock reports.
Princess Health and Princess Health andSponsor of statewide smoking ban says House leaders are blocking a vote to protect some members from political fallout.Princessiccia

Princess Health and Princess Health andSponsor of statewide smoking ban says House leaders are blocking a vote to protect some members from political fallout.Princessiccia

By Al Cross
Kentucky Health News

The bill for a statewide smoking ban has stalled, with the prime sponsor saying House leaders are blocking a vote to protect members who have told the sponsor they would vote for it, but have told the leaders they don't want a vote because they don't want it to be used against them in their re-election bids.

The prime sponsor, Rep. Susan Westrom, D-Lexington, told Kentucky Health News on Thursday, Feb. 27 that she thinks the bill would pass if Speaker Greg Stumbo would let it be called up for a vote, but he is protecting members who fear how the issue will play politically.

"Wrong," Stumbo replied in an email to KHN Sunday night. "Others in leadership have problems." In another message Monday morning, he said "I'm for [the] bill; may be the only member of leadership supporting it; so you figure out why it's not being called. I told her in all my years as majority floor leader, I never refused to call a bill unless a majority of leadership opposed doing it."

The other leaders of the House Democratic majority are Floor Leader Rocky Adkins of Morehead, who calls bills up for votes; Speaker Pro Tem Larry Clark of Louisville; Majority Whip Tommy Thompson of Owensboro; Democratic Caucus Chair Sannie Overly of Paris.

Westrom told Ryan Alessi of cn|2 that the leaders are divided on the issue. "It depends on what member of leadership you talk to," she said. "It's just a little bit schizophrenic right now."

Adkins said in a prepared statement, "This bill is being handled like other bills that are high profile. It has been House leadership's long-standing position to vet these kinds of bills to our members through a vote count before they are brought to the House floor. As of Friday the votes for passage were not there. We will continue to monitor the count as we move forward in the session."

Stumbo, who has said he supports House Bill 173, said Feb. 26 that he wasn't counting votes but sensed that the bill wasn�t �quite there yet� but was within �striking distance� of passage.

The leaders kept the bill in the House Rules Committee for the maximum five days allowed by House rules, then posted it for passage on Feb. 14.

On Feb. 18, Westrom and the bill's main Republican sponsor, Rep. Julie Raque Adams of Louisville, filed a floor amendment to exempt electronic cigarettes, private clubs and cigar bars. Adams told Alessi that has helped get Republican votes and allay some legislators' concerns about over-regulation of private property.

"When you open up that private property for public purpose, government always involves itself," she said. "This does not cost a business owner any money."

Adams said the larger issue is Kentucky's poor health and what it costs the state. "This is the only proposal that's before lawmakers right now that actually addresses the cost of health care," she said. "The cost to our budget is so dramatic, and it's really on an unsustainable course right now, that if we don't make some significant changes relative to health care and how we deliver it in this state, we're not gonna be able to afford anything else."

Adams acknowledged that the bill might be easier to pass in 2015 because this is an election year. "It absolutely is a factor in people's re-elections," she said. But she and Westrom said that issue cuts both ways, because most Kentuckians don't smoke. However, about 28 percent do, more than in any other state.

Some House members may be reluctant to vote for the bill because its prospects are poor in the Senate, where President Robert Stivers, R-Manchester, opposes it. Some House Democrats say privately that Westrom didn't help her cause by being the only Democrat not to vote for the bill Stumbo has called his top priority, to raise the minimum wage. She passed.

Westrom's harder push for a vote in recent days coincided with a Feb. 26 tweet from the Kentucky Chamber of Commerce, which favors the bill. The message on Twitter read, "The only way to know the vote count is to take a vote. Kentuckians deserve a vote on HB 173, the Smoke-free Kentucky Act."