Health officials in Kentucky, especially in the eastern part of the state, hope to increase lung-cancer screenings by following a successful colon-cancer screening initiative, Jackie Judd reports for PBS NewsHour. (Centers for Disease Control and Prevention graphic: Colon-cancer screenings are up)
In rural Eastern Kentucky, smoking and lung cancer rates are double the national average, while the state is second in adult smoking rates and leads the nation in lung cancer and rates of death from it. That is "fueled by a toxic combination of poverty, medical illiteracy, limited access to care, lifestyle choices like smoking, and a fatalism that says knowing you have cancer won�t save you."
Another challenge is that local bans of smoking in public places have left two-thirds of residents living in areas with no such bans, and a statewide ban seems unlikely because it failed to pass the state House this year after narrowly passing last year. New Republican Gov. Matt Bevin opposes a statewide ban.
Fifteen years ago Kentucky led the nation in "both the highest incidence and mortality rates for colorectal cancer," Allison Perry reports for University of Kentucky News. Rural residents didn't seek care, partly because of a lack of facilities and partly because of a refusal to schedule an appointment. If local residents wouldn't seek care, health officials decided to bring care to local residents.
"In the seven years following this new focus on colorectal cancer, the screenings rates nearly doubled, from 34.7 percent of the age-eligible population receiving screenings to 63.7 percent," Perry writes. "This raised Kentucky�s rank from 49th in the country to 23rd compared to other states. No other state has had such a dramatic increase in colorectal screenings in such a short period of time. As a result, the lives of many Kentuckians have been saved: the incidence rate for colorectal cancer is down nearly 25 percent, and the mortality rate has dropped 30 percent. Through colorectal screenings, doctors can find precancerous lesions and remove them before they become cancer. Screenings also allow physicians to find these cancers at an earlier stages, when they are more likely to respond to treatment."
The number of cancer screenings jumped in 2014 and 2015, as the state expanded eligibility for the Medicaid program under federal health reform, making many more people eligible for free screenings. Bevin is seeking change the state's program in ways that could require co-payments, premiums and deductibles.
In Kentucky "the challenge is to not only encourage certain lifelong smokers to get screened, but to get them to quit, and for others to never start," especially because of the addictive nature of smoking, Judd reports. "It will be even more difficult than changing the profile of colon cancer, because smoking involves addiction. The hope of public health officials is that the model used to bring down colon cancer deaths can be used to the same effect, not only for lung cancer, but for other diseases plaguing this depressed swath of America."
This was a wonderful Easter. Except for getting home over an hour later than expected, it was just perfect. I maintained the integrity of my calorie budget, continued my abstinence from refined sugar, exceeded my water goal by four cups, engaged in spot support communications via text and phone and spent the majority of the day in company of loved ones--and really, that's such a precious gift.
There was a topic I wanted to elaborate on--but this is clearly not the time. I must drop in bed. I'll save it for another night. Instead--I'll tell the rest of today's story with pictures and captions--and the Live-Tweets of the day as it unfolded.
This was Noah's first official Easter egg hunt. Courtney, unfortunately, had to work today and couldn't be there, so Irene, Allen, Amber, KL and I accompanied Noah to his age group and waited for the huge firetruck to start the egg hunting frenzy with a blow of its extremely loud horn. When the time came, it slightly startled our little man!
He has grown beyond the 'frightened of people in costumes' phase--and straight into the, 'this is cool,' phase.
We all gathered at the restaurant prior to the big hunt.
Noah and I made the trip to see mom this evening. We enjoyed a late dinner out and a great Easter evening visit before heading back home--and taking little man to his Nana's (Irene's) house for a sleepover.
I rarely have a day that includes two restaurant meals. Today was the exception. I feel like I navigated well. It helped that both places were really easy for me to navigate. Instead of tacos at lunch--I made it a salad, knowing I'd have tacos later. Beef for lunch--chicken for dinner. I enjoyed some variety--including an unusual breakfast. Mainly, I enjoyed the time spent with everyone--and Noah, oh my, that little guy owns my heart.
It feels so good to be at a healthy weight, enabling me to keep up with him--and not just the physical part of that equation--it's also about not being in a constant food fog. It's hard to express gratitude and appreciate important things and others, when under the influence of the food fog. Before I elaborate any further--turning this into a big exploration of thoughts and experiences, I better go to bed! Another time...
Today was a solid one. I accomplished all of my goals for this day. I maintained the integrity of my calorie budget. I remained abstinent from refined sugar. I exceeded my water goal and I had a great workout this afternoon. I also made fantastic support exchanges and conversations very important.
I prepared a nice meal this evening in a kitchen other than mine! Italian Enchiladas (see Tweets below) was absolutely something different. Amber and Kristin loved them! We enjoyed the dinner and had a great visit.
It's a nearly Tweets Only edition tonight. Tomorrow, little Noah takes part in his first Easter egg hunt! A bunch of us will be taking him. That kid will have his own entourage tomorrow!
My Tweets Today:
2 cups water & 20 push-ups required before I receive morning coffee pass. DONE ??. Now, let's sip, shall we? pic.twitter.com/8llh7oQEH7
The first half of this day was relaxed and full of rest. I stayed up way too late last night watching Better Call Saul. I still managed a full eight hours sleep--but here's the deal: When I sleep in like this--and it's almost 11am when I get out of bed, my food schedule is automatically tilted and challenged. On a day like today, when the second half is jam packed with work and an extra commitment--it makes it extra challenging. This is when planning becomes super-important.
I had two back to back location broadcasts today--a 3-5 and a 5:30 to 8pm, followed by being a judge at a big karaoke contest involving sixteen singers performing three songs each. The contest didn't wrap until nearly 1am. The top three finishers were amazing singers. It was a fun contest, even with it being way too long of a production. But anyway--oh yeah, the tilted food schedule...you see,
I had a very late brunch--and that pushed my lunch until at least the middle of my first broadcast. The client had plenty of free food--but I knew the choices there wouldn't be anything for me. I planned and prepared by picking up the ingredients for my favorite, sour cream chicken tacos, and set it up in the back of the station's broadcast vehicle. Lunch around 4:30--then around 8pm, I had an "on-the-go" dinner of almonds, two kinds of cheese and a banana. It worked very well. Add the coffee with half & half and plenty of water, capped with some good fruit as my #lastfoodofday, and I could count this day as exceptional in the food department.
I maintained the integrity of my plan in every way. I'm very proud of that. Today could have gone differently in many ways. But it didn't. That's a wonderful thing.
I decided early in the day that my activity level would be high enough to excuse not going to the gym. I did do my morning routine before coffee, thing.
I'm exhausted. Wow, good thing I was off this morning!
I'm letting the Tweets take it the rest of the way...
My Tweets Today:
Some mornings are easier than others. Almost forgot to do water & push-ups before coffee. Both are in the books??. pic.twitter.com/HBF09UjBNR
Gov. Matt Bevin and other Republicans have said they want to make Kentucky's version of Medicaid look like Indiana's, but a leading Medicaid official says that Indiana's program hasn't proven itself to save money or improve health, so it's unlikely other states will be allowed to use it as a model, Phil Galewitz reports for Kaiser Health News and The Washington Post.
Matt Salo, executive director of the National Association of Medicaid Directors, told Galewitz, �Other states have looked at it, but the Obama administration has made it pretty clear that Indiana is going to be a test case and much evaluation will need to be done before they approve any more like it.�
Now Bevin's office says it is looking at other states, too, as it negotiates with the U.S. Department of Health and Human Services, trying to come up with a revised program to save money, perhaps by August.
"The Indiana model is just one of many models that we are looking at for influence in crafting a plan that is specifically tailored for the needs of Kentucky," Bevin spokeswoman Jessica Ditto said in an e-mail. "We are working closely, and in good faith, with HHS as this process moves forward and have confidence that what we offer for their consideration will be a thoughtful, deliberate and unique plan that will improve health outcomes in a sustainable manner."
Under federal health reform, then-Gov. Steve Beshear expanded Medicaid to those in the state with incomes up to 138 percent of the federal poverty level, adding 400,000 people. The federal government pays for this expanded population through this year, but then the state will be responsible for 5 percent of the expansion, rising to the reform law's limit of 10 percent in 2020.
Bevin has said that Kentucky's revised program should require its members to have "skin in the game," and that the state cannot continue to pay for the health insurance of "able-bodied adults."
Healthy Indiana Plan That sounds like Indiana, which has monthly fees and co-payments and refers its participants to a work program.
Even if it is just a dollar, everyone on Medicaid in Indiana pays something, whether it's through a monthly fee or through co-payments.
The Healthy Indiana Plan has two levels, HIP Plus and HIP Basic. Both plans offer incentives for using preventive services, but HIP Plus, which requires a monthly fee, also includes dental and vision services.
Those fees go into an account that is like a health savings account and is used for the first $2,500 of medical expenses each year. The state of Indiana pays the bulk of the $2,500 and if the participant's health-care expenses exceed this amount, the state will pay for the additional care at no cost to the individual.
HIP Plus is considered the best value and is available to everyone in the state with income below 138 percent of the federal poverty level. The consequences for not paying the required monthly fee vary by income level.
Those in HIP plus who make at or below the poverty level and fail to pay the fee are moved down to HIP Basic plan, which requires co-payments of up to $8 per service and $75 for each inpatient hospital stay. Both plans have a co-payment for using the emergency room for non-emergency reasons, $8 the first time and then $25 per visit thereafter.
HIP Basic members who make more than the poverty level are locked out of coverage for six months if they fail to make their monthly payment.
"No other program has been allowed to require health spending accounts, much less threaten to yank coverage for a person not paying in," Galewitz writes, paraphrasing Salo.
HIP members who are unemployed or work less than 20 hours a week are referred to available employment, work search and job training programs to help them gain employment or find better employment. This is a free and voluntary program and does not affect the receipt of benefits.
All members of HIP Plus must pay something. About half of Indiana Medicaid members have annual incomes below $600; they must pay a $1 monthly premium.
The monthly fee adjusts with income and family size. For example, a single person who makes $16,242, the maximum for expanded Medicaid, pays $27.07 per month to get HIP Plus, or $324.85 per year. A family of two could make as much as $21,983 and would pay $36.64 or $439.68 per year; and a family of four could make $33,465 and would pay $55.78, or $669.36 per year. Information comes from the eligibility calculator on the Healthy Indiana Plan website.
Is Indiana's plan working?
Indiana health officials told Galewitz that 94 percent of those who have signed up for HIP Plus continue to pay their fees.
Michelle Stoughton, senior director of government relations for Indianapolis-based Anthem Insurance Cos., called that a success. She said nearly 75 percent of Anthem's members on this HIP Plus have visited a dentist, and 65 percent sought vision care in the first three months of coverage. Anthem is one of three private insurers providing coverage under the Healthy Indiana Plan.
�What we heard for years .?.?. is that these people won�t pay and don�t have the ability to pay,� Stoughton told Galewitz. �But this has turned those arguments around and been able to show that people do want to be engaged.�
Indiana's hospitals and doctors support the Healthy Indiana Plan, mostly because the state increased their Medicaid rates, hospitals by an average of 20 percent and doctors' reimbursements by an average of 25 percent, Galewitz reports.
"As a result, Medicaid has gained more than 5,300 providers in the past year, and patients report few problems getting care," he writes. But he also noted that about 2,200 members have lost coverage since it began in May 2015 because they didn't pay their monthly fees.
Critics of Indiana's plan worry that the monthly payments and complicated structure will keep the poor from getting care. which goes against the core goal of Medicaid expansion, Galewitz writes. In addition, some conservative groups say the program may be more expensive than traditional Medicaid, because it provides dental and vision care and pays providers more. Others say that the red tape in the plan exceeds that of any state's Medicaid expansion.
The state had also hoped third parties would step up and help the poor pay for their monthly contributions, but this hasn't happened, Joan Alker, executive director of the Georgetown University Center for Children and Families, told Galewitz. She said, �It�s premature for Indiana to take a victory lap.�
Novartis AG said it agreed to pay $25 million to settle a U.S. Securities and Exchange Commission case that claimed the Swiss drugmaker paid bribes to health professionals in China to increase sales from 2009 to 2013.
In particular,
The SEC detailed a number of Foreign Corrupt Practices Act violations where Novartis employees provided items of value to health-care professionals in China, under the supervision of complicit managers. It also cited examples of how the company improperly recorded as legitimate expenses payments employees made for travel and entertainment, conferences, lecture fees, marketing events, educational seminars and medical studies.
For some vivid examples,
In one example cited in the SEC order on Novartis, a sales representative at the drugmaker�s Sandoz China subsidiary submitted a $1,154 receipt to buy holiday gifts for 25 health-care professionals, which was instead used to pay for their spa and sauna sessions. A regional sales manager approved the purchase, the SEC said.
The SEC order also cited how Sandoz China sponsored 20 health-care professionals to attend a 2009 medical conference in Chicago. During the trip, the company paid for the group�s recreational activities such as a Niagara Falls excursions, $150 in 'walking around' money for their spouses, and cover charges to a strip club. The group was accompanied by a Sandoz China senior manager and other staff, according to the SEC.
So, thus far, the allegations were that Novaris bribed Chinese physicians to use their products, and the bribes includes gifts, travel money, and admission to a strip club. It is likely that these bribes induced the physicians to unnecessarily or excssively prescribe Sandoz drugs to patients, leading to excess expenses, overtreatment, and quite likely adverse effects that should have been prevented.
As per the Wall Street Journal, and as usually happens in such cases, Novartis was allowed to settle without "admitting or denying the findigs." In the Bloomberg article, a Novartis spokesperson gave the usual vague response,
'The issues raised by the SEC, which relate to our subsidiaries in China and go back as far as 2009, largely pre-date many of the compliance-related measures introduced by Novartis across its global organization in recent years,' Novartis spokesman Eric Althoff said in an e-mailed statement Thursday.
The implication was that the company no longer does these bad things, but did not include a promise not to do them. And, of course, just like in many, many other health care cases, and in many, many other cases involving big, powerful, or influential organizations, no one at a top management level went to jail, or even suffered any negative consequences, even for such sleazy allegations as those in this case. Finally, partially because the amount of this settlement was so small related to the financial bulk of the company involved, this case was relatively anechoic, only reported in the small items in the business press.
Summary
As we are distracted by bloviating billionaires and other spectacles on the US 2016 campaign trail, we continue to accumulate evidence of the corruption of large health care organizations and the impunity of their leaders. Yet this evidence remains anechoic, even given the apparent recidivism involved. For example, it was only in last November that we discussed what were then the latest misadventures by Novartis and its leadership. At that time, our post included these section headings covering 2014-15:
- Japanese Health, Labor and Welfare Ministry Found that Novartis Concealed Serious Adverse Effects - Novartis Executive Pleads Guilty to Bribing Polish Official - Novartis Subsidiary Sandoz Settles Allegations that it Misrepresented Pricing Data to US Medicaid - Express Scripts Settles Allegations that it Accepted Kickbacks from Novartis - Novartis Settles US Allegations of Kickbacks to Enhance Sales of Multiple Drugs
Furthermore, in that post we also documented Novartis' previous record. In March, 2014, we had noted: - Italian authorities had fined Novartis and Roche for colluding to promote the use of an expensive opthamologic treatment - the NY Times published interviews with physicians ostensibly showing how Novartis turned them into marketers for the drug Starlix - Japanese investigators charged Novartis with manipulating clinical research - Indian regulators canceled a Novartis import license, charging the company with fraud.
Also, in 2013, Novartis was fined for anti-competitive practices in its marketing of Fentanyl by the European Commission (look here), and in 2011 its Sandoz subsidiary settled allegations of misreporting prices in the US for $150 million (look here) Other Novartis misadventures from 2010 and earlier appear here. So Novartis has quite an impressive, if not infamous record of ethical failures.
Yet no Novartis top manager suffered any negative consequences then (although one apparent mid-level company manager at the Polish subsidiary did plead guilty), and all these previous episodes apparently did not suggest a pattern of recidivism to US authorities this time sufficient to attempt to impose any negative consequences on higher level managers. Meanwhile, Novartis executives continue to be paid handsomely. The 2015 Novartis executive compensation report listed over 51 million Swiss francs paid
Also, this goes on while large health care companies continue to pay out dizzying amounts to physicians, health care professionals, hospitals and academic institutions, which partially may secure their loyalty. Novartis, for example, which ProPublica lists as only the 28th biggest payer to physicians, paid out $31.7 million in 2013-14 just to US physicians. The 2015 Novartis board of directors included Dr Nancy C Andrews, the Dean of the Duke Medical School and Vice-Chancellor for Academic Affairs at Duke University, Dr Dimitri Azar, Dean of the College of Medicine at the University of Chicago, Illinois, and Dr Charles L Sawyers, a professor and department chair at Weill-Cornell Medical School. I am unaware that anyone of them have publicly raised any concerns about Novartis' recent misadventures, although I am also unaware whether anyone has publicly asked them such questions.
No wonder that ordinary US (and other countries' citizens) feel that they are trapped in a hopeless economic situation by rigged systems designed to benefit from the corrupt insiders. No wonder that someone of them are seeking the protection of some of those powerful insiders. But I digress...
In terms of health care, as we have said like a broken record (if anyone remembers what that means), or, if you prefer, where every verse is same as the first...
There seems to be increasing recognition that the continuing rise in US health care costs is unsustainable, and that these costs are not buying us good health care. There are calls to avoid unnecessary, and sometimes harmful care. Yet there is a persistent disconnect between how continuing dishonest behavior by health care organizations, impunity of their leaders, and lack of accountability by their board members fuel rising costs, shrinking access, and bad outcomes for patients.
To truly reform health care, we will have to at least recognize the causes of the current dysfunction. Recognizing how health care dysfunction is created by unaccountable, dishonest leadership should lead to true reform that would promote well-informed, honest, accountable leadership that puts patients' and the public's health ahead of personal gain.
Our musical interlude ("second verse, same as the first,") Herman's Hermits, Henry VIII
Students in Greater Cincinnati, including Northern Kentucky, are more likely to use marijuana and electronic vapor products than cigarettes, according to a drug-use survey of students in the region.
Graph from PreventionFirst report
The survey found that students in the area were most likely to use alcohol (16.3 percent) within the past 30 days, followed by marijuana (11.7 percent), electronic vapor products (13.4 percent), tobacco (8.2 percent) and non-prescribed prescription drugs (4.6 percent).
This was the first year a question was included about electronic vapor products in the biennial surveys by PreventionFirst (formerly the Coalition for a Drug-Free Greater Cincinnati), a comprehensive effort to reduce adolescent alcohol and drug use.
The good news is that most students are not using alcohol, tobacco or other drugs, says the report.
The study surveyed nearly 40,000 students in grades seven through 12 from 88 public and private schools in several counties in Greater Cincinnati and Kentucky's Kenton County. They were asked whether they'd used any of 21 drugs.
The survey found that use of alcohol, tobacco and marijuana have declined significantly since 2000: alcohol down 46 percent, tobacco down 61 percent and marijuana declining 22 percent. Since 2012, non-prescribed prescription drug use has declined 29 percent.
It found that students' perception of the harm that alcohol can do has increased, while they were less concerned about marijuana.
With marijuana, as students get older "their perception of harm decreases, and use increases," said PreventionFirst CEO Mary Haag told Terry DeMio of the Cincinnati Enquirer.
"Marijuana has become very prevalent and it's becoming more so," Hamilton County Commissioner Dennis Deters, who chairs the Hamilton County Heroin Coalition, told DeMio. "It's dangerous to our children and it enhances their risk when they become adults for serious addiction."
The report calls age 13 a "pivotal age" because this is when first drug use often occurs in students.
The report also finds that peer and parental disapproval rates are at an all-time high.
"We know how important friends and parents are in a young person's life," Haag said in the news release. "Students whose peers and family express disapproval are more likely to make the healthy choice to not use drugs and alcohol."
