Action Phase Podcast Episode #19

fudin headshotThe pain doctor is in! Dr. Jeffrey Fudin discusses pretty much everything you need to know about opioid pain medication, how to keep it in the hands of patients who need it and out of the hands of people who abuse pills, and how he thinks we can maintain the balance. Action Phase is on iTunes. Subscribe so you never miss an episode. Ratings help other people find the show and have the added benefit of giving me a little ego boost!

As always, you can stream it here, too.

https://ia600508.us.archive.org/33/items/19-JeffreyFudin-ActionPhasePodcast/19-JeffreyFudin-ActionPhasePodcast.mp3

Friday Five: Cigarettes, taxes, cancelled insurance, krokodil, pre-term births

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. This time, it's Bloomberg-heavy!  

New Yorkers have to be 21 to buy cigarettes

In what may be his last public health move before leaving office, New York City mayor Michael Bloomberg is set to sign a bill that will raise the purchasing age of nicotine products to 21. The bill covers cigarettes, e-cigarettes, cigars, and cigarillos. About 90% of adult smokers become smokers before age 20, so I understand the public health rationale. However, I question whether it is ethical to make a product illegal for some adults to purchase based simply on the person’s age. The fallout from this soon-to-be law will help frame tobacco laws around the country, and I’m eager to see what happens next.

 

Mexico creates a junk food tax

Mexico has one of the highest rates of overweight and obese citizens—higher than even the United States. This week, the Mexican Congress approved a bill adding an 8% tax to all “high-calorie” foods like potato chips and sweets and a one peso/liter (about $0.08) tax to all soft drinks. The tax initiative was funded in part by Michael Bloomberg’s foundation. It is resolutely opposed by Femsa, the Mexican manufacturer and distributor of Coca-Cola, and Bimbo, which owns Sara Lee, Entenmann’s, and other processed food companies. Hopefully, when the costs inevitably are passed along to consumers, consumption of these items will fall and the population move toward a healthier weight.

 

Some health insurance plans have been cancelled due to the ACA

Before the implementation of the ACA, about 5% of Americans purchased health insurance individually. Many of these plans are now being cancelled because they do not fit the requirements all plans must meet under the new law. There’s lots of outrage, particularly at President Obama, because people feel misled. It’s pretty clear what’s happening: there’s a combination of insurance companies ended “grandfathered” plans early (which is their decision, not mandated by the ACA) and plans being cancelled because they were purchased after the “grandfathering” date and therefore are not legal. For an excellent flowchart showing how and why this is happening, Jon Lovett made an intricate one.

 

Pre-term birth rates fall again

The US pre-term birth rate fell to a 15 year low of 11.5%, or 1 in 9, in 2012. Although we still have the worst pre-term birth rate of all the industrialized nations, this is a positive development. This is the sixth year in which the rates declined, but the reasons why are not clear. Pre-term, low birth weight, and very low birth weight babies can have developmental delays, need more care, and cost more—on average, about $51,600. For more detailed information, see the March of Dimes 2013 Premature Birth Report Card.

 

Appearance of krokodil may be a false alarm in the US

(Warning: DO NOT Google image search for krokodil. Trust me.)

A month or two ago, the internet was abuzz with reports of people losing body parts to a new drug, krokodil. This homemade heroin substitute popular in rural Russia causes horrible sores that lead to severe disfigurement. A few cases popped up in a number of states earlier this year, but now the DEA suggests these were heroin use-related problems, like staph or MRSA infections at the users’ injection sites. Compounding the skepticism is the fact that in some places, a dose of heroin costs only $5 (!!!), virtually eliminating the need for even the most desperate user to knowingly inject his or herself with krokodil. Here’s to hoping that it really hasn’t shown up here, and that this interest we now have leads to getting actual krokodil users help.

Action Phase Podcast Episode 2

This week, it's all about drugs, violence, and psychology as I talk with Kate Schaeffer. She's the Alcohol and Other Drug, Interpersonal Violence, and Mental Health Coordinator at the Wellness Resource Center at Temple University. You can download the episode by going here and saving the page as an mp3.

Or you can listen to it right here!

https://ia601904.us.archive.org/21/items/KateSchaeffer-ActionPhasePodcastEpisode2/Ep2_KateSchaeffer_Final.mp3

Friday Five: 9/11, tobacco in India, painkiller labels, Chobani recall, child abuse & neglect

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week.  

9/11 responders are suffering from cancer

While we remember the 12th anniversary of the attacks on the World Trade Center, another attack is being waged upon the responders: cancer. So far, 1,140 people have been certified by NIOSH to have 9/11-related cancer. The types of cancer are varied—from non-melanoma skin cancer to non-Hodgkins lymphoma to colon cancer—and thankfully, the September 11th Victim Compensation Fund will cover all related medical and mental health expenses. However, an important deadline approaches: if a person knew of their related medical condition before October 2011, he or she must sign up with the Fund before October 3, 2013 in order to have their treatment covered. If you know anyone who may be eligible for this benefit, please (1) thank them for their selflessness and (2) tell them to sign up ASAP.

 

Tobacco + India = Bad News

Approximately 275 million people out of India’s 1.2 billion population use smokeless tobacco or cigarettes. According to a report from the International Tobacco Control Project, the country could see 1.5 million deaths annually if the number of tobacco users is not reduced by 2020. What’s even more alarming is that 94% of tobacco users surveyed said they had no plans to quit, despite government efforts to curb consumption and self-reported regret for beginning the habit. Citizens groups also advocate for tobacco-free living. This ad from Cancer Patients Aid Association is an example of the kinds of messaging Indians receive.

 

Source

 

New labels for some, but not all, narcotic painkillers

The FDA has announced updates to the labels for extended release narcotic painkillers to remove the idea that the painkillers should be prescribed for “moderate-to-severe pain.” Instead, opiates like OxyContin (oxycodone) and MS Contin (morphine sulfate) should be prescribed only when a patient’s pain cannot be controlled by other methods. These changes do not apply to fast-acting painkillers like Percocet (acetaminophen and oxycodone) or Vicodin (acetaminophen and hydrocodone) because the FDA sees that class of opioids to be less susceptible to abuse and overdose. Hopefully the new label will encourage doctors to think carefully about which painkillers they prescribe. The misuse of these drugs is out of control, and as doctors are the gatekeepers of prescriptions, their cooperation is essential to reducing addiction and unintentional deaths.

 

Chobani yogurt is moldy

Beloved and wildly popular Chobani brand Greek yogurt has been recalled. The problem of bloated, exploding containers is said to be due to contamination by the mold Mucor circinelloides. Although this kind of mold is not known to cause gastrointestinal problems, 89 people have reported nausea and vomiting after eating the recalled yogurt. That said, if your breakfast is fizzing through the lid, please don’t eat it. Let’s have some common sense, okay?

 

New child abuse and neglect report demands changes to the system

A report released this week from the Institute of Medicine described the fractured, underfunded, and unevaluated way the US researches and addresses child abuse and neglect. There are more than three million reports of abuse each year, involving at least six million children. The most common form of mistreatment is neglect, or when a caregiver fails to provide food, supervision, protection, medical care, education, or nurturing and affection. The full report gives a sense of how poorly the US manages child abuse and neglect, and this infographic also gives the basics. Children who are victims of abuse or neglect are far more likely to have serious health problems, including mental health issues, so eliminating violence against children should be at the forefront of public health efforts.

 

This week’s Friday Five is extra-depressing, so I’m going to leave you with a bonus uplifting story:

Wearing a sandwich board may help you find a kidney donor

Larry Swilling of South Carolina has been walking around wearing a sandwich board asking for a kidney donor for his wife Jimmie Sue. A complete stranger, a woman named Kelly Weaverling from Virginia Beach, decided to get tested and was found to be a match. The transplant happened on Wednesday and both Jimmie Sue and Kelly are doing well. Bonus: Larry’s efforts have led to 125 new registered kidney donors in South Carolina.

Friday Five: Non-fatal illness, Medicare, gay blood donors, e-cigarettes, infographic

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Q: What’s the most prevalent form of non-fatal illness in the world? A: Mental illness and substance abuse disorders. That’s right—mental and emotional issues such as depression, anxiety, drug abuse, and schizophrenia account for 22.8% of all non-fatal illnesses. This isn’t just in the US, but across 187 countries and 30 years. It’s time to stop pretending these disorders don’t exist. The authors of the study presenting these findings say it best: In view of the magnitude of their contribution, improvement in population health is only possible if countries make the prevention and treatment of mental and substance use disorders a public health priority.

Doctors still take Medicare beneficiaries Rumor has it that in light of the Affordable Care Act’s changes to Medicare reimbursement, doctors are fleeing the system and leaving seniors without medical care. But a report from the Department of Health and Human Services showed that in 2012, 90.7% of doctors accepted new Medicare patients, compared to 87.9% in 2005. Furthermore, more doctors are accepting new Medicare patients than are accepting those with private insurance. If you have Medicare, nearly all doctors will accept you. ACA myth debunked.  

Banned4Life wants the FDA to allow gay blood donors Men who have sex with men cannot donate blood. The FDA reasons that because gay men comprise 2% of the US population but in 2010 accounted for 66% of all new HIV infections, and because HIV goes through an “undetectable” period just after initial infection, keeping gay men out of the donor pool maintains the safety of the blood supply. The newly formed Banned4Life group seeks to change this policy. Banned4Life is urging the FDA to consider sexual behaviors, rather than sexual preference or orientation, when deciding who cannot donate blood. Life-threatening illnesses, gay rights, and government regulations can rile up lots of people, and I hope the FDA looks carefully at its policy and is transparent about the decision it makes.  

E-Cigarettes are getting popular among teens Combining two of their favorite things, rebellion and new technology, teens are adopting the newest form of nicotine on the market, electronic cigarettes (or e-cigarettes). Nearly 10% of high schoolers have tried them, doubling the rate from 2011 and far exceeding the 6% of adult smokers who have given e-cigarettes a puff or two. This finding from the CDC raises some interesting questions: are e-cigarettes safer than regular ones? Are the anti-smoking campaigns aimed at teens intended to be anti-cigarette or anti-addiction? Hypothetically, if e-cigarettes carry no risk of disease, would it be okay for teens to use them? Will indoor smoking bans apply to e-cigarettes? These will be crucial questions to address as e-cigarettes gain popularity.

Just how imperfect is US health care, anyway? This colorful, informative, and slightly dizzying infographic from the MPH program at George Washington University shows us how not-so-well our health care stacks up to the rest of the world. Interesting points to consider:

  • 79% of Americans use some kind of contraceptive, one of the only times we’re mostly ahead of the pack, trailing only Russia, the UK, and Canada.
  • Ghana, Algeria, Mexico, and many more countries have higher measles vaccination rates among one year olds.
  • There is 1/3 of a general practitioner for every 1000 Americans, while there is just over two specialists for every 1000 people (87.5% of practicing doctors are specialists).

US vs World Infographic

Friday Five: heat, Bloomberg, Texas, heroin, ACA

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Let’s all do the heat wave! Just in case you’ve ignored the Facebook status updates, tweets, and complaints from co-workers, I want to inform you that it is Very Hot Outside. Growing up in Florida gives a person a skewed sense of the appropriate level of summertime heat and humidity, but this week has been tough even for me. In all seriousness, the heat is severe and dangerous, especially because so many people in the affected areas (map) don’t have air conditioning. So follow the heat advisory instructions: stay inside, run that AC (if you have it), drink water, and check in on seniors—they’re especially susceptible to high temperatures. And remember, we’ll all look back fondly this week while we wait for snow plows in January.

Bloomberg’s at it again But this time, he just wants New Yorkers to bypass the elevator and take the stairs instead. Mayor Bloomberg signed an executive order on Wednesday that requires all government building to be laid out using “Active Design” principles in order to promote physical activity like taking the stairs. We often talk in public health about making the healthy choice the easy choice and changing the built environment to encourage physical fitness. Bloomberg’s latest move may spark an interest in healthier buildings. Could Active Design be the new LEED certification?

You haven’t heard the whole story about Texas This was a big week for abortion controversy in Texas, and there’s already extensive coverage of what happened, so here’s some news you may have missed:

  •  You can now purchase Rick Perry voodoo dolls (cultural appropriation isn’t just for Miley Cyrus)
  • Texas Democrat Rep. Harold Dutton introduced a bill that would ban all abortion legislation until the state abolishes the death penalty.
  • The pink running shoes Wendy Davis wore during her filibuster have over 280 positive reviews on Amazon, and not all of them extol the arch support.

What did I miss?

Heroin’s popularity is growing in Northern New England In New Hampshire, the number of fatal heroin overdoses jumped from just seven in 2003 to a surprising 40 in 2012. The increase has also been observed in Vermont, with a 40% increase in heroin addiction treatment, and Maine, which had three times the heroin overdoses in 2012 as in 2011. There are a few factors that may contribute to this growing problem: increased control over prescription painkillers, the relative cheapness of heroin compared to painkillers, and because heroin can be sold at a higher price in rural areas than in urban centers, distributors are incentivized to sell more. Heroin is now taking up most of drug enforcement agents’ time in the area. Controlling infectious diseases like HIV and Hepatitis C will be the next challenge for the area’s public health community.

Curious about what’s happening next with the ACA? Kaiser Family Foundation released a new ACA video starring its charming YouToons. This one, a follow up to 2010’s “Health Reform Meets Main Street,” explains how to “Get Ready for Obamacare.” (Interesting, the change in terminology over three years!) This easy to understand breakdown of the complicated law is accessible to all audiences. Anyone talking to the public should be emulating this kind of clear communication. http://www.youtube.com/watch?v=JZkk6ueZt-U