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: Lea-Ann Ellison, antibiotic resistance, apps, medical marijuana, adorableness

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

Surprise! Lifting weights while pregnant is controversial

Americans do a great job of finding reasons to criticize women, especially when it comes to reproduction and motherhood. This week, we were subjected to a wave of judgment about Lea-Ann Ellison, who has the audacity to lift weights while 33 weeks pregnant. She says her doctor is fine with her exercise. Pregnant women are told to continue being active, and that’s exactly what she’s doing. If her doctor—not the ones quoted by media outlets—deem her exercise intensity level safe, then we should butt out.

 

Antibiotic resistance is going to be a big problem

A first-of-its-kind report from the CDC on the status of antibiotic resistance classifies 18 microorganisms as “urgent,” “serious,” or “concerning” in their ability to fight antibiotics. The list includes everyone’s favorite infections: gonorrhea, typhoid, and tuberculosis. Antibiotics are one of the most important reasons our life expectancy has grown, and losing the ability to kill bacteria will certainly mean more severe illness. This is a great opportunity for primary prevention (preventing illness before it starts); strategies such as advocating for condom use, safe food handling practices, and vaccines will be necessary. Meanwhile, doctors should be discerning about prescribing antibiotics, and we must invest more money and effort into developing new drugs.

 

Now some apps will come with an “FDA approved” message

The FDA has made its final decision about which mobile health apps it will regulate. It is focusing on apps that could cause significant risk to users if the app does not function correctly. Apps that allow the user to check blood glucose levels or turn the phone into an ultrasound machine could be game changers for providers and patients. However, when I looked for these apps on the iTunes store, I couldn’t find any. Is this because they won’t be released until after the FDA approves them?

 

Egg Harbor dispensary is set to open

The long-awaited South Jersey medical marijuana dispensary run by the Compassionate Care Foundation is set to open in just a few weeks in Egg Harbor. Sales will be by appointment only and the building cannot have any illuminated signs, ostensibly to reduce the inevitable interest of recreational users. Interestingly, the non-profit Compassionate Care Foundation will have to pay federal income taxes because the federal government does not recognize its non-profit, leading to a projected cost to consumers of $400 per ounce, with a limit of two ounces per month. Could the rules and restrictions placed on the Egg Harbor dispensary be a model for regulating dangerous yet legal painkillers? We have a lot to learn from the state-by-state legalization of marijuana, and I’m interested to see how this evolves.

 

Adorable Care Act. That’s right. Adorable.

The Adorable Care Act has stolen my heart. These animals are just too damn cute. And they’re advocating for the Affordable Care Act on Tumblr and Twitter? Oh man, sign me up for insurance right now. Observe these baby animals that I poached right from the Tumblr:

This kitten is so excited she can stay on her parents' insurance for a few more years.

adorable_care_piglet

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: Transplant ethics, Planned Parenthood, Hepatitis C, immigrants, Google

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Child in dire need of lung transplants starts a debate on ethics

Ten year old Sarah Murnaghan has been waiting for lung transplants for 18 months due to her cystic fibrosis and related lung failure. Doctors say she is not likely to live past the weekend without a transplant, so the severity of her illness placed her at the top of the pediatric list. However, Sarah is on very bottom of the adult list, meaning that any adults in need of lungs will be offered the organs before her, regardless of whether or not their need is as pressing as hers. Since 2005, organs are supposed to be distributed based on need, but that rule applies only to patients over age 12. Sarah’s parents have petitioned Kathleen Sebelius to change the rules to allow pediatric transplants of adult organs based not on age but on medical necessity. Hopefully, Sarah’s dire situation will ignite a conversation on organ donation and the ethics of treating children as if they are adults. (Okay, so this is six sentences but I think it’s worth it.)

Planned Parenthood case will not be heard by the Supreme Court

Indiana tried—and failed—to refuse Medicaid funding to Planned Parenthood. The Supreme Court refused to consider an appeal on behalf of the state to allow Indiana to withhold money from Planned Parenthood because it offers abortion services, even though federal law prohibits Medicaid dollars from being spent on abortion. Hopefully, this development will stall other attacks on low-income women’s right to choose their health care providers. However, the wily anti-choice movement is probably cooking up other ways to deny services to women—Indiana already has a law in place requiring facilities that offer non-surgical abortions to meet the same standards as facilities that perform surgical abortions. The Supreme Court’s choice not to hear the appeal is important, but as usual, fighting against restrictions on this legal medical procedure is a constant battle.

Is the “war on drugs” to blame for millions of Hepatitis C cases?

The Global Commission on Drug Policy called for an end on “the war on drugs,” in part because criminalization of injection drugs has lead to a quiet epidemic of Hepatitis C. The Commission estimates that of the 16 million injecting drug users (IDUs), 10 million are living with Hepatitis C; China, the Russian Federation, and the USA have the highest rates of Hepatitis C among IDUs. Arguing that harsh drug laws dissuade IDUs away from public health efforts such as needle exchanges, the Commission recommends reforming existing drug laws and focusing on health rather than incarceration and forced treatment. While I doubt many countries will decriminalize heroin and other injectable drugs, I’m pleased the Commission is drawing attention to the broader health concerns of IDUs. Regardless of drug use or dependence, a person has a right to access public health initiatives without fearing arrest and imprisonment.

Immigrants subsidize Medicare

A study published in June’s Health Affairs showed that in 2009 naturalized and non-citizen immigrants contributed $33 billion to the Medicare trust fund and received $19 billion in expenditures, creating a surplus of $14 billion. American-born citizens, on the other hand, contributed $192 billion and used $223 billion, creating a deficit of $31 billion. There are a few reasons why immigrants’ contributions lead to surplus: there are 6.5 working immigrants for every one retired immigrant and the cost of care for immigrants is less than the cost of care for the American-born. In a time when immigration and a path to citizenship are pressing issues, focusing on the positive contributions of new residents and citizens can only help decision makers to make choices to encourage new immigration. This study reminds us that immigration is crucial to the success and longevity of the United States, and treating all immigrants with respect and dignity is non-negotiable.

Google nutrition facts and get a clear answer

This coming week, Google is launching a new search feature: type a question about nutrition facts, and it provide you with a precise answer. The screen shots look much like the results when Googling conversions from cups to liters or the definition of a word. The feature is rolling out in the United States over the next ten days, but it shown up yet in Philadelphia so I haven’t been able to give it a try myself. Having the ability to ask direct questions about the nutrient content of food helps demystify some of the complicated information about healthy eating. This is health communication done right!

If you're looking to change up your workout routine this weekend, may I suggest Prancercise?

http://www.youtube.com/watch?v=o-50GjySwew