There are many possible causes of pain in the hands or wrists, including injuries, repetitive strain, cysts, and arthritis. Some home remedies may help relieve the discomfort, but a person should see a doctor for severe, persistent, or reoccurring hand pain. Learn more here.
Thursday, February 28, 2019
Surge by a stronger strain of the flu is another warning that the season for the disease is not over; shots still available
"Though influenza activity typically peaks by February’s end, the flu season isn’t over – and a harsher strain called H3N2 has increased in circulation both nationwide and in Kentucky," reports Caroline Eggers of the Bowling Green Daily News.
“Some people may think flu season is over, but it is not,” Glynda Chu, spokeswoman for The Medical Center at Bowling Green, told the Daily News in an email. “Many people in our area are suffering with the flu and we encourage everyone to please get a flu shot.”
Among the four types of flu viruses, "influenza A accounts for the majority of cases and is the only strain that is divided into subtypes, which are most commonly H1N1 and H3N2," Eggers notes. "Although the H1N1 virus has predominated this flu season, the H3N2 virus accounted for nearly half of influenza A detected nationally through the week of Feb. 16. In Kentucky and the Southeast, the H3N2 virus is considered predominant."
That calls for caution because H3N2 causes more greater number of hospitalizations and deaths in children and the elderly, according to the Centers for Disease Control and Prevention. The CDC recommends getting a flu vaccination even at this point, because the flu season won't end until May.
"Other methods of protection include frequent hand washing, especially before eating or touching the face, and avoiding touching public surfaces," Eggers notes. "If you suspect the illness, remain home from work, school or errands to prevent further spread, and consider getting tested at the hospital and starting antiviral medications. But mostly, the best treatment is plenty of rest and drinking lots of water."
“Some people may think flu season is over, but it is not,” Glynda Chu, spokeswoman for The Medical Center at Bowling Green, told the Daily News in an email. “Many people in our area are suffering with the flu and we encourage everyone to please get a flu shot.”
Among the four types of flu viruses, "influenza A accounts for the majority of cases and is the only strain that is divided into subtypes, which are most commonly H1N1 and H3N2," Eggers notes. "Although the H1N1 virus has predominated this flu season, the H3N2 virus accounted for nearly half of influenza A detected nationally through the week of Feb. 16. In Kentucky and the Southeast, the H3N2 virus is considered predominant."
That calls for caution because H3N2 causes more greater number of hospitalizations and deaths in children and the elderly, according to the Centers for Disease Control and Prevention. The CDC recommends getting a flu vaccination even at this point, because the flu season won't end until May.
"Other methods of protection include frequent hand washing, especially before eating or touching the face, and avoiding touching public surfaces," Eggers notes. "If you suspect the illness, remain home from work, school or errands to prevent further spread, and consider getting tested at the hospital and starting antiviral medications. But mostly, the best treatment is plenty of rest and drinking lots of water."
Medical News Today: What causes flank pain?
Flank pain is pain that occurs on either or both sides of the torso, just below the ribs. The most common reason for flank pain is a muscle strain, but there are other possible underlying causes. Learn more here.
Guthrie tries to preserve funding for Medicaid program that gets beneficiaries out of facilities and into community-based support
U.S. Rep. Brett Guthrie says he is working to find money to save a program that is aimed at moving Medicaid beneficiaries out of facilities and into community-based, long-term support services.
The "Money Follows the Person" demonstration program got only three months of funding in the latest appropriations bill because of its cost, reports Michele Stein of Inside Health Policy. Guthrie and his Democratic counterpart are co-sponsoring a bill for a five-year extension.
Guthrie is from Bowling Green and represents the Second Congressional District. His role in the issue stems from his top rank among Republicans on the Oversight and Investigations Subcommittee of the House Energy and Commerce Committee.
The demonstration program began in 2007, and was funded by the 2010 Patient Protection and Affordable Care Act through September 2016. "While no additional funding was provided for the demo after September 2016, states could continue to use unspent funds," Stein reports. "A 2017 evaluation found the program to be popular and said [it] provided strong evidence that beneficiaries’ quality of life improves when transitioned back to the community."
But the program's cost is a challenge. Because of that, the Energy and Commerce Committee considered a one-year extension, rather than a five-year extension that had been proposed, and then the partial government shutdown intervened; new committee Chair Frank Pallone (D-N.J.) "said he didn’t want the program to be collateral damage from the shutdown," Stein reports.
On Feb. 25, Guthrie and subcommittee Chair Debbie Dingell (D-Mich.) introduced a bill to fund the program for five years, drawing endorsements from advocates for the poor and elderly.
“Money Follows the Person has been one of the most effective disability rights programs of the twenty-first century," said Vania Leveille, senior legislative counsel for the American Civil Liberties Union. "It offers people with disabilities a meaningful alternative to institutionalization and helps safeguard their autonomy, liberty and self-determination."
Matt Salo, executive director of the National Association of Medicaid Directors, said five-year funding has bipartisan support, and time to get through Congress, Stein reports: "He expressed hope the legislation would pass if lawmakers agree on how to pay for it."
The "Money Follows the Person" demonstration program got only three months of funding in the latest appropriations bill because of its cost, reports Michele Stein of Inside Health Policy. Guthrie and his Democratic counterpart are co-sponsoring a bill for a five-year extension.
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| Guthrie (Ft. Collins Coloradoan photo) |
The demonstration program began in 2007, and was funded by the 2010 Patient Protection and Affordable Care Act through September 2016. "While no additional funding was provided for the demo after September 2016, states could continue to use unspent funds," Stein reports. "A 2017 evaluation found the program to be popular and said [it] provided strong evidence that beneficiaries’ quality of life improves when transitioned back to the community."
But the program's cost is a challenge. Because of that, the Energy and Commerce Committee considered a one-year extension, rather than a five-year extension that had been proposed, and then the partial government shutdown intervened; new committee Chair Frank Pallone (D-N.J.) "said he didn’t want the program to be collateral damage from the shutdown," Stein reports.
On Feb. 25, Guthrie and subcommittee Chair Debbie Dingell (D-Mich.) introduced a bill to fund the program for five years, drawing endorsements from advocates for the poor and elderly.
“Money Follows the Person has been one of the most effective disability rights programs of the twenty-first century," said Vania Leveille, senior legislative counsel for the American Civil Liberties Union. "It offers people with disabilities a meaningful alternative to institutionalization and helps safeguard their autonomy, liberty and self-determination."
Matt Salo, executive director of the National Association of Medicaid Directors, said five-year funding has bipartisan support, and time to get through Congress, Stein reports: "He expressed hope the legislation would pass if lawmakers agree on how to pay for it."
Medical News Today: What are the best dietary sources of vitamin D?
Vitamin D can improve bone, muscle, and immune system health. Foods with a high vitamin D content include oily fish, some mushrooms, and egg yolks. Learn more about the best dietary sources of vitamin D here.
Medical News Today: What causes upper stomach pain?
There are many possible causes of upper stomach pain, from gas and indigestion to more serious issues involving the liver or pancreas. Learn about the causes and treatments here.
Medical News Today: What testosterone supplements should I take?
Testosterone supplements may include injectable treatments or those that are transdermal, meaning people apply them to the skin. Learn more about testosterone supplements here.
Medical News Today: How to tell if it's bipolar disorder or ADHD
Bipolar disorder and ADHD share some symptoms, but their treatments are different. In this article, we discuss diagnosis and how to tell the two conditions apart.
Medical News Today: What are the best juices for constipation?
Drinking juices can help relieve constipation due to their fiber, water, and nutrient content. In this article, we look at the best fruit juices for relieving constipation, why they work, and how to make them at home.
Medical News Today: Pale stool: Causes and treatments
The occasional pale stool in adults is often not a cause for concern. However, long-lasting pale stool or stool that is white can indicate a serious issue with the liver, pancreas, or gallbladder. Learn more.
Health providers and advocates oppose Medicaid co-payment, say it creates barrier to care and administrative burden
By Melissa Patrick
Kentucky Health News
Health advocates at a regulatory meeting about the state's new Medicaid co-payment requirements said the new rule is riddled with problems, all of which they anticipated.
The co-payments, which range from $1 for some prescriptions to $50 for any type of inpatient service, went into effect Jan. 1 for most adult Medicaid recipients in Kentucky.
Jason Dunn, a policy analyst for Kentucky Voices for Health, said the coalition of organizations strongly opposes the co-pays, and reiterated many of the points made in a Dec. 11 letter to the Medicaid commissioner asking the state to reconsider implementing the program. The letter was signed by 26 groups.
Dunn said research shows that even small co-pays cause many low-income people to go without care, especially when they need ongoing care or multiple medications.
"The unintended consequences of creating barriers to care are too often offset by increased cost and more expensive care down the road," Dunn said. "In short, this is not a best practice and for that reason we are opposed to mandatory co-pays for Medicaid beneficiaries."
Pikeville dentist Bill Collins, a former president of the Kentucky Dental Association, opposed te co-pays in written comments that were read at the meeting. He said his offices don't collect them, largely because of the administrative burden.
"Some of my peers have collected and had to reimburse the patient," he wrote. "This is not a simple task; bookkeeping is initiated, and costs are then upon the provider; the $3 copay then becomes a $5 to $10 return. The bookkeeping is a nightmare."
He added, "We as providers want to treat our patients, but no one, not even government can constantly lose revenue and stay in business. We feel with noncollectable copays, additional difficult administrative tasks, and the unknown of "my rewards dollars" make it difficult to accept."
The new co-pays are separate from the state's new Medicaid plan, called Kentucky HEALTH, which is set to roll out April 1, unless a court orders otherwise. When that plan begins, monthly premiums ranging from $1 to $15 per month will replace the co-pays for most beneficiaries. The plan will also require beneficiaries to earn "virtual dollars" to pay for vision and dental care, rather than getting teh benefits as part of their basic package.
KVH also submitted comments it had collected from a survey about the mandatory co-payments. One respondent wrote, "We have chosen to get food and pay bills over medications and considering we both have health issues, including diabetes, this is making things rough."
Another wrote, "As I have 10 prescriptions I must fill each month, and most are not generically available, I am concerned about meeting my monthly bills since my co-pay will probably be around $30 monthly. I am already relying on a food bank to eat. I am elderly and disabled and cannot work."
Emily Beauregard, executive director of KVH, said the survey of 140 people found that 90 percent of them opposed the copays. The survey respondents included 23 Medicaid providers and 90 Medicaid beneficiaries, family members of beneficiaries, and others.
Beauregard said 21 of the respondents reported they couldn't fill prescriptions because they couldn't afford the co-pay, 30 said they were avoiding or delaying care, and many expressed concerns about rationing their care or having to make trade-offs between paying their bills.
Beauregard also gave several examples of people who were denied care because they couldn't afford a co-pay, but shouldn't have been because they were below the federal poverty level. A state regulation requires providers to see or treat such people even if they can't afford the co-pay.
"It's important to understand that in practice sometimes the safeguards we write into policies aren't always adhered to in practice," Beauregard said. "Providers may not understand them, their staff might not be aware or trained properly or they may simply may not be following the practice."
Is the Cabinet for Health and Family Services or the state Department for Medicaid Services hearing about any of these issues from Medicaid providers and beneficiaries? Asked that question via email, cabinet spokesman Doug Hogan said 39 other states have some sort of cost-sharing in Medicaid and it's important for beneficiaries to "plan for their health care visits and prepare to pay the minimum co-pay we require."
Hogan added that there are financial-planning resources, such as community-based advocacy groups, available to help Medicaid beneficiaries become better prepared to pay the "very minimal co-pay."
He said, "Kentucky taxpayers are spending thousands of dollars to fund health-care services for our recipients. Asking our recipients to pay co-pays that are, in most instances, $1 to $3, is a reasonable request for that healthcare that is worth thousands — and it helps prepare them for commercial market coverage in the event they move into that market."
The state has until March 15 to respond to the public comments.
Kentucky Health News
Health advocates at a regulatory meeting about the state's new Medicaid co-payment requirements said the new rule is riddled with problems, all of which they anticipated.
The co-payments, which range from $1 for some prescriptions to $50 for any type of inpatient service, went into effect Jan. 1 for most adult Medicaid recipients in Kentucky.
Dunn said research shows that even small co-pays cause many low-income people to go without care, especially when they need ongoing care or multiple medications.
"The unintended consequences of creating barriers to care are too often offset by increased cost and more expensive care down the road," Dunn said. "In short, this is not a best practice and for that reason we are opposed to mandatory co-pays for Medicaid beneficiaries."
Pikeville dentist Bill Collins, a former president of the Kentucky Dental Association, opposed te co-pays in written comments that were read at the meeting. He said his offices don't collect them, largely because of the administrative burden.
"Some of my peers have collected and had to reimburse the patient," he wrote. "This is not a simple task; bookkeeping is initiated, and costs are then upon the provider; the $3 copay then becomes a $5 to $10 return. The bookkeeping is a nightmare."
He added, "We as providers want to treat our patients, but no one, not even government can constantly lose revenue and stay in business. We feel with noncollectable copays, additional difficult administrative tasks, and the unknown of "my rewards dollars" make it difficult to accept."
The new co-pays are separate from the state's new Medicaid plan, called Kentucky HEALTH, which is set to roll out April 1, unless a court orders otherwise. When that plan begins, monthly premiums ranging from $1 to $15 per month will replace the co-pays for most beneficiaries. The plan will also require beneficiaries to earn "virtual dollars" to pay for vision and dental care, rather than getting teh benefits as part of their basic package.
KVH also submitted comments it had collected from a survey about the mandatory co-payments. One respondent wrote, "We have chosen to get food and pay bills over medications and considering we both have health issues, including diabetes, this is making things rough."
Another wrote, "As I have 10 prescriptions I must fill each month, and most are not generically available, I am concerned about meeting my monthly bills since my co-pay will probably be around $30 monthly. I am already relying on a food bank to eat. I am elderly and disabled and cannot work."
Emily Beauregard, executive director of KVH, said the survey of 140 people found that 90 percent of them opposed the copays. The survey respondents included 23 Medicaid providers and 90 Medicaid beneficiaries, family members of beneficiaries, and others.
Beauregard said 21 of the respondents reported they couldn't fill prescriptions because they couldn't afford the co-pay, 30 said they were avoiding or delaying care, and many expressed concerns about rationing their care or having to make trade-offs between paying their bills.
Beauregard also gave several examples of people who were denied care because they couldn't afford a co-pay, but shouldn't have been because they were below the federal poverty level. A state regulation requires providers to see or treat such people even if they can't afford the co-pay.
"It's important to understand that in practice sometimes the safeguards we write into policies aren't always adhered to in practice," Beauregard said. "Providers may not understand them, their staff might not be aware or trained properly or they may simply may not be following the practice."
Is the Cabinet for Health and Family Services or the state Department for Medicaid Services hearing about any of these issues from Medicaid providers and beneficiaries? Asked that question via email, cabinet spokesman Doug Hogan said 39 other states have some sort of cost-sharing in Medicaid and it's important for beneficiaries to "plan for their health care visits and prepare to pay the minimum co-pay we require."
Hogan added that there are financial-planning resources, such as community-based advocacy groups, available to help Medicaid beneficiaries become better prepared to pay the "very minimal co-pay."
He said, "Kentucky taxpayers are spending thousands of dollars to fund health-care services for our recipients. Asking our recipients to pay co-pays that are, in most instances, $1 to $3, is a reasonable request for that healthcare that is worth thousands — and it helps prepare them for commercial market coverage in the event they move into that market."
The state has until March 15 to respond to the public comments.
Medical News Today: Quietness better than background music for creativity
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Medical News Today: Letter from the Editor: Making plans
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Water chestnuts are tuber vegetables that grow underwater. They are low in calories and contain antioxidants, and they can be a healthful addition to a balanced diet.
Fat is more than calorie storage
A group of researchers based at the Joslin Diabetes Center and Harvard Medical School just published a paper in the journal Nature Metabolism that tells us something new and amazing, as well as confirms something we all know already.
They studied a protein that is secreted by mouse and human fat cells in response to cardiovascular exercise. The protein, called transforming growth factor-beta 2, or TGFB2, is an adipocytokine (which literally means “fat cell movement”) that seems to lower blood sugars in mice. Previous research has shown that transplanting fat cells from mice of normal weight who exercised on a wheel into mice who were overweight and sedentary resulted in improved blood sugars.
These researchers administered this “fat cell movement” protein to mice with diet-induced obesity for nine days, and found significantly improved blood sugar response to a sugar load as well as increased sensitivity to insulin, both markers of improved metabolism and lower risk for diabetes.
They found that human fat cells also secrete TGFB2 in response to cardiovascular exercise. They hypothesize that TGFB2 could be used as a treatment for the metabolic problems often linked to obesity, such as glucose intolerance, insulin resistance (both of which increase risk for developing diabetes), and diabetes.
But they also state the obvious conclusion: exercise training improves metabolism.
Why take a pill when you can take a walk?
From my perspective, the next step is not to discuss how we can make this protein into a profitable pill, but rather to discuss how we can become more active in our day-to-day lives.
We know that activity — any activity — has multiple health benefits beyond those on blood sugar. This blog has reviewed research showing that exercise lowers cardiovascular risk, relieves stress, improves memory and cognition and mood, prevents dementia, increases longevity, helps treat cancer, and on and on.
Right now, the recommended weekly amount of physical activity for adults is at least 150 minutes of moderate activity (think walking or easy biking) or 75 minutes of vigorous activity (think running or stair climbing). Children and teens should be getting 60 minutes per day of moderate to vigorous activity. These evidence-based recommendations were released by the US Department of Health and Human Services and are supported by many organizations, including the American Heart Association. (Check out our post on the new activity guidelines.)
According to a 2018 CDC study based on survey data from over 150,000 Americans from all 50 states, only 23% of adults meet those activity levels.
How can we make that happen?
On an individual level, we can realize that all activity counts, and it doesn’t have to be at the gym.
On a family level, we can make playtime more active by encouraging more outdoor play (basketball, biking, jumping rope) and discouraging indoor sitting time (video games, television). We can make family time more active by taking walks, hiking, or doing sports together.
On a community level, we can work to make walking or biking to school safer for kids, and organize or get involved with activities like town soccer leagues.
There’s more, of course, a lot more, and all of it is better (and safer) than taking another pill.
The post Fat is more than calorie storage appeared first on Harvard Health Blog.
Medical News Today: What are the main symptoms of mania?
The symptoms of mania in bipolar disorder include high energy levels, euphoria, and elevated self-esteem. Learn more about bipolar mania symptoms here.
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Artemisinin, a compound in the sweet wormwood plant, may have potential in future cancer treatments. Research is still underway. This article looks at recent investigations into artemisinin and cancer.
Kentucky's level of volunteerism depends on how you measure it; studies show that volunteer work helps your health
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| Foundation for a Healthy Kentucky chart; for a larger version, click on it |
"Volunteering can improve a community’s health and build connections between neighbors," says the Foundation for a Healthy Kentucky. "To learn more about volunteering and civic participation in the commonwealth, the 2018 Kentucky Health Issues Poll asked Kentucky adults whether they engaged in a variety of civic activities in the prior year. Seven of these activities were related to political engagement and three were related to community participation."
The poll found that 78 percent of Kentucky adults are involved in civic activities of some kind from volunteer work to talking about politics, and 68 percent are engaged in politics in some way, including an in-person discussion about politics and government. It found that 54 percent were active in their communities through volunteering at their church or other nonprofit group, working on a community project or donating blood.
The poll found that 78 percent of Kentucky adults are involved in civic activities of some kind from volunteer work to talking about politics, and 68 percent are engaged in politics in some way, including an in-person discussion about politics and government. It found that 54 percent were active in their communities through volunteering at their church or other nonprofit group, working on a community project or donating blood.
"Getting involved can actually be a prescription for improving individual health as well as the health of our communities," said Ben Chandler, president and CEO of the foundation. "It's that 'helper's high' that occurs when we're contributing with no expectation of getting paid. Studies show this sense of purpose leads to lower mortality rates, reduced depression and better functionality."
In the latest ratings by the Corporation for National and Volunteer Service, which use narrower definitions than the Kentucky poll, only 23.5 percent of Kentuckians were considered volunteers. The state's volunteer rate has been declining since 2005, when it was above the national average.
In the Kentucky poll, engagement varied by education level. Adults with more education were more likely than adults with less education to participate in each of the activities. In the past year, 89 percent of college graduates participated in a political activity, but that was true of only 37 percent of adults who had not graduated high school. Three-fourths of college graduates participated in community activities, but only 31 percent of high-school dropouts did.
KHIP is an annual telephone poll of Kentucky adults about health and health-policy issues; it is funded jointly by the Foundation for a Healthy Kentucky and Interact for Health, a Cincinnati-area foundation.
Medical News Today: Alcohol may be less harmful for people over 50
A new study investigates the potential protective effects of alcohol at different ages. They find that it is not a level playing field.
Medical News Today: Growing up in a green area may help support mental health
A new study uncovers emerging evidence suggesting that growing up in close contact with nature may help us enjoy good mental health throughout adulthood.
Wednesday, February 27, 2019
Medical News Today: What are the pros and cons of GMO foods?
The use of GMO foods remains controversial. In this article, we discuss the pros and cons of growing and eating genetically modified organisms, including the effects on human health and the environment.
Medical News Today: 12 natural ways to relieve pain
People have used natural pain relief methods for centuries. In this article, we discuss 12 natural pain relievers that people can try, including herbal remedies, yoga, and acupuncture.
Medical News Today: How to treat eye discharge in newborns
Eye discharge or excessive eye watering in newborns often indicates a blocked tear duct. The blockage is usually harmless and tends to resolve on its own. However, if there is also redness, swelling, or tenderness in the eye area, this may signify an infection that requires prompt medical treatment. Learn more here.
Medical News Today: What to know about 24-hour cortisol urine tests
Doctors use cortisol urine tests to help diagnose many medical conditions that affect cortisol levels. In this article, we discuss the uses, procedure, and how to interpret the results of a 24-hour cortisol urine test.
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Small penis syndrome is not a physical condition but long-term anxiety about the size of one's penis. It is a type of body dysmorphic disorder. Learn more about the symptoms here.
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Ringworm is a fungal infection that causes a distinctive raised rash. Babies are particularly prone to ringworm because they are often in close contact with others. Learn more about ringworm in babies here.
Medical News Today: Which foods to avoid when trying to lose weight
When trying to lose weight, it is important to choose nutritionally dense foods and to avoid those that are high in calories, sugars, and unhealthful fats but low in nutrients. Here, learn about 14 foods to avoid when dieting.
Can vaping help you quit smoking?
It’s hard to overstate the dangers of smoking. Nearly 500,000 people die of tobacco-related disease each year in the US. Over the next decade, estimates are that around eight million people will die prematurely worldwide each year due to tobacco use. The list of tobacco-related diseases and conditions is long and growing. It includes:
- cardiovascular disease, including heart attack and stroke
- emphysema, bronchitis, and asthma
- lung and other types of cancer
- tooth decay
- weathering of the skin
- having a low-birthweight baby
- diabetes
- eye damage (including cataracts and macular degeneration).
And there are others. The point is, if you smoke, you should try hard to quit. And if you don’t smoke, don’t start!
While the dangers of smoking are clear, the best way to quit is not. In fact, there is no single best way. And most people who quit for good have to try more than once before they succeed.
What about e-cigarettes?
Users of electronic cigarettes (e-cigarettes) inhale an aerosol created by heating nicotine, flavorings, and other substances. There seems to be general agreement that vaping(the term often used to describe use of e-cigarettes) is safer than smoking cigarettes. That said, vaping can cause mouth or throat irritation, nausea, and coughing, and the long-term effects are not yet known.
E-cigarettes have been in the news a lot lately because of concerns that they are being marketed to kids, with flavor options such as cotton candy, cupcake, and tutti-fruiti. One survey found that about 80% of middle school students had seen ads for e-cigarettes. Since we know that nicotine is highly addictive and the long-term risks to kids of vaping are not known, the rising popularity of vaping among young people might create a host of unforeseen health problems in the future.
And that’s not an idle concern. Animal studies and limited human research have shown that vaping can lead to changes in the airways that are similar to those caused by smoking. And some of the same chemicals detected in the flavorings have been removed from food products because they’ve been linked with health problems. There are also concerns that teenagers who become addicted to nicotine by vaping may be more likely to smoke cigarettes as adults or try other addictive drugs such as opiates. Finally, “dual use” of tobacco products — vaping and smoking cigarettes — is not rare. A 2015 survey cited by The Truth Initiative (an anti-tobacco organization) found that nearly 60% of e-cigarette users also smoked cigarettes.
What about vaping to help you quit smoking?
Advocates of vaping have promoted it as a way to help cigarette smokers to quit. Although giving up nicotine products altogether might be the ultimate goal, there may be health benefits to a smoker who becomes a long-term vaper instead, though this remains unproven.
A new study compares vaping with other common nicotine replacement approaches as a way to help smokers quit. The findings support the idea that vaping may help some smokers.
Researchers recruited nearly 900 people who wanted to quit smoking, and randomly assigned half to receive e-cigarettes and the other half to receive other nicotine replacement products (such as nicotine patches and gum). All of the study participants received weekly individual counseling for four weeks. After one year, smoking cessation was confirmed by measures of exhaled carbon monoxide (which should be low if you’ve quit but high if you’re still smoking).
Here’s what they found:
- Among those assigned to vaping, 18% had stopped smoking, while about 10% of those using nicotine replacement therapy had quit.
- Among successful quitters, 80% of those in the e-cigarette group were still vaping; only 9% of those in the nicotine-replacement group were still using those products.
- Reports of cough and phlegm production dropped more in the e-cigarette group.
So, while e-cigarette use was associated with nearly twice the rate of smoking cessation, more than 80% of smokers entering this study continued to smoke a year later. One other caveat to note: the e-cigarettes used in this study contained much lower levels of nicotine than found in some common brands used in the US (such as Juul). The importance of this difference is unclear, but a higher nicotine level could contribute a higher rate of addiction to the e-cigarette.
Recommended ways to quit smoking
If you’re trying to kick the habit, you’ll get lots of advice. Many people try to quit cold turkey, but success rates are quite low. Hypnosis and acupuncture seem to work for some people, but these remain unproven. The best studied smoking cessation strategies include:
- behavioral therapy, such as individual counseling
- nicotine replacement therapy, such as a long-acting nicotine patch and short-acting nicotine gum
- medications to reduce the urge to smoke, such as varenicline (Chantix) or bupropion (Zyban).
In studies of these approaches, quit rates were around 20% to 25% over six to 12 months. While these may seem low, they’re significantly higher than observed among people trying to quit on their own.
What’s next?
While I think concerns about vaping are appropriate (especially regarding use among youth), this study demonstrates that it could help people quit smoking. So, vaping could soon get approval from the FDA as a smoking cessation aid, but even if that happens, it should not be the first choice given how much is still unknown. It’s possible we’ll see regulations and legislation on vaping in this country, including a higher age limit on its use, a ban on its marketing to young people, a limit to nicotine concentrations, and even a ban on flavored e-cigarettes altogether.
Ultimately, we’ll need good studies to assess the long-term safety of vaping, to confirm that when used to aid smoking cessation we aren’t just replacing one bad habit with another.
The post Can vaping help you quit smoking? appeared first on Harvard Health Blog.
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A new review suggests that the prefrontal cortex, a brain area involved in planning and decision making, has a 'reciprocal relationship' with obesity.
Tuesday, February 26, 2019
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Doctors measure pregnancy from the first day of a woman’s last period, so week 2 is often when conception occurs. Learn more about the possible symptoms here.
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Among the many changes that women experience during pregnancy, they may notice that their sex drive increases or decreases in different trimesters. Learn more about sex drive changes and the safety of sex and masturbation during pregnancy here.
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An anterior placenta occurs when the placenta attaches to and grows on the front of the uterus. It is not usually a cause for concern. Learn more in this article.
Medical News Today: Can prune juice help relieve constipation?
Constipation is a common problem that people can often treat at home by making dietary and lifestyle modifications. A popular home remedy for constipation is drinking prune juice. Learn whether prune juice is effective for treating constipation here.
Medical News Today: What to know about tachypnea
Tachypnea is a respiratory condition that results in fast and shallow breathing. Causes include a lack of oxygen or excess carbon dioxide. Learn more about tachypnea here.
Medical News Today: Study ties arthritis pain reliever to heart valve disease
An analysis of 8,600 electronic medical records has found a specific link between the use of the NSAID celecoxib (Celebrex) and aortic stenosis.
Medical News Today: New device can detect cancer in just a drop of blood
A newly developed state-of-the-art diagnostic tool that is cost-effective and easy to make can detect the presence of cancer in the tiniest drop of blood.
Bill to raise legal age to buy tobacco products to 21 fails on 4-6 committee vote; effectiveness questioned
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| Sen. Steve Meredith, middle, with Altria Vice President David Fernandez, right, and Juul Labs lobbyist Jennifer Cunningham about his bill to raise the legal age for buying tobacco products. (Photo: Adam Beam, The Associated Press) |
"Where I come from, tobacco is still king," said Republican Sen. Stan Humphries, a Trigg County tobacco farmer who then voted against Senate Bill 249 on Feb. 25.
Historically, the tobacco industry has opposed efforts to restrict tobacco use from people who older than 18, the age Americans can register to vote and join the military, but at least one company is supporting such bills as the "bets its future on e-cigarettes and other vapor products," Beam reports. "In December, Altria — one of the world's largest tobacco companies — purchased a $13 billion stake in Juul," by far the leading maker of an electronic cigarette that is the favorite of teenagers.
Last week, Virginia, where Altria subsidiary Philip Morris is based, became the seventh state to raise the to age to 21. Altria Vice President David Fernandez told the Kentucky committee, "Putting tobacco on par with alcohol makes sense and we do hope that doing that will also persuade policymakers to approach tobacco regulation a bit more reasonably,"
Senate Bill 249's sponsor, Sen. Stephen Meredith, R-Leitchfield, pointed out the health reasons to pass the bill, including an oft-cited fact that tobacco-related illnesses cost Kentucky $2 billion each year, including $600 million from Medicaid, Beam reports.
Committee Chairman Paul Hornback, R-Shelbyville, made an economic argument, warning that the Food and Drug Administration "could put Kentucky 'out of the tobacco business' with its potential rulings impacting the sale of e-cigarettes and other vapor products because of concerns about their impacts on youth smoking rates."
But it wasn't enough the bill failed on a 4-6 vote.
"Hornback indicated lawmakers could try to vote on the bill again before adjourning next month," Beam writes. "But it appears the bill, or any other tobacco-prevention bill, would have a tough time passing the state legislature." He noted that a bill to make all school properties and events tobacco-free has stalled in the House.
The latest Kentucky Health Issues Poll found that 56 percent of Kentucky adults support raising the legal age to buy tobacco products to 21.
According to a 2015 Institute of Medicine report, such a law would reduce the smoking rate by about 12 percent and smoking-related deaths by 10 percent over the long term. The report adds that among teens ages 15 to 17, such a law would decrease initiation of tobacco use 25 percent, said the news release about the poll.
Ben Chandler, CEO of the Foundation for a Healthy Kentucky, said after the meeting, "We have an epidemic of youth e-cigarette use in Kentucky and the nation that, in less than a year, has erased years of progress in protecting kids from nicotine and secondhand tobacco emissions," and called the bill a public-relations maneuver by the tobacco industry.
Chandler said such a bill should "include more severe penalties on retailers who sell these products to underage youth without taking reasonable precautions to verify age. By supporting a bill without these measures, the tobacco industry knows it will be ineffective."
Medical News Today: 'Antibacterial' chemical in toothpaste could strengthen bacteria
New research finds that triclosan, a compound that is in many consumer products, could make the bacteria it is supposed to kill stronger.
Medical News Today: What to know about DEXA scans
The DEXA scan assesses bone density and can determine whether a person has weaker bones that are at risk of fracture. No special preparation is necessary. Learn more about DEXA scans here.
Do you really have a penicillin allergy?
Chances are, you or someone you know is one of the 10% of Americans with a documented penicillin allergy. But just because you were told you had a penicillin allergy, or had one in the past, does not mean you have one now. People with a penicillin allergy history have their allergy disproved with allergy testing more than 90% of the time.
Penicillin: a primer
Penicillin is part of a larger drug class called beta-lactam antibiotics, which include the common penicillins and cephalosporins.
Common penicillins include ampicillin, amoxicillin, and Augmentin. Among other uses, penicillins are often used to treat ear infections, strep throat, sinus infections, and to prevent dental infection. Cephalosporins are used for similar reasons. Certain intravenous (IV) cephalosporins are important for hospitalized patients.
What is a true penicillin allergy?
True allergies can result from any medication. Symptoms can range from mild, like itching, to severe, like anaphylaxis, which can involve low blood pressure and difficulty breathing. If a reaction to penicillin included skin redness, itching, rash, or swelling, there may have been a penicillin allergy, but these symptoms can also occur for other reasons. Shortness of breath, wheezing, fainting, and chest tightness are all reactions that may indicate anaphylaxis. These reactions can be safely evaluated by a trained medical professional. Even patients with severe penicillin allergy histories are often able to take penicillins safely again, because penicillin allergy often does not persist for life.
Rarely, people have reactions to drugs, such as peeling or blistering skin, or liver or kidney injury, that are so troubling that we recommend avoiding the medication in the future.
Side effects like fatigue, nausea, and vomiting are not allergies, but because side effects are recorded in the “allergy” section of health records, their documentation contributes to confusion surrounding what is a true penicillin allergy.
Why does it matter if I have a true penicillin allergy or not?
People with a penicillin allergy on their medical record are not given penicillins, and may not be given any beta-lactam antibiotics because of concern that the allergy is shared across the antibiotic class. Instead, the antibiotics prescribed may be broader-spectrum. Broad-spectrum antibiotics may be as effective, but they often have more side effects and toxicities, such as increased risk of developing infections like C. diff (Clostridioides difficile, formerly called Clostridium difficile) or methicillin-resistant Staphylococcus aureus (MRSA). Confirming or ruling out a penicillin allergy through allergy testing could justify the risk, or potentially avert it by allowing your doctor to prescribe beta-lactams.
In other cases, your doctor may have to prescribe less-effective drugs than penicillins and cephalosporins because of a documented penicillin allergy.
What does penicillin allergy testing entail?
An allergist can assist in the diagnosis of a penicillin allergy using a skin test. This test involves pricking the skin, usually on the back or on the inside of the forearm, and placing a small amount of allergen on the punctured skin. The allergist will compare how your skin reacts to penicillin versus a positive control (histamine) and a negative control (saline). Anyone with a positive skin test to penicillin — there’s usually itching, redness, and swelling at the site of the skin prick — is allergic and should avoid penicillin.
People who have no reaction to the skin test can safely undergo the amoxicillin challenge. In this test, the allergist gives the person amoxicillin and observes signs and symptoms for at least one hour. This is done under medical supervision.
Although these tests are very useful for diagnosing penicillin allergies that are immediate, there are other types of allergies that may still occur. The most common is a minor drug rash that happens days into the course of antibiotic treatment.
When should I get tested?
I am often asked to evaluate penicillin allergies when a patient needs penicillin or another beta-lactam, and the documented allergy is obstructing the best treatment. However, the best time to have a penicillin allergy evaluated is when you’re healthy.
You can discuss allergies as part of routine health maintenance with a primary care doctor or pediatrician. Clarifying medication allergies is also a good idea before an operation; a penicillin allergy can impact infection risk, and allergies to latex and pain medications can get in the way of a smooth operation and post-operative period. Finally, women of childbearing age who are thinking of conceiving might want to evaluate an allergy to penicillin. Penicillins are used for infections in pregnancy and during deliveries for a variety of reasons. Pregnant patients can also be evaluated safely for a penicillin allergy in their third trimester.
Follow me on Twitter @KimberlyBlumen1
The post Do you really have a penicillin allergy? appeared first on Harvard Health Blog.
Medical News Today: What can cause back pain while breathing?
Back pain when breathing can indicate an underlying health condition, such as infection, inflammation, or spinal curvature. The symptom can also signal a medical emergency, such as a heart attack or pulmonary embolism. Learn more here.
Medical News Today: The best home remedies for baby constipation
Babies rarely experience constipation, but it can occur. The first treatment for baby constipation is to try home remedies, such as taking their rectal temperature or practicing light belly massage. Learn more here.
Medical News Today: Insomnia: Certain types of brain cell explain genetic risk
Groundbreaking research uses innovative methods to identify specific brain cells that explain why some people are genetically prone to insomnia.
Medical News Today: Osteoporosis: Some yoga poses may cause bone injuries
New research warns that certain yoga poses can be risky for people with osteoporosis and advises caution when engaging in this practice.
Monday, February 25, 2019
Medical News Today: What to know about back pain in pregnancy
Back pain affects around two-thirds of women during pregnancy. In this article, we look at the causes of back pain in the first, second, and third trimester, and ways to relieve the pain.
Medical News Today: Uses of methylsulfonylmethane
Methylsulfonylmethane, or MSM, is a compound that may help with arthritis, joints, and muscle recovery. It is available in certain foods and supplement form. Learn more here.
Medical News Today: What is a TFCC tear?
The triangular fibrocartilage complex (TFCC) is a network of ligaments, tendons, and cartilage in the wrist. Injuries to this structure are called TFCC tears, and they can cause pain, swelling, and limited movement in the wrist. Treatment options include splints or casts, physical therapy, and surgery. Learn more here.
Diet and exercise limit heart disease risk in men undergoing hormonal treatments for advanced prostate cancer
Men with advanced prostate cancer are typically treated with drugs that prevent the body from making or using testosterone. A hormone (or an androgen, as it’s known), testosterone drives prostate cancer cells to grow faster, so shutting it down is essential to keeping the illness in check. About 600,000 men with advanced prostate cancer in the United States today are undergoing this type of anti-hormonal treatment, which is called androgen deprivation therapy (ADT). But even as ADT helps men live longer, it exerts a toll on the body. Men can lose muscle and bone mass, gain weight, and they face higher risks for heart disease and type 2 diabetes.
The good news is that a few helpful strategies can lessen these metabolic side effects. Engaging in aerobic exercise and resistance training, for instance, has been shown to drop levels of inflammation in the body that might otherwise lead to heart disease. Quitting smoking is similarly beneficial, since tobacco smoke’s toxic effects on the heart are more pronounced in the absence of testosterone.
In a new study, researchers have shown that taking daily walks and eating a low-carbohydrate diet can also lessen ADT’s harms. During the investigation, 42 men who were just starting on ADT were split into two groups: Half the men took daily walks lasting at least half an hour five days a week, and were instructed to limit their carbohydrate intake to no more than 20 grams per day. The other half of the men (the control group) maintained their usual diet and exercise patterns.
After six months, typical weight loss among men in the walking/low-carbohydrate group was about 20 pounds, compared to a nearly 3-pound weight gain among men who stuck to their usual dietary and exercise routines. Men in the walking/low-carbohydrate group also had significantly higher blood levels of high-density lipoprotein (HDL), which removes cholesterol and lessens risks of atherosclerosis and heart disease. And they also had significant improvements in insulin resistance (a pre-diabetic condition), but only at three months and not when the levels were checked again three months later.
The study’s lead author, Dr. Stephen Freedland from Cedars-Sinai Medical Center in Los Angeles, California, says exercise combined with low-carbohydrate diets appears to be a promising strategy in men undergoing ADT that should be studied further. Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org, agreed, pointing out that weight gain can be a real problem for men that endures even after ADT is discontinued. “The weight loss in the experimental group is encouraging and should be validated in larger studies,” he said. “In the meantime, combining exercise with low-carbohydrate diets is a common-sense strategy that clinicians should recommend to their patients.”
The post Diet and exercise limit heart disease risk in men undergoing hormonal treatments for advanced prostate cancer appeared first on Harvard Health Blog.
Medical News Today: What to know about respiratory alkalosis
Respiratory alkalosis occurs when the blood pH level is out of balance. Causes include breathing too fast, which may be a side effect of another condition. Learn more about respiratory alkalosis, including how doctors treat it, here.
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A heavy feeling in the chest can have a range of causes, from anxiety or depression to problems with the heart or lungs. In this article, learn about the possible causes and how to treat them.
Medical News Today: 12 signs and symptoms of hypothyroidism
Hypothyroidism, or underactive thyroid, is when the thyroid gland does not produce enough hormones. Low levels of thyroid hormones can cause a wide range of symptoms. Learn about 12 common signs and symptoms of hypothyroidism here.
Medical News Today: Could these brain changes explain phantom limb?
Changes in communication between sensory and motor areas of the brain after lower limb amputation could explain phantom sensation, even without pain.
Medical News Today: Vitamin D and brain health: New mechanism may explain link
A new study in mice shows a previously unknown effect of vitamin D deficiency on the brain. The findings may explain why vitamin D is key for brain health.
Medical News Today: How chronic stress boosts cancer cell growth
New research in mice explains the mechanism through which chronic stress contributes to cancer cell growth and suggests a potential therapeutic strategy.
Medical News Today: When to see a doctor if a child has a nosebleed
Nosebleeds are common in young children. Most nosebleeds are not a cause for concern, and it is usually possible to treat them at home by applying gentle pressure to the child’s nose. However, persistent, recurring, or very heavy bleeding may require medical attention. Learn more here.
Infertility: Maintaining privacy, avoiding secrecy
When Michelle Obama’s memoir, Becoming, was released in October 2018, several reviewers noted that her book reveals that the Obamas struggled with infertility. When I was lucky enough to receive a copy as a gift, I learned that Michelle and Barack didn’t simply have a ‘touch of infertility’: they went through IVF in order to have both Malia and Sasha.
Why, some reviewers seemed to wonder, was the public learning this significant piece of the Obamas history now? And, to be bipartisan about it, we learned in Laura Bush’s 2010 memoir, Spoken From the Heart, that she and her husband had endured a long struggle with infertility and were planning to adopt when they found they were expecting twins Jenna and Barbara.
My response is this: The Obamas and the Bushes, so different in so many ways, share the perspective of countless other infertile couples and individuals: infertility is not a secret, but it is private.
One might also say that the Obamas and Bushes acknowledge their infertility because it is in the past. For both couples, it brought them two cherished daughters. I have seen that when people are in the trenches of infertility, questions about what to say, when, and how swirl around in their heads.
Secrets, truth, and privacy
Most people recognize the danger of secrets. Secrets lead to feelings of shame. They distance family and friends and promote misunderstandings. Couples determined to tell no one about their infertility may find others assume they don’t want children, are selfish, or are clueless in thinking they can wait as long as they want. Hence, most people coping with infertility decide to tell others something — the challenge for them is avoiding the pitfalls of too much information.
When counseling infertility patients, I often suggest that they tell a simple truth. Not the whole truth. Not nothing but the truth. Less is more when it comes to talking about infertility.
Couples can think through what they want others to know. In most instances, it is simply that they want children, are having trouble making that happen, and are receiving good medical care. They want others to respect their privacy and to simply stay tuned, knowing that when there is good news to be shared, they will joyfully share it. Specifics of diagnosis, types, and timing of treatments are usually too much information.
Maintaining privacy while avoiding secrecy also arises when individuals and couples are exploring or pursuing other paths to parenthood, such as adoption, egg or sperm donation, or surrogacy. Again, I advise people to share only what others really need to know. Adoption is never a secret these days. But how much do others really need to know while people are waiting for a match with a birth mother or counting down the hours until she signs surrender papers? Often, it adds to the stress of the situation.
Is there an obligation to tell?
Similarly, when people choose egg or sperm donation, do they have an obligation to tell all to others? Years ago, I thought that those who did not acknowledge donor conception were being secretive. Then I realized that fertile heterosexual couples do not tell others how they conceived. Why should it be different for those who participate in third-party reproduction?
On NPR one day, I heard a wonderful interview with an author who had a baby at 50. The interviewer said, “I understand that you had a baby at an older age.”
“Yes, we are so fortunate that there are all sorts of ways to become pregnant these days,” the author responded. She spoke a simple truth and felt no need, it seemed, to tell the whole truth and nothing but the truth.
Privacy and dignity
The word that I have come to pair with privacy is dignity. Perhaps it is my response to living in a time of oversharing. I believe a certain dignity comes with maintaining privacy, especially when it comes to one’s family. Years ago I realized this when a couple I was counseling adopted their son. I was overjoyed for them and filled with questions. They answered some of my questions: where he was born, how long they had to remain out of state. They chose not to answer questions regarding his birth family.
“We feel that’s our son’s story to tell or not tell,” they said. “Until he is old enough to make these decisions for himself, we want to respect his privacy.”
Infertility so often feels like an out of control experience. By actively making decisions about privacy and secrecy, it’s possible for people to take back some of their lost control and gain pride in their ability to tend to and preserve their unfolding family story.
The post Infertility: Maintaining privacy, avoiding secrecy appeared first on Harvard Health Blog.
Medical News Today: Pulled muscle in chest: Symptoms and treatment
A pulled muscle in the chest can result in mild discomfort or cause severe symptoms. Learn about the causes and treatment of a pulled chest muscle, as well as other possible causes of similar chest pain.
Medical News Today: US adults do not consume enough protein, study warns
New research examines the protein intake, overall diet, and physical functioning of adults over the age of 51 living in the United States.
Medical News Today: Diabetes: Nuts could reduce cardiovascular risk
Individuals with type 2 diabetes have an increased risk of cardiovascular disease. According to a new study, eating nuts regularly might reduce the danger.
Sunday, February 24, 2019
Ambulance runs for rural patients are 76% longer when their hospital closes, and for seniors, it's 98% longer, study finds
And it's even worse for seniors: "The times increased from 13.9 minutes to 27.6 minutes, a 13.7-minute or 97.9 percent increase.," report researchers SuZanne Troske and Alison Davis. They noted that studies have found that communities, rural and urban, where hospitals have closed "tended to have a higher percentage of elderly and poor residents."
Describing their methods, they write, "Intuition suggests that patients are in an ambulance longer after the nearest hospital closes. However, no one has previously measured the travel time change. Our study is the first we are aware of that measures change in time in an ambulance based on reported ambulance trips." They noted that the study "should not be used to draw conclusions about transport times for rural patients who may have relied on a closed hospital but do not reside in the zip code of that closed hospital."
Addressing the implications for rural areas, Troske and Davis wrote, "More than half the hospitals in the country are located in rural areas and are the primary source of emergency medical services in these communities. When asked to rank attributes of rural health care facilities in a recent study, rural residents strongly valued access to emergency services through emergency departments s in their communities. . . . Access to emergency department services in communities, especially rural communities, persists as a priority for the Medicare program. In the 2017 annual report of the Medicare Payment Advisory Commission, the commissioners stressed the need to find more efficient and financially stable ways to deliver emergency services in rural communities. In the MedPAC report, they stated while there was reduced demand for inpatient hospital care, there was still need for emergency care among Medicare beneficiaries."
Medical News Today: Onions and garlic could protect against cancer
According to a recent study, eating more allium vegetables, such as garlic and onions, might reduce the risk of developing colorectal cancer.
Medical News Today: What diet is best for older adults?
Finding the best way for older adults to lose weight safely can be challenging. A new study may help guide nutritional decisions in this population.
Saturday, February 23, 2019
Medical News Today: Sleep apnea: Daytime sleepiness might help predict cardiovascular risk
A recent study finds that people with obstructive sleep apnea who experience the most daytime sleepiness have the highest risk of cardiovascular disease.
Medical News Today: Blueberries may lower cardiovascular risk by up to 20 percent
New research finds that eating 200 grams of blueberries every day can reduce blood pressure and improve cardiovascular health among healthy individuals.
Friday, February 22, 2019
Report on Medicaid pharmacy benefit managers confirms they are making a profit at the expense of pharmacies; calls for new payment model
A "long-awaited state report" on how pharmacy benefit managers are paid seems to confirm the suspicion that they "are reaping big profits from state Medicaid dollars at the expanse of pharmacies," Deborah Yetter reports for the Louisville Courier Journal.
Pharmacy benefit managers, or PBMs, are the middlemen between insurance companies and drug companies. They process about $1.7 billion a year in Kentucky Medicaid prescriptions.
The report, titled "Medicaid Pharmacy Pricing: Opening the Black Box," shows that last year Kentucky PBMs "took in $123 million through a practice known as 'spread pricing,' the difference between what the pharmacy benefit company pays the pharmacist and what it bills the state Medicaid program," Yetter reports.
The report, compiled by the Department of Medicaid Services and ordered by the General Assembly, shows that the $123 million represents a 12.9 percent increase over the previous year.
"I truly believe this was a very conservative number," said Sen. Max Wise, R-Campbellsville, who sponsored the legislation for the report to create more transparency in how the PBMs are paid.
Wise told Yetter that he believes more investigation is warranted: "I have full faith that we will continue to receive further data that will support what I have been saying since day one, the PBMs are taking full advantage of not only the pharmacies of this commonwealth but the taxpayers at large."
Medicaid Commissioner Carol Steckel, in a news release, said her agency will continue to monitor the matter: "This report represents the first step in introducing transparency to the pharmacy program. We have additional steps that we will need to take in order to make this program fully transparent."
Yetter writes, "Lawmakers grumble that the current system is not transparent because the state Medicaid program contracts with managed care companies that, in turn, subcontract with PBMs, which report to the managed care companies, not the state, and have not previously disclosed information about their operations."
CVS Caremark has most of the PBM business in Kentucky. Christine Cramer, a spokeswoman from CVS Health, told Yetter that managed-care organizations choose the "pricing model that best fits with their needs" and that spread pricing is a "common contracting model." She added that the money kept by a PBM isn't necessarily profit, but may also be used to fund services and patient programs.
Yetter notes that the report does not include mail-order prescriptions or the state's largest managed-care organization, WellCare, which has about 35 percent of the nearly 1.3 million Kentucky Medicaid enrollees. WellCare told the state it didn't have any data to report because it uses a different pricing model, which bills the state the same amount it pays the pharmacists.
The report recommended eliminating spread pricing and requiring PBMs to bill the state Medicaid program for what they actually pay pharmacists.
Independent pharmacists in Kentucky have long complained that the current PBM payment models threaten to put them out of business, Yetter reports.
"My business literally has been trashed by the low reimbursement rates of the PBMs in the past year," Trimble County pharmacist Jennifer Grove said in a letter to legislators. "I am faced daily with keeping the doors open or turning patients away because I lose money every time I fill their prescriptions."
Yetter notes that Ohio and West Virginia are also dealing with the issue.
To further address it, Sen. Jimmy Higdon, R-Lebanon, has filed Senate Bill 139 to create more oversight of such companies and to rein in some of their practices. It awaits a hearing in the Senate Banking and Insurance Committee.
Pharmacy benefit managers, or PBMs, are the middlemen between insurance companies and drug companies. They process about $1.7 billion a year in Kentucky Medicaid prescriptions.
The report, titled "Medicaid Pharmacy Pricing: Opening the Black Box," shows that last year Kentucky PBMs "took in $123 million through a practice known as 'spread pricing,' the difference between what the pharmacy benefit company pays the pharmacist and what it bills the state Medicaid program," Yetter reports.
The report, compiled by the Department of Medicaid Services and ordered by the General Assembly, shows that the $123 million represents a 12.9 percent increase over the previous year.
"I truly believe this was a very conservative number," said Sen. Max Wise, R-Campbellsville, who sponsored the legislation for the report to create more transparency in how the PBMs are paid.
Wise told Yetter that he believes more investigation is warranted: "I have full faith that we will continue to receive further data that will support what I have been saying since day one, the PBMs are taking full advantage of not only the pharmacies of this commonwealth but the taxpayers at large."
Medicaid Commissioner Carol Steckel, in a news release, said her agency will continue to monitor the matter: "This report represents the first step in introducing transparency to the pharmacy program. We have additional steps that we will need to take in order to make this program fully transparent."
Yetter writes, "Lawmakers grumble that the current system is not transparent because the state Medicaid program contracts with managed care companies that, in turn, subcontract with PBMs, which report to the managed care companies, not the state, and have not previously disclosed information about their operations."
CVS Caremark has most of the PBM business in Kentucky. Christine Cramer, a spokeswoman from CVS Health, told Yetter that managed-care organizations choose the "pricing model that best fits with their needs" and that spread pricing is a "common contracting model." She added that the money kept by a PBM isn't necessarily profit, but may also be used to fund services and patient programs.
Yetter notes that the report does not include mail-order prescriptions or the state's largest managed-care organization, WellCare, which has about 35 percent of the nearly 1.3 million Kentucky Medicaid enrollees. WellCare told the state it didn't have any data to report because it uses a different pricing model, which bills the state the same amount it pays the pharmacists.
The report recommended eliminating spread pricing and requiring PBMs to bill the state Medicaid program for what they actually pay pharmacists.
Independent pharmacists in Kentucky have long complained that the current PBM payment models threaten to put them out of business, Yetter reports.
"My business literally has been trashed by the low reimbursement rates of the PBMs in the past year," Trimble County pharmacist Jennifer Grove said in a letter to legislators. "I am faced daily with keeping the doors open or turning patients away because I lose money every time I fill their prescriptions."
Yetter notes that Ohio and West Virginia are also dealing with the issue.
To further address it, Sen. Jimmy Higdon, R-Lebanon, has filed Senate Bill 139 to create more oversight of such companies and to rein in some of their practices. It awaits a hearing in the Senate Banking and Insurance Committee.
Tobacco-free schools bill is in trouble in the House; sponsor, a Republican, can't get enough of her party's members to be for it
By Melissa Patrick
Kentucky Health News
A bill to make all Kentucky school properties and events tobacco-free is in trouble in the state House, prompting advocates to mount a rescue effort.
Fifteen organizations took to social media and sent a letter to every representative asking for their support for House Bill 11, the statewide tobacco-free school bill, 15 groups, including the Kentucky School Boards Association,
“We respectfully urge the Kentucky House of Representatives to call HB 11 for a vote on the House floor as soon as possible," says the letter. "Please do not sacrifice the health of all of our school children to the convenience of fewer than a quarter of Kentucky adults who use tobacco."
The bill's sponsor, Rep. Kim Moser, R-Taylor Mill, told Kentucky Health News in a telephone interview that she still has hope it will get called up for a vote and is still working toward that end, but couldn't get any answers as to what was going on with it. She said she had heard it was going to be pulled from the House's orders of the day.
That would be a death knell for the bill, which passed unanimously out of the committee Moser chairs on Feb. 7 and was put on the consent calendar, used to pass bills without debate. Then it was moved to the regular orders, a switch that required signatures of three lawmakers: Reps. Lynn Bechler, R-Marion; Myron Dossett, R-Pembroke; and Reginald Meeks, D-Louisville. Meeks said he was for the bill but wanted it to be debated.
Bonnie Hackbarth, vice-president for external affairs with the Foundation for a Healthy Kentucky, told Kentucky Health News that House Republican Caucus Chair Suzanne Miles of Owensboro is opposed to the bill. Moser said that she was not aware of that. Miles did not respond to a request for comment.
Opposition from one of the five leaders of the House's Republican majority is a danger sign for the bill, which is already under attack through floor amendments.
Rep. R. Travis Brenda, R-Cartersville, a Rockcastle County teacher, filed an amendment to allow use of tobacco products if children were not present, an effort likely meant to appease some of the bill's opponents. Moser promptly filed an amendment to clarify that the law, if passed, would prohibits smoking by all persons at all times on school properties, activities or trips.
Then Rep. Richard Heath, R-Mayfield, filed an amendment that would gut the bill and let local school boards make all decisions about tobacco use in their districts, as they already do. Rep. Lynn Bechler, R-Marion, filed an identical amendment the next day, Feb. 22.
Bechler who initiated the effort to move the bill from the consent calendar, told Kentucky Health News last week that he opposes the bill because it is government overreach. Rep. Myron Dossett, R-Pembroke, who also signed the petition, said likewise. He also spoke up for tobacco, noting that he represents Christian County, a large tobacco producer and home to a large smokeless-tobacco factory.
Moser noted that the opposition comes from members of her own party. "I think I have the votes in the House as a total to pass this," she said, "but if they are worried about there being more Democrats than Republicans, at this point they might be right -- and that's kind of sad." The House has 61 Republicans and 39 Democrats.
All the bill's active opponents but Brenda are from Western Kentucky, which has fewer school districts with 100 percent tobacco-free school policies (but not as many as in Eastern Kentucky). Most of the schools in Miles's district are already tobacco-free.
Overall, 74 of the state's 173 districts have adopted such policies, covering 740 schools and 58 percent of the state's students. Federal law only prohibits smoking inside schools that receive federal funding.
“It's just too bad, too bad for Kentucky," Moser said. "The whole thing is just beyond me as to why this is something that we can't pass in Kentucky."
Moser said Kentucky needs a statewide tobacco-free school law because of the "exploding rates of [youth] vaping and Juuling," which she said leads to an addiction to nicotine "that is priming their brains for future addictions." Further, she said it's a great way to prevent Kentucky's teens from becoming adult smokers, noting that 90 percent of adult smokers started smoking in their teens.
"People complain that we don't do enough about prevention, and this is a prime example of something that is great that we can do -- and they won't do it," she said.
The letter to the lawmakers also points to reasons to pass such a law: “House Bill 11, the tobacco-free schools bill, would create an environment where smoking cigarettes and e-cigarettes is not the norm, reduce youth tobacco initiation, provide positive adult role modeling, and protect students, faculty, and visitors from the harms of secondhand smoke and aerosol 24 hours a day, seven days a week."
Health advocates have also taken to social media. On Twitter and Facebook, the Foundation for a Healthy Kentucky writes: Parents, teachers, health advocates, business leaders, students: Don't allow #tobaccofreeschools bill to languish and die in the House. Urge your state representative to call HB11 for a floor vote today!
Hackbarth said the advocates are arguing that since the bill passed the House Health and Family Services Committee unanimously, and most Kentucky adults in a recent poll supported it, "It really deserves the right to be heard."
The latest Kentucky Health Issues Poll, taken in September and October, found that 87 percent of Kentucky adults supported such a law. Polls since 2013 have found strong support for the policy.
"This is a short session and we cannot afford to wait any longer," Moser said in the news release about the letter. "We won't let this bill die quietly. Our constituents deserve to see a floor debate and vote on this important health legislation."
The letter was signed by the foundation, the American Heart Association, the American Lung Association, Baptist Health, the Campaign for Tobacco-Free Kids, the Kentucky Cancer Foundation, the Kentucky Chamber of Commerce, the Kentucky Council of Churches, the Kentucky Equal Justice Center, the Kentucky Health Collaborative, the Kentucky Health Departments Association, the Kentucky Hospital Association, the Kentucky Medical Association, the Kentucky School Boards Association and Kentucky Youth Advocates.
The policy also has the support of the Kentucky Association of School Superintendents and the Coalition for a Smoke-free Tomorrow, a coalition of about 180 groups in the state.
Kentucky Health News
A bill to make all Kentucky school properties and events tobacco-free is in trouble in the state House, prompting advocates to mount a rescue effort.
Fifteen organizations took to social media and sent a letter to every representative asking for their support for House Bill 11, the statewide tobacco-free school bill, 15 groups, including the Kentucky School Boards Association,
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| Rep. Kim Moser |
The bill's sponsor, Rep. Kim Moser, R-Taylor Mill, told Kentucky Health News in a telephone interview that she still has hope it will get called up for a vote and is still working toward that end, but couldn't get any answers as to what was going on with it. She said she had heard it was going to be pulled from the House's orders of the day.
That would be a death knell for the bill, which passed unanimously out of the committee Moser chairs on Feb. 7 and was put on the consent calendar, used to pass bills without debate. Then it was moved to the regular orders, a switch that required signatures of three lawmakers: Reps. Lynn Bechler, R-Marion; Myron Dossett, R-Pembroke; and Reginald Meeks, D-Louisville. Meeks said he was for the bill but wanted it to be debated.
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| Rep. Suzanne Miles |
Opposition from one of the five leaders of the House's Republican majority is a danger sign for the bill, which is already under attack through floor amendments.
Rep. R. Travis Brenda, R-Cartersville, a Rockcastle County teacher, filed an amendment to allow use of tobacco products if children were not present, an effort likely meant to appease some of the bill's opponents. Moser promptly filed an amendment to clarify that the law, if passed, would prohibits smoking by all persons at all times on school properties, activities or trips.
Then Rep. Richard Heath, R-Mayfield, filed an amendment that would gut the bill and let local school boards make all decisions about tobacco use in their districts, as they already do. Rep. Lynn Bechler, R-Marion, filed an identical amendment the next day, Feb. 22.
Bechler who initiated the effort to move the bill from the consent calendar, told Kentucky Health News last week that he opposes the bill because it is government overreach. Rep. Myron Dossett, R-Pembroke, who also signed the petition, said likewise. He also spoke up for tobacco, noting that he represents Christian County, a large tobacco producer and home to a large smokeless-tobacco factory.
Moser noted that the opposition comes from members of her own party. "I think I have the votes in the House as a total to pass this," she said, "but if they are worried about there being more Democrats than Republicans, at this point they might be right -- and that's kind of sad." The House has 61 Republicans and 39 Democrats.
All the bill's active opponents but Brenda are from Western Kentucky, which has fewer school districts with 100 percent tobacco-free school policies (but not as many as in Eastern Kentucky). Most of the schools in Miles's district are already tobacco-free.Overall, 74 of the state's 173 districts have adopted such policies, covering 740 schools and 58 percent of the state's students. Federal law only prohibits smoking inside schools that receive federal funding.
Moser said Kentucky needs a statewide tobacco-free school law because of the "exploding rates of [youth] vaping and Juuling," which she said leads to an addiction to nicotine "that is priming their brains for future addictions." Further, she said it's a great way to prevent Kentucky's teens from becoming adult smokers, noting that 90 percent of adult smokers started smoking in their teens.
"People complain that we don't do enough about prevention, and this is a prime example of something that is great that we can do -- and they won't do it," she said.
The letter to the lawmakers also points to reasons to pass such a law: “House Bill 11, the tobacco-free schools bill, would create an environment where smoking cigarettes and e-cigarettes is not the norm, reduce youth tobacco initiation, provide positive adult role modeling, and protect students, faculty, and visitors from the harms of secondhand smoke and aerosol 24 hours a day, seven days a week."
Health advocates have also taken to social media. On Twitter and Facebook, the Foundation for a Healthy Kentucky writes: Parents, teachers, health advocates, business leaders, students: Don't allow #tobaccofreeschools bill to languish and die in the House. Urge your state representative to call HB11 for a floor vote today!
Hackbarth said the advocates are arguing that since the bill passed the House Health and Family Services Committee unanimously, and most Kentucky adults in a recent poll supported it, "It really deserves the right to be heard."
The latest Kentucky Health Issues Poll, taken in September and October, found that 87 percent of Kentucky adults supported such a law. Polls since 2013 have found strong support for the policy.
"This is a short session and we cannot afford to wait any longer," Moser said in the news release about the letter. "We won't let this bill die quietly. Our constituents deserve to see a floor debate and vote on this important health legislation."
The letter was signed by the foundation, the American Heart Association, the American Lung Association, Baptist Health, the Campaign for Tobacco-Free Kids, the Kentucky Cancer Foundation, the Kentucky Chamber of Commerce, the Kentucky Council of Churches, the Kentucky Equal Justice Center, the Kentucky Health Collaborative, the Kentucky Health Departments Association, the Kentucky Hospital Association, the Kentucky Medical Association, the Kentucky School Boards Association and Kentucky Youth Advocates.
The policy also has the support of the Kentucky Association of School Superintendents and the Coalition for a Smoke-free Tomorrow, a coalition of about 180 groups in the state.
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Officials rejected infectious-disease chief's plea to move faster against hepatitis A outbreak, now nation's largest and deadliest
In an April 2018 e-mail obtained by the Louisville newspaper, Dr. Robert Brawley, the state's infectious-disease chief at the time, wrote to his health department colleagues: "Need to move faster. The virus is moving faster than we and [local health departments] are … immunizing persons.”
"Brawley argued that a powerful state response was needed: $10 million, including $6 million for a fusillade of 150,000 vaccines and $4 million for temporary health workers to help administer them. In an email, he also lobbied for a public health emergency declaration to bolster the case for more federal money," Ungar and Kenning report. "His urgent pleas went nowhere. And in the months that followed, Kentucky’s outbreak metastasized into the nation's largest and deadliest."
The Courier Journal found that Brawley's "aggressive recommendations" were rejected by his boss, 31-year-old acting Health Commissioner Dr. Jeffrey Howard. Now Kentucky's death toll from this outbreak is the highest in the nation.
"Amid limited state budgets, county staffing constraints and the availability of more than $220 million in local health-department reserve funds — he stuck instead to a $3 million state response," the CJ reports. "The state ultimately sent $2.2 million to local departments and declined to declare an emergency. In addition, county health departments added little to no staff to increase efforts to find and vaccinate drug users and homeless people."
Ungar and Kenning report that Kentucky "never tried strategies used successfully by some of the other 15 states who fought outbreaks with limited budgets," like seeking money from the state legislature, deploying "strike teams" of state health workers to counties, and immediately deploying state funds for the epidemic.
The article details the decision-making process of Howard, who stood by his decisions, though he did acknowledge that in retrospect he could have done some things differently.
"I wish I would've been more bold and said, 'Let's move into Eastern Kentucky,' as opposed to waiting, as we did," said Howard, who grew up in Appalachia. "As an Eastern Kentucky guy, it's heartbreaking to see this disease spread out in rural Kentucky. And I knew the struggles that they'd have once it started."
Adam Meier, secretary of the Cabinet for Health and Family Services, told the reporters that he stood by Howard's choices, saying in a statement that the "challenges Kentucky faced were less financial and more logistical in nature as it related to identifying and engaging the at-risk populations. While hindsight might provide more context for some things now, in retrospect there’s not a single decision that I’m aware of that was made in real time, with the information available at the time, that I would change."
But Brawley, who resigned in June, told the Courier Journal that much greater resources were needed to battle Kentucky's spread of hepatitis A and called the state's response "too low and too slow" for what has become "the worst hepatitis A outbreak in the United States in the 21st century."
He added, "Had the state hastened its vaccination efforts, it may have more quickly reduced the risk of the disease's spread and prevented acute cases, hospitalizations for about 50 percent of those cases, deaths and avoided millions of dollars in healthcare expenses for emergency department visits and hospitalizations."
Ungar and Kenning reported that several others in the health department agreed with Brawley's recommendations, including nurse Margaret Jones, manager of the state's immunization program. "We should have done more sooner," said Jones, who retired last summer. "If we had been able to get the vaccines out early, we may not have near as many cases or near as many hospitalizations. … He knew what to do. I think his advice should have been heeded."
Now, state health officials are hopeful the hepatitis A outbreak has crested. The number of new cases each week is down from 150 in early November 2018, averaging 87 a week this year. Officials said their plans in 2019 include "working to help local departments vaccinate more regularly at jails, increase vaccinations generally, enlist more federally qualified health centers to administer vaccines, and continue to push out federally funded vaccine to counties," the CJ reports.
The newspaper published four other articles on this topic on the same day.
Ungar tells the story of an Eastern Kentucky woman who learned she had hepatitis A, along with her existing hepatitis C, while getting treatment for her heroin and methamphetamine addiction. Another story covers how other states have responded to the outbreaks of the disease, reporting that since 2017, 16 states have had outbreaks, infecting more than 13,000 people. Another details how hepatitis A spread across Kentucky.
the final story, written by Kenning, chronicles the story of an Appalachian woman with a heroin addiction who said she didn't know about the highly contagious virus, and even if she had, she wouldn't have cared. "People who are addicted like myself, I really didn't care if I lived or died. So I (wouldn't have) really cared if I was infected with it," she said.
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Poll finds those with dental insurance are more likely to visit the dentist, and insurance often depends on income
Nearly 60 percent of Kentucky adults saw a dentist in the past year, but 26 percent said they delayed dental care because it cost too much, according to the latest Kentucky Health Issues Poll.
"Good dental health is about more than an attractive smile; taking care of your teeth and gums and seeing a dentist regularly can help prevent a whole host of diseases that affect the entire body," Dr. Laura Hancock Jones, a Morganfield dentist, said in a news release from the Foundation for a Healthy Kentucky, a co-sponsor of the poll.
Jones, a member of the foundation's Community Advisory Council, also said, "Health policies that make comprehensive dental care affordable and otherwise improve access are critical to improving overall health in Kentucky."
The poll, taken Aug. 26 through Oct. 21, also found that people with higher incomes were more likely to have dental insurance, and those with dental insurance were more likely to have visited a dentist.
Of the 60 percent of Kentucky adults who reported having dental insurance, the poll found that 73 percent had household incomes greater than 200 percent of the federal poverty level; 55 percent had an income between 138 percent and 200 percent of the federal poverty level; and 41 percent had an income less than 138 percent of the federal poverty level.
It may be interesting to see what happens in next year's poll, after Kentucky moves to its new Medicaid plan on April 1. Right now everyone on Medicaid who earns up to 138 percent of the federal poverty level has access to dental care, but after April 1 everyone except children and those on Medicaid who are not part of the new plan will be required to accrue "virtual dollars" to use for dental-care benefits by completing certain qualifying activities.
While the poll found that fewer Kentucky adults who saw a dentist had dental insurance in 2018 than in 2012, the last time the poll asked this question, the conclusion remains the same -- people who have dental insurance are more likely to go to the dentist.
In 2018, 73 percent of the adults who had gone to the dentist reported they had dental insurance, compared to 27 percent who did not. In 2012, those numbers were 63 percent and 36 percent respectively.
Some good news is that the number of Kentucky adults who delayed or skipped dental care because of cost has dropped over the years, to 26 percent in 2018 from 37 percent in 2012 and 43 percent in 2009.
Ben Chandler, president and CEO of the foundation, pointed out that this is another example of how insurance coverage, which is known to improve overall health outcomes, is often not accessible to those with lower level incomes.
"This KHIP report shows that the people who can least afford dental screenings and other preventive care, let alone treatment for gum disease and other oral health issues, are also the least likely to have insurance to help cover the cost of that care," Chandler said in the release.
The poll is co-sponsored by Interact for Health, a Cincinnati area foundation. It surveyed a random sample of 1,569 adults via landline and cell phone. Its margin of error is plus or minus 2.5 percentage points.
"Good dental health is about more than an attractive smile; taking care of your teeth and gums and seeing a dentist regularly can help prevent a whole host of diseases that affect the entire body," Dr. Laura Hancock Jones, a Morganfield dentist, said in a news release from the Foundation for a Healthy Kentucky, a co-sponsor of the poll.
Jones, a member of the foundation's Community Advisory Council, also said, "Health policies that make comprehensive dental care affordable and otherwise improve access are critical to improving overall health in Kentucky."
Of the 60 percent of Kentucky adults who reported having dental insurance, the poll found that 73 percent had household incomes greater than 200 percent of the federal poverty level; 55 percent had an income between 138 percent and 200 percent of the federal poverty level; and 41 percent had an income less than 138 percent of the federal poverty level.
It may be interesting to see what happens in next year's poll, after Kentucky moves to its new Medicaid plan on April 1. Right now everyone on Medicaid who earns up to 138 percent of the federal poverty level has access to dental care, but after April 1 everyone except children and those on Medicaid who are not part of the new plan will be required to accrue "virtual dollars" to use for dental-care benefits by completing certain qualifying activities.
While the poll found that fewer Kentucky adults who saw a dentist had dental insurance in 2018 than in 2012, the last time the poll asked this question, the conclusion remains the same -- people who have dental insurance are more likely to go to the dentist.
In 2018, 73 percent of the adults who had gone to the dentist reported they had dental insurance, compared to 27 percent who did not. In 2012, those numbers were 63 percent and 36 percent respectively.
Some good news is that the number of Kentucky adults who delayed or skipped dental care because of cost has dropped over the years, to 26 percent in 2018 from 37 percent in 2012 and 43 percent in 2009.
Ben Chandler, president and CEO of the foundation, pointed out that this is another example of how insurance coverage, which is known to improve overall health outcomes, is often not accessible to those with lower level incomes.
"This KHIP report shows that the people who can least afford dental screenings and other preventive care, let alone treatment for gum disease and other oral health issues, are also the least likely to have insurance to help cover the cost of that care," Chandler said in the release.
The poll is co-sponsored by Interact for Health, a Cincinnati area foundation. It surveyed a random sample of 1,569 adults via landline and cell phone. Its margin of error is plus or minus 2.5 percentage points.
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Sweeteners: Time to rethink your choices?
When it comes to low-calorie sweeteners, you have a lot of choices. There’s the blue one, the pink one, the yellow one, or the green one. Whichever one you choose, know that scientists have probably studied it extensively. What they’ve found may surprise you.
Artificial and other non-caloric sweeteners: The major players
The marketers for artificial sweeteners have color-coded their products, but they differ in some important ways beyond their packaging. In the US, the most popular FDA-approved non-sugar sweeteners (NSSs) and their most common packaging color are:
- aspartame (blue): examples include Nutrasweet and Equal
- saccharin (pink), as in Sweet’N Low
- stevia-derived (green), including Truvia
- sucralose (yellow), as in Splenda.
How are they different? Stevia is considered a “natural non-caloric sweetener.” Saccharin and sucralose are considered “non-nutritive sweeteners” (few or no calories). Aspartame is a “nutritive sweetener” (adds some calories but far less than sugar).
Aspartame comes with a warning to be used cautiously (or not at all) by people with a rare genetic disease (called phenylketonuria, or PKU) because they have trouble metabolizing it; that’s not true for the other sweeteners. And all four vary on their level of sweetness and aftertaste, which is likely why people often prefer one over another.
Researchers take on artificial sweeteners
The reason these sweeteners exist is that people want to eat or drink sweet foods and drinks without the calories of sugar. We assume that over time, fewer calories will translate to less weight gain, more loss of excess weight, and lower risk of weight-related problems such as diabetes and high blood pressure. Although unproven, such assumptions seem reasonable: a 12-ounce can of Coca-Cola contains nearly 10 teaspoons of sugar totaling 140 calories. Over time, such empty calories can add up to many pounds of weight gain. As a result, non-caloric sweeteners long been a mainstay of dieters or anyone trying to limit caloric or sugar intake.
Are there downsides to non-sugar sweeteners?
Despite the rationale above, the effectiveness of using NSSs to lose weight, avoid weight gain, or achieve other health benefits is unproven. In fact, some studies (such as this one) found that people who often drank diet soda actually became obese more often than those who drank less diet soda or none. Another study found higher rates of metabolic syndrome and type 2 diabetes among the highest consumers of diet soda. How can this be? Researchers speculate that using NSSs may cause cravings for sweet foods, alter taste perception, or change how nutrients are absorbed. And of course, it’s possible that people simply justify eating more high-calorie (and potentially less nutritious) foods because they’ve chosen diet sodas.
In addition, research has raised questions regarding safety over the years. For example, cyclamate (which was often combined with saccharin) was banned from all US food and drink products due to concerns regarding cancer risk. Saccharin’s possible link to cancer led to a warning label; as additional research suggested no increased cancer risk in humans, this warning was dropped in 2000.
There have been reports of headaches, learning difficulties, changes in the balance of bacteria in the intestinal tract, and other problems associated with NSS consumption.
Can a new study lay safety concerns to rest?
Given all of these concerns, researchers in Europe took on the task of trying to assess the risks and benefits of various NSSs with an analysis of the best research available, including 56 previously published studies. They sought to determine the effect of various NSSs on the health of adults and kids, including those who were overweight, obese, or at a healthy weight. The effects they studied included:
- body weight
- oral health
- blood sugar
- eating behavior
- cancer risk
- cardiovascular disease risk
- kidney disease risk
- mood and brain function.
Spoiler alert: More research is needed
After an exhaustive examination of the most relevant studies, researchers concluded that:
- There were no clear differences in health outcomes between people who used NSSs often or not at all.
- No clear health benefits were observed with NSS use, but “potential harms could not be excluded.”
- The quality of the research to date wasn’t very good, and no definitive conclusions could be made regarding NSS use and these important health effects.
Disappointed? I am. Then again, at least no dramatic or severe harms were detected. And I was glad they didn’t find that my favorite (stevia) was the worst of the bunch. Until we know more, it seems reasonable to suggest the usual: “all things in moderation.” Read nutrition labels and try not to consume more than a few servings per day of any NSS.
Or, do the unthinkable: do without them.
The post Sweeteners: Time to rethink your choices? appeared first on Harvard Health Blog.
