Flu shots limit infection rates, which are still elevated in Kentucky

State health department graphs, adapted by Kentucky Health News

By Melissa Patrick
Kentucky Health News

The Kentucky Department for Public Health still considers hospitalizations for respiratory illnesses high and says flu activity remains elevated. 

Health officials say the best way to protect yourself from these viruses is to stay up to date with your vaccines. 

The Centers for Disease Control and Prevention recommends that everyone 6 months old and older get the annual flu vaccine and updated Covid-19 vaccines, especially children younger than 5 or anyone at high risk for complications.

Vaccines for respiratory syncitial virus are recommended for some infants and young children, pregnant women and adults 60 and older. At some places and times, there has been a shortage of these vaccines. 

This year's "flu vaccines have worked, substantially reducing the risk of flu-related medical visits and hospitalizations across all age groups, with some estimates higher than have been previously observed, even during well-matched seasons," said a CDC report released on Feb. 29.

"Specifically, flu vaccination has reduced the risk of flu medical visits by about two-thirds and flu-related hospitalization by about half for vaccinated children and flu medical visits by half and hospitalization by about 40% for vaccinated adults."

Even though flu season usually peaks between around January, it lasts until May. Health experts say that if there is any flu activity occurring, it's not too late to get vaccinated.

What the numbers say

Emergency-department visits for respiratory illness in Kentucky have stayed about the same for the last two weeks, with 3,607 visits reported in the week ended Feb. 24.

Hospitalizations for respiratory disease in that week stayed about the same as the week prior, with 491 hospitalizations reported in the week ended Feb. 24. 

Kentucky had 20 counties with Covid-19 hospitalizations between 10 and 19.9 hospitalizations per 100,000 people, a rate that the  CDC considers "medium." 

Those counties are Adair, Green, Russell, Taylor, Clinton, Cumberland, Lewis, Elliott, Menifee, Morgan, Rowan, Barren, Hart, Metcalfe, Monroe, Bath, Montgomery, Floyd, Johnson and Magoffin. 

Overall, there was little change in the three respiratory viruses tracked by the state health department: Covid-19, influenza and RSV, with flu continuing to drive ED visits and hospital admissions. 

The state reported 3,857 laboratory confirmed cases of the flu in the week ended Feb. 24 and 2,246 laboratory confirmed cases of Covid-19. This reflected a slight drop in flu cases and a nearly 9% drop in Covid cases.

Among children, ED visits for respiratory disease increased 12% in children four and younger, to 671, compared to the prior week, and hospitalizations for children 5 to 17 increased 50%, to 18. The increase in ED visits for younger children was driven by the flu, and hospitalizations for the older children were driven by an increase in  both flu and Covid-19.

Since the respiratory-illness season began the first week in October, 384 Kentuckians have died from Covid-19, and 51 from flu, according to the health department. One Covid-19 victim and one flu victim have been children. 

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State's health chief urges parents to get kids vaccinated against measles, the most contagious disease, which can do great harm

By Melissa Patrick
Kentucky Health News

A highly contagious childhood disease that was declared eliminated in the United States in the year 2000 is making a comeback, largely driven by a declining vaccination rate in the country.  

"Unfortunately, as the measles vaccination rate has decreased, it's just one of those things where folks are opting out of vaccination more often, we're starting to see the increase of measles in the United States," Dr. Steven Stack, commissioner of the Kentucky Department for Public Health, said at a Feb. 29 press conference. 

In Kentucky, about 90% of the state's kindergarteners are vaccinated for measles, mumps, and rubella "and that has to be 95% or higher to stop transmission," said Stack. 

Stack spent the bulk of his time talking about a disease that he said most people in our country, including health-care providers, have never seen. Further, he said, it is a disease that is "virtually, entirely vaccine-preventable." 

"If you are vaccinated, you almost certainly will get no symptoms from measles," he said. "In fact, the vaccine is so effective, you won't get sick at all and you don't transmit the virus." 

Stack said symptoms of measles include a cough, congestion, fever that may go up to 104 degrees, and a full-body rash. The Centers for Disease Control and Prevention also mentions sore, red eyes that may be sensitive to light; watery or swollen eyes; small greyish-white spots in the mouth, and a loss of appetite. 

"You feel miserable," said Stack, adding, "In the unlucky ones, the complications are pneumonia, diarrhea, ear infections, and even sometimes brain swelling that can lead to things like seizures, developmental disabilities and other permanent brain damage."

Among the unvaccinated population, Stack said more than one in five measles victims are hospitalized and one in 20 get pneumonia, which is the most common cause of death. 

"The most common age of death is under 5,  those are the individuals hurt the most by this disease if you're unvaccinated," he said. "And for the really unlucky, one in one thousand can get a permanent brain injury from the brain swelling that I talked about." 

Because measles is a highly contagious virus that is spread through the air, with an incubation period of 10 to 12 days, it is easy to spread it unknowingly. Stack said a person is contagious for four days before the rash and four days after the rash, which is why it is recommended for anyone who has been exposed to measles or who has it to stay at home for 21 days to avoid spreading the disease. 

"Measles is probably the most contagious viral disease on planet Earth at present. The only thing that could maybe compete with it is Covid," he said. "In this room, all of us in this press conference for a period of 40 to 60 minutes, if one person had measles in this room and we were unvaccinated, nine out of 10 of us would become infected with measles in about 10 to 12 days." 

As of Feb. 29, the CDC reported there had been 41 measles cases reported in 16 states, none in Kentucky.  

"This is becoming more common and because people travel a lot and are portable in ways that weren't possible . . . in the prior century, it spreads too easily and can cause too many problems," said Stack. "Everybody please go get yourselves and your children vaccinated if you are not already vaccinated."

Florida, with its many airports and a regular vacation spot for many Kentuckians, is one of the states with a recent outbreak. Of concern to public health officials is a letter issued by the Florida State Health Department that does not urge parents of unvaccinated children at that school to get vaccinated or to quarantine. Instead, it leaves these decisions up to parents.

These recommendations go against well-established public health guidelines that call for unvaccinated people or those with no prior immunity to isolate for 21 days after exposure and for unvaccinated children to get vaccinated within 72 hours of exposure, which allows them to return to school as long as they don't develop symptoms,  Katelyn Jetelina and Dr. Kristen Panthagani, write in their Your Local Epidemiologist newsletter.

Asked about what precautions Kentuckians should take if they are traveling through the Florida airports or spending time in the state, Brice Mitchell, spokesperson for DPH said a person's level of concern should be determined by whether they are vaccinated or not.  

"If you are vaccinated for measles, there are no special precautions necessary. If you are unvaccinated for measles, the Kentucky Department for Public Health urges that you get vaccinated," he said in an email. "For further information, please review the Centers for Disease Control and Prevention guidance." 

Two doses of measles, mumps and rubella (MMR) vaccine are recommended to children starting at 12 months. Adults can also be vaccinated against the measles. 

“Two doses of MMR vaccine are 97% effective at preventing measles and provides lifelong protection if exposed to the virus,” Stack said in a news release. “Even if exposed to measles, vaccinated persons may continue routine activities.”

The CDC says that while detectable antibodies generally appear within just a few days after getting the measles vaccination, it takes about two or three weeks to be fully protected. Ideally, the CDC says a person should be fully vaccinated at least two weeks before they travel.

More information can be found in a Los Angeles Cedars-Sinai Hospital blog post, "Measles Makes a Comeback: What Parents Need to Know." It says measles cases worldwide increased 79% in 2023, according to the World Health Organization. In 2022, the WHO estimated that measles killed more than 130,000—most of them children.

“Measles is a huge concern and directly related to declining measles vaccination rates,” said Dr. Priya Soni, a pediatric infectious-disease specialist with Cedars-Sinai Guerin Children’s Hospital. “Vaccine hesitancy, fueled during the pandemic by the anti-vaccine movement, has affected vaccination rates nationwide. In addition, because children were quarantined during the pandemic, many missed out on well-child visits and didn’t catch up on their vaccines. That has meant 61 million fewer doses distributed nationwide between 2020 and 2022.”

Although the first dose of the MMR vaccine is traditionally given to infants 12-15 months of age, and the second around a child’s fifth or sixth birthday, Soni said infants as young as 6 months can receive the first vaccine if they are traveling to areas where the measles infection rate is high.

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Five days of isolation no longer required with Covid-19, CDC says

McKenna Shuster worked on a linocut art print on the last night of a two-week self-isolation while recovering from symptoms of Covid-19 in Somerville, Mass., on March 26, 2020. The Centers for Disease Control and Prevention now says people who test positive for Covid no longer need to stay in isolation for five days, and can return to work or regular activities if their symptoms are mild and improving and it's been a day since they've had a fever. (AP file photo by David Goldman)

Associated Press

Americans who test positive for Covid-19 no longer need to stay in isolation for five days, U.S. health officials announced Friday.

The Centers for Disease Control and Prevention changed its longstanding guidance, saying that people can return to work or regular activities if their symptoms are mild and improving and it's been a day since they've had a fever.

The change comes at a time when Covid-19 is no longer the public health menace it once was. It dropped from being the nation's third leading cause of death early in the pandemic to 10th last year.

Most people have some degree of immunity to the coronavirus from vaccinations or from infections. And many people are not following the five-day isolation guidance anyway, some experts say.

“Our goal here is to continue to protect those at risk for severe illness while also reassuring folks that these recommendation are simple, clear, easy to understand, and can be followed,” said Dr. Mandy Cohen, the CDC’s director.

However, some experts worry that the change may increase the risk of infection for older people and others who are more vulnerable to getting seriously ill.

Why are the guidelines changing? Covid-19 is not causing as many hospitalizations and deaths as it did in the first years of the pandemic. The change is an effort to streamline recommendations so they are similar to longstanding recommendations for flu and other respiratory viruses. Many people with a runny nose, cough or other symptoms aren't testing to distinguish whether it's Covid-19, flu, or something else, officials say.

It may not be as stringent, but the guidance emphasizes that all people with respiratory symptoms should stay home while they are sick, said Dr. David Margolius, the head of Cleveland's health department.

People are likely still contagious when they test positive, and that hasn’t changed, said Jennifer Nuzzo, director of the Pandemic Center at Brown University’s School of Public Health in Providence, R.I.

“What has changed is how much Covid is harming us as a population,” Nuzzo said.

Officials noted that some other countries and California and Oregon have eased isolation guidance in a manner similar to CDC’s latest change — and did not see an increase in cases.

What are the new guidelines? If you have symptoms, stay home until your symptoms are mild and improving and it’s been a day since you've had a fever. But then you can remain cautious by wearing a mask and keeping a distance from others.

However, the CDC guidance for workers at nursing homes and other health care facilities is staying the same. That includes a recommendation that medical personnel stay home at least seven days after symptoms first appear, and that they test negative within two days of returning to work.

The agency is emphasizing that everyone should still try to prevent infections in the first place, by getting vaccinated, washing their hands, and taking steps to bring in more outdoor fresh air.

Is there opposition to this change? Yes, and even some who understand the rationale for the change have concerns.

“My biggest worry in all of this is that employers will take this change in guidance to require employees to come back to work . . . before they are ready to, before they feel well enough, and before they are not likely to pose harm to their co-workers,” Nuzzo said.

Covid-19 remains especially dangerous to older people and those with other medical conditions. There are still more than 20,000 hospitalizations and more than 2,000 deaths each week due to the coronavirus, according to the CDC. Those 65 and older have the highest hospitalization and death rates.

This week, the CDC said seniors should get another dose of the updated Covid-19 vaccine.

Will schools change their rules? Not necessarily. Schools and child care providers have a mixed record on following CDC recommendations and often look to local authorities for the ultimate word. And sometimes other goals, such as reducing absences, can influence a state or district’s decisions.

When California eased its guidance, it encouraged kids to come to school when mildly sick. It also said students who test positive for COVID-19 but don't have any symptoms can attend school.

Is the first such change? No. The CDC originally advised 10 days of isolation, but in late 2021 cut it to five days for Americans who catch the coronavirus and have no symptoms or only brief illnesses. Under that guidance for the general public, isolation only ended if a person had been fever-free for at least 24 hours without the use of fever-reducing medications and if other symptoms were resolving.

AP education writer Bianca Vázquez Toness in Boston contributed to this report. The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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UK doctor points up treatment for 'hidden disability' of hearing loss

By Rick Childress

University of Kentucky

Forty years ago, there was no effective treatment for deafness.

Now, a nine-month-old infant can get a cochlear implant — a procedure that first got Food and Drug Administration approval in 1984.

“In my opinion, it is one of the greatest achievements of modern medicine,” said Dr. Beth McNulty, a UK HealthCare neurotologist — a doctor who specializes in the ears, nose and throat, commonly known as an ENT.

In the inner ear, a cochlear implant converts acoustic energy into electric energy, stimulating the auditory nerve electrically. It may restore hearing in those born with congenital deafness, as well as patients with slowly progressive hearing loss for whom hearing aids no longer work.

“Cochlear implants are performed on infants up to 103-year-olds,” McNulty said. "I always counsel patients that there's no age limit. We treat each patient individually as far as candidacy for surgery.”

The sense of sound can help a deaf mother hear her crying infant, or help a baby born deaf learn to speak. In honor of World Hearing Day Sunday, March 3, McNulty wanted to highlight how the gift of hearing can connect people and change lives.

“As the hearing loss progresses to the point of cochlear implantation, a lot of patients feel isolated, they feel like they have no hope,” McNulty said. “Communication is what ties you to the world.”

World Hearing Day brings awareness for hearing loss — so often an invisible disability. That became particularly apparent during the Covid-19 pandemic and patients who were hard of hearing couldn’t read the lips of masked people.

“It caused frustration for them, for those trying to communicate with them, like, ‘Why can't you get this?’” McNulty said. “Because they don't have a sign on their forehead that says, ‘I have hearing loss’ or ‘I have deafness.’”

Many of McNulty’s patients are in their mid-life and have had hearing loss that has progressed to where their hearing aids are no longer effective. Sadly, in some places in Kentucky, those individuals aren’t referred for cochlear implantation because of a lack of awareness of the treatment options.

“Through World Hearing Day we want to bring awareness to hearing loss as a disability, an often hidden disability, and bring awareness to the fact that nowadays we have options for treatment,” McNulty said.

Starting in 2019, the surgery can also be performed on those who are deaf in one ear.

Candidates for the surgery often score less than 50% of word understanding during audiology testing. After the surgery, average word recognition increases to 70-80%.

Before surgery, McNulty speaks directly and slowly or uses dictation software when talking with a patient. On activation day, she loves to “test the water” and speaks normally to see if the patient responds. While speech clarity may take time, often, they do respond and describe hearing sounds they haven’t heard in years.

“It’s opening closed doors for patients, bringing back the connection to their loved ones, their friends and family,” McNulty said. “It is such a rewarding part of my job.”

An infant who is born deaf would start with hearing aids by the time they’re six months old, then get a cochlear implant before their first birthday.

“If we do all those things, they will have speech,” McNulty said. “They will be in a regular classroom and may progress like nothing ever happened.”

Few in Kentucky perform the surgery; the state has only six neurotologists. Four work at UK, which also has pediatric otolaryngologists who perform cochlear implants on children, as well as audiologists who are specially trained for cochlear implantation. The audiologists are key members of the team.

“This is their passion,” McNulty said. “They work with these individuals about once a month for a whole year, programming and reprogramming to try to get this to sound just right.”

The team also consists of two cochlear-implant coordinators who help schedule appointments, answer questions and are adept at working with deaf individuals and their families.

McNulty recommends considering getting your hearing checked starting at age 50 — based off data that shows getting hearing loss treated at that age can help slow the onset or progression of dementia.

Other reasons to get your hearing checked:

• Family history of hearing loss
• History of noise exposure like in construction or the military
• Asking people to repeat themselves
• Struggling with background noise
• Tinnitus (Hearing ringing, buzzing, crickets in your ears)

Cochlear implants are a treatment option for nerve hearing loss, but hearing loss may also be conductive, or due to a mechanical problem such as a hole in the eardrum, or a bad infection. Sometimes this can also be treated surgically and reversed.

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As doctors plead for end to state abortion ban, legislators file bills to protect in vitro fertilization from court rulings like Alabama's

Dr. Virginia Stokes, an obstetrician-gynecologist, said she’s treated many conditions that required abortion to prevent sepsis and preserve patients’ fertility. (Kentucky Lantern photo by Sarah Ladd)

By Sarah Ladd

Kentucky Lantern

In response to a ruling from the Alabama Supreme Court stating that frozen embryos are children, Kentucky state senators from both parties have filed bills aimed at protecting access to in vitro fertilization in Kentucky.

Meanwhile, nearly 300 Kentucky health-care providers and medical students signed a letter asking legislators to restore access to abortion in the state, saying its ban on abortion handicaps their ability to provide comprehensive care.

Republican Sen. Whitney Westerfield of Christian County, a staunch opponent of abortion, filed a bill Wednesday saying that any facility or “procedure related to in vitro fertilization shall not be liable” for damages “to a patient or patient’s surviving spouse or partner resulting from the loss of a human embryo, except in cases of negligence or wanton, willful, malicious or intentional misconduct.”

It also protects health care providers “performing any procedure” related to IVF from criminal charges. The day before, Sen. Cassie Chambers Armstrong, a Louisville Democrat, filed a similar bill. The Alabama Legislature passed similar legislation Thursday.

IVF is used to treat infertility, and can help other people trying to get pregnant to do so, according to the Mayo Clinic. About 2 percent of U.S. births are results of the procedure. It sometimes involves freezing embryos for future attempts at insemination; damage to frozen embryos at a fertility clinic prompted the lawsuit that led to the Alabana ruling.

Westerfield’s filing comes as he and his wife are expecting triplets, which he announced in January. He said at that time in a Senate floor speech that they adopted and transferred embryos for the pregnancy. His 6-year-old son is an “embryo adoption” baby, he said.

At a Thursday news conference, Democratic Gov. Andy Beshear said the Alabama ruling “is what happens . . . when you embrace extremism.”

He cited Kentucky’s near-total abortion ban as another example: “Women that have non-viable pregnancies still have to oftentimes carry that pregnancy to term knowing they’re going to hear their child die moments afterwards if it hasn’t already happened.”  

Kentucky bans abortion except in cases of threat to the woman's life or of serious, permanent damage to a life-sustaining organ, under a law triggered by the U.S. Supreme Court's 2022 overturn of Roe v. Wade, the 1973 decision that created a constitutional right to abortion. 

The ban causes “devastating consequences” for patients, Louisville’s Dr. Marjorie Fitzgerald said at the health-care providers' event. “We are losing obstetricians who will not practice in our state,” a nd because of the restrictions, “Doctors are violating their Hippocratic oath to do no harm.”

Fitzgerald was joined in the Capitol Annex by Democratic lawmakers, other medical providers and a second-year medical student in Frankfort to discuss the letter written by the Kentucky Physicians for Reproductive Freedom and signed by 280 providers.

They detailed the complex nature of medical decisions that lead to abortions and slammed lawmakers for restricting their ability to provide that care.

Dr. Nancy Newman, a board-certified obstetrician, said she would not now come to the state because of a “culture of fear that our legislature has created” in which providers have to decide between jail time and what their patients need. “How do you practice medicine in a culture of fear? I don’t think you can.”

Dr. Michelle Elisburg, a Louisville pediatrician, told the story of a 14-year-old patient who was raped by a 60-year-old landlord and got pregnant.

“She had the baby and then dropped out of high school to get a job” to support herself and her child, Elisburg said. “Now both mother and child have multiple risk factors for poor health, educational and vocational outcomes, requiring more financial assistance from the state.”

Elisburg said that as a Jewish physician, she’s governed not only by the Hippocratic oath to do no harm, but also a faith-based oath to act in the best interest of her patients: “As a physician in Kentucky, I am now being forced to make impossible choices that put my professional ethics and my faith in direct conflict with the law.”

Urooj Nasim, who attends the University of Louisville medical school and said she spoke only for herself, said abortion bans may keep her and her classmates from getting the hands-on training they need to become obstetrician-gyneciogists and tackle Kentucky’s high rates of maternal mortality.

“In order to make the best calls for the patients of my future, I need to receive high quality training and all of the tools and procedures available,” Nasim said. “And in a state where physicians live in fear of being prosecuted for delivering standard care, that is just not possible.”

The American College of Obstetricians and Gynecologists says “In states with abortion bans, medical students and residents are not able to receive the hands-on training they need in order to provide patients with comprehensive care.”

Nasim, who was born in St. Louis and lived in Somerset until she was 8, told the Lantern she is “undecided” on her specialty path but was “moved by that patient population” when she worked with an obstetrician previously.

“I’m a very … mission-driven medical student,” she said. “I really want to help patients with a lot of the social factors that affect their health. And OB is a really great specialty to do that in.”

Latest in a line of protests

The Thursday letter is the latest in a long line of efforts to protest Kentucky’s tight abortion bans.

In 2022, Kentucky voters defeated a constitutional amendment that would have keptt courts from finding a right to an abortion in the state constitution.

In late 2023, a Kentucky woman sued for the right to access abortion and end an unwanted pregnancy, but dropped the lawsuit when the fetus lost cardiac activity.

Republicans and Democrats have filed bills seeking to loosen or undo Kentucky’s abortion bans, to no avail.

Several anti-abortion lawmakers have focused their efforts during the 2024 session on making Kentucky a safer place to give birth and codifying support for expectant parents.

This week state Rep. Ken Fleming, R-Louisville, filed a bill seeking rape and incest exceptions to Kentucky’s abortion bans — but only in the fist six weeks of pregnancy

Newman, an obstetrician, said “Most women don’t even know that they’re pregnant by six weeks,”  an in case of assault, “The victim likely may not even tell anyone before six weeks.”

Dr. Virginia Stokes, a board-certified obstetrician-gynecologist, said she’s treated many conditions in her tenure as a physician that required abortion — placenta previa, first and second trimester ectopic pregnancies, preterm rupture of membranes, cancer, sepsis and more.

A lack of early interventions, she said, can cause “total body sepsis and death due to the sepsis. And if death is avoided, there is a frequent loss of fertility due to disruption of the uterus.”

“The fetus will not survive if the mother doesn’t survive,” Stokes said.

In such cases she’s treated, she said, these are “gut wrenching decisions with no choice to be made” involving “very much wanted and cherished pregnancies.”

“There are lots of really bad things that can happen between six and 12 weeks,” Stokes added. “and we need to have permission to take care of those patients.”

“I am pro-life,” Stokes said. “I am for saving the life of these women who have these early pregnancy complications that require, unfortunately, a cessation of the pregnancy …. As an OB-GYN, my first priority is the life of my female patient. Please don’t tie my hands.”

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UK researcher says chemicals in plastics can speed Alzheimer's

Researchers at the University of Kentucky are studying chemical compounds used in the production of water bottles and their link to Alzheimer's disease. (Photo by monticelllo, iStock/Getty Images Plus)

By Lindsay Travis
University of Kentucky

Researchers at the University of Kentucky are studying how elements of our natural surroundings can be potential risk factors for Alzheimer’s disease — including chemicals widely used in plastics.

“Bisphenols can accelerate Alzheimer’s disease and lead to cognitive deficits. Simply: Be smart and stay smart by avoiding plastics,” says Anika Hartz, the UK professor leading the study.

Anika Hartz, Ph.D., is the lead resarcher. (Pete Comparoni, UK) 

“Identifying environmental risk factors for Alzheimer’s is critical to mitigate cognitive decline in humans,” said Hartz, who holds positions in the College of Medicine and the College of Pharmacy. She is also affiliated with UK's Sanders-Brown Center on Aging, one of the nation’s leading centers on aging, Alzheimer’s disease and related neurodegenerative disorders. It is one of 33 National Institute on Aging-funded Alzheimer’s research centers in the U.S.

The study is funded by a grant from the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health.

Alzheimer’s is a progressive and irreversible neurological disorder. It’s estimated that 6.2 million Americans aged 65 and older are living with the disease that affects cognitive function, memory and behavior.

Hartz and her colleagues are examining three types of bisphenols, chemical compounds used in the production of polycarbonate plastics and epoxy resins. Theys are commonly found in food containers, water bottles and the lining of cans.

“Human exposure to bisphenols is inevitable due to their widespread presence in the environment,” said Hartz. “Our data show that bisphenols trigger blood-brain barrier dysfunction and memory problems, both hallmarks of Alzheimer’s, indicating that environmental bisphenols are a critical yet underrecognized risk factor for the disease.”

Hartz’s research team provided some of the first evidence that the chemicals are a clinically relevant environmental risk factor for Alzheimer’s. Bisphenols are a concern because previous research has shown they can affect the endocrine system, which regulates hormones. The brain plays a complex role in that system.

UK researchers want to better understand how the chemicals’ disruption of the endocrine system impacts the blood-brain barrier function, potentially driving cognitive decline and accelerating Alzheimer’s disease.

“The goal of this project is to develop fundamental knowledge of environmental impacts on human health that will help promote healthier lives and reduce the burden of diseases and conditions related to aging,” said Hartz. “New insights are expected from our study that will open the door for future evidence-based health management aimed at preserving cognition in health and disease.”

The work builds on preliminary data funded by a pilot grant from the UK Center for Appalachian Research in Environmental Sciences. Hartz said, “Without the pilot funding, the strong support of the UK-CARES leadership Drs. Ellen Hahn and Erin Haynes, the entire UK-CARES team, my colleagues Drs. Bjoern Bauer, Kevin Pearson, Richard Kryscio, Bernhard Hennig, Peter Nelson, Scott Stanley and the continuous support from Dr. Linda Van Eldik and the team at the Sanders-Brown Center on Aging, this would have not been possible.”

This study brings together a multidisciplinary group of researchers spanning the colleges of Medicine, Pharmacy, Public Health and Martin-Gatton College of Agriculture, Food and Environment.

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Whipsawed by the system, dozens of independent pharmacies closed in Kentucky last year, and more are expected to follow suit

“No one can withstand this onslaught,” independent pharmacist Rosemary Smith of Beattyville told the Lexington Herald-Leader of the factors causing stores like hers to close. (H-L photo by Silas Walker)

Kentucky Health News

In the past year, at least 67 independent pharmacies have closed in Kentucky, and more are expected to close because of a recent change in the system that favors big pharmacy chains. 

So reports Alex Acquisto of the Lexington Herald-Leader, in a significant story for rural Kentucky. 

"Pharmacists are often the first – and most accessible – health-care-provider point of contact in their communities, particularly in rural parts of Kentucky," Acquisto writes. "Independent pharmacies in Kentucky filled more than half of all prescriptions statewide and before 2023’s closures, independents operated in all but one of the state’s 120 counties."

That's according to Rosemary Smith, who owns six pharmacies across Eastern Kentucky with her husband, Luther, and is co-founder of the Kentucky Independent Pharmacists Alliance. KIPA is seeking help from the Kentucky General Assembly, which has previously tried to insulate independent pharmacists from the middlemen between insurance companies and pharmacies, pharmacy benefit managers.

The sponsor of earlier bills aimed at PBMs, Sen. Max Wise, R-Campbellsville, told Acquisto that he will probably file a bill similar to the recent “commercial pharmacy PBM reform” bills in Tennessee and West Virginia. The Tennessee law "gives independent pharmacies greater control over the PBM contracts they agree to, including by mandating those groups reimburse no less than the actual cost for a prescription drug," Acquisto reports. "That is an aspect not currently mandated by law in Kentucky."

The system

Acquisto explains how it got this way: "Each time an independent pharmacist fills a patient’s prescription, how that pharmacy is reimbursed by insurance companies — and what amount in fees are levied for filling it — is decided by a somewhat arbitrary and complex tangle of decisions by entities outside a hometown pharmacy’s control. This lack of control and contractual obligation to pay every fee levied has paved the way for independents to be financially gouged from multiple angles: Low or break-even reimbursement rates set by insurance companies often blunts a pharmacy’s ability to make a profit on every prescription they fill."

Pharmacy benefit managers charge pharmacies direct and indirect remuneration fees. "Federal regulations have historically dictated these fees be collected retroactively, up to six months after a prescription is filled. But that changed Jan. 1, when DIR fees began to be collected at the point of sale," Acquisto reports. "Pharmacists told the Herald-Leader they expect this temporary overlap, where DIR fees from as far back as June 2023 continue to be retroactively deducted as new fees are levied on prescriptions filled currently, will inevitably force more closures."

“This increase in DIR fees has resulted in many independent pharmacies being left with little to no capital funds to survive 2024,” Maysville druggists Dr. Michael Berry and Elizabeth Berry wrote in a Dec. 31 email to Chiquita Brooks-LaSure, adminstrator of the Centers for Medicare and Medicaid Services. “Most independent pharmacies have been on life support for the last several years. We are witnessing the initial stages of an industry in collapse.”

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