State Broadens Investigation Of Doctors For Issuing Questionable Vaccination Exemptions

The California agency that regulates doctors is investigating at least four physicians for issuing questionable medical exemptions to children whose parents did not  want them immunized.

The Medical Board of California’s investigations are unfolding amid the nation’s worst measles outbreak in more than a quarter-century, as California lawmakers consider controversial legislation to tighten the requirements for exempting children from the vaccinations required to attend schools and day care centers.

Last month, the Department of Consumer Affairs, which oversees the medical board, sued in state court to obtain medical records for patients of Sacramento-area pediatricians Dr. Kelly Sutton and Dr. Michael Fielding Allen.

In the past nine months, the board also has sought patients’ records in connection with two Santa Rosa physicians under investigation for writing allegedly inappropriate exemptions.

The state acted on the Sutton and Allen cases following complaints to the medical board from Dr. Wendy Cerny, assistant chief of pediatrics at a Kaiser Permanente clinic in Roseville, court documents show. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanante.) Cerny contacted the board about Sutton in February 2017 and followed up with an email about Allen 15 months later, according to the documents.

Cerny became concerned after seeing permanent medical exemptions for Kaiser Permanente pediatric patients written by Sutton and Allen that cited reasons including “a personal history of genetic defect,” food and environmental allergies, “neurological vulnerability” and a family history of mental health disorders, according to the legal documents.

The doctors under investigation are not Kaiser Permanente doctors, but parents went to them for vaccination exemptions. In one case, Sutton issued a “lifelong medical exemption from all vaccines” to a boy before his family joined Kaiser Permanente, according to Cerny’s complaint. When one of Cerny’s colleagues refused to write similar exemptions for the boy’s two younger siblings, the mother said she would go back to Sutton to get them, the complaint says.

“We feel this doctor and perhaps her colleagues … are making easy money on these exemptions that are not based on true medical need and are actually putting children and other people in the community at risk for contracting and spreading serious infectious diseases,” Cerny wrote in her complaint about Sutton.

A physician appointed by the medical board to review exemptions issued by Sutton and Allen described them as “either of questionable validity or patently without medical basis.”

Vaccine exemptions for medical reasons should be rare, according to the Centers for Disease Control and Prevention. They are typically reserved for children with severely compromised immune systems, like those being treated for cancer or those who are allergic to a vaccine component or have previously had a severe reaction to a vaccine.

A spokesman for the medical board declined to comment on the cases. The agency generally does not acknowledge investigations publicly unless a formal accusation is filed against a physician.

But the board’s legal efforts to obtain patient records sheds rare light on how the agency handles such complaints.

It “tells me that there are doctors who are giving problematic exemptions and the Medical Board of California is taking this issue very seriously,” said Dorit Reiss, a professor at University of California-Hastings College of the Law in San Francisco who researches vaccine law.

Sutton and Allen did not respond to phone calls and emails seeking comment.

Sutton, based in Fair Oaks, is known as a go-to doctor for medical vaccine exemptions. She offers a $97 “program” that purports to “help protect your child from the ‘One Size Fits All’ California vaccine mandate.”

Cerny submitted copies of exemption letters by Sutton and Allen in the complaints she filed with the medical board, but the names of the patients were blacked out. The board wants the names of those children and their parents, and it asked the court to compel the Permanente Medical Group, a subsidiary of Kaiser Permanente, to hand over unredacted versions of the letters.

The board also wants Kaiser Permanente to hand over the patients’ medical charts, which it believes will help determine whether the exemptions written by Sutton and Allen were indeed unmerited.

In June, Superior Court Judge Ethan Schulman ordered the Permanente Medical Group to disclose the names of the patients known to have received medical exemptions from Allen, as well as the names and addresses of their parents. He has not yet issued a ruling in the Sutton case.

Kaiser Permanente said it would comply with court orders.

“We take the health and safety of our members, patients and communities very seriously,” said Dr. Stephen Parodi, associate executive director of the Permanente Medical Group, via email.

In a case similar to Sutton’s and Allen’s, a judge ordered the Permanente Medical Group in November to provide the names of patients and parents subpoenaed in a medical board investigation of Dr. Kenneth Stoller, a Santa Rosa physician who gave vaccine exemptions to children who were Kaiser Permanente patients, as well as to others in the Mammoth Unified School District.

Stoller, who is not affiliated with Kaiser Permanente, is also being investigated by the city attorney of San Francisco, where he used to practice. He didn’t respond to a request for comment.

In April, Judge Schulman granted a petition from the state ordering Dr. Ron Kennedy to hand over the medical records of children to whom he had issued vaccination exemptions. Kennedy, a psychiatrist who runs an anti-aging clinic in Santa Rosa, has written numerous exemptions for kids, according to court records.

Kennedy’s lawyer, Michael Machat, said his client has handed over the records as ordered.

“The medical board has adopted the practice of thinking it can invade people’s privacy and search children’s private medical records to see whether or not the doctors are following the law,” Machat said. “Where does this stop?”

To date, the only doctor sanctioned for inappropriate medical vaccine exemptions is Southern California pediatrician Robert Sears, the well-known author of “The Vaccine Book.”

In 2015, California banned all philosophical and religious exemptions for immunizations in the wake of a large measles outbreak that originated at Disneyland. It is one of four states to have done so, and its vaccination rate rose sharply for three years after the law was tightened. But vaccination rates have declined in the past two years, in part because many parents opposed to vaccines have found doctors willing to write questionable medical exemptions — sometimes for a fee.

California’s vaccination policies are once again drawing national attention in the wake of the nation’s recent measles outbreak, which totaled 1,095 cases as of June 27. In California, 55 cases were reported as of June 26.

A bill pending in the California legislature, SB-276, would impose more oversight on vaccine exemptions written by doctors. After it passed the state Senate in May, it was softened to appease Gov. Gavin Newsom but would still allow the state Department of Public Health to review some exemptions. It also would prevent doctors who are under investigation for writing unwarranted exemptions from issuing new ones.

Newsom has said he will sign the legislation if it lands on his desk.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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Facebook to tackle content with misleading health claims

The logo of Facebook is pictured during the Viva Tech start-up and technology summit in Paris, France, May 25, 2018. REUTERS/Charles Platiau

(Reuters) – Facebook Inc said on Tuesday it was taking steps to reduce promotion of products based on misleading health-related claims.

In a blog post here, the social media company said it had made two updates last month to reduce posts with exaggerated or sensational health claims.

Facebook said it will take actions to reduce posts making assertions about a “miracle cure”, and against the ones aimed to promote products or services on health-related claims, such as a pill for weight loss.

The company and its peers around the world are under growing pressure to rid their platforms of fake news and misinformation, and the spread of misleading health claims were highlighted as a concern in some recent media reports.

The Wall Street Journal had earlier reported that Facebook and YouTube were filled with “harmful information” about health treatments.

“We know that people don’t like posts that are sensational or spammy, and misleading health content is particularly bad for our community,” Facebook product manager Travis Yeh said.

The update will not have a major impact on users’ news feed, Facebook said.

Reporting by Sayanti Chakraborty in Bengaluru; Editing by Anil D’Silva and Shounak Dasgupta

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States agree to pause lawsuits against bankrupt opioid maker Insys

(Reuters) – Five states have agreed to facilitate settlement talks by dropping objections to a bid by Insys Therapeutics Inc (INSYQ.PK) in bankruptcy court to put on hold their lawsuits alleging the drugmaker helped fuel the opioid epidemic.

FILE PHOTO: John Kapoor (R), the billionaire founder of Insys Therapeutics Inc., leaves the federal courthouse during the trial accusing Insys executives of a wide-ranging scheme to bribe doctors to prescribe an addictive opioid medication, in Boston, Massachusetts, U.S., March 13, 2019. REUTERS/Brian Snyder/File Photo

The agreement was announced on Tuesday by a lawyer for Chandler, Arizona-based Insys during a hearing before a federal bankruptcy judge in Wilmington Delaware, who was set to consider whether to block the states from moving forward with their cases.

Insys requested the injunction when it filed for Chapter 11 bankruptcy protection on June 10, becoming the first drugmaker accused in lawsuits by state and local governments of contributing to the deadly opioid epidemic to do so.

Insys filed for bankruptcy days after striking a $225 million settlement with the Justice Department resolving claims it paid doctors bribes to prescribe Subsys, the company’s addictive fentanyl spray.

A federal jury in Boston in May found Insys founder John Kapoor and four other former executives guilty of engaging in a racketeering conspiracy involving Subsys marketing practices.

Filing for bankruptcy normally halts active litigation against a company while it reorganizes. But a longstanding exception in U.S. bankruptcy law allows for lawsuits to proceed enforcing government officials’ “police powers.”

Lawyers for Maryland and Minnesota, where Insys faced upcoming administrative trials in August and September, last week opposed Insys’ motion to stay their cases, citing that exception. New York, New Jersey and Arizona joined them.

A ruling on Insys’ motion could have influenced whether OxyContin maker Purdue Pharma LP – another opioid manufacturer facing some 2,000 lawsuits – decides to file for bankruptcy protection, according to a person familiar with the matter and legal experts.

But at Tuesday’s hearing, Ronit Berkovich, a lawyer for Insys, told U.S. Bankruptcy Judge Kevin Gross that the five states, as well as North Carolina, had agreed to stay their cases in order to support a settlement negotiation protocol.

After hearing arguments over the proposal’s merits, Gross agreed to approve it, saying it initiates negotiations that need to take place to avoid draining cash-strapped Insys of money.

“We don’t want to reduce that money by litigating and the like,” he said.

Cities and counties pursuing hundreds of similar cases against Insys are not part of the deal, nor are several states that had already agreed to put their lawsuits on hold.

But Berkovich said they would be invited to participate in the negotiation process, which she said envisions putting Insys in a position to file a restructuring plan for the court’s approval by Sept. 2.

Reporting by Nate Raymond in Boston; Editing by Bill Berkrot

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Medicare recipients may pay more for generics than their brand-name counterparts, study finds

Medicare Part D enrollees may pay more out of pocket for high-priced specialty generic drugs than their brand-name counterparts, according to new research by health policy experts at Vanderbilt University Medical Center and the University of North Carolina at Chapel Hill.

Researchers examined differences in brand-name and generic or biosimilar drug prices, formulary coverage and expected out-of-pocket spending across all of the Medicare Part D plans available in the U.S. in the first quarter of 2018.

The study, published in the July issue of Health Affairs, found that current Medicare Part D beneficiaries can have higher out-of-pocket spending for generics than their branded counterparts if they use expensive specialty drugs and if the price differences between brands and generics are not large. This can be common for individuals prescribed specialty drugs typically used to treat rare or complex conditions such as cancer, rheumatoid arthritis or multiple sclerosis.

Ironically, even if we assume that generic drugs have lower list prices than brands, for Medicare beneficiaries with $20,000 to $80,000 in annual drug spending, using only brand-name drugs could actually save them money.

This is happening because branded drug manufacturers now pay a discount in the donut hole, which gets counted as out-of-pocket spending. This helps patients reach catastrophic coverage faster, where they pay 5% of the drug’s price instead of 25%. Generic drug makers do not pay these same discounts, so patients have to spend more of their own money to make it to the catastrophic phase of the benefit.”

Stacie Dusetzina, PhD, associate professor of Health Policy and Ingram Associate Professor of Cancer Research at VUMC, the study’s lead author

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In 2019, this means people using brand-name drugs who reach the donut hole, or coverage gap, have to spend $982 to get to the catastrophic coverage phase. People using generic drugs have to spend $3,730 to reach that point. The study also notes policy changes set to take effect in 2020 will only make the situation worse by increasing patient out-of-pocket spending requirements for the catastrophic phase coverage from $5,100 to $6,350.

In response, the Trump administration and the Medicare Payment Advisory Commission (MedPAC) have included recommendations to exclude the manufacturer discount from out-of-pocket spending calculations.

“While this would level the playing field between generic drugs and brands, it would do so by making brand-name drugs more expensive instead of making generic drugs less expensive,” said Dusetzina. “Congressional committees have signaled interest in addressing this and other issues in Medicare Part D, including placing a cap on out-of-pocket spending.

“The Part D benefit needs a redesign so that it works for people needing expensive drugs. I hope Congress will take this opportunity to make changes to Part D, including making sure that generic drug users aren’t overpaying for these drugs.”


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Have Cancer, Must Travel: Patients Left In Lurch After Hospital Closes

FORT SCOTT, Kan. — One Monday in February, 65-year-old Karen Endicott-Coyan gripped the wheel of her black 2014 Ford Taurus with both hands as she made the hour-long drive from her farm near Fort Scott to Chanute. With a rare form of multiple myeloma, she requires weekly chemotherapy injections to keep the cancer at bay.

She made the trip in pain, having skipped her morphine for the day to be able to drive safely. Since she sometimes “gets the pukes” after treatment, she had her neighbor and friend Shirley Palmer, 76, come along to drive her back.

Continuity of care is crucial for cancer patients in the midst of treatment, which often requires frequent repeated outpatient visits. So when Mercy Hospital Fort Scott, the rural hospital in Endicott-Coyan’s hometown, was slated to close its doors at the end of 2018, hospital officials had arranged for its cancer clinic — called the “Unit of Hope” — to remain open.

Then “I got the email on Jan. 15,” said Reta Baker, the hospital’s CEO. It informed her that Cancer Center of Kansas, the contractor that operated and staffed the unit, had decided to shut it down too, just two weeks later.

“There are too many changes in that town” to keep the cancer center open, Yoosaf “Abe” Abraham, chief operating officer of the Cancer Center of Kansas, later told KHN. He added that patients would be “OK” because they could get treated at the center’s offices in Chanute and Parsons.

From Fort Scott, those facilities are 50 and 63 miles away, respectively.

For Endicott-Coyan and dozens of other cancer patients, the distance meant new challenges getting lifesaving treatment. “You have a flat tire, and there is nothing out here,” Endicott-Coyan said, waving her arm toward the open sky and the pastures dotted with black Angus and white-faced Hereford cattle on either side of the shoulderless, narrow highway she now must drive to get to her chemo appointment.

When the cancer clinic at Mercy Hospital Fort Scott closed in January 2019, cancer patients such as Karen Endicott-Coyan had to continue their treatments in different locations. Endicott-Coyan has a rare form of multiple myeloma and now drives an hour from her farm near Fort Scott, Kan., to Chanute, Kan., for weekly chemotherapy injections.(Christopher Smith for KHN)

Nationwide, more than 100 rural hospitals have closed since 2010. In each case, a unique but familiar loss occurs. Residents, of course, lose health care services as wards are shut and doctors and nurses begin to move away.

But the ripple effect can be equally devastating. The economic vitality of a community takes a blow without the hospital’s high-paying jobs and it becomes more difficult for other industries to attract workers who want to live in a town with a hospital. Whatever remains is at risk of withering without the support of the stabilizing institution.

The 7,800 residents of Fort Scott are reeling from the loss of their 132-year-old community hospital that was closed at the end of December by Mercy, a St. Louis-based nonprofit health system. Founded on the frontier in the 19th century and rebuilt into a 69-bed modern facility in 2002, the hospital had outlived its use, with largely empty inpatient beds, the parent company said. For the next year, Kaiser Health News and NPR will track how its citizens fare after the closure in the hopes of answering pressing national questions: Do citizens in small communities like Fort Scott need a traditional hospital for their health needs? If not a hospital, what then?

Traveling The Distance For Cancer Care

Reta Baker, the hospital’s president who grew up on a farm south of Fort Scott, understood that the hospital’s closure was unavoidable. She scrambled to make sure basic health care needs would be met. Mercy agreed to keep the building open and lights on until 2021. And Baker recruited a federally qualified health center to take over four outpatient clinics, including one inside the hospital; former employees were bought out and continue to operate a rehabilitation center; and the nonprofit Ascension Via Christi Hospital in Pittsburg reopened the emergency department in February.

But cancer care in rural areas, which requires specialists and the purchase and storage of a range of oncology drugs, presents unique challenges.

Rural cancer patients typically spend 66% more time traveling each way to treatment than those who live in more urban areas, according to a recent national survey by ASCO, the American Society of Clinical Oncology. Dr. Monica Bertagnolli, a cattle rancher’s daughter who is now chair of ASCO’s board, called this a “tremendous burden.” Cancer care, she explained, is “not just one visit and you’re done.”

ASCO used federal data to find that while about 19% of Americans live in rural areas, only 7% of oncologists practice there.

People in rural America are more likely to die from cancer than those in the country’s metropolitan counties, according to a Centers for Disease Control and Prevention report in 2017. It found 180 cancer deaths per 100,000 people a year in rural counties, compared with 158 deaths per 100,000 in populous metropolitan counties.

The discrepancy is partly because habits like smoking are more common among rural residents, but the risk of dying goes beyond that, said Jane Henley, a CDC epidemiologist and lead author of the report. “We know geography can affect your risk factors, but we don’t expect it to affect mortality.”

From an office inside a former Mercy outpatient clinic, Fort Scott’s cancer support group, Care to Share, continues its efforts to meet some of the community’s needs — which in some ways have increased since the Unit of Hope closed. It provides Ensure nutritional supplements, gas vouchers and emotional support to cancer patients.

Lavetta Simmons, one of the support group’s founders, said she will have to raise more money to help people pay for gas so they can drive farther to treatments. Last year, in this impoverished corner of southeastern Kansas, Care to Share spent more than $17,000 providing gas money to area residents who had to travel to the Mercy hospital or farther away for care.

According to the U.S. Centers for Disease Control and Prevention, cancer kills more people in rural America than in the country’s metropolitan counties — 180 deaths per 100,000 people in rural counties, compared with 158 deaths per 100,000 in highly populated metropolitan counties.(Sarah Jane Tribble/KHN)

The group expects to spend more on gas this year, having spent nearly $6,000 during the first four months of 2019.

And the reserves of donated Ensure from Mercy are running out, so Simmons is reaching out to hospitals in nearby counties for help.

With Mercy Hospital Fort Scott closed, the likelihood of residents here dying from their cancer will grow, experts worry, because it’s that much harder to access specialists and treatments.

Krista Postai, who took over the Fort Scott hospital’s four primary care clinics, said it’s not unusual for her staff to “see someone walk in [with] end-stage cancer that they put off because they didn’t have money, they didn’t have insurance, or it’s just the way you are. … We wait too long here.”

‘If They Can’t Cure Me, I’m Done’

Art Terry, 71, a farmer and Vietnam veteran, was one of them. Doctors discovered Terry’s cancer after he broke a rib while bailing hay. When they found a mass below his armpit, it was already late-stage breast cancer that had metastasized to his bones.

With his twice-weekly chemotherapy treatment available in the “Unit of Hope,” Terry spent hours there with his son and grandchildren telling stories and jokes as if they were in their own living room. The nurses began to feel like family, and Terry brought them fresh eggs from his farm.

“Dad couldn’t have better or more personalized care anywhere,” said his son, Dwight, bleary-eyed after a factory shift.

Art Terry, center, stands for a family photo at the Mercy Hospital Fort Scott cancer unit before its January closure. From left are Terry’s daughter-in-law, Sabrina; granddaughters Aubry and Shaylee; son Dwight; and grandson Blaiton.(Courtesy of Dwight Terry)

Terry knew it was difficult to find trustworthy cancer care. The shortage of cancer specialists in southeastern Kansas meant that many, including Mercy Hospital Fort Scott’s patients, counted on traveling oncologists to visit their communities once or twice a week.

Wichita-based Cancer Center of Kansas has nearly two dozen locations statewide. It began leasing space in Fort Scott’s hospital basement in the mid-2000s, the center’s Abraham said. The hospital provided the staff while the Cancer Center of Kansas paid rent and sent roving oncologists to drop in and treat patients.

At its closing, the Unit of Hope served nearly 200 patients, with about 40% of them on chemotherapy treatment.

When Art Terry was diagnosed, his son tried to talk to him about seeking treatment at the bigger hospitals and academic centers in Joplin, Mo., or the Kansas City area. The elder Terry wasn’t interested. “He’s like, ‘Nope,’” Dwight Terry recalled. “I’m going right there to Fort Scott. If they can’t cure me, I’m done. I’m not driving.’”

In the end, as the elder Terry struggled to stay alive, Dwight Terry said he would have driven his father the hour to Chanute for treatment. Gas — already a mounting expense as they traveled the 20 miles from the farm near tiny Prescott, Kan., to Fort Scott — would be even more costly. And the journey would be taxing for his father, who traveled so little over the course of his life that he had visited Kansas City only twice in the past 25 years.

As it turned out, the family never had to make a choice. Art Terry’s cancer advanced to his brain and killed him days before the hospital’s cancer unit closed.

What Happens Next?

As Endicott-Coyan and her friend Palmer drove to Chanute for treatment, they passed the time chatting about how the hospital’s closure is changing Fort Scott. “People started putting their houses up for sale,” Palmer said.

Like many in Fort Scott, they had both spent their days at the Fort Scott hospital. Endicott-Coyan worked in administration for more than 23 years; Palmer volunteered with the auxiliary for six years.

Debbie Endicott, Karen Endicott-Coyan’s sister-in-law, drives to chemotherapy in Chanute, Kan. The trip takes an hour on mostly narrow, two-lane highways from Endicott-Coyan’s home south of Fort Scott. “You can see there are no gas stations, there is nothing on the way,” Endicott-Coyan says. “There isn’t anything.”(Sarah Jane Tribble/KHN)

The hospital grew with the community. But as the town’s fortunes fell, it’s perhaps no surprise that the hospital couldn’t survive. But the intertwined history of Mercy and Fort Scott is also why its loss hit so many residents so hard.

Fort Scott began in 1842 when the U.S. government built a military fort to help with the nation’s westward expansion. Historians say Fort Scott was a boomtown in the years just after the Civil War, with its recorded population rising to more than 10,000 as the town competed with Kansas City to become the largest railroad center west of the Mississippi. The hospital was an integral part of the community after Sisters of Mercy nuns opened a 10-bed hospital in 1886 with a mission to serve the needy and poor. Baker, Mercy Hospital Fort Scott’s president, said the cancer center was an extension of that mission.

The Unit of Hope began operating out of the newest hospital building’s basement, which was “pretty cramped,” Baker said. As cancer treatments improved, it grew so rapidly that Mercy executives moved it to a spacious first-floor location that had previously been the business offices.

“Our whole purpose when we designed it was for it to be a place where somebody who was coming to have something unpleasant done could actually feel pampered and be in a nice environment,” Baker said.

The center, with its muted natural grays and browns, had windows overlooking the front parking lot and forested land beyond. Every patient could look out the windows or watch their personal television terminal, and each treatment chair had plenty of space for family members to pull up chairs.

Endicott-Coyan and her husband, John Coyan, laugh while sitting in their kitchen. John, 74, began showing signs of dementia in 2015. Together, they run a cow-calf operation on 240 acres south of Fort Scott and go to church every Sunday. (Christopher Smith for KHN)

Endicott-Coyan worked for nearly 24 years in the administration offices at Mercy Hospital Fort Scott, specializing in reimbursement issues. Diagnosed with cancer in October 2015, Endicott-Coyan receives weekly chemo treatment and says she experiences a lot of fatigue. “It’s 2019 and I’m still here and I’m still fighting,” she says. (Christopher Smith for KHN)

When Endicott-Coyan and Palmer arrived at the Cancer Center of Kansas clinic in Chanute in February, things looked starkly different. Patients entered a small room through a rusted back door. Three brown infusion chairs sat on either side of the entry door and two television monitors were mounted high on the walls. A nurse checked Endicott-Coyan’s blood pressure and ushered her back to a private room to get a shot in her stomach. She was ready to leave about 15 minutes later.

The center’s Abraham said the Chanute facility is “good for patients for the time being” and not a “Taj Mahal” like Mercy’s Fort Scott hospital building, which he said was too expensive to maintain. Cancer Center of Kansas plans to open a clinic at a hospital in Girard, which is about 30 miles from Fort Scott, he said.

Some oncology doctors would say driving is not necessary. Indeed, a few health care systems across the country, such as Sanford Health in South Dakota and Thomas Jefferson University Hospitals in Pennsylvania, are administering some chemotherapy in patients’ homes. Oncologist Adam Binder, who practices at Thomas Jefferson in Philadelphia, said “over 50% of chemotherapy would be safe to administer in the home setting if the right infrastructure existed.”

But the infrastructure — that is, the nurses who would travel to treat patients and a reimbursement model to pay for such care within our complex health care system — is not yet in place.

Back in the car, Palmer took the wheel and Endicott-Coyan began planning for future cancer treatments in the void left by Mercy Hospital Fort Scott’s closure. “I put a note on Facebook today and said, ‘OK, I have drivers for the rest of February; I need drivers for March!’”

This is the first installment in KHN’s year-long series, No Mercy, which follows how the closure of one beloved rural hospital disrupts a community’s health care, economy and equilibrium.

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U.S. states sue EPA for stricter asbestos rules

(Reuters) – Ten U.S. states and Washington, D.C. sued the Environmental Protection Agency to begin working on rules to tighten oversight of asbestos, and reduce the health risks that the substance poses to the public.

FILE PHOTO: A “Danger Asbestos” sign is seen as a demolition crew removes the remains of a demolished home, next to an occupied one, in a neighborhood filled with blight in Detroit, Michigan, November 24, 2015. REUTERS/Rebecca Cook/File Photo

The attorneys general from California and Massachusetts, Xavier Becerra and Maura Healey, said on Monday they are leading the case, after the EPA denied the states’ petition that it collect more data on asbestos.

Representatives for the agency and EPA Administrator Andrew Wheeler did not immediately respond to requests for comment.

Asbestos is a carcinogen once used widely in fireproofing and insulation. Many companies stopped using it by the mid-1970s after it was linked to mesothelioma and other types of cancer.

Federal law still allows limited uses of asbestos, and Congress in 2016 amended the federal Toxic Substances Control Act (TSCA) to create a process for regulating the substance. Symptoms from asbestos exposure can take decades to surface.

“Asbestos is a known carcinogen that kills tens of thousands of people every year, yet the Trump administration is choosing to ignore the very serious health risks it poses,” Healey, a Democrat, said in a statement.

“There’s too much at stake to let the EPA ignore the danger that deadly asbestos poses to our communities, including to workers and children,” added Becerra, also a Democrat.

Connecticut, Hawaii, Maine, Maryland, Minnesota, New Jersey, Oregon and Washington state joined the lawsuit.

In denying the states’ petition, the EPA determined that it was already aware of all current uses of asbestos, and had the essential information needed to assess the risks, according to the Federal Register.

But the states believe this denial was arbitrary and capricious, and violated the EPA’s obligations under the TSCA.

The lawsuit was filed late on Friday in the federal court in Oakland, California.

It is one of many lawsuits by Democratic-controlled or Democratic-leaning states challenging policies by the administration of U.S. President Donald Trump, a Republican, including the rolling back of some environmental protections.

The case is California et al v Environmental Protection Agency et al, U.S. District Court, Northern District of California, No. 19-03807.

Reporting by Jonathan Stempel in New York; Editing by Bill Berkrot

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Weight loss support helps people with fatty liver disease

People who have fatty liver disease related to being overweight may get the disease under better control when they get lots of support to lose weight, a research review suggests.

Most people have a little bit of fat in their liver, but fatty liver disease can be diagnosed when more than 5% of the liver is made up of fat. If the condition isn’t linked to liver damage from heavy drinking, it’s known as non-alcoholic fatty liver disease (NAFLD) and is most often associated with obesity and certain eating habits.

For the current analysis, researchers examined data on 2,588 patients who were participating in 22 clinical trials of various interventions to help them lose weight. Fifteen studies tested behavioral weight loss programs; six tested medications; one tested weight loss surgery.

The trials also looked at whether those interventions would improve biomarkers for NAFLD that can help predict the likelihood of serious complications.

Compared with little or no weight loss support, the interventions that offered the most support were associated with greater weight loss and bigger reductions in biomarkers for NAFLD like elevated liver enzymes in the blood, elevated blood sugar, and reduced sensitivity to the hormone insulin, or insulin resistance.

“It shows clearly that weight loss improves the health of the liver,” said Dimitrios Koutoukidis, a researcher at the University of Oxford in the U.K. and lead author of the study.

“We found some evidence that weight loss improved NAFLD through improvements in the control of blood glucose levels and reductions in insulin resistance, but we need more research to understand the exact mechanisms,” Koutoukidis said by email.

Different approaches to weight loss didn’t appear to impact whether fibrosis, or scarring, in the liver got better or worse.

Worldwide, about one in four adults have NAFLD, as do at least half of people with obesity, researchers note in JAMA Internal Medicine.

There’s no drug treatment for NAFLD. Doctors typically advise patients to lose weight by cutting calories and getting more exercise, or sometimes by taking weight-loss medications or considering weight-loss surgery. The new findings, according to the researchers, “appear to support the need to change the clinical guidelines and to recommend formal weight loss programs for people with NAFLD.”

One limitation of the analysis is that the smaller studies tested a wide range of weight-loss interventions over varying lengths of time and used different tests to assess patients’ liver disease.

Still, weight loss through a combination of dietary improvements and increased exercise can improve fatty liver, said Dr. Danielle Brandman, director of the Fatty Liver Clinic at the University of California San Francisco and coauthor of an editorial accompanying the study.

Ideally, patients should try to lose 7% of their weight and maintain this weight loss in order to have long-term improvements in NAFLD, Brandman said by email.

“Patients have the potential to improve or cure their disease,” Brandman said.

“However, they should know that this is an ultra-marathon rather than a sprint,” Brandman added. “Weight loss – and the behavior change needed to achieve it – can be really difficult for many patients for a variety of reasons.”

SOURCE: JAMA Internal Medicine, online July 1, 2019.

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