The Rx for Reducing Pharmacy Compounding Risks

October 16, 2012

By Melissa Bynes Brooks

According to the International Academy of Compounding Pharmacists (IACP), the compounding industry now makes up an estimated 1 to 3 percent of the U.S. prescription market, which is $300 billion overall.

The Food and Drug Administration (FDA) is aware of a number of product quality problems associated with compounded drugs including contamination, poor compounding processes, and product toxicity. Unlike commercial drug manufacturers, pharmacies aren’t required to report adverse events associated with compounded drugs. Recent deaths from fungal meningitis associated with epidural steroid injections on or outside the outermost membrane covering the spinal cord to relieve back pain have shined a light on the regulation or lack thereof, of pharmacy compounding.

Clinical meningitis is defined as having one or more symptoms (e.g., headache, fever, stiff neck, or photophobia-sensitivity to light) and cerebral spinal fluid (CSF) pleocytosis (more than five white blood cells per µL or microliter), adjusting for the presence of red blood cells, regardless of CSF protein and glucose levels.

On September 18, 2012, the Tennessee Department of Health was alerted by a clinician regarding a patient with culture-confirmed Aspergillus fumigatus meningitis diagnosed 46 days after an epidural steroid injection at a Tennessee ambulatory surgical center. An additional eight patients with clinically diagnosed, culture-negative meningitis were later identified.

Patients had received one or more epidural steroid injections used to treat both peripheral joint and back pain from three lots of single-dose vials (17,676 single vials) with preservative-free methylprednisolone acetate solution (MPA), compounded at New England Compounding Center (NECC) in Framingham, Massachusetts. On October 4, 2012, the Centers for Disease Control (CDC) and FDA recommended that all health care professionals cease use and remove from their pharmaceutical inventory any product produced by NECC.

The states below received injections:

California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Texas, and West Virginia.

As of October 16, a multistate investigation led by CDC in collaboration with state and local health departments and the FDA have identified 233 cases and 15 deaths associated with this outbreak in 10 states, with 14,000 persons potentially exposed to medications from NECC.

Four categories of cases in patients who received an injection with MPA produced by NECC have been identified:

1) Fungal meningitis or nonbacterial and non-viral meningitis of subacute (recent) onset following epidural injection on or after May 21.

2) Basilar stroke following epidural injection on or after May 21, in a person from whom no cerebrospinal fluid (CSF) specimen was obtained.

3) Spinal osteomyelitis (inflammation of bone and bone marrow) or epidural abscess (pus-filled cavity) at the site of injection following epidural or sacroiliac injection on or after May 21.

4) Septic (infectious) arthritis or osteomyelitis of a peripheral (near the surface) joint (e.g., knee) diagnosed following injection of that joint on or after May 21.

What is pharmacy compounding?

Pharmacy compounding involves combining, mixing, or altering ingredients to create a customized medication. This is carried out by a state licensed pharmacist. It may involve taking an approved drug substance and making a new medicine when a traditional approved drug is not available to meet the medical needs of a specific patient as prescribed by a physician, veterinarian, or other prescribing practitioner. For these patients, customized medications are the only way to better health. For example, this may involve making a suspension or suppository dosage form for a child or elderly patient who has difficulty swallowing a tablet or a capsule. There is an increased need for pharmacy compounding due to drug shortages and the need to access drugs or dosage forms that have been withdrawn from the market.

Because traditional pharmacy compounding serves an important public health function, the FDA exercises enforcement discretion to allow legitimate forms of pharmacy compounding that is regulated under state laws governing the practice of pharmacy. Therefore, all pharmacies and pharmacists are licensed and strictly regulated at the state level.

How does pharmacy compounding increase safety risks in the public healthcare system?

Although state boards are constantly updating their standards and regulations, the safety and effectiveness of compounded drugs is not proven or established by supporting data which the FDA requires for approving new drugs. Compounded drugs are considered to be unapproved new drugs by the FDA. It is estimated that one fifth of all prescriptions written for FDA-approved drugs are for uses, for which they were not specifically approved.

One caveat is that the risk of obtaining a product of less than desired quality outweighs the benefits of obtaining a compounded drug. Other issues include large-scale drug manufacturing under the deceptive appearance of pharmacy compounding; compounding products containing an active ingredient not approved by the FDA; copying compounded products for economic gains; and selling products removed from the market by the FDA for safety reasons.

Similar circumstances no doubt contributed to the observed fungal contaminated steroid shots made by NECC and confirmed by FDA direct microscopic examination of foreign matter taken from a sealed vial.

More than 200 adverse events involving 71 compounded products since 1990 have occurred resulting in devastating consequences. For example, three patients died of infections stemming from contaminated compounded solutions that are used to paralyze the heart during open-heart surgery. The FDA issued a warning letter in March 2006 to the firm that compounded the solutions.

On October 8, 2012, Senator Richard Blumenthal (D-Conn.) called for stronger federal oversight of pharmacy compounding which manufactures drugs without a patient prescription in a letter to the commissioner of the FDA.

In the meantime, the public healthcare system would be better served if compounding guidelines set forth in the United States Pharmacopeial Convention (USP) were implemented by all pharmacy compounding companies. The USP is a scientific nonprofit organization that sets standards for the identity, strength, quality, and purity of medicines, food ingredients, and dietary supplements manufactured, distributed and consumed worldwide. USP’s drug standards are enforceable in the United States by the Food and Drug Administration, and these standards are developed and relied upon in more than 140 countries.

Validation from the independent Pharmacy Compounding Accreditation Board (PCAB) represents another gold standard benchmark. PCAB offers accreditation to compounding pharmacies that meet nationally accepted quality assurance, quality control, and quality improvement standards. When choosing a compounding pharmacy, PCAB suggests looking for the designation “PCAB Accredited® compounding pharmacy” or the PCAB Seal.

The PCAB evaluation includes:

• An assessment of the pharmacy’s system for assuring and maintaining staff competency.
• A review of facilities and equipment.
• Review of records and procedures required to prepare quality compounded medications.
• Verification that the pharmacy uses ingredients from FDA registered and or licensed sources.
• Review of the pharmacy’s program for testing compounded preparations.

The New England Compounding Center (NECC), the company supplying the epidural steroid injections which resulted in the fungal meningitis outbreak, was not accredited by PCAB.

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Is Getting too Little Sleep Making You Sick?

Fall 2012

http://www.browardhealthmagazine.com/BHMagOnline/index.html?page=12

REFERENCES

Centers for Disease Control and Prevention (2012). Adult Obesity Facts. Retrieved August 28, 2012, from http://www.cdc.gov/obesity/data/adult.html

Chung, F., Yegneswaran, B., Liao, P., Chung, S., Vairavanathan, S., Islam, S., Khajehdehi, A., Shapiro C. (2008). STOP questionnaire. A tool to screen patients for obstructive sleep apnea. Anesthesiology, 108 (5), 812-21.

Institute of Medicine. Sleep disorders and sleep deprivation: An unmet public health problem. 2006. Washington, D.C.: National Academies Press;

Jean-Philippe Chaput*, Jean-Pierre Després*,†, Claude Bouchard‡ and Angelo Tremblay* Short Sleep Duration is Associated with Reduced Leptin Levels and Increased Adiposity: Results from the Québec Family Study. Obesity (2007) 15, 253–261; doi:10.1038/oby.2007.512

Kryger MH: Diagnosis and management of sleep apnea syndrome. Clin Cornerstone 2000; 2:39–47

Lack of Sleep Found to be a New Risk Factor for Aggressive Breast Cancers (2012). Retrieved August 28, 2012, from http://www.msnbc.msn.com/id/48802740/ns/local_news-peoria_il/

Pagel JF. Obstructive sleep apnea (OSA) in primary care: evidence-based practice. J Am Board Fam Med 2007; 20: 392–8.

Sushmita Pamidi, Kristen Wroblewski, Josiane Broussard, Andrew Day, Erin C. Hanlon, Varghese Abraham, and Esra Tasali. Obstructive Sleep Apnea in Young Lean Men: Impact on insulin sensitivity and secretion Diabetes Care published ahead of print August 21, 2012, doi:10.2337/dc12-0841

Walters AS; Silvestri R; Zucconi M; Chandrashekariah R; Konofal E. Review of the Possible Relationship and Hypothetical Links Between Attention Deficit Hyperactivity Disorder (ADHD) and the Sim- ple Sleep Related Movement Disorders, Parasomnias, Hypersomnias, and Circadian Rhythm Disorders. J Clin Sleep Med 2008;4(6):591-600.

Medicare and Obamacare: The Numbers Square

August 19, 2012

By Melissa Bynes Brooks

Despite the massive media hype portraying President Obama as being fiscally irresponsible, he has improved the solvency of the Medicare Program for beneficiaries while saving tax payers billions of dollars. He has also invested in the American people by expanding health care coverage for millions who are uninsured. The Affordable Care Act (ACA) has been a contributing factor to the Medicare program’s sustainability and enhanced financial outlook, albeit for a period of 8 more years. The Medicare debate is currently front and center in the upcoming presidential election. A  PEW Research Center poll conducted among registered voters in April 2012 shows that 74 percent of Americans rank health care as the fourth most important issue to their vote.

Output has exceeded input in the Social Security and Medicare trust funds. In 2011, 36 percent of federal spending was for Medicare and Social Security. The trend for rising costs is expected to continue due to the aging population of the baby boom generation coupled with decreasing population numbers in subsequent generations. According to the U.S. Census Bureau, life expectancy  has increased and people 90 and older now comprise 4.7 percent of the older population of people that are age 65 and older. This has increased from 2.8 percent in 1980 and is projected to be 10 percent in 2050.

Medicare’s costs under the Trustees’ current-law assumptions rise from their current level of 3.7 percent of GDP to 6.0 percent in 2040 and 6.7 percent in 2085. If the Sustainable Growth Rate (SGR) restraint were overridden, Medicare costs would rise to 6.5 percent of GDP in 2040 and 7.8 percent in 2085. Under the full scenario, in which adherence to the ACA cost-saving measures also erodes, costs would rise to 7.0 percent of GDP in 2040 and 10.3 percent in 2085. The SGR system compares the accumulated amount of actual physician- related spending to a specified target level.

The Affordable Care Act decreases Medicare spending in the following ways:

• It permanently reduces Medicare payment updates for most categories of providers by the increase in economy-wide multifactor productivity. “Multifactor productivity” is a measure of real output per combined unit of labor and capital, reflecting the contributions of all factors of production. There are reductions in the annual updates to Medicare’s payment rates for most services in the fee-for-service sector (other than physicians’ services) which will decrease Medicare spending by $415 billion. Physicians’ services are based on a fee schedule, which reflects the relative level of time and effort required for each service and its relative complexity. Relative factors per service are translated into dollar payment amounts through a conversion factor, which is updated each calendar year based on the SGR. Medicare payment rates for physician services are scheduled to be reduced by approximately 31 percent in 2013.
• The ACA Reduces Medicare Advantage payment benchmarks and permanently extends the authority to adjust for coding intensity. A new mechanism for setting payment rates in the Medicare Advantage program will decrease Medicare spending by $156 billion. A Medicare Advantage Plan is a type of health plan offered by a private company that contracts with Medicare to provide all Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. Premium subsidy amounts will be calculated for low-income beneficiaries to help ensure that the premium subsidy in each Part D region, provides low-income beneficiaries with a sufficient choice of plans for which they would incur no premium liability.
• The ACA Reduces Medicare Disproportionate Share Hospital (DSH) payments and refines imaging payments. DSH adjustment payments provide additional help to those hospitals that serve a significantly disproportionate number of low-income patients. States receive an annual DSH allotment to cover the costs of DSH hospitals that provide care which is not paid by other payers, such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) or other health insurance. Federal Financial Participation (FFP) is limited and is not available for state DSH payments that are more than the hospital’s eligible uncompensated care cost. Unnecessary DSH spending will be decreased by $56 billion.

The estimated amount of deficit reduction from penalty payments and other effects on tax revenues under the ACA will be $5 billion.

Under Mitt Romney’s and Paul Ryan’s Medicare Plan, the CBO estimates that costs for senior citizens could increase by as much as $6,000.00 a year. Low-income beneficiaries who are not eligible for both Medicare and Medicaid would receive a medical savings account (MSA). This account will be used to pay premiums, co-pays, and other out-of-pocket costs. Low-income seniors would be offered the same range of plan options offered to other seniors. Whether they will be able to afford it is another issue since eligibility levels for low income beneficiaries are unspecified. Additionally, there are no price controls for out of pocket expenses for the coverage of essential benefits and unspecified prescription drug coverage. The specificities have not been clarified and senior citizens have expressed their concerns regarding the information provided or lack thereof.

“Our plan is very simple.  Which is, that for people 55 years of age and older there’s no change,” said Mitt Romney during an interview with ABC Green Bay affiliate, WBAY . “The only change I’d mention is we’d restore the $817 billion President Obama took out of the Medicare trust fund.  We’d restore it to Medicare.” 

I beg to differ. 

Mitt Romney’s plan to repeal Obamacare will be much more complicated. Several of the Medicare benefits and payments enacted by ACA will not be able to be retroactively adjusted. There are negotiated contracted payment rates and subsidized benefits in the Medicare Advantage program and the Part D prescription drug program. Likewise the Internal Revenue Service may not be able to collect revenues retroactively; relevant to provisions that have already been provided as new or increased tax benefits. If Mitt Romney repeals Obamacare, he will contribute to increasing federal budget deficits by $109 billion over the 2013–2022 periods. 

Clearly, Mitt Romney’s plan for healthcare is to transfer its ownership, finances, and accountability from the public sector to private enterprises. Read the fine print. The Romney- Ryan policies have the potential to fail to protect the poorest and most vulnerable citizens from social-economic injustices. Nothing happens by coincidence and efforts may be underway at this very moment, to promote their agenda by silencing the voices of those who will be impacted the most, with voter suppression laws. 

Melissa Bynes Brooks is the editor of BrooksSleepReview.

Contact information: melissabynesbrooks@comcast.net

Follow on Twitter @Mlbbrooks

 

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“Obamacare: Win-Win for the Economy”

August 1, 2012

By Melissa Bynes Brooks

Theoretically, the cost of healthcare should decrease as the demand for products and services increase because the healthcare industry is the exception to the “basic economic” model of supply and demand. It is more complex. Health insurance costs are lower when larger groups of people are involved in the consumer pool thus increasing demand and lessening the costs of unhealthy or risky individuals with healthy or less risky individuals.

Despite looming promises of repeal by Republicans, the Affordable Care Act (ACA) is an essential component for cost containment and strengthening of the U.S. economy. This is especially true when 17 percent of the nation’s GDP is spent on health care with a GDP growth rate of only 1.5 percent.

Further analysis by the CBO, after the Supreme Court ruled that the ACA is constitutional, indicates that repealing the law would reduce direct spending by $890 billion and reduce revenues by $1 trillion between 2013 and 2022, adding $109 billion to federal budget deficits over that period. Additionally, an estimated 60 million nonelderly people would be uninsured.

Regulatory requirements have not eluded corporate leaders currently brainstorming and investing in new strategies and innovative technologies to position their companies for competition in a market place projected to expand health insurance coverage, to an estimated 14 million people by 2014, and 30 million people by the latter part of the coming decade.

Business mergers are forming between companies directly impacted by the ACA.

In early July, the first major health care sector merger occurred when health care giant WellPoint said it will buy Amerigroup, a managed health care company with 4.5 million customers of state sponsored health care programs, for $4.9 billion or $92 a share in cash.

“We believe that this combination will create an industry leader in the government sector serving Medicaid and Medicare enrollees,” said WellPoint CEO Angela Braly in a statement. Braly added that the merger, which focuses on Medicaid recipients like the poor and the elderly, is an opportunity to “position our companies for future growth as the health insurance industry changes and as we prepare for health insurance exchanges.”

Amerigroup shares increased 40 percent, to over $89.84 a share following news of the merger. WellPoint shares increased 3 percent, to $61.64 a share. Shares for both companies had decreased in value after the Supreme Court decision in June.

The ACA presents broad economies of scale for health information technology (HIT) companies specializing in the provision of secure platforms for accessing and sharing patient data through the installation of electronic health records (EHR), telemedicine, and mobile health applications. 88 percent of physicians said they would like their patients to track their health information and 40 percent of individuals said they would buy a personal health-monitoring device or pay for a monthly subscription to send health information to their providers.

Authentidate Holding Corp. provides secure web-based software applications and telehealth products and services that enable healthcare organizations to coordinate care for patients and enhance related administrative and clinical workflows.

Their alliance with hospitals, physicians, and consumers generated revenues for the quarter ending on March 31, 2012 of approximately $764,000, compared to $729,000 for the prior year period. Revenues were mostly from telehealth products and services. For the third quarter of fiscal year 2012, revenues increased approximately 16 percent compared to the second quarter of fiscal year 2012, due to higher telehealth revenues for the current period.

There are an estimated 5.9 billion mobile-cellular subscriptions. Mobile-broadband subscriptions have grown 45 percent annually over the last four years. PwC estimates the U.S. mHealth market opportunities will be $6.5 billion by 2017, for remote mobile-enabled services used to monitor symptoms and manage chronic conditions like high blood pressure and diabetes. Growth is expected to be driven in part by the ACA objectives of providing cost effective preventative care.

Administration of the U.S. health system alone accounts for 7 percent of total spending. ACA has established regulations to rein in costs. Health insurance providers are now required to decrease administrative costs. They must spend 80 to 85 percent of premium dollars on medical care and health care quality improvement or they will be required to provide rebates to their customers. This year an estimated nine million Americans may be eligible for rebates worth up to $1.4 billion.

There are reimbursement incentives for hospitals and healthcare providers busy implementing certified EHR technology to meet the Centers for Medicare & Medicaid Services’ (CMS) and Office of the National Coordinator’s (ONC) requirements for meaningful use by 2015. Health systems will see a decrease in their Medicare and Medicaid reimbursements if they are not able to demonstrate meaningful use relevant to e-prescribing, the electronic exchange of health information to improve quality care, and the submission of clinical quality and other measures.

Love it or hate it, the Affordable Care Act appears to be a win-win for the economy and healthcare industry stakeholders consisting of consumers, health systems, providers, and technology business enterprises.

“When you eliminate the impossible whatever remains however improbable must be the truth!”

-Sir Arthur Conan Doyle, Scottish author and creator of Sherlock Holmes.

Melissa Bynes Brooks is the editor of BrooksSleepReview.

Contact information: melissabynesbrooks@comcast.net

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What Happens to the Poor If SCOTUS Repeals ‘Obamacare?’

June 27, 2012
By Melissa Bynes Brooks

Since 2000, hospitals of all types have provided more than $326 billion in uncompensated care to their patients. This was no small feat considering there were 46.2 million people in poverty in 2010, up from 43.6 million in 2009 ─ the fourth consecutive annual increase and the largest number in the 52 years for which poverty estimates have been published.

The number of people without health insurance coverage rose from 49.0 million in 2009 to 49.9 million in 2010. The percentage covered by Medicaid was 15.9 percent. In 2010, 9.8 percent of children under 18 (7.3 million) were without health insurance.
The poverty calculation is based solely on money income and does not reflect the fact that many low-income persons receive noncash benefits such as food stamps, Medicaid, and public housing.

The passage of the Affordable Care Act in 2010 has provided for health care insurance at lower costs for everyone by allowing the uninsured and poor to either become eligible for the Medicaid program or get coverage through the new health exchanges.

The health care law has expanded access to care for 30 million Americans. An estimated 32.5 million people with Medicare received at least one free preventive benefit in 2011, including the new Annual Wellness Visit, since the health reform law was enacted.

Hospitals across the nation had a vested interest in meeting the new regulations. As a result, hospitals have transformed their business models as the law entails placing the necessary policies in place. Some of the changes have included an increased implementation of health information technology (HIT); a transition from a fee for services payment model to a bundle payment model; and insurance providers and hospitals receiving incentives geared towards pay for performance and quality over quantity.

The law dictated that under Sec. 9007 of PPACA, a charitable hospital organization shall not be treated as an Internal Revenue Code Sec. 501(c) (3) organization unless it meets specific new requirements. Specifically, hospitals would only be exempt from the tax on corporations by rising to challenges in the way that hospitals would be expected to, to deliver health care to the nation’s indigent population.

The changes included conducting and implementing ongoing community health needs assessments, maintaining a financial assistance policy which incorporates new measures for notifying patients of financial assistance policies available to them, implementing limits on certain charges to uninsured, indigent patients, and meeting new billing and collection requirements.

Essentially, there was now a mandate for hospitals to perform with the safety net mission of placing a high priority on the treatment of low-income patients defined as Medicaid, charity care, or self-pay patients.

As defined by the Office of Management and Budget and updated for inflation using the Consumer Price Index, the weighted average poverty threshold for a family of four in 2010 was $22,314 and $11,139 for an individual person.

“What will happen to the ability of hospitals to provide indigent care for the poor if the Affordable Care Act is struck down?”

There are essential benefits applicable to the Medicaid program which would also be included in the health care insurance exchanges. For example, there will not be an opportunity to expand this low cost insurance to adults without children with incomes below 133 percent of the poverty line. This indigent population would be ineligible for Medicaid coverage and would have a decreased ability to pay for care. Eligible Medicaid patients, despite having insurance, would have trouble gaining access to health care services because of the historically low program payment rates.

The uninsured and those disproportionately affected by poverty will be less likely to seek preventive health care services that are now provided for by the Affordable Care Act such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults.

These groups would also be less likely to follow up on necessary health care recommendations from their physicians, instead seeking treatment in an emergency room or urgent care facility which is a more expensive alternative and further compounds sky rocketing health care costs.

Finally, hospitals must have funds to operate, pay staff, and purchase the necessary equipment. This is directly related to pricing which in turn increases costs. With decreased access to federal support for the provision of services in tandem with increased debt generated by indigent and uninsured patients, hospitals would be compelled to increase prices while decreasing services for all consumers, those with insurance and those living in poverty.

Melissa Bynes Brooks is the editor of BrooksSleepReview.
Contact information: melissabynesbrooks@comcast.net
Follow on Twitter @Mlbbrooks

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References

111th Congress Public Law 148 (2009-2010). Entitled The Patient Protection and Affordable Care Act. Retrieved June 25, 2012, from http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/html/PLAW-111publ148.htm

Affordable Care Act (2010). Rights and Protections. Retrieved June 25, 2012, from http://www.healthcare.gov/law/features/rights/index.html

Alliance for Excellent Education (2006). Healthier and Wealthier: Decreasing Health Care Costs by Increasing Educational Attainment. Retrieved June 25, 2012, from http://www.all4ed.org/files/HandW.pdf

American Hospital Association (2012). American Hospital Association Uncompensated Hospital Care Cost Fact Sheet. Retrieved June 25, 2012, from http://www.aha.org/content/12/11-uncompensated-care-fact-sheet.pdf

Analysis of the Joint Distribution of Disproportionate Share Hospital Payments (2002). A Policy Framework for Targeting Financially Vulnerable Safety Net Hospitals. Retrieved June 25, 2012, from http://aspe.hhs.gov/health/reports/02/DSH/ch2.htm

Carpenter, D. (2012). Health Care Organizations Start Overhauls for a New Delivery Model. Retrieved June 25, 2012, from http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/05MAY2012/0512HHN_FEA_ManagingTransition1&domain=HHNMAG

Healthcare Finance News (2012). Retrieved June25, 2012, from http://www.healthcarefinancenews.com/resource-topics/community-benefit
Results.org (2011). Medicaid. Retrieved June 25, 2012 from http://www.results.org/issues/us_poverty_campaigns/health_care_for_all/medicaid/

U.S. Census Bureau, Statistical Abstract of the United States: 2012 (2012). Income, Expenditures, Poverty, and Wealth Retrieved June 25, 2012 from http://www.census.gov/prod/2011pubs/12statab/income.pdf

U.S. Department of Health and Human Services (2012). Frequently Asked Questions Related to the Poverty Guidelines and Poverty. Retrieved June 25, 2012, from http://aspe.hhs.gov/poverty/faq.shtml#official

Bath Salts and Zombies: A Cautionary Tale

June 1, 2012
By Melissa Bynes Brooks

Public sentiment and perspectives regarding the recent incident of a zombie gone wild is a cautionary tale that brought to surface, the anxieties and potentially uncontrollable consequences of a turbulent society.

In fact, because of the infatuation and cult following of zombies in pop culture, the Centers for Disease Control and Prevention began a blog titled, “Preparedness 101: Zombie Apocalypse.” CDC officials say it’s all about emergency preparation. The campaign stemmed from concerns of radiation fears following the earthquake and tsunami that rocked Japan last year.

CDC spokesman Dave Daigle told FoxNews.com that someone had asked CDC officials if zombies would be a concern due to radiation fears in Japan and traffic spiked following that mention. “It’s kind of a tongue-in-cheek campaign,” Daigle said. “We were talking about hurricane preparedness and someone bemoaned that we kept putting out the same messages.”

Are we going down a “Walking Dead” path?

In an overwhelming unstable global economy, concerns are paramount as more and more people panic financially as a result of being increasingly poor, hungry, homeless, and jobless. People around the world are becoming angrier and less trusting of the establishment. Ruling governments are viewed as profiting economically from cheap labor and guaranteed free markets while the less fortunate bear the costs and tax burdens. Worsening circumstances have given rise to the Tea Party, Arab Spring, and Occupy Wall Street movements.

Throw in the mix, additional threats related to terrorist attacks, weapons of mass destruction, bioterrorism, nuclear proliferation, lethal disease pandemics, and cyber warfare.

So it’s no coincidence that at first glance, the unthinkable was considered when news reports went viral about the naked man in Miami, Florida last week, who chewed off the face of another man in a zombie-like attack. The incident was stopped only after a police officer shot the attacker several times, killing him. Unknown at the time, the “zombie” was acting under the influence of bath salts.

Doctors and clinicians at U.S. Poison centers are increasingly concerned about products marketed as bath salts that are causing increased blood pressure, increased heart rate, agitation, hallucinations, extreme paranoia and delusions.

As of April 30, 2012, there have been 1,007 closed human exposures calls to poison centers about exposures to bath salts.

Bath salts are laced with a dangerous chemical which elicits extreme adverse events and side effects in people who use them to get high. The products are believed to contain Methylenedioxypyrovalerone, or MPDV, a chemical that is not approved for medical use in the United States. These substances are also sold as insect repellants or plant fertilizers.

The products have been sold on the Internet and, in some states, are being sold at gas stations and head shops. They’re known by a variety of names, including “Red Dove,” “Blue Silk,” “Zoom,” “Bloom,” “Cloud Nine,” “Ocean Snow,” “Lunar Wave,” “Vanilla Sky,” “Ivory Wave,” “White Lightning,” “Scarface” and “Hurricane Charlie.”

They can cause a person to become psychotic.

“We are incredibly concerned about the extreme paranoia being reported by people who are taking these drugs,” said Mark Ryan back in 2010, director of the Louisiana Poison Center. He said then, the products were being touted as cocaine substitutes and caused intense cravings akin to methamphetamine use. He worried that the paranoia could cause those experimenting with the drugs to harm themselves and others. Ryan said most patients calling poison centers have snorted the substances. In at least one case, he said, a person injected the substance into his veins.

Henry A. Spiller, director of the Kentucky Regional Poison Center, said the patients his center has treated “are having a break with reality.”
“They have completely lost it,” he said.

This exact thought was probably shared by many upon first hearing the news about the zombie attack before becoming aware and learning more about bath salts.
Only in a different framework, “Have things really gotten so bad that people are losing their minds and eating people now?”

Melissa Bynes Brooks is the editor of BrooksSleepReview.
Contact information: melissabynesbrooks@comcast.net
Follow on Twitter @Mlbbrooks

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References

American Association of Poison Control Centers (2012). Retrieved June 1, 2012, from http://www.aapcc.org/dnn/Portals/0/Bath%20Salts%20Data%20for%20Website%205.23.2012.pdf

Bath Salts Data (2012) Retrieved May 31, 2012, from http://www.aapcc.org/dnn/Portals/0/Bath%20Salts%20Data%20for%20Website%205.23.2012.pdf.

CNN (2012). Reports: Miami ‘Zombie’ Attacker may have been using ‘Bath Salts.’ Retrieved May 31, from http://news.blogs.cnn.com/2012/05/29/reports-miami-zombie-attacker-may-have-been-using-bath-salts/

Drezner, D. W., Professor of International Politics, Fletcher School of Law and Diplomacy at Tufts University (2011). Theories of International Politics and Zombies. Princeton: New Jersey. Princeton University Press.

Miller, J. R., Fox News (2011). CDC Warns Public to Prepare for ‘Zombie Apocalypse’. Retrieved May 31, 2012, from http://www.foxnews.com/health/2011/05/18/cdc-warns-public-prepare-zombie-apocalypse/

O’Connor, T. (2011). “Superterrorism,” MegaLinks in Criminal Justice. Retrieved June 1, 2012, from http://www.drtomoconnor.com/3400/3400lect06b.htm

Wehrman, J. (2010). U.S. Poison Centers Raise Alarm about Toxic Substance Marketed as Bath Salts. Retrieved June 1, from http://www.aapcc.org/dnn/Portals/0/prrel/bathsalts-final.pdf

Why are Black People Dying in Their Sleep?

May 26, 2012
By Melissa Bynes Brooks

Public awareness has increased about the health risks associated with obstructive sleep apnea (OSA). While Blacks suffering from obesity and daytime sleepiness are more likely to seek initial sleep consultations, most Blacks are less likely to have a medical evaluation or seek treatment for OSA. They are not aware of the inherent risks of having OSA.

This may be because symptoms of sleep disorders are not routinely screened for or recognized in the primary care setting. To date, the United States Preventive Services Task Forces, the American Academy of Family Physicians, and the Center for Disease Control have not recommended routine screening for sleep disorders.

The use of validated questionnaires may be able to efficiently identify patients at risk for common sleep disorders though further study is required.

In a community-based sample of Black patients, of the 421 patients referred by their private care physicians, 38% followed the recommendation for a sleep consultation. Even when Blacks have adequate insurance coverage, they are not as likely as their White counterparts to utilize available services. This suggests that physicians practicing in those communities may have to develop innovative strategies to encourage participation of Black patients in healthcare practices.

Ethnic differences highlight the need to further examine social support, socioeconomic status, access to care, and cultural factors to guide future health-related quality of life (HR-QOL).

OSA, the most common breathing sleep disorder, sets off an unstable chain of physiological reactions.

It begins with a blockage in the upper airway which interferes with the ability to breathe normally while sleeping. The blockage leads to loud snoring followed by silence. Oxygen levels decrease in the blood. Then chemoreceptors in the brain detect increased carbon dioxide levels in the blood. This results in the person choking or gasping for air, arousing momentarily or waking up completely from their sleep. At the same time, rapid changes occur with the heart rate, heart rhythm, and blood pressure. The body works overtime to recover from each episode lasting at least 10 seconds.

Throughout all this, the individual is totally clueless. After awakening, the only traces of life threatening events are symptoms of tiredness, excessive daytime sleepiness, dry mouth, morning headaches, and sometimes memory loss. In fact, sleep interruption due to OSA is often times mistaken as a need to get up and use the bathroom. The alternative to the interruptions caused by the apnea is sudden death.

That scenario brings Reggie White to mind, the former NFL football player, who reportedly suffered from sleep apnea which was believed to play a role in his death from a fatal cardiac arrhythmia. Nighttime is the deadliest time of day in persons with obstructive sleep apnea, according to a report in The New England Journal of Medicine, 2005, by Apoor S. Gami, MD, and colleagues of the Mayo Clinic in Rochester, Minn.

Those at high risk for OSA are: Black, Hispanic or Pacific Islander; male; over the age of 65; related to someone who has sleep apnea; and a smoker. Demographics are steadily changing to include children and adolescents because of increased obesity and diabetes rates in these groups.
Physical risk factors are attributes of a thick neck, deviated septum, receding chin, enlarged tonsils or adenoids.

OSA is directly linked to high blood pressure, heart disease, diabetes, obesity, and cancer. Blacks have a higher risk of death from OSA because of greater genetic tendencies for these medical conditions.

First, more than 40 percent of non-Hispanic Blacks have high blood pressure (HBP) which is more severe in Blacks than Whites and develops earlier in life. It contributes to 14% of deaths occurring in the United States, and to nearly half of all cardiovascular disease-related deaths annually. From 1997 to 2007, the death rate caused by high blood pressure increased to 9.0%, and the actual number of deaths rose 35.6%.

OSA represents an independent risk factor for high blood pressure. Hypertension constitutes a significant predictor of cardiovascular deaths among patients with OSA. The prevalence of resistant hypertension itself among men with a diagnosis of OSA may be as high as 85%. Blacks exhibit greater resistance to treatment and black women have the highest prevalence of hypertension and the lowest blood pressure control.

Blacks with a family history of hypertension are likely to have higher baseline blood pressure, a greater number of lower blood oxygen levels, and more episodes of “not breathing” while asleep, when compared to Whites.

Second, the National Commission on Sleep Disorders Research estimated that sleep apnea is probably responsible for 38,000 cardiovascular deaths yearly, with an associated 42 million dollars spent on related hospitalizations. Obstructive sleep apnea increases the risk of heart failure by 140%, the risk of stroke by 60%, and the risk of coronary heart disease by 30%.

The evaluation, diagnosis, treatment, and management of OSA have significant positive effects in reducing cardiovascular disease risk.
Linkage between obstructive sleep apnea and cardiovascular disease has been corroborated by evidence that treatment of sleep apnea with continuous positive airway pressure (CPAP) reduces systolic blood pressure, improves left ventricular systolic function, and diminishes platelet activation.

CPAP is a treatment that uses mild air pressure to keep the airways open. CPAP typically is used by people who have breathing problems, such as sleep apnea. Sleep medicine care providers, generalists, and specialists focusing on cardiovascular disease in OSA patients, need to emphasize preventative and ongoing care for active cardiovascular diseases. Care for OSA should also be initiated.

Third, more than 24 million Americans have diabetes mellitus (DM), and nearly one million new cases of diabetes are diagnosed every year. Type 2 diabetes accounts for 90% to 95% of all cases of diabetes. Diabetes mellitus was the sixth leading cause of death in 2002, with the risk of death almost twice that of non-diabetic patients of similar age. According to the Centers for Disease Control and Prevention, Blacks have a 1.8-fold increase and Hispanics have a 1.7-fold increase in the prevalence of diabetes mellitus compared to Whites.

With diabetes, OSA is associated with impaired glucose tolerance and insulin resistance. Type 2 diabetes occurs when the body fails to use insulin effectively. Research suggests that OSA can contribute to the onset of diabetes.

Fourth, a little more than one-third of U.S. adults (35.7%) are obese. Non-Hispanic Blacks have the highest rates of obesity (44.1%) compared with Mexican Americans (39.3%), all Hispanics (37.9%) and non-Hispanic whites (32.6%). The link between OSA and obesity is somewhat of a “Catch 22.” While being overweight is a risk factor for OSA, OSA may promote weight gain by reducing daytime energy and physical activity, and disrupting metabolism. OSA may alter the levels of hormones that regulate your appetite, which may lead you to eat more.

Short sleep duration < 7 hours is associated with elevated prevalence of obesity.

Last, a recent study found that people with the most severe sleep apnea — those who have 30 or more episodes of low or no oxygen in an hour of sleep — had almost five times the risk of cancer death compared to someone without sleep apnea.

When you have cancer and you repeatedly have episodes of low or no oxygen, the cancer cells “try to compensate for the lack of oxygen by growing additional blood vessels to get more oxygen. It’s a defense mechanism,” Dr. Javier Nieto, Chair of the department of population health sciences at the University of Wisconsin School of Medicine and Public Health, in Madison said. And, as those blood vessels keep growing, it helps the tumor to spread, he explained.

In an effort to improve positive health outcomes, The Adult OSA Task Force of the American Academy of Sleep Medicine (AASM) recommends that questions regarding OSA should be incorporated into routine health evaluations. Suspicion of OSA should trigger a comprehensive sleep evaluation. The presence or absence and severity of OSA must be determined before initiating treatment in order to identify those patients at risk of developing the complications of sleep apnea.

Melissa Bynes Brooks is the editor of BrooksSleepReview.
Contact information: melissabynesbrooks@comcast.net
Follow on Twitter @Mlbbrooks

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References

American Heart Association (2012). High Blood Pressure and African Americans. Retrieved May 25, 2012, from http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandYourRiskforHighBloodPressure/High-Blood-Pressure-and-African-Americans_UCM_301832_Article.jsp

Bachmann, R., Demede, M., Donat, M., Jean-Louis, G., McFarlane, S.I., Ogedegbe, G, Pandey, A., and Zizi, F. (2011). Resistant Hypertension and Obstructive Sleep Apnea in the Primary-Care Setting. Retrieved May 25, 2012, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132606/

Centers for Disease Control and Prevention (2012). Adult Obesity Facts. Retrieved May 12, 2012, from http://www.cdc.gov/obesity/data/adult.html

Daily Mail (2012). The Moment a Frantic Woman Heard 911 Dispatcher Snoring as She Tried to get Help for her Husband who Couldn’t Breathe. Retrieved May 25, 2012, from http://www.dailymail.co.uk/news/article-2148146/911-dispatcher-falls-asleep-snores-phone-woman-tries-ambulance.html#ixzz1vvLDw3K5

Epstein LJ; Kristo D; Strollo PJ; Friedman N; Malhotra A; Patil SP; Ramar K; Rogers R; Schwab RJ; Weaver EM; Weinstein MD. Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults. J Clin Sleep Med 2009; 5(3):263-276.

Gami, A.S. The New England Journal of Medicine, March 24, 2005; vol 352: pp 1206-1214.

Gordon, S. Health Day (2012). Sleep Apnea Linked to Higher Cancer Death Risk Cancer Compensates, Spreads in Search for Oxygen, Researcher Suggests. Retrieved May 25, 2012, from http://www.healthfinder.gov/news/newsstory.aspx?Docid=664843

Hudgel DW; Lamerato LE; Jacobsen GR; Drake CL. Assessment of Multiple Health Risks in a Single Obstructive Sleep Apnea Population. J Clin Sleep Med 2012; 8 (1):9-18.

Jean-Louis G; von Gizycki H; Zizi F; Dharawat A; Lazar JM; Brown CD. Evaluation of Sleep Apnea in a Sample of Black Patients. J Clin Sleep Med 2008; 4(5):421–425.

Jean-Louis G; Zizi F; Clark LT; Brown CD; McFarlane SI. Obstructive Sleep Apnea and Cardiovascular Disease: Role of the Metabolic Syndrome and its Components. J Clin Sleep Med 2008; 4(3):261- 272.

Mahmood K; Akhter N; Eldeirawi K; Önal E; Christman JW; Carley DW; Herdegen JJ. Prevalence of type 2 diabetes in patients with obstructive sleep apnea in a multi-ethnic sample. J Clin Sleep Med 2009; 5(3):215-221.

National Institutes of Health. Department of Health and Human Services (2012). What is CPAP? Retrieved May 25, 2012, from http://www.nhlbi.nih.gov/health/health-topics/topics/cpap/

Pagel JF. Obstructive sleep apnea (OSA) in primary care: evidence-based practice. J Am Board Fam Med 2007; 20: 392–8.

Senthilvel E; Auckley D; Dasarathy J. Evaluation of sleep disorders in the primary care setting: History Taking Compared to Questionnaires. J Clin Sleep Med 2011; 7(1):41-48.

Sleep Disturbances, Quality of Life, and Ethnicity: The Sleep Heart Health Study. Baldwin, C.M., Ph.D.; Ervin, A-M., Ph.D., MPH; Mays, M.Z., Ph.D.; Robbins, J., M.D.; Shafazand, S., M.D., M.S.; Walsleben, J., Ph.D.; Weaver, T., Ph.D. J Clin Sleep Med 2012; 6 (2):176-183.

Your Sleep. American Academy of Sleep Medicine (2008). Eight Health Risks of OSA. Retrieved May 25, 2012, from http://yoursleep.aasmnet.org/topic.aspx?id=87

Your Sleep. American Academy of Sleep Medicine (2004). OSA Believed to Have Contributed to the Death of NFL Legend Reggie White. Retrieved May 25, 2012, from http://yoursleep.aasmnet.org/article.aspx?id=33

Can We handle a Flesh Eating Bacteria Epidemic?

May 19, 2012

By Melissa Bynes Brooks

The recent news of flesh eating bacteria incidents has heightened the consciousness of many people regarding their susceptibility to being infected with this deadly disease. The idea that a simple scratch or minor injury can trigger the onset of life threatening circumstances is frightening.

Even more alarming, is wondering whether the public health care system would be prepared to handle a flesh eating bacteria epidemic or something similar if there was an outbreak.

Flesh eating disease is also known as necrotizing fasciitis. It is a rare but severe, group A streptococcus (GAS) bacterial infection. It can destroy the muscles, skin, and underlying tissue. The word “necrotizing” refers to something that causes body tissue to die.

About 20% of patients with necrotizing fasciitis die.

A variety of bacteria can cause this infection. Necrotizing soft tissue infection develops when the bacteria enters the body, usually through a minor cut or scrape.

The bacterium begins to grow and release harmful substances (toxins) that kill tissue and affect blood flow to the area. As the tissue dies, the bacterium enters the blood and rapidly spreads throughout the body.

Most notable, is the case of Aimee Copeland, a 24 year old graduate student currently fighting for her life due to complications from the flesh-eating bacteria. She received a cut on her left calf when a homemade zip line she stopped to ride along the river broke.

The type of bacteria causing her infection was an organism named Aeromonas hydrophila. It invaded her body through the cut causing doctors to amputate her left leg. She was later told that her hands and remaining foot would need to be amputated in order to improve her chances of survival.

Aeromonas hydrophila is a species of bacterium that is present in all freshwater environments and in brackish water. Humans may acquire infections through open wounds or by ingestion of a sufficient number of the organisms in food or water.

By now, many people may be wondering how likely it is for them to get the disease.

Persons with impaired immune systems are more susceptible to getting infected. They include diabetics, intravenous drug users, infants, the elderly, and individuals suffering from leukemia, cirrhosis of the liver, and those undergoing chemotherapy for cancer.

The risk increases for pregnant women in the postpartum period if the mother has diabetes and with procedures such as cesarean section or episiotomy.

Visible infections to the skin, hair, and nails are more likely to be noticed and treated than some deep infections. Deep infections to the muscle, bone, and joints are less noticeable and have a higher risk of becoming life threatening.

Most cases of flesh eating bacteria have been sporadic rather than associated with large outbreaks. But, there are increasingly more reports from clinical centers. The disease is difficult to treat and immediate treatment is needed to prevent death.

For this reason, the public health system’s ability to contain a flesh eating bacteria epidemic or similar outbreak remains questionable in the minds of many.

The discovery of the 2009 H1N1 influenza pandemic and the emergence of other diseases such as SARS have highlighted the important role that diagnostic tools can play in improving the surveillance of infectious disease threats at the population level.

Experiences with these events have shown that recognition of outbreaks, management of epidemics, and development of countermeasures can depend heavily on having access to highly specific surveillance information that is typically obtained from testing clinical specimens.

Consequently, the rising threat of emerging diseases and concern about biological weapons has led to an emphasis in governments on improving laboratory and diagnostic capacity in order to improve global bio-surveillance for infectious diseases.

Bio-surveillance is the technique of tracking communicable diseases such as sexually transmitted diseases (STDs) and streptococcal infections. Using special software, doctors, hospitals, clinics and emergency rooms all report individual cases of any communicable disease.

The program requires information on the patient such as location, age, gender, race, and other specifics designed to create a demographic portrait of the current victim and potential victims. Names are not used to preserve the anonymity of the patients.

In 2009, the U.S. National Security Council (NSC) identified enhanced disease surveillance, detection, and diagnosis as priority goals that the United States government (USG) should work toward. This was done for the purposes of improving national security and improving the ability to report any public health emergency of international concern.

The Obama Administration’s Global Health Initiative includes efforts to promote the development and acquisition of infectious disease diagnostic tools. A robust and strong regulatory process is necessary to ensure that diagnostic tests produce accurate and reliable results.

Data Mining is another indicator that could be used to predict epidemics before they spread based on mass behavior. Use of this technology could help prepare first-responders and other health professionals for emergencies.

For example, the National Retail Data Monitor (NRDM), tracks transactions of over-the-counter healthcare items from 21,000 outlets across the United States. The purchasing information of these items assists health care officials with preliminary trends in illness transmission.

Furthermore, Data from the NRDM show that sales of over-the-counter products like cough medicines and electrolytes actually spike before visits to the emergency room do. The lead time can be significant in the case of respiratory and gastrointestinal illnesses. In this scenario, it was about two and a half weeks, according to one paper.

Public health components have been incorporated into the National Response Framework and the National Incident Management System. Public health bodies at the local, state, and federal levels now routinely use this system to ensure that everyone has the same focus, whether responding to daily incidents or major disasters.

In 1999, the Centers for Disease Control and Prevention (CDC) established the Laboratory Response Network (LRN). The LRN and its partners maintain an integrated national and international network of laboratories that are fully equipped to respond quickly to acts of chemical or biological terrorism, emerging infectious diseases, and other public health threats and emergencies.

Although preparedness and response capabilities for public health emergencies have been difficult to determine and measure, reports from the CDC and the Trust for America’s Health have documented substantial improvements.

Public health departments are now better equipped to identify health threats rapidly and have improved their abilities to respond e­ffectively and communicate emergencies. For example, 48 of 50 states (96%) have shown their ability to activate staff­ and their emergency operations centers.

There is always room for growth but there have been improvements in public health preparedness from 1999–2011.

One sign of progress is the CDC’s Strategic National Stockpile which ensures the availability of key medical supplies. 100% of states have plans to receive, distribute, and dispense these assets.

The eff­ectiveness of responses is judged by accurate communications of emerging health threats in addition to response and health outcomes.

Another sign of progress is the CDC’s secure, web-based Epidemic Information Exchange (Epi-X) which allows state and local public health officials to access and share health surveillance information about illnesses.

Some of these have included cases about: human bubonic plague (2010); reports about airline travelers potentially exposed to communicable disease (2010); and the recreational use of designer drugs that were components of items marketed as bath salts (2011).

The Food and Drug Administration (FDA) has also developed a program for granting Emergency Use Authorization for devices and medicines that are likely to be needed during public health emergencies.

Finally, what would be the response to high risk communities or low income communities with limited access to health care?

Government has the obligation to protect the health of all its citizens.

Distribution and rationing decisions for vaccination and treatment should be based on the goal of minimizing the detrimental health effects of an epidemic or pandemic. Public health measures must not be based on race, color, ethnicity, national origin, religion, gender or sexual orientation.

However, some would argue it can be based on age or disability when there is good reason to believe particular groups are either at much higher risk of death or have a much higher likelihood of spreading the disease if not vaccinated or treated.

More emphatically, there are special obligations to those in custody who should be a priority regarding vaccination and treatment. Consideration and advance planning should take place for high risk populations with physical or mental conditions and socio economic disparities.

Melissa Bynes Brooks is the editor of BrooksSleepReview.

Contact information: melissabynesbrooks@comcast.net

Follow on Twitter @Mlbbrooks

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References

Adalja, A.A., Cicero, A., and Inglesby, T.V., Nuzzo, J.B., Rambhia, K.J., Toner, E., and Wollner, S.B. (2011). Diagnostics for Global Biosurveillance: Turning Promising Science into the Tools Needed in the Field. Retrieved May 19, 2012, from http://www.upmc-biosecurity.org/website/resources/publications/2011/2011-09-13-global-biosurveillance-DTRA.html

American Civil Liberties Union (2008). Pandemic Preparedness: The Need for a Public Health- Not a Law Enforcement/National Security– Approach . Retrieved May 19, 2012, from http://www.aclu.org/pdfs/privacy/pemic_report.pdf

Centers for Disease Control and Prevention, Emergency Preparedness and Response (2012). Facts About the Laboratory Response Network. Retrieved May 18, 2012, from http://www.bt.cdc.gov/lrn/factsheet.asp

Fung, F. The Atlantic (2012). Using Data Mining to Predict Epidemics before They Spread. Retrieved May 18, 2012, from http://www.theatlantic.com/health/archive/2012/05/using-data-mining-to-predict-epidemics-before-they-spread/256605/

Jaslow, R., CBS News (2012). Flesh-eating bacteria victim Aimee Copeland on amputations: “Let’s do this.” Retrieved May 18, 2012, from http://www.cbsnews.com/8301-504763_162-57437136-10391704/flesh-eating-bacteria-victim-aimee-copeland-on-amputations-lets-do-this/

Khan, Dr. A, S., Lancet (2011). Public health preparedness and response in the USA since 9/11: a national health security imperative. Retrieved May 19, 2012 from http://www.cdc.gov/phpr/documents/Lancet_Article_Sept2011.pdf

Medline Plus. A service of the U.S. National Library of Medicine, National Institutes of Health (2012). Necrotizing soft tissue infection Retrieved May 18, 2012 from http://www.nlm.nih.gov/medlineplus/ency/article/001443.htm

National Center for Immunization and Respiratory Diseases: Division of Bacterial Diseases (2008). Group A Streptococcal (GAS) Disease (strep throat, necrotizing fasciitis, impetigo. Retrieved May 18, 2012, from http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcal_g.htm

National Response Framework Homeland Security (2008). Retrieved May 19, 2012, from http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf

Spring, M. Healthguide Information.com (2008). Bio-Surveillance and Pandemic Surveillance, What’s the Difference? Retrieved May 19, 2012, from http://www.healthguideinfo.com/health-informatics/p19091/

U.S. Food and Drug Administration (2012). BBB – Aeromonas hydrophila. Foodborne Pathogenic Microorganisms and Natural Toxins Handbook. Retrieved May 19, 2012 from http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm070523.htm

U.S. Food and Drug Administration (2012). Emergency Use Authorization of Medical Products Guidance – Emergency Use Authorization of Medical Products. Retrieved May 19, 2012 from http://www.fda.gov/RegulatoryInformation/Guidances/ucm125127.htm

Can the Government Mix Drugs and Post- Combat Stress?

April 29, 2012
By Melissa Bynes Brooks

A broad debate is taking place as political views evolve and regulatory postures soften towards the use of Schedule I drugs. Schedule I drugs are classified as having a high potential for abuse, present an unacceptable safety risk, and have no acceptable medical use. Drugs in this category typically include marijuana and psychedelics.

Last year, Representative Barney Frank, (D-MA) sponsored a bill, H.R.2306- Ending Federal Marijuana Prohibition Act of 2011. The bill would amend the Controlled Substances Act so that marijuana would no longer be considered a scheduled drug, allowing states to establish their own laws and regulations. The only federal authority that would remain would be prevention of marijuana traveling over state borders in violation of the individual states’ laws.

Recently on April 25, during an interview with Jann Wenner of Rolling Stone Magazine about the War on Drugs, President Obama made clear his position on medical marijuana saying, “I can’t ask the Justice Department to say, ‘Ignore completely a federal law that’s on the books.” What I can say is, “Use your prosecutorial discretion and properly prioritize your resources to go after things that are really doing folks damage.” As a consequence, there haven’t been prosecutions of users of marijuana for medical purposes. He also said, “I do think it’s important and useful to have a broader debate about our drug laws.”

At the Food and Drug Administration (FDA) and in the scientific community, considerable thought is being given to the potential legitimacy of psychedelics which have come out of the past and into the present.

In the past, researchers conducted extensive investigations of psychedelics or hallucinogens in the 1950s and 1960s. But political and cultural pressures forced the termination of all projects by the early 1970’s.

The heightened focus on psychedelics can be attributed to contemporary research which validates the therapeutic benefits of administering psychedelic drugs in unison with psychotherapy, when other conventional treatments fail. Further support of psychedelics has been garnered because of transparency and applied ethical standards to the research methods being used.

The FDA recognizes the fundamental risk of psychedelic drug treatment is no different than the risk associated with other drugs reviewed before. “They decided they would put science over politics and permit research to go forward, says Rick Doblin, director of the Multi-Disciplinary Association for Psychedelic Studies (MAPS). MAPS is a drug development firm that funds FDA-approved clinical trials to examine the potential therapeutic uses of psychedelics.
What are psychedelic drugs?

Psychedelics or hallucinogens are mind-altering drugs capable of inducing distorted perceptions of thought, often including intense sensual input with diminished control of the induced experience. The experiences are commonly known as daydreams, hallucinations, and fantasies. These drugs have profound benefits based on research findings in the treatment of Post-Traumatic Stress Disorder (PTSD), alcoholism, cluster headaches, depression, and anxiety in dying patients.

Three commonly known psychedelic drugs are 3, 4-methylenedioxymethamphetamine (MDMA) whose street name is Ecstasy; LSD (d-lysergic acid diethylamide); and Psilocybin (4-phosphoryloxy-N, N-dimethyltryptamine).

MDMA is a synthetic, psychoactive drug that is chemically similar to the stimulant methamphetamine and the hallucinogen mescaline. It produces feelings of increased energy, euphoria, emotional warmth, and distortions in time, perception, and tactile experiences.

It is worth noting, the composition of pure MDMA is not the same as the street drug Ecstasy. Ecstasy usually contains MDMA in addition to ketamine, caffeine, BZP, and other narcotics and stimulants and its safety for use in humans is questionable. On the other hand, MDMA has been proven to be adequately safe for human consumption when taken a limited number of times in moderate doses.

A flashpoint has been the approval of clinical trials with MDMA for the treatment of PTSD in war veterans by the FDA when medications such as sertraline (Zoloft) and paroxetine (Paxil) are ineffective.

First, Dr. Michael Mithoefer conducted clinical trials using MDMA and a placebo. He found the drug, when administered in tandem with psychotherapy, helped patients recall traumatic, but long-buried, memories. “So what we are seeing with MDMA is it seems to allow people to access the trauma, revisit it with a sense that they are not going to be overwhelmed by the fear and anxiety,” Mithoefer says, “but at the same time, helps them to overcome whatever emotional numbing they have so they can connect with the emotions, and process the trauma that way.”

Two months after their sessions, 83 percent of the subjects who had been given MDMA had significantly fewer PTSD symptoms or none at all, while 25 percent of subjects in the placebo group showed such improvements. And the benefits lasted more than three years.

This is encouraging considering, since 2005, 89,000 deployed veterans have been diagnosed with PTSD which also affects nearly 7.7 million American adults in a given year.

Second, a recent study regarding the use of LSD in alcoholism treatment was conducted by researchers at the Norwegian University of Science and Technology and published in the March 2012 issue of Journal of Psychopharmacology. The findings showed about 58% of the participants, who were alcoholics, became less likely to relapse due to a spiritual sense of self-acceptance they experienced while on LSD. This spiritual “trip” led them to more honestly confront the issues that caused their alcoholism and take the steps necessary to overcome their addiction.

Third, Dr. Torsten Passie, a psychiatrist at the Hannover Medical School in Germany and expert on LSD, along with Dr. John Halpern, a Harvard Medical School researcher and noted expert in the long-term effects of drug use with colleagues decided to test 2-bromo-LSD (BOL). Six patients with severe cluster headaches were given BOL once every 5 days for a total of three doses. All patients reported a reduction in frequency of attacks, and five patients reported having no attacks several months later up to a year.

Fourth, Dr. Charles S. Grob, Department of Psychiatry, Harbor-UCLA Medical Center led a study using psilocybin which is obtained from certain types of magic mushrooms. The study demonstrated that the careful and controlled use of psilocybin may provide an alternative model for the treatment of conditions that are minimally responsive to conventional therapies. These include the existential anxiety and despair that often accompany advanced-stage cancers. The data revealed a positive trend toward improved mood and anxiety in terminally ill patients.

Finally, Roland Griffiths, a behavioral biologist at the Johns Hopkins University School of Medicine in Baltimore, Maryland, is investigating the influence of psilocybin on smoking cessation. He says psychedelics sometimes give rise to distinctive, insightful experiences that can produce enduring positive changes in attitude, mood and behavior.

There is much hope and anticipation as the future of these drugs seems promising based on proven outcomes for improving the quality of life and diminishing fears associated with perceived emotional threats. However, more research is needed in order to access the safety and efficacy of medicinal marijuana and psychedelics before completely integrating them into legitimate medical treatments.

Melissa Bynes Brooks is the editor of BrooksSleepReview.
Contact information: melissabynesbrooks@comcast.net
Follow on Twitter @Mlbbrooks

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References

Curtin, L. and Mirkin, M. (20012) Healing the injured brain: VA, DOD Joins Forces on
Research to Combat TBI, PTSD. Retrieved March 28, 2012, from

http://home.fhpr.osd.mil/press-newsroom/fhpr-news/current_news/12-02-10/Healing_the_injured_brain_VA_DoD_join_forces_on_research_to_combat_TBI_PTSD.aspx?id=?id.

Doblin, R. and Rosenbaum, M. (1991) Sage Publications. Why MDMA Should Not Have Been Made Illegal? Chapter 6 of The Drug Legalization Debate, edited by James A. Inciardi. From the SAGE Publications series: Studies in Crime, Law and Justice Vol. 7. ISBN 0-8039-3678-8. Retrieved April 28, 2012, from http://www.psychedelic-library.org/rosenbaum.htm.

Encyclopedia Britannica (2012). Hallucinogens. Retrieved, April 22, 2012, from http://www.britannica.com/EingBchecked/topic/252931/hallucinogen.

Grob, MD, C. National Center for Biotechnology Information, U.S. National Library of Medicine. Archives of General Psychiatry (2011). Pilot Study of Psilocybin Treatment for Anxiety in Patients with Advanced-Stage Cancer. Retrieved April 28, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/20819978.

Halpern, J., Karst, M., and Passie, T. In an earlier Cluster headache attack cessation and remission extension of months or longer in six treatment-refractory patients administered only 3 doses of BOL-148. Retrieved April 28, 2012, from http://www.abstractserver.com/ihc2011/planner/index.php?go=abstract&action=abstract_iplanner&absno=575&amp;.

Info Facts: Hallucinogens – LSD, Peyote, Psilocybin, and PCP. Retrieved April 21, 2012, from http://www.drugabuse.gov/publications/infofacts/hallucinogens-lsd-peyote-psilocybin-pcp.

Kurtzweil, P. Medical possibilities for psychedelic drugs (1995). Retrieved April 29, 2012, from http://findarticles.com/p/articles/mi_m1370/is_n7_v29/ai_17434487/.

MAPSMDMA (2011). Rick Doblin, Ph.D., Answers Questions from the Reddit Community (Parts1-4). Retrieved April 27, 2012, from http://www.youtube.com/watch?v=L25kJDEVofg&feature=relmfu.

MedicineNet.com (2012). Definition of Marijuana. Retrieved April 29, 2012, from http://www.medterms.com/script/main/art.asp?articlekey=12124.

National Institutes of Health National Institutes on Drug Abuse (2010). Info Facts: MDMA (Ecstasy). Retrieved April 27, 2012, from http://www.drugabuse.gov/publications/infofacts/mdma-ecstasy.

Open Congress for the 112th United States Congress (2012). H.R.2306- Ending Federal Marijuana Prohibition Act of 2011. Retrieved April 29, 2012, from http://www.opencongress.org/bill/112-h2306/show.

Phillips, A. Multidisciplinary Association for Psychedelic Studies (2012). Scientists Explore Hallucinogen Treatments for PTSD, Sex Abuse Victims. Retrieved April 21, 2012, from http://www.maps.org/media/view/scientists_explore_hallucinogen_treatments_for_ptsd_sex_abuse_victims/.

Soleyman, P. (2012). Health Benefits of LSD. Retrieved April 28, 2012, from http://www.theundergroundbootcamp.com/health-benefits/health-benefits-of-lsd/.

The Beckley Foundation (2010). LSD Helps to Treat Alcoholism. Retrieved April 28, 2012, from http://www.beckleyfoundation.org/2012/03/16/lsd-helps-to-treat-alcoholism/.

U.S. Department Health and Human Services (2011). NIH Fact Sheet: Post-Traumatic Stress Disorder (PTSD). Retrieved April 27, 2012, from

http://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=58&key=P#P.

Wenner, J.S. April 25, (2012). Ready for the Fight: Rolling Stone Interview with Barack Obama. Retrieved April 28, 2012, from http://www.rollingstone.com/politics/news/ready-for-the-fight-rolling-stone-interview-with-barack-obama-20120425?page=2.

Will Discussing Minority Healthcare Make It Better?

April 24, 2012
By Melissa Bynes Brooks

When it comes to minority healthcare issues, a meeting of the minds is worthwhile because according to the 2010 U.S. Census, approximately 36 percent of the population belongs to a racial or ethnic minority group.

This is especially true when representatives of different minority groups come together to express their concerns and opinions about racial and ethnic disparities uniquely relevant to their communities. Furthermore, raising awareness and effective communication leads to better teamwork with a congruency of ideas and recommendations which usually translates into a call to action and progress.

As Dr. David Williams of the Harvard School of Public Health says in Unnatural Causes, “Housing policy is health policy. Educational policy is health policy. Antiviolence policy is health policy. Neighborhood improvement policies are health policies. Everything that we can do to improve the quality of life of individuals in our society has an impact on their health and is a health policy.”

Public policy that drives inequities can be changed.

April is National Minority Health Month. The U.S. Department of Health and Human Services (HHS) and the White House has planned a Minority Healthcare forum to discuss racial and ethnic health disparities in minority communities with stakeholder groups and minority bloggers. The achievements of the Affordable Care Act, enacted to make healthcare less expensive and accessible, is also on the agenda.

Though health indicators such as life expectancy and infant mortality have improved for most Americans, some minorities experience a disproportionate burden of preventable disease, death, and disability compared with non-minorities. They are less likely to get the preventive care they need to stay healthy and have access to quality health care. Minorities are also more likely to receive unequal medical treatment.

Children living in poverty are about seven times more likely to be in poor or fair health than children living in high-income households. Middle class children are twice as likely to be in poor or fair health as those at the top.
The racial and ethnic health inequities don’t just reflect income. More African American, Native American, Latino and Pacific Islanders are in poor or less fair health than whites at practically every income level (although recent Latino immigrants report better health).

A caveat is that most of the risk factors associated with poor health for minorities such as heart disease and stroke, high blood pressure, high cholesterol, smoking, sleep apnea, and obesity are preventable and controllable.

As of 2007, African American men were 30% more likely to die from heart disease than were non-Hispanic white men. African American adults of both genders are 40% more likely to have high blood pressure and 10% less likely than their white counterparts to have their blood pressure under control. African Americans also have the highest rate of high blood pressure of all population groups, and they tend to develop it earlier in life than others.

The FY 2013 budget request from HHS includes an increase of $78,210,000 for Centers for Disease Control (CDC) from the Affordable Care Act Prevention and Public Health Fund for a total of $903,210,000 of the $1,250,000,000 that is available.

According to the CDC, the Prevention and Public Health Fund (Prevention Fund) helps win the future in health by empowering communities to support longer, healthier, more productive lives by preventing heart attacks, strokes, cancer, and other disabling, costly, deadly conditions; improving health protection agencies’ capacity to detect and control threats; and identifying and monitoring the health system’s successes and challenges.

The American Medical Association (AMA) has enacted policies and activities which seek to avoid fragmentation of health plans along socioeconomic status lines and strengthen the stability of patient-provider relationships in publicly funded health plans. They also seek to increase the proportion of underrepresented US racial and ethnic minorities among health professionals and apply the same managed care protections to publicly funded HMO enrollees that apply to private HMO enrollees

Inequities in minority health care can be eliminated when there is a clear pathway regarding the objectives to promote healthy behaviors. The implementation of transparent programs and intervention services along with proper allocation of resources is necessary to close health care gaps and decrease priority disparities.

That being said, a proactive discussion about minority healthcare can “make it better” by providing insight and increasing community awareness and education about the connection between racial and ethnic disparities, and socio-economic conditions which are oftentimes preventable.

Melissa Bynes Brooks is the editor of BrooksSleepReview.
Contact information: melissabynesbrooks@comcast.net
Follow@Mlbbrooks on twitter

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References

American Medical Association (2012). Eliminating Disparities. Retrieved April 23, 2012, from http://www.ama-assn.org/ama/pub/physician-resources/public-health/eliminating-health-disparities/research-findings-recommendations.page

California Newsreel (2007). Unnatural Causes. Retrieved April 23, 2012, from http://www.ok.gov/health/documents/What%20is%20Health%20Equity.pdf

California Newsreel (2007). Unnatural Causes… Is Inequality Making Us Sick? Retrieved April 23, 2012, from http://www.unnaturalcauses.org/amazing_facts.php

Dickelson, Nicole (2012). U.S. Department of Health & Human Services. Via email to melissabynesbrooks@comcast.net, on April 20, 2012, from Nicole.dickelson@hhs.gov

Million Hearts about Heart Disease and Stroke (2012). Centers for Disease Control. Retrieved April 23, 2012, from http://millionhearts.hhs.gov/abouthds/risk-factors.html#hdRace

U.S. Census Bureau (2012). Public Information Office Retrieved April 23, 2012, from http://www.census.gov/

U. Department of Health and Human Services (2012). Centers for Disease Control Justification of Estimates for Appropriations Committees. Retrieved April 23, 2012, from http://www.cdc.gov/fmo/topic/Budget%20Information/appropriations_budget_form_pdf/FY2013_CDC_CJ_Final.pdf

U.S. Department of Health and Human Services Centers for Disease Control and Prevention. The CDC Health Disparities and Inequalities Report – United States, 2011. Retrieved April 23, 2012 from

http://www.cdc.gov/minorityhealth/reports/CHDIR11/FactSheets/EducationIncome.pdf

U.S. Department of Health and Human Services and the White House to Host a Minority Health Blogger Townhall Event

April 20, 2012
By Melissa Bynes Brooks

April is National Minority Health Month.

The Department of Health and Human Services (HHS) and the White House observes this month by raising awareness about the health disparities that continue to affect racial and ethnic minorities. The month is also a celebration of the opportunities of the Affordable Care Act’s groundbreaking policies to reduce those health disparities.

Despite the progress our nation has made over the past 50 years, racial and ethnic minorities still lag behind the general population on many health fronts. Minorities are less likely to get the preventive care they need to stay healthy, more likely to suffer from serious illnesses, such as diabetes, heart disease and colon cancer, and they are less likely to have access to quality health care.

HHS and the White House have organized a live in-person Minority Health Blogger Townhall scheduled for Tuesday, April 24th, 2012, from 12:30 p.m. to 2:00 p.m. at the White House. The event has been organized to engage with members of online and social media spheres to discuss the healthcare accomplishments that have been made possible for racial and ethnic minorities by the Affordable Care Act.

The Minority Health Blogger Townhall event will be an interactive, open dialogue with stakeholder groups and bloggers to highlight what the health care law, the Affordable Care Act, means for racial and ethnic minorities. There will be a discussion regarding racial and ethnic heath disparities and how the Administration is addressing these disparities.

The event will begin at 12:30 p.m. with opening remarks, followed by a question and answer period. The Townhall is in-person and on the record. It will also be live streamed via http://www.whitehouse.gov/live and http://www.hhs.gov/live.
The HHS and White House are encouraging members of the online community to submit questions. They will be using the hashtag #MinorityHealth.

The following members of President Obama’s Administration will be in attendance:

Cecilia Munoz, Director of Domestic Policy Council, the White House
Kathleen Sebelius, Secretary, US Department of Health & Human Services
Dr. Regina Benjamin, Surgeon General, US Department of Health & Human Services
Dr. J. Nadine Gracia, Acting Deputy Assistant Secretary for Minority Health & Director of the Office of Minority Health, US Department of Health and Human Services
Mayra Alvarez, Director of Public Health Policy, Office of Health Reform, US Department of Health & Human Services

References

Dickelson, Nicole (2012). U.S. Department of Health & Human Services. Via email to melissabynesbrooks@comcast.net, on April 20, 2012, from Nicole.dickelson@hhs.gov

U.S. Department of Health & Human Services (2012). News Release: Secretarial Statement on National Minority Health Month (2012). Retrieved, April 20, 2012, from http://www.hhs.gov/news/press/2012pres/04/20120402c.html

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HOW HEALTH INSURANCE EXCHANGES ARE TRANSFORMING THE HEALTH CARE MARKET PLACE

By Melissa Bynes Brooks
April 9, 2012

“Despite the current period of regulatory ambiguity swirling around the Supreme Court’s final decision on whether to uphold or repeal the Patient Protection and Affordable Care Act (Obama Care), the creation and establishment of health insurance exchanges continues to be implemented at the state level and is one of the major components shaping the health care market place.”

The insurance exchanges allow individuals and small businesses to use a Web-based system to compare private health plans, get information about coverage options, determine eligibility for tax credits, and enroll in a health plan that meets their needs at lower costs. Essentially, consumers have an opportunity to make informed and educated decisions about purchasing health insurance. They can keep the insurance they have, upgrade, or switch to another provider altogether.

In an effort to lower costs and improve quality care, all states are required to implement affordable insurance exchanges by the year 2014 under Obama Care. States have the option to establish one or more state or regional exchanges, partner with the federal government to run the exchange, or to merge with other state exchanges. If a state chooses not to create an exchange, the federal government will set up the exchange(s) in the state. As of March 2012, 13 states and the District of Columbia have enacted state-based health insurance exchanges. Massachusetts and Utah passed laws prior to the enactment of Obama Care in March 2010.

Last month, the U.S. Department of Health and Human Services (HHS) published a final rule on Affordable Health Insurance Exchanges offering a framework to assist states in setting up Affordable Insurance Exchanges. The framework preserves and, in some cases, expands the significant flexibility in the proposed rules that enables states to build an Exchange that works for their residents.

For example, the final rule allows states to decide whether their Exchange should be operated by a non-profit organization or a public agency, how to select plans to participate, and whether to partner with HHS for some key functions. The final rule offers additional flexibility regarding the eligibility determination process. It also makes it easier for small businesses to get coverage through the Small Business Health Options Program (SHOP), strengthens consumer protections, and keeps it simple for health plans interested in participating in Exchanges.

“Perhaps, even in this uncertain economic and political environment, many of the state based insurance exchanges are being created because there is a perfect fit in the exchange of goods and services with the ideological concepts of a free market place and competition.” For example, Florida which is one of the 26 plaintiff states against Obama Care and the individual mandate, is working on an insurance exchange that would open in 2012 to small businesses only, with 50 or fewer employees. The exchange will not provide subsidies or tax credits, or have an essential benefits requirement but will provide an online tool allowing businesses to easily shop for health plans offered in their respective county. Florida’s exchange would be implemented to attract employers who are less likely to offer insurance coverage to their employees.

A PwC Health Research Institute Consumer Survey conducted in 2011, regarding consumer expectations about exchanges, showed that 34% of the consumers reported they would have a less than favorable impression of a health insurance company that decided not to participate in their state’s exchange. 37% of consumers surveyed think health insurance exchanges will make it easier for them to find and purchase a competitive health insurance plan. 29% of the consumers felt they do not know enough about health insurance exchanges to form an opinion.

As a result, marketing strategies for many insurance providers now consist of targeting specific businesses and population segments, as well as providing information and expanding direct-to-consumer sales while new channels for reaching consumers directly are being explored. These are all signs of the health care market place steadily transforming and providing opportunities to offer health insurance exchanges to different market niches.

References

Galewitz, P. Kaiser Health News (2011). Florida Readies its Own Health Insurance Exchange. Retrieved April 8, 2012, from http://www.kaiserhealthnews.org/Stories/2011/October/09/florida-health-exchange.aspx

HealthCare.gov (2012). Affordable Insurance Exchanges: Choices, Competition and Clout for States. Retrieved April 8, 2012, from http://www.healthcare.gov/news/factsheets/2011/07/exchanges07112011a.html

HealthCare.gov (2012). Affordable Insurance Exchanges. Retrieved April 8, 2012, from http://www.healthcare.gov/law/features/choices/exchanges/index.html HealthCare.gov (2012).

Kaiser Health Reform Source (2012). State Action toward Creating Health Insurance Exchanges, as of March 1, 2012. Retrieved April 8, 2012, from http://www.statehealthfacts.org/comparemaptable.jsp?ind=962&cat=17

National Conference of State Legislatures (2012). State Actions to Implement the Health Benefit Exchange. Retrieved April 8, 2012, from http://www.ncsl.org/issues-research/health/state-actions-to-implement-the-health-benefit-exch.aspx

PricewaterhouseCoopers LLP, (2011).Top health industry issues of 2012: Connecting In
Uncertainty. Retrieved April 8, 2012, from http://www.pwc.com/us/en/health-industries/publications/top-health-industry-issues-of-2012.jhtml

PRESIDENT BARACK OBAMA’S PREDICTION

By Melissa Bynes Brooks
April 3, 2012

“Outsiders see and insiders know.”

It’s not a coincidence that President Barack Obama was unabashedly certain in his prediction about the outcome of the Supreme Court’s imminent decision regarding the Affordable Care Act (Obama Care), when he said on April 2, 2012, “I’m confident that the Supreme Court will not take what would be an unprecedented, extraordinary step of overturning a law that was passed by a strong majority of a democratically elected Congress.”

President Barack Obama, an “Insider”, possesses knowledge of the legal precedents and constitutional merits that will influence the decision about Obama Care. Many “Outsiders” do not fully comprehend all of the dynamics at play. The Supreme Court has been charged with ensuring that, the American people will not have their rights infringed upon in tandem with an individual mandate to purchase health care insurance. Conservatives form a majority on the Supreme Court and most opponents of Obama Care are betting the law is going to be repealed.

The caveat is that even as opponents of Obama Care come out of the shadows peering with contempt for supposed infringements on their personal freedoms and liberties, the faux pas will be jurisprudence of originalism which may just be the conservative lifeline that keeps Obama Care from sinking. Many conservatives are proponents of jurisprudence of originalism which says the Constitution should be read according to its original implications at the time it was drafted and ratified. Translation, decisions regarding law should be considered in tandem to the purpose and values of the constitution and should not be influenced by partisan philosophies. Conservative principles and values often times align with, “What is in the best interest of the Union.”

As Ramesh Ponnuru of National Review has put it, judicial restraint “is best understood as a finger on the scales, tipping judges in close cases against invalidating the actions of Congress, or state or local governments.” During his 2005 Senate confirmation hearings, Chief Justice John Roberts stressed his belief that the Supreme Court should practice “judicial modesty,” a respect for precedent and consensus that he extended even to the abortion-legalizing Roe v. Wade (1973), a case Roberts described as “the settled law of the land.”

Then again, you never know. In Citizens United later demonstrated, Roberts’ judicial modesty has limits. In his concurrence in that case, Roberts argued that the Court was perfectly justified in overturning its decisions “if adherence to a precedent actually impedes the stable and orderly adjudication of future cases”—when, for example, “the precedent’s validity is so hotly contested that it cannot reliably function as a basis for decision in future cases.”

As with most things in life, the pendulum swings both ways but I’m all in with President Barack Obama’s prediction that the law will be upheld, since the price tag for repealing Obama Care would have an incontrovertible impact on the nation’s deficit of at least, a trillion dollars.

And…how productive will that be?

REFERENCES

Feller, B. AP White House (2012). Obama Confident Health Care Law Will Be Upheld. Retrieved April 3, 2012, from
Househttp://hosted2.ap.org/CAANR/e109e277e48c4e219e07a1d4710177b3/Article_2012-04-02-US-Obama-Health-Care/id-f2299e61d504ecda2232ee06e55f6ce

Healthcare.gov. (2011). The Price of Repealing the Affordable Care Act. Retrieved April 3, 2012, from http://www.healthcare.gov/news/factsheets/2011/01/repealcosts.html

Whittington, K.E. (2006). The Heritage Foundation. How to Read the Constitution Self Government and the Jurisprudence of Originalism. Retrieved April 3, 2012, from http://www.freerepublic.com/focus/f-news/1624813/posts

The New York Times (2012).Health Care Reform and the Supreme Court (Affordable Care Act). Retrieved April 3, 2012, from

http://topics.nytimes.com/top/reference/timestopics/organizations/s/supreme_court/affordable_care_act/index.html

Root, D. Conservatives v. Libertarians (2010). The Debate Over Judicial Activism Divides Former Allies. Retrieved April 3, 2012, from F http://reason.org/news/show/conservatives-versus-libertariansrom

Small, R. C. (2011). Harvard Law School Forum on Corporate Governance and Financial Regulation. A Theory of Income Smoothing, When Insiders Know More Than Outsiders. Retrieved on April 3, 2012, from http://blogs.law.harvard.edu/corpgov/2011/12/26/a-theory-of-income-smoothing-when-insiders-know-more-than-outsiders/

THE IMPACT OF PTSD AND TBI DURING COMBAT THEATER ON THE HEALTHCARE SYSTEM

By Melissa Bynes Brooks

Friday, March 30, 2012

Expenditures for the treatment of Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) in soldiers returning from combat theater in Iraq and Afghanistan has an exponential impact on the U.S. health care system. PTSD and TBI are common conditions in soldiers that witness trauma and are exposed to explosions.

On March 28, 2012, U.S. Senator Barbara A. Mikulski (D-Md.), a senior member of the Senate Appropriations Committee, during a Senate Defense Appropriations Subcommittee hearing that examined the health care of wounded soldiers said, “Just because a war is over for us doesn’t mean it is over for the soldier, or his spouse, or her children. Some bear the permanent injuries of war, but all bear the permanent impact.”

There is no doubt that increased health care spending is related to the number of PTSD and TBI diagnosed cases. The U.S. spends approximately 17% of its gross domestic product (GDP), on health care. GDP is important because it serves as an indicator of the condition, of a country’s economy. No other country spends more than 12% of its GDP on health care and the U.S. does worse than most other countries in every measure of health outcomes.

It’s estimated that PTSD occurs in 11 to 20 veterans out of every 100, for the Iraq and Afghanistan wars. Since 2000, 229,000 soldiers have been diagnosed with TBI. Since 2005, TBI has occurred in 17,000 Iraq and Afghanistan soldiers during combat theater. 89,000 deployed veterans have been diagnosed with PTSD. The Department of Defense (DoD) focuses on acute detection while the U.S. Department of Veterans Affairs (VA) focuses on long term complications. The number of TBI injuries according to data from the DoD, which provides medical care to service members while deployed, totaled 30, 380 during the fourth quarter of 2011 (October through December).

In February 2012, the Congressional Budget Office (CBO) did a study that examined costs for the Veterans Health Administration (VHA), which provides health care after service members return from deployment, for the treatment of PTSD and TBI. The findings indicated the VHA spent about $2 billion in fiscal year 2010, from October 1 to September 30, to treat combat veterans. The medical costs per veteran during the first year of treatment averaged $8,300.00 for PTSD; $11, 700.00 for TBI; $13, 800.00 for PTSD and TBI combined; and $2,400.00 for recent veterans with neither condition. In subsequent years of treatment, the costs decreased when compared to the first year. Amounts did not include initial care provided by the DoD or care by other providers outside of the VHA. The VHA has also hired more than 7,500 mental health professionals to serve the growing population of veterans and has established specialized rehabilitation centers for veterans with multiple complex injuries including TBI since 2005. This increased costs also.

It is important to estimate the required costs for providing necessary evaluation, diagnosis, treatment and management for combat veterans. However, forecasts regarding costs are ambiguous without knowing the number of veterans that will actually be diagnosed with PTSD and TBI, and without knowing the number of veterans that will seek treatment. Some policymakers have questioned whether DoD and VHA have the resources and capacity to serve the veteran population with PTSD and TBI.

There is some hope. The Affordable Care Act which was signed into law by President Barack Obama on March 23, 2010, includes measures aimed at making health care less expensive and more accessible, including upgrades to government-run Medicare and Medicaid. There are provisions in the law for veterans with advanced appropriations to ensure efficient, timely, and predictable medical services. Unfortunately, if the law is repealed, implications for veterans will consist of higher costs and fewer choices for services. The Affordable Care Act may be a tenable solution within the context of a costly health care system and should be upheld by the U.S. Supreme Court.

REFERENCES

i) U.S. Senator Barbara A. Mikulski (D-Md) (2012). Mikulski Stands Up For Access to Treatment and Care for Wounded Service Members. Retrieved March 30, 2012, from http://www.mikulski.senate.gov/media/pressrelease/3-28-2012-1.cfm

ii) Organization for Economic Cooperation and Development (2011). Health at a Glance. Retrieved March 30, 2012, from http://www.oecd.org/dataoecd/12/16/49084355.pdf

iii) U.S. Department of Veteran Affairs National Center for PTSD Public Section Information on Trauma and PTSD Veterans General Public and Family (2012). Retrieved March 28, 2012, from

HTTP://MILITARYFAMILY.ABOUT.COM/GI/O.HTM?ZI=1/XJ&ZTI=1&SDN=MILITARYFAMILY&CDN=PARENTING&TM=18&GPS=287_4_1366_650&F=00&TT=12&BT=0&BTS=0&ZU=HTTP%3A//WWW.PTSD.VA.GOV/

iv) Curtin, L. and Mirkin, M. (2012). Healing the injured brain: VA, DOD Joins Forces on
Research to Combat TBI, PTSD. Retrieved March 28, 2012, from

http://home.fhpr.osd.mil/press-newsroom/fhpr-news/current_news/12-02-10/Healing_the_injured_brain_VA_DoD_join_forces_on_research_to_combat_TBI_PTSD.aspx?id=?id

v) Defense Medical Surveillance System (DMSS) and Theater Medical Data Store (TMDS) Prepared by Armed Forces Health Surveillance Center (AFHSC) (2012). TBI Numbers By Severity – All Armed Forces. Retrieved March 29, 2012 from,

http://www.dvbic.org/pdf/dod-tbi-2011Q4-as-of-120210.pdf

vi) Congress of the United States Congressional Budget Office (2011). The Veterans Administration Treatment of PTSD and Traumatic Brain Injury Among Recent Combat Veterans. Retrieved March 28, 2012, from http://www.cbo.gov/sites/default/files/cbofiles/attachments/02-09-PTSD.pdf

vii) The White House Washington. Health Reform for American Veterans and Military Personnel. (2010). Retrieved March 29, 2012, from http://www.whitehouse.gov/sites/default/files/rss_viewer/health_reform_for_veterans.pdf

THE AFGHANISTAN MASSACRE: MURDER OR SLEEP VIOLENCE?

By Melissa Bynes Brooks
March 26, 2012

No one could have ever predicted the massacre involving Staff Sgt. Robert Bales who was charged on Friday, March 23, 2012, with 17 counts of murder and six counts of attempted murder, along with other charges, in Afghanistan. Or could they? The warning signs were there in his history of traumatic brain injury and multiple deployments to Iraq.

Research findings at the Puget Sound Veterans Affairs hospital in Washington indicate providers should screen for anger and aggression among Iraq and Afghanistan War veterans who exhibit symptoms of Post-traumatic stress disorder (PTSD) and incorporate relevant anger treatments into early intervention strategies. PTSD is an anxiety disorder some people develop after seeing or living through an event that caused or threatened serious harm or death. Symptoms may include strong and unwanted memories of the event, bad dreams, emotional numbness, intense guilt or worry, angry outbursts, feeling “on edge,” and avoiding thoughts and situations that are reminders of the trauma.

The impetus for a review of the Army’s Post Traumatic Stress Disorder program comes after statistics showed staff at Madigan Medical Center on Joint Base Lewis McCord (JBLM), the home base of Staff Sgt. Robert Bales, had reversed the PTSD diagnoses of 40% of the troops they evaluated, according to Sen. Patty Murray, Washington-D, who recently raised the issue at a hearing on Capitol Hill.

It bodes well if the Army considers implementing a screening program that includes the use of a sleep study known as a polysomnogram (PSG). A PSG can confirm a diagnosis for the parasomnia, REM sleep behavior disorder (RBD), for soldiers with PTSD. REM sleep behavior disorder (RBD) is a frequent complaint in people who have suffered a traumatic brain injury. Traumatic brain injury (TBI) is acquired when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue.

Sleep disorders are a common finding after the acute or sudden onset phase of TBI. This can result in daytime sleepiness, heightened anxiety, a poor individual sense of wellbeing, insomnia and depression. Sleep changes and disturbed sleep are common in chronic TBI, defined as 3 months to 2 years after an injury has occurred. Neuroimaging studies have shown highly significant relation¬ships between reduced prefrontal cortical size or prefrontal corti¬cal activity with increased aggression and violence. A large study of head injuries in combat veterans found damage to the frontal lobes was associated with an increased risk for violent behavior.

Head trauma may contribute to the development of REM sleep behavior disorder (RBD) during arousals from REM sleep when most dreams occur. RBD is noticeable by intense and frightening dreams. Normally, the muscles of the body are temporarily paralyzed while dreaming. With RBD, the muscles are not temporarily paralyzed and people can act out their dreams. This is when behaviors such as sleep walking, sleep talking, and vigorous, violent episodes occur that can cause serious bodily injury. Between 33% and 65% of RBD patients have been reported to have sleep related injury to self or bed partner. Persons experiencing RBD episodes are usually unaware of the events as they are taking place.

Violent behavior, in the case of sleepwalking, occurs only after the sleepwalking episode has been triggered and is underway. During the sleepwalking episode, while moving about the environment, the sleepwalking individual encounters someone else – most likely a family member. This person may approach, block, touch, or grab the sleepwalker, triggering a violent reaction.

Simultaneous video and sleep study (PSG) recording is essential for evaluating patients with suspected RBD, so that vocalizations and limb movements can be captured and viewed concurrently with PSG data. When vocalizations, excessive muscle activity in the chin and/or limb movements emerge during REM sleep, without associated seizure activity, the diagnosis of RBD is established.

John Henry Browne, the leading defense attorney for Army Staff Sgt. Robert Bales, said about Sgt. Bales, “He has an early memory of that evening, and he has a later memory of that evening, but he doesn’t have a memory of in between.” Because all persons with REM sleep behavior disorder have a history of acting out their dreams, one can only ponder whether a sleep study screening to evaluate RBD in Army Staff Sgt. Robert Bales, might have revealed a propensity for sleep violence, which could have thwarted such a wretched tragedy.

Melissa Bynes Brooks is the editor of BrooksSleepReview. She is the Clinical Coordinator of Coral Springs Medical Center Sleep Disorders Center, accredited by the American Academy of Sleep Medicine, in Broward County, Fl. She is a Registered Polysomnographic Technologist and Certified Respiratory Therapist with a B.S. in Respiratory Therapy from FAMU and MBA from Nova Southeastern University.

Contact information: melissabynesbrooks@comcast.net
Follow@Mlbbrooks on twitter

REFERENCES

[i] Raison, Charles (2012). What’s the link between PTSD, TBI and violence? Retrieved March 23, 2012, from

http://www.cnn.com/2012/03/22/health/raison-robert-bales-tbi-ptsd/index.html

[ii] Jakupcak, M., Conybeare, D., Phelps, L., Hunt, S., Holmes, H. A., Felker, B., Klevens, M. and McFall, M. E.
(2007), Anger, hostility, and aggression among Iraq and Afghanistan war veterans

[iii] National Institutes of Health Fact Sheet (2010). Post-traumatic stress disorder (PTSD). Retrieved March 22,
2012, from http://report.nih.gov/NIHfactsheets/Pdfs/PostTraumaticStressDisorder(NIMH).pdf

[iv] Shaughnessy, Larry (2012). Army Reviewing PTSD Evaluation Program. Retrieved March 21, 2012, from

http://www.cnn.com/2012/03/21/us/army-ptsd-evaluation-program/index.html

[v] Boeve, B. F. (2010), REM sleep behavior disorder. Annals of the New York Academy of Sciences, 1184: 15–
54. doi: 10.1111/j.1749-6632.2009.05115. National Institute of Neurological Disorders and Stroke (2012). NINDS Traumatic Brain Injury Information Page. Retrieved March 24, 2012, from http://www.ninds.nih.gov/disorders/tbi/tbi.htm

[vi] National Institute of Neurological Disorders and Stroke (2012). NINDS Traumatic Brain Injury Information
Page. Retrieved March 24, 2012, from http://www.ninds.nih.gov/disorders/tbi/tbi.htm

[vii] Verma A; Anand V; Verma NP. Sleep disorders in chronic traumatic brain injury. J Clin SleepMed 2007;3(4):357-362.

[viii] Brower MC, Price BH. Neuropsychiatry of frontal lobe dysfunction in violent and criminal behaviour: a
critical review. Journal of Neu¬rology, Neurosurgery & Psychiatry 2001;71:720-6.

[ix] Aurora RN; Zak RS; Maganti RK; Auerbach SH; Casey KR; Chowdhuri S; Karippot A; Ramar K; Kristo DA; Mergenthaler TI. Best practice guide for the treatment of remsleep behavior disorder (rbd). J Clin Sleep Med
2010;6(1):85-95.

[x] Pressman MR. Disorders of arousal from sleep and violent be¬havior: the role of physical contact and proximity.
SLEEP 2007;30(8):1039-1047

[xi] Boeve, B. F. (2010), REM sleep behavior disorder. Annals of the New York Academy of Sciences, 1184:
15–54. doi: 10.1111/j.1749-6632.2009.05115.

[xii] CNN Wire Staff (2012). Lawyer Suspect in Afghan Massacre Has Memory Loss, Lawyer Says. Retrieved
March 24, 2012, from

http://articles.cnn.com/2012-03-19/asia/world_asia_afghanistan-shooting_1_afghan-forces-shooting-rampage-

afghan-massacre? s=PM:ASIA

STOP- Undiagnosed Obstructive Sleep Apnea Is a High Risk for Surgery

 

Providing patients with the most current health care information empowers them to be proactive and make better decisions about their treatment. Studies have indicated that obstructive sleep apnea (OSA) may be a risk factor that leads to adverse or harmful events in patients who undergo surgery. A patient with sleep apnea is more likely to experience complications[i] during and following major surgery due to breathing problems associated with certain medications and general anesthesia. Problems are more prevalent when the patient is sedated and lying on their back. It is important for a doctor to know when a patient has been diagnosed with obstructive sleep apnea and how it is being treated.

Sleep apnea is the most common breathing sleep disorder,[ii] and occurs due to a blockage in the upper airway that interferes with the ability to breathe normally. Symptoms may include tiredness, excessive daytime sleepiness, snoring, gasping for air or choking while asleep, dry mouth, morning headaches, high blood pressure, and abnormal body jerks or sounds when asleep. High risk groups for OSA are: male; over the age of 65; black, Hispanic, or a Pacific Islander; related to someone who has sleep apnea; and being a smoker. More risk factors include certain physical attributes, such as having a thick neck, deviated septum, receding chin, or enlarged tonsils or adenoids. Medical problems such as insulin resistance, diabetes mellitus, systemic hypertension, pulmonary hypertension,congestive heart failure, strokes, irregular heart rhythm, nocturnal angina, heart disease, obesity, stroke, heart attack, and early death may be caused or worsened by OSA.[iii]

The STOP questionnaire is a concise and easy-to-use screening tool to identify patients with a high risk for OSA. It has been developed and validated in surgical patients at preoperative clinics. The patient answers four questions respectively related to snoring, tiredness during daytime, observed apnea, and high blood pressure (STOP). High risk of OSA is determined by answering yes to two or more questions. Low risk of OSA is determined by answering yes to less than two questions.[iv] STOP promotes an optimal outcome before, during and after the surgery period.

Follow- up should be considered for patients at high risk before their scheduled surgery. Follow- up should include a medical examination, sleep history questionnaire, use of the Epworth Sleepiness Scale (ESS)[v] to measure the level of daytime sleepiness, and a polysomnogram to diagnose the severity of OSA and to determine the appropriate treatment.

A sleep study is performed in a sleep disorders center and involves the monitoring and recording of physiological activity such as breathing patterns, brain wave activity to determine light or deep sleep including dreams, blood oxygen levels, heart rhythm, leg movements, and snoring.

 

STOP Questionnaire for Obstructive Sleep Apnea (OSA)

Height: _________ inches Weight: _________ lbs

Age: _______ Male / Female Body Mass Index (BMI): _________

Collar size of shirt: S M L XL or _________ inches

Neck Circumference: _________ cm

The STOP test consists of four questions:

1. Snoring

Do you snore loudly (louder than talking or loud enough to be heard through closed door)?

Yes   No

2. Tired

Do you often feel tired, fatigued or sleepy during the day?

Yes   No

3. Observed

Has anyone observed you stop breathing during your sleep?

Yes   No

4. Blood Pressure

Do you have or are you being treated for high blood pressure?

Yes   No

High risk of OSA: answering yes to two or more questions

Low risk of OSA: answering yes to less than two questions

Chung, F., Yegneswaran, B., Liao, P., Chung, S., Vairavanathan, S., Islam, S., Khajehdehi, A., Shapiro C. (2008). STOP questionnaire. A tool to screen patients for obstructive sleep apnea. Anesthesiology, 108 (5), 812-21.

 

References

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[i] Mayo Foundation for Medical Education and Research (MFMER). (2010). Retrieved March 13, 2011, from http://www.mayoclinic.com/health/sleepapnea/DS00148/DSECTION=complications

[ii] Kryger MH: Diagnosis and management of sleep apnea syndrome. Clin Cornerstone 2000; 2:39–47

[iii] Pagel JF. Obstructive sleep apnea (OSA) in primary care: evidence-based practice. J Am Board Fam Med 2007; 20: 392–8.

[iv] Chung, F., Yegneswaran, B., Liao, P., Chung, S., Vairavanathan, S., Islam, S., Khajehdehi, A., Shapiro C. (2008).    STOP questionnaire. A tool to screen patients for obstructive sleep apnea. Anesthesiology, 108 (5), 812-21.

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The information provided is not a substitute for a consultation with a physician.