Category: Health Policy

Soot Happens

A new study released from the Queen Mary University of London has shown for the first time that air pollution exposure can affect a pregnant woman’s placenta. The placenta is a vital organ which develops during a woman’s pregnancy. It is responsible for providing nutrients and oxygen to a developing baby. In addition, it also serves as an immune system barrier for the baby, which is vulnerable during pregnancy. Any injuries inflicted on the placenta can have serious health effects on the unborn child.

The Queen Mary study examined placenta cells of five women who were exposed to air pollution. Within the samples, researchers found evidence of the presence of soot. Soot is a common air pollutant classified as particulate matter. This type of pollution is made of large damaging particles, and can often be found coming from power plants, manufacturing sites, and motor vehicles. Soot exposure is dangerous, and it is the cause of thousands of premature deaths annually. The findings of this study are novel and alarming – it demonstrates that inhaled particulate matter can travel from the lungs to the placenta.

Placental immune cells are necessary to keep an unborn baby healthy. If the placental immune system is compromised, so is that of the growing baby. It is still unclear what this study’s findings mean for fetal-placental health in the long term. However, researchers on this study are particularly concerned about how soot exposure may disrupt this system.

One thing is clear – this news is disturbing. The study demonstrated that air pollution damage does not stop at the lungs. The conversation about air pollution is not always an environmental one; many pollutants like soot affect human health dramatically. Going forward, it is important to consider how these findings should influence policy. Regulating air pollution is a necessary step to take in order to protect the health of people worldwide.

 

 

https://www.momscleanairforce.org/soot-facts/

https://www.qmul.ac.uk/media/news/2018/smd/first-evidence-that-soot-from-polluted-air-may-be-reaching-placenta.html

https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/placenta/art-20044425

https://www.nichd.nih.gov/research/supported/HPP/default

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025805/

 

 

New things to know about your cup of joe

The general public loves to scrutinize the coffee drinking habit. Multitudes are drinking it (in relatively large amounts) – so what does that mean for us? In recent years, research and public opinion has begun to favor the pros of drinking coffee. Some studies have even shown that there are significant health benefits which may be associated your daily cup of joe.

Despite this trend, news has recently surfaced which may upset these well-received findings. When coffee beans are roasted at a high temperature, they produce a chemical called acrylamide. It has been shown that higher doses of acrylamide can be harmful, and has been linked to cancer. This chemical cannot be separated from a coffee product; if someone drinks coffee, they are likely exposed to the chemical.

This evidence appears grim, but don’t dismay coffee drinkers. There are a few silver-linings to this story. The formal research on acrylamide is still inconclusive, as exposure has not been directly linked to any specific cancer. Along with this, the amount of acrylamide in coffee appears to be minute. Due to this, California has recently pushed back against labeling coffee as a cancer-causing substance. Acrylamide intake can also be avoided by considering the amount and type of coffee consumed. Drinking a little less coffee means a little less exposure. Additionally, opting for dark-roasted beans tends to minimize exposure to chemical.

https://www.bmj.com/content/359/bmj.j5024

http://time.com/5222563/what-is-acrylamide/

https://www.healthline.com/nutrition/acrylamide-in-coffee#section3

https://www.usnews.com/news/healthcare-of-tomorrow/articles/2018-09-04/cancer-schmancer-in-california-coffee-is-king

 

 

 

 

Dirty Lungs: the Affordable “Clean” Energy rule

The U.S. Environmental Protection Agency recently proposed the Affordable Clean Energy (ACE) rule. In spite of the word “clean”, the plan will likely lead to an increase in coal emissions across the United States. ACE will grant states the individual responsibility of policing their own air pollution. Without federal regulation, this may lead to a net increase in green house gas emissions. The policy also aims to cut other protocols which limit emissions from coal plants.
 
The consequences of this legislation concern many health professionals. The EPA’s own impact analyses has shown what health effects can be expected by 2030. Changes in air quality could lead to as many as 1,400 new premature deaths per year. Along with this, increases in asthma, cardiovascular disease, and respiratory problems are expected. The same report projected 15,000 new upper-respiratory cases yearly. These grim side effects are due to the expected increase in fine particulate matter in the air. Particulate matter is a type of air pollution which comes from burning fuels like coal and oil.
 
When creating new legislation, the EPA must consider studies on effects of air pollution on human health. With this in mind, a new policy by the EPA worries scientists and health professionals. It states that the EPA will not consider research unless all original data is made public for scientists and industry. Although transparency is good in theory, this new policy would exclude a large number of studies which use human health data. Much of this research relies on confidential patient health information. Data like this often remains private to protect patients’s rights. Excluding this research may lead to misinformation and underestimates of premature death. This new provision would interfere with ethical creation of air pollution policy.

Resources:

Current Climate of HIV Disparity in NC: Part 2

Impact of Disparity

Research has shown that the prevalence of HIV diagnoses and the rates of new HIV infections are highest in the southern US, including North Carolina.7 In the state of North Carolina:

  • Male-to-male sexual contact represents the mode of transmission for almost 70% of men living with HIV8
  • Almost 6% of transmissions for men living with HIV were the result of dual exposure through injection drug use and male-to-male sexual contact8
  • Almost three-fourths of total HIV transmission in the state are the result of male-to male sexual contact8
  • Among new diagnoses, these numbers only seem to be increasing, closer to 84%8
  • Black men in the state of North Carolina are also 6 times more likely to be living with HIV than white males8
  • The Durham-Chapel Hill, Winston-Salem, Greensboro-High Points metropolitan areas were also identified within the top 25 metropolitan areas for prevalence of HIV diagnoses and rates of new infections7

Causes of Disparity

Pre-exposure prophylaxis offers many opportunities to prevent the spread of HIV; however, stigma surrounded the drug itself may be preventing many gay and bisexual men from seeking out the drug and many medical providers from prescribing the drug to their gay and bisexual patients. This could partially be a result of general stigma about asking patients sexual health questions or questions about sexuality. Simply prescribing PrEP to all gay and bisexual men would result in overuse. Hence, discussions about sexual risk behaviors is important for assessing an individual’s need for the drug. However, medical provider stigma might represent a larger barrier to accessing PrEP, especially for black men who have sex with men. Further, the population of medical providers has been less of a focus for current public health interventions to increase the use of PrEP.

 

References

  1. Duran, D. Truvada Whores? Huffinton Post. 2012. https://www.huffingtonpost.com/david-duran/truvada-whores_b_2113588.html
  2. Addison, V. Larry Kramer, Truvada Whores and the Angry Divide Between Two Generations. HIVEqual. n.d. http://www.hivequal.org/homepage/larry-kramer-truvada-whores-and-the-angry-divide-between-two-generations
  3. Logo. Revisiting “Truvada Whore” Three Years Later. NewNowNext. 2016. http://www.newnownext.com/revisiting-truvada-whore-three-years-later/02/2016/
  4. Emory University Rollins School of Public Health. North Carolina. AIDSVu. n.d. https://aidsvu.org/state/north-carolina/
  5. Calabrese SK, Underhill K. How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize “Truvada Whores”. American journal of public health. 2015;105(10):1960-1964.
  6. Calabrese SK, Earnshaw VA, Underhill K, Hansen NB, Dovidio JF. The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access. AIDS and behavior. 2014;18(2):226-240.
  7. Rosenberg ES, Grey JA, Sanchez TH, Sullivan PS. Rates of Prevalent HIV Infection, Prevalent Diagnoses, and New Diagnoses Among Men Who Have Sex With Men in US States, Metropolitan Statistical Areas, and Counties, 2012-2013. JMIR Public Health Surveill. 2016;2(1):e22.
  8. Britz JJ. To Know or not to Know: A Moral Reflection on Information Poverty. Journal of Information Science. 2004;30(3):192-204.

Current Climate of HIV Disparity in NC: Part 1

For many people, the term AIDS is no longer representative of the state of HIV; with current treatment options, no individual’s manifestation of HIV should reach the level of AIDS. However, more work needs to be done to prevent the spread of HIV, specifically with a goal of protecting men in the gay community. In the US, men who have sex with men continue to carry the burden of prevalence of individuals living with HIV and rates of new diagnoses. This issue is exacerbated in the South and among black men who have sex with men. Pre-exposure prophylaxis for HIV (PrEP) represents an opportunity to drastically reduce the number of new HIV diagnoses; however, individuals must be able to gain access to this preventative treatment.

Evidence of Disparity

On November 12, 2012, more than five years ago, David Duran wrote an article for the Huffington Post, titled “Truvada Whores?” Duran argued that pre-exposure prophylaxis for HIV (PrEP) allows gay men (and other men who have sex with men) to engage in unsafe sex while taking a pill, rather than encouraging them to partake in safer-sex practices, by which I assume he means the use of a barrier method like a condom.1 In the past five years, little has changed in the way that people think about stigma and PrEP. Even within gay publications and HIV-centered advocacy groups, people continue to write about the “Truvada Whore.”2,3 The use of this term is strongly connected to stigma related to the use of PrEP, which is pervasive even within the medical community4,5 Stigma is exasperated when coupled with the implicit racial bias of providers that causes them to assume that black men who have sex with men engage in riskier sex6 As a result, there is stigma from within the gay community that assumes men who take PrEP are riskier or more likely to have HIV, from outside of the gay community that assumes they’re sluts or whores, and also specifically from the medical community, which assumes that prescribing PrEP will increase risk behaviors, leading to more HIV infections.

 

References

Works Cited

  1. Duran, D. Truvada Whores? Huffinton Post. 2012. https://www.huffingtonpost.com/david-duran/truvada-whores_b_2113588.html
  2. Addison, V. Larry Kramer, Truvada Whores and the Angry Divide Between Two Generations. HIVEqual. n.d. http://www.hivequal.org/homepage/larry-kramer-truvada-whores-and-the-angry-divide-between-two-generations
  3. Logo. Revisiting “Truvada Whore” Three Years Later. NewNowNext. 2016. http://www.newnownext.com/revisiting-truvada-whore-three-years-later/02/2016/
  4. Emory University Rollins School of Public Health. North Carolina. AIDSVu. n.d. https://aidsvu.org/state/north-carolina/
  5. Calabrese SK, Underhill K. How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize “Truvada Whores”. American journal of public health. 2015;105(10):1960-1964.
  6. Calabrese SK, Earnshaw VA, Underhill K, Hansen NB, Dovidio JF. The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access. AIDS and behavior. 2014;18(2):226-240.
  7. Rosenberg ES, Grey JA, Sanchez TH, Sullivan PS. Rates of Prevalent HIV Infection, Prevalent Diagnoses, and New Diagnoses Among Men Who Have Sex With Men in US States, Metropolitan Statistical Areas, and Counties, 2012-2013. JMIR Public Health Surveill. 2016;2(1):e22.
  8. Britz JJ. To Know or not to Know: A Moral Reflection on Information Poverty. Journal of Information Science. 2004;30(3):192-204.

 

The Continuing HIV Disparity for Black Men

Despite only making up 2% of the U.S. population, men who have sex with men (MSM) account for 52% of the U.S. population of individuals living with HIV, and these rates don’t seem to be decreasing.[1] In 2013, MSM accounted for 65% of new HIV diagnoses.[2] Among MSM, black men are disproportionately at risk of contracting HIV, accounting for 30% of MSM living with HIV and almost 40% of new HIV diagnoses in 2012 though black people only constitute about 13% of the U.S. population.[3] Of these black MSM newly diagnosed, 38% were between the ages of 13 and 24 in 2015.[4] Of black gay and bisexual men living with HIV, only 54% received continuous HIV care.[5]

These statistics illustrate the stark disparity in HIV treatment and prevention for queer black men, especially younger queer black men. According to a 2018 CDC report, black men are not receiving PrEP prescriptions or being provided PrEP at the rate that they should be.[6] Some health professionals will likely attempt to target black MSM, claiming that they are less likely to be aware of PrEP, are more likely to have sex with other black men and are thus more likely to contract HIV because of the higher prevalence rate in black communities, are more likely to participate in riskier sexual behaviors, are less willing to take medications, etc. Many of the reasons for lower PrEP usage among black MSM will likely be attributed to decisions made by black MSM themselves.

However, in 2014, Calebrese et al found, in a nationally representative sample of medical students, that students were less likely to prescribe PrEP to a black man than a white man.[7] A pervasive logic surrounding PrEP, exacerbated by the stereotype of the Truvada Whore, is that people who take PrEP will participate in riskier sex.[8] However, PrEP should be the answer to protecting individuals who are participating in riskier behavior.[9] Ultimately, this logic is backwards and slut-shaming, and it puts black MSM at greater risk because it keeps them from being prescribed PrEP.

We should be looking to medical schools to better prepare their students to provide necessary care to LGBTQ+ people more broadly, but also from this example more specifically to black MSM. We should also be targeting current providers to combat issues of implicit bias, homophobia, and heterosexism that are preventing LGBTQ+ individuals, especially black MSM, from accessing the best possible care.

[1] “MSM Population Profile.” AIDSVu, 9 Mar. 2018, aidsvu.org/aidsvu-in-use/msm-population-profile/. AIDSVu is maintained by faculty and staff at Emory University’s Rollins School of Public Health in partnership with Gilead Sciences, Inc. and the Center for AIDS Research at Emory University (CFAR) with assistance from members of other institutions. Some of the data and statistics presented on the AIDSVu website is provided from other medical and health surveillance institutions, such as the CDC.

[2] Ibid.

[3] Ibid.

[4] Ibid.

[5] “HIV among African American Gay and Bisexual Men.” Centers for Disease Control and Prevention, 14 Feb. 2018, www.cdc.gov/hiv/group/msm/bmsm.html.

[6] “HIV prevention pill not reaching most Americans who could benefit – especially people of color.” Centers for Disease Control and Prevention, 6 Mar. 2018, www.cdc.gov/nchhstp/newsroom/2018/croi-2018-PrEP-press-release.html.

[7] Calabrese, S. K., Earnshaw, V. A., Underhill, K., Hansen, N. B., & Dovidio, J. F. (2014). The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access. AIDS Behav, 18(2), 226-240. doi:10.1007/s10461-013-0675-x

[8] Calabrese, S. K., & Underhill, K. (2015). How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize “Truvada Whores”. Am J Public Health, 105(10), 1960-1964. doi:10.2105/ajph.2015.302816

[9] Calabrese, S. K., Magnus, M., Mayer, K. H., Krakower, D. S., Eldahan, A. I., Hawkins, L. A. G., . . . Dovidio, J. F. (2017). “Support Your Client at the Space That They’re in”: HIV Pre-Exposure Prophylaxis (PrEP) Prescribers’ Perspectives on PrEP-Related Risk Compensation. AIDS Patient Care STDS, 31(4), 196-204. doi:10.1089/apc.2017.0002

Bed shortages result in waiting for days in North Carolina ED’s

In recent years the phenomenon of boarding psychiatric patients in emergency departments has not only become a nationwide problem but a growing problem here in North Carolina. Psychiatric boarding refers to the phenomenon of patients with primary behavioral health complaints experiencing excessive waiting times in emergency departments (EDs). Many claim that the root of this problem arises from the continued cutting of funding for psychiatric institutions. Currently, North Carolina falls below the national average with the number of available inpatient psychiatric beds and ranks 40th number of beds per person in the country. An addition, the average wait time for a patient with a psychiatric compliant to be either discharged or be admitted is 2.5 days. This number is even worse for individuals who are waiting to be admitted to an inpatient bed at one of the psychiatric hospitals in the state, patients wait almost 4 days. How do we go about fixing this problem? This is a question that psychiatrists, policymakers and mental health professionals are striving to answer but with limited funding from the state it is challenging to do so.

References

http://www.charlotteobserver.com/news/local/article161034564.html

http://www.treatmentadvocacycenter.org/evidence-and-research/studies

 

Local Governments take Legal Action against Opioid Manufacturers

In response to the Opioid Epidemic currently being faced in North Carolina and the US, several local jurisdictions have taken steps towards legal action against the manufacturers and distributors of prescription opioids. Over four hundred federal lawsuits have emerged from local governments across the country, and these have been consolidated into a lawsuit in Ohio.

Yesterday, the City Council of Greensboro voted to join a nationwide lawsuit that targets manufacturers and distributers of prescription opiate painkillers. Later this week, the Davidson County Board of Commissioners will have a hearing and presentation around joining national opioid litigation. In total, more than forty of the State’s 100 counties have joined the lawsuit. In Forsyth County, containing the city of Winston-Salem, a similar lawsuit was filed that included defendants of more than 20 drug manufacturers.

Many of these local jurisdictions cited that the risks for addiction and dependency to prescription opiates were never communicated by drug companies, while manufactures continued to make profits with increasing supply and demand. As more municipalities continue to join litigation of file new lawsuits, while trying to adopt laws and policies to limit overprescribing, further attention should be paid to find and utilize effective strategies to limit opioid overdose deaths.

 

Sources –

 

News & Record: Greensboro joins lawsuit against drug manufacturers over opioid epidemic – http://www.greensboro.com/news/government/greensboro-joins-lawsuit-against-drug-manufacturers-over-opioid-epidemic/article_22ff745e-2002-5c27-a41a-454ab80403b7.html

Winston-Salem Journal: Forsyth County sues opioid manufacturers, distributers, claiming deceptive marketing practices – http://www.journalnow.com/news/local/forsyth-county-sues-opioid-manufacturers-distributors-claiming-deceptive-marketing-practices/article_7f8a2bf3-958f-5462-b63b-4c1affeca27d.html

The Dispatch: County to hear opioid litigation presentation – http://www.the-dispatch.com/news/20180430/county-to-hear-opioid-litigation-presentation

 

STOP Act: Implementation and Effects Part II

Earlier today, The News & Observer reported that thousands of doctors in North Carolina were breaking the recently passed STOP Act, by over-prescribing prescription opioids. In a previous post I briefly explained provisions under the STOP Act, STOP Act: Implementation and Effects on the Opioid Epidemic in North Carolina.

Based on preliminary data from the North Carolina Department of Health and Human Services, and Blue Cross and Blue Shield, showed that many were over-prescribing. The STOP Act limits opioid prescriptions to five days to first time patients, or seven days if the patient had surgery. The state health department presented their findings to staff of the North Carolina Medical Board, who noted that they do not have the capacity to investigate every prescriber reported to determine if prescriptions were legitimate.

Blue Cross and Blue Shield had started to electronically block the filling of prescription opioids for more than seven days at the start of April, noting that this policy had blocked more than 1,100 prescriptions. While there were questions about the precision of the data and its accuracy, these preliminary reports showcase the difficulties of challenging the opioid epidemic by policies limiting prescribing.

 

Sources –

The News & Observer – Thousands of N.C. doctors are over-prescribing opioids, breaking a new state law – http://www.newsobserver.com/news/business/article209824434.html

Looking at Our Health Care System

By now, we’ve probably all heard statements comparing United States’ health care against other countries- we have the most expensive healthcare (1), we have many suffering due to lack of access (2), medical bills are the leading cause of bankruptcy  (3), etc.  Then we’re met with opinions who like our healthcare system stating that Americans have choice (4), we have better technology (5), we treat patients quickly (6), and the list goes on.

Many Americans seem to take pride in our capitalist healthcare system. I know that I grew up hearing that all other systems were socialized medicine which removed the incentives to innovate and increased wait times for patient care.  However, I have recently looked more closely into other health care systems, and it has caused me to re-examine the stories of my youth.

For today, I would like to examine Germany’s healthcare system.  Even though everyone has health insurance, they still use a mix of public and private insurance companies (7), their costs are lower than American healthcare (8), they have similar wait times (8), no one is going bankrupt due to medical bills (9), and they continue to innovate (10).

I don’t presume to know how to change our health care system, but I do believe it is time to turn it upside down.  In the 1990’s, Switzerland successfully moved away from a system structured like ours to one that granted universal coverage (11).  I believe that if they can take care of their own, then so can we.

I know that an overhaul will take lots of conversations and time.  For now, I ask that we start questioning if this really is the best health care system for all Americans or is it just the best one for the healthy and wealthy.  If you think that we are no longer serving everyone, then I encourage you to be part of the conversation.  Even if you don’t have to wait a long time for a doctor, should another American have to wait because they don’t have insurance?

 

References

  1. Peterson-Kaiser. Total Health Spending. Kaiser Family Foundation. [Online] March 19, 2017. https://www.healthsystemtracker.org/indicator/spending/health-expenditure-gdp/.
  2. Centers for Disease Control and Prevention. Access to Health Care. Centers for Disease Control and Prevention. [Online] May 3, 2017. https://www.cdc.gov/nchs/fastats/access-to-health-care.htm.
  3. Backman, Maurie. This is the No. 1 reason Americans file for bankruptcy. USA Today. [Online] May 5, 2017. https://www.usatoday.com/story/money/personalfinance/2017/05/05/this-is-the-no-1-reason-americans-file-for-bankruptcy/101148136/.
  4. Speaker Ryan Press Office. The American Health Care Act: Fact Sheet. Speaker Paul Ryan. [Online] March 7, 2017. https://www.speaker.gov/general/american-health-care-act-fact-sheet.
  5. Evans, Maria. What Are the Benefits of the United States Health Care System? Pocket Sense. [Online] October 25, 2017. 2017.
  6. Dhand, Suneel. 5 things that make U.S. health care great. KevinMD.com. [Online] August 5, 2014. https://www.kevinmd.com/blog/2014/08/5-things-make-u-s-health-care-great.html.
  7. Carroll, Aaron E. and Frakt, Austin. The Best Health Care System in the World: Which One Would You Pick? The New York Times. [Online] September 18, 2017. https://www.nytimes.com/interactive/2017/09/18/upshot/best-health-care-system-country-bracket.html.
  8. Bernstein, Lenny. Once again, U.S. has most expensive, least effective health care system in survey. The Washington Post. [Online] June 16, 2014. https://www.washingtonpost.com/news/to-your-health/wp/2014/06/16/once-again-u-s-has-most-expensive-least-effective-health-care-system-in-survey/?noredirect=on&utm_term=.a2ef07f4a443.
  9. Underwood, Anne. Health Care Abroad: Germany. The New York Times. [Online] September 29, 2009. https://prescriptions.blogs.nytimes.com/2009/09/29/health-care-abroad-germany/.
  10. German Foreign Ministry for Economic Affairs and Energy. Innovative German medical technology a key healthcare industry driver. German Foreign Ministry for Economic Affairs and Energy. [Online] January 5, 2018. https://www.exportinitiative-gesundheitswirtschaft.de/EIG/Redaktion/EN/Kurzmeldungen/News/2018/2018-01-05-innovative-german-medical-technology.html.
  11. Thacher, Emily. Switzerland: Regarding Health System Reform. The Yale Global Health Review. [Online] October 3, 2015. https://yaleglobalhealthreview.com/2015/10/03/switzerland-regarding-health-system-reform/.