By MIKE STOBBE, AP Medical Writer

NEW YORK (AP) — For about 50 years, adding cavity-preventing fluoride to drinking water was a popular public health measure in Yorktown, a leafy town north of New York City.

But in September, the town’s supervisor used his emergency powers to stop the practice.

The reason? A recent federal judge’s decision that ordered U.S. regulators to consider the risk that fluoride in water could cause lower IQ in kids.

“It’s too dangerous to look at and just say ‘Ah, screw it. We’ll keep going on,’” said the town supervisor, Ed Lachterman.

Yorktown isn’t alone. The decision to add fluoride to drinking water rests with state and local officials, and fights are cropping up nationwide.

Communities in Florida, Texas, Oregon, Utah, Wyoming and elsewhere have debated the idea in recent months — the total number is in the dozens, with several deciding to stop adding it to drinking water, according to Fluoride Action Network, an advocacy organization against water fluoridation. In Arkansas, legislators this week filed a bill to repeal the state’s fluoridation program.

The debates have been ignited or fueled by three developments:

• In August, a federal agency reported “with moderate confidence” that there is a link between high levels of fluoride exposure — more than twice the recommended limit — and lower IQ in kids.
• In September, the federal judge ordered the U.S. Environmental Protection Agency to further regulate fluoride in drinking water because high levels could pose a risk to the intellectual development of children.
• This month, just days before the election, Robert F. Kennedy Jr. declared that Donald Trump would push to remove fluoride from drinking water on his first day as president. Trump later picked Kennedy to run the Department of Health and Human Services.

In Durango, Colorado, there was an unsuccessful attempt to stop fluoridating the water during Trump’s first term in office. A new push came this year, as Trump saw a surge of political support.

“It’s just kind of the ebb and flow of politics on the national level that ultimately affects us down here,” said city spokesman Tom Sluis.

Fluoride is a public health success story but opposition persists

Fluoride strengthens teeth and reduces cavities by replacing minerals lost during normal wear and tear, according to the U.S. Centers for Disease Control and Prevention. In 1950, federal officials endorsed water fluoridation to prevent tooth decay, and the addition of low levels of fluoride to drinking water has long been considered one of the greatest public health achievements of the last century.

Fluoride can come from a number of sources, but drinking water is the main source for Americans, researchers say. Nearly two-thirds of the U.S. population gets fluoridated drinking water, according to CDC data.

There is a recommended fluoridation level, but many communities exceed that, sometimes because fluoride occurs naturally at higher levels in certain water sources.

Opposition is nothing new, though for decades it was considered a fringe opinion. Adherents included conspiracy theorists who claimed fluoridation was a plot to make people submissive to government power.

Health officials could point to studies that showed that cavities were less common in communities with fluoridated water, and that dental health worsened in communities without it.

But fluoride isn’t just in water. Through the years it became common in toothpaste, mouthwash and other products. And data began to emerge that there could be too much of a good thing: In 2011, officials reported that 2 out of 5 U.S. adolescents had at least mild tooth streaking or spottiness because of too much fluoride.

In 2015, the CDC recommended that communities revisit how much they were putting in the water. Beginning in 1962, the government recommended a range of 0.7 milligrams per liter for warmer climates where people drink more water to 1.2 milligrams in cooler areas. The new standard became 0.7 everywhere.

Over time, more studies pointed to a different problem: a link between higher levels of fluoride and brain development. The August report by the federal government’s National Toxicology Program — summarizing studies conducted in Canada, China, India, Iran, Pakistan and Mexico — concluded that drinking water containing more than 1.5 milligrams of fluoride per liter was associated with lower IQs in kids.

“There’s no question that fluoride prevents cavities,” said Dr. Tom Frieden, who was director of the CDC when the agency changed the recommended fluoride levels. “There’s also no question we’re getting more fluoride than we were 50 years ago, through toothpaste and other things.”

Frieden said “a legitimate question” has been raised about whether fluoride affects brain development, and studies making that link “need to be looked at carefully.”

U.S. towns wrestle with what to do

Many people in health care strongly embrace water fluoridation. The American Dental Association and the American Academy of Pediatrics reaffirmed their endorsement of current CDC recommendations in the wake of the federal report and the judge’s ruling.

Colorado’s health department, which weighed in during a Nov. 5 Durango city council meeting, said in a statement that it “seeks to align its public health recommendations with the latest scientific research. The facts of this court ruling are not sufficient” to revise current fluoridation levels.

Durango officials are waiting to see what the EPA does in reaction to the recent court decision, said Sluis, the city spokesman.

“We follow the science,” he said. “It wouldn’t be in the best interest of the city to stop fluoridation based on one judge’s interpretation.”

In Yorktown, Lachterman concluded the judge’s decision was enough to halt fluoridation. He recalled a community discussion several years ago in which most people in the room clearly favored fluoridation, but recently it seems public comment has reversed.

“It’s like a total 180,” he said.

But not all public pressure these days is against the idea.

In September, Buffalo, New York, announced it would resume water fluoridation after not having it for nearly a decade. News reports had described an increase in tooth decay and families sued, seeking damages for dental costs.

The Buffalo Sewer Authority’s general manager, Oluwole McFoy declined to discuss the decision with The Associated Press, citing the litigation.

For its part, the EPA “is in the process of reviewing the district court’s decision,” spokesman Jeff Landis said this week.

Debates have become heated

In Monroe, Wisconsin, fluoridation “has become a very hot issue,” said its mayor, Donna Douglas.

The small city, near Madison, started fluoridating its drinking water in the early 1960s. But in the late summer, some residents began calling and emailing Douglas, saying she needed to do something about what they saw as a public health danger. The first call “was more like a threat,” she recalled.

Douglas said she did not take a position on whether to stop, but decided to raise it to the city council for discussion. The discussions were unusually emotional.

Few people tend to speak during public comment sessions at council meetings, said Douglas. But more than two dozen people spoke at a city council meeting last month, most of them in favor of fluoridation. At a subsequent meeting, about a dozen more people — all opposed to fluoridation — came out to speak.

“This is the first time we’ve had any debates at all” like this, Douglas said. “I didn’t realize it would be such a heated discussion.”

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AP video journalist Brittany Peterson and AP reporter Andrew DeMillo contributed to this report.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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By Nina Heller, CQ-Roll Call (TNS)

WASHINGTON — Despite deep partisan divides on issues like abortion and contraceptive access, lawmakers from both parties appear to have forged a cautious consensus on another women’s issue: menopause.

The agreement became evident earlier this year, when a bipartisan group of female senators introduced legislation that would increase federal research on menopause and coordinate the federal government’s existing programs related to menopause and midlife women’s health for the first time.

At a press conference with actress Halle Berry in May, Sens. Tammy Baldwin, D-Wis.; Patty Murray, D-Wash.; Lisa Murkowski, R-Alaska; Susan Collins, R-Maine; Sen. Amy Klobuchar, D-Minn.; and Shelley Moore Capito, R-W.Va., touted the bill outside of the Capitol. On Wednesday, Murray joined Denise Pines and Tamsen Fadal, national advocates for improving menopause care and executive producers of the documentary “The M Factor: Shredding the Silence on Menopause” to highlight the bill at a panel on Capitol Hill — the first time, according to Murray, that such a discussion about menopause took place in the U.S. Capitol

“As one of my Republican colleagues said, that if men were experiencing this, it would already be funded (at NIH), but it’s not,” she said.

Kathryn Schubert, the CEO of the Society for Women’s Health Research, said the issue is one drawing consensus during a time of divisiveness on other women’s issues.

“We’re seeing this as an issue where people can sort of coalesce around in the women’s health space,” she said.

Schubert said a key issue hindering research on menopause is the inability to track it to begin with. Unlike other chronic or debilitating health conditions, menopause lacks Research, Condition and Disease Categorization codes at the National Institutes of Health.

The codes are the system that sort NIH-funded projects into scientific categories for reporting to the public. The Senate bill would, among other provisions, establish new codes for chronic or debilitating conditions among women related to menopause and midlife women’s health.

Another reason advocates say there’s been a lack of research on menopause is the fallout from the Women’s Health Initiative, a series of clinical trials from the NIH that began in 1991 and focused on strategies for preventing heart disease, breast and colorectal cancer and osteoporosis in postmenopausal women.

The findings of a portion of the Women’s Health Initiative, which have since been found to be flawed, found that there was an increased risk of developing breast cancer, cardiovascular disease, stroke and pulmonary embolisms in those who took hormones.

Since then, further research has demonstrated that hormone replacement therapy does not necessarily lead to an increased risk of breast cancer and that the benefits of hormones can outweigh the risks. But the findings linking hormone therapy and breast cancer led to a drop-off in treatment for some of the more disruptive side effects of menopause, Schubert said.

“We’re pretty behind when it comes to menopause in particular, and I think now we’re having a much more open and public dialogue about that time in a person’s life and coming to the realization that we really do need to know more, but we also need to know more about the other health risks associated with healthy aging,” Schubert said.

Schubert said support for federal research on menopause spans both sides of the aisle, and other women’s health issues, like research on conditions such as endometriosis, are emerging in a similar way.

In April, California Sen. Laphonza Butler, a Democrat, and Alabama Sen. Katie Britt, a Republican, introduced a bill that would fund maternal mortality research annually for seven years as well as approve research that would target disparities associated with maternal mortality and reduce preventable causes of deaths, among the bill’s other provisions. The House has its own version of the bill.

“I do think when people hear the words ‘women’s health,’ they may think that they are politically charged,” Schubert said. “I think we have to shift the thinking on that and make sure that we all understand that we’re really thinking about health across the lifespan in a variety of different ways. It’s really not a matter of one specific disease, condition or organ, it really is all connected together.”

The focus on menopause has united members of Congress who might not typically work together. Unlike abortion, lawmakers have been able to come together on the issue without controversy and the partisan divides that often plague their work.

“It hasn’t had the same divide within the pro-choice and what others would call the pro-life community,” said Samara Daly, the co-founder and board chair at Let’s Talk Menopause, a national nonprofit focused on menopause. “It’s a different medical issue that sort of crosses literally all political, social, economic lines. It’s a natural part of one’s life … as a result, you know, we’ve really been able to have people from both sides of the aisle join forces.”

Underrepresented

Women have been underrepresented in medical research for decades — with it even being the policy at one point.

In 1977, the Food and Drug Administration created a policy to exclude women who could biologically have children from Phase 1 and Phase 2 clinical trials unless they had a life-threatening medical condition.

After pregnant women who took the drug thalidomide gave birth to babies with limb deformities, researchers adopted a cautious approach to female participation in clinical trials. Thalidomide was a sedative that was never approved for use in the U.S. but was used widely in Europe and Canada. The resulting FDA policy recommended excluding even women who used contraception, were single or whose husbands had had vasectomies.

The NIH did not establish a policy encouraging researchers to include women in studies until 1986, and it wasn’t until 1993 that Congress passed a law that required women to be included in clinical research.

“There are other health issues that may only affect some women. This is one that’s universal. Over the last couple of decades, we’ve seen more and more stigmas drop around women’s health issues of different sorts,” said Cindy Hall, president of the Women’s Congressional Policy Institute.

A 2022 study by Harvard Medical School found that as recently as 2019, women made up roughly 40% of participants in clinical trials for the three diseases affecting women the most: cancer, cardiovascular disease and psychiatric disorders, despite women being 51% of the U.S. population.

Only roughly 30% of U.S. residency programs offer a formal menopause curriculum, according to a survey from The Menopause Society.

“We’re just actually at the very beginning of trying to figure out what we need in terms of what happens during the menopause transition, which hormone therapies work, which don’t,” said Stephanie Faubion, the medical director of The Menopause Society and the director of the Mayo Clinic Center for Women’s Health.

Another bipartisan bill would require the NIH to evaluate the results and status of completed and ongoing research related to menopause, perimenopause or midlife women’s health, as well as support that research.

“It’s really significant because it would actually mandate the NIH to review existing research, but also invest dedicated funding for additional research around not only treatments and health outcomes but also really correcting the (Women’s Health Initiative) study,” Daly said.

White House involvement

In addition to bipartisan bills in Congress, the departing Biden administration has backed increased research funding for menopause as part of President Joe Biden’s investment in women’s health. It’s unclear, however, whether the incoming Trump administration will follow up on that work.

In November 2023, Biden announced the White House Initiative on Women’s Health Research, led by first lady Jill Biden and the White House Gender Policy Council.

On Oct. 23, the Biden administration announced $110 million in awards from the Advanced Research Projects Agency for Health (ARPA-H) to accelerate research and development for women’s health across 23 research teams.

Two of those awards focused on menopause: one aiming to construct a novel ovarian therapy to prevent disease in menopause and another aiming to develop a drug that would eliminate the adverse effects of menopause.

One award, which received $3.5 million, would fund a study to test the development of a drug to extend ovarian function and lifespan. The other, which received $10 million, would fund research on a cell therapy implant that would replace deficient ovarian function, restore normal hormonal processes, manage menopause-associated symptoms and minimize the adverse health outcomes related to menopause.

Jill Biden launched ARPA-H’s Sprint for Women’s Health in February, making it the first major deliverable of the White House Initiative on Women’s Health Research.

The nature of the awards means the projects have the potential to be commercialized and widely used sooner, rather than decades down the road, according to the White House.

Advocates say they hope the shared understanding among female lawmakers of what it’s like to go through menopause will continue movement on the issue.

“It’s a universal experience. Obviously, each woman has a different individual experience of menopause, but the symptoms and the experience of embarrassing hot flashes and different symptoms that make it a tough thing to go through is kind of a uniter,” Hall said.

©2024 CQ-Roll Call, Inc., All Rights Reserved. Visit cqrollcall.com. Distributed by Tribune Content Agency, LLC.

A new long COVID study could be a “game changer,” according to local researchers who found that an AI tool can identify hidden cases of the mysterious condition from patient health records.

While some diagnostic studies suggest that about 7% of the population suffers from long COVID, this new approach from Mass General Brigham researchers revealed a much higher 22.8% of the population.

The Mass General Brigham scientists developed the AI algorithm to sift through electronic health records to help clinicians identify cases of long COVID — an often mysterious condition that can be debilitating and lead to chronic fatigue, cough, and brain fog.

The study could help identify more people who should be receiving care for long COVID, according to the researchers, who said the greater 22.8% figure may align more closely with national trends and paint a more realistic picture of the pandemic’s long-term toll.

“Our AI tool could turn a foggy diagnostic process into something sharp and focused, giving clinicians the power to make sense of a challenging condition,” said senior author Hossein Estiri, head of AI Research at the Center for AI and Biomedical Informatics of the Learning Healthcare System at Mass General Brigham.

“With this work, we may finally be able to see long COVID for what it truly is — and more importantly, how to treat it,” added Estiri, who’s also an associate professor of medicine at Harvard Medical School.

The algorithm used in the AI tool was developed by drawing patient data from the clinical records of nearly 300,000 patients across 14 hospitals and 20 community health centers in the Mass General Brigham system.

The AI uses a novel method developed by Estiri and colleagues called “precision phenotyping,” which sifts through individual records to identify symptoms and conditions linked to COVID, and to track symptoms over time in order to differentiate them from other illnesses.

For instance, the algorithm can detect if shortness of breath may be the result of pre-existing conditions like heart failure or asthma rather than long COVID. Only when every other possibility was exhausted would the tool flag the patient as having long COVID.

“Physicians are often faced with having to wade through a tangled web of symptoms and medical histories, unsure of which threads to pull, while balancing busy caseloads,” said Alaleh Azhir, the co-lead author who’s an internal medicine resident at Brigham Women’s Hospital. “Having a tool powered by AI that can methodically do it for them could be a game changer.”

The patient-centered diagnoses may also help alleviate biases built into current diagnostics for long COVID, according to the researchers.

Their study showed that the individuals they identified as having long COVID mirror the broader demographic makeup of Massachusetts — unlike long COVID algorithms that rely on a single diagnostic code or individual clinical encounters, skewing results toward certain populations such as those with more access to care.

“This broader scope ensures that marginalized communities, often sidelined in clinical studies, are no longer invisible,” said Estiri.

Future studies may explore the algorithm in cohorts of patients with specific conditions, like COPD or diabetes. The researchers also plan to release this algorithm publicly on open access where physicians and healthcare systems globally can use it in their patient populations.

In addition to opening the door to better clinical care, this work may lay the foundation for future research into the genetic and biochemical factors behind long COVID’s various subtypes.

Estiri said, “Questions about the true burden of long COVID—questions that have thus far remained elusive—now seem more within reach.”

 

 

By LAURA UNGAR, Associated Press Science Writer

LOUISVILLE, Ky. (AP) — Janet Rapp strode briskly down a paved path through the city zoo, waving at friends and stopping briefly to greet emus she knows by name.

The 71-year-old retiree starts each morning this way with a walking club.

“I’m obsessed,” she said. Not only does it ease her joint pain, “it just gives me energy … And then it calms me, too.”

Medical experts agree that walking is an easy way to improve physical and mental health, bolster fitness and prevent disease. While it’s not the only sort of exercise people should do, it’s a great first step toward a healthy life.

“You don’t need equipment and you don’t need a gym membership,” said Dr. Sarah Eby, a sports medicine physician with Mass General Brigham. “And the benefits are so vast.”

What can walking do for you?

Walking can help meet the U.S. surgeon general’s recommendation that adults get at least 2 1/2 hours of moderate-intensity physical activity every week. This helps lower the risk of heart disease, high blood pressure, dementia, depression and many types of cancer.

Walking also improves blood sugar levels, is good for bone health and can help you lose weight and sleep better, added Julie Schmied, a nurse practitioner with Norton Healthcare, which runs the free Get Healthy Walking Club.

Another advantage? It’s a low-impact exercise that puts less pressure on joints as it strengthens your heart and lungs.

James Blankenship, 68, said joining the walking club at the Louisville Zoo last year helped him bounce back after a heart attack and triple bypass in 2022.

“My cardiologist says I’m doing great,” he said.

For all its benefits, however, walking “is not enough for overall health and well-being” because it doesn’t provide resistance training that builds muscle strength and endurance, said Anita Gust, who teaches exercise science at the University of Minnesota Crookston.

That’s especially important for women’s bone health as they age.

Experts recommend adding such activities at least twice weekly – using weights, gym equipment or your own body as resistance — and doing exercises that improve flexibility like yoga or stretching.

Do you really need 10,000 steps a day?

Nearly everyone has heard about this walking goal, which dates back to a 1960s marketing campaign in Japan. But experts stress that it’s just a guideline.

The average American walks about 3,000 to 4,000 steps a day and it’s fine to gradually work up to 10,000, Shmied said.

Setting a time goal can also be useful. Shmied suggests breaking the recommended 150 minutes per week into 30 minutes a day, or 10 minutes three times a day, for five days. During inclement weather, people can walk in malls or on treadmills.

As they become seasoned walkers, they can speed up the pace or challenge themselves with hills while still keeping the activity level moderate.

“If you can talk but not sing,” Eby said, “that’s what we consider moderate-intensity exercise.”

How do you stay motivated?

Walking with friends – including dogs – is one way.

Walking clubs have popped up across the nation. In 2022, New York personal trainer Brianna Joye Kohn, 31, started City Girls Who Walk with a TikTok post inviting others to walk with her.

“We had 250 girls show up,” she said.

Since then, the group has walked every Sunday for around 40 minutes, with some meeting afterward for brunch or coffee.

The Louisville Zoo launched its walking club in 1987, partnered with Norton in 2004 to expand it, and now boasts more than 15,000 registered members. Every day from March 1 through Oct. 31, people walk around and around the 1.4-mile loop before the zoo officially opens.

Tony Weiter meets two of his siblings every Friday. On a recent morning, they caught up on each other’s lives as they zipped past zebras in a fenced field and a seal sunning itself.

“I enjoy the serenity of it. It’s cold but the sun is shining. You get to see the animals,” said Weiter, 63. “It’s a great way to start the morning.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Jon Healey | (TNS) Los Angeles Times

LOS ANGELES — To try to keep young people from becoming addicted to tobacco, Congress took two steps in 2020 to keep minors from posing as adults to buy vaping products online: It barred e-cigarette sites from delivering through the U.S. Postal Service, and it required whatever delivery service they did use to check the recipient’s ID.

The state of California added its own twist that year, banning most flavored tobacco products. That prohibition did not explicitly cover online sales, but the city of San Diego is one of a number of local governments that adopted laws to eliminate any potential loophole.

Researchers at UC San Diego, Cal State San Marcos and Stanford decided to test how well those protections were working. If the results in San Diego are any indication, they’re hardly working at all.

The team lined up eight pairs of adults to try to buy flavored nicotine vaping products from 78 online retailers in October 2023. Each team made two identical orders from each retailer, with one buyer ordering from within the city of San Diego and the other in a different city in San Diego County with no explicit restrictions on online delivery of flavored vapes. In each order, they asked for delivery by the Postal Service if it was offered.

Ideally, the researchers would have struck out completely — none of the 156 orders delivered, given the state’s ban on the sale of flavored e-cigarettes, and certainly none delivered by the Postal Service. Failing that, at least the purchasers within the city of San Diego should have come up empty, considering the city’s explicit ban on online sales of flavored vapes.

And even if those measures failed, at the very least, each buyer’s ID should have been checked upon delivery to make sure they weren’t minors.

The results of the study, which were published online Monday by the Journal of the American Medical Assn., showed that more than two-thirds of the buyers successfully obtained flavored vapes, including almost 70% of the buyers in the city of San Diego — again, where those sales are explicitly prohibited, the study said.

Of the successful deliveries, 80% were handled by the Postal Service, which shouldn’t have carried any of them, the study found. An additional 9% came from services such as UPS and FedEx that have policies against delivering tobacco products.

Finally, 93% of the deliveries were completed with no attempt to verify the buyer’s age. In the vast majority of cases, the products were dropped off without any interaction between the buyer and the delivery person, according to the study. And in only one case did the delivery person scan the buyer’s ID, as required by federal law.

“These results demonstrated pervasive nonadherence to age verification, shipping, and flavored tobacco restrictions among online tobacco retailers,” the study’s authors wrote.

The authors also acknowledged that they examined sales in just one county. But that county has some of the toughest anti-tobacco measures in the country.

Eric Leas, an assistant professor at UCSD and director of the Tobacco E-commerce Lab, said in a statement that online sales of e-cigarettes are the largest and fastest growing sector of the tobacco industry.

“There are longstanding surveillance systems in place that help implement laws at brick-and-mortar stores, but we do not have a system in place for online retailers,” Leas said, adding, “The results of this study highlight the need for greater oversight and enforcement of online tobacco retailers.”

Representatives of the Vapor Technology Assn., a trade group for the e-cigarette industry, and Consumer Advocates for Smoke-free Alternatives Assn., which supports vaping, did not respond immediately to requests for comment Monday. Both groups have pushed against bans on flavored e-cigarettes and have argued that vaping is a safer way to consume tobacco than cigarette smoking.

According to the Centers for Disease Control and Prevention, “No tobacco products, including e-cigarettes, are safe, especially for children, teens, and young adults.”

The latest survey by the CDC and the Food and Drug Administration found that although vaping remains the most popular form of tobacco use among minors, the number of middle- and high-school students who said they were currently vaping dropped sharply from 2023 to 2024.

©2024 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.

By Jazmin Orozco Rodriguez, KFF Health News (TNS)

Natalie Holt sees reminders nearly everywhere of the serious toll a years-long syphilis outbreak has taken in South Dakota. Scrambling to tamp down the spread of the devastating disease, public health officials are blasting messages to South Dakotans on billboards and television, urging people to get tested.

Holt works in Aberdeen, a city of about 28,000 surrounded by a sea of prairie, as a physician and the chief medical officer for the Great Plains Area Indian Health Service, one of 12 regional divisions of the federal agency responsible for providing health care to Native Americans and Alaska Natives in the U.S.

The response to this public health issue, she said, is not so different from the approach with the coronavirus pandemic — federal, state, local, and tribal groups need to “divide and conquer” as they work to test and treat residents. But they are responding to this crisis with fewer resources because federal officials haven’t declared it a public health emergency.

The public pleas for testing are part of health officials’ efforts to halt the outbreak that has disproportionately hurt Native Americans in the Great Plains and Southwest. According to the Great Plains Tribal Epidemiology Center, syphilis rates among Native Americans in its region soared by 1,865% from 2020 to 2022 — over 10 times the 154% increase seen nationally during the same period. The epidemiology center’s region spans Iowa, Nebraska, North Dakota, and South Dakota. The center also found that 1 in 40 Native American and Alaska Native babies born in the region in 2022 had a syphilis infection.

The rise in infections accelerated in 2021, pinching public health leaders still reeling from the coronavirus pandemic.

Three years later, the outbreak continues — the number of new infections so far this year is 10 times the full 12-month totals recorded in some years before the upsurge. And tribal health leaders say their calls for federal officials to declare a public health emergency have gone unheeded.

Pleas for help from local and regional tribal health leaders like Meghan Curry O’Connell, the chief public health officer for the Great Plains Tribal Leaders’ Health Board and a citizen of the Cherokee Nation, preceded a September letter from the National Indian Health Board, a Washington, D.C.-based nonprofit that advocates for health care for U.S. tribes, to publicly urge the Department of Health and Human Services to declare a public health emergency. Tribal leaders said they need federal resources including public health workers, access to data and national stockpile supplies, and funding.

According to data from the South Dakota Department of Health, 577 cases of syphilis have been documented this year in the state. Of those, 430 were among Native American people — making up 75% of the state’s syphilis cases, whereas the group accounts for just 9% of the population.

The numbers can be hard to process, O’Connell said.

“It’s completely preventable and curable, so something has gone horribly wrong that this has occurred,” she said.

The Great Plains Tribal Leaders’ Health Board first called on HHS to declare a public health emergency in February. O’Connell said the federal agency sent a letter in response outlining some resources and training it has steered toward the outbreak, but it stopped short of declaring an emergency or providing the substantial resources the board requested. The board’s now months-old plea for resources was like the recent one from the National Indian Health Board.

“We know how to address this, but we do need extra support and resources in order to do it,” she said.

Syphilis is a sexually transmitted infection that can result in life-threatening damage to the heart, brain, and other organs if left untreated. Women infected while pregnant can pass the disease to their babies. Those infections in newborns, called congenital syphilis, kill dozens of babies each year and can lead to devastating health effects in others.

Holt said the Indian Health Service facilities she oversees have averaged more than 1,300 tests for syphilis monthly. She said a recent decline in new cases detected each month — down from 92 in January to 29 in September — may be a sign that things are improving. But a lot of damage has been done during the past few years.

Cases of congenital syphilis across the country have more than tripled in recent years, according to the Centers for Disease Control and Prevention. In 2022, 3,700 cases were reported — the most in a single year since 1994.

The highest rate of reported primary and secondary syphilis cases in 2022 was among non-Hispanic American Indian or Alaska Native people, with 67 cases per 100,000, according to CDC data.

O’Connell and other tribal leaders said they don’t have the resources needed to keep pace with the outbreak.

Chief William Smith, vice president of Alaska’s Valdez Native Tribe and chairperson of the National Indian Health Board, told HHS in the organization’s letter that tribal health systems need greater federal investment so the system can better respond to public health threats.

Rafael Benavides, HHS’ deputy assistant secretary for public affairs, said the agency has received the letter sent in early September and will respond directly to the authors.

“HHS is committed to addressing the urgent syphilis crisis in American Indian and Alaska Native communities and supporting tribal leaders’ efforts to mobilize and raise awareness to address this important public health crisis,” he said.

Federal officials from the health department and the CDC have formed task forces and hosted workshops for tribes on how to address the outbreak. But tribal leaders insist a public health emergency declaration is needed more than anything else.

Holt said that while new cases seem to be declining, officials continue to fight further spread with what resources they have. But obstacles remain, such as convincing people without symptoms to get tested for syphilis. To make this easier, appointments are not required. When people pick up medications at a pharmacy, they receive flyers about syphilis and information about where and when to get tested.

Despite this “full court press” approach, Holt said, officials know there are people who do not seek health care often and may fall through the cracks.

O’Connell said the ongoing outbreak is a perfect example of why staffing, funding, data access, and other resources need to be in place before an emergency develops, allowing public health agencies to respond immediately.

“Our requests have been specific to this outbreak, but really, they’re needed as a foundation for whatever comes next,” she said. “Because something will come next.”

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Morayo Ogunbayo | (TNS) The Atlanta Journal-Constitution

You probably have a cabinet full of rapid COVID-19 tests you’ve accumulated. The expiration dates have come closer and closer, with some tests even reaching them.

The Food and Drug Administration, however, has said those expiration dates are subject to change, providing a list of the tests that have had their dates extended.

COVID-19 rapid antigen tests allow people to check for SARS-CoV-2 infections without help from professionals. They provide positive or negative results for the virus, typically within 15 minutes.

Rapid COVID tests list their shelf life — how long the test should work as expected — and expiration date — the date through which the test is expected to perform accurately — on the box. According to the FDA, expiration dates can be extended when the manufacturer provides data showing the shelf life is longer than originally expected.

Finding the shelf life, called stability testing, often takes a long time for test manufacturers, with the FDA opting to give them a shelf life of four to six months instead of waiting. After the test maker finds the true results of stability testing, they will contact the FDA with their new date.

The FDA has extended the expiration date for hundreds of tests, available to search here.

When should you take a rapid COVID test?

It can be hard to know when exactly to break out one of the tests, but it is often better to be safe than sorry.

According to the FDA, you should take a test when you start having symptoms, such as shortness of breath, fever or chills, sore throat, congestion, new loss of taste and smell, or nausea and vomiting. Headaches, body aches and diarrhea can also be signs to look for.

Respiratory virus season will begin later this month, with the probability of COVID-19 or RSV infections getting higher. It is important to stay mindful of these possible symptoms, and even if you are not in possession of an at-home rapid test, stay home if you are feeling ill until you can get one.

©2024 The Atlanta Journal-Constitution. Visit at ajc.com. Distributed by Tribune Content Agency, LLC.

By MIKE STOBBE

NEW YORK (AP) — The U.S. syphilis epidemic slowed dramatically last year, gonorrhea cases fell and chlamydia cases remained below prepandemic levels, according to federal data released Tuesday.

The numbers represented some good news about sexually transmitted diseases, which experienced some alarming increases in past years due to declining condom use, inadequate sex education, and reduced testing and treatment when the COVID-19 pandemic hit.

Last year, cases of the most infectious stages of syphilis fell 10% from the year before — the first substantial decline in more than two decades. Gonorrhea cases dropped 7%, marking a second straight year of decline and bringing the number below what it was in 2019.

“I’m encouraged, and it’s been a long time since I felt that way” about the nation’s epidemic of sexually transmitted infections, said the CDC’s Dr. Jonathan Mermin. “Something is working.”

More than 2.4 million cases of syphilis, gonorrhea and chlamydia were diagnosed and reported last year — 1.6 million cases of chlamydia, 600,000 of gonorrhea, and more than 209,000 of syphilis.

Syphilis is a particular concern. For centuries, it was a common but feared infection that could deform the body and end in death. New cases plummeted in the U.S. starting in the 1940s when infection-fighting antibiotics became widely available, and they trended down for a half century after that. By 2002, however, cases began rising again, with men who have sex with other men being disproportionately affected.

The new report found cases of syphilis in their early, most infectious stages dropped 13% among gay and bisexual men. It was the first such drop since the agency began reporting data for that group in the mid-2000s.

However, there was a 12% increase in the rate of cases of unknown- or later-stage syphilis — a reflection of people infected years ago.

Cases of syphilis in newborns, passed on from infected mothers, also rose. There were nearly 4,000 cases, including 279 stillbirths and infant deaths.

“This means pregnant women are not being tested often enough,” said Dr. Jeffrey Klausner, a professor of medicine at the University of Southern California.

What caused some of the STD trends to improve? Several experts say one contributor is the growing use of an antibiotic as a “morning-after pill.” Studies have shown that taking doxycycline within 72 hours of unprotected sex cuts the risk of developing syphilis, gonorrhea and chlamydia.

In June, the CDC started recommending doxycycline as a morning-after pill, specifically for gay and bisexual men and transgender women who recently had an STD diagnosis. But health departments and organizations in some cities had been giving the pills to people for a couple years.

Some experts believe that the 2022 mpox outbreak — which mainly hit gay and bisexual men — may have had a lingering effect on sexual behavior in 2023, or at least on people’s willingness to get tested when strange sores appeared.

Another factor may have been an increase in the number of health workers testing people for infections, doing contact tracing and connecting people to treatment. Congress gave $1.2 billion to expand the workforce over five years, including $600 million to states, cities and territories that get STD prevention funding from CDC.

Last year had the “most activity with that funding throughout the U.S.,” said David Harvey, executive director of the National Coalition of STD Directors.

However, Congress ended the funds early as a part of last year’s debt ceiling deal, cutting off $400 million. Some people already have lost their jobs, said a spokeswoman for Harvey’s organization.

Still, Harvey said he had reasons for optimism, including the growing use of doxycycline and a push for at-home STD test kits.

Also, there are reasons to think the next presidential administration could get behind STD prevention. In 2019, then-President Donald Trump announced a campaign to “eliminate” the U.S. HIV epidemic by 2030. (Federal health officials later clarified that the actual goal was a huge reduction in new infections — fewer than 3,000 a year.)

There were nearly 32,000 new HIV infections in 2022, the CDC estimates. But a boost in public health funding for HIV could also also help bring down other sexually transmitted infections, experts said.

“When the government puts in resources, puts in money, we see declines in STDs,” Klausner said.

Maryland was one of 10 states that had measures to protect abortion access on the ballot during the presidential election, and one of seven to pass it. But what does it mean when states act to preserve abortion access while the country returns to the White House, Donald Trump, who has previously boasted about appointing the U.S. Supreme Court justices who were instrumental in overturning Roe v. Wade in 2021?

“It’s a conundrum,” said Robyn Elliott, a managing partner at Public Policy Partners in Annapolis. “I think when we, as a public, think about abortion and reproductive health, that we often frame it as a right. The challenge that we are going to be facing almost immediately is that … rights do not equate to access.”

Questions swirl about whether a new Trump administration will block abortion care, especially in states like Maryland that have enshrined access. Many are turning their eyes to Project 2025, which is a presidential transition project created by the Heritage Foundation for conservative administrations.

“The top line: It is about using federal authority in any manner possible to restrict access to reproductive health services, so anything from potentially defunding Medicaid programs to rolling back some of the protections that we currently have through either federal law or, in some cases, regulation,” said Elliott.

‘The fight is not over’

Project 2025, from which Trump distanced himself during the campaign, states that “Abortion and euthanasia are not health care,” and that the U.S. Centers for Disease Control and Prevention should not promote it as such.

Among many anti-abortion measures under Project 2025, it recommends that the CDC fund studies into the risks abortion may pose, and suggests that the U.S. Department of Health and Human Services cut funding from states like Maryland that don’t participate in abortion data collection. The data collection includes how many abortions take place, at what gestational period and for what reason — including spontaneous miscarriage. It also calls for the U.S. Food and Drug Administration, FDA, to reverse the approval of abortion medications like mifepristone and the implementation of the 1873 Comstock Act to prohibit abortion pills from being sent through the mail.

The Victorian-era Comstock Act is a law that prohibits sending lewd or lascivious material, like pornography, or any material intended for producing abortions, like the drug mifepristone, through the mail. It is not typically adhered to in the modern day, but Elliott questions how it will be interpreted under a new Trump administration.

According to the Guttmacher Institute, a research nonprofit that aims to advance sexual and reproductive health and rights, medication abortions account for more than half of U.S. abortions.

Mifepristone’s FDA approval was recently challenged in the federal courts. The U.S. Supreme Court preserved access to the drug earlier this year, deciding that the plaintiffs in the case lacked the legal right or standing to sue.

Ahead of the Supreme Court’s ruling, Gov. Wes Moore, a Democrat, made efforts to stockpile Mifepristone.

“We will see other attempts to test whether or not the Comstock law can be applied in today’s world,” Elliott warned.

Still, many are celebrating enshrining access to reproductive freedom in the state constitution while acknowledging the challenges ahead.

“While this week marked an enormous victory in our work to protect a woman’s right to choose, our fight is not done,” Moore posted on X.com. “The mission continues to keep Maryland a safe haven for abortion access, deliver critical supports centered on protecting bodily autonomy, and provide Marylanders with the resources they need to make their own, informed decisions about family planning and health care.”

House Speaker Adrienne A. Jones, a Baltimore County Democrat who sponsored the legislation creating the ballot question, thanked everyone who voted in its favor.

“But the fight is not over!” she posted on X. “It won’t be until EVERY woman in EVERY state has the same access to the reproductive care they need to stay healthy & safe.”

How Maryland has tried to protect abortion access

Tuesday’s passage of the measure to enshrine access to abortion care in the state Constitution isn’t Maryland’s first attempt at protecting access.

In 1991, Maryland lawmakers passed a bill barring the state from interfering with abortion access until a fetus reaches viability, which occurs around 24 weeks. After that point, abortions can only be performed if there is a fetal anomaly or the pregnant person’s life is at risk. That measure was codified through a statewide ballot referendum in 1992.

In 2019, former state House Speaker Michael E. Busch, an Anne Arundel County Democrat, introduced a bill that would have created a ballot initiative to enshrine abortion access in the state constitution. Busch withdrew the legislation, citing a lack of interest that session from former Senate President Thomas V. “Mike” Miller Jr, a Democrat from Calvert County.

“That the people have the right to bodily integrity and privacy to make personal decisions about childbearing and procreation without unwarranted government intrusion,” Busch’s proposed ballot measure read.

In 2019, Busch’s chief of staff Alexandra Hughes said he planned to re-introduce the legislation the following year. Busch died just before the end of the 2019 legislative session.

In 2022, Jones sponsored legislation that would have put the 2024 constitutional amendment on that year’s midterm ballot. Her bill passed out of the House chamber, but stalled in the Senate.

With the knowledge that the U.S. Supreme Court decision that overturned Roe v. Wade was imminent, the Maryland General Assembly made more successful steps in recent years to ensure that access to reproductive health care services in the state would be expanded rather than erased.

In 2022, the legislature passed the Abortion Care Access Act, which requires the state to earmark $3.5 million in its annual budget for training medical professionals, including nurse practitioners, nurse midwives, physician assistants and licensed certified midwives, to provide abortion care. It also made Maryland’s existing abortion care coverage under Medicaid permanent, and mandated that private health insurance plans cover abortion care without cost-sharing or deductibles, save for those with religious or legal exemptions.

Project 2025 seeks to prohibit Planned Parenthood from receiving Medicaid funding.

Elliott said that Maryland pays for abortion care in Medicaid “entirely with state funds.”

“So the legal question that would arise is whether or not the federal government had the legal authority to restrict what Maryland does with its own funding,” she said.

In 2023 — the same year the General Assembly voted in favor of putting Question 1 on the ballot — the legislature passed a bill requiring patient consent in order for records regarding their reproductive health care, including abortion and pharmaceutical dispensing data, to cross state lines via digital health information exchanges. The Reproductive Health Protection Act, which prohibits Maryland from aiding other states’ criminal investigations of and court proceedings against patients and providers involved in abortions, was passed the same year.

A big ‘if’

Though Maryland is well set to protect abortion, the state’s biggest threat to access would be a federal ban.

“All of it goes away, I think, if there’s going to be a federal ban, and that’s a big ‘if’ right now that everybody’s worried about,” said Katie Curran O’Malley, a retired judge and the executive director of the Women’s Law Center of Maryland. “But is there a will?”

Todd Eberly, a political science professor at St. Mary’s College of Maryland, said that Trump stated clearly on the campaign trail that he is not in favor of an all-out ban on abortion access.

“That would be a pretty big reversal for him to embrace it,” he said.

While the U.S. Senate has secured a Republican majority, the party that will lead the House chamber was still unclear as of Friday afternoon.

In terms of Congress passing a federal ban, Eberly said it’s dependent on how serious current Senate Minority Leader Mitch McConnell is about maintaining the filibuster, which allows for prolonged debate and requires 60 of 100 senators to end.

“I know that there are pressures on the Republican Party to look at the victory as proof that they can take a harsher stand on abortion,” Eberly said. “You still have the real math problem of, if the filibuster remains, how do you pass it?”

Elliott said that, should Congress pass a ban that Trump signs, there would be a “very comprehensive nationwide strategy” to utilize the courts to preserve access.

Should it come to pass, Attorney General Anthony Brown said Thursday that the goal of his office and like-minded attorneys general would be to challenge restrictions or bans in court, whether they come in the form of criminalizing the assistance of a pregnant person seeking an abortion or stripping funding from states that don’t accept restrictions.

Through the Maryland Defense Act of 2017, Brown has the authority to proceed with civil or criminal lawsuits against the federal government based on actions or inactions it takes against the public interest. He said his office is planning to submit a budget request for the 2026 fiscal year that is “over the target” to fund his federal litigation unit, and has posted job openings for five attorneys and a paralegal to staff the team.

In his final years in office, Brown’s predecessor, Attorney General Brian Frosh, sent over 90 letters to former Gov. Larry Hogan informing him of actions he was taking against the first Trump administration.

But, even with a prepared attorney general, the impact of a second Trump presidency on abortion access remains unclear.

“We unfortunately don’t know the outcome of what that litigation would be, just like in any other case, given the way that the courts have been appointed during the past Trump administration,” Elliott said. “So what we’re really looking at, unfortunately, is a question mark.”

Brett Kelman, Anna Werner, CBS News | (TNS) KFF Health News

Becky Carroll was missing a few teeth, and others were stained or crooked. Ashamed, she smiled with lips pressed closed. Her dentist offered to fix most of her teeth with root canals and crowns, Carroll said, but she was wary of traveling a long road of dental work.

Then Carroll saw a TV commercial for another path: ClearChoice Dental Implant Centers. The company advertises that it can give patients “a new smile in as little as one day” by surgically replacing teeth instead of fixing them.

So Carroll saved and borrowed for the surgery, she said. In an interview and a lawsuit, Carroll said that at a ClearChoice clinic in New Jersey in 2021, she agreed to pay $31,000 to replace all her natural upper teeth with pearly-white prosthetic ones. What came next, Carroll said, was “like a horror movie.”

Carroll alleged that her anesthesia wore off during implant surgery, so she became conscious as her teeth were removed and titanium screws were twisted into her jawbone. Afterward, Carroll’s prosthetic teeth were so misaligned that she was largely unable to chew for more than two years until she could afford corrective surgery at another clinic, according to a sworn deposition from her lawsuit.

ClearChoice has denied Carroll’s claims of malpractice and negligence in court filings and did not respond to requests for comment on the ongoing case.

“I thought implants would be easier, and all at once, so you didn’t have to keep going back to the dentist,” Carroll, 52, said in an interview. “But I should have asked more questions … like, Can they save these teeth?”

Dental implants have been used for more than half a century to surgically replace missing or damaged teeth with artificial duplicates, often with picture-perfect results. While implant dentistry was once the domain of a small group of highly trained dentists and specialists, tens of thousands of dental providers now offer the surgery and place millions of implants each year in the U.S.

Amid this booming industry, some implant experts worry that many dentists are losing sight of dentistry’s fundamental goal of preserving natural teeth and have become too willing to remove teeth to make room for expensive implants, according to a months-long investigation by KFF Health News and CBS News. In interviews, 10 experts said they had each given second opinions to multiple patients who had been recommended for mouths full of implants that the experts ultimately determined were not necessary. Separately, lawsuits filed across the country have alleged that implant patients like Carroll have experienced painful complications that have required corrective surgery, while other lawsuits alleged dentists at some implant clinics have persuaded, pressured, or forced patients to remove teeth unnecessarily.

The experts warn that implants, for a single tooth or an entire mouth, expose patients to costs and surgery complications, plus a new risk of future dental problems with fewer treatment options because their natural teeth are forever gone.

“There are many cases where teeth, they’re perfectly fine, and they’re being removed unnecessarily,” said William Giannobile, dean of the Harvard School of Dental Medicine. “I really hate to say it, but many of them are doing it because these procedures, from a monetary standpoint, they’re much more beneficial to the practitioner.”

Giannobile and nine other experts say they are combating a false public perception that implants are more durable and longer-lasting than natural teeth, which some believe stems in part from advertising on TV and social media. Implants require upkeep, and although they can’t get cavities, studies have shown that patients can be susceptible to infections in the gums and bone around their implants.

“Just because somebody can afford implants doesn’t necessarily mean that they’re a good candidate,” said George Mandelaris, a Chicago-area periodontist and member of the American Academy of Periodontology Board of Trustees. “When an implant has infection, or when an implant has bone loss, an implant dies a much quicker death than do teeth.”

In its simplest form, implant surgery involves extracting a single tooth and replacing it with a metal post that is screwed into the jaw and then affixed with a prosthetic tooth commonly made of porcelain, also known as a crown. Patients can also use “full-arch” or “All-on-4” implants to replace all their upper or lower teeth — or all their teeth.

For this story, KFF Health News and CBS News sought interviews with large dental chains whose clinics offer implant surgery — ClearChoice, Aspen Dental, Affordable Care, and Dental Care Alliance — each of which declined to be interviewed or did not respond to multiple requests for comment. The Association of Dental Support Organizations, which represents these companies and others like them, also declined an interview request.

ClearChoice, which specializes in full-arch implants, did not answer more than two dozen questions submitted in writing. In an emailed statement, the company said full-arch implants “have become a well-accepted standard of care for patients with severe tooth loss and teeth with poor prognosis.”

“The use of full-arch restorations reflects the evolution of modern dentistry, offering patients a solution that restores their ability to eat, speak, and live comfortably — far beyond what traditional dentures can provide,” the company said.

Carroll said she regrets not letting her dentist try to fix her teeth and rushing to ClearChoice for implants.

“Because it was a nightmare,” she said.

‘They Are Not Teeth’

Dental implant surgery can be a godsend for patients with unsalvageable teeth. Several experts said implants can be so transformative that their invention should have contended for a Nobel Prize. And yet, these experts still worry that implants are overused, because it is generally better for patients to have their natural teeth.

Paul Rosen, a Pennsylvania periodontist who said he has worked with implants for more than three decades, said many patients believe a “fallacy” that implants are “bulletproof.”

“You can’t just have an implant placed and go off riding into the sunset,” Rosen said. “In many instances, they need more care than teeth because they are not teeth.”

Generally, a single implant costs a few thousand dollars while full-arch implants cost tens of thousands. Neither procedure is well covered by dental insurance, so many clinics partner with credit companies that offer loans for implant surgeries. At ClearChoice, for example, loans can be as large as $65,000 paid off over 10 years, according to the company’s website.

Despite the price, implants are more popular than ever. Sales increased by more than 6% on average each year since 2010, culminating in more than 3.7 million implants sold in the U.S. in 2022, according to a 2023 report produced by iData Research, a health care market research firm.

Some worry implant dentistry has gone too far. In 10 interviews, dentists and dental specialists with expertise in implants said they had witnessed the overuse of implants firsthand. Each expert said they’d examined multiple patients in recent years who were recommended for full-arch implants by other dentists despite their teeth being treatable with conventional dentistry.

Giannobile, the Harvard dean, said he had given second opinions to “dozens” of patients who were recommended for implants they did not need.

“I see many of these patients now that are coming in and saying, ‘I’ve been seen, and they are telling me to get my entire dentition — all of my teeth — extracted.’ And then I’ll take a look at them and say that we can preserve most of your teeth,” Giannobile said.

Tim Kosinski, who is a representative of the Academy of General Dentistry and said he has placed more than 19,000 implants, said he examines as many as five patients a month who have been recommended for full-arch implants that he deems unnecessary.

“There is a push in the profession to remove teeth that could be saved,” Kosinski said. “But the public isn’t aware.”

Luiz Gonzaga, a periodontist and prosthodontist at the University of Florida, said he, too, had turned away patients who wanted most or all their teeth extracted. Gonzaga said some had received implant recommendations that he considered “an atrocity.”

“You don’t go to the hospital and tell them ‘I broke my finger a couple of times. This is bothering me. Can you please cut my finger off?’ No one will do that,” Gonzaga said. “Why would I extract your tooth because you need a root canal?”

Jaime Lozada, director of an elite dental implant residency program at Loma Linda University, said he’d not only witnessed an increase in dentists extracting “perfectly healthy teeth” but also treated a rash of patients with mouths full of ill-fitting implants that had to be surgically replaced.

Lozada said in August that he’d treated seven such patients in just three months.

“When individuals just make a decision of extracting teeth to make it simple and make money quick, so to speak, that’s where I have a problem,” Lozada said. “And it happens quite often.”

When full-arch implants fail, patients sometimes don’t have enough jawbone left to anchor another set. These patients have little choice but to get implants that reach into cheekbones, said Sohail Saghezchi, an oral and maxillofacial surgeon at the University of California-San Francisco.

“It’s kind of like a last resort,” Saghezchi said. “If those fail, you don’t have anywhere else to go.”

‘It Was Horrendous Dentistry’

Most of the experts interviewed for this article said their rising alarm corresponded with big changes in the availability of dental implants. Implants are now offered by more than 70,000 dental providers nationwide, two-thirds of whom are general dentists, according to the iData Research report.

Dentists are not required to learn how to place implants in dental school, nor are they required to complete implant training before performing the surgery in nearly all states. This year, Oregon started requiring dentists to complete 56 hours of hands-on training before placing any implants. Stephen Prisby, executive director of the Oregon Board of Dentistry, said the requirement — the first and only of its kind in the U.S. — was a response to dozens of investigations in the state into botched surgeries and other implant failures, split evenly between general dentists and specialists.

“I was frankly stunned at how bad some of these dentists were practicing,” Prisby said. “It was horrendous dentistry.”

Many dental clinics that offer implants have consolidated into chains owned by private equity firms that have bought out much of implant dentistry. In health care, private equity investment is sometimes criticized for overtreatment and prioritizing short-term profit over patients.

Private equity firms have spent about $5 billion in recent years to buy large dental chains that offer implants at hundreds of clinics owned by individual dentists and dental specialists. ClearChoice was bought for an estimated $1.1 billion in 2020 by Aspen Dental, which is owned by three private equity firms, according to PitchBook, a research firm focused on the private equity industry. Private equity firms also bought Affordable Care, whose largest clinic brand is Affordable Dentures & Implants, for an estimated $2.7 billion in 2021, according to PitchBook. And the private equity wing of the Abu Dhabi government bought Dental Care Alliance, which offers implants at many of its affiliated clinics, for an estimated $1 billion in 2022, according to PitchBook.

ClearChoice and Aspen Dental each said in email statements that the companies’ private equity owners “do not have influence or control over treatment recommendations.” Both companies said dentists or dental specialists make all clinical decisions.

Private equity deals involving dental practices increased ninefold from 2011 to 2021, according to an American Dental Association study published in August. The study also said investors showed an interest in oral surgery, possibly because of the “high prices” of implants.

“Some argue this is a negative thing,” said Marko Vujicic, vice president of the association’s Health Policy Institute, who co-authored the study. “On the other hand, some would argue that involvement of private equity and outside capital brings economies of scale, it brings efficiency.”

Edwin Zinman, a San Francisco dental malpractice attorney and former periodontist who has filed hundreds of dental lawsuits over four decades, said he believed many of the worst fears about private equity owners had already come true in implant dentistry.

“They’ve sold a lot of [implants], and some of it unnecessarily, and too often done negligently, without having the dentists who are doing it have the necessary training and experience,” Zinman said. “It’s for five simple letters: M-O-N-E-Y.”

Hundreds of Implant Clinics With No Specialists

For this article, journalists from KFF Health News and CBS News analyzed the webpages for more than 1,000 clinics in the nation’s largest private equity-owned dental chains, all of which offer some implants. The analysis found that more than 70% of those clinics listed only general dentists on their websites and did not appear to employ the specialists — oral surgeons, periodontists, or prosthodontists — who traditionally have more training with implants.

Affordable Dentures & Implants listed specialists at fewer than 5% of its more than 400 clinics, according to the analysis. The rest were staffed by general dentists, most of whom did not list credentialing from implant training organizations, according to the analysis.

ClearChoice, on the other hand, employs at least one oral surgeon or prosthodontist at each of its more than 100 centers, according to the analysis. But its new parent company, Aspen Dental, which offers implants in many of its more than 1,100 clinics, does not list any specialists at many of those locations.

Not everyone is worried about private equity in implant dentistry. In interviews arranged by the American Academy of Implant Dentistry, which trains dentists to use implants, two other implant experts did not express concerns about private equity firms.

Brian Jackson, a former academy president and implant specialist in New York, said he believed dentists are too ethical and patients are too smart to be pressured by private equity owners “who will never see a patient.”

Jumoke Adedoyin, a chief clinical officer for Affordable Care, who has placed implants at an Affordable Dentures & Implants clinic in the Atlanta suburbs for 15 years, said she had never felt pressure from above to sell implants.

“I’ve actually felt more pressure sometimes from patients who have gone around and been told they need to take their teeth out,” she said. “They come in and, honestly, taking a look at them, maybe they don’t need to take all their teeth out.”

Still, lawsuits filed across the country have alleged that dentists at implant clinics have extracted patients’ teeth unnecessarily.

For example, in Texas, a patient alleged in a 2020 lawsuit that an Affordable Care dentist removed “every single tooth from her mouth when such was not necessary,” then stuffed her mouth with gauze and left her waiting in the lobby as he and his staff left for lunch. In Maryland, a patient alleged in a 2021 lawsuit that ClearChoice “convinced” her to extract “eight healthy upper teeth,” by “greatly downplay[ing] the risks.” In Florida, a patient alleged in a 2023 lawsuit that ClearChoice provided her with no other treatment options before extracting all her teeth, “which was totally unnecessary.”

ClearChoice and Affordable Care denied wrongdoing in their respective lawsuits, then privately settled out of court with each patient. ClearChoice and Affordable Care did not respond to requests for comment submitted to the companies or attorneys. Lawyers for all three plaintiffs declined to comment on these lawsuits or did not respond to requests for comment.

Fred Goldberg, a Maryland dental malpractice attorney who said he has represented at least six clients who sued ClearChoice, said each of his clients agreed to get implants after meeting with a salesperson — not a dentist.

“Every client I’ve had who has gone to ClearChoice has started off meeting a salesperson and actually signing up to get their financing through ClearChoice before they ever meet with a dentist,” Goldberg said. “You meet with a salesperson who sells you on what they like to present as the best choice, which is almost always that they’re going to take out all your natural teeth.”

Becky Carroll, the ClearChoice patient from New Jersey, told a similar story.

Carroll said in her lawsuit that she met first with a ClearChoice salesperson referred to as a “patient education consultant.” In an interview, Carroll said the salesperson encouraged her to borrow money from family members for the surgery and it was not until after she agreed to a loan and passed a credit check that a ClearChoice dentist peered into her mouth.

“It seems way backwards,” Carroll said. “They just want to know you’re approved before you get to talk to a dentist.”

CBS News producer Nicole Keller contributed to this report.

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

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By Maria Cheng, AP Medical Writer

LONDON (AP) — No pain, no gain, as the old exercise adage goes. But just how much pain do you have to endure to benefit from weight training? That depends on what you’re trying to accomplish, fitness experts say.

For years, some trainers have instructed gym-goers that to get the best results, they need to train “until failure,” meaning until you cannot physically do one more repetition or exercise. Some recent studies, however, suggest this extreme regimen, when applied to weight training, may only benefit certain people.

“If somebody wants to increase muscle mass as much as they possibly can, then training to failure is something to consider,” said Michael Zourdos, chair of exercise science and health promotion at Florida Atlantic University, who co-authored a review of 55 research papers on the subject in the journal, Sports Medicine.

Zourdos and colleagues found that lifting weights “until failure” may build bigger muscles, but isn’t needed to increase strength. He said people who work out hard, but don’t push themselves to exhaustion, will still likely improve their health and fitness. “There is a difference between training for health and training for elite performance benefits,” he said.

For the average person simply looking to increase their fitness levels, Zourdos said it’s much easier to get results. He said people who work out regularly would benefit from an intense session that comes within five to 10 repetitions of failure, rather than training to complete exhaustion.

He also said “failure training” often comes at a cost, since people working to that standard might be so tired and sore that they skip their next gym session or two.

In extremely rare instances, overdoing it can be harmful, leading to a potentially fatal condition called rhabdomyolysis, where damaged muscles begin to break down, possibly causing kidney damage.

James Fisher, a sport science expert and consultant in Southampton, England, said the idea of working until complete exhaustion can be a turn off for many people.

“What we’re really talking about is how hard you should work when you go to the gym,” he said, adding that the concept should be interpreted to mean that people can spend less time in the gym — if they work hard.

“If you’re short on time, then you can push yourself harder, and then you don’t need to work out as long,” he said.

Fisher explained that to boost strength, it’s critical to push your muscles to a certain threshold.

“If you lift a weight you can easily lift 10 times or more, you never really work hard enough,” he said. “Now, if we increase the weight so that on the ninth and 10th rep, it feels properly hard, that will benefit your muscle fibers.”

Still, Fisher said that the best workout is ultimately “one that people will actually do,” regardless of how hard they push themselves. He said that for improving overall health, strength training is probably the best single thing people can do for their health, quality of life and longevity.

Whatever your fitness goal, Fisher said the concept of failure training can be incorporated into your workout. People should then rest the muscle group they’ve trained for about two days, he said.

For people who have more experience, experts recommend saving the failure training for occasional workouts, or on the last set of exercises in your session.

“It’s not meant to be for every person, every time they work out,” Fisher said. “This is a tough way to exercise.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

As parents, one of your top priorities is the safety and well-being of your children. With all the potential pitfalls of day-to-day life, however, navigating the risks can be difficult.

These everyday safety tips can help you navigate everything from car seat safety to baby-proofing and safe sleep, keeping your child out of harm’s way as much as possible from birth through his or her toddler years.

Car seat safety

• Always use a valid (typically less than 6 years old), federally approved car seat in motor vehicles.
• Ensure the seat is properly installed. Refer to the instruction manual with any questions.
• If you use an infant carrier, strap your child in on the floor, never a counter or tabletop.
• For at least the first two years of your child’s life, the car seat should be rear-facing.
• The safest location for a car seat is in the middle of the back seat.

Choking prevention

• Avoid giving your child nuts, popcorn, hard candies, hot dogs and raw fruits and vegetables, such as grapes or carrots, as they may present a choking hazard.
• Never prop up a bottle and leave your baby unattended.
• Inspect toys often to ensure they’re not broken and do not have small pieces that could easily become detached.
• Be cautious of strings and buttons on clothing.

Safe sleep

• The safest place for your baby to sleep is on his or her back, which reduces the risk for Sudden Infant Death Syndrome (SIDS).
• Avoid placing anything in the crib or bassinet that may suffocate your child, such as pillows, blankets or bumpers.
• Keep your child’s room at a moderate temperature and dress him or her appropriately to avoid overheating.
• Never leave your baby alone on a bed, couch, changing table, swing or infant seat.

Water safety

• Set your hot water heater no higher than 120 F.
• Test the temperature of bath water before setting your baby in the tub.
• Never leave your baby unattended in the bathtub.
• Keep toilet lids down and consider installing toilet lid locks.

Baby-proofing

• Install smoke and carbon monoxide detectors on every level of your home and in every sleeping area.
• Secure cords on blinds and drapes out of reach.
• Keep sharp objects, such as knives, scissors and tools, and other hazardous items, like coins, beads and pins, in a secure place out of the baby’s reach.
• Store cleaning products and medications in locked cabinets. Never store potentially toxic substances in containers that could be mistaken for food or drink.
• Cover all electrical outlets.
• Cushion hard edges and sharp corners of furniture and decor.
• Secure cords to electrical items along baseboards using electrical tape.
• Attach heavy or tall furniture to the wall and avoid placing items that could fall, like electronics or lamps, on top of dressers or shelves.
• Install safety gates with straight, vertical slats securely in front of all stairwells.

Find more tips and ideas to keep your children safe at home and on the go at eLivingtoday.com.

By Taylor Sisk, KFF Health News (TNS)

On learning last year she was pregnant with her second child, Cailyn Morreale was overcome with fear and trepidation.

“I was so scared,” said Morreale, a resident of the small western North Carolina town of Mars Hill. In that moment, her joy about being pregnant was eclipsed by fear she would have to stop taking buprenorphine, a drug used to treat opioid withdrawal that had helped counter her addiction.

Morreale’s fear was compounded by the rigidity of the most common approach to treating babies born after being exposed in the womb to opioids or some medications used to treat opioid addiction.

For decades throughout the opioid crisis, most doctors have relied on medication-heavy regimens to treat babies who are born experiencing neonatal opioid withdrawal syndrome. Those protocols often meant separating newborns from their mothers, placing them in neonatal intensive care units, and giving them medications to treat their withdrawal.

But research has since indicated that in many, if not most, cases, those extreme measures are unnecessary. A newer, simpler approach that prioritizes keeping babies with their families called Eat, Sleep, Console is being increasingly embraced.

In recent years, doctors and researchers have found that keeping babies with their mothers and ensuring they’re comfortable often works better and gets them out of the hospital faster.

Despite her worst fears, Morreale was never separated from her son. She was able to begin breastfeeding immediately. In fact, she was told, the trace of buprenorphine in her breast milk would help her son withdraw from it.

Her experience was different because she had found her way to Project CARA, an Asheville, North Carolina-based program, administered through the Mountain Area Health Education Center, that supports pregnant people and parents with substance use disorders. Morreale’s care team assured her she did not need to discontinue buprenorphine and that her baby would be assessed and monitored using the Eat, Sleep, Console approach. The protocol deems babies OK to be sent home so long as they’re eating, sleeping, and consolable when upset.

“By the grace of God, he was awesome,” Morreale said of her son.

David Baltierra, former director of West Virginia University’s Rural Family Medicine Residency Program, chair of WVU’s Department of Family Medicine – Eastern Division, and a family physician, suggests this protocol could simply be called “parenting.”

The method is increasingly being used instead of the long-embraced approach to treating opioid-affected newborns called the Finnegan Neonatal Abstinence Scoring System. That tool includes a list of 21 questions (is the baby crying excessively, sweating, experiencing tremors, sneezing, etc.), the answers to which determine whether the newborn should get medication to counteract withdrawal symptoms, which would then require an extended stay in a neonatal ICU.

Baltierra, though, has issues with the Finnegan method. For example, it often results in a soundly sleeping baby being awakened to be scored. That didn’t make sense to Baltierra. If the baby is sleeping, she’s likely doing fine.

Instead, health professionals should look for the telltale signs of a baby experiencing opioid withdrawal syndrome, he said. “Their body is in tension, they have a high pitch, they don’t calm down.”

Baltierra and his colleagues have been training residents to use an Eat, Sleep, Console approach for a decade, progressively more so in the past six years. The results are persuading more health professionals to adopt the method.

A 2023 study found babies treated this way were discharged from the hospital in nearly half the time and less likely to receive medication than those receiving Finnegan-based care.

Matthew Grossman, an associate professor of pediatrics at the Yale School of Medicine, refers to the introduction of the model of treatment he has helped pioneer as “the least innovative” undertaking imaginable.

Research shows that optimal care for pregnant women who’ve experienced opioid use disorder includes treatment with buprenorphine or methadone, which carries the risk their newborn will have withdrawal symptoms. Grossman and colleagues found a non-pharmacological-first approach works best.

He said the Finnegan tool is useful but often too rigid. Under its scoring, one sneeze too many could send a baby to the NICU for weeks.

Grossman said he observed that some babies receiving medications did well for a few days but began to decline when their mothers were sent home without them. Those observations made him ask, “Did the kid need more medicine, or more mom?”

Research by Leila Elder and Madison Humerick, who each did their residency in WVU’s rural program, found that median stays for newborns in withdrawal dropped from 13 days in 2016 to three in 2020.

Elder said babies born at the 25-bed rural hospital where they performed deliveries received medications to treat their withdrawal symptoms only when unrelated issues sent them to other hospitals for NICU care.

The simpler treatment also means more babies born in rural communities can receive care closer to home and has reduced the likelihood a mother will be released before her baby is cleared to go home.

Grossman suggested that rural hospitals are better suited to employ the Eat, Sleep, Console approach than big-city institutions, given the latter’s generally easier access to a NICU and propensity to choose that option.

Sarah Peiffer recalls the first time, as a medical student, she witnessed a nurse administering the Finnegan protocol, discussing it in clinical terms at a new mother’s bedside.

“And I remember being kind of horrified,” she said. The process was clearly distressing to both mother and child. “I felt like there was almost a punitive feeling to it, like we were telling this mom, ‘Look what you did to your baby.’”

Peiffer is now a Project CARA practitioner and family health physician at Blue Ridge Health in western North Carolina and a vocal proponent of ESC and its approach to partnering with families. “You look at all the nonpharmacologic stuff you’re supposed to be doing — like keeping the lights low in the room, keeping the baby swaddled, doing as much skin-to-skin with mom as possible — and you really treat mom as medicine.”

Research suggests immediate postbirth skin‐to‐skin contact offers “vital advantages” to short‐ and long‐term health and bonding.

That contact, Elder said, “releases endorphins for mom,” which helps lower the risk of postpartum depression.

Grossman said developing the Eat, Sleep, Console protocol was simply a matter of pausing to reassess.

The original intent of the Finnegan tool wasn’t to render the process so rigid. But “everybody is excited to have a tool, and then this approach calcified around it,” he said.

Grossman said the objective of the simpler approach was to place the family at the core of care, and shorter hospital stays for babies was simply a fortuitous outcome. The shift in approach fits into a wider move toward judgment-free, family-centered care for those who’ve experienced addiction and for their children.

Now, he said, after five days, mothers often say “‘Can we go home? I think I got this,’” and they’re treated “with the same respect as any other mom.”

Peiffer said she has witnessed this mother-centric care counter “that sense of shame that people feel instead of families feeling empowered to care for their infant.” It represents “such a major shift in how we think about neonatal withdrawal both medically and culturally.”

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.