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By Paul Sisson, The San Diego Union-Tribune

SAN DIEGO — More than 100 locations nationwide participating in new clinical trials for a drug that shows promise for treating epileptic seizures among patients for whom other medications do not work.

The drug, BHV-7000, activates potassium receptors in the brain in a way that appears to modulate seizures, explained Dr. Taha Gholipour, a neurologist at the University of California, San Diego, a participant in the trial and the study’s local investigator. Other commonly prescribed anti-seizure medications act on sodium and calcium channels in neurons, routes that are effective for some but not all patients.

About 40% of the estimated 1.5 million people with epilepsy are resistant to drugs that engage the calcium and sodium routes, meaning that having a third avenue, through potassium, would be a major expansion of the options for treating seizures.

“The potassium channel is not completely new or unknown in our neuroscience community — there have been many attempts in the past to study this route — but we have had no success in getting a drug that has minimal side effects and also effective seizure control,” Gholipour said. “But years of preclinical work in labs, in cell models, in animal models, and then in early clinical trials in humans, have shown that it looks like this drug is well tolerated and potent in controlling seizures, which is exciting news.”

A phase 1 trial tested the drug in 58 patients, mostly white men with a median age of 40, finding that the main side effects, observed in just a handful of participants, were headaches and abdominal discomfort, which resolved when they stoped taking the drug.

Biohaven Ltd. a Connecticut-based biopharmaceutical company, is working to enroll 390 participants for the second and third phases of a clinical trial designed to determine whether the drug can decrease the average seizure frequency in patients diagnosed with focal onset epilepsy, which causes seizures in a specific part of the brain.

Participants must be aged 18 to 75 and are randomly assigned to receive one of two different dose strengths or a placebo, a non-active dose that is vital for comparison purposes. A diagnosis of focal onset epilepsy must have been made at least one year prior and participants must experience four or more seizures in a 28-day period, have been unsuccessfully treated with at least two anti-seizure medications, and must be “on a stable dose of at least one and up to three anti-seizure treatments.”

By Deborah Vankin, Los Angeles Times

Your heart is racing, your arms are tingling and your breathing is shallow. You’re having an anxiety attack. And you’re in a public place, to boot. A crowded restaurant, say, or at the office. Not a space where you can comfortably lay on the ground and do some deep breathing exercises to calm yourself.

What if there were a pill that would instead induce that kind of calm breathing for you? That scenario might be possible after a new scientific breakthrough.

Neuroscientists at the Salk Institute for Biological Studies in La Jolla have identified a brain pathway that instantly deflates anxiety. The new study, which published earlier this week in the scientific journal Nature Neuroscience, lays out how the aforementioned brain circuit regulates voluntary breathing — meaning conscious breathing as opposed to automatic breathing that happens without your having to think about it — allowing us to slow our breath and calm our mind.

The discovery opens up the potential for the creation of new drugs that would mimic the relaxed state common during breath work, meditation or yoga. Sung Han, senior author of the study, says he’d like to one day see a “yoga pill,” as he calls it, on the market to ease anxiety. It would likely be useful for the more than 40 million adults in the U.S, who, according to the National Alliance on Mental Illness, suffer from an anxiety disorder.

Han says the new discovery is a real scientific breakthrough.

“As a scientist, finding something never known before is always exciting,” he told the Los Angeles Times. “This top-down breathing circuit has been a longstanding question in the neuroscience field. It’s exciting to find the neural mechanism to explain how the slowing down of breathing can control negative emotions, like anxiety and fear.”

We’ve long known that we can control our breathing patterns to alter our state of mind — when we get stressed, we might take a deep, slow breath to feel calmer. But scientists didn’t understand how that worked — which parts of the brain were actually slowing our breath and why that activity makes us calmer. Now they know that there is a group of cells in the cortex, the higher part of the brain responsible for more conscious, complex thought, that send messages to the brain stem, which in turn sends information to the lungs. That’s the aforementioned “circuit.”

The discovery validates soothing behavioral practices such as yoga, mindfulness and even “box breathing” — the latter a technique that involves repeatedly breathing in, then holding your breath, for four-second counts in order to relieve stress — because it grounds these behavioral practices in science.

But the practical applications is what makes the Salk discovery so important, Han says.

“It can, potentially, create a whole new class of drugs that can more specifically target anxiety disorder,” he says.

These would differ from common anti-anxiety medications by more specifically targeting areas of the brain. Common anti-anxiety drugs like Xanax and Lexapro target multiple areas of the brain that control multiple brain processes and behaviors. It’s why these drugs don’t work for everyone in the same way and may create unwanted side effects. More precisely targeting an individual brain circuit makes a medication more effective and reduces potential side effects. And, in extreme cases, such a pill might be more efficient for targeting anxiety than doing breathing exercises.

“If you’re in panic, breathing techniques alone may not be sufficient to suppress anxiety,” Han says.

Han’s team is now trying to find the opposite circuit — a fast breathing circuit — that increases anxiety.

“To target the slow breathing circuit, we need to understand the opposite circuit, so we can avoid targeting it,” Han says. “To relieve the anxiety.”

While Han hopes his findings will lead to a “yoga pill,” that’s likely a long ways off. The research, and ensuing clinical trials, could take as much as 10 years, he says. And nothing is for certain.

“I cannot say that this discovery is directly connected to the discovery of the new medication,” Han says. “But I can say it’s a stepping stone. We now know the pathway. That’s exciting. That is the first step.”

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

Karen Kaplan | (TNS) Los Angeles Times

It’s been two weeks since Donald Trump won the presidential election, but Stacey Lamirand’s brain hasn’t stopped churning.

“I still think about the election all the time,” said the 60-year-old Bay Area resident, who wanted a Kamala Harris victory so badly that she flew to Pennsylvania and knocked on voters’ doors in the final days of the campaign. “I honestly don’t know what to do about that.”

Neither do the psychologists and political scientists who have been tracking the country’s slide toward toxic levels of partisanship.

Fully 69% of U.S. adults found the presidential election a significant source of stress in their lives, the American Psychological Association said in its latest Stress in America report.

The distress was present across the political spectrum, with 80% of Republicans, 79% of Democrats and 73% of independents surveyed saying they were stressed about the country’s future.

That’s unhealthy for the body politic — and for voters themselves. Stress can cause muscle tension, headaches, sleep problems and loss of appetite. Chronic stress can inflict more serious damage to the immune system and make people more vulnerable to heart attacks, strokes, diabetes, infertility, clinical anxiety, depression and other ailments.

In most circumstances, the sound medical advice is to disengage from the source of stress, therapists said. But when stress is coming from politics, that prescription pits the health of the individual against the health of the nation.

“I’m worried about people totally withdrawing from politics because it’s unpleasant,” said Aaron Weinschenk, a political scientist at the University of Wisconsin-Green Bay who studies political behavior and elections. “We don’t want them to do that. But we also don’t want them to feel sick.”

Modern life is full of stressors of all kinds: paying bills, pleasing difficult bosses, getting along with frenemies, caring for children or aging parents (or both).

The stress that stems from politics isn’t fundamentally different from other kinds of stress. What’s unique about it is the way it encompasses and enhances other sources of stress, said Brett Ford, a social psychologist at the University of Toronto who studies the link between emotions and political engagement.

For instance, she said, elections have the potential to make everyday stressors like money and health concerns more difficult to manage as candidates debate policies that could raise the price of gas or cut off access to certain kinds of medical care.

Layered on top of that is the fact that political disagreements have morphed into moral conflicts that are perceived as pitting good against evil.

“When someone comes into power who is not on the same page as you morally, that can hit very deeply,” Ford said.

Partisanship and polarization have raised the stakes as well. Voters who feel a strong connection to a political party become more invested in its success. That can make a loss at the ballot box feel like a personal defeat, she said.

There’s also the fact that we have limited control over the outcome of an election. A patient with heart disease can improve their prognosis by taking medicine, changing their diet, getting more exercise or quitting smoking. But a person with political stress is largely at the mercy of others.

“Politics is many forms of stress all rolled into one,” Ford said.

Weinschenk observed this firsthand the day after the election.

“I could feel it when I went into my classroom,” said the professor, whose research has found that people with political anxiety aren’t necessarily anxious in general. “I have a student who’s transgender and a couple of students who are gay. Their emotional state was so closed down.”

That’s almost to be expected in a place like Wisconsin, whose swing-state status caused residents to be bombarded with political messages. The more campaign ads a person is exposed to, the greater the risk of being diagnosed with anxiety, depression or another psychological ailment, according to a 2022 study in the journal PLOS One.

Political messages seem designed to keep voters “emotionally on edge,” said Vaile Wright, a licensed psychologist in Villa Park, Illinois, and a member of the APA’s Stress in America team.

“It encourages emotion to drive our decision-making behavior, as opposed to logic,” Wright said. “When we’re really emotionally stimulated, it makes it so much more challenging to have civil conversation. For politicians, I think that’s powerful, because emotions can be very easily manipulated.”

Making voters feel anxious is a tried-and-true way to grab their attention, said Christopher Ojeda, a political scientist at UC Merced who studies mental health and politics.

“Feelings of anxiety can be mobilizing, definitely,” he said. “That’s why politicians make fear appeals — they want people to get engaged.”

On the other hand, “feelings of depression are demobilizing and take you out of the political system,” said Ojeda, author of “The Sad Citizen: How Politics is Depressing and Why it Matters.”

“What [these feelings] can tell you is, ‘Things aren’t going the way I want them to. Maybe I need to step back,’” he said.

Genessa Krasnow has been seeing a lot of that since the election.

The Seattle entrepreneur, who also campaigned for Harris, said it grates on her to see people laughing in restaurants “as if nothing had happened.” At a recent book club meeting, her fellow group members were willing to let her vent about politics for five minutes, but they weren’t interested in discussing ways they could counteract the incoming president.

“They’re in a state of disengagement,” said Krasnow, who is 56. She, meanwhile, is looking for new ways to reach young voters.

“I am exhausted. I am so sad,” she said. “But I don’t believe that disengaging is the answer.”

That’s the fundamental trade-off, Ojeda said, and there’s no one-size-fits-all solution.

“Everyone has to make a decision about how much engagement they can tolerate without undermining their psychological well-being,” he said.

Lamirand took steps to protect her mental health by cutting social media ties with people whose values aren’t aligned with hers. But she will remain politically active and expects to volunteer for phone-banking duty soon.

“Doing something is the only thing that allows me to feel better,” Lamirand said. “It allows me to feel some level of control.”

Ideally, Ford said, people would not have to choose between being politically active and preserving their mental health. She is investigating ways to help people feel hopeful, inspired and compassionate about political challenges, since these emotions can motivate action without triggering stress and anxiety.

“We want to counteract this pattern where the more involved you are, the worse you are,” Ford said.

The benefits would be felt across the political spectrum. In the APA survey, similar shares of Democrats, Republicans and independents agreed with statements like, “It causes me stress that politicians aren’t talking about the things that are most important to me,” and, “The political climate has caused strain between my family members and me.”

“Both sides are very invested in this country, and that is a good thing,” Wright said. “Antipathy and hopelessness really doesn’t serve us in the long run.”

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

WASHINGTON — President elect Donald J. Trump announced on Tuesday night that he would nominate Dr. Jay Bhattacharya, a Stanford professor of health policy and outspoken critic of the nation’s public health system, to lead the National Institutes of Health.

In a statement on social media, Trump said that “Together, Jay and RFK Jr. will restore the NIH to a Gold Standard of Medical Research as they examine the underlying causes of, and solutions to, America’s biggest health challenges, including our Crisis of Chronic Illness and Disease,” referring to Robert F. Kennedy Jr., his choice to lead the NIH’s parent agency, the Department of Health and Human Services.

If confirmed by the U.S. Senate, Bhattacharya would lead the $47.5 billion agency that is the world’s largest funder of biomedical research. NIH is a collection of 27 institutes and centers focusing on cancer, infectious disease, mental health, heart and lung ailments and drug abuse, among other medical matters.

“I am honored and humbled by President Trump’s nomination of me to be the next NIHdirector,”  Bhattacharya said on X. “We will reform American scientific institutions so that they are worthy of trust again and will deploy the fruits of excellent science to make America healthy again!”

In choosing Bhattacharya, Trump is picking someone with expertise in economics and health care policy who leads Stanford’s Center on the Demography and Economics of Health and Aging. With an MD and PhD in economics, he is a senior fellow at the Stanford Institute for Economic Policy Research, as well as a research fellow at the Hoover Institution.

But he has no experience in basic or applied clinical biomedical research and has never held a government post. For the past 50 years, NIH has been led by known authorities in fields ranging from radiology to genetics. Many of them directed smaller agencies before stepping up to lead NIH, a job with immense administrative responsibilities.

He would replace Dr. Monica M. Bertagnolli, a cancer surgeon and lab scientist who championed the use of artificial intelligence tools to create a research database. She also worked to make clinical trials more accessible to rural and minority patients.

Prior to spring 2020, Bhattacharya was a little-known academic who specialized in health policy issues such as physician payment, costs and quality of care, geographic variation in medical practices and regulatory surveillance of FDA-approved products. Prior to joining the Stanford faculty, he was an economist at the RAND Corporation and taught classes in the economics department at UCLA.

But when the COVID pandemic broke out, Bhattacharya emerged as a leading critic of the interventions taken against the pandemic, such as business and school closings, mask and social distancing advisories and lockdowns.

The lockdowns and school closures created economic and societal devastation, he argued. He called for pursuing “herd immunity” through natural infections of those who were not sick or elderly.

He took aim at the NIH, saying it engaged in “massive suppression of scientific debate and research.” The CDC, he said, “exaggerated risk.” The FDA approved vaccines and therapeutics with “little to no evidence, sometimes based on faulty modeling,” he claimed.

In response, he experienced racist attacks and death threats during the pandemic, he wrote.

He praised the outcome of the 2024 election, calling it a “vote against the establishment and in favour of fundamental reforms,” in a recent essay on the website Unherd. The Biden administration engaged in “orchestrated PR campaigns,” he wrote, “spreading falsehoods and misinformation.”

Critics say he lacks the credentials needed to lead NIH.

“NIH is an institution that is founded on the basis of respect for subject matter expertise,” said Dr. Robert Morris, an epidemiologist and former professor at Tufts University School of Medicine.

“Dr. Bhattacharya has repeatedly shown disregard for subject matter expertise over the course of the COVID pandemic,” he said, “dismissing feedback from experts in virology, pathology, and epidemiology, while he, as an economist, was conducting an epidemiological study, despite having almost no training or experience in the field.”

Lucky Tran, a science communicator and PhD biochemist based in New York City, said “Dr.Bhattacharya has spread misinformation about vaccines and COVID, fought against lifesaving public health measures during the pandemic, and is backed by well-funded organizations which undermine public health in order to further corporate interests.  More than ever, the NIH needs to be led by an expert who is a strong supporter of groundbreaking research on new vaccines, treatments, and emerging infectious diseases. “

It was rumored that the Trump team was initially seeking candidates who could bring strong operational experience to helm the huge health research agency. According to the biopharma newsletter Endpoints News, the search included Moncef Slaoui, a longtime pharmaceutical executive at GSK who led Operation Warp Speed, the successful COVID-19 vaccine rollout by the previous Trump Administration.  A source told the newsletter that Slaoui said he was not interested, and volunteered other names.

But Bhattacharya’s contrarian stance has earned support with many leading conservatives on Capitol Hill, who say they are seeking reformers willing to battle the bureaucracy.

“Dr. Bhattacharya understands the need for significant reform following the failure of the public health establishment during the COVID-19 pandemic and has the knowledge and fortitude to do it,” said Rep. Brad Wenstrup (R-Ohio), chairman of the Select Subcommittee on the Coronavirus Pandemic, in a statement. “He would ensure that public health returns to science-based solutions — not bureaucratic failed practices.”

Bhattacharya is a co-author of the controversial Great Barrington Declaration, a manifesto published in October 2020 that argued for an easing of restrictions in favor of “focused protection” — sheltering those at risk of dying but allowing younger people to return to public life and build up immunity through the natural spread of the virus.

He accused Dr. Anthony Fauci, former director of the National Institute of Allergy and Infectious Disease, of  seeking to destroy the careers of dissenting scientists.

Bhattacharya was a plaintiff in a lawsuit, Murthy v. Missouri, that claimed Biden administration officials pressured social media outlets to suppress content critical of the government’s COVID policies. The U.S. Supreme Court in June ruled the plaintiffs lacked standing to pursue their claims.

He is a supporter of Health and Human Services secretary nominee Robert Kennedy Jr., commending Kennedy’s vows to end the United States’ chronic disease epidemic and clean up corruption in the medical and pharmaceutical industries.

If appointed, Bhattacharya would have no direct authority over the CDC and FDA, agencies he fiercely criticized during the COVID pandemic, The CDC, FDA and NIH are separate operating divisions within the Department of Health and Human Services.

At NIH, Bhattacharya vowed he would change NIH’s “top-down leadership,” setting term limits on institute directors to encourage the influx of new ideas, he told NewsMax TV.  He also said he would strengthen the role of replication in research, helping build confidence in the reliability and generalizability of study results.

“Turn the NIH from something that…control(s) society,” he said on NewsMax, “into something that’s aimed at the discovery of truth to improve the health of Americans.”

Nada Hassanein | (TNS) Stateline.org

Houston OB-GYN Dr. Hillary Boswell says she has seen how abortion bans affect teenage girls: More of them are carrying their pregnancies to term.

“These are vulnerable girls, and it’s just heartbreaking to see the number of pregnant 13-year-olds I’ve had to take care of,” Boswell said, referring to the change since Texas prohibited abortions after six weeks in September 2021. In June 2022, after the U.S. Supreme Court overturned Roe v. Wade, Texas enacted a total abortion ban.

“They would come in, and they would be very distressed,” said Boswell, who spent the past decade treating underserved women and girls at community health clinics. Not being able to help them get an abortion when they wanted one, she said, “was so hard — and so against everything that I trained for.”

In the year after Texas began implementing its six-week abortion ban, teen fertility rates in the state rose for the first time in 15 years, according to a study released earlier this year by the University of Houston.

Overall, the increase in teen fertility in Texas was slight: only 0.39%. But the University of Houston researchers said the change was significant, because it reversed a 15-year trend and because the national teen fertility rate declined during the same period. They also noted that the increases were larger for Hispanic teens (1.2%) and Black teens (0.5%), while the rate for white teens declined by 0.5%.

So far, the Texas data is the first evidence that abortion bans might lead to an increase in teen births. But as abortion restrictions have spread post-Roe — 13 states now have total bans — some providers and other experts predict that other states will see increases. If so, the nation’s nearly 30-year trend of declining teen births could be in jeopardy.

Boswell and other providers note that teens are having a harder time accessing contraception and abortions — and they fear the incoming Trump administration could make it even more challenging for teens, whose pregnancies are riskier and who disproportionately sought abortions before the Supreme Court overturned Roe.

“In a lot of ways, Texas is sort of a microcosm of what we’re going to see in other parts of the country,” said Dr. Bianca Allison, a pediatrician and assistant professor at the University of North Carolina School of Medicine. “Historically, it has always felt like young people — those who are minors but of reproductive potential — are left out of the conversation of reproductive autonomy and rights.”

Access to pills

People seeking abortions have been relying on the broader availability of telehealth for medication abortions, which now account for nearly two-thirds of all abortions. The number of abortions in the U.S. has increased since the fall of Roe, largely because more people are using the easier-to-access method, according to the Society of Family Planning.

But the Trump administration could make it harder to procure the pills by reversing a current U.S. Food and Drug Administration policy that allows them to be sent through the mail. Some anti-abortion groups want the Trump administration to enforce the Comstock Act, a long-dormant 1873 law they believe could be used to make it a federal crime to send or receive abortion medication.

States also could require in-person physician visits for abortion medication, effectively barring patients from accessing it via telemedicine.

And Louisiana last month began classifying mifepristone and misoprostol — the two medications used in nonsurgical abortions — as controlled substances, making it a crime to possess them without a prescription. A Texas state lawmaker has proposed similar legislation in his state.

“I would absolutely predict that we will see a reversal in our progress of reducing teen pregnancies,” said developmental psychologist Julie Maslowsky, an associate professor at the University of Michigan who studies adolescent reproductive and sexual health.

“If someone does not want to be pregnant, they should have all the options available to them to prevent pregnancy,” Maslowsky said. “And the majority of teens do not desire a pregnancy.”

Teenage girls tend to have less money, less access to transportation and less independence than adult women. That makes it harder for them to cross state lines for abortion care, or to obtain and pay for abortion medication. A medication abortion can cost as much as $800, according to Planned Parenthood.

Many teens have trouble ordering abortion medication online because they don’t have credit or debit cards or a safe place where the pills can be mailed, said Rosann Mariappuram, senior reproductive rights policy counsel at the State Innovation Exchange, a nonprofit that advocates for progressive policies. Abortion funds that help people who can’t afford the care have been struggling to keep up with demand.

Thirty-six states require parental consent or notification before a minor can get an abortion, creating another barrier. And teens are more likely to have irregular menstrual cycles, which makes them less likely to notice a missed period. Overall, about a fourth of women might not realize they’re pregnant at six weeks, which is the gestational time limit for abortions in Florida, Georgia, Iowa and South Carolina.

In addition, a law in Texas that went into effect in April mandates that family planning clinics get parental consent for minors seeking birth control. Lawmakers in Oklahoma and Indiana have argued that IUDs and emergency contraceptives are types of abortions, and thus should not be covered by insurance or shouldn’t be available, said Mariappuram.

“That conflation of contraceptives with abortion care is just evidence that they’re coming for contraception,” she said.

Health risks, diminished prospects

Teenage girls from disadvantaged backgrounds are more likely to become pregnant. There have been persistent racial disparities in the national teen birth rate, with rates at least twice as high among Black, Hispanic and Native American girls. And while the average age of a girl’s first menstrual period has been declining for all girls, the trend is particularly pronounced among racial minorities.

“These downstream impacts [of abortion restrictions] are not the same for everyone,” said Mayra Pineda-Torres, an assistant professor of economics at Georgia Tech who specializes in gender and inequality. “The reality is that, still, there is a racial component here that may be exacerbating racial inequalities or this inability to access abortion services.”

Teenage motherhood often derails a girl’s education and diminishes her long-term financial prospects. And pregnancy poses particular health risks for teens: They are more likely to experience serious complications, including blood pressure-related disorders such as preeclampsia, and their babies are more likely to be born underweight. For those reasons, the American Academy of Pediatrics says teens should have access to legal abortion care.

But to abortion opponents, teen pregnancies and births are preferable to teen abortions. Joe Pojman, founder and executive director of the Texas Alliance for Life, said the state has programs designed to help families, including teen parents, take care of their children.

“[The program] teaches them a variety of things, like how to manage a budget, how to apply for a job, how to basically make that child self-sufficient to be able to function,” Pojman told Stateline.

“We don’t want to encourage a child to be responsible for taking the life of her own unborn child,” he said.

Last month, Missouri Attorney General Andrew Bailey filed a lawsuit with fellow Republican attorneys general in Kansas and Idaho that asked a Texas judge to order the FDA to reinstate restrictions on mifepristone. They argued that lower teen birth rates harmed their states by shrinking their population, costing them federal money and congressional representation.

But some studies suggest the opposite. The federal government cites research showing that teen pregnancy costs taxpayers about $11 billion per year because it leads to more public spending on health care, foster care, incarceration rates of teen parents’ children, and lower education and income.

“Pregnancy is not benign,” said Allison, the North Carolina pediatrician. “It’s not a joyful, welcome thing for a lot of people across the country.”

©2024 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

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By JONEL ALECCIA

Ready or not, the holidays are here. It’s a time when many Americans accustomed to preparing simple meals find themselves responsible for safely serving multi-dish feasts.

It’s no easy task. Outbreaks of some types of food poisoning tend to rise in November and December, according to the U.S. Centers for Disease Control and Prevention. Tainted turkey, undercooked stuffing and germ-laced gravy from holiday buffets have all led to past illnesses — and even deaths — CDC investigators have found.

It can be tricky for occasional cooks to prepare big meals in a way that avoids the common hazards that can make people sick, said Donald Schaffner, a food science expert at Rutgers University.

“Cooking takes longer with big masses of food. Cooling takes longer with big masses of food,” said Schaffner, who co-hosts the food-safety podcast “Risky or Not?”

Together with podcast co-host Benjamin Chapman, a food scientist at North Carolina State University, Schaffner outlined common ways to keep holiday meals both festive and safe.

Prepare the turkey

Nearly 90% of U.S. hosts plan to serve turkey on Thanksgiving this year, according to the turkey producer Butterball.

But raw turkey can harbor illness-causing bacteria such as salmonella, campylobacter and other germs. It must be handled safely to prevent those bugs from contaminating refrigerator surfaces, sinks and kitchen counters.

A frozen bird must be thawed first. There are several accepted methods, including in the refrigerator, in the microwave or in cold running water, Schaffner said.

“All of these methods pose risks,” he cautioned.

A frozen turkey needs about 24 hours for every 4 to 5 pounds of weight to thaw in a refrigerator, according to the Agriculture Department. If you use a microwave or the cold water method, the bird must be cooked immediately. For details about safe turkey handling, check out the thawing and cooking calculators created by the USDA.

And don’t wash the turkey. It’s a bad idea to rinse it in the sink, even though many cooks still insist on the practice, often out of habit, said Chapman.

“Anything that hits that surface and generates spray is going to basically spread contamination around your kitchen,” he said.

Instead, pat the turkey dry with paper towels and toss them, or use a kitchen towel and disinfect it in the laundry.

What about roasting?

Turkey needs to reach a cooked temperature of 165 degrees Fahrenheit before serving. The best way to tell if it’s cooked is to use a tip-sensitive digital thermometer inserted in the innermost section of the thigh, not touching the bone.

Don’t rely on the plastic pop-up thermometers stuck in some commercial turkeys. Chapman’s past research shows that those buttons can activate well before the bird is actually done.

At the same time, don’t determine doneness by relying on signs such as golden-brown skin, whether the meat is no longer pink or whether the juices run clear.

“None of those are great indicators of temperature,” Chapman said.

Side dishes and leftovers

How you handle the rest of the meal — mashed potatoes, gravy, green beans or yams — is just as important as the main dish. It’s crucial to avoid the so-called danger zone of temperatures between 40 degrees and 140 degrees Fahrenheit, where bacteria can easily grow.

The key is to keep hot foods piping hot and cold foods cold — and to refrigerate everything promptly, Schaffner said.

“The recommendation is that you get those leftovers into the refrigerator within two hours of when they came off of the stove,” he said.

Make sure to refrigerate dense foods like sliced turkey, cooked sweet potatoes or gravy in shallow containers to help them cool down fast. Schaffner’s recent research showed that foods cooled in containers at a depth of no more than 2 inches posed little risk of growing dangerous germs.

Keep it clean

One key way to avoid food poisoning is through scrupulous cleaning in the kitchen.

Wash your hands before preparing food and after touching raw poultry. Use separate cutting boards, knives and other utensils when handling raw meat and fresh foods such as vegetables and salads.

Pay close attention to any surface that may be contaminated. It’s important to clean first with soap and water and then sanitize with a disinfectant — a two-step process.

 

Julie Appleby | KFF Health News

Unauthorized switching of Affordable Care Act plans appears to have tapered off in recent weeks based on an almost one-third drop in casework associated with consumer complaints, say federal regulators. The Centers for Medicare & Medicaid Services, which oversees the ACA, credits steps taken to thwart enrollment and switching problems that triggered more than 274,000 complaints this year through August.

Now, the annual ACA open enrollment period that began Nov. 1 poses a real-world test: Will the changes curb fraud by rogue agents or brokerages without unduly slowing the process of enrolling or reducing the total number of sign-ups for 2025 coverage?

“They really have this tightrope to walk,” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. “The more you tighten it up to prevent fraud, the more barriers there are that could inhibit enrollment among those who need the coverage.”

CMS said in July that some types of policy changes — those in which the agent is not “affiliated” with the existing plan — will face more requirements, such as a three-way call with the consumer, broker, and a healthcare.gov call center representative.

In August, the agency barred two of about a dozen private sector online-enrollment platforms from connecting with healthcare.gov over concerns related to improper switching.

And CMS has suspended 850 agents suspected of being involved in unauthorized plan-switching from accessing the ACA marketplace.

Still, the clampdown could add complexity to enrollment and slow the process. For example, a consumer might have to wait in a queue for a three-way call, or scramble to find a new agent because the one they previously worked with had been suspended.

Given that phone lines with healthcare.gov staff already get busy — especially during mid-December — agents and policy analysts advise consumers not to dally this year.

“Hit the ground running,” said Ronnell Nolan, president and CEO of Health Agents for America, a professional organization for brokers.

Meanwhile, reports are emerging that some rogue entities are already figuring out workarounds that could undermine some of the anti-fraud protections CMS put in place, Nolan said.

“Bottom line is: Fraud and abuse is still happening,” Nolan said.

Brokers assist the majority of people actively enrolling in ACA plans and are paid a monthly commission by insurers for their efforts. Consumers can compare plans or enroll themselves online through federal or state marketplace websites. They can also seek help from people called assisters or navigators — certified helpers who are not paid commissions. Under a “find local help” button on the federal and state ACA websites, consumers can search for nearby brokers or navigators.

CMS says it has “ramped up support operations” at its healthcare.gov marketplace call centers, which are open 24/7, in anticipation of increased demand for three-way calls, and it expects “minimal wait times,” said Jeff Wu, deputy director for policy of the CMS Center for Consumer Information and Insurance Oversight.

Wu said those three-way calls are necessary only when an agent or a broker not already associated with a consumer’s enrollment wants to change that consumer’s enrollment or end that consumer’s coverage. It does not apply to people seeking coverage for the first time.

Organizations paid by the government to offer navigator services have a dedicated phone line to the federal marketplace, and callers are not currently experiencing long waits, said Xonjenese Jacobs, director of Florida Covering Kids & Families, a program based at the University of South Florida that coordinates enrollment across the state through its Covering Florida navigator program.

Navigators can assist with the three-way calls if a consumer’s situation requires it.

“Because we have our quick line in, there’s no increased wait time,” Jacobs said.

The problem of unauthorized switches has been around for a while but took off during last year’s open enrollment season.

Brokers generally blamed much of the problem on the ease with which rogue agents can access ACA information in the federal marketplace, needing only a person’s name, date of birth, and state of residence. Though federal regulators have worked to tighten that access with the three-way call requirement, they stopped short of instituting what some agent groups say is needed: two-factor authentication, which could involve a code accessed by a consumer through a smartphone.

Unauthorized switches can lead to a host of problems for consumers, from higher deductibles to landing in new networks that do not include their preferred physicians or hospitals. Some people have received tax bills when unauthorized policies came with premium credits for which they did not qualify.

Unauthorized switches posed a political liability for the Biden administration, a blemish on two years of record ACA enrollment. The practice drew criticism from lawmakers on both sides of the aisle; Democrats demanded more oversight and punishment of rogue agents, while Republicans said fraud attempts were fueled by Biden administration moves that allowed for more generous premium subsidies and special enrollment periods. The fate of those enhanced subsidies, which are set to expire, will be decided by Congress next year as the Trump administration takes power. But the premiums and subsidies that come with 2025 plans that people are enrolling in now will remain in effect for the entire year.

The actions taken this year to thwart the unauthorized enrollments apply to the federal marketplace, used by 31 states. The remaining states and the District of Columbia run their own websites, with many having in place additional layers of security.

For its part, CMS says its efforts are working, pointing to the 30% drop in complaint casework. The agency also noted a 90% drop in the number of times an agent’s name was replaced by another’s, which it says indicates that it is tougher for rival agents to steal clients to gain the monthly commissions that insurers pay.

Still, the move to suspend 850 agents has drawn pushback from agent groups that initially brought the problem to federal regulators’ attention. They say some of those accused were suspended before getting a chance to respond to the allegations.

“There will be a certain number of agents and brokers who are going to be suspended without due process,” said Nolan, with the health agents’ group. She said that it has called for increased protections against unauthorized switching and that two-factor authentication, like that used in some state marketplaces or in the financial sector, would be more effective than what’s been done.

“We now have to jump through so many hoops that I’m not sure we’re going to survive,” she said of agents in general. “They are just throwing things against the wall to see what sticks when they could just do two-factor.”

The agency did not respond to questions asking for details about how the 850 agents suspended since July were selected, the states where they were located, or how many had their suspensions reversed after supplying additional information.

As open enrollment for Affordable Care Act plans continues through Jan. 15, you’re likely seeing fewer social media ads promising monthly cash cards worth hundreds, if not thousands, of dollars that you can use for groceries, medical bills, rent and other expenses.

But don’t worry. You haven’t missed out on any windfalls. Clicking on one of those ads would not have provided you with a cash card — at least not worth hundreds or thousands.

But you might have found yourself switched to a health insurance plan you did not authorize, unable to afford treatment for an unforeseen medical emergency, and owing thousands of dollars to the IRS, according to an ongoing lawsuit against companies and individuals who plaintiffs say masterminded the ads and alleged scams committed against millions of people who responded to them.

The absence of those once-ubiquitous ads are likely a result of the federal government suspending access to the ACA marketplace for two companies that market health insurance out of South Florida offices, amid accusations they used “fraudulent” ads to lure customers and then switched their insurance plans and agents without their knowledge.

In its suspension letter, the Centers for Medicare & Medicaid Services (CMS) cited “credible allegations of misconduct” in the agency’s decision to suspend the abilities of two companies — TrueCoverage (doing business as Inshura) and BenefitAlign — to transact information with the marketplace.

CMS licenses and monitors agencies that use their own websites and information technology platforms to enroll health insurance customers in ACA plans offered in the federal marketplace.

Suit names long list of defendants

The alleged scheme affected millions of consumers, according to a lawsuit winding its way through U.S. District Court in Fort Lauderdale that seeks class-action status.

An amended version of the suit, filed in August, increased the number of defendants from six to 12:

— TrueCoverage LLC, an Albuquerque, New Mexico-based health insurance agency with large offices in Miami, Miramar and Deerfield Beach. TrueCoverage is a sub-tenant of the South Florida Sun Sentinel in a building leased by the newspaper in Deerfield Beach.

— Enhance Health LLC, a Sunrise-based health insurance agency that the lawsuit says was founded by Matthew Herman, also named as a defendant, with a $150 million investment from hedge fund Bain Capital’s insurance division. Bain Capital Insurance Fund LP is also a defendant.

— Speridian Technologies LLC, accused in the lawsuit of establishing two direct enrollment platforms that provided TrueCoverage and other agencies access to the ACA marketplace.

— Benefitalign LLC, identified in the suit as one of the direct enrollment platforms created by Speridian. Like Speridian and TrueCoverage, the company is based in Albuquerque, New Mexico.

— Number One Prospecting LLC, doing business as Minerva Marketing, based in Fort Lauderdale, and its founder, Brandon Bowsky, accused of developing the social media ads that drove customers — or “leads” — to the health insurance agencies.

— Digital Media Solutions LLC, doing business as Protect Health, a Miami-based agency that the suit says bought Minerva’s “fraudulent” ads. In September, the company filed for Chapter 11 protection from creditors in United States Bankruptcy Court in Texas, which automatically suspended claims filed against the company.

— Net Health Affiliates Inc., an Aventura-based agency the lawsuit says was associated with Enhance Health and like it, bought leads from Minerva.

— Garish Panicker, identified in the lawsuit as half-owner of Speridian Global Holdings and day-to-day controller of companies under its umbrella, including TrueCoverage, Benefitalign and Speridian Technologies.

— Matthew Goldfuss, accused by the suit of overseeing and directing TrueCoverage’s ACA enrollment efforts.

All of the defendants have filed motions to dismiss the lawsuit. The motions deny the allegations and argue that the plaintiffs failed to properly state their claims and lack the standing to file the complaints.

Defendants respond to requests for comment

The Sun Sentinel sent requests for comment and lists of questions about the cases to four separate law firms representing separate groups of defendants.

Three of the law firms — one representing Brandon Bowsky and Number One Prospecting LLC d/b/a Minerva Marketing, and two others representing Net Health Affiliates Inc. and Bain Capital Insurance Fund — did not respond to the requests.

A representative of Enhance Health LLC and Matthew Herman, Olga M. Vieira of the Miami-based firm Quinn Emanuel Urquhart & Sullivan LLP, responded with a short message saying she was glad the newspaper knew a motion to dismiss the charges had been filed by the defendants. She also said that, “Enhance has denied all the allegations as reported previously in the media.”

Catherine Riedel, a communications specialist representing TrueCoverage LLC, Benefitalign LLC, Speridian Technologies LLC, Girish Panicker and Matthew Goldfuss, issued the following statement:

“TrueCoverage takes these allegations very seriously and is responding appropriately. While we cannot comment on ongoing litigation, we strongly believe that the allegations are baseless and without merit.

“Compliance is our business. The TrueCoverage team records and reviews every call with a customer, including during Open Enrollment when roughly 500 agents handle nearly 30,000 calls a day. No customer is enrolled into any policy without a formal verbal consent given by the customer. If any customer calls in as a result of misleading content presented by third-party marketing vendors, agents are trained to correct such misinformation and action is taken against such third-party vendors.”

Through Riedel, the defendants declined to answer follow-up questions, including whether the company remains in business, whether it continues to enroll Affordable Care Act clients, and whether it is still operating its New Mexico call center using another affiliated technology platform.

Lawsuit: COVID relief package made ‘scheme’ possible

The suspension notification from the Centers for Medicare and Medicaid Services letter cites several factors, including the histories of noncompliance and previous suspensions. The letter noted suspicion that TrueCoverage and Benefitalign were storing consumers’ personally identifiable information in databases located in India and possibly other overseas locations in violation of the centers’ rules.

The letter also notes allegations against the companies in the pending lawsuit that “they engaged in a variety of illegal practices, including violations of the (Racketeer Influenced & Corrupt Organizations, or RICO Act), misuse of consumer (personal identifiable information) and insurance fraud.”

The amended lawsuit filed in August names as plaintiffs five individuals who say their insurance plans were changed and two agencies who say they lost money when they were replaced as agents.

The lawsuit accuses the defendants of 55 counts of wrongdoing, ranging from running ads offering thousands of dollars in cash that they knew would never be provided directly to consumers, switching millions of consumers into different insurance policies without their authorization, misstating their household incomes to make them eligible for $0 premium coverage, and “stealing” commissions by switching the agents listed in their accounts.

TrueCoverage, Enhance Health, Protect Health, and some of their associates “engaged in hundreds of thousands of agent-of-record swaps to steal other agents’ commissions,” the suit states. “Using the Benefitalign and Inshura platforms, they created large spreadsheet lists of consumer names, dates of birth and zip codes.” They provided those spreadsheets to agents, it says, and instructed them to access platforms linked to the ACA marketplace and change the customers’ agents of record “without telling the client or providing informed consent.”

“In doing so, they immediately captured the monthly commissions of agents … who had originally worked with the consumers directly to sign them up,” the lawsuit asserts.

TrueCoverage employees who complained about dealing with prospects who called looking for cash cards were routinely chided by supervisors who told them to be vague and keep making money, the suit says.

When the Centers for Medicare and Medicaid Services began contacting the company in January about customer complaints, the suit says TrueCoverage enrollment supervisor Matthew Goldfuss sent an email instructing agents “do not respond.”

How it started

The lawsuit states the “scheme” was made possible in 2021 when Congress passed the American Rescue Plan Act in the wake of the COVID pandemic.

The act made it possible for Americans with household incomes between 100% and 150% of the federal poverty level to pay zero in premiums and it enabled those consumers to enroll in ACA plans all year round, instead of during the three-month open enrollment period from November to January.

Experienced health insurance brokers recognized the opportunity presented by the changes, the lawsuit says. More than 40 million Americans live within 100% and 150% of the federal poverty level, while only 15 million had ACA insurance at the time.

The defendants developed or benefited from online ads, the lawsuit says, which falsely promised “hundreds and sometimes thousands of dollars per month in cash benefits such as subsidy cards to pay for common expenses like rent, groceries, and gas.”

Consumers who clicked on the ads were brought to a landing page that asked a few qualifying questions, and if their answers suggested that they might qualify for a low-cost or no-cost plan, they were provided a phone number to a health insurance agency.

There was a major problem with the plan, according to the lawsuit. “Customers believe they are being routed to someone who will send them a free cash card, not enroll them in health insurance.” By law, the federal government sends subsidies for ACA plans to insurance companies, and not to individual consumers.

Scripts were developed requiring agents not to mention a cash card, and if a customer mentions a cash card, “be vague” and tell the caller that only the insurance carrier can provide that information, the lawsuit alleges.

In September, the defendants filed a motion to dismiss the claims. In addition to denying the charges, they argued that the class plaintiffs lacked the standing to make the accusations and failed to demonstrate that they suffered harm. The motion also argued that the lawsuit’s accusations failed to meet requirements necessary to claim civil violations of the RICO Act.

Miami-based attorney Jason Kellogg, representing the plaintiffs, said he doesn’t expect a ruling on the motion to dismiss the case for several months.

The complaint also lists nearly 50 companies, not named as defendants, that it says fed business to TrueCoverage and Enhance Health. Known in the industry as “downlines,” most operate in office parks throughout South Florida, the lawsuit says.

Complaints from former employees and clients

The lawsuit quotes former TrueCoverage employees complaining about having to work with customers lured by false cash promises in the online ads.

A former employee who worked in the company’s Deerfield Beach office was quoted in the lawsuit as saying that senior TrueCoverage and Speridian executives “knew that consumers were calling in response to the false advertisements promising cash cards and they pressured agents to use them to enroll consumers into ACA plans.”

A former human resources manager for TrueCoverage said sales agents frequently complained “that they did not feel comfortable having to mislead consumers,” the lawsuit said.

Over two dozen agents “came to me with these complaints and showed me the false advertisements that consumers who called in were showing them,” the lawsuit quoted the former manager as saying.

For much of the time the companies operated, the ACA marketplace enabled agents to easily access customer accounts using their names and Social Security numbers, change their insurance plans and switch their agents of record without their knowledge or authorization, the lawsuit says.

This resulted in customers’ original agents losing their commissions and many of the policyholders finding out they suddenly owed far more for health care services than their original plans had required, the suit states.

It says that one of the co-plaintiffs’ health plans was changed at least 22 times without her consent. She first discovered that she had lost her original plan when she sought to renew a prescription for her heart condition and her doctor told her she did not have health insurance, the suit states.

Another co-plaintiff’s policy was switched after her husband responded to one of the cash card advertisements, the lawsuit says. That couple’s insurance plan was switched multiple times after a TrueCoverage agent excluded the wife’s income from an application so the couple would qualify. Later, they received bills from the IRS for $4,300 to cover tax credits issued to pay for the plans.

CMS barred TrueCoverage and BenefitAlign from accessing the ACA marketplace.

It said it received more than 90,000 complaints about unauthorized plan switches and more than 183,500 complaints about unauthorized enrollments, but the agency did not attribute all of the complaints to activities by the two companies.

In addition, CMS restricted all agents’ abilities to alter policyholders’ enrollment information, the lawsuit says. Now access is allowed only for agents that already represent policyholders or if the policyholder participates in a three-way call with an agent and a marketplace employee.

Between June and October, the agency barred 850 agents and brokers from accessing the marketplace “for reasonable suspicion of fraudulent or abusive conduct related to unauthorized enrollments or unauthorized plan switches,” according to an October CMS news release.

The changes resulted in a “dramatic and sustained drop” in unauthorized activity, including a nearly 70% decrease in plan changes associated with an agent or broker and a nearly 90% decrease in changes to agent or broker commission information, the release said.

It added that while consumers were often unaware of such changes, the opportunity to make them provided “significant financial incentive for non-compliant agents and brokers.”

But CMS’ restrictions might be having unintended consequences for law-abiding agents and brokers.

A story published by Insurance News Net on Nov. 11 quoted the president of the Health Agents for America (HAFA) trade group as saying agents are being suspended by CMS after being flagged by a mysterious algorithm that no one can figure out.

The story quotes HAFA president Ronnell Nolan as surmising, “maybe they wrote too many policies on the same day for people who have the same income or they’re writing too many policies on people of a certain occupation.”

Nolan continued, “We have members who have thousands of ACA clients. They can’t update or renew their clients. So those consumers have lost access to their professional agent, which is simply unfair.”

Ron Hurtibise covers business and consumer issues for the South Florida Sun Sentinel. He can be reached by phone at 954-356-4071, on Twitter @ronhurtibise or by email at rhurtibise@sunsentinel.com.

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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.”

---

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.

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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.