Sunday, April 30, 2023

Ky. Covid-19 numbers continue to improve; study says even mild cases of the disease can be hard on the cardiovascular system

By Melissa Patrick
Kentucky Health News

State and federal measurements of Covid-19 in Kentucky continue to improve each week, but Kentuckians are still dying from the virus and new research suggests that even mild cases of the disease can have long-term effects on cardiovascular health. 

The latest weekly report from the state Department for Public Health showed there were 1,717 new cases of the coronavirus in Kentucky last week, or 245 per day. That's a 24% drop from the previous week's 2,264 cases. 

The state's new case-rate dropped to 3.83 cases per 100,000 residents, down a bit from 3.93 the prior week. The top 10 counties were Breathitt, 24.88 cases per 100,000 residents; Clinton, 12.58; Wayne, 10.54; Green, 10.45; Knott, 9.65; Edmonson, 9.41; Shelby, 9.03; Webster, 8.83; Carter, 7.46; and Grant, 7.41.  

The Centers for Disease Control and Prevention risk map shows a small cluster of  three Kentucky counties with a medium risk of Covid-19 transmission, Bracken, Mason and Fleming. The medium risk counties are shown in yellow. The rest of the state has a low risk of Covid-19 transmission, shown in green. 

Centers for Disease Control and Prevention map; click on it to enlarge.
The CDC also has a community-level transmission map, largely used by health-care facilities and researchers, that shows the level of virus in each county, at one of four levels. The latest map shows 25 counties with a low level of transmission and 67 with a medium level; the rest are either substantial or high, withe the biggest cluster in the Bowling Green area. The state says residents should take their guidance for prevention from the other map.

Last week, the state attributed 57 more deaths to Covid-19, up from 51 in the previous report, bringing the state's death toll to 18,512. 

Mild cases of Covid-19 can hurt your heart 

A first-of-its-kind study that compared artery stiffness in participants pre- and post-infection found that  "even mild cases of Covid-19 can have long-term detrimental effects on cardiovascular health, says a University of Portsmouth news release.

“Given the number of people infected with Covid-19 worldwide, the fact that infection can have harmful effects on cardiovascular health in young people who had a mild form of the disease warrants close monitoring," Professor Ana Jeroncic from the University of Split in Croatia, who led the study, said in the release. “The question remains as to whether this harmful effect is irreversible or permanent, and if not, for how long it lasts.”

The release notes that the study, published in the Journal of Clinical Medicine, was the first to compare pre and post Covid-infection levels of arterial stiffness, a marker associated with aging and function of arteries. Participants were monitored between October 2019 and April 2022 and most were less than 40 years old and healthy. 

The international team of scientists used baseline measurements from a group of participants involved in a separate study that began pre-pandemic that was also investigating arterial stiffness. They found that "age and time from Covid-19 infection is associated with increased ageing of the arteries, which "could lead to cardiovascular disease development." 

“We were surprised to observe such a decline in vascular health, which deteriorated even further with time since Covid-19 infection. Usually, you’d expect inflammation to decrease with time after infection, and for all the physiological functions to go back to normal or a healthy level," study co-author Dr. Maria Perissiou of the University of Portsmouth’s School of Sport, Health & Exercise Science, said in the release.

She added, “We can only speculate on what causes this phenomenon without further investigation, but emerging evidence suggests that it stems from Covid-19 triggering the auto-immune process that leads to vasculature deterioration.”

The paper concludes that these results have important implications for understanding the long-term cardiovascular consequences of Covid-19 and may guide prevention and management strategies for associated vascular disease. It also recommends further research is needed to strengthen our understanding of causes and contributing factors.

988 suicide-and-crisis lifeline is free and available to anyone in crisis; calls have increased 23% since launch nine months ago

By Melissa Patrick
Kentucky Health News

Kentucky calls to 988, the short, easy-to-remember crisis hotline for mental health, have increased by 23% since it rolled out nine months ago, and there have been 15% fewer abandoned calls, according to Gov. Andy Beshear.

"More people are calling and more people are staying on and talking to someone that can help," Beshear said at his weekly news conference Thursday. "This means Kentuckians facing a risk of suicide, mental-health distress or an addiction crisis are getting connected with compassionate trained counselors more often and faster than ever before. "

988 is confidential and accepts calls, texts, and chats from anyone who needs support for a suicidal, mental-health and/or substance-use crisis.

It is available 24 hours a day, every day and is free of charge. It is available to people of all ages in crisis, and to family members and loved ones seeking guidance. 

"Our first mission is to be here," says Kentucky's 988 website. "So often, the lifeline is about listening and providing an understanding voice. In fact, 95% of lifeline calls are resolved over the phone. But when that’s not enough, we’ll ensure the warmest possible handoff of 988 callers within Kentucky’s crisis service system." 

Most of Kentucky's 988 calls go to one of the state's 13 regional mental-health agencies; callers are connected to the center that is closest to them. 

According to state data from the federal Substance Abuse and Mental Health Services Administration, Kentucky's 988 call centers got 2,888 calls in March and 78% of them were answered in-state. 

SAMHSA says Kentucky calls are answered, on average, in 25 seconds, The national average is 35 seconds and the average talk time is just over 13 minutes.

"That shows that 988 is working and has been a great improvement," said Beshear. "I want to thank all of our partners and mental health advocates across the state and beyond who have worked so hard to make this possible. This administration will always support Kentuckians as they seek health care. We believe that mental health is just as important as physical health, and this is helping us to be able to intervene and ensure that we don't lose people."

Saturday, April 29, 2023

UK HealthCare planning major expansions at Lexington locations

UK's Albert B. Chandler Hospital opened the first patient rooms in two new bed towers in 2011; it is about to complete the last of the rooms and start on a new bed tower. (University of Kentucky photo)
By Kentucky Lantern staff

UK HealthCare is launching an expansion that is expected to add 4,800 employees to its “skilled workforce” over the next several years, according to UK news releases.

The plan includes construction of another bed tower near the 12-story hospital that opened in 2011. The projects in UK’s “refreshed” strategic plan could ultimately have a $2.4 billion price tag.

UK trustees on Friday also advanced plans to build an outpatient medical facility in the Hamburg area of Lexington near the intersection of Interstates 75 and 64. Baptist Health is already building an outpatient facility at Hamburg that is expected to open next year.

The area around Hamburg, specifically the 40509 zip code, has the largest concentration of UK employees and is also one of the region’s fastest growing, said UK President Eli Capilouto.

“Our mission is to advance Kentucky in everything that we do and a healthier state where more people have greater access to quality patient care, closer to their home is a critical part of that mission,” Capilouto said.

The UK board had previously approved acquisition of 41 acres in Hamburg and on Friday approved $30 million to begin design of the outpatient project.

Meanwhile, plans for expanding UK's Albert B. Chandler Hospital will provide more inpatient beds and other services.

The plan addresses “steady increases in inpatient volumes” and challenges posed by aging facilities in the original sections of the Chandler Hospital built in 1962 and UK Good Samaritan Hospital, which opened at its current South Limestone location in 1907, a UK news release said.

In addition to the new bed tower, UK will launch an $82 million renovation plan to accommodate improved mother, baby, delivery units; advanced endoscopy; an observational unit in space that now accommodates overflow patients from the emergency department, and up to eight additional operating rooms.

UK will move forward with $180 million to initiate the design phase of the main campus projects.

The first three patient-care floors of the two 12- story bed towers were opened in 2011; the fit-out of the last patient floor will be completed later this year, and UK HealthCare said it expects these beds to be used as soon as the space opens.

UK said the projects are designed to expand access to advanced subspecialty care on campus as well as provide more primary and specialty care in the community to UK employees and for medically underserved areas of Lexington.

The gap in life expectancy across some Fayette County ZIP codes is 11 years, based in part on access to care, a UK release said.

UK Trustee Britt Brockman, chair of the board’s health-care committee, said: “We will remain focused on the mission we established more than 15 years ago — that no matter who you are or where you live in Kentucky, there is a place close to home to meet your advanced care needs. This is who we are. This is what we do. But that also means recognizing and responding to the growing primary and ambulatory care needs of our people and those who don’t have access to the care we provide.”

Friday, April 28, 2023

UK medical school and recently added regional campuses will graduate largest class ever, with 42% staying in Ky. for residency

Students in this year's graduating class of the University of Kentucky College of Medicine at Lexington celebrated Match Day in March, when they learned their residency locations. (UK photo by Mark Mahan)
By Allison Perry
University of Kentucky

In 2013, the Commonwealth of Kentucky Health Care Workforce Capacity Report announced a grim statistic: by 2025, Kentucky would be facing an estimated shortage of 960 primary-care physicians, the third-greatest shortfall in the U.S.

The physician shortage is not limited to primary care. The greatest physician shortages in the state include surgical subspecialties, psychiatry, and pediatric primary and specialty care. Rural areas have long had physician shortages, and 61 percent of the greatest physician needs in Kentucky are in rural areas.

“The physician shortage in Kentucky is severe,” said Dr. Charles “Chipper” Griffith III,  acting dean of the University of Kentucky College of Medicine. “There are counties without a single physician, and even in parts of Lexington and Louisville, there are areas that are underserved.”

In the past two decades, the UK College of Medicine has gradually increased enrollment, boosting class size from 100 per year in the early 2000s to 136 graduating physicians by the year 2013.

With class sizes at maximum limits due to classroom constrictions and clinical capacity, UK was forced to turn away several hundred qualified Kentucky applicants to medical school every year, but the College of Medicine and UK HealthCare have worked with other Kentucky clinical partners and other state universities to create opportunities for more Kentucky medical students through regional medical campuses.

The goal is to increase the number of physicians who will stay in Kentucky to practice medicine, expresed as “training Kentuckians in Kentucky to practice in Kentucky,” 

This year, across all four sites of the UK College of Medicine – Lexington, Morehead, Bowling Green, and Northern Kentucky – a record-setting class of 190 medical students are set to graduate and begin practicing medicine.

All combined, these campuses will be able to graduate up to 201 new physicians each year, with a total enrollment of up to 804.

A banner Match Day for Kentucky

Match Day is a longstanding medical-school tradition, a nationwide event where medical students learn where they have matched for their residencies following graduation. The national initial match rate for medical students is roughly 92%, and UK’s rate has historically been higher. This year’s rate, with the largest-ever class of graduating medical students, is 97%. 

But even more important is the match rate of students remaining in Kentucky, Griffith says. Historically, 25 to 30% of UK medical students matched to a residency in Kentucky. That number began growing in 2019, and this year, 42% of UK graduates will be staying in state to begin practicing medicine as a resident. Since 2017, UK has more than doubled the number of new physicians remaining in the state.

With UK’s largest graduating class matching in Kentucky at the school’s highest rate, this bodes well for reducing the physician gap.

“The biggest factor for a physician practicing in Kentucky is both going to medical school and doing a residency in Kentucky,” Griffith said. “Nearly nine of 10 physicians who do both will remain in state to practice when residency is finished.”

With this in mind, UK has placed more emphasis on enrolling in-state students – in recent decades, roughly 70-75% of medical students were from Kentucky, and the goal now is for 85% of each medical class to be a Kentuckian or have a tie to the state.

The Rural Physician Leadership Program

UK's regional approach began with the Rural Physician Leadership Program, developed with Morehead State University and the Morehead hospital, St. Claire HealthCare. The program was developed to train students who are interested in practicing rural medicine after graduating, and the program has capacity for up to 12 students per year.

RPLP students complete their first two years of education on UK’s main campus in Lexington and spend years three and four in Morehead, rotating through St. Claire and other rural clinical sites in the area.

The program began in 2009. With this year’s class, the RPLP will have graduated 110 physicians well-versed in rural medicine, with their top three residency choices being areas of primary care.

Two of every three RPLP alums are practicing in the state, and 92% of the participants from Kentucky now practice in rural Kentucky.

“The premise behind this program works,” said Dr. Rebecca Todd, associate dean for the RPLP and an obstetrician-gynecologist at the UK HealthCare Morehead Women’s Health Clinic at St. Claire. “It’s hard to transplant someone who is used to – and who loves – an urban area into a rural area. But if you take students from rural communities and train them to be physicians, they want to go back and practice in those rural communities.”

Having the opportunity to live and train in a smaller community allows RPLP students to have more one-on-one time with the physicians they’re learning from, almost like an apprenticeship, Todd says. Students get the advantage of closer mentorship coupled with UK’s rigorous curriculum to prepare them for their careers in medicine.

“When you work with regional campuses, you get both the resources from the larger institution, like UK, but you also have that smaller, close-knit feel,” Todd said. “I think this program really brings out the best in all medical training.”

The UK College of Medicine-Bowling Green campus

In 2018, UK took another huge step in growing its class size by partnering with Western Kentucky University and Med Center Health of Bowling Green, which operates six hospitals and more than 30 clinics in Southern Kentucky. Students complete their classwork and clinical experience in Bowling Green, primarily at The Medical Center at Bowling Green, the system's main hospital.

“We’re meeting the mission,” said Dr. Todd Cheever, a UK associate professor of psychiatry and the associate dean of the Bowling Green campus. “Having students from this region, where they can train close to their families and support systems, is very important.”

Adding this regional campus has enabled UK to train up to 30 more future doctors each year. This year, the Bowling Green campus will graduate its second class, and seven graduates will stay in Bowling Green for residency.

Nearly half of the Bowling Green campus’s two graduating classes matched into primary-care residencies, and 27 matched into Kentucky health systems.

The UK College of Medicine-Northern Kentucky campus

UK’s most recent regional campus, a partnership with Northern Kentucky University and St. Elizabeth Healthcare, will graduate its first class next month.

This campus has an annual capacity of 35 students, who complete coursework and clinical experience in Northern Kentucky. More than 90% of the students are from Kentucky or nearby counties in southwestern Ohio.

Seven of this year’s inaugural class of 30 graduates will remain in Kentucky for residency, while eight will be working at health-care facilities just across the river in Ohio. Five graduates from across all UK College of Medicine sites will go into residency at St. Elizabeth Healthcare.

Looking toward future growth

Griffith offers some simple math to demonstrate the importance of graduating new doctors: If UK graduates 65 more doctors a year than in the recent past, history shows that roughly half – around 33 – will eventually practice in Kentucky. And if the average physician takes care of roughly 5,000 patients in their lifetime, that could be an additional 165,000 patients in Kentucky each year that now have access to a physician compared to past years, he says.

The regional campuses have room for growth, and UK's Lexington medical campus is growing, too. A Health Education Building now being designed, combined with expansion of UK HealthCare’s clinical services, means that the College of Medicine could add 50 to 65 new students per class in Lexington. By the end of the decade, UK could be graduating nearly 280 new doctors each year – more than double the number who graduated in 2021.

Growing class size also means the need for more teachers, but the response from faculty at the regional campuses, has been overwhelmingly positive. The presence of a medical school has helped Med Center Health and St. Elizabeth Healthcare recruit new physicians, and alumni from UK have been particularly energized and engaged.

“A lot of these physicians didn’t plan on being teaching physicians, but they’ve found that it’s invigorating,” Griffith said. “They really enjoy it, and they’re ready to have more students.”

Thursday, April 27, 2023

First round of state grants from settlements with opioid makers and distributors, more than $8 million, go to 24 organizations

Operation UNITE was one of 24 organizations to get a grant from the first round of opioid settlement money. It got $1 million to be used for prevention. (Photos by Melissa Patrick)

By Melissa Patrick
Kentucky Health News

Attorney General Daniel Cameron announced the first 24 organizations to receive over $8 million in grant funding from the state Opioid Abatement Advisory Commission on Thursday, with 14 of the grants going toward treatment and recovery and 10 for prevention of opioid abuse. 

Attorney General Daniel Cameron makes the announcement.
"The opioid crisis lingers and won't be defeated merely with these dollars," Cameron said at a news conference to announce the awards. "But for the first time in a long time, meaningful relief is here. For the first time in a long time, we have something to rally around, we have a reason for hope." 

So far, Kentucky is in line to get nearly $900 million in settlements with drug makers, distributors and big retailers. Cameron has implied he should get sole credit, at odds with the account of Gov. Andy Beshear, who preceded him as attorney general and whose job he wants. 

Under state law, half of opioid-settlement money is allocated annually by the commission, which is housed in the attorney general's office, and the other half is allocated by cities and counties, among themselves. Cameron said he has worked closely with local governments and the legislature to manage these funds responsibly because "Not a dime can be wasted; too much is at stake." 

The money is required to be used for reimbursement of prior expenses and the funding of new programs related to the prevention, treatment and recovery of people with opioid-use disorders and co-occurring substance-use disorders or mental-health issues.

Bryan Hubbard, executive director and chairman of the commission, praised the ongoing commitment of commission members, noting that since being appointed in June 2022, they have had 11 town-hall meetings across the state, 10 business meetings and numerous subcommittee meetings. 

Asked what was gleaned from the town halls, Hubbard said thousands of people attended them and that they inevitably became a "collective, cathartic exercise in communal grief" that revealed common needs across the state, including child-centered prevention programs and recovery services that include housing, transportation services, life-skill training, educational opportunities and formalized vocational training. 

"The organizations that are here . . . have all been resourced to meet those acute needs based on the collected feedback that we receive from thousands," Hubbard said. 

He said the commission hopes to make its next grant announcements sometime in "early to mid-fall" after considering about 65 applications that are seeking $130 million, with only $30 million available. 

Commission Chair and Executive Director Bryan Hubbard
Hubbard said they have 200 applications in the pipeline and that the commission is working to provide grant makers who can offer individualized assistance to organizations that are not used to writing grants "to ensure good, full consideration of our grassroots organizations." 

"We will always remember the thousands of lives that paid for the settlement from which these funds come, for it is blood money," said Hubbard. " You are here because you are the front line foot soldiers who will get in the streets and get in the hollers and bring Kentucky some unified victory." 

Cameron said, "I'm proud to say that because of this office's action, with a lot of you all that are here today, Kentucky stands to receive nearly $900 million in settlement from funds from pharmacies, distributors, wholesalers and manufacturers of opioids. This is Kentucky's share of what is a historic settlement, the second largest such agreement in American history."

Cameron claims sole credit; Beshear says he's shocked

Cameron is a candidate in the May 16 Republican primary to pick a nominee to run against Beshear, who has nominal Democratic opposition. Last week on WKYT-TV's Kentucky Newsmakers, Cameron talked about Beshear filing a lot of lawsuits but bringing no settlement money to the state. Asked about that Thursday, Cameron said: "We wanted to quit talking about the epidemic and bring meaningful dollars into the state. And we've been able to do that. We're in the process of bringing nearly $900 million into the state. Andy Beshear, when he was attorney general, didn't bring any money into the state. So this has been about not just talking, again, but taking action so that we can hopefully start to have meaningful change in Kentucky."

Beshear was attorney general four years, and such suits usually take many years to litigate. Cameron said, "The fortunate thing is that the settlements that we entered into were separate and apart from the litigation that he was involved in here in Kentucky. And so we had to make a decision about, you know, whether we want to continue to talk as he did for four years in this office, or do we want to bring money into the state, and we chose to bring money into the state." 

Nicer in 2019: Beshear at Cameron's swearing-in
Asked at his weekly news conference about Cameron's comments, Beshear said, "I'm a little shocked that the attorney general would say I haven't brought any dollars in in opioid settlements. I filed more lawsuits against opioid manufacturers and distributors than any other attorney general in the country. I think he filed one. Every single lawsuit he's settling right now, I not only filed, but I argued personally in court showing up when companies were trying to blame us, for the millions of pills that they sent, hundreds of thousands into really smart communities.

"Listen, as an attorney, you're always supposed to share credit with other lawyers on the suit on a lawsuit or especially the ones who filed it. And if you'll remember, I settled. Actually, Attorney General [Jack] Conway settled the first opioid lawsuit on his way out of office, I was able to award those funds, but we gave credit all the way back to Greg Stumbo, who filed that [suit]. So certainly, first, as attorney general, we did bring in funds to help treatment. Look at Hope in the Mountains in Prestonsburg; it was going to close down without those funds that we provided. Now, they're Medicaid eligible.

"But, I know I filed those lawsuits. I know I did it so that we could have our best shot of getting out of this epidemic. This is blood money that needs to be spent the right way to get people better." 

The list of grants mentioned specific uses in some cases but not in most. Asked for details, Krista Buckell, communications director for the attorney general's office, merely parroted the law: "Each awardee will be pursuing one or more aspects of prevention or treatment and recovery for individuals and communities that have been impacted by the opioid epidemic across the commonwealth."

By far the largest grants were $1 million each to Operation UNITE (Unlawful Narcotics Investigations, Treatment and Education) of London, for prevention, and Volunteers of America Mid-States of Louisville, for treatment and recovery. The Louisville-based organization says it "operates nearly 50 distinct human service programs in Kentucky, Tennessee, West Virginia and Clark and Floyd counties in Indiana." 

The other 13 grants for treatment and recovery are going to:
  • Shepherd's House of Lexington, a long-term residential recovery program, $141,450. 
  • Appalachian Restoration Project, a residential rehabilitation facility in Barbourville, $250,000. 
  • Chrysalis House of Lexington, Kentucky’s oldest and largest residential treatment program that specializes in treating pregnant and parenting women, $250,000. 
  • Isaiah House, an addiction treatment center with locations across the state, will get $250,000 to support a "comprehensive, dual diagnosis program to help Kentuckians achieve a lifetime of recovery," the list says.
  • Lake Cumberland District Health Department, which serves 10 counties, $250,000. 
  • Mountain Comprehensive Care Center of Prestonsburg, $250,000.
  • Mountain Comprehensive Health Corp., Whitesburg, $250,000.
  • Seven Counties Services, a Louisville-based community mental-health center, $250,000.
  • Young People in Recovery of Louisville, which serves youth and young adults recovering from substance use disorder, $308,232. 
  • Family Scholar House in Louisville, which helps disadvantaged single parents and children reach their educational and career goals, $316,500.
  •  Lake Cumberland Community Action Agency will get $375,268 for "comprehensive programs that help low-income Kentuckians achieve greater economic self-sufficiency."
  • Appalachian Research and Defense Fund of Kentucky, offering free civil legal help to low-income people in 37 counties, $250,000. 
  • Revive Ministries of Nicholasville will get $500,000 to support its faith-based addiction recovery program in Central Kentucky.
The other nine prevention-service grant recipients are: 
  • Kentucky Alliance of Boys & Girls Clubs, $500,000. 
  • Kentucky Harm Reduction Coalition of Louisville, $500,000.
  • Legal Aid of the Bluegrass, $250,000. It provides legal assistance to vulnerable Kentuckians. 
  • Legal Aid Society of Louisville, $250,000 to provide free civil legal help concerning opioid-specific matters to people with incomes at or below federal poverty levels. 
  • Cumberland Trace Legal Services, dba Kentucky Legal Aid, Bowling Green, $250,000. It provides free legal counsel to those struggling with addiction.
  • YMCA of Greater Louisville, $250,000. 
  • Prevent Child Abuse Kentucky, Lexington, $243,050. 
  • Taylor County School District, Campbellsville, $100,000. 
  • Scott County Sheriff, Georgetown, $92,354.13.

Wednesday, April 26, 2023

UK study finds children who were exposed to opioids before birth are more likely to develop chronic diseases when they grow up

By Lindsay Travis
University of Kentucky

What happens to the cardiovascular health of babies exposed to opioids in the womb?

A new study at the University of Kentucky suggests that children born to mothers who use opioids during pregnancy may be more likely to develop chronic diseases as adults, including cardiovascular and metabolic diseases. 

Opioid abuse is a key public-health challenge in Kentucky and the U.S., which saw over half a million opioid-related overdose deaths in 2022 alone. The use and misuse of opioids during pregnancy have grown rapidly over the past decade. On average, about one baby born every 15 minutes in the U.S. has an array of symptoms stemming from opioid use during pregnancy, called neonatal opioid withdrawal syndrome.

NOWS symptoms are usually treatable in babies, but scientists have known little about the potential long-term health impacts of in utero opioid exposure once these children grow up.

Analia Loria, Ph.D.
“It is challenging to predict the long-term impact on the cardiovascular health of children from women with opioid misuse and opioid overdoses due to the lack of follow-ups after discharge,” said Analia Loria, Ph.D., senior study author and an associate professor in the Department of Pharmacology and Nutritional Sciences in the University of Kentucky College of Medicine. “However, our studies provide insights regarding how opioids could affect the programming of the mechanisms regulating cardiovascular function and increase the cardiovascular risk.”

The researchers developed a rat model that mimics the use of drugs during pregnancy and studied what happens to the offspring from birth until adulthood. They found that babies of mothers who used drugs while pregnant were shorter at birth and weighed less during the breastfeeding stage. When they started eating independently, they gained weight quickly and caught up to their non-exposed peers, a pattern that has been found to increase the risk of cardiovascular and metabolic disease.

“Overall, we found that the systems that control blood pressure and how sugar and lipids are processed in our bodies are altered in drug-exposed babies,” said Nermin Ahmed, a registered dietitian and UK doctoral candidate in pharmacology and nutritional sciences. “This could mean that adults who were exposed to drugs in the womb are more likely to develop chronic diseases like high blood pressure, diabetes, chronic kidney disease and high cholesterol, and they may also be more susceptible to other drugs and environmental stressors. This prenatal exposure can permanently change how the body handles a second exposure to opioids.”

As adults, rats exposed to drugs in the womb had higher blood pressure, poorer blood sugar control and increased levels of bad cholesterol despite eating the same type of diet as the nondrug-exposed rats. The researchers also observed differences in the expression of certain proteins and receptors involved in regulating how the brain responds to drugs, raising the possibility that people exposed to opioids in the womb may also face a higher risk of drug dependence later in life.

The study draws attention to the effects of the opioid epidemic on childbearing women and the importance of screening for prenatal opioid exposure. Researchers say that knowing more about such exposures could help to inform disease prevention and treatment approaches throughout the lifespan.

Researchers presented their work in April to the American Physiological Society. The study was published in the American Heart Association’s journal Hypertensiononline here.

Tuesday, April 25, 2023

Beshear administration issues regulations to restore expansion of Medicaid dental, vision and hearing benefits legislature nixed

Family Health Centers in Louisville serves many
Medicaid patients. (FHC Louisville website photo)
By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear has again proposed regulations to expand dental, vision and hearing benefits for  Kentucky adults on Medicaid, after the legislature found similar regulations deficient, thus ending the benefits. 

Each regulation says why it is "substantially different" from the original regulation. Most of the reasons have to do with changes in the services offered under the original and new regulations. This language was necessary because the bill that quashed Beshear's original regulation to expand dental, vision and hearing services for Medicaid adults requires any new regulation to be "substantially different."

The bill had an emergency clause, so it became law as soon as the legislature overrode Beshear's veto. But it also told the Medicaid program to reimburse health-care providers "for services rendered or initiated prior to the effective date of this act," which was March 29.

The proposal is open for public comment through the end of May. 

"The legislature needs to hear from people about whether dental, vision and hearing services do make a difference in their life, if in the past there have been times when they needed additional hearing care or hearing aids or additional dental work," Cara Stewart, policy-advocacy director for Kentucky Voices for Health, which favors expansion of such benefits, told Kentucky Health News.

Anyone interested in participating in a Zoom hearing at 9 a.m. ET May 22 should notify the Cabinet for Health and Family Services in writing by May 15.  Those who have made this request will have a Zoom invitation emailed to them the week before the scheduled hearing. If no requests to attend the public hearing are received by May 15, the hearing may be canceled. 

The cabinet is accepting written comments on the regulations until May 31. Comments should be sent to Krista Quarles, Policy Analyst, Office of Legislative and Regulatory Affairs, 275 East Main Street 5 W-A, Frankfort KY 40621. Her phone number is 502-564-6746; her fax is 502-564-7091; and her email is

Kentucky Voices for Health will also be collecting comments from anyone who would like to make a public comment on these regulations, as they have done before for other rules.  Stewart said KVH will include these comments in their written public comment submission to the health cabinet. 

Stewart said the purpose of their easy-to-use comment collector is to be able to hear people's "real voices" tell what these policies mean in their "real lives because that's what matters most." 

Each of the new regulations addressing expanded dental, vision and hearing services for adults on Medicaid starts by giving reasons they are needed, including concern that failure to implement these services, which have gained federal approval, could result in the loss of federal funds. 

They say the regulations are needed to be able to pay providers for these services, and as a way to ensure that appropriate services are being offered in appropriate settings, instead of emergency rooms. 

Stewart also noted that it is especially important for people to get dental care from an appropriate provider because dental pain in the emergency room is a gateway "to addiction to pain medication." 

"Offering better and more comprehensive dental services is a way to stop that," Stewart said. "So literally, it's a way to save lives and save suffering." 

The regulations say these services will help more than 900,000 Medicaid recipients in Kentucky who are 21 and older return to the workplace.

The governor's veto of Senate Bill 65 said the dental expansion had served "more than 1,000 Kentuckians in all 120 counties" with "nearly 3,330 dental services, including from a dentist in Clay County, who . . . has provided four sets of dentures for patients and has 44 more sets of dentures in progress." Clay County is the home of Senate President Robert Stivers, R-Manchester.

Beshear added, "Nearly 7,000 Kentuckians have received vision services under these regulations, with nearly 43,000 services provided. And 40 Kentuckians have received hearing services with these regulations in place."

Stewart said that having access to dentures and hearing aids will make the biggest difference because many of the managed care organizations already offer glasses as an extra benefit, but not the others. As an example, she noted that many domestic-violence survivors and crime victims have lost teeth and need access to dentures.

"And that really affected their recovery and their ability to feel great about themselves," she said. "And also, every time they open their mouths to smile, they have memories of being abused. . . . There are so many populations for where this is a really big deal." 

State Sen. Stephen West, R-Paris, the sponsor of the bill, has not responded to a request for comment. Legislators complained that Beshear, without consulting them, funded the expansion through savings that Medicaid achieved by having only one pharmacy benefit manager, a middleman between drug manufacturers and the managed-care organizations that deal with Medicaid beneficiaries.

UPDATE, April 26: In a statement to Kentucky Health News, the heath cabinet said the bill affected Medicaid members treated by providers that the state reimburses through fees for services. "Managed-care organizations have the flexibility to continue to provide the extra dental, hearing and vision services referenced in Senate Bill 65 as a value-added benefit to plan enrollees," the cabinet said.

Experts look back at the pandemic and issue a report saying the nation's public-health system was not equipped to deal with it

By Krista Mahr and Daniel Payne
Politico Pulse

As the Covid-19 public health emergency enters its final weeks, Washington is still gripped by debate over how the pandemic started and what the Trump and Biden administrations got wrong. But one thing most can agree on: This won’t be the last time we face off with a deadly pathogen, and we’d better be ready. That’s the premise of a new report released by the Covid Crisis Group, headed by Philip Zelikow, former executive director of the 9/11 Commission.

The group of 34 experts was assembled in 2021 to lay the groundwork for a future Covid commission that never came to be. So they released their findings Tuesday, offering a series of lessons about what went wrong — and occasionally right — in America’s pandemic response. A few highlights:

When 19th century infrastructure met a 21st century virus: America's public-health infrastructure was built on a 19th century design, researchers wrote, focused on the state and local response to outbreaks. The Centers for Disease Control and Prevention, founded as a research center early in the 20th century, was neither conceived nor updated to manage a national health emergency. The modern health-care system evolved separately and with more resources from the nation’s public-health infrastructure, and both public health and the health-care system were detached from the bio-pharma complex, which ultimately made the drugs that saved Americans’ lives.

Policy failure created the pandemic partisan divide, not the other way around: Red and blue states had surprisingly similar approaches to lockdowns and reopenings early in the pandemic, upending the narrative that there were distinct “red” and “blue” pandemic responses. Instead, researchers said, it was a series of federal policy failures that created the toxic political environment that has come to define many people’s feelings about Covid and the government’s response.

Health security is national security: The report hails Operation Warp Speed as a major success in the pandemic response, partly due to researchers already being familiar with coronaviruses and the mRNA vaccine platform already being so advanced. The program helped invest, manufacture and distribute vaccines, and its leadership was granted unusual autonomy by the Trump administration, researchers wrote.

Sunday, April 23, 2023

Kentucky's Covid-19 death rate lower than U.S. average when adjusted for health conditions and average ages in the states

Rates before (L) and after (R) adjustment for conditions; click image to enlarge
By Melissa Patrick
Kentucky Health News

Now that Covid-19 has gone beyond the pandemic phase to the endemic phase, how did Kentucky handle the pandemic? A study has found that Kentucky's coronavirus infection rate and Covid-19 death rate were above the national averages, but the death rate was below average when states' rates were adjusted for their residents' health conditions and average age.

“It is encouraging that the authors found that Kentucky outperformed in preventing Covid-19 deaths relative to the health status of our population," state Health Commissioner Steven Stack said in an email response to Kentucky Health News's request for comment.

"It’s important we remain mindful, however, that more than 18,000 Kentuckians have died from Covid-19 and that our shared journey has been difficult," said Stack, a physician. "I am grateful, though, that Kentuckians confronted this threat together and together have overcome it while showing kindness and caring towards each other." 

The research, published in The Lancet, a British medical journal, aimed to compare the states' successes in mitigating the impact of Covid-19. 

To compare state data, the researchers, led by Thomas Bollyky of the Council on Foreign Relations and Emma Castro of the Institute for Health Metrics and Evaluation at the University of Washington, standardized the Covid-19 infection rates for population density and the death rates for age and the prevalence of comorbidities, which is the existence of more than one disease or other health condition at the same time. 

They found that Kentucky's unadjusted Covid-19 death rate from January 2020 through July 2022 was 472 deaths for every 100,000 residents. But after adjusting for age and comorbidities, the rate was only 341 deaths per 100,000 population—lower than the national rate of 372. 

The state with the lowest adjusted death rate was Hawaii (147 per 100,000 residents) and the highest was Arizona (581 per 100,000).

After adjusting the rates, the researchers looked at the effect of states' characteristics before the pandemic began, such as education levels, health spending per person, state mitigation policies, and individual factors such as vaccine coverage and employment. 

Income, education, vaccines, personal trust, preventive mandates cited

The researchers found that states with low poverty rates, higher education rates and a greater share of people expressing interpersonal trust—defined as the trust that people report having in one another—had lower infection and death rates. 

States that offered access to quality health care also had fewer Covid-19 deaths and infections, but states with higher public-health spending and more public-health personnel per capita did not. 

A state's use of protective mandates were associated with lower infection rates, as were mask use, lower mobility and higher vaccination rates. And, higher vaccination rates were associated with lower death rates.

What about politics? The political affiliation of a state's governor was not associated with lower infection or death rates, but worse outcomes were associated with the proportion of a state's voters who voted for then-President Donald Trump in 2020.

Kentucky was a strong Trump state and has a Republican legislature, but has a Democratic governor, Andy Beshear, who imposed mask mandates and limitations on business activity and public gatherings.

States that did not close businesses, such as restaurants, had higher infection rates, the researchers found, based on unemployment rates: "On average, 1,574 additional infections per 10,000 population were associated in states with a one percentage point increase in the employment rate."

State policies were a factor, the researchers wrote: "States' struggles in the Covid-19 pandemic were not inevitable. The nearly four-fold differences that existed across states in Covid-19 death rates, even when standardized for factors such as age and comorbidities, suggest that lower death rates were achievable." 

The researchers added that while "Covid-19 magnified the polarization and persistent social, economic, and racial inequities that already existed across U.S. society . . . the next pandemic threat need not do the same. U.S. states that mitigated those structural inequalities, deployed science-based interventions such as vaccination and targeted vaccine mandates, and promoted their adoption across society, were able to match the best-performing nations in minimizing Covid-19 death rates. These findings could contribute to the design and targeting of clinical and policy interventions to facilitate better health outcomes in future crises." 

Saturday, April 22, 2023

Ky. Psychological Association to offer program May 11 for news media on strategies for coping when covering traumatic events

Mind Ecology graphic
In the wake of the mass shooting in Louisville on April 10, the Kentucky Lantern has worked with the Kentucky Psychological Association to create an event for people working in the news media to learn coping strategies, including how to get professional help when needed. 

The Zoom event will be held at 12 noon ET May 11. It will be led by Dr. Eric Russ with the association and is titled, "Stress, Trauma and Coping for Journalists and People Working in the Media." 

Journalists who would like to attend should register here.

Friday, April 21, 2023

Covid-19 levels stay low; memorial expected to be finished soon; FDA approves new booster, gives new guidance on vaccination

Workers laid brick walkways to the pandemic monument at the Capitol (in background) Saturday. One said the work should be finished in about 10 days. (Kentucky Health News photo by Al Cross)
By Melissa Patrick
Kentucky Health News

The state and federal Covid-19 reports remain good this week, but Kentuckians are still dying from the disease. Over the last four weeks, the state has attributed an average of 53 deaths a week to Covid-19. 

Gov. Andy Beshear said at his weekly news conference Thursday that the memorial to honor the thousands of Kentuckians who have died in the pandemic, with a sculpture being created by Kentucky artist Amanda Matthews, is being installed and is expected to be finished this spring. 

“While we have reached better days in our fight against the pandemic, we will not forget those that have been lost, over 18,000 of our loved ones. . . . We want to make sure that we are truly creating a type of memorial that remembers this time, gives people a place to grieve, but also shows the heroism that Kentuckians have shown," Beshear  said. 

Matthews, of Lexington, was chosen by a committee made up of families who had lost someone to the virus. She told Amber Philpott of Lexington's WKYT-TV, “The reason for creating something like this is to memorialize a difficult time in history. Memorialize lives lost way too soon, but also to show the strength of communities when they stick together.”

Her design, "United We Stand, Divided We Fall," is a three-dimensional representation of the state seal and motto, Philpott reports. The memorial, which was paid for by the Team Kentucky Covid-19 Memorial Fund, will be placed in Monument Park, in the northwest quadrant of the Capitol grounds. 

Weekly Covid-19 reports

The latest weekly report from the state Department for Public Health showed there were 2,264 new cases of the coronavirus in Kentucky last week, or 323 cases per day. That's a 20.5 percent drop from the previous week's 2,848 cases. 

 The state's new case-rate dropped to 3.93 cases per 100,000, from 4.28 the week before. The top 10 counties were Breathitt, 14.7 cases per 100,000 residents; Metcalfe, 12.77; Green, 10.45; Whitley, 8.67; Nelson, 8.65; Clinton, 8.39; Greenup, 8.14; Powell, 8.09; Butler, 7.76; and Mason, 7.53. 

The Centers for Disease Control and Prevention risk map, based on new cases and hospital numbers, shows only two of the state's 120 counties, Breathitt and Letcher, at medium risk from Covid-19. Medium-risk counties are shown in yellow and the 118 counties at low risk are shown in green. Last week, Letcher County had a high rsk of Covid-19 and was the only Kentucky county not in green on the map. 

The CDC also provides a community-level transmission map, largely used by health-care facilities and researchers, that shows the level of virus in each county, at one of four levels. The latest map shows 15 counties with a low level of transmission and 74 with a medium level; the rest are either substantial or high. The state says residents should take their guidance from the other map.

Last week, Kentucky attributed 51 more deaths to Covid-19, bringing the state's death toll to 18,455.

FDA recommends a second booster for some

The best way to protect yourself from severe illness, hospitalization and death from Covid-19 is to get vaccinated and boosted. 

This week, the U.S. Food and Drug Administration approved a second Omicron booster, also referred to as the bivalent Covid-19 vaccine, for immunocompromised people and people over the age of 65.

The FDA says people who are over 65 qualify for the second booster if they got their initial bivalent dose at least four months ago and immunocompromised people can get another bivalent dose at least two months after their initial bivalent shot. Further, the FDA says that additional doses could be warranted for immunocompromised people at the discretion of their health care provider. 

For young kids (ages 6 months through 4 years) who are immunocompromised, however, eligibility for additional doses will depend on the vaccine they previously received, the agency said.

The new guidance also says that a single dose of a bivalent vaccine will suffice as initial vaccination for unvaccinated adults, instead of the two doses of the original vaccine. 

Further, anyone who has not yet been boosted with the bivalent vaccine is eligible for a single dose of it. If you've already received the bivalent booster and you are not over 65 or immunosuppressed, you do not qualify for a second booster. 

"The FDA intends to make decisions about future vaccination after receiving recommendations on the fall strain composition at an FDA advisory committee in June," says the agency. 

The new recommendations also set new rules for children, depending on their age and their vaccine history. 

“At this stage of the pandemic, data support simplifying the use of the authorized mRNA bivalent Covid-19 vaccines and the agency believes that this approach will help encourage future vaccination,” Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, said in a news release. 

He added, "Covid-19 continues to be a very real risk for many people, and we encourage individuals to consider staying current with vaccination, including with a bivalent Covid-19 vaccine. The available data continue to demonstrate that vaccines prevent the most serious outcomes of Covid-19, which are severe illness, hospitalization, and death.”

Long Covid is keeping many Americans from returning to work

Medscape graphic
About 16 million Americans have long Covid-19 and four million of them say this has significantly reduced their ability to carry out day-to-day activities, including their jobs, Paul Solman reports for PBS News Hour

Long Covid, also called long-haul Covid, post-Covid or chronic Covid, occurs when Covid-19 symptoms continue long after the initial infection. 

The American Medical Association says "fatigue and “brain fog” are among the most-reported symptoms of long Covid. According to an article in the AMA journal JAMA Network, other symptoms include insomnia, changes in smell and taste, shortness of breath, chest pain, palpitations, dizziness, depression and anxiety. In some cases, the symptoms are disabling, preventing patients from working or even going about their normal daily activities."

David Lazer of Boston's Northeastern University told Solmon that 16 percent of people with long Covid are less likely to be employed. 

Katie Bach, a Brookings Institution researcher, told Solmon that she estimates about 500,000 people are no longer working because of long Covid, and not including people who have reduced their work hours or days.

"We do have a big long-Covid problem," she said. "And the afflicted don't appear to be coming back anytime soon, due to a slew of symptoms." 

One of the many long-Covid patients no longer able to work is Meredith Hurst, who was a paralegal in Wilmington, Delaware. Solmon reports that Hurst hasn't been able to work in three years and doing the interview was a struggle. 

"I have to prepare ... by resting days in advance. . . . I also get extremely exhausted getting dressed," Hurst told him. Her daughter, six-year-old Carly Anna Hurst, told Solman that her mom is no longer able to take walks or do picnics with her.  Her son Dan, 22, said their mother is bedridden "at least a good bit of the day, every day." 

Another long-Covid sufferer unable to work is Phillip Baczewski, a longtime Massachusetts social worker. Baczewski said he has been heartbroken that he can no longer do the adoption work that he loves, and spoke about his struggles with depression and suicide ideation and rage, saying there have been times when he didn't leave his room for days. 

Chimere Smith, who was a teacher in Baltimore schools before she got sick and quit working, said she too had times when she just wanted to die. She called long Covid a "sneaky, invisible condition that people don't recognize unless there are visible symptoms." She said because she is no longer able to work, "Eighty percent of my income is government assistance," Social Security, subsidized housing and food stamps.

Bach, of the Brookings Institution, told Solmon that the impact on the economy is estimated to cost hundreds of billions. "It includes lost wages for people who are not working," she said. "It includes increased health-care costs, and then there's lost quality of life, which is a concept in health economics where there is a cost to people suffering."

'Addiction and the media: Stigmatizing language and best practices' virtual meeting May 17; free, but registration required

National Institute on Drug Abuse image
The HEALing Communities Study Learning Collaborative at the University of Kentucky is will offering an online session titled "Addiction and the media: Stigmatizing language and best practices" at 11 a.m. ET May 17.

The event is open to journalists, journalism students, community members, health-care professionals and interested coalition members, but requires registration. Click here to register. 

The featured speaker will be Carol Krause, senior advisor consultant to the National Institute on Drug Abuse and the National Institutes of Health. Following her presentation, there will be a roundtable discussion with Terry DeMio, opioid-epidemic reporter with the Cincinnati Enquirer; Brittany Hurley, peer support specialist with Ramey Estep Regroup; and Alene Kennedy-Hendricks, assistant professor with Johns Hopkins Bloomberg School of Public Health. 

The panelists will discuss best practices in reporting on addiction and the media's response to reducing stigma. One continuing education credit will be offered for registered nurses, advanced practice nurses, pharmacists, physicians, social workers and licensed clinical alcohol and drug counselors who attend.

The session resembles one held in Ashland in November 2019 at "Covering Substance Abuse and Recovery: A Workshop for Journalists," sponsored by Oak Ridge Associated Universities and the University of Kentucky's Institute for Rural Journalism and Community Issues, publisher of Kentucky Health News.

"Nobody has the power to change language like us," Bishop Nash said at the workshop. A former health reporter at the Herald-Dispatch in Huntington, W.Va., a city that has been called the epicenter of the opioid epidemic, Nash said that once he understood the science of addiction and why it was important to not use stigmatizing language, it has been an easy switch. "It really requires a change of heart," he said. "When you get your heart wrapped around this issue, you really don't have to think about it."

The HEALing (Helping End Addiction Long Term) Communities Study is a four-year, $87 million study to see how tools for preventing and treating opioid misuse and opioid-use disorder are most effective locally. 

Findings from the study will establish best practices for integrating prevention and treatment strategies that can be replicated by communities nationwide. The goal of the study is to reduce opioid-related overdose deaths by 40 percent. Kentucky is one of four states chosen for the study.

Thursday, April 20, 2023

Annual overdose deaths in Kentucky fell for first time in four years

By Melissa Patrick
Kentucky Health News

For the first year since 2018, Kentucky saw a drop in drug overdose deaths last year.  

Provisional data gathered by the Kentucky Injury Prevention and Research Center shows that 2,127 Kentuckians died of overdose in 2022, 5 percent less than the 2021 figure of 2,257. 

"I think it's important that we note that because it ought to give us at least hope," Gov. Andy Beshear said at his weekly news conference Thursday. "Hope that progress is possible, hope that we can see fewer deaths next year than we saw this year, hope that we can get more people better and back with their families, back in society, back in a good job." 

Dana Quesinberry, co-principal investigator for surveillance of the Kentucky Drug Overdose Data to Action Program, said "We're really optimistic about this finding" because it could be an early signal that the state's prevention and intervention efforts are having an effect. It could also reflect the increased avaialbilty of Narcan (naloxone), which can stop an overdose by blocking action of the opioid(s).

"While this news is encouraging, there's still a lot of work to be done," Quisenberry said. "And we really hope that this early signal will . . . strengthen our resolve to address substance-use issues, including the diagnosis and treatment of substance-use disorders and continue to support Kentuckians . . . in their recovery and our joint recovery as we move forward." 

Beshear was asked if he expected the new availability of medical marijuana to certain people to further reduce OD deaths, "Well, I certainly hope that the medical marijuana program, or what's allowed under my executive order, is resulting in fewer people having to take opioids," he said. "So if we can take another step to decrease people's uses of opioids, if they can treat pain instead with medical marijuana, yes, I do believe that it will result in fewer opioid deaths." 

Kentucky lawmakers passed a bill to legalize medical marijuana for people meeting certain qualifications in 2025 on the last day of the 2023 legislative session, and Beshear quickly signed it into law. Last year, Beshear issued an order to use  his pardon power to allow people with 21 specified medical conditions and a doctor's certificate to possess up to eight ounces of marijuana bought legally in another state. (Illinois is the only adjoining state where non-residents can legally buy cannabis now.)

The legislature also passed a law to decriminalize possession of fentanyl test strips, which are used to detect the synthetic opioid that contributed to 73% of Kentucky's 2021 drug overdose deaths. 

Wednesday, April 19, 2023

Sneezing? Sniffling? Climate change means U.S. allergy seasons last a month longer than in 1990 and have 21% more pollen

Medical News Today photo
By Laurel Swanz

Kentucky Health News

With allergy season in full swing in Kentucky, those suffering from nasal allergies and asthma may feel as though the pollen gets worse every year.

The American College of Allergy, Asthma and Immunology says there is some truth to this – and climate change, which is causing warmer temperatures, longer growing seasons and decreased air quality, is to blame.

Pollen season starts earlier and lasts longer than in previous years, according to research led by William Anderegg of the University of Utah School of Biological Sciences and the National Institute of Food and Agriculture.

Andregg’s research found that pollen seasons “start 20 days earlier, are 10 days longer, and feature 21% more pollen than in 1990.”

Kentucky has had a longer pollen seson this year because it had an unseasonably warm February, putting parts of the state in bloom for months, according to Lexington's WKYT-TV.

“The strong link between warmer weather and pollen seasons provides a crystal-clear example of how climate change is already affecting peoples’ health in the U.S.,” Anderegg said in a report for the National Institute of Food and Agriculture.

According to Anderegg’s research, the warming temperatures confuse plants’ internal timing, or phenology, causing them to start producing pollen earlier in the year.

That means people who suffer from seasonal allergies and asthma and their health-care providers must start preparing sooner, as many treatments take varying amounts of time before becoming effective.

For example, immunotherapies to treat allergies through dissolving tablets or shots can take anywhere from 12 weeks to years to become effective, so knowing when allergy season is coming is essential to the timing and effectiveness of these treatments.

The Mayo Clinic offers several strategies to relieve seasonal allergies before resorting to allergy shots, including staying indoors when pollen counts are high to reduce exposure and using over-the-counter remedies such as antihistamines, decongestants and nasal irrigation.

The American College of Allergy, Asthma and Immunology reports that allergies and asthma often go hand in hand. And because climate change leads to heightened symptoms of both conditions, people need to know what they’re dealing with and how to treat it.

“What many people don’t realize is that the same things that trigger your seasonal ‘hay fever’ symptoms – things like pollen, dust mites, mold and pet dander – can also cause asthma symptoms,” allergist Kathleen May said in an ACAAI news release. “If you have allergies, and you are wheezing or coughing, an allergist can determine if you also have asthma. Allergists are specialists at treating asthma and can put together a treatment plan to help you deal with both conditions.”

Anderegg’s research found that climate change’s contribution to increasing pollen counts is only rising.

“Climate change isn’t something far away and in the future. It’s already here in every spring breath we, and increasing human misery,” Anderegg said in the report. “The biggest question is — are we up to the challenge of tackling it?”

Tuesday, April 18, 2023

Ads and social media hype new, expensive weight-loss drugs; doctors sound alarms about off-label uses and side effects

AFP photo via Getty Images and KFF Health News
By Darius Tahir
and Hannah Norman
KFF Health News

Suzette Zuena is her own best advertisement for weight loss.

Zuena, the “founder/visionary” of LH Spa & Rejuvenation in Livingston and Madison, N.J, has dropped 30 pounds. Her husband has lost 42 pounds.

“We go out a lot,” Zuena said of the pair’s social routine. “People saw us basically shrinking.” They would ask how the couple did it. Her response: Point people to her spa and a relatively new type of medication — GLP-1 agonists, a class of drug that’s become a weight-loss phenomenon.

But she’s not just spreading her message in person. She’s also doing it on Instagram. And she’s not alone. A chorus of voices is singing these drugs’ praises. Last summer, investment bank Morgan Stanley found mentions of one of these drugs on TikTok had tripled. People are streaming into doctors’ office to inquire about what they’ve heard are miracle drugs.

What these patients have heard, doctors said, is nonstop hype, even misinformation, from social media influencers. “I’ll catch people asking for the skinny pen, the weight-loss shot, or Ozempic,” said Priya Jaisinghani, an endocrinologist and clinical assistant professor at New York University’s Grossman School of Medicine.

Competition to claim a market that could be worth $100 billion a year for drugmakers alone has triggered a wave of advertising that has provoked the concern of regulators and doctors worldwide. But their tools for curbing the ads that go too far are limited — especially when it comes to social media. Regulatory systems are most interested in pharma’s claims, not necessarily those of doctors or their enthused patients.

Few drugs of this type are approved by the Food and Drug Administration for weight loss; those include Novo Nordisk’s Wegovy. But after shortages made that treatment harder to get, patients turned to other pharmaceuticals, like Novo Nordisk’s Ozempic and Eli Lilly’s Mounjaro, that are approved only for Type 2 diabetes. Those are often used off-label — though you wouldn’t hear that from many of their online boosters.

The drugs have shown promising clinical results, Jaisinghani and her peers emphasize. Patients can lose as much as 15% of their body weight. Novo Nordisk is sponsoring research to examine whether Wegovy causes reductions in the rate of heart attacks for patients with obesity.

The medications, though, come at a high price. Wegovy runs patients paying cash at least $1,305 a month in the Washington, D.C., area, according to a GoodRx search in late March. Insurers only sometimes cover the cost. And patients typically regain much of their lost weight after they stop taking it.

Hype drives demand

But patients are not necessarily coming to doctors’ offices now because of the science. They are citing things they saw on TikTok, like Chelsea Handler and other celebrities talking about their injections. It leads to the questions “how come she can get it” and “why can I not,” said Juliana Simonetti, a physician and co-director of the comprehensive weight management program at the University of Utah.

The excitement — which doctors worry may cause some patients to use medications inappropriately — is coming also from business interests. Some are doctors promoting their venture-capital-backed startups. Others are spas hawking everything from wrinkle-smoothing and lip-plumping to, yes, weight-loss benefits of semaglutide, the active ingredient in Wegovy and Ozempic; their prices, often in the hundreds of dollars, are well below what consumers would pay if picking up the prescription at a pharmacy.

In the U.S., the FDA has oversight over ads from the pharmaceutical industry, which must acknowledge risks and side effects of drugs. But ads from people who write prescriptions don’t necessarily have the same restrictions. FDA regulations apply if the prescriber is working on behalf of a regulated entity, like a pharmaceutical manufacturer or distributor.

“The FDA is also committed to working with external partners, including the Federal Trade Commission, to address concerns with prescription drug marketing practices of telehealth companies on various platforms, including social media,” agency spokesperson Jeremy Kahn emailed KFF Health News.

Pharma firms run campaigns to educate health-care professionals or raise “awareness” that may indirectly tout drugs. Novo Nordisk has an ongoing internet campaign to redefine and destigmatize how Americans think of obesity — and, left unmentioned, the drugs that treat it.

Australian regulators have taken down nearly 1,900 ads as of early March for improperly plugging various GLP-1 agonists, an agency spokesperson told KFF Health News. Novo Nordisk says it didn’t put up the ads, the majority of which were for their product Ozempic. The regulators are declining to say who’s involved.

Doctors are also sounding alarms about the publicity. They believe patients will be driven to use these medications off-label, obtain unreliable forms of these drugs, or exacerbate other health conditions, like eating disorders. The drugs act in part as an appetite suppressant, which can dramatically reduce calorie intake to a concerning degree when not paired with nutritional guidance.

Elizabeth Wassenaar, a regional medical director of the Eating Recovery Center, said she believes the drugs and associated advertising buildup will inadvertently trigger eating disorders. KFF Health News found ads showing thin patients measuring themselves with a tape measure and stepping on the scale, with accompanying captions goading viewers into going on GLP-1s.

“They’re being marketed very, very pointedly to groups that are vulnerable to experiencing body image dissatisfaction,” she said.

Remi Bader, a curve model and TikTok creator specializing in documenting her “realistic” clothing buys, told one podcast her story of coming off a “few months” on Ozempic. She said she gained twice the weight back and that her binge eating disorder got “so much worse.” One study, published in the journal Diabetes, Obesity and Metabolism, found two-thirds of lost weight came back after discontinuation of semaglutide.

But social media users and influencers — whether with white coats or ordinary patients — are hopping on every platform to spread news of positive weight-loss outcomes. There are those, for instance, who had gastric bypass surgery that didn’t work and are now turning to TikTok for guidance, support, and hope as they begin taking a GLP-1. There’s even a poop-centric Facebook group in which people discuss the sometimes fraught topic of the drugs’ effect on their bowel movements.

Commercialism, compounding spark excitement, concern

Some have been so delighted by their medication-assisted weight loss they have become brand ambassadors. Samantha Klecyngier has dropped at least 58 pounds since she started on Mounjaro. She heard of the drug and her telemedicine weight loss program, Sequence, on TikTok. She and many others who have experienced considerable weight loss since starting the medication regimen point to its positive impact and their improved quality of life. Now she officially promotes the company on the app.

Though Klecyngier, a mother of two from the Chicago area, is not diabetic, she uses Mounjaro. When she was growing up, her parents had Type 2 diabetes and other chronic diseases that led them both to have open-heart surgery. Her father lost his life to complications of diabetes. She wants to avoid that fate.

But Klecyngier’s story — combining a personal journey with a profit-making entity — is symbolic of another trend on social media: commercialism. There’s a spate of startups eyeing big money matching pharmaceuticals and related support with patients. (Sequence, the company Klecyngier pitches, just got acquired by WW, also known as WeightWatchers.)

Some doctors use social media to educate viewers about the drugs. Michael Albert, chief medical officer of telehealth practice Accomplish Health, says offering information to his more than 250,000 followers has helped point patients to the medical practice. It’s received thousands of patient inquiries, more than the clinic can take on.

Companies like Accomplish — startups with well-credentialed doctors — are the glossy side of this social media boom.

But there are others — like many spas and weight loss centers — that offer the drugs, sometimes without much medical support, often alongside Botox and dermal fillers. Obesity doctors worry such marketing is creating unrealistic expectations.

Some spas and telemedicine operators claim to have “compounded” semaglutide. But compounding — when pharmacies, rather than drug manufacturers, prepare a drug — is a risky proposition, doctors caution. “The risks are enormous,” Simonetti said, warning of potential contamination from poor compounding practices. “The risks of getting bacteria,” she warned, “the risks include death.”

Weight loss clinics also frequently tout unconventional additions to semaglutide, including vitamin B-12 and amino acids. Some patients incorrectly believe the former helps with nausea, Jaisinghani said; other clinics tout greater weight loss.

Novo Nordisk spokesperson Allison Schneider told KFF Health News in an email that the company shares doctors’ concerns about compounding and that it’s begun sending letters warning “certain health-care providers” about the related risks.

Some operations defend their use of often-cheaper compounded drugs. LH Spa & Rejuvenation, founded by Zuena, offers a compounded semaglutide formulation from QRx Weight Loss for $500 over four weeks. The spa learned about the regimen from a doctor. “I’m purchasing it,” Zuena said. “It comes next-day air in legitimate vials with lot numbers, expirations.” Patients’ injections and dosages are overseen by on-site medical staff.

Most operators in this burgeoning industry are keen to emphasize their products’ high quality or their company’s good works, as they seek money. Ro, a telehealth firm offering GLP-1s, said its marketing campaign in the New York City subway “aims to start an important, sometimes difficult, conversation focused on de-stigmatizing obesity as a condition.”

This widespread tactic is nothing short of maddening for pharma-industry critics. “They talk about trying to destigmatize obesity at the same time they’re talking about losing weight. They’re co-opting the concept,” said Judy Butler, a research fellow at PharmedOut, a Georgetown University Medical Center project focusing on evidence-based practices for drugs. “They’re trying to sell a weight loss drug.”

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