UK expands heart and vascular care to hospitals across the state

By Melissa Patrick
Kentucky Health News

One of the many ways that UK HealthCare strives to improve the heart health of Kentuckians is through its Gill Heart and Vascular Institute Affiliate Network, which includes a community of hospitals across the state working to ensure patients receive high-quality cardiac care close to home. 

The program serves a great need, since heart disease is the leading cause of death in Kentucky and the state has one of the country’s highest rates of heart disease. 

Dr. Navin Rajagopalan

Dr. Navin Rajagopalan, director of the affiliate network, said it is made up of over 20 hospitals throughout the state.  

"Our key mantra is always . . . one of collaboration," he said. "The University of Kentucky is a big hospital, we have lots of services here. But we never want to be seen as competing with local, community hospitals for their patients. So we want patients to stay local for as long as possible to receive optimal cardiovascular care." 

He added that while it's important for UK's program to remain strong for patients who may need higher levels of care, the goal of the network is to "provide resources, education, and training, where appropriate, to the hospitals in our network." 

New to the network is Owensboro Health Muhlenberg Community Hospital in the Muhlenberg County seat of Greenville, featured recently in a UK news release. CEO Ed Heath said being in the network "furthers our mission to heal the sick and to improve the health of the communities we serve." 

“We look forward to utilizing the expertise of UK HealthCare and the perks of this affiliation to better serve our patients," he added.

Rajagopalan stressed that the program isn't about UK taking over a hospital's cardiovascular program, but is designed to foster collaboration and expertise-sharing among the member hospitals. Members of the network have access to educational resources, quality-improvement initiatives and specialized training, and Rajagopalan said the network can provide outreach clinics or assist with cardiovascular imaging. "The idea . . . is that patients can receive specialized care close to home," he said.

When Dr. Michael Karpf was running UK HealthCare in 2013, he said it needed to expand its geographical reach to maintain its newly raised national status and to ensure access to quality care for Kentuckians. "We want the hospital to be the first choice when it comes to complex care,” he said, identifying several regional competitors. First on his list was Vanderbilt University in Nashville, which is 80 miles closer to the Greenville hospital than UK and gets many patients from Western and Southern Kentucky. It has locations in Hopkinsville and Franklin.

Asked if UK's program is driven by competition in any way, Rajagopalan said, "No, we make it very clear that this is not based on referrals." 

Hospitals in UK's Gill Heart and Vascular Institute Affiliate Network (UK HealthCare map)

Rajagopalan said UK is not actively recruiting new hospitals into the network and already had some relationship with many of them. More often, he said, hospitals will call UK with a question about something and that's how they learn about the program. He added that UK HealthCare also offers the Markey Cancer Center Affiliate Network and a Stroke Care Network. 

As for money, he said fees collected within the affiliate network are put back into the program in some way: "We don't make any money off the network." 

According to the news release, the affiliate network includes 24 hospitals, more than 15 outreach locations and more than 12 sites where Gill provides cardiac image interpretation services across cardiovascular imaging modalities.

Rajagopalan told Kentucky Health News that the work they are doing at the Gill Heart and Vascular Institute Affiliate Network is "relatively unique." 

"We're kind of hoping to have more success stories and kind of share what we're doing to  other academic centers," he said. "Because I think the way that we, as an academic institution, interact with the community hospitals in our region is rather unique in terms of the spirit of collaboration and in trying to support all the hospitals  in the community."

Huge grant fails to reduce ODs by 40%; does show a 9% drop over four states, saving an estimated 483 lives, but few in Ky.

The National Institues of Health’sNational Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration funded the study through the NIH HEAL Initiative.

By Melissa Patrick

Kentucky Health News

A four-state, $350 million research grant that included Kentucky fell far short of its goal of reducing opioid overdose deaths by 40% over four years, instead showing an estimated 9% drop in such deaths. 

"That translates into an estimated 483 opioid-overdose deaths that were averted in the communities that received the intervention," said Patricia Freeman, part of the HEALing Communities Study research team and an associate professor of pharmacy at the University of Kentucky.  

Another model, comparing those to communities to a control group of counties with similar charcteristics, showed a 15% average reduction in opioid-overdose deaths in the intervention communities, which Freeman said was "very close to reaching statistical significance."

"It's still consequential even though it didn't reach statistical significance," said Freeman. "An estimated 483 lives were saved. And just because it didn't reach statistical significance doesn't mean that it was not a meaningful public-health impact." 

In Kentucky, there was no real difference in the adjusted rate of opioid-related overdose deaths between the intervention counties and the control-group counties, with 59.8 deaths per 100,000 residents in the intervention communities and 59.3 per 100,000 in the control communities. 

The study compared the control and intervention communities for one year, July 2021 through June 2022. 

"In retrospect, I think people will say that the 40% was a very ambitious goal," said Freeman. The researchers in the paper said likewise, adding, "The trial may have been underpowered to detect substantially smaller yet clinically meaningful differences."

An underpowered study does not have a sufficiently large sample size to answer the research question of interest,"  says the National Library of Medicine. according to L.D. Case and W.T. Ambrosius in an article titled "Power and Sample Size," published in Topics in Biostatistics.

The study, published June 16 in The New England Journal of Medicine, found no differences in estimated opioid-overdose deaths among the four states, nor any statistical differences between urban and rural communities, by age, by sex or among racial and ethnic groups. 

The research paper identifies several unforeseen challenges that likely diminished the impact of the interventions. Those include the Covid-19 pandemic, which began just two months after the start of the study’s intervention, an increase in the prevalence of fentanyl in illicit drug markets, and a 10-month implementation period, which may have been too short for communities to fully implement and see the effects of their efforts, says a UK news release.  

The four-year study, launched in 2019, included 67 communities affected by opioid abuse, including 16 Kentucky counties. UK  received $87 million from the National institutes of Health for the study, the largest competitive award UK has ever received. 

The other participants were Boston Medical Center in Massachusetts, Columbia University in New York City and Ohio State University. 

The Kentucky counties where interventions were made were Boyd, Boyle, Clark, Fayette, Floyd, Franklin, Kenton and Madison. The control-group counties were Bourbon, Campbell, Carter, Greenup, Jefferson, Jessamine, Knox and Mason.

Freeman noted that the published study results don't reflect county-level data, but the impact of the interventions in all 67 communities.  

The interventions involved increasing education about overdoses; increasing overdose-prevention education and distribution of the anti-overdose drug naloxone; increasing access to and retention of medications to treat opioid-use disorder, including methadone and buprenorphine; safer opioid prescribing, dispensing and disposal practices; and reducing the stigma of addiction.

 

"Specific efforts in Kentucky included partnering with 145 organizations to distribute more than 40,000 naloxone units," the news release says. "Strategies to help people find and stay in treatment deployed 26 peer-recovery coaches and 16 care navigators and provided $411,848 in transportation support.

"Other activities included partnering with 35 pharmacies to install permanent medication-disposal drop boxes, which has resulted in the incineration of more than 6,500 pounds of leftover medication. Efforts to reduce stigma and increase awareness of treatment resources produced 64 communication campaigns, resulting in 73 million engagements."

The study's principal investigator, Sharon Walsh, a professor in the College of Medicine and College of Pharmacy and director of the UK Center on Drug and Alcohol Research, said in the release, “Our findings demonstrate that implementing these evidence-based practices through community-engaged strategies and partnerships can make a meaningful impact on combating overdoses, even amid the rapidly evolving opioid epidemic and unprecedented disruptions like the Covid-19 pandemic,”  

Freeman said researchers are continuing to analyze the data to look at the impact of each strategy used in the study, and have written a paper that is under peer review, looking at how naloxone distribution changed in the intervention and control communities.

She said they will also continue to analyze the impact of the interventions on non-fatal overdoses, the impact on overdoses that involved opioids and other substances, since this study was specific to opioids, among other things.

Also coming are results from the control communities, which received the interventions after the comparisons between the control communities and intervention communities were complete.

"We'll be trying to really understand what were the strategies that were the most impactful in our communities," Freeman said. 

Looking forward, Freeman said she thought Kentucky could see some long-term benefits from this study because of the infrastructure, technical assistance and training that was set up with the agencies and organizations to implement the study. "I'm interested to see what's going to be a longer term impact," she said. 

The good news is that Kentucky has experienced two years of declines in overdose deaths. In  2022, it was one of only eight states that saw a decrease in drug overdose deaths, and in 2023, it saw a 10% drop in such deaths, according to the state's Office of Drug Control Policy.

Updated 06/25/24: This article has been updated to reflect the correct attribution for the definition of an "underpowered study" to be  L.D. Case and W.T. Ambrosius in an article titled "Power and Sample Size," published in Topics in Biostatistics.

Dr. Wendell Kingsolver, a doctor for more than half a century and an advocate for family medicine and rural health, dies at 96

Wendell Kingsolver, M.D.

Dr. Wendell Roy Kingsolver, a longtime physician and advocate for family medicine and public health, especially in rural Kentucky, died Thursday, May 30. He was 96 and lived in Nicholasville.

After graduation from the University of Kentucky and an internship and residency, Kingsolver set up a family practice at Carlisle in his home Nicholas County. He was one of the few physicians in the area and served patients of all ages at all hours in emergency, operating, and delivery rooms, He was among the first physicians certified by the American Board of Family Practice, and trained UK medical students in rural family practice as they lived in his home and learned what a diverse rural medical career was like. In the 1960s he was a medical volunteer in the Republic of Congo, and later on the Caribbean island of St. Lucia and the Newfoundland coast town of St. Anthony. After retiring from five decades of full-time private practice, he was a public-health doctor for the Wedco District Health Department in in Nicholas, Harrison, Bourbon and Scott counties.

Kingsolver was an early adopter of organic farming, and he and his first wife Virginia were founding members of the Sierra Club chapter in Kentucky, the group that built Lake Carnico in Nicholas County, and the First Christian Church in Carlisle, where he was an elder and sang in the choir. He was a board member of the Cane Ridge Meeting House, where the Disciples of Christ denomination began. He enjoyed birdwatching and served a term as president of the Kentucky Ornithological Society. He and Ginny, who predeceased him, established a KOS scholarship for young people interested in the study of birds, and worked to preserve natural land in Nicholas County, some of it donated to the Blue Licks Battlefield State Resort Park.

Kingsolver's survivors include his wife, Eva Lee (Lynam Kanatzar) Kingsolver; son Robert (Paula) Kingsolver; daughter and noted author Barbara Kingsolver (Steven Hopp); and Ann Kingsolver, former director of the Appalachian Center at UK. A viewing will be held Tuesday, June 4, at 2 p.m., followed by the funeral at 4 p.m., at Milward Funeral Home, 391 Southland Drive in Lexington.

Information for this article was taken from the obituary.

Kentucky Children's Hospital at UK opens center to treat children who are harmed by abuse and neglect, in which Ky. ranks 14th

University of Kentucky and Kosair for Kids representatives celebrate opening of the Kosair for Kids Center for Safe & Healthy Children & Families at Kentucky Children's Hospital. (Photo by Adam Padgett)

By Hilary Brown
University of Kentucky

Representatives from Kentucky Children’s Hospital and the nonprofit foundation Kosair for Kids cut the ribbon recently on the Kosair for Kids Center for Safe & Healthy Children and Families, a new clinic space for the treatment of children harmed by abuse and neglect at KCH, part of the University of Kentucky. This center was made possible by a $2 million gift from Kosair for Kids.

“I’ve spent the better part of my career looking at the challenges that Kentucky faces, especially when it comes to the ability of vulnerable Kentuckians to get care they desperately need,” said Mark D. Birdwhistell, vice president for health system administration and chief of staff, UK HealthCare. “I’ve seen how hard it can be to effect change for Kentucky’s vulnerable citizens, and that’s why I’m so proud of this new center and of what we’ve been able to accomplish with the partnership of Kosair for Kids.”

Kentucky ranks 14th in the country for child abuse and neglect; according to the state Cabinet for Health and Family Services, in 2022, 11,002 children experienced neglect, 1,146 suffered physical abuse and 756 were victims of sexual abuse. Those numbers have decreased over the years, due largely to the efforts of Kosair for Kids and their partners across the state.

“Today we celebrate opening a center dedicated to giving the best to children who have experienced the worst, said Barry Dunn, Kosair for Kids president and CEO. “Our goal, our aspiration, is that this center serves as a beacon of hope for children who have experienced unfathomable trauma. We stand with them, united in purpose, on the road to healing. We are proud to call them a Kosair Kid, and we want to show them the love and care they deserve. Kosair for Kids is proud of this place, the skilled and dedicated staff on the front lines of this epidemic, and the growing alliance we have formed to protect all children.”

“I’m an ardent believer that you can’t separate physical health from mental and emotional health,” said Dr. Scottie B. Day, physician-in-chief at Kentucky Children’s Hospital. “Maltreatment and childhood trauma have effects that ripple out into adolescence and adulthood and continue to inform patterns of behavior for generations. Through our partnership with Kosair for Kids, we can disrupt generational cycles of abuse and make Kentucky much safer for kids.”

KCH is home to one of only two pediatric forensic medicine programs in Kentucky. Of the five child-abuse pediatricians practicing in Kentucky, four are at KCH’s Division of Pediatric Forensic Medicine along with specially trained advanced nurse practitioners, social workers and psychologists.

Features of the new clinic include:

• Secure and private space to provide trauma-informed care, including three exam rooms and two therapy services rooms
• Proximity to the Makenna David Pediatric Emergency Center and other services such as radiology and sedation with private entrance and egress to those sites
• Space for therapeutic interventions, evidence storage and consultation with law enforcement and other partners
• Technology to consult virtually with the child’s care team which may include state child protective services, guardian ad litem and law enforcement.

The pediatric forensics staff also provides regular education to medical students, family medicine providers as well as community organizations. They developed a core curriculum for the Department of Community Based Services in the Cabinet for Health and Family Services that includes 16 one-hour lectures. Forensics providers lead a multi-hour training to each new class of Kentucky State Police cadets, as well as continued education to healthcare providers in the community.

Children who are abused and neglected may suffer immediate physical injuries, but also may have emotional and psychological problems, such as anxiety or posttraumatic stress. Over the long term, children who are abused or neglected are also at increased risk for experiencing future violence victimization and perpetration, substance abuse, sexually transmitted infections, delayed brain development, lower educational attainment, and limited employment opportunities. Chronic abuse may result in toxic stress, which can change brain development and increase the risk for problems like posttraumatic stress disorder and learning, attention, and memory difficulties.

All Kentuckians are mandated reporters of child abuse and neglect. If you believe a child is being abused or neglected, call the Child Protection Hotline at 1-877-KYSAFE1 or 1-877-597-2331 or report online.

UK, Asbury University announce nursing education partnership

Nursing students work with IVs at the University of Kentucky
College of Nursing Simulation Center. (UK photo by Shaun Ring) 

Asbury University of Wilmore and the University of Kentucky College of Nursing have announced a dual enrollment agreement for students to complete both an Asbury bachelor’s degree and, after transferring to UK with preferred admission to the College of Nursing, a Bachelor of Science in Nursing in under five years, meeting a direct need for highly qualified nurses in the state of Kentucky and beyond, according to a UK news release.

 

“We are so excited to partner with Asbury University to develop the next generation of nurses. This coordinated effort between our institutions will help us to address the statewide emergency nursing shortage declared by the governor,” said UK College of Nursing Dean Rosalie Mainous.

The partnership program is designated as the Dual Degree Nursing Program and became effective in the curricula of both Asbury and the College of Nursing on Jan. 1. 

It includes the UK College of Nursing Traditional and Accelerated Bachelor of Science in Nursing (ABSN) tracks. Each academic year, UK will have allotted spaces for Asbury students for the Traditional BSN and the ABSN under this dual degree agreement.

The new partnership is one of several new majors, minors, concentrations and partnerships at Asbury, as the school continuously seeks to meet the needs of today’s workforce — in a Christian liberal arts setting with small class sizes and personal attention for students.

UK has $3 million grant to study impact of mothers' opioid use on babies; Ky. 3rd in rate of babies with opioid-withdrawal syndrome

Photo: healthychildren.org

By Lindsay Travis
University of Kentucky

A team of researchers at the University of Kentucky is working to better understand the impact of opioid-use disorder on mothers and babies.

Every 24 minutes in the United States, a baby is born with neonatal opioid withdrawal syndrome (NOWS) after being exposed via  a mother with opioid-use disorder.

In Kentucky, about 2 percent of babies born in 2020 had symptoms of NOWS — the third-highest rate in the U.S. In Appalachia Kentucky, that frequency increases to 7.7 percent — 77 of every 1,000 babies.

Early delivery can complicate pregnancies with opioid-use disorder and give children an increased risk of impaired neural development, including cognitive, motor, social and emotional abilities.

UK’s research team wants to understand how inflammation and dysregulation in the placenta caused by opioid use are linked to negative cognitive consequences in the baby.

The study titled “POPI: Placenta, Opioids and Perinatal Implications” is funded by a $3 million grant from the National Institute on Drug Abuse, part of the National Institutes of Health. Additional funding is possible, pending progress with the research.

Part of the research team, led by Ilhem Messaoudi, left
center (University of Kentucky photo by Jorge Castorena)

“This study is going to have a tremendous impact on Kentuckians, many of whom know first-hand the profound devastation opioid use has on the overall health of the commonwealth,” said Ilhem Messaoudi, chair of the Department of Microbiology, Immunology and Molecular Genetics in the College of Medicine and a principal investigator on the grant.

“NIDA specifically called for research on the placenta-brain axis — the idea that what happens during pregnancy and the placenta’s health will have long-term ramifications on the offspring, including brain development,” said Messaoudi. “The team assembled to find answers for our smallest Kentuckians all bring a variety of expertise to this study including to maternal-fetal medicine, pathology, neuroscience and neonatology.”

Pregnant women who seek care at UK HealthCare’s Perinatal Assistance and Treatment Home (PATHways) program will be eligible to enroll in the study. PATHways, a comprehensive treatment program, is designed to help pregnant and postpartum mothers who are living with substance use disorders.

“Kentucky has one of the highest maternal mortality rates in the country combined with a high rate of opioid use disorder. PATHways provides us a unique opportunity to support pregnant mothers and invest in those lives through this kind of project that blends a variety of scientific specializations,” said Dr. John O’Brien, chief of the Division of Maternal-Fetal Medicine at UK HealthCare, a professor in the Department of Obstetrics and Gynecology in the College of Medicine and co-principal investigator on the grant.

As part of the study, researchers will collect ultrasound data, blood samples, the placenta and umbilical cord blood and conduct neurodevelopment assessment on babies for one year after birth. The data will help them determine the impact of maternal opioid use disorder on both the health of the placenta and the baby’s brain.

“In previous studies, using a rat model, we’ve learned maternal opioid use disorder increases inflammation in the brain and alters microglia — cells that are like the housekeepers of the brain,” Messaoudi said. “The alteration can affect the way the brain continues to develop.”

Investigators can measure that change in the brain through another type of immune cells found in the blood, called monocytes. The team will track neurobehavioral outcomes through a series of assessments in the newborn period and at age 3, 6 and 12 months.

O'Brien said, “Our hope is this research project will provide health-care professionals the knowledge and evidence necessary to improve the care of pregnant mothers with opioid use disorder, reduce risks and optimize neonatal outcomes.”

The study also includes researchers in the College of Medicine’s departments of Pediatrics and Pathology and Laboratory Medicine, as well as the Spinal Cord and Brain Injury Research Center and the Dr. Bing Zhang Department of Statistics in the College of Arts and Sciences.

If you or someone you know is pregnant and dealing with substance-use disorder, contact UK's Polk-Dalton Clinic at 859-218-6165 to make an appointment for prenatal care.

UK's largest academic building will be the Michael D. Rankin M.D. Health Education Building, named for an alumnus from Danville

A rendering of the building, to be built on University Drive between the main library and Cooper Drive

By Kristi Willett
University of Kentucky

The University of Kentucky Board of Trustees approved Tuesday the naming of the university's new building for health education as the Michael D. Rankin M.D. Health Education Building.

As an alumnus, Rankin has devoted himself to the UK College of Medicine, its success and the success of its students. He has been an invaluable member of the UK Medical Alumni Association, its past president, chair of the Dean's Advisory Council and volunteer faculty in the Department of Family and Community Medicine. In addition, he has served many years on the College of Medicine scholarship and admissions committees.

The Board of Trustees previously accepted a gift commitment of $22 million from Rankin for scholarships in the college and to support the construction of the building — which, when completed, will be the largest academic building in the history of UK.

“Dr. Rankin has left an indelible mark of healing and hope, not just on this university, but on the state of Kentucky,” said UK President Eli Capilouto. “His influence will be felt by generations of students and the patients they later serve.”

At over 500,000 square feet, the new Health Education Building will house programs in the colleges of Medicine, Public Health, Health Sciences and Nursing as well as the Center for Interprofessional and Community Health Education. The new facility will become a prominent campus landmark at the intersection of Huguelet and University drives when it opens in 2026.

Rankin when his gift was revealed in 2021 (UK photo)

Rankin, of Danville, received his bachelor’s degree in electrical engineering from UK in 1971 and his medical degree from the College of Medicine in 1980. He completed his residency in family medicine in 1983 at UK HealthCare and pursued a successful practice in primary care and family medicine in Atlanta before retiring and returning to Boyle County on a farm 10 miles from where he grew up.

“One of the greatest challenges facing the commonwealth is the current and growing shortage of health care providers, including physicians, nurses, physician assistants, physical therapists, athletic trainers, medical laboratory scientists, speech language pathologists, audiologists, public health officials and other health care professionals,” Capilouto said. “With this new facility, we will be addressing this health care workforce shortage head-on and, but it couldn’t be done without our partners like Dr. Michael Rankin, who share with us a vision for a healthier Kentucky.”

UK doctor debunks myths about lung-cancer screening, which can find cancer before it spreads or causes symptoms, and save lives

Photo illustration by dragana991, iStock/Getty Images Plus

By Dr. Timothy Mullett

University of Kentucky

Lung cancer is the leading cause of cancer deaths in the U.S., claiming more lives than prostate cancer, breast cancer, and colorectal cancer combined. However, it can be a curable disease if detected early through screening, which can often identify cancer before it spreads or causes symptoms.

The U.S. Preventive Services Task Force recommends annual low-dose CT scans for lung-cancer screening for individuals who meet the following criteria:

• Are 50 to 80 years old
• Currently smoke or have quit smoking within the past 15 years
• Have at least a 20 pack-year smoking history, which is determined by multiplying the number of packs a person smoked per day by the number of years the person has smoked

Despite the benefits of screening, only a fraction of eligible people get screened due to public unawareness, stigma, and prevalent myths and misconceptions about the procedure. Here I address some of the most common myths:

Myth: “Lung cancer screening is not covered by my insurance or is too expensive.”
Fact: If you meet the eligibility criteria, lung cancer screening is covered by Medicare, Medicaid and most private insurance plans without cost-sharing. In rare instances where insurance coverage is unavailable, many programs including UK’s Lung Cancer Screening Program, offer screenings at a relatively low cost.

Myth: “I quit smoking years ago, so I don't need to be screened.”
Fact: Even individuals who have quit are at high risk for lung cancer and should get screened. While screening is primarily recommended for those who quit within the past 15 years, the American Cancer Society recently expanded its guidelines to encourage screening for people with a smoking history outlined above regardless of the number of years since quitting.

Myth: “I currently smoke, so I will get screened after I quit.”
Fact: If you currently smoke, you are at the highest risk. Everyone deserves empathetic health care, and you should not feel judged or ashamed for smoking. In addition to screening, your doctor can help connect you to smoking cessation resources. Quitting smoking at any time, even after a lung cancer diagnosis, reduces the risk of dying from other diseases besides cancer, including heart and lung disease.

Myth: “Lung cancer diagnosis is a death sentence. I’d rather not know.”
Fact: A lung cancer diagnosis today is not the same as it was even 10 years ago. Surgery for lung cancer is becoming much less invasive, and improved treatment options include targeted therapy and immunotherapy. Getting screened is your best defense against lung cancer — if it’s caught early, outcomes are greatly improved, and in some cases, the cancer can be cured.

Myth: “Lung cancer screening is time-consuming and invasive.”
Fact: Lung cancer screening is less invasive than procedures like mammograms or colonoscopies. It is a painless, quick process that involves a low-dose CT scan of the chest, taking only a few minutes to complete. Minimal preparation is required, and no needles or contrast dye are used.

Myth: “Lung cancer screening has a high rate of false positives.”
Fact: While cancer screenings provide valuable tools for early detection, they also carry a potential for false positives. These results may appear as abnormalities on imaging tests but don't necessarily translate to a need for invasive procedures.

Timothy Mullett, M.D., is a UK Markey Cancer Center surgeon and the medical director of the UK Markey Cancer Center Affiliate and Research Networks.

Center for Excellence in Rural Health celebrates Rural Health Day

Director Fran Feltner, front and center, poses with her staff at the University of Kentucky Center for Excellence in Rural Health in Hazard. (UK photo)

By Beth Bowling
University of Kentucky

HAZARD, Ky. — The University of Kentucky Center of Excellence in Rural Health and the Kentucky Office of Rural Health are proud to join communities across Kentucky and the nation in celebration of National Rural Health Day on Thursday, Nov. 16, 2023.

The National Organization of State Offices of Rural Health spearheads the event, held on the third Thursday of November each year. Rural-focused organizations throughout the state and nation are celebrating the “Power of Rural” and honoring the individuals and organizations dedicated to addressing the unique health care needs of more than two million Kentuckians living in rural areas and nearly 61 million people living in rural areas across the U.S.

"In Kentucky, over two million people live in rural and more than 100 Kentucky counties are designated as rural,” said Center for Excellence in Rural Health Director Fran Feltner. “It is vital that we ensure all rural Kentuckians have the opportunity to be healthy and have access to affordable, quality health care.”

Kentucky Office of Rural Health Director Matt Coleman said the mission for both the center and the KORH is to improve access to care and health outcomes for Kentuckians living in rural.

“Having a nationally and statewide recognized day to focus on rural health is extremely important to not only highlight the work being done across the state, but also to give an opportunity to stakeholders and providers to find out what’s going on in their communities,” said Coleman.

“KORH was established by the federal government in 1991 as a way to help support the health and well-being of Kentuckians in rural. We do this a number of ways by providing a framework that links small, rural communities with resources while working toward long-term solutions to rural health issues.”

Since its inception, the KORH has helped clinicians, administrators, and consumers find ways to improve access to and quality of health care through programs like the Rural Hospital Flexibility Program, the Kentucky State Loan Repayment Program, the Kentucky EMS Leadership Academy and many more, while ensuring that funding agencies and policymakers are made aware of the needs of rural communities.

The Center for Excellence in Rural Health, which is the federally designated state Office of Rural Health, has made strides in improving access to education by bringing degrees close to home and securing funding for health care worker loan relief programs. More than 1,000 students have graduated in recent years from rural programs offered at the CERH in Hazard, with most working in rural settings.

CERH Data Analyst Sydney Howard explained that rural health workforce studies conducted at the center highlight the continued need for rural health workers, including physicians, nurses, dentists, medical laboratory scientists, social workers, community health workers and more.

“We have been fortunate to see rural-based health care training opportunities expand in Kentucky in recent years, which is critically important given that more than 30 rural Kentucky counties are currently facing health professions shortages,” said Howard. “Rural Kentucky is also home to 29 critical-access hospitals and nearly 400 rural health clinics, all of which are key in reaching rural populations across the Commonwealth.”

Feltner said, “We are optimistic that Kentucky’s future will be bright with the continued dedication and investment of people and resources to address the needs of rural communities. CERH is proud to recognize the incredible rural health workers, researchers, teachers, students, volunteers and many others in our community on National Rural Health Day and throughout the year.”

CERH and KORH created a special rural health day video to highlight the dedicated individuals and important work going on across Kentucky. Watch the video here.

UK researchers, with samples from patients, help map how heart muscle behaves; that could lead to new heart-disease treatments

The research was led by Kenneth Campbell, Ph.D., of UK's College of Medicine.

By Lindsay Travis
University of Kentucky

A University of Kentucky researcher has helped solve a 60-year-old mystery about the human heart and published his findings in one of the world's top scientific journals.

Kenneth S. Campbell, director of translational research in the Division of Cardiovascular Medicine in the UK College of Medicine, helped create a molecule-level map of an important type of heart tissue. The study was published in the peer-reviewed journal Nature earlier this month.

The heart has billions of cells. Each cell contains thousands of smaller structures that are the building blocks of muscle. In each block are hundreds of filaments of myosin, a motor protein. If the heart is a continent, Campbell and fellow researchers are looking at single strands of hair.

“Each filament has roughly 2,000 molecules arranged in a really complicated structure that scientists have been trying to understand for decades,” said Campbell. “We knew quite a lot about the individual molecules and people thought the myosins could be arranged in groups of six that were called crowns, but not much beyond that.”

Working with researchers at the University of Massachusetts Chan Medical School, the UK researchers produced three-dimensional reconstructions of the cardiac filaments, provide=ing a new framework for interpreting structural, physiological and clinical observations.

Campbell said their most interesting discovery was that there are three different types of crowns. “We think this means that heart muscle can be controlled more precisely than we had realized,” he said. “We were also excited to see how myosin binding protein C, another protein that is linked to genetic heart disease, sits within the structure. It gives us a new level of information about how the molecules are arranged in the heart. . . . It gives us a much better understanding of how the molecules in our hearts interact.”

He said the study could help development of new drug therapies for heart disease, which is the leading cause of death in Kentucky, which among the top 10 states with the highest heart-disease death rate, according to the Centers for Disease Control and Prevention.

The research team collected heart samples from the 15-year-old Gill Cardiovascular Biorepository, of which Campbell is the director. Samples are donated for research purposes from patients who receive cardiovascular care at UK. “We’ve built a huge resource with roughly 15,000 samples from nearly 500 people,” Campbell said. “To the patients at UK HealthCare who’ve donated samples to us, we hope they know how much they’ve helped drive world-class research to, hopefully, help others who get sick.”

The samples are shared with researchers around the world, and “This study in Nature comes from one of those collaborations,” Campbell said.

Nature is a weekly international journal and is considered one of the most prestigious and widely respected scientific journals in the world. It covers a wide range of scientific disciplines and publishes original research, review articles, opinion pieces and news related to various fields of science.

“If you get a paper published in Nature, it means that scientists think that this work is important to everybody, not just people who specialize in that particular area,” said Campbell. “It’s a career highlight.”

Campbell, who holds a joint appointment in cardiovascular medicine and physiology, has taken an undergraduate degree in physics and transformed it into a career focused on helping people. “I used to care a lot about math and molecules,” he said. “But after hearing a friend who’s a cardiothoracic surgeon talk about patients, I realized I could take my scientific skills and do research that has a chance of helping people. It’s given my science purpose.”

Beshear defends pandemic work as Cameron cites learning loss, makes false claim about founder of Planned Parenthood

Candidates' supporters at KET Monday night (Kentucky Lantern photo by Matthew Mueller)

By Al Cross
Kentucky Health News

In their next-to-last debate before the Nov. 7 election, Gov. Andy Beshear defended his response to the Covid-19 pandemic against criticism from Republican Attorney General Daniel Cameron. Appearing for an hour on KET, the candidates also debated each other's positions on abortion, and Cameron made  a false claim about the founder of Planned Parenthood.

Moderator Renee Shaw opened the "Kentucky Tonight" forum by asking Cameron how he would have handled the pandemic that hit the state in March 2020. He said he would have "done like other red-state governors" and tried to get businesses "open as quickly as possible."

Asked if he would have shut down schools at any point, he did not say, but said "I wouldn't have infringed on your constitutional rights." That was a reference to court decisions, some successfully sought by Cameron, that said a few of Beshear's state-of-emergency restrictions went too far.

Beshear was asked if he had any misgivings about the strength and duration of his restrictions, specifically the application on Easter Sunday of his ban on mass indoor gatherings.

He did not address that specific point, but said, "This is about leadership. I showed people during the pandemic I was willing to make the hard decisions, even if it cost me. I put politics out the window, and I made the best decisions I could to save as many lives as possible.”

Asked if he would do it all over again the same way, Beshear didn't answer directly, but said "I believe we made the best decision we did with the information we had," and said he was the first governor to prioiritized teachers for immunizations when vaccines for Covid-19 became available.

Cameron claimed that Beshear "said he had no regrets," and said he would not admit regret "because of pride."

Noting repeatedly that Beshear closed schools, Cameron said "Your kids are behind because of this short-sighted decision," and noted his "catch-up plan" to help them.

Beshear, asked if he has a strategy for that, said he does, but tried to spread blame to the Republican-controlled legislature: "This is something that was happening before the pandemic, primarly because of not enough educators," due to low pay causing teacher shortages.

He also shifted blame when asked if he would take responsibility for the huge backlog in unemployment claims during the pandemic. He noted the downsizing of the agency under his GOP predecessor and said "If we'd had the resources that were there in the last administraton we could have done much better."

Abortion

Cameron has said that if the legislature sent him a bill to put rape and incest exceptions into the state's abortion ban, he would sign it. Asked to say "yes or no" if he personally favors such exceptions, he repeatedly declined to answer, and made a false claim about the founder of Planned Parenthood.

Cameron, an African American, noted the organization's strong support of Beshear, and said its founder, Margaret Sanger, favored the extermination of his race. This claim has been made and debunked several times, but Cameron said Sanger "said I didn't deserve to live." UPDATE, Oct. 25: In a debate Tuesday night, Cameron put it another way: "Margaret Sanger wanted to destroy the Black community," and said 79% of abortion clinics are in Black neighborhoods. 

Sanger believed in eugenics, which taught white superiority and discouraged reproduction of races and ethnicities it deemed inferior. In 1939 she started a project to expand birth-control services for African Americans in the South. In a letter, she told a director of the program that it should hire African American doctors and ministers to gain trust in Black communities because “We do not want word to go out that we want to exterminate the Negro population ...”

That was “inartfully written” but was “frequently taken out of context to suggest Sanger was seeking to exterminate blacks,” The Washington Post reported in 2015. The Reuters news service said in a fact check last year, "Sanger’s concern was to avoid a suspicion that the program’s objective was to stop Black people having babies, which having white people in charge could create."

Sanger's full quote was, “We do not want word to go out that we want to exterminate the Negro population, and the minister is the man who can straighten out that idea if it ever occurs to any of their more rebellious members.”

During the debate on abortion, Shaw noted that Cameron and 18 other attorneys general signed a letter in June opposing a proposed federal privacy rule that would keep state officials from getting information on any reproductive health-care services that in-state residents obtained outside the state, and asked if he wants to criminalize women seeking abortions.

"Absolutely not," Cameron replied, returning to the attack: "Andy Beshear is trying to gaslight you tonight. . . . He wants no limits on abortion." Not so, Beshear said.

Asked if a woman be allowed to terminate a pregnancy at any point, Beshear said his long-held position is that "I am in favor of reasonable restrictions on abortion, especially late-term abortions. . . . He signed a letter saying that he should be able to come after your medical record if you go out of state for care."

On another hot-button social issue, Beshear was asked about an early campaign commercial in which he said that transgender surgeries are not performed on minors in Kentucky. A letter from UK HealthCare, written in March but not released by state Rep. James Tipton, R-Taylorsville, until August, said UK had “a small number of non-genital gender reassignment surgeries on minors, such as mastectomies for older adolescents.”

Shaw asked Beshear if he knew that when he made the ad. He said, "No, I didn't know."

Numerous pro-Cameron commercials have used the ad and the letter to argue that Beshear was lying. Immediately after Beshear answered, Cameron claimed, "The governor just told you a lie," because Beshear vetoed this year's Senate Bill 150, which banned transition surgeries for minors after the legislature overrode the veto.

Beshear said the bill "had a lot more in it" than the ban, but "Our parents should be able to make complicated medical decisions, rather than the government . . . This was all passed just for political points."

The candidates' final debate is scheduled for 7 p.m. ET Tuesday on Lexington's WKYT-TV and on sister Gray Television stations in Evansville, Ind., and Bowling Green.

Kentucky Children's Hospital branch to open Monday in former home of Shriners Hospital on Richmond Road in Lexington

Every aspect of the clinic was designed to meet the unique needs of patients with complex medical and developmental conditions. (Photo by Adam Padgett, via UK HealthCare strategic communications)

Kentucky Children’s Hospital, part of the University of Kentucky, will open a facility with four pediatric specialty clinics Monday, Oct. 16 in Lexington.

A university press release said the four clinics are:

• Complex Care Clinic, which provides medical and developmental follow-up care for infants and young children up to age 5 with medical complexity.
• Developmental Pediatrics Clinic, which offers screening, diagnostic and therapeutic services for children with complex developmental-behavioral conditions such as autism.
• NICU Graduate Clinic, a clinical site for babies and young children with special medical needs. The clinic not only serves babies who were cared for in the KCH Neonatal Intensive Care Unit but also children born prematurely who are at risk for developmental problems.
• Physical Medicine and Rehabilitation Clinic, where patients over age 5 with complex care needs can go to improve their functional abilities and strength.

"Children with complex medical and behavior needs may not feel comfortable or have their needs met in a traditional clinic space," the release said. "Kentucky Children’s Richmond Road was designed with this unique patient population in mind. Carefully considered features were included to not just alleviate the stress of appointments and treatment for patients, but to also reduce the physical and logistical obstacles for parents and caregivers.

The facility's amenities include "a quiet waiting room with soothing features for patients with complex sensory needs who need a calming environment in which to wait prior to their appointment," the release said. It includes "an observation area where parents and caregivers can watch providers interact with and assess their children without interruption" and "comfortable, private areas for one-on-one treatment, discussion and interaction between the provider and the patient."

The facility is in the former Shriners Hospital building, in space shared space with Easterseals Bluegrass, a nonprofit organization that serves adults and children with special needs. Funding for the renovation and services expansion of services came partly from the local community partners of Children’s Miracle Network Hospitals.

“The mission of Kentucky Children’s Hospital has always been to provide the most advanced, comprehensive care to our patients and their families without them having to travel far from home,” said Dr. Scottie B. Day, KCH physician-in-chief. “Having access to a full range of specialized medical and developmental care in one location, reduces the travel burden on families, and allows us to offer a continuity of care not found elsewhere in the commonwealth.”

UK gets $19 million to study tobacco-product markets and possible additional federal regulation of them in Kentucky

AppalTRuST draws from UK's colleges of Medicine, Nursing, Public Health, Education and Arts and Sciences, the Markey Cancer Center and Bridging Research Efforts and Advocacy Toward Healthy Environmennts (BREATHE). (Photos by Jeremy Blackburn , UK Research Communications)

Kentucky Health News

The University of Kentucky is one of seven institutions that are getting about $20 million each in federal money over the next four years to examine the potential impact of federal tobacco regulations.

The Appalachian Tobacco Regulatory Science Team, which UK has dubbed AppalTRuST, is funded by $19 million from the National Institute on Drug Abuse of the National Institutes of Health and the Food and Drug Administration Center for Tobacco Products.

"The goal of AppalTRuST is to investigate the impact of federal regulatory policies in rural communities through collaboration, education and pioneering regulatory scientific research," said a UK news release that alluded to Kentucky's longstanding health problems from using what was once its top cash crop.

“This is a state with its own struggles and health disparities associated with tobacco use, particularly in Appalachian Kentucky,” Dr. Seth Himelhoch, chair of the UK Department of Psychiatry and the grant's principal investigator, said in the release. “While America has overall reduced its use of combustible tobacco, Appalachian Kentucky, in particular, has not moved along at the same pace.”

Kentucky's adult smoking rate, 19.6% in 2021, is second only to West Virginia's.

Co-directors Teresa Waters, Seth Himelhoch and Ellen J. Hahn

“It seems very important to me that when the federal government is going to evaluate regulations for tobacco use it should certainly be doing so in a part of the country where decreasing combustible tobacco use is likely to lead to long-term health benefits including reductions in cancer and cardiovascular disease,” Himelhoch said.

UK Vice President for Research Lisa Cassis said, “Tobacco has long been an issue that challenges the health and well-being of Kentucky. It is our mission as scientists and stewards of our land-grant institution to advance the commonwealth beyond any obstacles to its public health. This award offers the team behind AppalTRuST an opportunity to lay a foundation for high-level, innovative and interdisciplinary research to make an impact on our state.”

The co-directors of AppalTRuST are Ellen J. Hahn, an endowed nursing professor and director of the Bridging Research Efforts and Advocacy Toward Healthy Environments (BREATHE), and Teresa M. Waters, dean of public health at Augusta University in Georgia, the former chair of health management and policy in the UK College of Public Health. The project involves that college and the colleges of Nursing, Medicine, Education, and Arts and Sciences, as well as the UK Markey Cancer Center.

Hahn said, “Kentuckians are at a much higher risk for heart disease, lung conditions and cancer due to high smoking rates and weak smoke-free protections. AppalTRuST will learn with and from the community to better understand their use of tobacco, retail marketing of tobacco projects, and consumer behaviors in rural communities. The health and economic burdens from tobacco use in our state is enormous, and we hope to foster sustainable change in our communities through this work.”

The project will focus on two regions — Boyd, Carter and Greenup counties in northeastern Kentucky, partly in a metropolitan area, and a more rural group of counties in southeast Kentucky: Breathitt, Knott, Leslie, Letcher and Perry.

The AppalTRuST team will start its research by looking at how people get tobacco products and provide an overview of the marketplace, including the prevalence and impact of marketing and how FDA regulations may affect tobacco use. It will also use a virtual storefront to evaluate how possible regulations would affect purchases of tobacco products.

“We hope the findings AppalTRuST produces will provide important information to the FDA as they regulate tobacco products in a way that positively impacts the health of Kentucky’s rural communities,” said Hahn, who created UK's Kentucky Center on Smoke-Free Policy.

The other six institutions awarded grants for Tobacco Centers of Regulatory Science are the University of North Carolina at Chapel Hill, the University of Michigan, Pennsylvauia State University, Ohio State University, the University of South Carolina and Yale University.

Nonalcoholic fatty liver disease now common in children; experts at UK and elsewhere say causes include diet and lack of exercise

Dr. Samir Softic (Washington Post photo by Drea Cornejo)

Kentucky Health News

For uncertain reasons, nonalcoholic fatty liver disease has become more common in American children, especially in Kentucky, and “It’s the worst disease you’ve never heard of,” said Samir Softic, a pediatric gastroenterologist at the University of Kentucky Children’s Hospital, who specializes in the disease.

Softic is a main focus of a long story in The Washington Post about the disease, which is estimated to affect 5 to 10 percent of U.S. children, "making it about as common as asthma, Post reporter Ariana Eunjung Cha writes. A video with the story says Kentucky's rate "is believed to be among the highest."

Cha reports, "The crisis is especially acute in swatches of the Southeast, where rates of pediatric obesity are highest," including Appalachian Kentucky. "But obesity is only part of the puzzle. Scientists have been surprised to find that not all kids with obesity have fatty liver, and not all kids who have fatty liver disease struggle with weight."

Softic runs UK's pediatric fatty liver clinic, which this spring was "often fully booked two to six months in advance," Cha reports. The disease often has few symptoms until it becomes serious, at which point it can cause weakness, severe tiredness, weight loss, yellowing of the skin or eyes, spiderlike blood vessels on the skin and long-lasting itching," says Johns Hopkins Medicine.

"For Softic, the fatty liver crisis is as much about policy as science. He has collected a stack of letters from insurers refusing to cover some patients’ treatment with a new generation of weight-loss drugs known as semaglutides, sold under brand names including Ozempic and Wegovy. The companies say the medications are not yet proven to help with fatty liver.

"While Softic believes that fundamental changes in how we eat and exercise are needed in the long term, he said lives could be saved in the short term if these drugs were widely and cheaply available. He’s lobbying state and federal regulators to help pay for the treatments — which can cost upwards of $1,300 a month — for patients younger than 18, who arguably have the most to gain because they have more of their lives ahead of them.

Washington Post graphic frrom Trilliant Health analysis of claims

"Liver transplants in children diagnosed with fatty liver disease remain rare, but Softic recently referred a 6-year-old for a transplant evaluation. There has been a clear rise in transplants for fatty liver in people in their 20s and 30s, meaning if he can’t help his pediatric patients now, they may soon face a transplant."

Softic told Cha the disease “goes unnoticed and unrecognized, and over time it catches up. For a good number of these young transplant patients, the disease process started in childhood,” he said. “On so many levels, we are not prepared to deal with this disease in children.”

A seven-minute video with the story includes the case of Sydney Woods, a Kentucky 15-year-old with fatty liver disease who improved her liver function by "cutting out soda and making other changes to her diet . . . but it's not as easy for most families to buy less procesed food." That's especially true in rural areas, said her mother, Angela Woods, a physician's assistant.

Softic says in the video, "Eating healthy requires time, it requires money, and not everyone has those resources."

Cha reports, "Many doctors believe that our modern lifestyle — diet, the increase in sedentary activities related to technology and environmental exposures — is to blame. One of the liver’s jobs is to filter toxins, and when something in the body is out of balance, the organ can become damaged and fail. Some pediatric experts theorize there’s a mismatch between our genetics and the highly processed and sugary foods that have come to dominate childhood diets," including some types of infant formula. The video says 67% of children's diets consist of ultra-processed foods.

"It's a major problem, and it's been exacerbated by diet and inactivity," Simon Fisher, director of UK's Barnstable Brown Diabetes Center, says in the video.

Cha reports, "The escalation of pediatric fatty liver cases has unfolded in tandem with the presence among the young of other conditions once viewed as almost exclusively adult diseases: high blood pressure, high cholesterol, diabetes, even gallstones."

'The only way we can take care of others is if we first take care of ourselves," UK President Eli Capilouto says in a health message

Kentucky Health News

Before he became an academic and a university administrator, Eli Cailouto was a public-health dentist. He returned to his roots in his latest campus-wide message as University of Kentucky president, promoting preventive measures as the weather cools, we spend more time inside and viruses circulate more. It's aimed at the UK campus but is generally applicable to everyone.

Dr. Eli Capilouto

By Eli Capilouto

As we continue to settle into the academic year, I encourage you to prioritize taking care of yourself.

Be healthy.

Listen to your body. Pay attention when you don’t feel well or when something doesn’t seem right — when in doubt, check it out. We have an outstanding, world-class health care system that is here to take care of you.

Get outdoors. Visit a garden, go to the park, take a walk. Exercising outdoors can help reduce stress and anxiety, improve sleep and ease your mind. The arboretum — open daily from dawn until dusk — has beautiful gardens, a two-mile paved path and a half-mile trail through its woods.

Prepare yourself. Vaccines are safe, effective and an important way to stay healthy. Employees have access to multiple pharmacies and clinics that offer flu, Covid-19, RSV and other vaccines. Flu shots are also available to UK students at University Health Service, UK retail pharmacies and various on-campus flu shot clinics. Find more information here.

The only way we can take care of others is if we first take care of ourselves.

I hope you will join me in making every effort to stay healthy this fall and winter season.

Some experts say Alzheimer's drug is brilliant first step to a cure; others say it's a waste of money that shortchanges the poor

Photo from Eisai Co., maker of the drug

By Arthur Allen
KFF Health News

The first drug purporting to slow the advance of Alzheimer’s disease is likely to cost the U.S. health care system billions annually even as it remains out of reach for many of the lower-income seniors most likely to suffer from dementia.

Medicare and Medicaid patients will make up 92% of the market for lecanemab, according to Eisai Co., which sells the drug under the brand name Leqembi. In addition to the company’s $26,500 annual price tag for the drug, treatment could cost taxpayers $82,500 per patient per year, on average, for genetic tests and frequent brain scans, safety monitoring, and other care, according to estimates from the Institute for Clinical and Economic Review (ICER), a nonprofit that evaluats the cost-effectiveness of health care.

The Food and Drug Administration gave the drug full approval July 6. About 1 million Alzheimer’s patients in the U.S. could qualify to use it. The drug is still in a clinical trial being conducted at many unversities, including the University of Kentucky.

Patients with early Alzheimer’s disease who took lecanemab in the trial showed mental decline five months later than other subjects over an 18-month period, but many suffered brain swelling and bleeding. Although those side effects usually resolved without obvious harm, they apparently caused three deaths.

The great expense of the drug and its treatment raises questions about how it will be paid for, and who will benefit.

“In the history of science, it’s a significant achievement to slightly slow down progression of dementia,” said John Mafi, a researcher and associate professor of medicine at UCLA. “But the actual practical benefits to patients are very marginal, and there is a real risk and a real cost.”

To qualify for Leqembi, patients must undergo a PET scan that looks for amyloid plaques, the protein clumps that clog the brains of many Alzheimer’s patients. About 1 in 5 patients who took Leqembi in the major clinical test of the drug developed brain hemorrhaging or swelling, a risk that requires those taking the drug to undergo frequent medical checkups and brain scans called MRIs.

In anticipation of additional costs from the Leqembi drug class, the Centers for Medicare and Medicaid Services (CMS) in 2021 increased monthly premiums for Medicare patients by 15%, and premiums may rise again in 2024 after a slight decline this year.

Such increases can be a significant burden for many of the 62 million Medicare subscribers who live on fixed incomes. “Real people will be affected,” Mafi said. He contributed to a study that estimated lecanemab and related care would cost Medicare $2 billion to $5 billion a year, making it one of the most expensive taxpayer-funded treatments.

In its analysis, ICER suggested that Leqembi could be cost-effective at an annual price of $8,900 to $21,500. In an interview, David Rind, ICER’s chief medical officer, said $10,000 to $15,000 a year would be reasonable. “Above that range doesn’t seem like a good place,” he said.

Whatever its price, patients may be delayed getting access to Leqembi because of the relative shortage of specialists capable of managing the drug, which will require genetic and neuropsychological testing as well as the PET scan to confirm a patient’s eligibility. A similar drug, Eli Lilly’s donanemab, is likely to win FDA approval this year.

Already there are long waits for the testing needed to assess dementia, Mafi said, noting that one of his patients with mild cognitive impairment had to wait eight months for an evaluation.

Such testing is not readily available because of the lack of effective treatment for Alzheimer’s, which has helped to make geriatrics a relatively unappealing specialty. The United States has about a third as many dementia specialists per capita as Germany, and about half as many as Italy.

“Time is of the essence” for the neuropsychological testing, Mafi said, because once a patient’s cognitive ability declines below a certain threshold, they become ineligible for treatment with the drug, which was tested only in patients in the earliest stages of the disease.

Mafi’s study estimates that patients without supplemental Medicare coverage will have to pay about $6,600 out of pocket for each year of treatment. That could put it out of reach for many of the one in seven  “dual eligible” Medicare beneficiaries whose income is low enough to simultaneously qualify them for Medicaid. The two programs are responsible for about 20% of physician bills for drug infusions, but they don’t always cover the full amount.

Some practitioners, such as cancer centers, cover their Medicaid losses by charging privately insured patients more. But since almost all lecanemab patients are likely to be on government insurance, that “cross-subsidization” is less of an option, said Soeren Mattke, director of the Center for Improving Chronic Illness Care at the University of Southern California.

This poses a serious health-equity issue because “dual eligibles are low-income patients with limited opportunities and education, and at higher risk of chronic illnesses including dementia,” Mattke said in an interview. Yet many doctors may not be willing to treat them, he said. “The idea of denying access to this group is just appalling.”

Eisai spokesperson Libby Holman said the company is reaching out to specialists and primary-care physicians to make them aware of the drug, and that reimbursement options were improving. Eisai will provide the drug at no cost to patients in financial need, she said, and its “patient navigators” can help lock down insurance coverage.

“A lot of clinicians are excited about the drug, and patients are hearing about it,” said David Moss, chief financial officer of INmune Bio, a company that has another Alzheimer’s drug in development. “It’s a money center for infusion centers and MRI operators. It provides reasons for patients to come into the office, which is a billing thing.”

Outstanding doubts about Leqembi and related drugs have given urgency to efforts to monitor patient experiences. CMS is requiring Leqembi patients to be entered into a registry that tracks their outcomes. The agency has established a registry, but the Alzheimer’s Association, the leading advocacy group for dementia patients, is funding its own database to track those being treated, offering physician practices $2,500 to join it and up to $300 per patient visit.

In a letter to CMS on July 27, a group of policy experts said CMS should ensure that any and all Leqembi registries create and share data detailed enough for researchers and FDA safety teams to obtain a clear picture of the drug’s real-world profile.

The anti-amyloid drugs like lecanemab have created a polarized environment in medicine between those who think the drugs are a dangerous waste of money and those who believe they are a brilliant first step to a cure, said ICER’s Rind, who thinks lecanemab has modest benefits.

“People are as dug in on this as almost anything I’ve ever seen in medicine,” he said. “I don’t think it’s healthy.”

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