Robert Slaton dies at 81; was a catalyst for many health projects, including Passport Health Plan and Kentucky Health News

Robert Slaton, Ed.D.

Robert Slaton, a health-care consultant and former Kentucky public-health commissioner who was a catalyst for various health-improvement projects in the state, including Passport Health Plan and Kentucky Health News, died Dec. 27 after suffering a stroke a few days earlier. He was 81 and lived in Louisville.

Slaton, who had master's degrees in education and social work and a doctorate in education administration, was state health commissioner in 1978-79, then ran the Public Service Institute at Kentucky State University and was external-affairs administrator for Trover Clinic, now Baptist Health Deaconness Madisonville, his hometown, from 1983 to 1989. While at the University of Louisville, he was Gov. Brereton Jones' special assistant for health-care reform, executive director of the university's primary-care center, executive director of the Medical School Practice Association and executive vice president of University Health Care, retiring in 2007. As primary-care director, Slaton was part of a small group that planned, developed, and implemented Passport Health Plan, which started in 1997 and became a national model for managed care of Medicaid patients.

As a member of the national advisory board of the Institute for Rural Journalism and Community Issues at the University of Kentucky, he was the catalyst for funding of the institute's Kentucky Health News by the Foundation for a Healthy Kentucky. Sitting with Institute Director Al Cross and then-Foundation President Susan Zepeda at a Kentucky Chamber of Commerce luncheon in 2010, he said, "Al, you ought to ask Susan for some money." When Zepeda asked what the money would be for, Cross (who had no idea the proposition was coming) replied that the goal would be improving health coverage in Kentucky news media. The foundation continues to fund Kentucky Health News.

Slaton later chaired the advisory board, helping the Institiute develop a strategic plan. He was a member of the foundation's Community Advisory Council and chair of the chamber's Health Care Policy Council. In 2018, he won the Russell E. Teague Award from the Kentucky Public Health Association for his achievements and contributions to public health.

"Throughout his career in both public service and as a health-care consultant, he provided a politically savvy perspective and an astute management style that enabled institutions and organizations to make significant headway in policy change to improve the health of Kentuckians," his obituary says. "Robert always believed that health care was a right, not a commodity, and he worked very hard in a variety of settings to help move it in that direction."

As health commissioner, "He demonstrated an understanding of social and structural determinants of health that was ahead of its time," the obituary says. "Robert was a consensus builder and a natural organizer who was described as generous and down-to-earth. His talents included problem solving, strategic planning, and organizing a group of people to get a project done. He was proud that over his career he had helped young staff members develop beyond what they thought they could do. He could often see what needed to be done before most people, and he could handle personalities and egos to bring about change in organizations. Robert focused much of his career on building linkages and coalitions between different groups. This was eased by his genuine rapport with people. Robert’s strategic planning skills, insightful opinions, and wise counsel were valued by many leaders in the business, nonprofit, and political world."

He was co-author of two books about management, From Green Persimmons to Cranky Parrots, and Caught in the Middle Management. At the time of his death, he was working on a book about his mother’s life, based on the diaries she kept for decades. As he moved into assisted living, Robert was already making plans for his next book, stories of his colorful adventures as a parole officer in Western Kentucky in the 1960s. He was a delegate to the 1992 Democratic convention.

Slaton is survived by five adult children, Andrea, Lyle, Tom, Danny (Elizabeth), and Mike (Jake), and three grandchildren: Thia, Henry, and Lila. He is also survived by his companion, Mary B. Bradley, and her two children, whom he very much thought of as his own: Lizi Hagan and Clay McClure.

A memorial service will be held at 10 a.m. ET Saturday, Dec. 31 at Pearson’s, 149 Breckenridge Lane, Louisville. Visitation will be held from 4 to 7 p.m. ET Dec. 30 at Pearson’s. In lieu of flowers, donations may be made to Down Syndrome of Louisville, the Foundation for a Healthy Kentucky, or the Institute for Rural Journalism and Community Issues.

Book about opioid epidemic on the Tug Fork also tells story of reporter who overcame obstacles to win Pulitzer Prize

A new book from former Charleston Gazette-Mail reporter Eric Eyre takes a deep dive into the opioid epidemic through the lens of Kermit, W.Va., a town of 382 people whose pharmacy distributed 12 million pain pills in three years. It's right across the Tug Fork of the Big Sandy River from Warfield, Ky., in Martin County. Death in Mud Lick details one woman's fight to seek accountability from major pharmaceutical companies after her brother's overdose death.

"The story is also a reporter’s firsthand account about what it’s like to mine for the truth while working for a newspaper fighting for survival on multiple fronts, as greedy corporate owners make serious budget cuts to maintain the paper’s profit margins and as combative politicians stonewall," Ralph Berrier Jr. reports for The Roanoke Times. "Death in Mud Lick is for readers who root for the underdog, who want justice served and who love newspapers."

Eric Eyre

Readers should appreciate the scale of Eyre's battle and what it accomplished, ProPublica reporter Ken Armstrong, a former colleague of Eyre's, writes for The New Yorker. Eyre researched and wrote the book while he was still cranking out near-daily stories for the paper, facing off against the powerful drug industry with little funding, decrepit equipment, and an increasingly difficult battle with Parkinson's disease. He persevered, and "his reporting led to restrictions on prescriptions, greater tracking, more transparency. He shamed an industry and saved lives. Working at a small newspaper, Eyre made a big difference," Armstrong writes.

For Eyre, who won a Pulitzer Prize in 2017 for his coverage of the opioid epidemic in rural West Virginia, the book perhaps serves as his final bow in journalism: With his Parkinson's getting worse, he submitted his resignation letter last week; Armstrong reports: "The same day his book came out, Eyre left the paper."

Louisville psychiatrist writes book about landmark research that gets to root of why people struggle in their relationships

Nov. 18, 2018: Story updated to reflect Living on Automatic: How Emotional Conditioning Shapes Our Lives and Relationsips was chosen by American Book Fest as a finalist for the "2018 Best Book Award" for best new non-fiction .

By Melissa Patrick
Kentucky Health News

In a world inundated with interpersonal conflicts, a Kentucky psychiatrist has written a groundbreaking new book that explains what lies at the root of these conflicts and offers a way to resolve them.

"It's a book that talks about why the things that go wrong in our relationships go wrong, and why we live on automatic pilot and do things that we sometimes don't even want to do, but we repeat them over and over again and we wish we could stop," Dr. Christine B.L. Adams, one of the book's authors, said in a telephone interview.

The book, Living on Automatic: How Emotional Conditioning Shapes Our Lives and Relationships, is a collaborative effort between Adams, a child psychiatrist in Louisville, and the late Dr. Homer B. Martin, her colleague and mentor. Adams said their landmark research around emotional conditioning is based on 80 combined years of psychotherapy with thousands of patients. It was recently chosen by American Book Fest as a finalist for the "2018 Best Book Award" for best new non-fiction.

The authors write that people are emotionally conditioned within the first two to three years of life by their parents or caretakers to fall into one of two roles that form the basis of their personalities.

The two roles are called omnipotent and impotent. An omnipotent is conditioned to please and do for others; an impotent is conditioned to need constant emotional care and attention from others. Each role is a matter of degree, the authors say; people fall on a continuum from mild to severe for each of these conditioned roles.

The result of this emotional conditioning, Adams says, is that people tend to seek relationships that meet their own needs, rather than relationships that recognize each other as individuals.

But this isn't working, she said, pointing to how interpersonal conflicts have resulted in such high rates of divorce and substance abuse and increasing conflicts between parents and their children.

"So this says to me that the way we've been doing it has not been very successful and perhaps there is a better way," Adams said.

That way, she says, is for people to re-learn how to interact with each other in ways that promote better relationships. She calls it deconditioning, and explains it in the final chapters of the book.

"What you learn to adopt when you try to shed your conditioning is a standard of reasonableness rather than a standard of automatic conditioned responding," she said. "You have to learn a technique of evaluating yourself and the other person simultaneously in every exchange you have with them."

She added that this technique helps a person determine what is called for in each situation.

"In this way you don't automatically respond just to the role of the other person," she said. "You respond according to what each person needs for the particular situation at that particular time."

Adams said people who have gone through this process "have much better lives, are able to manage their lives better and have better relationships," and when one person goes through the process it typically has a "ripple effect" throughout a family and others who are close to them.

Beyond romantic relationships, Adams said the book also has applications for young parents to help them raise "more well-balanced" children, as well as help for agencies that work with children.

She said the book is written for a general audience, in hopes of bringing awareness to this new concept of emotional conditioning, and how this causes us to act on automatic pilot most of the time when it comes to our relationships.

"This is a landmark study of what really happens in relationships," she said. "And when you impart information to people that they've not known before, then a lot of people start thinking about it in new ways and will apply it to themselves and their family and their friends."

Author of Dreamland says opioid epidemic is making people talk about addiction, a first step in finding solutions

By Melissa Patrick
Kentucky Health News

Since Dreamland: The True Tale of America's Opiate Epidemic was published in 2015, the author says the nation has seen both positive and negative changes in the epidemic that is sweeping Kentucky and other states.

"The negative changes are pretty dramatic," Sam Quinones said in a telephone interview with Kentucky Health News. "The number of people who are dying from this is every year more, and there doesn't seem to be an end in sight. . . . It's a very scary time."

On the other hand, individuals and families have "come out of the shadows" and are now telling their stories of addiction, which he said will help lead to solutions.

Quinones came to Kentucky to speak at the Foundation for a Healthy Kentucky's annual Howard Bost Memorial Health Policy Forum, Monday, Sept. 25 in Lexington. It sold out.

He said in the interview that it's hard for him to talk about positive reactions to the epidemic, given the torment it has caused so many families. But he's glad there is talk.

"And that's what happened with AIDS. When people came out of the shadows, we found solutions to AIDS," he said. "With more awareness, more people are working together on this . . . and I definitely believe that is a crucial part of this whole response."

He added, "You have a lot more political action, you've got a lot more budgetary action, you've got media paying far, far greater attention to this than even a few years ago -- and so all of that is for the positive."

He also said the epidemic has caused people to question old dogma and re-think how the nation, the state and communities have treated addiction and its victims.

“In Kentucky, I would say one of the most radical ideas that has been tried – I would give it enormous applause – is you have two dozen counties at least that are now transforming part of their jails, pods that are within their jails, to full-time rehabilitation clinics," he said. "I think that is magnificent."

Dreamland, named for a huge, old swimming pool in Portsmouth, Ohio, a town ravaged by the opioid epidemic, is a collection of stories that traces the origins and effects of the epidemic, which started 20 years ago.

It tells the story of  a society that wants to be pain-free, both physically and emotionally; an extremely addictive prescription painkiller and its aggressive marketing campaign; the subsequent shift in how the medical community viewed pain, and how it became the fifth vital sign; and how a heroin trafficking operation out of Mexico, using a customer-service business model, forever changed how illicit drugs are delivered in America.

Sam Quinones

Quinones emphasized that he left his "politics at the door" when he wrote Dreamland and encouraged others to do the same when they read it, and not "cherry-pick" aspects of the book that suit their point of view, which he said sometimes happens.

"It's a big picture," he said. "It's a mosaic of things that went into this and you need to consider them all."

He said it will take a variety of responses to deal with the epidemic, including individual and humane care for patients who are addicted to prescription opioids, instead of just cutting them off; appropriate use of medication-assisted therapies, along with supportive group therapies; and a shift in the way we view pain, both physically and emotionally.

Quinones said the epidemic seems to be calling into question parenting practices that aim to protect children from all pain, such as the practice of giving all kids in an event a participation trophy; to question whether or not possessions actually lead to happiness; and to examine the role of personal responsibility related to diet and exercise as ways to approach issues of physical pain.

"I think there are a lot of ways in which this epidemic is calling us to question how we've been living."

Is sugar our nutritional enemy? New book claims it is

For about a decade as the century started, more and more Americans appeared to obey the U.S. Department of Agriculture's advice to eat less sugar.

But that trend of improvement has leveled off, according to statistics released Thursday by the federal Centers for Disease Control and Prevention. The data show that about half of American adults drink at least one sugar-sweetened beverage daily and the average adult consumes about 150 calories from sodas or other sugary drinks each day.

Gary Taubes
(Photo from Twitter)

That's a big problem, says Gary Taubes, author of The Case Against Sugar. The book points to sugar to explain why two-thirds of American adults are overweight or obese, one in seven is diabetic and about one in five will die from cancer, Jere Downs writes for The Courier-Journal.

The book makes sugar the villain in "metabolic syndrome," a term coined by medical researchers as early as 1987. Metabolic syndrome is the name for a group of risk factors that raises a person's risk for heart disease and other health problems, such as diabetes and stroke, according to the National Institutes of Health. Risk factors are traits, conditions, or habits that increase the likelihood of developing a disease.

Taubes's book points to sugar as the culprit
behind obesity, diabetes, and other lifestyle-
related diseases. (Photo via garytaubes.com)

"If you are overweight with a thickening middle and especially if you are approaching middle age or older, chances are good your body is wrestling with the effects of prolonged exposure to too much sugar," Downs notes.

The body manufactures insulin, a hormone that unlocks sugar's energy at the cellular level, in response to consuming sugar. Insulin can be elevated in the blood for years before the onset of Type 2 diabetes, as the pancreas produces more of the hormone to cope with the excess sugar. Even if the pancreas remains strong and diabetes does not develop, elevated insulin turns up blood pressure and levels of triglycerides, Downs writes. Such disturbances create and aggravate inflammation and hardening of the arteries.

Taubes's book, like others before it, attempts to dispel the myth that all calories are created equal, whether they come from candy bars or carrots. Straight sugar and highly refined carbohydrates, like white bread, trigger metabolic syndrome, which tells the body's cells to hoard fat, which in turn keeps a person overweight and sick, Downs notes.

"Remove the sugar and the insulin resistance improves, and weight is lost," Taubes told Downs.

However, there has been no definitive proof of sugar's role in metabolic syndrome, obesity, diabetes, and other illnesses and it is not likely to come soon. There are only a handful of small, limited clinical trials underway exploring sugar’s direct role in metabolic disease in the U.S., Taubes told Downs. Long-term lifestyle studies are expensive and face opposition from the sugar industry and other lobbies.

As far back as 1977, some Department of Agriculture researchers were so convinced of sugar's role in diabetes and heart disease that they called for Americans to reduce consumption by 60 percent, Downs writes. The average American today consumes 100 to 130 pounds of sugar a year; the estimates vary with the source of information.

In an effort to help combat the problem, new food labels emphasizing "added sugar" in packaged products are supposed to become mandatory on July 26. Whether the Food and Drug Administration will continue the Obama-era mandate under the new Trump administration is unclear.

Percentage of adults 20 and older who consumed sugary beverages on a given day, 2011-14 (Source: CDC)

Forrest W. Calico, national leader in rural health care, dies at 75

Forrest W. Calico

Dr. Forrest W. Calico, a nationally recognized expert on rural health-care quality, died Monday at his home near Crab Orchard "after striving against multiple myeloma for several years," said his obituary in the Lexington Herald-Leader. He was 75.

A native of Garrard County, Calico received his medical degree from the University of Kentucky in 1966. He also held a master's degree in public health from Harvard University. In the U.S. Air Force, he was a flight surgeon at Area 51 in Nevada, a family physician, residency director and hospital administrator, earning the Bronze Star. He was president and CEO of Appalachian Regional Healthcare from 1993 to 1999, a health-systems adviser to the federal Office of Rural Health Policy and a senior quality adviser to the National Rural Health Association. In 2007 he was named a Rural Hero by the National Rural Assembly and in 2010 entered the UK College of Public Health Hall of Fame.

In retirement, Calico remained active at the state and local levels, serving on the boards of the Foundation for a Healthy Kentucky, the Friedell Committee for Health System Transformation and the Lincoln County Board of Health. In 2012 he published a memoir, Out of the Blue, with the subtitle "How open doors and unexpected paths set the course of my life."

Calico is survived by his wife Patricia Calico, their son Jefferson and wife Cari, daughter Tricia and husband Wes Cohron, his sister Helen Eden, a nephew and six grandchildren. A celebration of his life will be held Saturday, June 18, from 2 to 5 p.m., with a memorial service at 3 p.m., at The Church at Cedar Creek at 5787 US 150, east of Stanford. Memorial donations may go to The Friedell Committee, PO Box 910953, Lexington KY 40591, or the Dr. Patricia A. Calico Endowed Nursing Scholarship at UK, 315 College of Nursing Building, Lexington KY 40536.

Authors of The Great Diabetes Epidemic appearing in half-hour show several times on KET channels this week

Dr. Gilbert Friedell and J. Isaac Joyner, co-authors of The Great Diabetes Epidemic: A Manifesto for Control and Prevention, discuss the topic with Dr. Wayne Tuckson in a half-hour "Kentucky Health" program airing on KET and its other channels this week.

"If you know diabetes, you know medicine," Tuckson says in introducing the show, "because diabetes affects everything, from the eyes, to the vascular system, to our extremities. Unfortunately, the incidence of diabetes is increasing, and diabetes is affecting people at a younger and younger age."

In their book, Friedell and Joyner recommend four steps to control the diabetes epidemic: "First, acknowledge that there is an epidemic, and deal with it as a public health problem, with community as well as individual action. . . . Second, our communities must take responsibility for diabetes and pre-diabetes in their populations," partly with "broad-based Community Diabetes Control and Prevention Councils representing all segments of the population in every county. . . . Third, the community and the Kentucky Department for Public Health need more precise information about the magnitude and extent of the epidemic. We therefore advocate universal screening of all residents over the age of 45 in doctors’ offices and in community screening locations. . . . Fourth, in order to prevent as many people with pre-diabetes as possible from developing diabetes, there should be numerous, available, affordable organized prevention programs in accessible community sites."

Here is the broadcast schedule for the program, in order of appearance:

KETKY: Monday, Jan. 4, at 6:30 a.m. ET

KET: Tuesday, Jan. 5, at 5 a.m. ET

KETKY: Jan. 5 at 7:30 p.m. ET

KETKY: Wednesday, Jan. 6, at 8:30 a.m. ET

KET2: Jan. 6 at 7 p.m. ET

KETKY: Thursday, Jan. 7, at 1:30 p.m. ET

KET2: Friday, Jan. 8, at 7:30 a.m. ET

KETKY: Saturday, Jan. 9, at 6 a.m. ET

Authors of The Great Diabetes Epidemic will talk on KET about its causes, myths, complications, treatment and prevention

Kentucky Health News

The message that the authors of The Great Diabetes Epidemic: A Manifesto for Control and Prevention want readers to take from their book is that "diabetes is a serious, but preventable disease, if proper early interventions are implemented through a community-based, public health approach," KET says in a press release.

Authors Dr. Gilbert Friedell and J. Isaac Joyner will discuss this message with host Renee Shaw, and look at the root causes of the high number of diabetes cases in the U.S. and what needs to be done about it, on "Connections with Renee Shaw" on KET2 Friday, March 27 at 5 p.m. ET and on KET Sunday, March 29 at 1:30 p.m. ET.

Other topics discussed include common misconceptions and barriers to treatment, belief systems around diabetes that aren't based on fact, and the significant health ramifications of the disease, including complications such as blindness, amputations and renal failure.

"In Kentucky alone, for example, there are 72,000 diabetes-related cases of blindness and visual impairment diagnosed each year – roughly 200 per day," KET notes.

Book about Appalachian health reveals region and culture-specific issues for researchers, region's residents

Editors of a new book hope it will shed light on the health problems facing Appalachia while debunking myths about the culture. Robert Ludke and Phillip Obermiller, both of the University of Cincinnati, compiled work for Appalachian Health and Well-Being from researchers "who present data addressing health disparities affecting urban and rural Appalachians and offers possible solutions," the Cincinnati Enquirer reports. Obermiller said most of the book's 40 contributors are from the region. The book will be officially debuted at the Appalachian Studies Association Conference this weekend in Indiana, Pa.

Ludke said the book is intended to be a resource to Appalachians or people studying public health. He said politicians and the general public need the information to better address Appalachians' health issues. The editors said they also wanted to draw attention to "urban Appalachians," or people of Appalachian heritage living in metropolitan areas. Ludke said the Appalachian population living in Cincinnati has assimilated less than in other metro areas. (Read more)