One case among thousands, highlighted at UK event, helps illustrate why Kentucky needed a comprehensive cancer center

Cancer survivor and medical student Anna Cox gets applause

at Friday's announcement; at right is Dr. Mark Evers, director

of the Markey Cancer Center. (University of Kentucky photo)

By Sarah Ladd

Kentucky Lantern

Anna Cox had just graduated from the University of Kentucky when she was diagnosed with blood cancer in 2018. She first sought emergency care for a “wrenching abdominal pain.” It turned out to be related to stage four diffuse large B-cell lymphoma, a type of non-Hodgkin lymphoma.

Cox was treated at the university’s Markey Cancer Center, which made history Friday by announcing it is recognized by the National Cancer Institute as a “comprehensive” cancer center — the only one in Kentucky.

“I had never been sick before, and I did not even have a primary-care doctor,” Cox said Friday at the Gatton Student Center, where she joined politicians and university staff to to announce the honor. “With a Stage 4 diagnosis, naturally I was scared of what was to come. But my team at Markey was with me every step of the way.”

Markey is now one of 56 comprehensive cancer centers in the United States. The designation goes to institutions that conduct in-depth research, among other things.

Because of the “compassionate” care she received there, the now cancer-free Cox returned to UK to pursue a medical degree.

“What started with time as a cancer patient led me to innovative cancer research and into medical school as a future physician — all at one institution,” Cox said. “This is what being a comprehensive cancer center is all about.”

State Senate President Robert Stivers, a Republican from Manchester, praised the “added value” the state will enjoy with the new designation.

“This is not a football school; this is not a basketball school,” Stivers said in Lexington. “This is a school that will be known as a center of excellence for cancer research and giving hope for a cure to those who fight this with their family and friends.”

Also on hand for the announcement were UK President Eli Capilouto, Democratic Gov. Andy Beshear, U.S. Rep. Andy Barr, R-Lexington, and others. In a pre-recorded video, U.S. Sen. Mitch McConnell said the honor paves the way “for even more groundbreaking research in the fight against cancer and ensuring that Kentucky’s communities will receive the gold standard of cancer care.”

In 2021, more than 10,000 Kentuckians died with cancer, according to the Centers for Disease Control and Prevention, making it one of the more deadly states for cancer patients. Almost all of Markey’s patients come from Kentucky, UK said in a press release.

Markey patients now have “access to new drugs, treatment options and clinical trials offered only at NCI-designated centers,” UK said in a statement. 

Barr said, “It means that we can attract the best clinicians, the best researchers, more research dollars, better clinical trials. And that means better outcomes. And, boy, do we need it in the Commonwealth of Kentucky.”

UK cancer center gets top U.S. designation, shared by 55 others

UK wasted no time promoting the new designation Friday on its
Cornerstone display on Limestone Street. (Photo by Al Cross)

Kentucky Health News

The University of Kentucky's cancer center has received the highest designation from the National Cancer Institute, making it the first such center in Kentucky, it announced Friday. The United States has 56.

In 2013, the Markey Cancer Center received its initial NCI designation, held by 72 centers in the nation. It worked for a decade to get the higher designation, based on research, treatment, diagnosis and prevention.

“It’s really the gold standard of clinical care, research and community outreach,” said Dr. Mark Evers, who has been director of the center since 2009, when the university started trying for NCI designation.

UK President Eli Capilouto said, “To truly be the University for Kentucky, we raised the stakes and decided that UK will continue to be a leader in cancer research by becoming a comprehensive cancer center.”

That required hundreds of millions of dollars in investment from UK and the state legislature, which put in $135 million in 2013 and another $20 million this year, state Senate President Robert Stivers said.

Kentucky has the nation's third highest rate of death from cancer, behind West Virginia and Mississippi, and cancer is the state's second most common cause of death, next to heart disease. 

The closest comprehensive cancer center to Lexington is nearly 200 miles away, a UK press release noted without mentioning the one at Vanderbilt University in Nashville, which competes with UK for patients living in Western Kentucky. Indiana University has a comprehensive cancer center in Indianapolis.

"The elevation to an NCI-designated comprehensive cancer center will further enhance Markey's ability to attract top-tier researchers and clinicians, secure additional research funding, collaborate with national and international partners, and give patients access to leading-edge treatments and clinical trials – resulting in better patient care and health outcomes for Kentuckians," the release said. "Numerous studies show that patients treated at NCI-Comprehensive Cancer Centers have better survival and recovery rates."

In addition to the comprehensive designation, NCI awarded the center $13.5 million through a five-year renewal of its grant for research programs, shared equipment and resources.

Since 2013, more than 100 cancer researchers have been recruited to UK and external funding to Markey researchers has more than doubled, the release said. Markey’s outpatient visits have increased by 69% and the number of new patients has gone up 75%.

The center's growth prompted UK to start work on a new treatment center and advanced ambulatory complex that will bring Markey's outpatient services under one roof. It is expected to open in 2027.

Kentucky keeps losing doctors when it needs more of them; in the 2022 fiscal year it had only seven for every eight it had in 2018

Ky. Health News graph from UK Center for Excellence in

Rural Health data; there are no data for Fiscal 2021 due to

the pandemic. (Click on any image to see a larger version.)

Kentucky Health News

Kentucky is losing physicians at a time when it needs many more of them, the top executive of the Kentucky Medical Association told a legislative committee Wednesday.

From 2019 to 2022, the last fiscal year for which data are available, “We lost 590 physicians out of the state . . . at a time that we needed more physicians in the state,” KMA Executive Vice President Patrick Padgett told the Interim Joint Committee on Health Services.

And the loss is even bigger going back to Fiscal 2018, the year that the number of licensed physicians in Kentucky peaked at 11,437. (Fiscal years run from July 1 to June 30.) In Fiscal 2019, the number dropped to 10,592. That was a drop of 7.4 percent. The decrease from 2018 to 2022 was just over 12.5 percent. That's one-eighth, so for every eight doctors in 2018, the state had only seven in 2022.

The decline in primary-care physicians was much less, 3.4 percent: from 2,825 to 2,729. However, 43 of the state's 120 counties are considered short of primary-care doctors, and Kentucky ranks 40th in the nation in the number of primary-care physicians per 100,000 people, according to a report by the University of Kentucky's Center for Excellence in Rural Health. It says 25 counties are considered short of doctors overall, and "Almost a third of Kentucky physicians have been licensed between 31 and 50-plus years," meaning many will retire relatively soon.

Padgett told John McGary of WEKU-FM that having fewer doctors overall "means that people have to wait longer to see a physician. I think that anyone around the state who tries to get in to see a physician, whatever the physician specialty, wherever they're located, when you have to wait weeks, or sometimes months to get in to see a physician, you're experiencing this problem." 

KMA executive Patrick Padgett

Padgett told the committee, “Three years ago, I would have come here to say that Kentucky badly needed more physicians. And unfortunately, the situation has only gotten worse. And we really need to work to not only bring in more physicians but keep the ones that we already have.”

A KMA survey last fall "showed many of the state’s physicians are dealing with increased levels of stress," notes Sarah Ladd of the Kentucky Lantern. "The degree to which that affected their work varied. Most cited administrative burdens such as prior authorization requirements as a driving force behind their stress. During the 2023 legislative session, legislators considered adding exemptions to the state’s prior authorization requirements, but the bipartisan bill was stuck in a committee."

The General Assembly did pass a bill to protect Kentucky doctors who seek mental-health help from wellness programs, by saying doctors don't need to report their participation, Ladd notes: "Their jobs will also be safe if they do so."

Much of the decline in licensed physicians came during the Covid-19 pandemic, when much attention was given to the increasing shortage of nurses. Delanor Manson, CEO of the Kentucky Nurses Association, told the committee that the state needs to improve the health-care workforce pipeline and keep nurses in the profession, Ladd reports.

“Health care is the engine for the economy,” Manson said. “And nurses are the engine for health care.”

OPINION: Criminologists say baseless anti-transgender claims fuel adoption of harmful laws in Kentucky and other states

By Henry Fradell and Alexis Rowland
Republished from The Conversation

It has been seven years since North Carolina made headlines for enacting a “bathroom bill” — legislation intended to prevent transgender people from using restrooms that align with their gender identity. After boycotts threatened to cost the state more than $3.7 billion, legislators repealed the law in 2017. Since then, however, religious and political conservatives have successfully spread an anti-trans moral panic, or irrational fear, across the United States.

As far back as 2001, Republican lawmakers proposed the first of what are now nearly 900 anti-LGBTQ+ bills. More than 500 of these were introduced in 49 state legislatures and the U.S. Congress during the first five months of 2023. To date, at least 79 have passed.

Many of these laws have been  written and financed by a group of far-right interest groups, including the Alliance Defending Freedom, the Family Research Council, the American Principles Project and Liberty Counsel.

These groups claim the laws protect cisgender women and girls – whose gender identity matches the sex they were assigned at birth – from violent trans people who are often depicted in movies and other media.

But as criminologists, we know these claims are without merit. No reliable data supports the argument that transgender people commit violent crimes at higher rates than cisgender men and women. In fact, transgender people are more than four times as likely to be the victim of a crime as cisgender people.

In the last year, at least 18 states including Kentucky have enacted laws that limit medically age-appropriate gender-affirming health care for trans minors, with similar bills pending in 14 more states. And Florida’s barrage of anti-LGBTQ+ regulations even prohibits the mere discussion of sexuality and gender identity in schools through the 12th grade. Journalist Adam Rhodes called these efforts a “centrally coordinated attack on transgender existence.”

We believe these laws and bills illustrate the increasingly hostile legislative landscape for LGBTQ+ people despite polls showing that most people in the United States want trans people to be protected from discrimination in public spaces on the basis of their gender.

What the data show

A variety of myths, false narratives, bad science, misconceptions and outright misrepresentations undergird anti-trans laws. The reality, however, is that trans-exclusionary laws do not protect cisgender women and girls from harassment or violence. Rather, they result in dramatic increases in violent victimization for transgender and gender-nonconforming adults and children.

When laws permit transgender people to access sex-segregated spaces in accordance with their gender identities, crime rates do not increase. There is no association between trans-inclusive policies and more crime. As one of us wrote in a recent paper, this is likely because, just like cisgender folks, “transgender people use locker rooms and restrooms to change clothes and go to the bathroom,” not for sexual gratification or predatory reasons.

Conversely, when trans people are forced by law to use sex-segregated spaces that align with the sex assigned to them at birth instead of their gender identity, two important facts should be noted.

First, no studies show that violent crime rates against cisgender women and girls in such spaces decrease. In other words, cisgender women and girls are no safer than they would be in the absence of anti-trans laws. Certainly, the possibility exists that a cisgender man might pose as a woman to go into certain spaces under false pretenses. But that same possibility remains regardless of whether transgender people are lawfully permitted in those spaces.

Second, trans people are significantly more likely to be victimized in sex-segregated spaces than are cisgender people. For instance, while incarcerated in facilities designated for men, trans women are nine to 13 times as likely to be sexually assaulted as the men with whom they are boarded.

In women’s prisons, correctional staff are responsible for 41% of women’s sexual victimization, with cisgender women committing the balance of nearly all prisoner-on-prisoner violence. Similarly, trans boys and girls who are barred from using the washrooms and locker rooms that align with their gender identity are respectively between 26% to 149% more likely to be sexually victimized in the locations they are forced to use than cisgender youths.

In society at large, between 84% and 90% of all crimes of sexual violence are perpetrated by someone the victim knows, not a stranger lurking in the shadows – or the showers or restroom stalls. But trans and nonbinary people feel very unsafe in bathrooms and locker rooms, though others experience relative safety there. In fact, the largest study of its kind found that upward of 75% of trans men and 64% of trans women reported that they routinely avoid public restrooms to minimize their chances of being harassed or assaulted.

Lies drive harm

Because criminological data does not support trans-exclusionary laws or policies, advocates of anti-trans laws often resort to lies, flawed anecdotal evidence, or what fact-checkers have called “extreme cherry-picking” to support their position.

For instance, one of us documented how isolated news stories, often from notoriously transphobic tabloids, conflate the actions of sexual predators with the “dangerousness” of trans women. Although there are undeniably examples of actual transgender people committing crimes, even deeply troubling ones, they are not evidence of any behavioral trends among the broader class of trans people. No such data exist.

We believe the spate of anti-trans proposals represents a textbook example of crime-control theater – an unnecessary, ineffective and harmful legislative response to unfounded fearmongering.

Anti-trans laws are not just baseless. They’re hurtful and damaging, especially to LGBTQ+ teenagers. Recent polls indicate that more than 60% of these people experience deteriorating mental health — including depression, anxiety and suicidal thoughts – as a result of laws and policies aimed at restricting their personhood.

The criminological research is clear that anti-trans laws do not help the people they are claimed to protect. In fact, these laws inflict harm on people who are even more vulnerable.

Henry Fradella is a professor in the School of Criminology and Criminal Justice at Arizona State University, where he also holds a law-school appointment . He is the author, co-author, or editor of 13 books, including LGBTQ+ Issues in Criminology and Criminal Justice. Alexis Rowland is a Ph.D. student in criminology, law and society at the University of California, Irvine.

S.C. high court is first in U.S. since Roe repeal to find abortion right in state constitution; Idaho says no; Ky. case still pending

By Al Cross
Kentucky Health News

The South Carolina Supreme Court has become the first to find a right to abortion in a state constitution since the U.S. Supreme Court said last June that there is no such right in the U.S. Constitution.

The Kentucky Supreme Court might have been the first, tentatively, but it still has not ruled in a case that it heard Nov. 15. Since then, two justices have retired and two new ones have been elected, and they can rehear the case or just watch and read the arguments, Supreme Court Clerk Kelly Stephens said, adding that she does not expect a decison this month.

Meanwhile, the Idaho Supreme Court declined Thursday to find a right to abortion in that state's constitution. The vote was 3-2, the same as in South Carolina, but with the opposite result.

The South Carolina justices said the state’s ban on abortion afer the sixth week of pregnancy violated the state constitution's explicit guarantee of privacy rights. Kentucky's constitutional privacy rights rely on unspecific language and previous interpretations by the state Supreme Court.

South Carolina’s constitution says “The right of the people to be secure in their persons, houses, papers, and effects against unreasonable searches and seizures and unreasonable invasions of privacy shall not be violated.”

The court's majority opinion said any limit of privacy rights “must be reasonable,” meaning that a woman needs “sufficient time to determine she is pregnant and take reasonable steps to terminate that pregnancy.” The court said that six weeks is “quite simply, not a reasonable period of time for those two things to occur” because “women typically do not realize they are pregnant until around six weeks.”

Kentucky also has six-week ban, but also a stronger ban, allowing abortion only to save the woman's life. The latter was in a "trigger law" that took effect after the U.S. Supreme Court struck down Roe v. Wade.

A Louisville judge issued an injunction that blocked the trigger law, but a state Court of Appeals judge blocked the injunction, allowing the law to take effect. A fractured Supreme Court allowed it to stay in effect while it considered the case. It set the hearing for a week after the Nov. 8 election, in which voters defeated a proposed amendment to the state constitution, saying it does not grant a right to abortion or funding of it.

At least initially, the Supreme Court's ruling will be on the injunction, not on the merits of the lawsuit, but a key piece of injunction law is the likelihood of prevailing on the merits.

Similar challenges to state abortion laws, citing state constitutional proviosions, are pending in Arizona, Georgia, Indiana, Iowa, North Dakota, Ohio, Utah, Wisconsin and Wyoming, according to Politico.

Four of the South Carolina court’s five justices are registered Republicans; Chief Justice Donald Beatty, who voted with the 3-2 majority, is a Democrat. All five were appointed by the Republican-conrolled legislature. Kentucky judges are elected by the people in nonpartisan races.

FDA expands availability of abortion-inducing medication

Women who want to use a pill to end their pregnancy in the first 10 weeks will now be able to get it directly from health-care providers and pharmacies. The move by the U.S. Food and Drug Administration expands options for women in Kentucky, where almost all abortions are currently illegal. The state Supreme Court, in a pending case, could change that.

The FDA announced the new rules for the abortion-inducing drug mifepristone Tuesday night. The drug is already used in more than half of the abortions in the United States.

"Prior to this announcement, mifepristone could only be dispensed by some mail-order pharmacies, or in person by specially certified providers," MedPage Today notes. "This week's decision will allow patients to pick up the abortion pill at brick-and-mortar locations, including local drugstores or chain pharmacies like CVS or Walgreens." Those chains said they would sell the drug. Rite Aid said it was reviewing the FDA's action, USA Today reports.

Last year, the FDA allowed the drug to be obtained by mail, but the Kentucky General Assembly banned that in a wide-ranging anti-abortion bill. FDA proposed the changes in December 2021, "six months before the Supreme Court overturned Roe v. Wade and left abortion policy up to individual states," notes Beth Wang of Inside Health Policy. In Kentucky, the decision activated a "trigger law" that bans abortion except to save the woman's life.

The changes announced Tuesday allow pharmacies that go through a certification process, still not specified, to dispense the drug directly to patients who have a prescription from a certified prescriber who has an agreement with the certified pharmacy, Wang reports.

UPDATE, Jan. 5: "Legal scholars slammed FDA’s certification requirements for pharmacies to dispense the abortion pill, mifepristone, saying they’re unnecessary and not based in science, and the experts called on FDA to get rid of the prescribing and dispensing restrictions altogether," Wang reports.

"FDA also has permanently removed the requirement that patients see a health-care provider in person before being prescribed the drug," Wang notes. "That requirement was temporarily removed during the Covid-19 public health emergency." However, Kentucky law bans the use of telemedicine to get a mifepristone prescription.

Rural Ky. needs more community health workers and medical-school residents, legislators and UK hospital executive say

Charles Aull of the Kentucky Chamber of Commerce, upper left, moderated the webinar.

By Al Cross
Kentucky Health News

Improving health care and health in rural Kentucky will take more people in the health-care workforce, specifically at the top and bottom of the pay scale, two key legislators and one of the state's top hospital administrators said Tuesday, June 8.

Kentucky needs more health-care workers overall, because it may lose some to the pandemic, Mark Birdwhistell, vice president for health services administration at the University of Kentucky and chief of staff for UK HealthCare, said during a Kentucky Chamber of Commerce webinar on rural-urban health disparities.

"Coming out of Covid . . . many of our clinical workforce are fatigued, and they're second-guessing: 'Is this the career path that I want to go on?' They've been in combat for a year and a half now," Birdwhistell said.

State Rep. Kim Moser, a Republican from Taylor Mill in Northern Kentucky, agreed. "Burnout is real," she said, noting that her husband is a pulmonologist who has treated Covid patients.

The need for more community health workers, who are not health-care providers but can educate people about care and help them get it, came up as Birdwhistell, a former state health secretary, discussed the 2014 expansion of the federal-state Medicaid program for lower-income Kentuckians.

"Just because you've got coverage doesn't mean you've got access" to the health care you need, Birdwhistell said, because "Many providers don't take Medicaid." He and Baptist Health Louisville President Larry Gray said health insurance tends to cost more in rural areas due to lack of competition, so people buy policies with high co-payments and deductibles.

The expansion of Medicaid made clearer how the "social determinants of health" leave rural areas with lower health status, Birdwhistell said. It's twice as likely for someone in an urban area to finish high school or college as someone in a rural area, he said, so health literacy is lower in rural areas. And that extends to health insurance, he said, giving one example: "Deductible. That's hard to explain in English."

Moser, a retired nurse who chairs the state House Health and Family Services Committee, said expanding the limited government and commercial-insurance reimbursement for community health workers' services would help. "That is one policy that we're looking at possibly expanding," she said.

Birdwhistell said that would be "very, very cost-effective," because "In a lot of communities, people don't know how to access care, and they show up in the emergency room. And that is probably the worst place for anybody to show up with a high fever, strep throat, whatever. They don't get a continuum of care. . . . They will listen to somebody that they grew up with, somebody that they go to church with, somebody that they see on the soccer field with their kids."

Service area of Kentucky Homeplace

Eastern Kentucky already has the third largest concentration of community health workers in the nation, trailing only Alaska and northwest Mississippi, according to the Bureau of Labor Statistics.

That is likely due to Kentucky Homeplace, a 27-year-old program of UK's Center for Excellence in Rural Health in Hazard. It says it helps people in the region with "lifestyle choices, environmental factors, inadequate health insurance and general lack of understanding of the health-care system."

Nationally, CHW pay averages $46,000 a year, but in Kentucky the average is $37,320.

The webinar discussion also addressed the need for more doctors in rural Kentucky.

Birdwhistell said a major obstacle to getting more physicians in rural areas of the state are the limits on federally funded residency slots at the UK and University of Louisville medical schools. "Flipping that switch could pretty instantly change the number of professionals we have coming out," he said.

Republican Sen. Ralph Alvarado of Winchester, a physician, agreed, saying that residents tend to set up practices within 80 miles of where they do their residency. Moser also endorsed the idea.

Alvarado, chair of the Senate Health and Welfare Committee, noted that some rural areas have a shortage of health-care providers, which he blamed on state laws that make malpractice insurance expensive.

Gray said the shortage is especially bad in Eastern Kentucky, which needs providers who are willing to come to the region with "a sense of mission and vocation." But even with enough providers, transportation to get some patients to them is still an obstacle in some areas, he said. The expansion of telehealth has helped, he said, but some areas still lack internet access that is fast enough for it.

And even with telehealth, a shortage of specialists blocks care. For example, Kentucky has only 59 child psychiatrists, and half of them "are cash-only, don't take insurance," Alvarado said.

The panel started out by discussing some of the state's poor health statistics. Alvarado said the use of tobacco is heavier in rural areas, leading to all sorts of health issues, and obesity is more common, causing "more negative outcomes."

The news isn't all bad, he said, noting how Kentucky has raised its screening for colon cancer from 47th to 19th in the nation. "That's going to rub off on our death rates . . . in 10 years," he said. "There is some hope." But he also noted that screening rates in Eastern Kentucky remain relatively low.