CDC says ground beef likely source of E. coli outbreak, but hasn't been able to identify the source; Kentucky has most cases

Centers for Disease Control and Prevention map

Investigation of people stricken by the recent outbreak of E. coli "suggests that ground beef is the source of this outbreak," the Centers for Disease Control and Prevention announced Friday. "At this time, no common supplier, distributor, or brand of ground beef has been identified."

The outbreak, centered in Kentucky, has sickened 109 people and sent 17 to the hospital, the CDC reported. One case was found this week in Indiana, making the sixth state touched by the outbreak. Kentucky has 54 cases, Tennessee 28, Georgia 17, Ohio 7 and Virginia 2.

The agency said it is continuing its probe "to determine the source of ground beef supplied to grocery stores and restaurant locations where ill people ate. At this time, CDC is not recommending that consumers avoid eating ground beef or retailers stop serving or selling ground beef."

However, the agency cautioned, "Raw ground beef should be handled safely and cooked thoroughly to kill germs that could cause foodborne illness." It offered detailed advice: to consumers, retailers, and restaurants:

• Consumers should cook ground beef to an internal temperature of 160˚F.
• Wash hands with soap and water after touching raw ground beef.
• Keep raw meat separate from foods that won’t be cooked before eating.
• Thoroughly wash countertops, cutting boards, plates, and utensils with hot, soapy water or a bleach solution after they touch raw meat.
• Don’t eat raw or undercooked ground beef.
• After cooking ground beef, refrigerate within two hours and use within three to four days.
• Thaw ground beef in the refrigerator. Cook or refreeze within two days.
• Talk to your doctor if you have symptoms of an E. coli infection.

Escherichia coli is a common bacterium found in the digestive tracts of mammals. Certain strains, such as the one numbered O103, which is identified with this outbreak, can produce Shiga toxin, which causes diarrhea (often bloody), severe stomach cramps, and vomiting.

"Most people recover within a week, but some illnesses can last longer and be more severe," the CDC says. "Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out." More information is at https://www.cdc.gov/ecoli/ecoli-prevention.html.

Kentucky judges and court staff will be offered opportunities to learn more about addiction, recovery and treatment

By Melissa Patrick
Kentucky Health News

Kentucky will soon offer an educational program to its judges and court staff that will provide "trauma-informed, evidence based content" around the issues of opioid- and substance-use disorders, treatment and recovery as a way to help them make informed decisions in cases that involve substance-use disorders.

Chief Justice John D. Minton Jr.
(Photo by Melissa Patrick)

The program is called RESTORE, for "Responsive Education to Support Treatment in Opioid Recovery Efforts." It is part of the Kentucky Opioid Response Effort, or KORE, which is funded by a $10.5 million federal grant. 

"We want to prepare our court officials to make decisions that support recovery rather than to hinder it," Chief Justice John D. Minton Jr. said as he announced the program in the state Supreme Court chamber. "Our vision for RESTORE is that we will gain a shared understanding of substance use disorders and embrace best court practices in courts in dealing with this disease all across the commonwealth."

State Justice and Public Safety Secretary John Tilley alluded to the need for this education in March when he told a room full of visiting Fulbright scholars at the University of Kentucky that Kentuckians with addictions are treated differently across the state when arrested, depending on judges' understanding of addiction and the availability of wrap-around services to help offenders.

"It's incredibly disparate, and it's unjust," Tilley said at UK. "It is injustice at its best." He was unable to attend the launch of the program because of scheduling issues.

The program does not offer a required course of action for the judges to follow for such offenders, but to laughter in the room full of judges, Family Court Judge Janie McKenzie-Wells of the 24th Judicial Circuit said, "When the chief makes a suggestion, we usually take it."

She then added, "Obviously you have to buy in to this program and part of the educational piece . . . is to sell what we are doing to the judges and staff."

The program will consist of two one-day summits in each of Kentucky's seven appellate-court districts. The summer session is titled "Understanding Opioid and Substance Use Disorder;" the fall session is titled, "Understanding Treatment and Recovery."

Minton said the justice system offers a unique opportunity to help people with substance-use disorders.

"The decisions made at each point of contact within the justice system can profoundly affect the recovery process of each adult, youth and family who interacts with the courts," he said. "We have a duty to understand what research puts forth as the most effective court processes, the most effective practices, interventions and treatment models that can support lifelong recovery."

Wendy Morris, commissioner of the state Department for Behavioral Health, Development and Intellectual Disabilities, which oversees KORE, said Kentucky's collaboration across departments on this issue is unique.

As examples, she pointed to the Department of Public Health's commitment to harm reduction, the Department of Community Based Services' work with families who are affected by substance abuse, Medicaid's robust array of treatment options, judges who volunteer their time in drug and family courts, and their own work to oversee it all. She added that the involvement of the criminal justice system will provide yet another opportunity for intervention with this population.

Van Ingram, executive director of the Kentucky Office of Drug Control Policy, said the state's collaborative efforts against what he called "the worst drug epidemic our country has ever seen" are paying off.

Ticking off a long list of things the state is doing to combat this epidemic, Ingram said the numbers show that we are headed in the right direction, with fewer emergency-room overdose deaths and fewer hospitalizations in 2018 than the prior year, and an upcoming report that will show for the first time in 15 years, overdose deaths in Kentucky are declining.

"It's been a long fight, but we are beginning to see some progress," said Ingram. "And it's really because of these kinds of collaborations."

McKenzie-Wells talked at length about the Johnson County Community of Hope, a program that works in Family Court to address a whole array of issues commonly faced by people with substance-use disorders, whether that be access to housing or as is often the case, the need for a gas card to get them where they need to go.

She reminded everyone that whether you know a person with a substance-use disorder personally or not, these are people who live in our communities and need our help. "This is a community problem, so let's work on the solution as a community," she said. "And I think that's what RESTORE is aimed at."

Kentucky leads the nation in child abuse, which in most cases is neglect that equals abuse; April is Child Abuse Awareness Month

From an editorial by The Winchester Sun

Kentucky ranks first in the nation in a terrible way, according to a recent report.

The most recent Child Maltreatment Report, issued in late March by the the Children’s Bureau of the U.S. Department of Health and Human Services, reveals Kentucky has the nation's highest rate of child abuse, which includes child neglect.

According to the report, Kentucky had 22,410 child-abuse victims in 2017, the last year for which data is available. That equates to a rate of about 22 victims per 1,000 children in the commonwealth, which is more than twice the national average rate of nine. Ten child fatalities were attributed to abuse in Kentucky in 2017.

Kentucky’s child-abuse rate has increased annually from 2013, when it was 17.3 per 1,000. That's an increase of more than 27 percent over the four-year period. Among the victims in 2017, more than 15,000 were first-time victims, meaning more than 7,000 children had been abuses in previous years.

Most of the the 22,410 cases (21,313) in 2017 were attributed to neglect. There were 487 cases of medical neglect, 1,533 cases of physical abuse, 44 cases of psychological maltreatment and 852 cases of sexual abuse. Many involved more than one of these serious issues.

More than 3,000 of Kentucky’s cases of child abuse involved alcohol abuse by their caretaker and nearly 12,000 involved drug abuse. Also, according to the report:

• Nationally, evidence indicates children are most likely to be abused by their parents
• Children in their first year of life have the highest rate of victimization at 25.3 per 1,000 children of the same age in the national population. In Kentucky, 3,090 cases were reported in children younger than 1 year in 2017.
• “Child fatalities are the most tragic consequence of maltreatment,” according to the report. “For 2017, 50 states reported 1,688 fatalities.”

While many die each year, and others are treated, there are likely thousands more cases in our state where the abuse goes unreported. These children survive, but are destined to deal with the negative ramifications of their childhood abuse for the rest of their lives — often prohibiting them from becoming well-functioning, healthy, productive adult citizens.

April is Child Abuse Awareness Month, a time dedicated to honoring and remembering the lives lost too soon to abuse and neglect. The month also serves as an opportunity for the community to band together to raise awareness, educate about risk factors and indicators and advocate for children.

It’s a problem that has no easy solution, but one that must be addressed from multiple angles and quickly. We can all take part in reversing this negative trend and helping survivors. The most important things we can do are advocate and educate. Learn about the indicators of abuse. There are many, including unexplained bruises, cuts, welts, scars, fractures and burns.

There are also behavioral indicators, like aggressiveness or withdrawal. Other obvious signs are children who are frightened of their parents or say they are afraid to go home. Be mindful of children who report being extremely hungry, who exhibit bad hygiene or dress inappropriately for the season.

Watch for children in your community who are often unsupervised, especially for long periods of time or in potentially dangerous scenarios. Report potential abuse to the police or by calling the Child Help National Child Abuse Hotline at 1-800-4ACHILD.

Encourage your legislators to support laws that protect children and strengthen punishments for abusers. Additionally, our state must continue fighting against addiction, including drugs and alcohol. They play a huge role in the quality of life for our families and children, and as this research indicates, contribute to child abuse and neglect in our state.

Our state needs to also allot more funding for the Department for Community Based Services and other child-welfare programs. There are shortages of qualified social workers and foster parents to help these children find their way out of abusive homes and into loving, safe places.

Finally, we need to improve access and funding for programs for parents, including parenting classes, HANDS programs, educational programs and other assistance programs to reduce the burden of stress many parents, especially first-time, young or low-income parents feel, which might result in abuse or neglect.

Childhood should be fun. It should be a time of growth and learning. It’s a time to be nurtured and loved. Our children are our future and they deserve better.

Be mindful. Speak up. Stop abuse. Report it. Be an advocate. Help make the world a better place for children.

McConnell attacks 'Medicare for All,' says he favors 'niche fixes'

Bret Baier of Fox News interviews U.S. Sen. Mitch McConnell.

Senate Majority Leader McConnell told Fox News April 10 that he favors “niche fixes” for health care, while vowing that next year's elections will include a debate “about whether we want to turn America into a socialist country.”

The day before, McConnell targeted "Medicare for all" and other health plans of Democrats at the annual meeting of the American Hospital Association, and the group's leader endorsed more modest changes to the 2010 Patient Protection and Affordable Care Act.

"The hospital lobby already opposes Medicare for All and says bolstering the exchanges and getting more states to expand Medicaid is a better path toward universal coverage," Chelsea Cirruzzo and Michelle Stein of Inside Health Policy report. "McConnell told the group that his health-care plan is 'keeping what works and fixing what doesn’t,' but he didn’t elaborate as he targeted Medicare for All as the wrong solution."

McConnell said hospitals "should not be the guinea pigs in some far-left social experiment," which would cost $32 trillion over 10 years by shifting most health-care costs to the government. "He similarly blasted other health care proposals being considered by Democrats, naming the public option and Medicare buy-in, which he said would take the power from patients and give it to the government."

Asked the next day by Bret Baier of Fox what the Republican plan is for health care, McConnell said, “Look, we made that effort last Congress, it didn’t work. Clearly the Democratic House is not going to pass it. So we’re not going to spend time in the Senate on things that have literally no chance of becoming law.”

AHA President and CEO Rick Pollack "suggested improvements to the Affordable Care Act as a better way to expand coverage," including expanding Medicaid in Republican-dominated states that have not expanded it, and giving them the same deal that Kentucky and most other states took: full federal funding for the first three years, then declining to 90 percent over four years.

Pollack also called for “restoring cost-sharing subsidies for low-income consumers and implementing well-designed reinsurance mechanisms” to protect insurance companies who may get stuck with disproportionately ill policyholders. "He also said an alternative should include bigger subsidies for low-income individuals who want to purchase exchange coverage and adequate funding for enrollment efforts," Cirruzzo and Stein report.

Trump administration appeals rulings that blocked Medicaid work rules in Ky. and Ark.; decision not likely until after Nov. 5 election

As expected, the Trump administration has appealed a decisions by a federal judge in Washington, D.C., that stopped Kentucky and Arkansas from requiring some people on Medicaid to work.

The Centers for Medicare and Medicaid Services appealed April 10 to the U.S. Court of Appeals for the District of Columbia Circuit, "which often has the final say on the legality of controversial regulatory policies," reports James Romoser of Inside Health Policy. Gov. Matt Bevin has said the issue will be decided by the U.S. Supreme Court, which could refuse to hear a further appeal.

U.S. District Judge James Boasberg

District Judge James Boasberg "ruled that CMS failed to show how the waivers would promote Medicaid’s central purpose of providing people with medical coverage," Romoser notes. "Boasberg’s rulings sent the waivers back to CMS for further review, meaning CMS had the option to re-evaluate or modify the waivers in hopes of satisfying Boasberg’s concerns. But the agency indicated in court papers last week that, rather than take any further action on the waivers right now, it intended to bring the case to the D.C. Circuit and seek to have Boasberg’s rulings overturned."

Appeals in federal courts are randomly assigned to three-judge panels. "It is not clear whether a single panel will oversee both the Arkansas and Kentucky cases," Romoser writes. "Among the D.C. Circuit’s 11 full-time judges, seven were appointed by Democratic presidents and four were appointed by Republican presidents. The court also has six senior judges, who handle a reduced caseload. Five of them are Republican appointees and one is a Democratic appointee."

The cases are likely to spend several months at the D.C. Circuit, probably beyond the Nov. 5 election, in which Bevin is highly likely to be the Republican nominee for another four-year term. Kentucky officials have intervened in the case and have said they will participate in the appeal. The Kentucky case is Stewart v. Azar, No. 1:18-cv-152.

The Trump administration is "expected to argue that Boasberg, an Obama appointee, failed to provide enough leeway to HHS Secretary Alex Azar to test new policies that he believes will serve Medicaid’s goals," Romoser writes.

UPDATE: In a statement, state Health Secretary Adam Meier voiced confidence that Boasberg would be found wrong, and that his worst mistake was his "unprecedented conclusion that Medicaid does not care about improving people’s health." That was a reference to the following passage in Boasberg's ruling (emphasis added):

"Rather than adequately addressing Kentucky HEALTH’s potential to cause loss of medical coverage, the Secretary continues to press his contention that the program promotes his alternative proposed objectives of beneficiary health, financial independence, and the fiscal sustainability of Medicaid. The Court finds that the first two of those three goals are not objectives of the [Medicaid] Act in their own right, and, regardless, the Secretary’s failure once again to adequately consider the effects of Kentucky HEALTH on coverage is alone — as it was in [the initial case] — fatal to the approval."

The state and federal governments argued that the objectives of Medicaid for the 450,000 people in the expansion differed from those of traditional Medicaid, and that the new plan would improve their health. Boasberg rejected that argument both times. In the latest ruling, he wrote, “The Secretary’s primary contention is that health must be an independent objective because there is little value in paying for health care if it is not advancing that goal. As the Court explained in its prior opinion, health was not necessarily the ultimate aim Congress pursued when it decided to 'provide health insurance to needy populations.' . . . Congress thus designed a scheme to address not health generally, but the provision of care to needy populations. The Secretary is not free instead to extrapolate the objectives of the statute to a higher level of generality and pursue that aim in the way he prefers.”

For second time during big outbreak of hepatitis A, state health officials fire the manager of their Infectious Disease Branch

For the second time during the nation's worst outbreak of hepatitis A, state health officials have fired their top infectious-disease leader.

Hepatitis A is a liver disease.

"Dr. John Bennett, the state's Infectious Disease Branch manager since last fall, told the Courier Journal on Monday that he was dismissed last Friday," Chris Kenning reports for the Louisville newspaper. Bennett told Kenning that he wasn't given a specific reason for his dismissal. That is typical in such cases. He "said he had no information to suggest it was related to the state's recently criticized response to its hepatitis A outbreak," Kenning reports.

"First declared in November 2017, the outbreak later exploded in rural Kentucky, mainly among drug users, and grew into the nation's deadliest," Kenning notes. "The outbreak has since sickened 4,419 and killed 52, according to the latest state report released Monday. Kentucky has had more deaths than any of the other 17 states with similar hepatitis A outbreaks."

Bennett was hired last September to replace Dr. Robert Brawley, who was allowed to resign in lieu of fired on June 4, 2018. Brawley had "lobbied for a more aggressive state response to the outbreak," Kenning notes. "He recommended $6 million for vaccines and $4 million for temporary workers in thinly staffed local health departments and also called for a public health emergency declaration to help pave the way for federal assistance." Instead, "The Department for Public Health sent $2.2 million in state funds to local health departments and declined to declare an emergency."

The department's commissioner, Dr. Jeffrey Howard, "has told the Courier Journal that he was willing to seek more funding if needed."

Two activists in recovery say addiction doesn't discriminate (one says recovery does), say it should be treated as a chronic disease

By Melissa Patrick
Kentucky Health News

The shared message of two Kentuckians in long-term recovery during a discussion about addiction, recovery and activism at the University of Kentucky was that addiction doesn't discriminate – but one said recovery does.

Alex Elswick and Ashley McCarty Dufour talked about their
addiction, recovery and activism. (Photo by Melissa Patrick)

Alex Elswick of Lexington and Ashley McCarty Dufour of London told a room full of health advocates about their struggles with addiction – Elswick to heroin and Dufour to methamphetamine and opioid painkillers – that started with prescription opioids. They talked about their rocky roads to recovery and said they've been "clean" for almost six years.

Another thing they had in common is that they came from stable, loving homes and had families that supported them.

"I was born in a middle-class, well-known family in Laurel County. People like that don't have children who are addicted to drugs – but they do," said Dufour, a community liaison for Addiction Recovery Care. "Addiction does not discriminate."

Yes, but recovery does, said Elswick, co-founder of the UK Collegiate Recovery Community and an extension specialist for substance-use prevention and recovery at UK.

Elswick explained that because of his "privilege," which he acknowledged was a term many are uncomfortable with, he had had all kinds of  "recovery capital" available to him – his parents' church found him a home, one of his father's patients found him a job, and he was able to see a therapist for his anxiety disorder because he had insurance. "The list just goes on and on," he said.

"Recovery does discriminate," he said. "There are huge disparities in access to resources in terms of race, socioeconomic status, in terms of sexual orientation."

Elswick said it was this realization that prompted him to focus his doctoral research at UK on long-term recovery for substance-use disorder. He focuses on "recovery capital," defined in a white paper on the topic as "the breadth and depth of internal and external resources that can be drawn from to initiate and sustain recovery from severe alcohol and other drug problems."

Elswick said the resources are in three main areas: personal, social, and community.

"What my experience taught me, and what subsequent research has taught me, is that people like me, people who come from really fortunate backgrounds, are able to leverage an immense amount of resources when the time comes to recover," he said.

Elswick, who is also the co-founder of Voices of Hope, said the organization offers recovery coaches who help people in recovery determine their available "recovery capital," then helps them figure out how to fill in the gaps, like finding safe housing or job training.

DuFour and Elswick spoke at an event sponsored by UK College of Public Health during National Public Health Week, in the first week of April.

Another shared topic was the importance of meeting people in addiction wherever they are, and treating it as a chronic disease like diabetes or high blood pressure.

Dufour said that in her work as a peer-support specialist with several syringe-exchange programs across the state, it's important to "meet them where they are," whether that is to make sure they are using clean needles to keep from spreading infectious diseases, like hepatitis C and HIV, to offer them access to screening and treatment for these diseases, or to help them get into treatment.

"IV drug users are five times more likely to enter treatment through a syringe-exchange program," Dufour said. "Five times more likely. Why? Because that's that population that nobody is touching. Nobody is talking with them. But when they come in, somebody is loving on them and caring about them and giving them hope, so they are five times more likely to go into treatment."

Dufour said Addiction Recovery Care offers peer support in 16 counties with syringe exchanges, and in those locations, 75 people have entered treatment in the last six months.

Elswick spoke at length about the "false dichotomy" that the only way to help someone in addiction is treatment. Rather, he said, you have to meet them where they are.

For example, he said Voices for Hope's telephone recovery-support program isn't clinical in nature and isn't meant to push treatment, but offers a safe place for someone in addiction and recovery to get help with their issue of the day.

"The intervention is the phone call," he said, adding that the program, like syringe exchanges, also serves as a touch point for those in addiction that provides them with a safe place to turn to when they are ready for treatment.

Elswick suggested that the concept of meeting someone with an addiction where they are is becoming accepted but has a long way to go. He said it's important to keep the doors open at other points of contact, such as arrest, jails and emergency rooms, as a way to help get people into treatment when they are ready, since they may not be ready at the initial point of contact.

And as he often says, the most important takeaway to remember is: "Addiction is a chronic disease."

He said the traditional approach to addiction care, treatment of 30 to 90 days with no support other than a pamphlet on how to follow a 12-step program upon discharge, is a recipe for relapse.

"It's because we are mismanaging a chronic disease with acute care," he said.

Like any other chronic disease,  Elswick says that if we want to improve recovery success, people with addictions need recovery support services for their lifetime, "so that we can match their chronic disorder with chronic disease management."

Erin Calipari's research explores how women's hormones may make them more vulnerable to addiction and relapse

Erin Calipari (Photo by Larry McCormack, The Tennessean)

Erin Calipari is getting noticed, and no longer just because she's the daughter of University of Kentucky coach John Calipari. As a researcher at Vanderbilt University, she has "dedicated herself to making groundbreaking discoveries about women's vulnerability to drug cravings and the immune system's role in the fight against the opioid crisis," reports Jessica Bliss of the Nashville Tennessean.

"When she was a girl, it used to bother her that people saw her only as the coach's daughter," Bliss writes. "Now she embraces the fact that she is the child of a man who leads one of the nation's most successful college sports programs. She sees it as a platform to share important scientific breakthroughs with people who might not otherwise be paying attention."

Addiction research has primarily focused on men, but "Calipari's work changes that," Bliss reports. "Her team has found 'massive differences' in what males and females value" when making decisions about whether to use a drug. "Her latest study found that, when fertility-related hormone levels are high, females . . . are more prone to seek rewards. That means women's hormonal cycles may make them more prone to drug addiction and relapse."

Calipari explains, "The hormonal cycle primes your brain to be more responsive to your environment. This is evolutionary, because, if you are more responsive, you are going to seek out rewarding environments and sexual experiences that propagate the species. That same process is hijacked by drugs. . . . And that makes women more vulnerable."

Her father said on Twitter, “I’m very proud of her because she’s working on important stuff. Addiction and the effects, especially on women, is an epidemic.” In another tweet, he said, “She’s trying to bring light to a serious problem in our country. She’s on a great path to having an impact to improve lives.”

Ky. has half the cases in odd, 5-state outbreak of E. coli infection

Video from The Washington Post

Kentucky has about half of the cases in an outbreak of infections from a strain of E. coli bacteria that has also sickened people in Ohio, Virginia, Tennessee and Georgia. The federal Centers for Disease Control and Prevention said Friday that the source of the 72 infections has not been identified.

The CDC said Kentucky had 36 cases, but the day before, the state Department for Public Health said 46 people in the state had been sickened by the O103 strain of E. coli, which is among those that produce Shiga toxin.  Spokeswoman Barbara Fox said six had been hospitalized. The toxin usually sickens people two to five days after they swallow the germ, the health department says.

"Most people get diarrhea (often bloody), severe stomach cramps and vomiting," The CDC says. "Most people recover within a week, but some illnesses can last longer and be more severe. Talk to your doctor if you have symptoms of an E. coli infection. . . . Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out."

The Mercer County Health Department said in a Facebook post, "These cases have been found in children and teenagers with an extensive exposure to fast food," but added, "The outbreak is not limited to young people."

That report, and the median age of those infected, 17, indicate that “It’s probably some convenience, fast food consumed by kids,” Bill Marler, a Seattle food-safety lawyer, told The Washington Post. "One silver lining, he added, is that people in this age range are typically healthy and not prone to further complications from E. coli," reports the Post's Michael Brice-Saddler.

Still, Marler said it is “concerning” that health officials haven't been able to trace the pathogen to a food source. “Given the size and the number of states that are involved, what you’re seeing is very unusual,” he told the Post. “If it was five people or 10 people, that’s a little harder to figure out. But when there’s 72 people and they’re being interviewed by epidemiologists, it’s pretty unusual you don’t have a culprit. The real question is, what do 72 people have in common over five states? It has to be something.”

"That something, Marler said, is likely a food or water product that people can’t remember they ate," the Post reports. "State and local health officials are required to interview ill patients and determine what they consumed in the week leading up to their symptoms, but recalling one’s dietary choices is often easier said than done, he said. Condiments, garnish, toppings, and spices can all contain traces of E. coli."

Marler said, “That’s probably why it’s taking longer to figure out, because people can’t remember what was in their meal.”

"Citing a CDC data set that dates to 1998, Marler noted outbreaks of E. coli O103 are relatively uncommon. Eighteen such outbreaks have been reported in the United States since 2000, with the highest number of reported illnesses being 29 during a 2010 outbreak in Minnesota. That makes this O103 outbreak by far the largest in recent memory, he said."

The state Department for Public Health says E. coli infections can be prevented by:

• Washing hands frequently for at least 20 seconds with soap and warm water, especially before eating, after going to the bathroom, handling raw meat and eggs, and after handling or petting animals;

• Thoroughly washing produce before eating;

• Thoroughly cooking meat;

• Cleaning and sanitizing food preparation areas;

• Avoiding swallowing lake or pool water;

• Drinking only pasteurized milk;

• Frequently cleaning and sanitizing restrooms, including door knobs and faucets; and

• Reporting diarrheal illnesses to your physician.

More information can be found here: https://www.cdc.gov/ecoli/ecoli-prevention.html.

Addict in recovery resumes writing his column for Appalachian newspapers after relapsing and going into treatment

Phillip Lee's book

A recovering drug addict who writes a column for newspapers in Appalachian Kentucky and Tennessee, and published a book, has relapsed, gone back into treatment and resumed his column.

Phillip Lee's return column for the Clinton County News in Albany emphasizes the nature of addiction, the humanity of those suffering it, and the promise of treatment. He writes: 

"I am a client at Hickory Hills Recovery and Treatment Center in Eastern Kentucky. This is a long-term treatment house for men who, like myself, suffer from the disease of addiction. Now, I know that some who read this may stop right here and say 'OK, I don’t want to read another word. Addiction is not a disease.' What I usually say to that is, absolutely nothing. Each person on God’s green earth has the free will and choice to decide if they believe addiction is a disease or not. I’m not here to debate anyone. I’m quite simple, just a guy with a pen who would much rather remain anonymous than anything, however, that is not possible if I wish to publish my work — so it may reach others in newspapers, in hopes of helping someone in need."

Lee writes that a client at the center noticed "a very poor man in the nearby community walking around in very worn out and distressed shoes. The client, without giving thought or second instinct to his own comfort, walked over and gave the gentleman in discomfort and need the very shoes off his feet. To many, this man would have been marked up and chalked off as a man of bad character, based solely on what they thought they knew or have seen from someone in active addiction. To this I must ask each of you, does this sound like a man of bad character? Does this sound like a man who should be thrown to the wolves for the slaughter? Does this sound like the kind of man you would rather not have in your communities? To me, it simply sounds like he’s a man who, through this program, has discovered his heart and true passion for his fellow."

He continues, "I’ve seen many great acts of both kindness and love, while here. I’ve seen and felt the spirit of God while here. I feel it even now as I write this small story for you. You see, folks, most of us here are not bad people at heart. Most here would much rather lift another up than to tear him down. We do suffer from a disease, and it is called addiction – and, yes, we have lost our way. But here, we are found. Here we are given every tool needed to recover and maintain and treat our disease. Here, we are taught how to utilize these tools in the most effective manner once we rejoin the communities in which we live. We are taught how to use these tools to regain our sanity and to gain or regain our love for life, in general. And here, we are taught how to reconnect with reality, entirely. So, if you know someone who is living the life of a using addict here in Kentucky, there are several Kentucky Recovery Centers all across the state like this one, where new life is born, every day."

Health advocates offer tips for getting reluctant local governments to OK syringe exchanges, now called 'harm reduction programs'

By Melissa Patrick
Kentucky Health News

Kentucky leads the nation in syringe exchanges for drug users, as a way to prevent the spread of disease, but local officials in some counties at risk of disease outbreaks from intravenous drug use have resisted pleas from experts to allow exchanges.

At a public-health panel discussion at the University of Kentucky, advocates of the exchanges shared some advice on how to overcome the opposition: persistence, partners, new terminology, realizing that politicians want to get re-elected, and having plenty of arguments at hand,

"Also remember that logic and rationality doesn't always win out, passion and persistence does," said Sheila Schuster, executive director of Advocacy Action Network, an umbrella organization of lobbies, who has lobbied the state legislature for more than 40 years.

The importance of early prevention, and access to care for mental health and substance-use disorders, were other topics of the panel, hosted by the UK College of Public Health during National Public Health Week, which falls during the first week of April.

Dr. Ardis Hoven, an infectious disease specialist and consultant with the state Department for Public Health, called Kentucky's syringe exchanges a "bright spot" when it comes to tackling the issue of substance abuse and addiction, adding that she was "exalted" that they had taken off as they had.

Kentucky lawmakers approved such programs in 2015 in an anti-heroin bill, as a way to decrease the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. They require both local approval and funding. Since, local governments have approved 52 syringe exchanges, with all but four operational.

State health department chart as of February; click on it for a larger version

However, exchanges exist in only about half the 54 Kentucky counties that the federal Centers for Disease Control and Prevention has identified among about 250 in the nation as most at risk from an outbreak of HIV (the virus that leads to AIDS) or hepatitis C as a result of intravenous drug use.

Hoven said people who advocate for exchanges should be prepared to defend them. She calls them "harm reduction programs," saying that the term more accurately describes what they do. She said they not only pass out clean needles and syringes, but also provide health screenings and vaccines, access to treatment, and a place to build trusting relationships between clients and workers.

Former Gov. Steve Beshear, who was governor when the anti-heroin bill passed, said that while it's important to recognize that politicians are always working toward re-election and don't want to deal with controversial issues, they often "answer to the squeaky wheel." He added that "persistence and leadership" are key to any advocacy work, adding that success often requires several attempts.

Dr. Hatim Omar, a pediatrics professor at UK, advised the advocates to make sure they put a human face to the problem, because that makes it real, and to present their case in a way that would benefit local officials, reiterating that their main concern is to get re-elected.

Schuster, who has worked with the legislature since 1978, said she learned early on that you have to show up with a better argument than "It's the right thing to do."

Schuster, who lobbies on mental-health and disability issues, said advocates need to find unlikely partners, such as the faith community; get to know local government and health officials; learn from communities that have succeeded; have multiple arguments ready; and, most important, just show up.

"You've got to stir the pot," Hoven said. In addition to being armed with data and information, she encouraged building coalitions that truly understand the issue and are able to articulate it and to work with their local health departments. She also encouraged them to make sure they bring the police to the table.

"The other thing that you need to be ready to do at any given moment is to defend what a syringe service program or exchange program is and what it is not," she said. "And you ought to be able to do that in your sleep. That's crucial."

Opponents of syringe exchanges often base their criticisms on belief, not fact, and that's sometimes true of policymakers, Schuster said. For example, she said some legislators tell her that they think the programs enable drug use, which they don't, according to research; or that they need to be a strict one-for-one exchange, which undermines the goal of thwarting infection.

"We need to be educating our policymakers, because they are operating on wrong information," said Schuster.

Prevention and underlying causes discussed

On another front, Omar said the best way to treat addiction is to prevent it.

He pointed to the National Longitudinal Study on Adolescent to Adult Health, which found that teens who have a solid support systems, like having an adult to talk to and living in a safe environment, along with having something useful to do, are more likely to be successful in school and are protected against many things, including addictions, suicide and early sexual activity.

"This is I think where we are failing our young people," he said. "We are not providing adequate support systems."

He stressed that we also have to be honest when we talk to children about these topics, adding that the U.S. has to get over the "repetitive myth" that providing factual information to young people about drugs, sex and suicide will prompt them to do it.

"All the science in the world shows it's exactly the opposite," he said. "Knowledge is power, it improves things. . . . People do it because they don't know any better."

Beshear, who expanded Medicaid to Kentuckians who earn up to 138 percent of the federal poverty level, spoke to the importance of having access to health insurance as a way to combat substance-use disorders. He said that since the expansion in 2014, Kentucky's uninsured rate has dropped from over 20 percent to 7.5 percent.

He pointed out that the Patient Protection and Affordable Care Act is also the reason health insurance plans now cover mental health and substance-use disorders, including the Medicaid expansion population. He added this coverage to the traditional Medicaid population. Schuster added that in the first three years after the state expanded Medicaid, there was a 700 percent increase in the utilization of substance-use-disorder treatment.

Everyone on the panel agreed that until Kentucky addresses its social determinants of health, which are things like housing, education, employment, and environmental exposures that are known to affect health and well-being, it's unlikely that the state will truly improvements in its health outcomes.

"For us to ultimately get somewhere we've got to address all of those things," said Beshear.

Hoven, who called this issue "the elephant in the room," said that when it comes to social determinants, "We can flap our gums all day long," but until Kentucky dedicates policies that are completely funded and that empower the leaders of communities to deal with these issues, the state won't make much progress.

Schuster reminded the group that we also have to overcome the stigma that continues to exist around mental health and substance use disorders: "Stigma is alive and well."

Appeals court upholds law requiring doctors to show and describe ultrasound, and play fetal heartbeat, for women seeking abortion

By Melissa Patrick
Kentucky Health News

On a 2-1 vote, a federal appeals-court panel has upheld a 2017 Kentucky law that requires women to have an ultrasound before having an abortion while their doctor displays the image and offers a medical description of the fetus with the heartbeat played loud enough for the woman to hear.

The law allows the woman to avert her eyes from the image and to ask for the heartbeat volume to be turned off, but not to refuse the procedure. Failure to comply with these requirements could result in the physician being fined and referred to the state's medical-licensing board.

A district judge blocked the law last year, saying it was unconstitutional because it violated free-speech rights of physicians. Gov. Matt Bevin appealed that decision to the Cincinnati-based 6th U.S. Circuit Court of Appeals.

The majority opinion on "The Ultrasound Informed Consent Act" found that because the law "requires the disclosure of truthful, non-misleading, and relevant information about an abortion, we hold that it does not violate a doctor's right to free speech under the First Amendment."

The opinion was written by Judge John Bush, who was appointed by President Donald Trump. He was joined in the majority opinion by Senior Judge Alan E. Norris, who was appointed to the appeals court by President Ronald Reagan.

Bush wrote, “The information conveyed by an ultrasound image, its description and the audible beating fetal heart gives a patient greater knowledge of the unborn life inside her. This also inherently provides the patient with more knowledge about the effect of an abortion procedure: it shows her what, or whom, she is consenting to terminate. That this information might persuade a woman to change her mind does not render it suspect under the First Amendment."

Bevin, in a news release, called the ruling "a major pro-life legal victory."

"Today is a historic day, as Kentucky continues to lead the charge in implementing strong pro-life protections for its citizens," Bevin said. "Patients should be well equipped with relevant information before making important medical decisions. I am grateful to be governor of a state that values every human life, and we are committed to continue our fight on behalf of the most vulnerable among us."

In a harsh dissent, Judge Bernice Bouie Donald, who was appointed to the appeals court by President Barack Obama, said the majority decision "opens the floodgates to states in this circuit to manipulate doctor-patient discourse solely for ideological reasons."

She wrote, "The Commonwealth has co-opted physicians’ examining tables, their probing instruments, and their voices in order to espouse a political message, without regard to the health of the patient or the judgment of the physician."

The American Civil Liberties Union, which represented EMW Women's Surgical Center in Louisville, the only abortion clinic left in Kentucky, said the law serves no medical purpose and is opposed by The American Medical Association, The American College of Obstetricians and Gynecologists and the American Public Health Association.

"Today’s ruling allows Kentucky politicians to continue enforcing a law with no medical basis whose sole purpose is to shame and coerce a woman who has decided to end her pregnancy," Alexa Kolbi-Molinas, senior staff attorney with the ACLU’s Reproductive Freedom Project, said in a news release. "Regardless of how you feel about abortion, such extreme political interference in the doctor-patient relationship should be a cause of serious concern to anyone seeking medical care.”

Since taking complete control of both state houses in 2016, the General Assembly has passed several bills to restrict or eliminate abortion. At this time the Bevin administration is defending three of them in federal court and has appealed the ruling of an older one that required abortion clinics to have signed agreements with a hospital and an ambulance service.

Bruce Schreiner of The Associated Press reports that the ACLU is disagreeing with Kentucky's Democratic attorney general over how to challenge the law that requires abortion clinics to have signed agreement with a hospital and an ambulance service.

Attorney General Andy Beshear is asking the appeals court to rule against the regulation, but not against the law underlying the regulation. The ACLU wants the law struck down, saying that otherwise it will remain an ongoing threat to the state's only abortion clinic.

Beshear is the leading Democrat for the May 21 nomination to face Bevin, who is seeking a second four-year term.