Ky. tops nation in share of kids ever diagnosed with Attention Deficit Hyperactivity Disorder; here are facts and fiction about it

While almost one in five of Kentucky's children have been diagnosed with attention deficit hyperactivity disorder, myths and misinformation about the condition are common.

Percent of Youth Aged 4-17 Ever Diagnosed with ADHD
National Survey of Children's Health

ADHD is a common condition. The latest data from the U.S. Centers for Disease Control and Prevention show that 19 percent of Kentucky's children have ever been diagnosed with it, the highest rate in the nation. The national average is 11 percent. The data also show that 14.8 percent of Kentucky's children are currently diagnosed with ADHD, compared to 8.8 percent nationally.

ADHD is a behavioral condition characterized by difficulty focusing, acting without thinking, and hyperactivity.

In a news release, Dr. Joshua Cabrera, clinical psychiatrist and assistant professor at Texas A&M College of Medicine, distinguishes between what is fact and what is fiction when it comes to ADHD.

Fiction: Just because a child is hyper they have ADHD: Cabrera points out that children are "inherently energetic" and if this is the only symptom, then it would be difficult for a professional to diagnose the child with ADHD. He adds that the main symptoms of ADHD are inattention, hyperactivity and impulsivity and says that "Diagnosis (would) require observations of numerous symptoms in multiple settings and evidence of significant impairment.”

Fact: ADHD diagnosis is on the rise: A recent study showed that ADHD diagnosis has gone up 43 percent from 2003 to 2011. Cabrera said that the study did not determine the reasons for this increase, but noted his concerns that it could be because of over-diagnosis, which he says could overlook possible stressors the child is dealing with like anxiety, home conflicts and learning disorders.

Fiction: People with ADHD are only affected in the classroom: Cabrera says that while children with this condition are at a higher risk for reduced school performance, their inattentiveness, hyperactivity and impulsivity also affect their social relationships, increase their chances for developing a conduct disorder and increase their chances for substance use and incarceration later on.

Fiction: ADHD is caused by bad parenting: The general consensus is that ADHD is likely the result of both genetic and environmental factors, says Cabrera.

Fiction: Children on ADHD can seem “drugged": “The common way that the term ‘drugged’ is used suggests lethargy and loss of capacity,” Cabrera says. “Stimulants, the most commonly prescribed medication, typically do not have this effect.” According to the CDC, between 70 to 80 percent of children with ADHD have fewer symptoms when they take prescribed stimulants.

Fact: ADHD can be treated: Cabrera says this depends on the individual. “Many people with easier to treat ADHD can successfully manage their symptoms,” he said. “Unfortunately, many others will struggle with ADHD in all aspects of their life despite the best possible treatment.”

Children and teens should see the doctor for any signs of a concussion; sometimes symptoms don't show up for several days

A person doesn't have to be knocked unconscious to have a concussion, so it's important to recognize the symptoms and seek medical attention quickly if warning signs appear.

Children hit their heads fairly often and are usually able to bounce back quickly, but that is less likely the older they get, according to Harris Health System, located in Texas.

“Children’s brains have the ability to regenerate after a concussion (or less serious head injury),” Dr. Shankar Gopinath, chief of neurosurgery at Ben Taub Hospital and associate professor of neurosurgery at Baylor College of Medicine, said in the news release. “Which is advice to be taken with a grain of salt, since parents should still consult their physician after an incident involving a head injury.”

Common Symptoms of a Concussion
graphic: The Children's Hospital of Philadelphia

A concussion is a mild form of a traumatic brain injury that occurs from a mild blow, bump or jolt to the head. Some people lose consciousness, but most do not. The leading causes of concussions are falls, motor-vehicle-related injuries, unintentionally being hit in the head with an object, assault or playing sports, says the Brain Injury Alliance of Kentucky website.

Concussion symptoms are similar in infants, children and adolescents, but there are some differences.

The most obvious symptom in infants is a loss of consciousness, but other signs include crying inconsolably, vomiting and excessive sleepiness. Refusing to eat, prolonged irritability or unusual or prolonged periods of quietness or inactivity are also signs of a concussion or a more serious injury, says the release. All of these symptoms call for an immediate trip to the doctor.

In addition to loss of consciousness, concussion symptoms in older children include severe headache, difficulty with bright lights or loud noises, blurred vision, trouble walking, memory loss, feeling mentally "foggy," confusion and saying things that don't make sense, slurred speech and unresponsiveness, irritability, sadness or nervousness and changes in sleep patterns, says the Brain Injury Alliance of Kentucky.

“Repeated concussions can cause permanent changes neurologically,” Dr. Asim Shah, chief of psychiatry, Ben Taub Hospital and professor at the Menninger Department of Psychiatry Baylor College of Medicine, said in the Harris Health release. “Sometimes even the ability to learn something new [cognition] lowers significantly.”

WebMD notes that symptoms of a concussion don't always show up right away, and can develop within 24 to 72 hours after an injury. And while most children and teens recover quickly from concussion, some symptoms, like memory loss, headaches and problems with concentration, may linger for weeks or months. You should also contact your doctor if symptoms are lingering.

Experts at Harris Health emphasized the importance of children and teens being treated quickly and checked by a physician when warning signs of a concussion appear. WebMD says: "An undiagnosed concussion can put someone at risk for brain damage and even disability."

Study finds that frequent consumption of energy drinks, even without alcohol, is associated with more frequent drunk driving

Image: childrensmd.org

Energy drinks don't have to be combined with alcohol to increase the risk of drunk driving, according to a new study.

Researchers had already found that frequent mixing of alcohol with energy drinks contributed to drunk driving, but they didn't expect to find that "consuming energy drinks without alcohol contributed additional risk for drunk driving, regardless of alcohol drinking patterns," said a Research Society on Alcoholism news release.

The report called this finding "unexpected" and said it "suggests that mechanisms other than the promotion of heavy drinking by energy drinks are involved in promoting drunk driving."

The researchers found that 57 percent of students consumed energy drinks; 9 percent drank them exclusively with alcohol, 16 percent drank them exclusively without alcohol, and 32 percent drank them both with and without alcohol, depending on the occasion.

"The authors encourage parents, clinicians, and college administrators to regard any style of energy drink consumption, whether with or without alcohol, as a warning sign that students might be at high risk for alcohol-related consequences such as drunk driving," the release said.

Feds add Boone, Kenton and Campbell counties to Ohio High Intensity Drug Trafficking Area, citing threats from illegal drugs

Citing the magnitude of threats posed by illegal drugs, the Office of National Drug Control Policy has added Boone, Campbell and Kenton counties to the Ohio High Intensity Drug Trafficking Area.

The designation was sought by the counties and U.S. Sen. Mitch McConnell, who announced it. Last year, McConnell hosted ONDCP Director Michael Botticelli in Kenton County "so he could see firsthand how Northern Kentucky has been devastated by the drug epidemic," A McConnell news release said.

“A HIDTA designation allows us to efficiently leverage federal resources along with those of state and local partners to directly benefit particularly hard-hit counties, such as those in Northern Kentucky,” McConnell said in the release. “Given its geographic proximity to Boone, Campbell and Kenton Counties and what I am told about the flow of illicit drugs into the region from Ohio, designation under Ohio HIDTA is a sensible and substantial step to combating the production, distribution and trafficking of illicit substances in the commonwealth.”

Chris Conners, Director of the Northern Kentucky Drug Strike Force, said the move “will enhance intelligence sharing, improve joint investigative efforts, and provide training and badly needed resources to address the current problems we face.”

Many Kentuckians still defer or delay health care and prescription medications due to cost

One in five Kentuckians aged 18 to 65 are delaying medical care or going without it due to cost, according to a study done for the Foundation for a Healthy Kentucky.  It found that almost one in four went without dental care, and nearly one in five skipped prescription medications, due to cost.

"Too many Kentuckians continue to delay or skip health care because the cost is just not in their budget, and they're probably hoping the decision won't undermine their health," Foundation President and CEO Ben Chandler said in a news release. "But we know that delaying or forgoing routine and preventive care doesn't save money in the long run, and it certainly doesn't result in better health outcomes. Access to health care is critical to improving Kentucky's health, and we simply have to do better."

The findings are based on a survey in Spring 2016 that asked people if cost had caused them to defer health care or medicine in the previous 12 months. It was  part of an ongoing, three-year study of the impact of the Patient Protection and Affordable Care Act in Kentucky, done for the foundation by the State Health Access Data Assistance Center at the University of Minnesota. The foundation is paying SHADAC more than $280,000 for the work.

Percent who delayed or went without medical care
due to cost by income, 2016. Graphs from report.

The survey found that almost 21 percent of Kentucky adults delayed or skipped medical care due to cost. The figures was 29.4 percent among Medicaid-eligible Kentucky adults, those with incomes up to 138 percent of the federal poverty level ($33,534 for a family of four in 2016), and 26 percent for those between 138 and 200 percent of the poverty level. Kentucky adults above 200 percent of poverty only skipped medical care due to cost 13.9 percent of the time.

The report also found that 39 percent, or nearly two in five, of Kentucky adults had trouble paying their medical bills in 2014, though this was a 10-percentage-point drop from 2012, when nearly half of Kentucky adults were struggling in this measure. The national rate in 2014 was 28.7 percent.

Compared with its neighboring states, Kentucky was the only one to show a significant decrease in the percentage of people who had trouble paying medical bills, but among those states, "No state had a rate that was significantly higher than Kentucky's," says the report.

Percentage of population delaying needed medical care in 2014 because of cost (SHADAC chart)

Forgone care due to cost by health status, 2016

Kentucky adults without insurance were more than twice as likely to forgo care due to cost compared to Kentuckians overall in this measure and three times as many who described themselves in poor health delayed or went without care compared to those who said their health was excellent.

The report also found that more than half (56.2 percent) of Kentucky adults without health insurance in 2016 said they didn't have it because they couldn't afford it, 17 percent said they simply weren't interested and 25 percent indicated they weren't opposed to obtaining coverage.

Of those who had health insurance in 2016, almost half (48.1 percent) had private insurance. This group was primarily white, married, employed, had some college education and incomes more than double the poverty line. Otherwise, 44.2 percent had coverage through an employer and the rest had it through the individual market.

Private health insurance in 2014 was most common in Northern Kentucky, where 61.5 percent reported having it, and the Lexington area, at 56.1 percent. The Louisville area and Western Kentucky, 48.8 percent and 47.6 percent respectively, had rates similar to the overall state rate of 48.1 percent. At 35.5 percent, Eastern Kentucky adults were the least likely to have private insurance.

The report also found that 41 percent of non-elderly Kentucky adults were on public coverage such as Medicaid, Medicare and military. This group was more likely to have a high-school diploma or less, be unemployed or a full-time student, be divorced or widowed, report fair or poor health, or live in Eastern Kentucky, says the report.

This semi-annual report analyzed data from several sources regarding health coverage, access to care, cost of care, quality of care and health outcomes and included the results of a spring 2016 Kentucky Health Reform Survey of non-elderly adults. Click here for a copy of the report.

Appalachian Health Hack-a-thon has innovative solutions around obesity, diabetes and substance abuse; many from students

By Melissa Patrick
Kentucky Health News

SOMERSET, Ky. – In just three days' time, 160 people came up with 19 innovative solutions to three of Appalachian Kentucky's most challenging health issues – diabetes, obesity and substance abuse – at the first-ever Massachusetts Institute of Technology Appalachian Health Hack-a-thon in Somerset Oct. 6-8.

The 19 teams, including six led by high-school students, presented their solutions to a panel of judges Saturday, Oct. 8, after spending less than 24 hours working on them. Participants came from diverse backgrounds and experiences and almost all were from Kentucky; the students took half the prizes.

Fifth District U.S. Rep. Hal Rogers

"These challenges aren't new. We've battled these demons for generations. We know a solution is not going to come overnight, but that isn't going to stop us from persevering the pressing problems," U.S. Rep. Hal Rogers, R-Somerset, said during the opening session. "We are here to change our trajectory with hopes of saving lives in Southern and Eastern Kentucky through powerful efforts like this hack-a-thon."

Rogers added, "We want to be holistically working to improve Southern and Eastern Kentucky from tourism to technology to infrastructure to health care. Our region suffers from the highest rates of cancer, diabetes, heart disease, obesity, you name it; we lead the nation."

The event was brought to Kentucky by MIT and Shaping Our Appalachian Region, a bipartisan, non-profit effort to improve the economy of Appalachian Kentucky, co-founded by Rogers and then-Gov. Steve Beshear in 2013. It was facilitated by a team from MIT, which has facilitated more than 40 "Hacking Medicine" events worldwide.

"More and more, research ends up being a quintessential team sport with people from different disciplines coming together to work and to try to solve a common problem," said Dr. Doug Lowy, acting director of the National Cancer Institute.

Morgan Kirk, a WellCare Health Plans community advocate who worked in a group that focused on diabetes, said her group consisted of a provider, someone representing a managed-care organization, a computer engineer, a professor, and the chief operating officer of a medical company.

The top solutions won cash prizes up to $1,500 and the potential to work with business partners toward implementation. Cash and prize awards were also given for targeted issue solutions. Students walked away with half of the prizes, including the student-only award.

Pikeville High student winners from virtual
team "Simple Health."  L-R: Ethan Francis,
 Devin Gayheart and Tori Gayheart

Thirty-eight students from Pikeville, Letcher County and Paintsville high schools participated virtually in the event, which was another first for a MIT Hacking Health event.

"They are on the forefront of what many of our other students I think will be doing in the near future in solving challenges that they know best in their local communities," said Jim Tackett, readiness lead for the Kentucky Valley Educational Cooperative, who helped organize the student groups.

Tackett said the students came to the event with a desire to make a difference in the health of their communities. Two schools were participating during their fall breaks, he said, and one passed up homecoming to work on the project.

"That shows you the impact and the interest that they had in this project," said Tackett, who is also executive director of Forward in the Fifth, a nonprofit educational organization for counties that are or have been in the Fifth Congressional District.

A Pikeville High group won the top prize in the obesity/diabetes category for their "Simple Health (555)" solution, which would create a mobile-phone application to encourage participants to drink five glasses of water per day, eat five servings of fruit and vegetables a day, and walk five minutes five times a day. They also won the Pikeville Medical Center Obesity and Diabetes Challenge to find an innovative way to motivate people to join weight-loss management programs.

A student group from Paintsville also won two prizes. Their plan would create an app for a chat room led by licensed professionals in which people would be required to interact before they could be prescribed any pain medications. The chat room is also meant to be used for social support.

This group won the student WellCare award for use of technology to help people access alternative supports for pain management and the Passport Health Plan substance-abuse contest that challenged participants to improve pain management among Medicaid beneficiaries.

Another Pikeville student group won the WellCare challenge for substance abuse for their idea to create an app that provides other options for pain management, as well as peer-to-peer interactions.

Second prize in the obesity/diabetes category went for a plan to create an online wellness program to address a lack of access to out-of-clinic preventive care. Third place went for an app to get students to become more active.

The Passport diabetes challenge award went for a plan called "Sugar Busters" that would add a preventive screening checklist to the back of Medicaid cards, including pre-diabetic screening. This checklist, along with incentives and scheduling options, would also be available on an app.

Groups tackled obesity, diabetes and substance abuse.

"This has been really enlightening, rubbing elbows with smart people and brainstorming ideas to solve a problem that is so prevalent," said Anne Punoose, who was part of the "Sugar Busters" group. "Not one single person can put this problem to bed and as it takes a village to raise a child, so it takes all of us, united, to solve this problem of diabetes and obesity in Appalachia." Punoose is a computer engineer who works remotely for Salesforce in California.

The top award for the substance abuse category went to a group with a plan for a mail-in needle exchange program, called "Holler Exchange." Their plan would require an initial face-to-face visit, a committed "buddy" who would be responsible for turning in the needles and an ongoing tele-health conference.

One of the members in this group from Pike County said that even though the county has approved a needle-exchange program, it is underutilized, citing limited hours of operation, transportation barriers and social stigma as reasons. The county is Kentucky's largest in land area.

The other prizes in the substance-abuse category went for programs involving naloxone, which can stop overdoses in progress. Second place went for an app to connect providers and volunteers who were trained in how to administer naloxone, sort of like an Uber app for the drug. Third place went to a proposed "nalox box" that would send a signal to notify emergency personnel via satellite when the box was opened to notify them of a potential overdose. This plan would also create a simple way for children to give naloxone to their parents.

Neva Francis, vice-president of Healthy Communities for Kentucky One Health's central-east region, said that she had appreciated working with "really smart people" toward a solution for diabetes in Appalachia, but she also added, "To be realistic and yet innovative has been difficult."

Dr. William Hacker

So, what's next?

Dr. William Hacker, chair of SOAR's Wellness Advisory Committee and former state health commissioner, said the state Cabinet for Health and Family Services and the federal Centers for Disease Control and Prevention, which sent senior officials to the event, wanted to be briefed on the innovative health solutions that came from the hack-a-thon to see if they would be able to use their resources to help implement any of them.

"The team from MIT was really impressed with the solutions that the teams came up with and are thinking about trying to connect us back to a major meeting they are going to sponsor in Boston to use what we've done in Somerset as a role model that they want to broadcast around the country," Hacker said. "But most importantly, we generated optimism that something can be done at the community level."

SOAR’s sponsors for the event were Passport, WellCare, the Pikeville hospital, Community Trust Bank, Lindsey Wilson College, Lake Cumberland Regional Hospital, the University Of Pikeville College Of Osteopathic Medicine/A-Optic, the Foundation for a Healthy Kentucky and Ugly Mugz Coffee.

Legislator, citing rural doctor shortages, files bill to give physician assistants authority to prescribe controlled substances

A Republican recently elected to the state House has filed legislation that would allow physician assistants to prescribe controlled substances, something they can do in every other state beginning in January.

State Rep. Daniel Elliott

Rep. Daniel Elliott, R-Gravel Switch, says the bill would help relieve the doctor shortages in some rural areas of the state. “If we can give these professionals the ability to care for sick people then I can’t see why we wouldn’t do that in a state that tends to be at the bottom of some categories of health,” Elliott told Insider Louisville's Joe Sonka. “I don’t see the rationale in prohibiting very well educated and trained medical professionals from practicing medicine, and that’s what we’re saying they can’t do in Kentucky, to a certain extent.”

Physician assistants have two-year master’s degrees and are supervised by physicians. Kentucky has more than 1,200 of them. They have less prescribing authority in Kentucky than nurse practitioners, who have been able to prescribe controlled substances since 2006. Florida was the last state to extend the authority to physician assistants, effective in January.

"Ben Swartz, the executive director for the Kentucky Academy of Physician Assistants, tells IL that this difference makes it harder to hire physician assistants, and changing the law would 'bring parity in line with the two professions' and 'level the job market' in Kentucky," Sonka reports. "He adds that because Kentucky lags behind the rest of the country on this law, physician assistants in Kentucky often leave to find work in other states where they have full prescription authority, even though their training is more thorough than that of nurse practitioners."

Swartz acknowledges that the General Assembly has been reluctant to give PAs prescription authority "due to the state’s problem of prescription painkillers being over-prescribed and leading to opioid addiction and overdoses," Sonka writes. "However, he says this change would provide more accurate and responsible tracking of prescriptions by the state, as the supervising physicians’ prescriptions are often inflated when their assistant refers patients to them."

Elliott won a special election in March to fill the seat vacated by state Auditor Mike Harmon. Republicans are in the minority in the House but appear to have a good chance of winning a majority in the Nov. 8 elections.

Fighting cancer in Appalachia: Getting people screened 'is still the hardest part;' prevention requires multi-pronged effort, experts say

University of Kentucky video

Leaders of the National Institutes of Health spent Thursday in Hazard with Fifth District U.S. Rep. Harold "Hal" Rogers and local health leaders to examine efforts to combat high rates of cancer and substance abuse in Appalachian Kentucky.

“Cancer rates in the region have been something we have been battling for many years and in more recent years this region has become ground zero for the prescription drug abuse epidemic,” Rogers told the gathering.

Screening rates are up, but Dr. Sam Bailey, oncologist at the Appalachian Regional Hospital Cancer Center in Hazard, told the group, “Getting patients to undergo the initial cancer screenings is still the hardest part. These screenings can save a person’s life but it is a challenge often to get people to take that first step that is so vital in detecting cancer early before it has advanced.”

The center often refers to the University of Kentucky's Markey Cancer Center patients who need specialized care, as well as for cancer clinical trials, but Bailey said getting people to travel to Lexington, or even the clinic in Hazard, "can be a barrier due to costs associated with gasoline and other transportation-related expenses," a UK news release said.

Hollie Harris Phillips, vice president of corporate strategy at ARH, said the hospital has raised money “to provide gas cards to patients for them to use to get here to Hazard for their treatment or to UK and we’ve found for some patients it really makes a difference in whether or not they are able to get the care they need.”

But what about preventing cancer in the first place? “To make strides we have to do it all -- clinical care, education, healthier food options and promoting more exercise,” said Dr. Tim Mullett, professor of surgery and medical director of the Markey Cancer Center Research Network. “Things are better now than they were 30 years ago in terms of engagement but things are worse than they were 30 years ago because of the consequences of obesity and lifestyle issues.”

Drug issues also discussed

Dr. Doug Lowy, director of the National Cancer Institute, complimented local health leaders' efforts: “To see the way you have marshaled your resources in a multi-pronged way to seek answers to the issue of cancer as well as the very difficult situation occurring with the severe problem of prescription drug addiction is impressive. I applaud you for not just focusing on one problem. You really are a community that has come together to try to deal with the multifaceted nature of health and health problems in your community.”

The event also included Dr. Nora Volkow, director of the National Institute on Drug Abuse, and researchers at UK and its Hazard-based Center of Excellence in Rural Health, and Operation UNITE, the regional anti-drug agency with law-enforcement powers.

Volkow said at a roundtable discussion on the prescription drug epidemic in the region, “I cannot tell you how valuable this day has been to me because it gives me a perspective that you can’t get by reading journals or through scientific meetings. I hope we can continue this relationship and continue the discussion on how to battle this epidemic together.”

Later, at an event in Somerset, Volkow said Rogers' efforts have made the Obama administration the first to commit "real resources" to the substance-abuse problem: "He has turned the tide and he has made it actually a priority that there is a problem with substance-abuse disorders in our country, and that is something that does not happen overnight."

Baptist Health Plan says it pulled out of state exchange because it attracted too many healthy people and got penalized for it

Baptist Health Plan pulled out of Kentucky's insurance exchange because it attracted too many healthy customers and thus drew a federal penalty, Boris Ladwig reports for Insider Louisville.

"The narrative is counter-intuitive and stands in contrast to some of the giant insurance companies’ complaints in recent months that the customers they’ve gained on the exchanges have been too sick and expensive," Ladwig writes.

The situation with Baptist is the other side of that coin. The Patient Protection and Affordable Care Act has a “risk corridor” rule to subsidize insurance companies that have sicker, and thus more expensive, customers.

The money comes in part from companies with healthier, less expensive customers, Ladwig notes. Republicans in Congress have limited the Obama adminstration's ability to fund the subsidies, which contributed to the bankruptcy of the Kentucky Health Cooperative and most of the other co-ops created under the health-reform law.

"The mechanism aims to prevent insurers from cherry-picking the healthier customers and leaving other insurers to incur the higher costs from the sicker patients," Ladwig writes. But because small insurers such as Baptist have limited claims data, that can "make their customers look healthier than they are."

“The federal risk assessment placed upon the organization under the Affordable Care Act is unsustainable by a corporation the size of Baptist Health Plan,” President James S. Fritz told state Insurance Commissioner Brian Maynard in a letter. He added

Jessica Kearney, the company's regulatory director, told Ladwig that the smaller number of insurers on the Kentucky exchange contributed to Baptist’s decision to withdraw from Kynect. "Baptist leaders worried that they would gain even more customers — which might have required an even greater risk adjustment payment," Ladwig reports. "So Baptist leaders decided to withdraw, rather than face an even greater loss on the individual exchange business."

Ladwig writes, "Baptist declined to tell IL how much of a risk adjustment payment it had incurred. However, Baptist this year gained 7,500 customers on the exchange, far more than the 1,000 it expected, Kearney said. . . . Baptist Health Plan, based in Lexington, is part of the Louisville-based nonprofit health system Baptist Health."

OxyContin sales reps used food, gifts to convince doctors to buy drugs, says investigative report

Pharmaceutical sales representatives from health-care giant Abbott Laboratories sales reps "were instructed to downplay the threat of addiction with OxyContin and make other claims to doctors that had no scientific basis," David Armstrong reports for Stat, the health-and-medicine supplement to The Boston Globe, after reading internal documents in a lawsuit that were unsealed by a judge.

The documents revealed that offering sugary sweets was the secret to getting one surgeon to listen to sales pitches for OxyContin, and to buy the painkiller, according to internal documents obtained by Using a tip from nurses that the surgeon liked junk food, the sales rep "showed up with a sheet cake box filled with doughnuts and snack cakes arranged to spell out the word 'OxyContin'," Armstrong reports. (Stat photo illustration)

"The doughnut ploy . . . shows the lengths to which Abbott went to hook in doctors and make OxyContin a billion-dollar blockbuster," Armstrong writes. "The sales force bought takeout dinners for doctors and met them at bookstores to pay for their purchases. In memos, the sales team referred to the marketing of the drug as a 'crusade,' and their boss called himself the 'King of Pain'.”

What Armstrong calls "a treasure trove of internal documents" became available a few months ago, when a Kentucky judge ordered their release in response to a motion by Stat, reported Kentucky Health News, published by the Institute for Rural Journalism and Community Issues, which also publishes The Rural Blog: "Documents were part of a state attorney general's lawsuit settled in December by payment of $24 million from Purdue Pharma, the maker of OxyContin."

Armstrong writes, "Abbott, a much larger company than Purdue, had a sales force entrenched in hospitals and surgical centers, and had existing relationships with anesthesiologists, emergency room doctors, surgeons, and pain management teams. Abbott devoted at least 300 sales reps to OxyContin sales—about the same number of people Purdue initially dedicated to the drug—as part of a co-promotional agreement with Purdue."

Abbott marketed OxyContin from 1996 through 2002 after it was approved by the U.S. Food and Drug Administration, Armstrong writes. "With Abbott’s help, sales of OxyContin went from a mere $49 million in its first full year on the market to $1.6 billion in 2002. Over the life of the partnership, Purdue paid Abbott nearly a half-billion dollars, according to court records." (Read more)

Rural veterans less likely than urban counterparts to receive mental health care, says study

Rural veterans are less likely than their urban counterparts to receive treatment for mental health conditions, says a study by the federal Center for Behavioral Health Statistics and Quality and the Substance Abuse and Mental Health Services Administration, published in The Journal of Rural Health. About 5.3 million veterans—24 percent of all veterans—live in rural areas, according to Office of Rural Health of the Veterans Health Administration.

The survey, which used data from SAMSHA's 2012-2014 National Survey on Drug Use and Health, found that veterans in rural areas were 36 percent less likely than urban veterans to receive any mental health treatment, 33 percent less likely to receive outpatient treatment and 44 percent less likely to be prescribed medications. (Table: Percent of respondents answering yes to each question)

Researchers analyzed the past 12 months for five factors: If patients stayed overnight in a hospital; received outpatient mental health treatment; received psychotropic medication; received any mental health treatment; and whether in the past 12 months they perceived an unmet need for mental health treatment/counseling that was not received. For the last variable respondents were asked, “During the past 12 months, was there any time when you needed mental health treatment or counseling for yourself but didn’t get it?”

Overall, 29 percent of rural respondents said they received any mental health treatment in the past 12 months, compared to 45 percent of urban ones. At the same time, 25 percent of rural respondents said they were prescribed medication, compared to 45 percent of urban veterans and 20 percent of rural veterans received outpatient treatment, compared to 33 percent of rural veterans.

Smoking marijuana isn't the biggest concern for your doctor, unless perhaps he or she is a Republican

Marijuana use is not among your doctor's major worries, but that might depend on his or her politics, according to a study published in the Proceedings of the National Academy of Sciences. Yale University researchers Eitan Hersh and Matthew Goldenberg "presented a representative sample of 233 primary-care physicians with nine hypothetical patient behaviors -- tobacco use, alcohol use, obesity, etc. -- and asked them how much of a problem they thought these behaviors were on a 10-point scale," Christopher Ingraham writes for The Washington Post.

Abortions and marijuana use were tied as the "least-worrisome behaviors," while alcohol use, tobacco use, obesity and depression were rated significantly more problematic. (In 2012-14, 32 percent of adults in Kentucky were obese, 27 percent smoked, and they averaged five mentally unhealthy days per month.) "By contrast, doctors rated not wearing a helmet while riding a motorcycle and having intercourse with sex workers several times a year as the most problematic behaviors on the list," Ingraham writes.

Washington Post chart

Though the findings "add some empirical heft" to a Scientific American essay by Nathaniel Morri, the original intent of the study was to find a political distinction between Republican and Democratic doctors' opinion on marijuana use. "Republican doctors were, on average, much more concerned about marijuana use than their Democratic colleagues," Ingraham writes. His colleague Erin Blakemore reported, "When faced with hypothetical scenarios involving politically charged issues, they make different treatment decisions."

Republican doctors are also more likely to discuss both health and legal risks of marijuana to "urge the patient to cut down," according to the study. Ingraham added: "The doctors were also polarized over the relative seriousness of previous abortions (Republican doctors more concerned) and of the presence of guns in the home (Democratic doctors more concerned)."

Researchers are more concerned with heavy use of marijuana -- the people who use marijuana daily, or multiple times a day, Ingraham writes. "Those people are at a greatest risk for dependency and various health problems associated with heavy use -- even if those problems don't appear to be as severe as the debilitating conditions associated with long-term heavy tobacco or alcohol use."