Category Archives: health

Meals On Wheels: Canary in the GOP Coal Mine

The entire “skinny budget,” which somehow manages to keep lots of fat on the Pentagon budget, offered up by the current administration is a mass of mischaracterizations packed into a myriad of outright lies.  The assault on programs like Meals on Wheels is a handle providing a way to understand the totality of the right wing Individualism of the GOP. It’s there, blatantly set forth without excuse, and as emblematic of the Culture of Selfishness as can be imagined.

Cast me not off in the time of old age; forsake me not when my strength faileth. Psalms 71:9

“Trump’s proposed budget completely eliminates the Community Development Block Grant, which provides $3 billion every year for, according to The Washington Post, “targeted projects related to affordable housing, community development and homelessness programs.” Among those is the Meals on Wheels program, which provides meals—and vital human contact—for older, impoverished Americans, many of whom are largely home-bound. According to MOW, one in six American seniors struggles with hunger, and the organization claims it saves the nation about $34 billion a year in medical expenses by decreasing the rate of falls for seniors. The program gets the vast majority of its funding from non-government sources, but the proposal still seems unnecessarily harsh.” [Esquire]

And the rationale for all this would be what, please?

“After a reporter brought up the Meals on Wheels controversy, Mulvaney at first tried to subtly evade the question. But then, as is the wont of this administration, he fell head over glutes explaining that while Meals on Wheels “sounds great,” the administration couldn’t keep wasting money on programs like it that “don’t work.” As in, feeding the elderly apparently isn’t showing strong enough empirical benefits to merit continued federal spending by this White House, which is now deeply wedded to evidence-based policymaking.” [Slate]

There are a couple of things to unpack herein. First, empirical benefits are hard to compile without first establishing a matrix of goals.  Benefits are precisely why the program “sounds good,” the goal is to feed people, and people are being fed in their own homes. In fact some 2.4 million elderly persons are participating in the program at a total cost of $1.4 billion. 500,000 of these are veterans of our Armed Forces. A study in New York City reports that the average age of a participant was 80, meaning the person was likely born around 1937, and if the person is a veteran he or she likely saw service during the Cold War into the Vietnam Era. How goals are framed makes a difference.

If the goal is to provide 2.4 million elderly people one meal per day with a minimum of 625 calories, then we can say it’s working.  If our goal is to be that no elderly Americans go a day without a sustenance level meal for a relatively inactive person, then, no the program has too many people on waiting lists to say it’s an unqualified success.

“The need is growing rapidly, and federal funding has not kept pace. The network is already serving 23 million fewer meals now than in 2005, and waiting lists are mounting in every state. At a time when increased funding is needed, we fear that the millions of seniors who rely on us every day for a nutritious meal, safety check and visit from a volunteer will be left behind.”[MOWAm]

At this point it needs to be said that Federal funding is combined with charitable and individual donations to keep the program literally on its wheels.  Further, the only logical way to pronounce the services a failure is to absurdly assert that because seniors get hungry the next day the program isn’t meeting its goals. However, it’s crucial to take a look at the second feature of GOP rationalization for pure selfishness.

Ultra-right wing conservatives are fond of explaining that services like Meals on Wheels could be better done by local charitable institutions, ignoring the fact that as mentioned above the Federal funding is not the primary source, and IN FACT is supplementary to local charitable funding sources. Catholic leadership, for example, is wary of the implications of the administration’s budget priorities, and Catholic Charities of Southern Nevada is providing some 2,000 daily meals to those on its list. Reducing funding for this single program by one third would have a profound, and profoundly negative, impact on its services.   There are times when the intersection of governance and religious institutions illustrates the point that while private donations are the core, when the need overruns the capacity then it’s time for a little help from friends around the country.  This Cult of Selfishness only works in the ethereal world of ideological fantasies, it doesn’t deliver a meal, even one of a minimum of 625 calories, to a single individual anywhere.

What makes the skinny budget so alarmingly obnoxious is that curtailing funding for Meals on Wheels is merely illustrative of a budget building process based on what the rich want to pay, rather than on what our society needs to be a truly great nation. It is a budget process to Make American Mean Again.

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Physicians Could Use A Bit Of Healing in Nevada: Opioid Prescription Problems

oxycontin  The Reno Gazette Journal has done a piece of highly recommended reporting – an in-depth account of opioid prescribing in Nevada.

“…a Reno Gazette-Journal analysis of DEA data showed that for certain drugs, Nevada ranks among the highest in the country.

Take oxycodone, Nevada’s most widely prescribed opioid. In 2012, nearly 1.04 million grams was distributed via retail in the state. That’s more than double what doctors prescribed in 2006. Nevada’s distribution rate is third highest in the country.

Nevada also ranks third for its hydrocodone distribution rate. In 2012, doctors prescribed more than 799,000 grams of hydrocodone — nearly three times the rate of New Jersey, which has triple Nevada’s population.”

OC pill There are some important points to take away from the article.  One of the first is that physicians, themselves, have opposed greater oversight of opioid distribution to patients, specifically in regard to SB 459.  One physician testified to the Assembly Committee on Health and Human Services that SB 459 sections 1-12 should be adopted, but the rest of the bill including reporting and medical education requirements should be dropped because it wouldn’t prevent overdoses. [AHHS pdf] Another doctor offering testimony “went there,” comparing the regulation of opioids to Nazi Germany:

“When people come to Las Vegas and need surgery or have chronic conditions and they hear that the climate here is like Nazi Germany in terms of regulations, the tightening of prescription pain medications, and the prosecution of doctors, it has a very chilling effect on these people who need those medications. […] there are folks who have chronic pain. I am an internist and I see this every single day. I sit there arguing with them about cutting their medications down and they start crying and throwing a fit because they need it.”  [AHHS pdf]

He continued:

We pull the DEA reports now and, as a private practitioner with a two- or three-man office, it creates a lot of extra work for my staff and more
documentation. It makes me pause every time I start to write a script for any controlled substance; I should not have to feel like that. At the end of the day, the doctor and the patient have the relationship, not the government in the middle. Doctors should be the ones who decide what is best for their patients. This bill has a chilling effect on that. [AHHS pdf]

The good news is that the language requiring that a doctor check the prescription drug monitoring database before writing a prescription for a narcotic to a new patient was retained in the bill.  However, the testimony presented should cause some alarm from members of the general public.

OC pill

As the article points out, a state with one third of the population of another probably shouldn’t be prescribing three times the amount of narcotic painkillers.

The argument that the state legislature shouldn’t try to do something to mitigate the problem if the proposal won’t fix the entire problem sounds altogether too analogous to the NRA’s arguments for doing absolutely nothing to prevent guns getting into the hands of felons, fugitives, and domestic batterers.  “If it doesn’t solve the whole problem, then it shouldn’t be done.”  The second piece of testimony is, itself, chilling.

Hyperbole rarely provides productive content in a civic discussion, and Godwin’s Law applies.  Bring up Hitler, and the audience moves along assuming the argument has been abandoned.  Secondly, it’s a bit more than disturbing that a licensed physician would be argued into prescribing medication he or she knows is deleterious or even dangerous for a given patient.

OC pill

No one wants the Hot Potato.  The state pharmacy board doesn’t want to use its database to flag doctors who are over-prescribing narcotics.  Their director: “Who’s to say what’s normal or what’s OK,” Pinson said. “It might be appropriate for a physician to be prescribing a ton of narcotics according to his specialty.” [RGJ]  It might be, and then again, it might very well not be. And the Board of Medical Examiners isn’t enthusiastic about clearing out their ranks either:

“It would be inappropriate, and it’s not the intent of the (prescription monitoring program), to find cases to investigate,” said Edward Cousineau, executive director of the Board of Medical Examiners, which licenses medical doctors and investigates malpractice complaints in the state.” [RGJ]

Again, we might ask: Why isn’t it appropriate to weed out physicians who are creating a situation in which Nevada is among the top five states for opioid pushing? Perhaps the next session of Nevada’s Assembled Wisdom will find the intestinal fortitude to (1) require that the Pharmacy Board use its drug monitoring database to look for BOTH doctor shopping patients and pill pushing physicians; and (2) more thoroughly investigate drug overdose deaths. 

OC pill

Kentucky, Tennessee, Texas, and Arizona have enacted such legislation. [RGJ] Nevada should join them.

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Filed under health, Health Care, nevada health, Nevada legislature, Pharmaceuticals, Politics, public health

Republican Water Wars: Clean Drinking Water and GOP Polluters

Amodei 3 It’s really hard to argue against Clean Water.  It’s especially difficult to argue against Clean Drinking Water in light of what’s happening to the public in Flint, Michigan.  However, that hasn’t stopped Republican members of Congress like Representatives Hardy (R-NV4), Heck (R-NV3), and Amodei (R-NV2) from aligning themselves with those who want to curtail, delay, and ultimately defeat regulations designed to prevent stream contamination in “coal country.”

Easy and Cheap Coal Mining or Clean Drinking Water?

Back in May 2015, opponents of clean water regulations decided to oppose any administration efforts to regulate what mining companies did with the debris from mountain top coal operations:

“Congressional Republicans are seeking to block an imminent rule protecting Appalachian streams from mountaintop removal mining, as opponents of the controversial practice say the mines are getting closer to communities and harming people’s health.

The White House is expected to announce a stricter rule for the disposal of mountaintop-removal mining waste into streams. Some Republicans in Congress are describing the move as the latest campaign in the Obama administration’s “war on coal.” [McClatchy DC] [see also The Hill]

The opposition would go beyond  the Reagan Era (1983) regulations which did not allow dumping debris within 100 feet of a river or stream.  The coal industry thought it had the system beaten when the George W. Bush administration allowed “waivers” from the rules during the last months of his presidency. [SeattleTimes]  The Obama administration promptly rescinded the last minute Bush Gift to the Coal Companies.  Coal interests just as promptly hauled out the hyperbole and declared the administration was declaring a War On Coal.

The result of the opposition clamor against allowing mining companies to dump debris into rivers and streams was the STREAM Act.  While the act doesn’t allow outright the trashing of American rivers and streams, it does wrap the EPA and Corps of Engineers in endless studies, evaluations of studies, and interminable hurdles to protecting water sources.  Representatives Heck, Hardy, and Amodei appear to be marching along with the coal industry.  Each voted in favor of the STREAM Act on January 12, 2016. [roll call 42]

Is Anyone Surprised?

The drinking water calamity in Flint, Michigan is a man-made problem.  Actions taken to “save money” have obviously proven to exacerbate contamination such that the population of Flint has been exposed to toxic lead levels.  We know what lead does – we also know what happens when a state government fails to act swiftly and responsibly to impending disaster.

What happens when creeks are filled with iron and aluminum hydroxides? When streams are polluted with contaminants from mountain top removal coal operations?  Three peer reviewed studies in central Appalachia found: (1) An overall increase in the rate of birth defects in counties with mountain top mining; (2) A 14.4% cancer rate compared to non-mountain top mining areas with a 9.4% rate; and (3) a $74.6 billion per year public health expense burden on Appalachian communities. [KFTC pdf]  This is not an isolated problem, nor is it new:

Between 1985 and 2001, 6,697 valley fills were approved in Appalachia, covering 83,797 acres of land and potentially affecting 438,472 acres of watershed.20 Valley fills can be as wide as 1,000 feet and over a mile long, and each can contain as much as 250 million cubic yards of wastes and debris—enough to fill almost 78,000 Olympic-sized swimming pools.
Burying fragile headwater streams located in valleys exterminates virtually all forms of life that get interred under millions of tons of waste and debris. From 1985 to 2001, the EPA estimates that valley fills buried 724 miles of streams.22 Another study conducted by the Office of Surface Mining Reclamation and Enforcement (OSM) found that approximately 535 miles of streams were negatively affected by mining from 2001 to 2005.23 All told, nearly 2,000 miles of Appalachian headwaters have been buried or polluted by mountaintop removal, and the damage to Appalachian watercourses has continued at an average rate of 120 miles per year. [NRDC(pdf)]

stream pollution

The track record doesn’t sound promising for those who want to protect their drinking water supplies, and the actions of the pollution protectors aren’t helping.  Perhaps Representatives Amodei, Heck, and Hardy, would care to explain why they don’t seem particularly disturbed about higher than normal levels of calcium, magnesium, manganese, sulfate, and selenium in coal country drinking water?

What does this stuff do?

 

We know that manganese is one of those minerals we need as part of a normal diet, but we also know that high concentrations of manganese isn’t a good thing for children – the young apparently having a greater absorption rate than adults – and that high absorption often correlates to learning disabilities. [WHO pdf] This is a bit more damage than just the brown staining on laundry common to manganese contaminated water, and much more than the toxicity it has for plant life – a burden for farmers downstream. [USGS]

Magnesium is not considered all that dangerous, in correct (normal) levels.  There is no “maximum contaminant level” assigned to this mineral. [EHS pdf]  However, both magnesium and calcium contribute to what is popularly known as “hard water,” that ever present danger to plumbing, and household appliances such as washing machines and hot water heaters.

Sulfates are another matter.   Right off the bat, water containing more than 400 mg/L should NOT be used when preparing infant formula. [MHealth] And, the stuff is corrosive, if the sulfate in the water exceeds 250 mg/L (MCL)  copper piping is particularly susceptible to corrosion. [MHealth]  Thus leading to copper contamination.  Sulfates have what is known politely as a “laxative effect,” which is not all that appealing when combined with the knowledge that sulfates are causing scale build up in the water pipes. [UGA edu pdf]  Nor should we diminish the impact of a “laxative effect” on young children and infants for whom diarrhea and dehydration can be quite serious health risks.

Selenium is a real mess.  It’s a heavy metal, and the current maximum contaminant level is 0.05 ppm (parts per million).  Long term higher-than-normal exposure can (and usually does) result in hair and fingernail loss, damage to the kidneys and liver tissue, as well as damage to the nervous and circulatory system.  In other words, it’s truly dangerous. [EPA]

Since much of the more obvious damage appears to be targeted at plumbing, pipes, and appliances, it’s too easy to dismiss the pollutants as mild (compared to the Lost Jobs?) about which the coal industry is concerned.  However, there are other contaminants to consider associated with coal mining operations:  Acid mine drainage; Coal Slurry, Coal Ash,  the ever present bug bear – Selenium, and Total Maximum Daily Loads.  [AppV]

And the mountain top removal contribution to the problems?  WV public.org reports: “It was pretty obvious to me that below valley fills, water was pretty tainted, and then it became a question of, ‘Is it getting into the human water supply?’” Stout said. “I started sampling people’s houses; some people’s water is really good, other people’s water is really appalling.” Stout has tested for and found water spiked with heavy metals and other contaminants. “Before it’s disturbed it’s as good of water you’re going to find anywhere on the planet. But after that it becomes tainted with heavy metals and bacteria and so forth and becomes unusable, except that these people don’t have any recourse,” Stout said.”

Nor, we might add, do the people of Flint have much recourse.

It’s a plausible argument that Representatives Hardy, Heck, and Amodei, are staunchly defending the exploiters and polluters who are managing a 19th century industry – rather like defending the profits of the buggy whip manufacturers before Ford.  Not only is natural gas making headway into the former domains of coal, but both wind and solar assets are increasing as well. As one environmental improvement advocacy group puts it, “Coal is making a long goodbye.”

Representatives Amodei, Heck, and Hardy appear to have both feet firmly planted in an America of the 20th century while we’re a decade into the 21st.  When they speak to their “visions” of America, voters might want to remember this point.

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Nevada’s Health Care Problem We’re Not Talking About

Skip the political blathering about “repeal and replace” the Affordable Care Act.  The law has enabled 16.4 million Americans to get health insurance as of March 2015. [OFacts]  This means there’s been a 35% reduction in the number of people in this country who are without health care insurance. [OFacts] So, instead of posturing and polarizing, let’s talk about improving the health care to which more people now have access.

NV Substance AbuseOne area in which we could be doing better is in addressing and treating addiction issues faced by citizens of Nevada. Notice the information from SAMHSA indicates most individuals who are in treatment programs are getting help with both alcohol and drug abuse problems.   However, the next two charts aren’t quite so positive.

NV Substance Abuse Treatment You read that correctly… over 85% did NOT receive treatment for substance abuse issues.

NV Alcohol Treatment PercentageYes, you read this one correctly too. Some 95.4% of individuals with alcohol addiction problems did NOT receive treatment in the year prior to the SAMSHA survey.   These numbers should improve as the policy requirements for comprehensive, basic, health insurance take effect:

“The ACA includes substance use disorders as one of the ten elements of essential health benefits. This means that all health insurance sold on Health Insurance Exchanges or provided by Medicaid to certain newly eligible adults starting in 2014 must include services for substance use disorders.” [WH.gov]

Nevada participates in the Medicaid Expansion provisions of the Affordable Care Act, and so we should expect some improvements in the percentage of individuals who have access to health insurance which covers addiction treatment programs.  That still doesn’t fully answer the question: Why are there so many untreated cases?

As of 2013 some 61% of those without health insurance said they couldn’t afford it, or they lost coverage when they lost a job. [KaiserFnd]  The financial assistance under the terms of the ACA should help, but there may still be some gaps.  “Not all workers have access to coverage through their job. Most uninsured workers are self-employed or work for small firms where health benefits are less likely to be offered. Low-wage workers who are offered coverage often cannot afford their share of the premiums, especially for family coverage.” [KaiserFnd]  So, who is most likely to be without health insurance?

    • “Individuals below poverty are at the highest risk of being uninsured, and this group accounted for 27% of all the uninsured in 2013 (the poverty level for a family of three was $19,530 in 2013). In total, almost nine in ten of the uninsured are in low- or moderate-income families, meaning they are below 400% of poverty.”
    • “While a plurality (46%) of the uninsured are White, non-Hispanic, people of color are at higher risk of being uninsured than White non-Hispanics. People of color make up 40% of the population but account for over half of the total uninsured population. The disparity in insurance coverage is especially high for Hispanics, who account for 19% of the total population but more than 30% of the uninsured population. Hispanics and non-Hispanic Blacks have significantly higher uninsured rates (25.6% and 17.3%, respectively) than Whites (11.7%).” [KaiserFnd]

And herein we run directly into the revolving door of addiction treatment access issues.

Those who may need access to treatment programs for addiction problems may (1) fall into the gap between the insured and the uninsured; because (2) of job loss or low wages; and (3) they may be spending funds on their addiction that would otherwise be available for treatment.

Enter the Boo Birds: “If these people would just stop spending money on booze and dope and start saving for addiction treatment programs… problem solved.”   How righteous? The problem is that we are speaking about ADDICTION.  We’re not talking about “discretionary” spending here in the classical sense.  And, the individuals who fall into the uninsured category are more likely low income or unemployed in the first place.

“Alcohol treatment costs vary widely depending on your individual treatment needs, your insurance, and the facility. Here are some tips to help you pay for treatment:

  • Check your insurance. If you have health insurance, call the number on the back of your card to ask about your mental health and substance abuse coverage. Find out what your out-of-pocket costs will be, including deductible and co-payment amounts.
  • Look into programs that offer sliding scale or reduced payment options. Check with your state’s substance abuse agency or call SAMHSA’s helpline (1-800-662-HELP) to ask about affordable treatment in your area.” [HelpGuide]

Checking your insurance is good advice – IF a person has insurance, “finding out the deductible/co-pay expenses is good advice as well – IF a person is in a financial position to pay those costs.  Yet again, we run into a situation in which if a person is “well off” financially, or has family resources which can absorb the costs, treatment is available.  Not “well off,” don’t have family resources to offset the costs?   Not. So. Much.

To drive this point closer to home, Nevada has 62 drug treatment center listings, 38 of which are shown as offering “payment assistance.” [DRHQ]  Making the point even more sharply – Nevada has 11 behavioral health professionals for every 1,000 people in the state, the lowest in the nation. Vermont has about 70 per 1,000; Connecticut about 60; Maine about 55. Nevada is sitting down at the bottom with Georgia, Texas, and Indiana. [PCT]

There are some efforts we could make before the next legislative season to address these issues:

  1. Research and publish the findings on the availability of alcohol and substance abuse treatment centers which provide payment assistance for low or middle income patients, and the uninsured. 
  2. Research and publish the findings on the availability of alcohol and substance abuse professional services in both our urban and rural regions.
  3. Research and publish the findings on the average waiting time for those who are seeking treatment, especially in residential treatment programs.
  4. Research and report the efforts made to attract more individuals and institutions into the field of behavioral health, including substance abuse professionals.
  5. Recommend ways the state might improve its ration of expenditures on prevention and treatment or incarceration.

It would seem logical to approach this health care issue from a positive perspective – now that the ACA makes health insurance more affordable for more people, how can we help Nevadans take advantage of treatment programs?  Further, how can we assist those who have fallen into the non-insured gap get the treatment they want and need?  How can we get Nevada off the bottom in the list of availability of behavioral health care professionals?

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It’s the Planning Part That Makes Them Crazy: GOP attacks on Planned Parenthood

Sanger

It must be campaign season: the Republican Party is once again attacking Planned Parenthood.  This current manufactured outrage moment was coordinated with the debunked video from a shadowy outfit whose “investigators” come complete with phony identification documents. [HuffPo]  [DemoNW] Since the GOP seems to have nothing on offer regarding national infrastructure, comprehensive immigration policy reform, Middle East Peace negotiation, manufacturing policy, minimum wage levels, job training and education, or any substantive proposals on the expansion of health insurance coverage – it must be time to look for Distractions. And, what better distraction than Planned Parenthood?

These attacks appeal to the rabidly anti-contraception/abortion advocates in the Republican base.  We can assume that this element is a small minority of the U.S. population because (1) more than 99% of women aged 15-44 who have ever had sexual intercourse have used at least one contraceptive method. (2) Approximately 62% of all women of reproductive age are currently using a contraceptive method. (3) 83% of Black women, 91% of Hispanic women, and 90% of Asian women of child bearing age currently use a contraceptive method during intercourse. (4) 92% of all women with incomes of 300% or more of the federal poverty standard are currently using contraception, as are 89% of those with incomes at 0-149% of the poverty line.  [Guttmacher]

Contraception method chartAs the statistical reports, and the chart, demonstrate, those who oppose contraception are a definite minority, and the religious argument begins to unravel when another survey is highlighted: “Some 68% of Catholics, 73% of Mainline Protestants and 74% of Evangelicals who are at risk of unintended pregnancy use a highly effective method (i.e., sterilization, the pill or another hormonal method, or the IUD).” [Guttmacher]

As with the polling and survey reports on contraception, the polling on the abortion issue also illuminates the minority position of the radical anti-abortionists.   Note the trends reported by Gallup:

abortion polling It doesn’t even require a calculator to see that as of 2015 approximately 80% of the U.S. population believes that abortion is acceptable, at least under some circumstances.  Only 19% believe the medical procedure should be illegal in any situation.  [Gallup]

Thus we have circumstances in which 99% of those women who have had sexual intercourse using some form of contraception, and 80% of the nation believing that under some circumstances (usually involving the welfare of the mother) abortion procedures should be legal.  Why would a major political party attempt to use contraception/abortion as a political issue?

If it worked before – it will work again?  Republicans have utilized “wedge issues” with some effect before – gay marriage, gun safety, contraception/abortion.  And, Thomas Frank’s book concluded:

“…the Republicans use social issues in a bait-and-switch routine: people are enticed into voting Republican over social issues like abortion or gay marriage, and then Republican pols, once elected, ignore all that and govern like the pro-business, rich-people’s party that they are at heart.”  [Atlantic]

The problem for Republicans is that while they are the pro-corporate (not small business) party of the hedge fund managers and the large banks, the bait is becoming harder to find.  Therefore the need to find another way to access the anti-contraception/abortion vote – let’s try fetal tissue research!

The GOP has two problems with this wrinkle – first, they were for it before they were against it. [Think Progress] and secondly, who wants to argue that fetal tissue should be turned into medical waste instead of having the family opt for tissue donation for medical research?

Nor is fetal tissue medical research a new thing – it’s been done since the 1930s, and the 1954 Nobel Prize for medicine was awarded for work with fetal tissue that lead to the development of the polio vaccine. [USNWR] Current work with fetal tissue involves studies related to birth defects, spinal cord injuries, Parkinson’s Disease, eye diseases, and HIV/AIDS. [Reuters] Fetal tissue research also yielded vaccines for chicken pox, rubella, and shingles. [CNN]  If one is truly “pro-life” in the comprehensive meaning of the term, then the research into finding a vaccine for rubella is instructive:

“From 1964-1965, before the development of a vaccine against the disease, a rubella epidemic swept the United States. During that short period there were 12.5 million cases of rubella. Twenty thousand children were born with CRS: 11,000 were deaf, 3,500 blind, and 1,800 mentally retarded. There were 2,100 neonatal deaths and more than 11,000 abortions – some a spontaneous result of rubella infection in the mother, and others performed surgically after women were informed of the serious risks of rubella exposure during their pregnancy.”  (CRS = Congenital Rubella Syndrome) [HistVac]

Interesting isn’t it: The use of fetal tissue in medical research to develop a vaccine against Rubella meant FEWER abortions (both natural and medical)  and 2,100 fewer neo-natal deaths.  OK, now stand at a podium and tell the voters that you are in favor of bringing all fetal tissue research to a grinding halt even if it means more miscarriages and abortions? In the name of “Life?”  There’s a purpose for fetal tissue research at the other end of the age spectrum:

“Stem cell therapy for retinal disease is under way, and several clinical trials are currently recruiting. These trials use human embryonic, foetal and umbilical cord tissue-derived stem cells and bone marrow-derived stem cells to treat visual disorders such as age-related macular degeneration, Stargardt’s disease and retinitis pigmentosa. Over a decade of analysing the developmental cues involved in retinal generation and stem cell biology, coupled with extensive surgical research, have yielded differing cellular approaches to tackle these retinopathies…” [NCBI]

The radical anti-abortionists haven’t mentioned the research into how to attack the 2.7 million cases of macular degeneration in the U.S. [NEI]  Do we dare tell them that most of those cases are among Caucasian Americans?

Mac Degeneration by race And, here we have it: attacks on an organization, often the target of radical anti-abortionists, which lawfully provides fetal tissue to medical research facilities  currently working on ways to prevent, cure, or alleviate diseases prevalent in America, many of which are  deadly (ALS, Parkinson’s) or debilitating (macular degeneration).  All for what?

For an issue most Americans don’t have at the top of their priorities?

abortion issue

To attract 21% of the respondents in the 2015 polling?  To appease those for whom family planning is anathema?  Nothing better illustrates the hold over the Republican Party like its pandering to a small minority in the national audience, a minority like Quiverfull (see Duggars), for whom women are merely the instruments of men’s procreation?  To appeal to those who follow the Army of God manual and bomb abortion clinics or kill providers? To address those ignorant enough to miss the connections between significant medical research and the use of fetal tissue?

Or, to appeal to those who firmly believe that the Little Woman should be barefoot and pregnant – in the kitchen – not the Senate or the House.  Families which plan for their children, which can assume two incomes, which can maintain intimacy without unintended pregnancies, and who can afford the $3500 it costs for the average uncomplicated birth of a child in a hospital [Parents] are generally better off, and so are their kids.  Here we hit the rough patch. 

Planning is Everything.   It’s impossible to attack those families which are practicing birth control for rational reasons —  in the face of irrationality.  Critics of social welfare programs offer, “If you can’t afford them then you shouldn’t have them.”  If we accept this criticism, then what rational premise might one have for defunding the organization which promotes responsible parenting by making contraception available? 

However, “If you give’em birth control they’ll just be promiscuous!”  Notice the emphasis is on the female, “boys will be boys.”  It’s hard to separate this attitude from good old fashioned garden variety misogyny.  If we actually want fewer unplanned pregnancies, especially among younger women, then what is the rational argument for cutting funding for clinics like those sponsored by Planned Parenthood which inform young women about contraceptive options?

Only 3% of Planned Parenthood’s medical procedures involve abortion at any stage and in any manner. For the radicals this is 3% too many.  For the deluded among us – every woman must carry every pregnancy to term, no matter the cost to her physical well being or to her mental health. Every pregnancy must end in a birth – even if the fetus is so badly deformed that it won’t survive outside the womb for more than 24 hours?  How many of the radicals are even aware of anencephaly,  exomphalos and gastroschisis? [Patient]  Pre-natal care is required in order to detect abnormalities like anencephaly, and where do women – especially low income women – get pre-natal care? From their local Planned Parenthood clinic.  Which, we should add, provides pre-natal care for the pregnancies, planned or unplanned, of many middle and lower income women.

If the Republicans who are chanting for Investigations! Funding Cuts! and other assaults on Planned Parenthood understood just how ridiculous they sound, and how close to the radicals associated with the Army of God and the  Quiverfull movement they’ve moved, then they’d have a much better grasp as to how counter-productive their shift to the radical right will be received in a general election.  In their attempt to manufacture another “crisis” in “poutrage” and to generate a wedge issue, they’ve only succeeded in forming alliances with the most misogynistic elements of the Right Wing: Those who neither want nor countenance Planning in family relationships. 

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Heck’s Votes on the ACA

Heck ACA votes

The Chamber of Commerce has been “on my TV” telling me how much I should like Representative Joe Heck (R-NV3), possibly because Rep. Heck doesn’t have much name recognition in the hinterlands.  He’s just full to the brim with Integrity! and Experience, or something. At any rate he’s not all that full of the milk of human kindness which is required when discussing other peoples’ need for health insurance. Especially the kind of health insurance that covers preventive medical treatment, or covers women for the same premium costs as men, or provides insurance for approximately 17 million Americans who might otherwise go without.

The record is clear.  Rep. Heck is one of those consistent soldiers answering the call of the Insurance Corporations.  For more on Rep. Heck’s record click on this link.   Sorry, but this kind of “integrity” I can do without, thank you very much.

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Filed under health, Health Care, health insurance, Nevada politics

Unleaded Truth Part II: Nevada’s Lead Contamination Issue

lead paint As noted yesterday, there are three jurisdictions in Nevada which have county health departments.  Health departments in the two metropolitan areas (Clark and Washoe counties) have addressed the issue of lead contamination in their areas.  In the remaining jurisdictions it appears to be a matter of state regulations, and the interest of county commissioners, as to whether particular attention is paid to toxic contamination in homes and businesses; and, it’s a matter of reliance on EPA regulations to protect renters and buyers.

All jurisdictions are required to uphold the provisions of the “federal Residential Lead-Based Paint Hazard Reduction Act enacted in 1992. This law is commonly known as Title X (ten). Environmental Protection Agency (EPA) regulations implementing Title X apply to rental property built before 1978.” [Openjurist]

“Before ratification of a contract for housing sale or lease, sellers and landlords must disclose any known information concerning potential lead-based paint hazards and available records, must provide purchasers and lessees with a lead hazard information pamphlet, and must include specific language in the lease or contract related to lead. In addition, sellers must give buyers time to conduct a lead inspection. Most private housing, public housing, federally-owned housing, and housing receiving federal assistance built prior to 1978 are affected by this rule.” [EPA]

One issue raises up when we look at the forms for renters and prospective buyers.  The rental agents and sellers may check off a box on the forms indicating they have no knowledge of real, potential, or unsuspected lead contamination in housing constructed prior to 1978.  The form does not require the renter or seller to conduct any inspection to determine if lead contamination exists on the premises.  That’s left to the renter or buyer.

“Before ratification of a contract for housing sale or lease, sellers and landlords must disclose any known information concerning potential lead-based paint hazards and available records, must provide purchasers and lessees with a lead hazard information pamphlet, and must include specific language in the lease or contract related to lead. In addition, sellers must give buyers time to conduct a lead inspection. Most private housing, public housing, federally-owned housing, and housing receiving federal assistance built prior to 1978 are affected by this rule.” [EPA]  (emphasis added)

The current provisions require those renting property or selling property to give their renters information about the dangers of lead contamination, any known information about lead in the housing or common areas, and an attachment to the lease about the proper issuance of a lead contamination warning.   The expression caveat emptor comes to mind.

And, this can be a problem for residents of rural Nevada counties because the EPA list of certified lead contamination inspectors,  and those firms which are certified for lead contamination abatement projects are based in Las Vegas, North Las Vegas, Reno, and Sparks.  As we’d suspect, state law (NRS 439.4797) puts those counties having more than 700,000 residents in charge (read: Washoe and Clark) and those with less than 700,000 (every other jurisdiction) under the auspices of the State Board of Health.

Advice from the state board of health might be cold comfort to those seeking affordable rental housing in those outlying jurisdictions, it begins with:

“Tenants and landlords should work cooperatively to investigate and correct lead based paint or other hazards. Nevada law requires that a landlord must provide a habitable condition inside of the dwelling (NRS 118A.290). Check your rental or lease agreement to determine your responsibility to address daily maintenance issues or repairs.”  [health.nv.gov pdf]

Indeed, NRS 118A.290 requires a residence be suitable for human habitation, the operative phrase may be: “A dwelling unit is not habitable if it violates provisions of housing or health codes concerning the health, safety, sanitation or fitness for habitation of the dwelling unit…” and, no, there is no specific mention of lead contamination.

Let’s focus in on rental property for the moment and the problems which may be faced by middle or lower income level inhabitants of these properties when it comes to coping with the state guidelines for lead contamination issues.  A tenant is advised to document instances of lead contamination with letters, photos, “evidence of health problems,” and work orders from private inspectors or contractors. This raises a reasonable hypothetical question.

A landlord in a jurisdiction outside of the two major metropolitan areas has signed off on a statement indicating he or she has no prior knowledge of any lead based paid issues in the building.  A tenant later notices peeling and chipping paint on window sills. The landlord again explains that he or she has no knowledge that lead based paint was ever used in the building, and doesn’t know if the underlying coat(s) of paint were lead based.  It would appear that the landlord has done all that is required at this point. After this point in the process it’s up to the tenant to provide certified mail notification to the landlord; allow the landlord 14 days to respond; and, then if nothing happens (like a certified inspection) launch the legal process. The question becomes: Who is responsible for paying for the certified inspection? For the cost of the “work orders, and private inspections?”  Return with us now to the real world – the one in which a lower or middle income family may not have the monetary resources, or the time required, to get an inspection, and launch into the legal processes required to get an intransigent landlord to move on the issue.

Yes, it would be nice if the tenant and the landlord worked cooperatively to resolve lead contamination issues – and, again in the real world, if this cooperation is going to bite into the landlord’s bottom line how realistic is it to believe that the tenant isn’t have to go to extraordinary lengths to bring the issue to the landlord’s attention, the attention of local authorities, and the attention of those who may assist in the resolution (and abatement) process.  It’s not like legal aid services aren’t already backed up with indigent defense cases, immigration issues, and other legal matters.

There are two elements of the situation in Nevada generally, and the rural areas in particular.  First, the onus moves very quickly to the buyer or renter when it comes to the inspection or abatement of lead contamination problems. A buyer has ten days to “check for lead,” in rural areas this means the buyer has ten days to find the list of certified inspectors (an easy enough task), then find one in the local region (not so easy outside the metropolitan areas), then find one who has time and resources to do the work within the ten days (now things are getting more complicated), and have the certified inspector perform the inspection and file the results —

Secondly, those tenants and buyers outside the metropolitan areas do not have much local support in terms of specific housing regulations other than building codes, state guidelines and statutes, and the federal lead contamination statute with EPA regulations. Again, caveat emptor is alive and well when it comes to the inspection for, and abatement of, lead contamination in local housing.

Surely, some future session of the state Legislature might offer consideration to (1) enacting statutes requiring the creation of a local board of health in areas with over 50,000 residents instead of the current 700,000; (2) empowering the local boards to enact ordinances regarding the inspection for and abatement of lead contamination; (3) requiring that sellers or landlords of property constructed before 1978  conduct an inspection of any properties offered for rent or sale – it not being enough to check off a box saying, “I just didn’t know…” or to have such an inspection record from a previous owner documenting that an inspection was indeed  conducted since 1978; (4) giving prospective buyers more than ten days to have such an inspection conducted before finalizing a sale. 14 would seem more reasonable, and 21 might be better.

The kind of contamination we’re discussing here isn’t an “inconvenience,” or some “tree hugger’s burst of imagination,” it’s a cause of damage to the brain and nervous system, behavioral problems, anemia, liver and kidney damage, hearing loss, hyperactivity, developmental delays, and in extreme cases, death in children. [EPA]  Additionally, in adults it can also cause abdominal pain, fatigue, headaches and irritability, loss of appetite, muscular weakness, and memory loss. [CDC]

There’s really no level of lead contamination that is acceptable, and there should be no question that in some instances caveat emptor isn’t really an appropriate civic response to the problem.

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Filed under EPA, health, nevada health, Nevada legislature, Nevada politics, public health