Trump to Sign Order to Improve Kidney Disease Care

Trump to Sign Order to Improve Kidney Disease Care

June 10, 2019 — Significant changes in how kidney disease is treated in the United States are outlined in an executive order expected to be signed Wednesday by President Donald Trump.

The objective is to switch from a system that emphasizes costly, time-consuming dialysis in large centers to at-home dialysis or transplants that can lengthen patients lives, the Associated Press reported.

There’s a severe organ shortage, which could impede the push for more transplants. In order to tackle that problem, the administration wants to ease financial challenges for living donors.

The executive order also includes measures to help groups that collect organs from deceased donors. Officials pointed to a study suggesting that in the long term, it may be possible to find 17,000 more kidneys and 11,000 other organs from deceased donors for transplant every year, the AP reported.

Another goal is to improve prevention of kidney disease.

The moves could save lives and millions in Medicare spending, the AP reported.

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FDA Cracks Down Again on Kratom Products

FDA Cracks Down Again on Kratom Products

National Institute on Drug Abuse: “What is Kratom?”

News release, FDA.

Michael E. Schatman, PhD, director of research and network development, Boston Pain Care; assistant professor of public health and community medicine, Tufts University School of Medicine.

Robert Glatter, MD, emergency medicine doctor, Lenox Hill Hospital, New York.

Eric Webb, spokesperson, Cali Botanicals, Rancho Cordova, CA.

Morbidity and Mortality Weekly Report, April 12, 2019.

National Institute on Drug Abuse.

Drug Enforcement Administration.

News release, University of Florida.

International Journal of Drug Policy: “Kratom policy: The challenge of balancing therapeutic potential with public safety.” “Petition Please do not make Kratom a Schedule I Substance,” “Kratom Legality Map.”

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Maine Legalizes Assisted Suicide

Maine Legalizes Assisted Suicide

FRIDAY, June 14, 2019 (HealthDay News) — Maine has become the eighth state to legalize medically assisted suicide.

“It is my hope that this law, while respecting the right to personal liberty, will be used sparingly,” Gov. Janet Mills, told the Associated Press.

Under the law, doctors can prescribe a lethal dose of a drug to terminally ill patients and it will not be legally a suicide.

The bill had failed to pass in a state referendum and also a number of times in the state Legislature. It finally passed by one vote in the House and a narrow margin in the Senate.

The new law was praised by Staci Fowler, who took on the fight for the law in honor of her friend Rebecca VanWormer, the AP reported.

VanWormer died of breast cancer in 2017 and had pressed for such a law for years before her death.

“This is what she wanted,” Fowler told the AP. “And now everybody has the option that she didn’t have.”

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Lesbian, Gay Youth at Higher Risk for Self-Harm

Lesbian, Gay Youth at Higher Risk for Self-Harm

MONDAY, June 3, 2019 (HealthDay News) — An alarming number of teens practice self-harm, but lesbian, gay and bisexual teens may be more than twice as likely as their straight peers to cut, hit or bruise themselves, new research warns.

While between 10% and 20% of heterosexual teens engaged in these dangerous behaviors, 38% to 53% of lesbian, gay and bisexual teens did, the study found.

“Rates of non-suicidal self-injury were consistently elevated among lesbian, gay and bisexual youth, compared to heterosexual peers,” said study author Richard Liu.

What’s more, “rates of [self-harm] have decreased among heterosexual youth from 2005 through 2017, but not among [lesbian and gay] youth over the same time period,” added Liu. He is an assistant professor in the department of psychiatry and human behavior at the Alpert Medical School of Brown University in Rhode Island.

That is a “striking” development, he said, “given that the very high [lesbian, gay and bisexual] rates meant that there was greater room for potential improvement.”

What explains the trend? Liu suggested that the “stigma and discrimination experienced by these youth may be contributing factors,” putting these teens at greater risk for “poor mental health outcomes, including depression, and suicidal thoughts and behaviors.”

The finding follows an analysis that looked at self-injury risk among more than 21,000 high schoolers in the state of Massachusetts between 2005 and 2017.

Bridget Hughes serves as senior director of youth services at the Hetrick-Martin Institute (HMI) in New York City, the nation’s first and largest organization that provides free services and advocacy for LGBTQ youth.

“While the findings are alarming, they aren’t surprising to us at HMI, given what we see regularly among youth coming in to our programs,” she said.

Hughes noted, for example, that from an early age, LGBT youth — particularly those of color — are often subject to “emotional isolation” as a result of blame, shame and criticism of their core identities and feelings. They are also much more likely to end up homeless, in foster care or involved with the juvenile justice system, and they face a harder time finding work, she added.

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Addiction Treatment Denied For Many, Study Finds

Addiction Treatment Denied For Many, Study Finds

By Serena Gordon

HealthDay Reporter

TUESDAY, June 4, 2019 (HealthDay News) — When people who are addicted to opioids make the difficult decision to quit, the last thing they need to face are barriers to treatment.

Yet, a new “secret shopper” study suggests most addicts seeking a prescription for buprenorphine — which helps people stop using opioids — would have trouble even getting an appointment with a doctor qualified to dispense the drug.

When researchers called doctors’ offices posing as addicts who wanted to get a prescription for buprenorphine so they could stop using heroin, 46% of those who said they had Medicaid were denied an appointment, while 38% of those who said they would pay in cash were turned away.

“When people are seeking treatment, you want to make it as easy as possible. But our study showed you have to be quite persistent. That can be tough and might lead to them giving up,” said study senior author Dr. Michael Barnett. He’s an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health in Boston.

Barnett said buprenorphine is “a long-acting medication that stimulates the same receptors in the brain as opioids. It helps quash cravings without the euphoria or high of opioids. It lets people get back to their life.”

The challenge in prescribing it, however, is that people have to be in mild to moderate withdrawal before they can be given the drug. Paradoxically, if you are high on opioids and you take buprenorphine, it sends you into an immediate and difficult withdrawal. So, it must be carefully administered by someone who’s had the right training, Barnett explained.

Providers have to obtain a federal waiver to be able to prescribe buprenorphine. Doctors have to have eight hours of training, and nurse practitioners and physician assistants need 24 hours of training. Fewer than 6% of doctors in the United States have these waivers. And even those who do aren’t always actively prescribing the drug.

The U.S. Substance Abuse and Mental Health Services Administration maintains a public list of doctors who agreed to be listed when they obtained their waivers to prescribe buprenorphine.


For the study, two female researchers called the doctors on this list. They posed as heroin addicts seeking an appointment for a buprenorphine prescription. They posed as either a patient with Medicaid or someone who would pay with cash. Each doctor’s office was called twice, several weeks apart.

The researchers planned to call nearly 1,100 providers in six states. However, 530 of the providers were culled from the list because they had invalid contact information (such as a non-working phone number) or they were no longer prescribing buprenorphine.

Some of the remaining doctors couldn’t be reached. For example, their phone may have gone to voicemail instead of a live person. The researchers completed just over 430 calls as a Medicaid patient, and nearly 420 as a cash payer.

Only between half and two-thirds of doctors scheduling an appointment planned to give a prescription on the first visit.

One bright spot the study found was when researchers did find a doctor willing to book an appointment, the wait time was often less than two weeks.

“We do have a prescriber workforce that is open for business and ready to help, but it may be hard for patients to find these providers in those directories,” Barnett said.

As to why people, particularly the Medicaid group, had trouble getting an appointment, Barnett said there are a number of reasons why. One is that Medicaid may put up barriers to prescribing buprenorphine, such as requiring a prior authorization before prescribing the medication. Also, he said, some doctors didn’t want to accept cash payments.

And, he said, there may still be a stigma against these patients. “They’re just people. It’s like treating any other chronic illness, and buprenorphine can literally turn people’s lives around,” Barnett explained.

The findings were published June 3 in the Annals of Internal Medicine.

Dr. Pooja Lagisetty, an assistant professor at the University of Michigan and a primary care physician herself, co-wrote an editorial that accompanied the study. “There was a big difference between those willing to take Medicaid versus the self-pay patients. It makes you question whether insurance may not be reimbursing enough,” she said.


“Addiction is a disease, and people do better on this medication when they’re on it long term. We need to make sure providers are being appropriately reimbursed for the care they’re providing,” Lagisetty said.

Dr. Paul Earley, president of the American Society of Addiction Medicine, said, “What’s most disconcerting is that some of the states with the worst opioid overdoses are where people had a harder time getting an appointment.”

Earley said in this age of data, it shouldn’t be too hard to ask a doctor to be sure to update their information on the list every year, so that people trying to get help aren’t frustrated by calling numbers that are out-of-date and aren’t working.

He also said that doctors seeking the federal waivers that allow them to prescribe should set up a system for caring for these patients. Earley said they need urine testing to be sure they’re taking the medication as they should, and that they need to be called more often with appointment reminders.

“All of those things require a certain amount of work to set up,” he said. But it can be done successfully, Earley noted, pointing to the doctors who were able to see patients quickly in this study.

WebMD News from HealthDay


SOURCES: Michael Barnett, M.D., M.S., assistant professor, health policy and management, Harvard T.H. Chan School of Public Health, and assistant professor, Harvard Medical School, and primary care doctor, Brigham and Women’s Hospital, Boston; Pooja Lagisetty, M.D., M.Sc., assistant professor, division of general internal medicine, University of Michigan, Ann Arbor; Paul Earley, M.D., president, American Society of Addiction Medicine; June 3, 2019,Annals of Internal Medicine

Copyright © 2013-2018 HealthDay. All rights reserved.

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Falls Are Increasingly Lethal for Older Americans – WebMD

Falls Are Increasingly Lethal for Older Americans – WebMD

TUESDAY, June 4, 2019 (HealthDay News) — Deaths from falls are increasing sharply among elderly Americans, a new study finds.

Nearly 25,000 people 75 and older died as a result of falls in 2016 — almost three times as many as in 2000. And experts warn that the toll is likely to rise along with population shifts.

“As the United States population continues to age, we can expect more deaths from falls,” said researcher Robin Lee, an epidemiologist at the Injury Center of the U.S. Centers for Disease Control and Prevention. “We can also expect more hospitalizations and nursing home admissions as a result of falls.”

An estimated $50 billion was spent on medical care related to falls in 2015, Lee said.

For both men and women, the death rate due to falls per 100,000 people roughly doubled between 2000 and 2016, according to the study.

For men, the rate rose from about 61 per 100,000 to 116. Among women, the death rate jumped from 46 to 106 per 100,000.

Not surprisingly, the danger rose as people got older, Lee’s team confirmed.

In 2016, for example, the death rate due to falls among 75- to 79-year-olds was 42 per 100,000. Among those 95 and older, the rate was 591 per 100,000.

Exactly why these rates are rising isn’t really clear, researchers said. What is clear, they emphasized, is that falls don’t have to happen in the first place.

“Caregivers should know that falls are preventable, and they can encourage their loved ones to speak to their doctor about their fall risk,” Lee said.

The report was published June 4 in the Journal of the American Medical Association.

Another study in the same issue tested a home-based exercise program aimed at helping seniors prevent falls.

That study was led by Teresa Liu-Ambrose of the University of British Columbia in Vancouver, Canada. Her team found that the program — in which a physical therapist visits the home and provides strength and balance retraining exercises — reduced falls over 12 months by 36%.

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Could Seeing Self-Harm On Instagram Spur Copycats?

Could Seeing Self-Harm On Instagram Spur Copycats?

By Serena Gordon

HealthDay Reporter

TUESDAY, June 4, 2019 (HealthDay News) — Being an Instagram influencer isn’t always a good thing. New research found that vulnerable young people who see online posts of self-harm — like cutting — may copy those destructive behaviors.

Almost one-third of teens and young adults who reported seeing self-harm posts on Instagram said they had performed the same or similar self-harming behavior afterwards.

Seeing these images online “normalizes” the behavior, according study senior author Dan Romer. He’s research director of the Annenberg Public Policy Center at the University of Pennsylvania.

“Vulnerable kids think, ‘Well, maybe that’s something I should consider doing,'” he said.

Romer noted that this problem goes beyond just Instagram. “Kids who don’t have mental health problems wouldn’t repeatedly self-harm. It’s vulnerable kids trying to relieve their distress,” he explained. But he added that this study indicates that these types of social media posts can be harmful to teens and young adults.

The researchers initially became concerned about the potential effects of self-harm posts after a British father said his 14-year-old daughter had looked at explicit self-harming images on Instagram before killing herself. The social media site has since said that graphic depictions of self-harm aren’t allowed in posts.

Self-harm typically refers to cutting, but can include other behaviors such as burning, hitting or head-banging. Self-harm isn’t usually suicidal, but people who engage in self-harm are at increased risk for suicide, the researchers said. Posts depicting self-harm on Instagram commonly show mild or moderate injuries. But some posts included bleeding flesh wounds from cutting an extremity.

Instagram has more than 500 million daily active users and more than 1 billion monthly users, according to the researchers. The social media site is very popular with young people.

The study included more than 700 teens and young adults (ages 18 to 29). Eighty percent of the study volunteers were women. They were interviewed twice, a month apart. The interviews occurred in May and June 2018, before Instagram said it would try to reduce graphic self-harm posts.

Almost half — 43% — said they had seen at least one self-harm post on Instagram. Many reported seeing more than one such post. Most — 80% — of those who reported seeing these posts said their exposure to them was accidental.


Almost two out of the three people surveyed said that the self-harm posts were emotionally disturbing.

Six out of 10 who saw these posts said they thought about how it might feel to do something like that. And 33% of those exposed to the self-harm posts said at the first interview that they had done the same or similar harm to themselves as a result of seeing the post.

During the second interview a month later, people who said they’d seen a self-harm post during the first interview were more likely to have self-harmed than people who hadn’t seen such a post.

Romer noted that the study cannot prove that seeing the posts directly led people to self-harm.

But, he said, “Kids who see these posts and are vulnerable probably aren’t going to get a good message.”

Romer said parents need to be concerned if they notice behaviors linked to depression in their kids, such as being online all the time, isolating themselves and sadness. These are kids that might be more susceptible to things they see online.

Since it’s nearly impossible to completely ban access to social media, Romer said open communication with parents is even more crucial for today’s young people.

Dr. Alan Geller, a psychiatrist at NewYork-Presbyterian’s Gracie Square Hospital in New York City, agreed that communication is key.

“Adolescents have to understand your limits and expectations,” said Geller, who wasn’t involved in the study. “It’s like limit-setting for anything — alcohol or cigarettes or, now, marijuana. Children and teens have access to these risks and parents have a responsibility to set limits and clearly communicate those limits.”

And, he said, parents need to routinely check in with their teens about these challenges. Geller suggested doing so at least once a week.

Like Romer, Geller said that parents need to be on the lookout for signs, including repeated self-harm, that a teen or young adult is depressed or suicidal. If parents or other loved ones have concerns, teens and young adults should see a psychologist or psychiatrist for help.

The study was published online May 27 in New Media and Society.

WebMD News from HealthDay


SOURCES: Dan Romer, Ph.D., research director, Annenberg Public Policy Center, University of Pennsylvania, Philadelphia; Alan Geller, D.O., attending psychiatrist, Gracie Square Hospital, NewYork-Presbyterian Regional Network, New York City; May 27, 2019,New Media and Society, online

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