- Associated Press - Saturday, June 4, 2016

Excerpts of recent editorials of statewide and national interest from New England newspapers:

The Providence Journal (R.I.), June 3, 2016

Rhode Island Attorney General Peter Kilmartin is among a dozen state attorneys general who recently appealed to Congress for better research on gun deaths. Spearheaded by Attorney General Maura Healey, of Massachusetts, the effort seeks the repeal of a 1996 measure that bars federal funding on any research that could be construed as politically backing gun control.

In a letter to lawmakers, the attorneys general noted that guns are involved in more than 33,000 deaths in the United States each year. Such sobering numbers point to a public health issue that is more than worth studying. Yet for years, the 1996 amendment has had a chilling effect on federally funded research that could help to improve safety.

Freeing the Centers for Disease Control and Prevention to conduct such research is in the interest of every American, gun owners perhaps most of all. But the National Rifle Association, which originally pushed the amendment, opposes relaxing its restrictions. It apparently makes no difference that the original sponsor, former Rep. Jay Dickey, R-Ark., now says that he was wrong to pursue the measure.

Several physicians’ organizations recently expressed support for repealing the amendment. The attorneys general have added an important voice to the cause. Mr. Kilmartin was right to join this attempt to put additional pressure on Congress. Better data on gun violence is nothing to fear. Willful ignorance, especially when it comes to firearms danger, is a far greater threat.




Portsmouth Herald (N.H.), May 29, 2016

In 1962, Rachel Carson published the book “Silent Spring,” which convincingly argued that chemicals used to kill insects, funguses and pests were also killing birds and harming the environment.

The book caused Americans to consider that using chemicals to solve one problem, such as plant and animal diseases, might create new, more harmful problems. Carson’s book was one of the driving forces behind the creation of the nation’s environmental movement and the federal Environmental Protection Agency.

Unfortunately, understanding the ill effects of toxic chemicals has not stopped consumer demand for products containing those chemicals nor industry production and often improper control and disposal of them.

As toxic mistakes come home to roost, officials and regulators at the federal, state and local level realize people need greater protections and they have begun to take action.

On Tuesday, the normally partisan and deadlocked U.S. House of Representatives voted 403-12 in favor of a bill to regulate thousands of toxic chemicals. The bill updates the federal Toxic Substances Control Act, which has not been revised since 1976. The Senate is expected to approve and the president to sign the legislation.

The bill had wide support not only from environmental organizations but also the chemical industry itself, which has lost some of the public’s confidence in the face of lawsuits and health concerns raised about its products.

“Today marks a milestone - for this Congress and for the American people as we make great strides to update our nation’s chemical safety laws,” said Rep. Fred Upton, R-Mich., chairman of the House Energy and Commerce Committee. “This bill is good for jobs. It’s good for consumers and it’s good for the environment.”

Also at the federal level, the EPA recently reduced the acceptable levels of certain perfluorochemicals (PFCs) in drinking water from 400 parts per trillion to 70 parts per trillion. This means that as more wells are tested more will need to be closed until filtration systems can be put in place to remove the chemicals increasingly linked to a number of serious diseases.

At the state level, faced with mounting evidence of PFC contamination in public drinking water at several sites around the state, Gov. Maggie Hassan also took action. This week she authorized the state Department of Health and Human Services to extend blood testing to every person exposed to PFCs from Pease International Tradeport’s Haven well, which was closed in 2014 after tests revealed levels of certain PFCs far in excess of EPA safety standards. This is good news. While roughly 10,000 people work or participate in other activities on the tradeport, including children attending day care, only about 1,500 have received blood tests. Those who had not been tested had been told they would now have to pay for it themselves, at a cost of about $1,000.

Anyone who has not been tested and who wishes to be should email [email protected]

The two remaining wells at Pease, Smith and Harrison, are both continuing to test well below the EPA health advisory. Once a new charcoal filtration system is put in place this summer, the city expects that no PFCs will be present in drinking water from those wells.

While we are pleased to see governmental efforts to remediate damage already done, it is well past time for our nation to re-engage in a conversation about toxic substances and public health. After all, as we learn about the ill-health effects of chemicals that have been on the market for decades, industries are using new, untested chemicals in products each and every day. We need to stop treating ourselves like medical science guinea pigs. It would be far better to improve the rigor of testing and regulation of chemicals before they are brought to market then to learn about the damage they have done after the fact.




Cape Cod Times (Mass.), June 2, 2016

The Affordable Care and Patient Protection Act (aka Obamacare) requires behavioral health be addressed by the legal, medical, and insurance communities on par with physical health. There has been progress, at least in Massachusetts, but work remains in order to overcome the weaknesses in various systems and the stubborn barriers raised by stigma.

Post-ACA legislation in the commonwealth began to address the lack of parity lingering after decades of deinstitutionalization of mental health patients and the long-term shift to community-based services. Minimum stays for behavioral and substance abuse services were increased recently, the opioid crisis has raised almost everyone’s awareness, and innovative, grassroots community services sprout up all around.

One continued weak point in the continuum of service for behavioral health is the insufficient reimbursement of outpatient services. We see barriers to maximizing the skills of devoted clinicians, and difficulty in retaining them in the face of limited financial resources.

According to Vic DiGravio, president and CEO of the Massachusetts-based Association for Behavioral Healthcare, outpatient care is the cheapest and most effective care that can be provided: It diverts patients from hospital emergency departments and reduces re-admissions, both of which are much more expensive than outpatient care. DiGravio recently noted that the cost of treatment for a physical condition such as asthma or chronic obstructive pulmonary disease is two to three times higher for a patient who also lives with behavioral health issues.

A study on outpatient services by the Massachusetts Behavioral Health Partnership, which offers integrated medical and behavioral health care to more than 360,000 MassHealth (Medicaid) members, showed that stagnation in rates since 2007 fails to provide coverage for five of six critical services.

Comprising diagnostic services, individual and family therapy, group therapy, medication management, family consultation, and case consultation, reimbursement rates are sufficient only for case consultation. It happens to be the one service of the six with more of a focus on planning and strategy than on the complicated social interactions tackled by the other five. Dealing with humans is expensive.

Medication management, for example, is dependent upon patients keeping their appointments, which is connected to diagnostic and therapy services, but also depends on highly skilled clinicians, such as psychiatrists and advanced practice registered nurses. The outdated, inadequate reimbursement system constrains the capacity of all outpatient clinicians, and works against an organization’s ability to retain workers enticed by higher salaries at hospitals, colleges, and other better funded institutions. And services curtailed by limited funds (another significant problem among many of the 85 members of the Association for Behavioral Healthcare) make it more likely that patients will need inpatient services instead of making progress toward healing.

Complicating the impacts of inadequate reimbursements is consideration of the financial status of the patients served by the myriad community-based organizations. It is the low-income client whose options are limited, and who tends to forgo services as they become harder to access.

Those in need of behavioral health services commonly face stigma, whether it be institutionalized discrimination that erects barriers to opportunity; public opinion that worries more about the common stresses of daily life than of citizens suffering from schizophrenia or depression; or self-loathing conceived by systemic marginalization.

The Baker administration has not ignored the reimbursement issue, and we look for more leadership from both the governor, the Legislature, and insurers as awareness grows of the value to society and our fellow citizens of supporting adequate outpatient care.




The (Barre-Montpelier) Times Argus (Vt.), June 4, 2016

The official confirmation this week of Prince’s death by opioid overdose is likely to reverberate in Washington, D.C., where lawmakers are trying to hammer out a deal on legislation attempting to stem a national crisis in abuse of those drugs.

In some ways, the high-profile celebrity death feels like old news here in Vermont. The Green Mountain State has been suffering at the hands of opioid addiction and the deadly mix of heroin and fentanyl for years now.

While the number of deaths from prescription drugs in Vermont has seemingly leveled off and even begun to go down, a new statistic has emerged in recent years showing that the number of deaths from heroin and its powerful painkiller cousin, fentanyl, has spiked.

Fentanyl is a synthetic opioid many times more powerful than heroin.

In one week last December, eight people died from a lethal strain of heroin in western Massachusetts, followed by a Christmas Eve overdose death in Newport. At the time, the Vermont State Police Narcotics Investigation Unit suspected that the “Hollywood” batch associated with the deaths may not be just heroin, but the deadly mix with fentanyl.

In April 2015, Donald Farnham, a 30-year-old Spaulding High School graduate and father, overdosed and died in the bathroom of the Randolph Cumberland Farms. In the same week, a man overdosed on fentanyl in Bethel but was revived with nine doses of Narcan. In the days leading up to those deaths, police around New England were asking law enforcement and drug users to be on the lookout for a deadly mix called “Ronald Reagan.”

A detailed data brief released by the Vermont Health Department last year went beyond statistics found in a similar report given to the Legislature. Statewide in 2012, there were 15 deaths in Vermont from heroin and fentanyl, according to statistics from the Vermont Health Department. In 2013, there were 53 deaths; last year, it was 42.

The most current data has yet to be compiled. The number of drug deaths does indicate Vermont remains in crisis. Officials here have been confronting what Democratic Gov. Peter Shumlin has called the crisis of addiction to prescription drugs, heroin and, more recently, drugs such as fentanyl a top priority across the state, from the governor’s office down to the community level. The efforts appear to be paying off in at least one area, with fewer deaths from overdoses of prescription drugs. The big jump noted by the most recent data brief published by the state’s Health Department found the spike in heroin and fentanyl deaths up to a statewide total of 53 in 2015 from 42 in 2014.

At the national level, lawmakers are very mindful of the crisis.

“No one is immune,” Sen. Rob Portman, an Ohio Republican. Portman is one of the main authors of the Senate legislation. “The heroin and prescription drug epidemic is devastating families and communities all over the country, and we need to get this bill to the president’s desk as quickly as possible.” Lawmakers have exhibited widespread bipartisan agreement that Congress needs to take steps to improve drug treatment, to better control prescription drug distribution and to enhance training of emergency responders in treating overdoses. But progress on the legislation has been slowed by disputes over funding and by other maneuvering over legislation that members of both parties see as a selling point in the fall elections. According to media reports, House and Senate negotiators have started preliminary talks on reconciling different versions of the opioid legislation that have been passed by the two chambers, and they now hope to produce a final package before the next recess, over the Fourth of July. Prince’s death is likely to spur them on. High-profile drug fatalities have had that effect in the past. The death from a cocaine overdose of the college basketball star Len Bias in June 1986 is widely credited with starting the crackdown of those years that came to be known as the war on drugs.

While Vermont is doing its part to fight this war on drugs, there is clearly still much more that needs to be done with regard to prevention, enforcement and rehabilitation. It is sad it took Prince’s death to wake up so many lawmakers to this crisis. But, now that they are aware of the issue and taking action, we will take all the help we can get.




The Portland Press Herald (Maine), May 31, 2016

As a strategy, it’s been pretty effective: Oppose any and all incremental improvements to employee rights and pay, putting workers so far behind that only substantial changes will make any real difference. Then, argue against those substantial changes on the grounds they are too radical of a shift.

It has worked for decades with the minimum wage, which has lost buying power to inflation and inaction steadily since 1968, and it is being deployed again in opposition to the Obama administration’s much-needed change to overtime eligibility rules, which are just as far behind the times.

Under the new rules, employers will be required to pay salaried workers who make less than $47,476 a year overtime once they exceed 40 hours in a given week.

That would double the current threshold of $23,660, which allows employers to put low-income employees on salary to avoid compensating them fairly. Fast-food and retail workers often became managers in name only, given a title and a salary of $25,000 a year so that they could continue to stock shelves and mop floors for 50 or 60 hours a week without any overtime pay.

The threshold was last adjusted in 2004, and now covers just 7 percent of full-time salaried workers. In 1975, the threshold covered 62 percent of workers. The new rules, which will be effective starting Dec. 1, will raise the rate to 35 percent, according to administration officials.

Still, the new rules are being painted by opponents as too drastic.

A statement issued by Maine Sen. Susan Collins is typical. She calls the change “huge and sudden” and warns of “dramatic new costs.” Although Collins says she supports some increase in the salary threshold, she wants the Department of Labor to nullify the rule and consider something smaller.

Maine’s other senator, Angus King, says he wants an increase, too, but is also concerned that Obama’s plan is “too much, too soon.” King also worries about linking increases in the threshold to inflation.

Both senators seem to ignore the fact that the change is “huge and sudden” only because lawmakers for so long sat on their hands. The new rule is only going to be “too much, too soon” for institutions and corporations that have gotten used to exploiting the hard work of their employees for so long that it is business as usual.

King and Collins may have sincere reservations about the new overtime rules.

But for decades, “sincere reservations” have just been an excuse to maintain the status quo, while workers have watched their rights, pay and power erode. Now, it is time for action.




The Day (Conn.), June 2, 2016

If an enemy threatened the United States with mass casualties possible, Americans would be willing to spend the money and make the sacrifices necessary to confront it.

Well, the country faces such an enemy.

Recently, came the news that a patient in the United States carried bacteria resistant to the antibiotic colistin, utilized as a treatment of last resort when all else fails. In the case of the 49-year-old woman, the strain of E. coli she carried did respond to other antibiotics. But scientists say it is only a matter of time before the colistin-resistant gene spreads to other bacteria already resistant to other antibiotics.

In other words, in time, a patient will arrive in a U.S. hospital with an E.coli that will not respond to any antibiotic, making it a potential killer. Strains of E.Coli can cause severe diarrhea, urinary tract infections and kidney failure.

A high percentage of hospital-acquired infections result from such highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci. Such treatment-resistant infections cause more than 2 million illnesses and at least 23,000 deaths each year in the United States, according to the Centers for Disease Control and Prevention.

And things could get worse - much worse. Resistance to antibiotics could lead to the deaths of ten million people a year globally by 2050, a report commissioned by the British government has warned.

The problem is that bacteria evolve. Antibiotic treatments that were once universally effective are now only partially so, unable to eradicate infections caused by bacteria that have evolved to survive the attack.

Overuse of antibiotics has expedited the growth of resistant strains. Unsure whether an infection is viral (and unresponsive to antibiotics) or bacterial, doctors will often prescribe an antibiotic. The more overuse, the more rapidly the little buggers gain resistance. The failure to take a full regimen of antibiotics leaves behind the toughest bugs, more resistant to later treatment and ready to spread to other individuals.

The wide prophylactic use of antibiotics in farm animals, also found to boost their weight, give bacteria the chance to develop resistance. The European Union has banned the practice. The U.S. should follow suit.

Serious consideration should be given to providing financial rewards - tax breaks or outright grants - to get pharmaceutical companies to invest in developing new antibiotics. There is no profit incentive in such research. A patient needs an antibiotic for only a few days until the infection clears. And doctors are encouraged to use new, less resistant antibiotics as little as possible, to delay the time they become ineffective.

This is a war humankind can’t afford to lose, because right now the bacteria are gaining the upper hand.




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