Archive for July 10th, 2018
Administration slashes grants to help Americans get Affordable Care Act coverage
President Trump really does not want the poor to have access to medical care, and the GOP strongly supports him in his effort to dismantle healthcare insurance for those not covered by employer healthcare insurance. Amy Goldstein reports in the Washington Post:
The Trump administration is eliminating most of the funding for grass-roots groups that help Americans get Affordable Care Act insurance and will for the first time urge the groups to promote health plans that bypass the law’s consumer protections and required benefits.
The reduction, the second round of cuts that began a summer ago, will shrink the federal money devoted to groups known as navigators from $36.8 million to $10 million for the enrollment period that starts in November.
Last August, federal health officials announced they were reducing the navigators’ aid by 41 percent — from $62.5 million — and slashing a related budget for advertising and other outreach activities to foster ACA enrollment by 90 percent.
The new reduction of help for navigators, announced late Tuesday afternoon by the Centers for Medicare and Medicaid Services, fits within a pattern of moves by the administration to weaken the sweeping health-care law that President Trump has vowed to demolish. During his first year in office, the president pressed the Republican-led Congress to repeal much of the 2010 law that was one of President Barack Obama’s signature domestic achievements.
Since Congress was unable to pass such a law, Trump and his aides have been taking a series of steps to weaken the law through administration maneuvers. The cuts to grass-roots groups around the country was announced three days after health officials revealed that, because of a pending lawsuit, they were suspending a program created by the law to even out the burden on health insurers whose customers are especially unhealthy or sick.
The president last fall also issued an executive order to try to make it easier for individuals and small businesses to buy health plans that cost less than ACA coverage because they cover fewer medical services and bypass the law’s rules intended to protect people from old insurance practices in which companies had charged higher prices to women, older people, and those with preexisting medical conditions.
Since then, the Department of Labor has issued a rule to broaden the use of one such kind of insurance, called “association health plans.” The Department of Health and Human Services is finishing another rule that will broaden the use of short-term insurance plans, originally intended as a brief bridge for people between jobs.
It is those two kinds of insurance that Tuesday’s announcement is requiring groups that apply for navigator grants to encourage clients to buy. Until now, the grants have been used only to help people choose and buy ACA health plans or to help steer people with low incomes toward Medicaid.
For the past five years, when . . .
Chart of the Day: Corporate Profits Under Threat From Skyrocketing Wages
Do take a look at the charts in Kevin Drum’s post. Shocking how wages have skyrocketed.
In Baby Teeth, Links Between Chemical Exposure in Pregnancy and Autism
Perri Klass, MD, reports in the NY Times:
If you are a parent worrying through pregnancy, or maybe trying to make sense of your child’s neurodevelopmental problems, you aren’t always glad to see another story about a new study looking at possible environmental risk factors. From pesticides in the food to phthalates in the plastics to pollutant particles in the air, so many different exposures have been linked to problems in the developing fetal brain that parents can sometimes feel both bewildered and, inevitably, at fault for failing or having failed to take all possible precautions.
That’s a great pity, because the accumulating research is of tremendous value, particularly to families struggling with an autism diagnosis. But there’s an unfortunate tendency to treat each new study as a single explanatory solution to what is in fact a tremendously complicated and multifactorial issue.
Autism is “a very diverse condition — not all kids with autism are alike,” said Dr. Leonardo Trasande, the chief of the division of environmental pediatrics and an associate professor of pediatrics, environmental medicine and population health at New York University School of Medicine. “There are a lot of shades of gray and a lot of differential dysfunction,” probably related to different parts of the brain, he said.
Craig Newschaffer, director of the A.J. Drexel Autism Institute at Drexel University, said that while it’s very important for the public to be aware that there are environmental risk factors in the development of autism, “pointing a finger at mom is not the endgame of this kind of research. The endgame isn’t going to be about individual decision making, but more about informing policy.” He offers more information in his webinar, “Four Things to Know About Environmental Autism Risk Factors.”
“I very much agree this is not about blaming the parent in any way,” said Manish Arora, professor of environmental medicine and public health at Icahn School of Medicine at Mt. Sinai. “It’s very hard to buy your way out of exposures; many exposures are present everywhere.”
From a research point of view, Dr. Arora said, one challenge has been to measure toxic chemicals and exposures during fetal development, and connect them with an outcome like autism, which is diagnosed years later. He has developed an innovative technique using baby teeth, which start to develop toward the end of the first trimester, and form a new layer each day, growing in what he called an “incremental archival manner.” The layers can capture traces of chemicals, so that they serve as “biologic hard drives,” records of what exposures occurred during fetal development, and when they occurred, in a manner similar to the rings on trees.
Using the teeth that children have shed between the ages of 6 and 12, Dr. Arora said, it’s possible to look back at exposures during fetal development, and at other aspects of early metabolism to see whether children who later go on to develop autism are biologically different early on. In a study published in Science Advances in May, scientists used this technique to compare early zinc and copper metabolism in children with autism with their siblings without autism.
Paul Curtin, an assistant professor of environmental medicine and public health at Mount Sinai who was first author on the study, said that in children with autism, regulation of zinc and copper metabolism shows differences beginning early in the course of fetal development. The point of the study was not to look at whether a child had been externally exposed to these metals, but rather at the internal metabolic rhythms of nutrients and possible toxins, at “what are the dynamics of zinc and copper metabolism, and how are those dysregulated in disease.”
Dr. Arora said this could lead to a biomarker for autism, a diagnostic test which could be administered before a child shows behavioral differences. Could finding ways to correct that disrupted pathway alter a child’s neurodevelopment?
“For the first time we have a biochemical pathway which, if we could modify, could have some effects,” Dr. Arora said. “If it turns out to be causal, there might be a therapeutic benefit — I doubt if this is the only pathway in autism, but if it is one of the more important ones, we might have something.”
Using baby teeth offers a remarkable new technique for looking back at all kinds of exposures during pregnancy. “Epidemiologists like myself are thrilled,” Dr. Newschaffer said. However, he said, “it’s very exciting but extremely early days.”
And there is never going to be one simple answer. “There are so many factors that likely contribute to the origins of autism,” Dr. Trasande said. “It’s impossible to point to any one factor for any one child,” he said. “We always speak about larger populations.”
From an epidemiologic point of view, Dr. Newschaffer said, the effects of any one exposure are likely to be of small magnitude for any one individual. The important gains in reducing autism would be seen at the population level, and therefore, the best response to the research about environmental risks would be policy change to protect the whole population.
But until those policy changes are enacted, individuals may still want to reduce their exposures and to be particularly careful during pregnancy, avoiding pesticides, for example, by buying organic produce, if that is economically feasible. “You can be a little more cautious during this time,” Dr. Newschaffer said.
“The other way more generally to limit the effect of these chemicals on the brain is healthy diet and particularly iodine,” to protect the thyroid, Dr. Trasande said, since hypothyroidism, both in children and in mothers, is emerging as a possible contributing factor to autism. And after a child is born, “we can make sure families are eating healthier diets and having the best possible environment for raising their children.”
Dr. Newschaffer said that autism researchers had previously been surprised by the link between exposure to air pollution and autism. Over 25 epidemiologic studies have found an association between prenatal and early postnatal air pollution exposure and autism. Women who have higher air pollution exposures may be living in neighborhoods where there are other exposures, he said, but still, there is an emerging body of evidence to support the association.
“Air pollution” is a very heterogeneous term, and different studies have suggested a range of pollutants as more closely linked. Other associations between prenatal risk factors and autism development are also complicated, Dr. Newschaffer said. There appears to be a connection with advanced parental age, both of the mother and of the father, and an association between autism and very closely spaced pregnancies.
Autism risk is associated with a range of perinatal and neonatal complications, but as with air pollution, it’s not a simple picture, because there are many different complications and there is not one simple or consistent relationship. There could conceivably be some biological mechanism that might be activated by a range of different complications, Dr. Newschaffer said, but whatever the mechanism . . .
Omega 21762 boar brush, Eufros Vetiver de Haiti, Rockwell 6S, and Fine Clean Vetiver
After a comment on the softness of the Omega 21762 boar brush, I decided to revisit mine. I try to approach things like this brush the way one of my St. John’s tutors said he approached his job as tutor: not to turn a cabbage into a rose, but to help the cabbage be the very best cabbage that it could be. (Only belatedly did I realize that he perhaps was kindly telling me that I was a cabbage and not a rose, a judgment with which I now concur.)
So I try to take the brush on its own terms and exploit its own gifts—what it brings to the party. The Omega 21762 (shown in the Razor & Brush memorial edition onced offered by Shoebox Shaveshop) is a boar brush, so it brings its boarness, and it is also an extremely soft brush, so it brings that as well.
I wet the brush well under the hot-water tap and let it stand soaking wet while I showered. After washing my stubble with MR GLO, I rewet it to heat it up, gave it a couple of good shakes, and began loading with JabonMan’s Vetiver de Haiti. The loading went very well: no additional water needed despite the size of the knot, and the softness of the brush was in no way a problem.
On the face, the softness is startling, particularly from a boar brush, and I can readily see that those who prefer a more scrubby brush would find this not to their taste. However, just using it as a soft brush, it is very nice indeed, exquisitely gentle and caressing on the face, and lays out the lather readily. I indeed took a little extra time in the first lathering just to enjoy the smoothness and softness.
The Rockwell 6S is for me a truly excellent razor, and the R3 blade deliver a flawless BBS result (“flawless” meaning not only perfectly smooth with no rough spots, but also no nicks or burn) without my even trying.
A good splash of Fiine’s Clean Vetiver aftershave (which I believe he has renamed), and I’m ready for my walk. Still no Nordic walking poles, but perhaps today.
Later On 