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Trump admin announces abstinence-focused overhaul of teen pregnancy program

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Moving to abstinence programs because it has come to their attention that the number of teen pregnancies is too low, I presume. (It has been well-established that abstinence programs don’t work, but I think the people who back them are more interested in making a statement than solving a problem.)

Jessie Hellmann reports in The Hill:

The Trump administration will shift federal funding aimed at reducing teen pregnancy rates to programs that teach abstinence.

The Department of Health and Human Services (HHS) announced Friday the availability of grants through the Teen Pregnancy Prevention Program, (TPPP) a grant program created under former President Obama that funds organizations and programs working to reduce teen pregnancy rates.

Trump’s HHS announced, however, that unlike under the Obama administration, grants will be geared toward organizations that teach abstinence education to teens instead of the comprehensive sex ed approach the previous administration supported.

In a funding announcement released Friday, the administration announced two tiers of funds for the TPP program.

In the first, grantees would have to follow one of two abstinence programs to receive funding.

One of the programs uses a “sexual risk reduction model,” which is designed to reduce sexual risk behaviors.

The other program uses a “sexual risk avoidance model,” which teaches teens to avoid sex completely.

“Projects will clearly communicate that teen sex is a risk behavior for both the physical consequences of pregnancy and sexual transmitted infections; as well as sociological, economic and other related risks,” the funding announcement reads. “Both risk avoidance and risk reduction approaches can and should include skills associated with helping youth delay sex as well as skills to help those youth already engaged in sexual risk to return toward risk-free choices in the future.”

In total, tier one will award up to $61 million in funds, ranging from $200,000 to $500,000 per year.

The second tier solicits applications to develop and test “new and innovative strategies” to prevent teen pregnancy while improving adolescent health and addressing “youth sexual risk holistically by focusing on protective factors.”

The changes represent a major change to the way the federal government treats teen pregnancy.

The Obama administration mostly awarded TPP grants to organizations that taught comprehensive sex education, which can include teaching teens about contraception and abstinence.

But the Trump administration has been shifting toward abstinence programs since hiring several HHS employees who support the approach, including Valerie Huber, the chief of staff for the Office of the Assistant Secretary of Health, which oversees the TPP program.

Prior to coming to HHS, Huber led Ascend, a national abstinence education advocacy group.  . .

Continue reading.

Against stupidity the gods themselves contend in vain.

Written by LeisureGuy

21 April 2018 at 10:23 am

Science hinted that cancer patients could take less of a $148,000-a-year drug. Its maker tripled the price of a pill.

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American healthcare has a serious problem, and it is spelled “g-r-e-e-d.” Carolyn Johnson reports in the Washington Post:

A group of cancer doctors focused on bringing down the cost of treatments by testing whether lower — and cheaper — doses are effective thought they had found a prime candidate in a blood cancer drug called Imbruvica that typically costs $148,000 a year.
The science behind Imbruvica suggested that it could work at lower doses, and early clinical evidence indicated that patients with chronic lymphocytic leukemia might do just as well on one or two pills a day after completing an initial round of treatment at three pills per day.
The researchers at the Value in Cancer Care Consortium, a nonprofit focused on cutting treatment costs for some of the most expensive drugs, set out to test whether the lower dose was just as effective — and could save patients money.
Then they learned of a new pricing strategy by Janssen and Pharmacyclics, the companies that sell Imbruvica through a partnership. Within the next three months, the companies will stop making the original 140-milligram capsule, a spokeswoman confirmed. They will instead offer tablets in four strengths — each of which has the same flat price of about $400, or triple the original cost of the pill.
Just as scientific momentum was building to test the effectiveness of lower doses, the new pricing scheme ensures dose reductions won’t save patients money or erode companies’ revenue from selling the drug. In fact, patients who had been doing well on a low dose of the drug would now pay more for their treatment. Those who stay on three pills a day won’t see a change in price.
“That got us kind of p—ed off,” said Mark J. Ratain, an oncologist at the University of Chicago Medicine who wrote about the issue in the Cancer Letter, a publication read by oncologists. “We were just in the early stages of planning [a clinical trial] and getting it organized, and thinking about sample size and funding, and we caught wind of what the company was doing.”

Research and anecdotal experience of physicians suggests that co-pays can be a major barrier to people staying on their drugs. Stacie Dusetzina, an associate professor of cancer research at Vanderbilt University Medical Center, said that if a patient were taking one of the old capsules each day, their out-of-pocket costs under Medicare would be close to $5,000. Under the new pricing regimen, the patient’s burden of the cost — for the same dosage — would roughly double. The difference in the cost to Medicare would be about $100,000. That does not reflect rebates paid by the drug company to Medicare.
“It’s fascinating and disturbing,” Dusetzina said. “It appears to be a program being implemented, possibly to save some of the profits they’d be losing if dose reductions are really rapidly going to start coming down the pike.”
In a statement, Janssen and Pharmacyclics said the companies began to develop the new single-tablet dosing regimen in 2015 “as a new innovation to provide patients with a convenient one pill, once-a-day dosing regimen and improved packaging, with the intent to improve adherence to this important therapy.” They called the studies on lower dosing “highly exploratory in nature” and noted that patients who take a higher dose of the drug will save money.
But the new regimen could undermine patient safety, Ratain and colleagues argue. People on Imbruvica often need to have their doses adjusted, because it can interact with other drugs. Physicians also may try lower doses when people have trouble tolerating the drug because of side effects, such as extreme joint pain.
The companies said in their statement that a dose exchange program with rapid shipment would allow physicians to make those changes.
Under the old regimen, doctors could adjust the dose immediately by telling a patient to take one or two pills a day, instead of three, then return them to the higher dose when necessary. Under the new regimen, physicians will have to initiate a dose-switching protocol that requires paperwork. The phone number physicians have been given to call is only open Monday to Friday during business hours, several oncologists noted.
“I do share their concerns,” said Jennifer Brown, director of the Center for Chronic Lymphocytic Leukemia at the Dana-Farber Cancer Institute, who was not an author of the Cancer Letter paper. “We frequently change the dose of this drug, in relation to drug interactions in particular, and usually we need to do that basically instantaneously.” . . .

Continue reading.

Written by LeisureGuy

18 April 2018 at 9:42 am

Why nuclear power is in general not a good idea: Contamination from a nuclear cleanup forced a shutdown.

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Ralph Vartabedian reports in the LA Times:

As crews demolished a shuttered nuclear weapons plant during 2017 in central Washington, specks of plutonium were swept up in high gusts and blown miles across a desert plateau above the Columbia River.

The releases at the Department of Energy cleanup site spewed unknown amounts of plutonium dust into the environment, coated private automobiles with the toxic heavy metal and dispensed lifetime internal radioactive doses to 42 workers.

The contamination events went on for nearly 12 months, getting progressively worse before the project was halted in mid-December. Now, state health and environmental regulators, Energy Department officials and federal safety investigators are trying to figure out what went wrong and who is responsible.

The events at the Hanford Site, near the Tri-Cities area of Richland, Pasco and Kennewick, vividly demonstrate the consequences when a radioactive cleanup project spirals out of control. The mess has dealt the Department of Energy’s nuclear weapons environmental management program yet another setback, following more than a decade of engineering miscalculations across the nation.

Energy Department officials said in a statement that workers received only a tiny fraction of the plutonium exposure that is allowed by regulations, and there should be no threat to their health. They declined requests for interviews.

If the current investigations substantiate that statement, it would be fortuitous.

“They are not in control,” John Martell, the Washington Department of Health official who oversees radioactive air emissions, said about the Energy Department and its contractors. “We want them to stop before they do become a public health threat.”

Tom Carpenter, executive director of the watchdog group Hanford Challenge, asserts that the demolition project used too many unskilled workers, attempted to do the work too fast and failed to adopt known safety measures that would have helped contain the contamination.

“They took shortcuts and stupid risks,” Carpenter said. “They gambled and lost.”

The mishap occurred at one of the nation’s most radioactively contaminated buildings, known as the Plutonium Finishing Plant. The factory, which opened in 1949 a few miles from the Columbia River, supplied plutonium for thousands of U.S. nuclear weapons before it was shut down in 1989. It was the notorious site where Harold McCluskey, later known as the Atomic Man, survived a 1976 explosion in which he was exposed to 500 times the occupational limit for radioactivity.

The exposures from the plutonium releases last year were minuscule by comparison, estimated to be a small fraction of the background radiation that every human gets from nature. But unlike cosmic radiation or radon gas, plutonium can lodge itself inside the body and deliver tissue damaging alpha particles over a lifetime.

Union officials say they can accept the health risk of working next to contaminated equipment, but not an “uptake” of plutonium when eating lunch or driving home in a car after protective gear is off.

“It is very upsetting because they don’t [care],” said one exposed worker who would speak only on condition of anonymity out of fear of retaliation. He said he was not given a kit to test for plutonium exposure until he asked for one in early December.

“They have no clue how I was exposed,” he said. “I look at it down the road and am mentally worried about it. It is emitting energy into my bones. Plus it is a poison. My wife is worried. My kids listen to the news and know what happened. I have to put it off in front of them as no big deal.”

The price tag for cleaning up nuclear waste at Hanford site just went up another $4.5 billion »

In their statement, Energy Department officials said they are “concerned about any health consequences, long-term or short-term, that any of the workers on site face at any time. We are addressing workers’ concerns by being as open and transparent with our workers as possible about what we are doing to stabilize the situation.”

Another longtime employee at the Plutonium Finishing Plant, or PFP, who met with a Times reporter, said the operation was out of control even before the demolition began. As workers removed equipment to prepare for walls to be torn down, air monitoring alarms sounded almost every day, he said. Workers were subjected to repeated nasal smears to determine if they had breathed plutonium dust, he said.

“Nobody wanted to work at PFP,” he said. “People who had been working at Hanford for 30 years were getting out, saying this is insane.”

And as the project fell behind schedule, many of the workers were compelled to put in as much as 90 hours a week, he said.

“Everything we were told to do at work began to deviate from the plan,” he said.

Seven employee automobiles were contaminated at the plant site, according to a Jan. 9 letter from the state Department of Ecology to Doug Shoop, the federal site chief at Hanford. When one worker demanded that his contaminated car be purchased because vent ducts were potentially still contaminated, Energy Department contractors nixed it and offered him a coupon for a free detailing from a car wash, according to collective bargaining grievance records cited by union officials. The account was confirmed by two other employees.

An even more serious concern was the potential for the workers to have contaminated their homes after leaving work. The Energy Department dispatched teams to take samples in eight private homes and found no contamination, a Hanford site spokesman said in a statement.

The demolition, costing $57 million, was being conducted by one of the nation’s largest engineering firms, CH2M, a unit of Texas-based Jacobs Engineering. CH2M is now under federal investigation for the releases, according to a letter sent by the Energy Department’s enforcement office in late March.

A spokesman for the company declined to comment and referred questions to the Energy Department’s Hanford site office. In March, the company released a preliminary analysis of the contamination and blamed it on a half dozen factors, including a “fixative” that was supposed to bind the dust but was too diluted to work properly and a decision to accelerate demolition when the contamination seemed to be stable.

The Energy Department plan for the demolition originally required the contractor to remove debris as it accumulated. But in January 2017, just before the first releases, officials authorized CH2M to allow the debris to pile up, according to a monthly site report by an inspector for the Defense Nuclear Facilities Safety Board, an independent agency.

In fact, workers at the plant said the demolition site was ringed by 8-foot-tall piles of radioactive debris with little to prevent dust from blowing off. . .

Continue reading.

It just gets worse and worse.

Am I imagining it, or is the world in general becoming less and less competent (and honest)?

Thank God we have Rick Perry to deal with this.

Written by LeisureGuy

16 April 2018 at 7:58 pm

White House Chief of Staff Contradicts White House Claim on VA Shakeup

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Isaac Arnsdorf reports in ProPublica:

White House chief of staff John Kelly contradicted the White House’s claims about David Shulkin’s departure as secretary of veterans affairs, a discrepancy that could lead to legal challenges of decisions made by Shulkin’s interim successor.

In a private meeting last week with major veterans groups, Kelly repeatedly said that the decision to remove Shulkin was President Donald Trump’s, according to several people who were present or briefed on the meeting. The White House has insisted that Shulkin resigned, disputing his assertion, in media appearances, that he was fired. (Whether voluntarily or not, his tenure as VA secretary ended on March 29.)

“Kelly said the president felt he needed to make a change with Secretary Shulkin and went ahead and made it to get the VA back on track,” said Dan Caldwell, the director of influential conservative group Concerned Veterans for America (also known as CVA), who attended the meeting.

A White House spokesman stood by the claim that Shulkin resigned.

The distinction isn’t just a matter of semantics. Under the Federal Vacancies Reform Act, the president can appoint an interim successor to succeed a cabinet secretary who dies, resigns or can’t perform his or her duties. But it doesn’t say what happens if the secretary is fired. It’s unsettled legal territory, but some scholars say it could open the door to challenging decisions made by the person Trump appointed as acting VA secretary, Robert Wilkie (an official in the Department of Defense). The argument would be that Wilkie lacked proper authority to make the decisions in question, the scholars say.

Opposition to Wilkie surfaced rapidly. Amvets, one of the largest veterans advocacy groups, called on Trump to remove Wilkie and instead elevate the VA’s deputy secretary, Tom Bowman. “This is what common sense, veterans and the law all require, and it needs to happen now,” Amvets national commander Marion Polk wrote in a letter to Trump on April 3. Bowman, a former senior Senate staffer, is popular with traditional veterans groups and on Capitol Hill. But, like Shulkin, he clashed with White House aides over legislation that would increase the use of private health care in the VA system.

Amvets and other major veterans groups recently had an introductory breakfast meeting with Wilkie. Amvets and other organizations were miffed that Caldwell from CVA was not only invited but given a prime seat. CVA, which is funded by the Koch brothers, has not attended such sessions in the past.

CVA and many veterans organizations are on different sides of the privatization debate. CVA advocates for a larger role for the private sector in veterans’ care. For their part, traditional veterans groups support a central role for the VA because the government-run health system remains popular with their members despite recent scandals. “I hope his legacy won’t be that he was the first to bring the Koch brothers into the VA,” Amvets executive director Joe Chenelly said of Wilkie.

Caldwell criticized veterans leaders for focusing on seating arrangements instead of policy. “The fact that there are people complaining about that shows you how misplaced their priorities are,” he said. “If there are leaders of veterans organizations who believe that placement at a table is going to determine priorities, then their competence to run those organizations should be questioned.”

Wilkie has already worried some veterans advocates. His first official public statement marked the anniversary of a massive scandal at the Phoenix VA four years ago. In the statement, he called on Congress to pass legislation that would increase the use of private care, which has been stalemated for months. In a rare alignment, veterans groups including Amvets and CVA endorsed a compromise that would have been attached to last month’s spending package, but House Democrats blocked it. At the recent meeting with Wilkie, the veterans groups generally agreed to proceed with that compromise.

But some were also unnerved by the presence of a colonel in uniform as an adviser to Wilkie. One participant described it as “DoD is running VA.” That idea is more sensitive than it might sound because the White House has floated the notion of merging the VA with the Pentagon’s health insurance system, known as Tricare. Some veterans groups warn that would increase privatization and out-of-pocket costs.

VA spokesman Curt Cashour said there  . . .

Continue reading.

Written by LeisureGuy

16 April 2018 at 5:00 pm

Stephanie Mencimer: “Did Drinking Give Me Breast Cancer?”

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Stephanie Mencimer writes in Mother Jones:

I thought I’d done everything right: breastfeeding my children, a careful diet, plenty of exercise. I wasn’t overweight and didn’t have a family history. I bought BPA-free bottles for my filtered water. But on a visit to the radiology department last spring, a pair of red brackets highlighted something worrisome on the ultrasound monitor.

Invasive lobular carcinoma—a malignant breast tumor. This spidery little beast measuring nearly three centimeters meant I had stage 2 cancer.

At 47, I was a decade and a half younger than the median age for breast cancer diagnosis in the United States. Was this just bad luck? Maybe, but the journalist in me was still curious to know: Why me? So I dug into the literature on risk factors to see where I might have fit in. It’s an impossible question to answer definitively for an individual, like trying to prove that a single weather event was caused by climate change. As one doctor told me, “You know who’s at risk for getting breast cancer? People with breasts!”

Still, most of the broad indicators didn’t seem to apply to me. The biggest one is age: The median diagnosis in the United States is at 62, and the highest breast cancer rates are in women older than 70. Another is taking hormone replacement therapy after menopause, but I’m premenopausal and haven’t taken it. Obesity raises risk, but I’ve never been overweight.

Then I saw one that gave me pause: alcohol consumption. I’m not a heavy drinker, but like most women I know, I have consumed a lot of alcohol in my lifetime.

While doctors have frequently admonished me for putting cream in my coffee lest it clog my arteries—a correlation that’s been pretty thoroughly debunked—not once has any doctor suggested I might face a higher cancer risk if I didn’t cut back on drinking. I’d filled out dozens of medical forms over the years asking how much I drank every week, but no one ever followed up other than to say with nodding approval, “So you drink socially.”

I quickly discovered that way back in 1988, the World Health Organization declared alcohol a Group 1 carcinogen, meaning that it’s been proved to cause cancer. There is no known safe dosage in humans, according to the WHO. Alcohol causes at least seven types of cancer, but it kills more women from breast cancer than from any other. The International Agency for Research on Cancer estimates that for every drink consumed daily, the risk of breast cancer goes up 7 percent.

The research linking alcohol to breast cancer is deadly solid. There’s no controversy here. Alcohol, regardless of whether it’s in Everclear or a vintage Bordeaux, is carcinogenic. More than 100 studies over several decades have reaffirmed the link with consistent results. The National Cancer Institute says alcohol raises breast cancer risk even at low levels.

I’m a pretty voracious reader of health news, and all of this came as a shock. I’d been told red wine was supposed to defend against heart disease, not give you cancer. And working at Mother Jones, I thought I’d written or read articles on everything that could maybe possibly cause cancer: sugar, plastic, milk, pesticides, shampoo, the wrong sunscreen, tap water…You name it, we’ve reported on the odds that it might give you cancer. As I schlepped back and forth to the hospital for surgery and radiation treatments, I started to wonder how I could know about the risk associated with all these other things but not alcohol. It turns out there was a good reason for my ignorance.

I was born and raised in Utah, and after my cancer diagnosis, I wondered what would have happened if I’d stayed put. My home state has one of the lowest rates of breast cancer in the country. Observant Mormon women don’t drink, and like other populations that abstain, they have significantly lower rates of breast cancer than drinkers. In Utah, Mormon women’s breast cancer rates are more than 24 percent lower than the national average. (Mormon men have lower rates of colon cancer, which alcohol can also cause.)

Researchers suspect the low overall rate of breast cancer in Utah has to do with the LDS church’s strict control over state alcohol policy. Gentiles, as we non-Mormons are called, grouse mightily over the watery 3.2 percent beer sold in Utah supermarkets, the high price of vodka sold exclusively in state-run liquor stores, and the infamous “Zion Curtain,” a barrier that restaurants were until recently required to install to shield kids from seeing drinks poured. Yet all those restrictions on booze seem to make people in Utah healthier, Mormon or not, especially when it comes to breast cancer.

Epidemiologists first recognized the connection between cancer and alcohol consumption in the 1970s. Scientists have since found biological explanations for why alcohol is carcinogenic, particularly in breast tissue.

When you take a drink, enzymes in your mouth convert even small amounts of alcohol into high levels of acetaldehyde, a carcinogen. People who consume more than three drinks a day are two to three times likelier to contract oral cavity cancer than those who don’t. Alcohol also damages the cells in the mouth, priming the pump for other carcinogens: Studies have found that drinking and smoking together pose a much higher risk of throat, mouth, and esophageal cancer than either does on its own.

Alcohol continues its trail of cellular damage as enzymes from the esophagus to the colon convert it into acetaldehyde. . .

Continue reading.

Written by LeisureGuy

16 April 2018 at 12:38 pm

One reason Chicago is so violent: Brain-damaging lead found in tap water in hundreds of homes tested across Chicago, results show

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Michael Hawthorne and Cecilia Reyes report in the Chicago Tribune:

Amid renewed national attention to the dangers of lead poisoning, hundreds of Chicagoans have taken the city up on its offer of free testing kits to determine if they are drinking tap water contaminated with the brain-damaging metal.

A Tribune analysis of the results shows lead was found in water drawn from nearly 70 percent of the 2,797 homes tested during the past two years. Tap water in 3 of every 10 homes sampled had lead concentrations above 5 parts per billion, the maximum allowed in bottled water by the U.S. Food and Drug Administration.

Alarming amounts of the toxic metal turned up in water samples collected throughout the city, the newspaper’s analysis found, largely because Chicago required the use of lead service lines between street mains and homes until Congress banned the practice in 1986.

The testing kit results provide the most conclusive evidence yet of widespread hazards that have remained hidden for decades. Yet as Mayor Rahm Emanuel borrows hundreds of millions of dollars to overhaul the city’s public water system, Chicago is keeping lead service lines in the ground.

Under the city’s plumbing code — the same ordinance that for nearly a century mandated the use of lead pipes to convey water to single-family homes and small apartment buildings — individual property owners are responsible for maintaining service lines. The mayor’s office has said it is up to homeowners, not the city, to decide if it is worth replacing the lead pipes at their own expense.

As a result, critics say, the city is leaving scores of Chicagoans at risk and failing to seize an opportunity to fix more than one problem when crews dig up streets to replace aging water mains.

“Chicago could be a leader on nationwide solutions to this problem, but instead they appear to be sticking their heads in the sand,” said Tom Neltner, chemicals policy director at the nonprofit Environmental Defense Fund and former assistant commissioner of the Indiana Department of Environmental Management.

Adam Collins, Emanuel’s chief spokesman, referred questions to the Department of Water Management, where a spokeswoman earlier had said she would need to consult with the mayor’s office before responding to the Tribune’s analysis. Asked why the city hasn’t removed lead service lines it once required by law, the department emailed a three-sentence statement:

“Since Mayor Rahm Emanuel took office, he has made it a priority to improve Chicago’s overall water quality and infrastructure,” the statement reads. “Today, the city’s water exceeds the standards set by the (U.S. Environmental Protection Agency) for clean, safe drinking water. And the Department of Water Management continues to take a proactive approach to mitigating lead in our water system and is continually evaluating additional methods of lead mitigation.”

City and EPA officials advise that residents can protect themselves by flushing household plumbing for three to five minutes when water hasn’t been used for several hours. But in one of five Chicago homes tested since January 2016, the Tribune analysis found, samples contained high levels of lead after water had been running for three minutes.

Even after water had been running for five minutes, 9 percent of the homes tested had lead levels above the FDA’s bottled water standard. . .

Continue reading.

Written by LeisureGuy

13 April 2018 at 10:38 am

Our Disgraceful Infant Mortality Epidemic

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Kevin Drum has a good post (with charts, of course). From the post:

. . . In 1960, we ranked 11th in infant mortality among rich countries. Not great, but not terrible. Today we rank 24th out of 27 rich countries, ahead of only Turkey, Mexico, and Chile. We are behind every single country in Europe by a large margin. This is the price we pay for our horrible health care system.

Read the whole thing.

And he has another post this morning:

Trump Administration Looking at Ways to Re-Sabotage Obamacare

Written by LeisureGuy

12 April 2018 at 12:32 pm

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