London, England, United Kingdom (AHN) – Malaria may be killing twice as many people as experts previously thought, and it could also be affecting older children and adults, long considered to be the least susceptible, according to a study published Friday in the journal Lancet.

The World Health Organization reports that malaria cases and deaths have been falling since 2004. The decline is largely attributed to large campaigns to distribute bednets, spray homes with insecticides and make better drugs available.

In December, the WHO reported about 655,000 had died from the disease in 2010.

However, using new available data and modeling tools, researchers put the 2010 figure at about 1.2 million, and note about 90 percent of the deaths were in Africa.

The new findings also challenge the belief that children who grow up in areas with malaria develop immunity to the disease as they get older.

Doctors have long believed that children under 5 years old and pregnant women were the most susceptible to the mosquito-borne disease. However, new findings contradict that notion.

The researchers analyzed data on malaria deaths from 1980 to 2010, including information not used in prior studies. The research was funded by the Bill & Melinda Gates Foundation.

Complicating the ability to come up with an accurate number is that most people killed by the disease are not hospitalized, so tracking their deaths is difficult.

WHO stands by its estimates.

Data from both the WHO and new Lancet study do show the same overall trend, that malaria has been dropping since 2004.

The study’s authors project malaria deaths will fall below 100,000 some time after 2020, thanks to campaigns to eradicate the disease. Experts caution that if health officials let their guard down, malaria could come roaring back.

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United States (KaiserHealth) – The health law’s biggest changes don’t take effect until 2014, when states and insurers must be ready to begin signing up an estimated 32 million people in Medicaid and private insurance. But a successful rollout in two years hinges on critical decisions that states must make – and take quick action on – this year.

It will be difficult for many states to meet fast-approaching deadlines, and some may not make it, says Brett Graham, a managing director at Leavitt Partners, a consulting firm working with states on implementation of the law.

Time is short, and states are missing key pieces of how-to guidance from the federal government about everything from what various insurance exchange options will look like to which benefits must be included in health plans, he says. To make matters worse, states are competing for a limited pool of information technology vendors to help them get started.

“It’s a pressure cooker,” said Graham. States are “in a position where they have to act with imperfect information.”

One of the most pressing tasks for states this year has to do with the creation of exchanges, through which individuals and small businesses can buy insurance starting in 2014.

On Jan. 1, 2013, the Department of Health and Human Services will certify which states will be ready to run exchanges on their own. To win certification, a state must enact laws to fund the continuing operations of an exchange. While the federal government is providing financial help up front for the creation of exchanges, states will assume the cost once they are underway. HHS can issue a conditional certification for those states that are making progress but need more time.

Only- states plus the District of Columbia have made legislative progress toward creating an exchange, according to a Jan. 22 Robert Wood Johnson Foundation report prepared by the Urban Institute. Another 21 states have demonstrated interest, and 15 have made little headway.

While some states are aggressively moving forward, “at the other end are states that say, ‘no way, no how, we’re not doing it.’ Montana, Texas, Louisiana, Florida, they are not going to build it and they’re playing a game of chicken,” said Graham. “They’re waiting for the Supreme Court,” hoping it will effectively kill the health law in June when it rules on challenges to its constitutionality.

Most states, though, are undecided about whether to build their own exchanges and are moving forward in varying degrees. Even some states that are part of the Supreme Court challenge are moving forward: Colorado, Washington and Nevada have created exchanges.

Originally, the only alternative to a state exchange was a fully federal entity. HHS has since offered to partner with states. That way, a state could retain overall control of an exchange while passing certain responsibilities to the federal government.

But creating a full or partial federal exchange also could be problematic: Some health care analysts question whether the task will be any easier for the federal government. It faces the same short timeline as states this year, and while Obama administration officials say they have the money to fund exchange activity, some health care analysts say they aren’t so sure.

Most state legislatures are scheduled to adjourn for the year by March or April, before the Supreme Court rules, according to the National Conference of State Legislatures. Reconvening after the ruling would be difficult in an election year.

Insurers Need Long Lead Time

Insurers, which will offer coverage to individuals and small businesses through the exchanges, also are worried about the timetable. Until they know more about required benefits, for example, health plans say it’s difficult to develop new products, negotiate with doctors and hospitals and invest in information technology.

“Open enrollment has to be ready to go by Oct. 1, 2013, so in January of 2013 we have to submit our products and rates for [state] approval,” said Alissa Fox, senior vice president of the Blue Cross and Blue Shield Association. If health plans make changes before the federal government issues its specific requirements, they might have to start over, and that can be costly and time consuming, she says. “We want to change our claims processing system once, our enrollment system once.”

Last fall, Blue Cross urged HHS to release all outstanding regulations by the beginning of 2012 to give states and insurers sufficient time to make decisions.

That hasn’t happened. Among other things, states urgently need guidance on how the federal government would partner with states on exchanges or run its own exchanges, says Joy Johnson Wilson, health policy director for the National Conference of State Legislatures. “No rule, no concept,” she said. “Soon is good.”

Chiquita Brooks-LaSure, director of coverage policy at HHS, said that working with states is a “top priority … As we get similar questions from states, we will put out guidance to answer general questions. We’re going to continue to be responsive.”

On Jan. 25, HHS provided more details about the kinds of benefits insurers will be required to offer consumers and small businesses beginning in 2014. The agency had been under pressure to provide more information after releasing a general “bulletin” in December giving states broad flexibility to design benefits.

State legislators are particularly eager to learn how they can divvy up responsibilities with the federal government in the case of a federal or partnered exchange. One of the most important questions is who decides whether low-income people are eligible for Medicaid or federal subsidies to buy insurance in an exchange. The Medicaid program is being expanded to include people with income higher than currently allowed.

Graham sees a possible clash of federal and state budget interests over Medicaid, which states help fund. For the first two years Washington will pay 100 percent of the costs for the newly eligible, but the federal contribution will taper off to 90 percent beginning in 2020.

“If the federal government wants someone to be covered, it may say that person is eligible for Medicaid,” Graham said. “A state that already has a significant budget crisis won’t want to expand Medicaid. Who owns the process?”

Krista Drobac, director of the health division at the National Governors Association, says states want authority over eligibility. “It’s hard to control your program design if you’re not responsible for determining eligibility and enrolling people,” she said.

That’s why states are beginning to lay the groundwork for information technology, she says. They’re scrambling to sign technology vendors, who are in short supply.

Drobac says states have enough information to get started, even while missing details. But officials are worried.

“We’re down to the wire,” said Wilson. “When the bill passed in 2010, 2014 seemed a long way away. But when you back into what it takes to get the program up and running, it’s a very short timetable.”

– Provided by Kaiser Health News.

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Myanmar (IRIN) – Aid workers in Myanmar’s northern Kachin State have expressed concern over the health of thousands of internally displaced persons (IDPs) along the border with China.

Preventable illnesses caused by unsanitary conditions and colder weather are taking their toll on the more than 45,000 IDPs in two dozen IDP camps as sporadic fighting between government forces and the Kachin Independence Army (KIA) nears almost eight months, they say.

“Many of the children in the IDP camps suffer from diarrhea and stomach parasites because they have to drink dirty water. When they go to the toilet, there aren’t enough,” May Li Aung, director of Wun Pawng Ninghtoi (WPN – “Light of Kachin”), a volunteer group comprising eight local NGOs and charity groups, told IRIN.

In one camp, aid workers report just five latrines for more than 1,200 people.

“A few people in the camps have already died from this and we are worried that diseases will spread,” she said.

While much of the water supply is trucked into the camps, many of the displaced while on the run have to drink directly from streams or boil pond water

The WPN assists 16 camps under KIA control in the southern part of Kachin State, where about 20,000 IDPs are housed in temporary bamboo shelters, but there is a growing strain on volunteers and resources as the conflict continues.

In the north, another 20,000 IDPs are housed in camps also under KIA control, with about 10,000 in the government-controlled area around the border town of Myitkyina.

Vulnerable women

“Women in the camps can use the clinics there; however, many women are not getting the midwife or family support they need,” Shirley Seng, a spokeswoman for the Kachin Women’s Association of Thailand (KWAT), based in Chiang Mai, said. “Many women feel insecure and at risk of possible assault by Burmese troops.”

“The problem that we face right now is that many women who are pregnant are having miscarriages,” explained nurse Di Di Ah Hkaw.

The pregnant women have no choice but to run from their homes to a safe place while many of their husbands are fighting on the frontline. Many of the women are carrying their household possessions with them, she explained.

“In December we had three women in our clinic who miscarried,” Di Di Ah Hkaw added.

Meanwhile, as the political dialogue between Myanmar and others in the international community slowly moves forward, international relief groups are calling for faster action to better address the needs of the displaced.

Earlier this month, Refugees International released a report calling for increased humanitarian aid to coincide with a string of recent political reforms by the country’s first nominally civilian government in decades.

At the same time, Bill Davies of Physicians for Human Rights (PHR) described a recent UN inter-agency mission to the KIA-controlled town border town of Laiza in December – which delivered essential household items to the displaced and conducted an initial assessment of the situation – as a positive step, but stressed the need for stronger assistance and access.

The UN and its humanitarian partners have repeatedly expressed their readiness to support all those affected by the conflict, and the most vulnerable in particular, a statement by the UN read at the time.

“There needs to be consistency and more access for bigger organizations to go in and provide better technical support for the people on the ground.

“Something as simple as diarrhea could kill someone as the dehydration leads to the immune system breaking down which could lead to respiratory problems and pneumonia – and eventually death,” the health worker warned.

On 9 June 2011, the 17-year-old cease fire that had been in place between the government and the KIA broke down, in part because the KIA rejected orders to transform into a single border guard force under Burmese military control. Others still cite the military’s desire to widen its control over areas with Chinese energy projects .

ss/ds/mw

– Provided by Integrated Regional Information Networks.

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Jacksonville, FL, United States (KaiserHealth) – For a candidate who keeps vowing to repeal the 2010 federal Affordable Care Act, former Massachusetts Gov. Mitt Romney sure can make a convincing argument on its behalf.

At least that’s how it appeared to a lot of people after Thursday night’s Republican presidential candidate debate in Jacksonville, FL.

During a more than 10-minute back-and-forth on health care largely between Romney and former Pennsylvania Sen. Rick Santorum, Romney ended up delivering a lengthy justification for his state’s decision to pass a 2006 law that included requiring nearly every resident to either have health insurance or pay a tax penalty.

“If you don’t want to buy insurance, then you have to help pay for the cost of the state picking up your bill, because under federal law if someone doesn’t have insurance, then we have to care for them in the hospitals, give them free care,” said Romney. “So we said, no more, no more free riders. We are insisting on personal responsibility. Either get the insurance or help pay for your care.”

“Does everybody in Massachusetts have a requirement to buy health care?” asked Santorum.

“Everyone has a requirement to either buy it or pay the state for the cost of providing them free care,” Romney shot back. “Because the idea of people getting something for free when they could afford to care for themselves is something that we decided in our state was not a good idea.”

Santorum’s conclusion was that “in Massachusetts, everybody is mandated, as a condition of breathing … to buy health insurance, and if you don’t … you have to pay a fine.”

But backers of the requirement saw Romney’s explanation in a somewhat different light.

Said John McDonough, a professor at the Harvard School of Public Health, “Romney has given in this entire presidential campaign last evening what I believe is the most effective and persuasive rationale and defense of the individual mandate.”

Of course, that may not be a good thing for Romney as he fights to win over Republicans who dislike the 2010 law in general, and the insurance requirement in particular. Santorum said the Massachusetts law passed under Romney’s stewardship in 2006 is too close to the federal law for Republicans to make health care an issue this fall.

“It does not provide the contrast we need with Barack Obama if we’re going to take on that most important issue. We cannot give the issue of health care away in this election,” he said.

And while Romney insisted that the Massachusetts law and the federal law differ in significant ways, McDonough, who was intimately involved in the development and passage of both the Massachusetts and federal health laws, insists that’s not really the case.

“The similarities go far far beyond the mandate,” he said. For example, “the essential architecture of the insurance reforms in the Affordable Care Act are taken wholly from the Massachusetts health reform law.”

On the other hand, Santorum may have overspoken when he claimed that the Massachusetts law isn’t working very well.

Just this week the policy journal Health Affairs published a study looking at the Massachusetts program’s first five years in operation.

“We find the state is continuing to do quite well in terms of maintaining high levels of health insurance coverage and improvements in access to care,” said lead author Sharon Long of the University of Minnesota and the Urban Institute. “Including for the first time we’re seeing reductions in emergency department use, and also some improvements in health status. So really, some very positive changes that came with health reform.”

Positive for Massachusetts residents, perhaps. Positive for Mitt Romney’s chances to win the Republican nomination? That still remains to be seen.

– Provided by Kaiser Health News.

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United States (KaiserHealth) – The latest casualty of the Great Recession may soon be the nation’s elderly. Cuts in government payments for patient care and less construction of new nursing homes are already taking a toll. Add to this the aging baby boom generation and you have a worst-case scenario in which older people who need full-time care won’t be able to get it. “We believe we’re at a tipping point,” says Mark Parkinson, head of the American Health Care Association (AHCA), which represents nursing homes.

If so, the timing couldn’t be worse. The first baby boomers hit age 65 last year. By 2030, 20 percent of the U.S. population will be at least 65, up from 13 percent today. In that same period, the number of 85-year-olds will increase more than 50 percent and the number of 100-year-olds nearly triple. But the number of nursing homes dropped almost 9 percent from 2000 to 2009.

Nursing homes and hospitals are places that everyone wants to avoid … until they can’t. Most people say they want to age at home, but as retiring boomers get older, more will need the type of 24-hour care that only a nursing home or hospital can offer. That’s because the prevalence of chronic illnesses like Alzheimer’s disease, cancer and diabetes increases with age. Fifty-five percent of all cancers are diagnosed in individuals 65 and older, and by 2030, 7.7 million of those 65 and older will suffer from Alzheimer’s, 50 percent more than today according to the Alzheimer’s Association. By 2025, the number of those 65 and older with diabetes is projected to almost double to 10.6 million.

Several trends are cutting into the number of nursing homes. Many homes were constructed during the 1960s under Lyndon Johnson’s Great Society programs. Often those homes are closed because they are old or, with their long hallways and large, multi-resident rooms, don’t fit what current residents want, says Robert Kramer of the National Investment Center for the Seniors Housing and Care Industry.

But the recession has made getting private financing for new nursing home construction tougher. From 2007 to 2011, the number of under-construction nursing home units (the sections of a facility that provide only nursing care) declined by a third. “I cannot tell you of anyone who has actually developed a new skilled nursing facility in at least the last five years in California,” says Edward Steinfeldt, a consultant to developers of retirement housing and health care.

And existing nursing homes are struggling. They long have lost money on patients whose stays are covered by state-run Medicaid programs, which pay for long-term care for chronically or terminally ill patients who have run out of money. According to a report this month by the AHCA, in 2011 nursing homes lost at least $20 per Medicaid resident per day nationwide. Total losses came to $6.3 billion nationally, the highest yearly total ever, with higher deficits to come next year, according to the report.

Making matters worse, last year the federal government also cut its reimbursement rates by 11 percent to nursing homes for Medicare patients—people released from hospitals to nursing homes who need short-term care to recover from injuries or acute illnesses. That’s a huge hit since Medicare payments are responsible for more than 20 percent of nursing home revenues. (Medicaid provides about 50 percent of revenues, and most of the rest comes from private long-term care insurance and people who pay out of pocket.) For the 187-bed nonprofit Lutheran Home in Milwaukee, which has gross receipts of about $20 million, the Medicare slash will take $700,000 to $750,000 straight off the organization’s bottom line this year says CEO Scott McFadden.

The real estate crash has added to nursing homes’ budget crunch. Many clients sell their homes and use the money to pay out of pocket for long-term care services from a nursing home. By obliterating more than $8 trillion in home equity, the collapse cut the number of patients who can pay their own way. McFadden says that the private-paying clients his home serves used to run out of money in two or three years. Now they’re broke much more quickly. Once they can’t pay, Medicaid picks up only some of the tab, and the Lutheran Home then starts losing money on them. It’s illegal for a Medicaid-certified nursing home to ask a patient to leave just because they run out of money.

Residing at a nursing home is not cheap. The median annual cost of a private U.S. nursing home room rose to $77,745 in 2011—up almost 30 percent from 2005. People without chronic conditions have less costly options—it takes about $43,500 yearly to pay for a home health care aide who doesn’t have specialized medical skills, and $39,000 to live in an assisted living facility that provides help with activities of daily life like cooking, but doesn’t necessarily offer health care services.

If nursing homes continue to be squeezed, they may need to cut more staff. A November 2011 report by the University of California-San Francisco concluded that poor quality of care is already endemic in many nursing homes, especially the largest for-profit chains where staffing levels have been cut the deepest to save money. Parkinson maintains that so far, homes in his association are keeping up their level of service with less money by eliminating managers, freezing wages, and cutting capital improvements like painting walls and replacing carpets—anything to avoid laying off caregiver staff.

Bill Mulligan, a managing director at Ziegler Capital Management, which provides low-cost financing for nursing home developments, argues that given the decreasing supply and rising demand, nursing homes are still a good investment. “The demographics are going to level off the number [of homes], maybe even increase it at some point,” he says. But Steinfeldt, who also works with developers, has little confidence in their profitability: “Why would you go into a business that can’t cover its costs?”

If major shortages of nursing home space do surface, they’ll likely show up in urban and high-poverty areas first. Widespread waiting lists have already been reported in Tallahassee in Florida, Rapid City in South Dakota, and San Francisco. Homes also have been closing in poor neighborhoods—a study published last year in the Archives of Internal Medicine showed that nursing homes shut down there more often than elsewhere (the hardest hit cities were New Orleans, Oklahoma City, San Francisco, and Dallas). And Medicaid patients may have an increasingly hard time finding nursing homes that will take them–Kramer says when homes replace their old buildings, they often cut the number of beds to make space for more private rooms and sophisticated medical facilities that can attract the higher paying Medicare and private-pay clients.

“Every adult is going to face this nursing home crisis in some way, whether it’s through their own care or the care of loved ones,” says McFadden. “Ignoring it is not going to make it better.”

– Provided by Kaiser Health News

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Juba, South Sudan (IRIN) – A small fridge in the corner of Juba Teaching Hospital’s laboratory is the only blood bank in South Sudan, the world’s newest nation with some of the worst health statistics in the world.

Health workers say a lack of blood is the main cause of mortality at the country’s main but extremely under-resourced hospital, and they face the anguish of having to watch patients who could be saved die.

“Sometimes they bleed until they die and we cannot do anything about it,” said Wani Mena, head of the hospital. “The first cause, the major cause, of maternal mortality in our department is bleeding,” said Chuol Kuma, an obstetrics and gynecology consultant.

While the rest of the hospital is sometimes left for days without power due to frequent cuts, capacity to keep more blood is hampered by only having a small fridge in the laboratory – the only room with a back-up generator.

“The blood bank we have is a very small refrigerator. It only takes around 50 units of blood. This is not enough,” Kuma said.

A 20-year-old mother of two recently died after suffering complications from a late miscarriage. “She needed an immediate blood transfusion and she needed blood and then she got the blood late and died,” he said.

This woman, like many others who enter the hospital, was already anemic.

“The need for blood is so great in this place because of injuries. Anemia is one of the most common presentations to our hospitals, both of women who are pregnant and for those who have malaria… and sometimes they die from it,” said Mena.

Fight for blood

But most of the time, the small amount of blood in the family-sized fridge cannot be touched even in emergencies, as it has been donated for specific patients due for surgery.

“Currently the system that exists is that somebody gets sick, relatives come and donate blood. That is not a good system. We should have a stock of blood that we can give to any patient in need of it, and immediately,” said Mena.

Cultural taboos and a lack of awareness about the risk-free benefits of giving blood also mean that getting relatives to give blood to save a life is often a struggle that staff do not win.

“In some tribes, somebody cannot, for example, give blood to his in-law, or somebody cannot receive blood from a foreigner, things like that,” said lab supervisor Charles Stanley Mazinda.

Other staff say families avert their eyes or want to know their loved one will make it before committing themselves. Amin Gerald, a nurse at Torit Hospital, about four hours’ drive from Juba, said he had come to give blood for his wife.

He understands the importance of giving blood, but would not do it for a stranger.

Gerald says he often comes across people who believe that giving blood will make them ill or weaken them, or that blood should never be mixed as it could kill the patient.

But Mazinda said that when there is an emergency, people rush to the laboratory expecting blood, only to find it cannot be touched.

Fighting fear

Technician Charity Ritti said the laboratory used to divert blood to emergency patients whose relatives promised to donate afterwards, but when they did not come back, staff faced a backlash from donors.

“The owners of the blood will come and quarrel and sometimes they even want to beat us,” she said.

Ritti is concerned that often the bank only has one unit of key blood types, such as O-negative, but says changing people’s mindsets to build up reserves is extremely difficult.

“They are afraid of donations – we have people coming here from Kenya, Uganda and Khartoum [Sudan] and giving blood… but our people here cannot face free donations,” she said.

“Sometimes we screen them, then we say go and have breakfast and they never come back,” she said.

Changing attitudes Hospital staff say awareness campaigns and better medical education are needed, among the huge challenges facing a nation where only 16 percent are literate and very few have access to health facilities. Even local doctors admit they too are scared to donate.

“There’s just not a lot of cultural education about giving blood and still being healthy. I think in the US and UK and Europe we are very educated about that,” said Matthew Fentress, an American doctor working at Juba Hospital.

In addition, Mazinda said getting people to the blood screening stage was a challenge, as people feared finding out they were HIV-positive.

“Sometimes we screen some blood donors, and when they are [HIV-]positive, we tell them to go to the VCT center down the road, but some of them don’t reach there [and flee],” he said.

Bridging the gap The government is planning to build a national blood bank here this year that will hold up to 200 pints (113 liters).

Meanwhile, doctors from the Harvard Initiative in Massachusetts have set up a “virtual blood bank” to try to beat storage and power problems.

The bank is made up of a database of pre-screened volunteer donors who are willing to come in and replace a unit of their blood type.

Fentress said this would free up blood for emergencies and when the hospital cannot get blood from patients’ friends and families.

“Right now we’re really focused primarily on foreigners, as their attitudes are already changed,” he said.

The hospital is advertising on the internet and in community centers, such as churches, until a government campaign hopefully ensures South Sudan’s first “real” blood bank is filled.

“It is just the beginning and I hope it will succeed. But I think they need assistance from the communities. There must be medical education or health education for the communities so that they accept to come and donate freely so that we may have enough blood in our blood bank,” said Kuma.

hm/mw

– Provided by Integrated Regional Information Networks.

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Schenectady, NY, United States (AHN) – Price Chopper Supermarkets is issuing a voluntary recall on its 16-ounce Coyote Joe’s Shredded Taco Cheese with UPC 41735-12509 and an expiration date of April 21, 2012, due to the possibility of shredded plastic fragments inside the packaging.

The cheese was sold chain-wide between the dates of Jan. 4 and Jan. 17, 2012.

Price Chopper has initiated its Smart Reply notification program, which uses purchase data and consumer phone numbers on file in connection with the company’s AdvantEdge loyalty card to alert households that may have purchased the product.

Customers can return the product to their local Price Chopper for a full refund.

For more information, visit the pricechopper.com website or call Price Chopper at 1-800-666-7667, option 3, between the hours of 8:30 a.m. and 7 p.m.

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Washington, DC, United States (KaiserHealth) – The U.S. Food and Drug Administration has gathered scientists and tobacco policy experts to study the potential health risks and benefits of dissolvable tobacco products. The Tobacco Products Scientific Advisory Committee met this week and advocates from all sides lined up to give their pitch to the FDA panel.

Dissolvables, which are made with finely milled tobacco, aren’t new, but they drew new attention last year when R.J. Reynolds and Philip Morris introduced new flavors and varieties in a few cities across the country. Some health officials and lawmakers dubbed the flavored melt-in-your mouth orbs and tongue strips “nicotine candy” and complained to the FDA.

Supporters say dissolvables could help smokers “step down” from their nicotine dependence on cigarettes. Opponents say it’s not clear how consumers actually use the products and who is using them. Will young people try dissolvables, develop a taste for nicotine, then graduate to smoking? Could dissolvables keep people hooked when some former smokers would have–eventually–become nicotine free?

Tobacco companies aren’t allowed to promote dissolvables as a stop-smoking aid, but there’s lots of Internet chatter from individual consumers who report that they’ve given up cigarettes or cigars with the help of dissolvables.

Rutgers University law student Gregory Conley was a smoker for eight years, but quit in August. The 24-year-old used electronic cigarettes—another smokeless product—to quit, and he says dissolvables suppress his cravings when he’s in class. He likes the tobacco-dipped toothpicks and says they give him a satisfying nicotine tingle along with a hit of mint or java flavor.

“You just put it in your mouth and hold it as if you were holding a piece of straw between your teeth,” Conley said.

He volunteers as a legal policy director for the Consumer Advocates for Smoke-Free Alternatives Association and testified during the FDA’s meeting this week. Conley says electronic cigarettes, dissolvables and other smokeless alternatives are powerful tools to help smokers avoid the most toxic aspects of cigarettes.

The Centers for Disease Control and Prevention links one in five deaths each year to tobacco use, about 440,000 people. Cigarette smoking costs America $193 billion a year, according to government estimates for 2000 to 2004. About half of that economic cost is direct health care spending, the other half lost productivity.

The FDA’s review of dissolvables was mandated by the 2009 Family Smoking Prevention and Tobacco Control Act. Matthew Myers, president of the Campaign for Tobacco-Free Kids, says the advisers will weigh the science and report on the consequences for population health, not just individual smokers.

“The FDA law recognizes that even if the product is less harmful, if it’s marketed in a way that its primary appeal is to young people, the net result will be more people becoming addicted to tobacco,” Myers said.

“What we’ve seen is that the colorful way that dissolvables have been promoted and the talk that they have generated has led a lot of people to believe that these products are less harmful—before there’s been an FDA review,” Myers said.

Right now, FDA regulates dissolvables like other smokeless tobacco. They’re stocked behind the counter at convenience and grocery stores, not sold to minors and they have some of the same warning labels as snuff and chew: “Smokeless tobacco is addictive.” “This product is not a safe alternative to cigarettes.”

The newer products have been available in just a handful of markets so far, including Denver, Indianapolis, Portland, Ore., Columbus, Ohio, and Charlotte, N.C. The Colorado Board of Health passed a resolution asking R.J. Reynolds to remove the products from its market, but the company is not complying with the request.

A group of U.S. lawmakers wants stricter rules for dissolvables. Some public health groups say the products should be removed from store shelves until the FDA has weighed in on the science behind dissolvables. Other advocates, sometimes called “harm reductionists” say smokeless products like dissolvables can lessen the disease, death and disability caused by smoking.

Jennifer Ibrahim, associate professor in the Department of Public Health at Temple University, says–done right–harm reduction is a good idea. “I think that everyone in the business of smoking cessation is realistic that people can’t quit cold turkey, but you don’t want to send the wrong message: that nicotine is safe at any level, because it’s not.”

“That’s absolutely true, nothing is absolutely safe,” said Conley, but he says smokers are dying while public health officials wait for definitive proof.

Psychologist Anna Tobia, director of the smoking cessation program at Thomas Jefferson University Hospital in Philadelphia, points out that the new dissolvables are not the only nicotine products meant to be ingested.

“To be fair, they are very similar to smoking cessation products that have been on the market for a very long time–a lozenge or a gum for people who are trying to get off of tobacco,” said Tobia.

Kenneth Warner, a health economist at the University of Michigan School of Public Health, says there’s reason to be skeptical of the tobacco industry’s intention for dissolvables and concerned about what the new products will do.

“The public health community got bamboozled” in the past, he said. When the tobacco makers began selling low-tar nicotine cigarettes, Warner says they were marketed as “mild, mellow,” and safer than regular cigarettes—and it turned out they weren’t.

The FDA’s advisers are wading in to a long-standing debate that shows up evolving and changing ideas about what’s acceptable and what’s safe. Health policy expert Ibrahim says electronic cigarettes and melt-in-your mouth tobacco are just the latest in a long line of novel products aimed at smokers and people trying to kick the habit.

“I won’t let my kids near the e-cigarettes, because I just don’t know what’s in the vaps [water vapor] that’s coming out of them. Once upon a time people thought exposure to second-hand smoke was safe and clearly that’s not the case,” Ibrahim said. “I don’t intend to expose myself or my family to things which 10, 15 years down the road, we’ll say: ‘Oh, yeah, that’s not good for you.’”

“We will take anything to get our patients better and to get them to reduce the amount of cigarettes that they are smoking,” said stop-smoking expert Anna Tobia. “If this is a good first step, and—maybe–if they can see that they can manage with less nicotine, that would be wonderful.” Many are waiting for the FDA to answer the question: Do dissolvables pose a greater or lesser risk to population health?

– Provided by Kaiser Health News.

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Washington, D.C., United States (AHN) – U.S. President Barack Obama on Wednesday refused to buckle under Republican deadline and rejected a bid to expand the Keystone XL oil sands pipeline according to the Obama Administration.

President Obama personally conveyed “his Administration’s decision on the Keystone pipeline,” to Canadian prime minister Stephen Harper according to the White House but media reports from across the border noted the disappointment of Canadian leader.

In an email statement Obama justified the denial as “not a judgment on the merits of the pipeline, but the arbitrary nature of a deadline that prevented the State Department from gathering the information necessary to approve the project and protect the American people.”

Blaming the Republicans in Congress, Obama said, “I’m disappointed that Republicans in Congress forced this decision,” adding, “the rushed and arbitrary deadline insisted on by Congressional Republicans prevented a full assessment of the pipeline’s impact.”

In a conference call on Wednesday with journalists, Kerri-Ann Jones, the state department official overseeing the pipeline application, said, “This decision today doesn’t make our commitment to energy independence and energy security any less of a priority,” she said, blaming the lawmakers for setting a February 21 deadline on a decision.

“We felt the imposition of a deadline would complicate the process,” Jones told journalists, adding, “The legislation really did not give us enough time to do a responsible evaluation.”

“The Obama Administration complains about a 60-day deadline, but in reality it has now had 1,217 days to make a decision. How long does it take for President Obama to put the needs of America’s workers ahead of his own political interests?” questioned Senator Richard Lugar from Indiana.

Most senior Republican Senator and longest serving Member of Congress in Indiana history, Lugar said, “In the face of Iranian threats against oil affordability, the Obama Administration once again is trying to blame Congress and the State of Nebraska instead of taking responsibility for American jobs and security.”

Jones, however, during the conference call, refused to guarantee an expedited review of future proposals for the KeystoneXL oil pipeline, even though TransCanada Corp. immediately in a statement said that it would reapply, noting that it expected the U.S. to process in a speedy manner its new application for the 1,700-mile pipeline.

“This outcome is one of the scenarios we anticipated. While we are disappointed, TransCanada remains fully committed to the construction of Keystone XL. Plans are already underway on a number of fronts to largely maintain the construction schedule of the project,” said Russ Girling, TransCanada’s president and chief executive officer.

“We will re-apply for a Presidential Permit and expect a new application would be processed in an expedited manner to allow for an in-service date of late 2014,” Girling said.

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United States (KaiserHealth) – If you saw that your doctor had written “SOB” in the notes he took during your latest office visit, you might be offended and wonder what you’d done to give him such a negative impression. But “SOB,” in physicians’ shorthand, simply means “shortness of breath.”

Concern about such misunderstandings is one of several reasons doctors are reluctant to share their notes with patients, according to a study published in December in the Annals of Internal Medicine.

The study surveyed 173 doctors and nearly 38,000 patients at three primary-care practices about sharing information with patients. After the survey, the practices joined a project called OpenNotes, in which patients were give electronic access to their files.

Although federal law guarantees patients the right to examine and get copies of their medical records, providers haven’t always made it easy to do so. But the movement to give patients direct access to their health information has picked up steam, and policymakers have encouraged it as a way to empower patients to help manage their health and their medical care.

Making lab test results available directly is more common, but it’s not routine, either. Just seven states and the District explicitly allow patients to get test results directly from the lab, and seven others permit it with provider approval.

Last fall, the Department of Health and Human Services proposed a rule giving patients in every state direct access to their lab test results. A comment period ended in November, but there’s no date set for release of a final rule, according to a spokesperson for the Centers for Medicare and Medicaid Services, which would release it.

Patients don’t share clinicians’ ambivalence about getting direct, easy access to their health information. No matter their age, education or health status, more than 90 percent of participants in the OpenNotes survey said they thought being able to see doctors’ notes was a good idea.

“In a way, that was the biggest surprise of the study,” says Jan Walker, the study’s lead author. Walker is a nurse at Beth Israel Deaconess Medical Center in Boston, whose practice participated in the study along with those at Geisinger Health System in rural Pennsylvania and Harborview Medical Center in Seattle. “It reflects consumers’ universal interest in their own care.”

In 2010, Quest Diagnostics, a large lab services company, introduced a free smartphone application called Gazelle that lets consumers in 33 states and the District download their lab test results directly. Since then, 125,000 patients have used the service, the company says. “[Gazelle] will help you have an educated conversation with your physician,” says Jon Cohen, chief medical officer for Quest.

John Hadley downloaded the Gazelle app to his iPhone after he developed deep vein thrombosis and was prescribed a blood thinner to help prevent another blood clot. At first, Hadley had to get a blood test every few days so his physician could adjust the medication dose if necessary; now he’s tested every few weeks.

Gazelle let Hadley, 53, track his results and make adjustments to his diet if they started to drift. (Foods high in Vitamin K can affect the ability of blood to clot.)

“It’s my health and my results, I should be able to get them as easily as possible,” says Hadley, IT manager who lives in Parsippany, N.J.

Giving patients direct access to their medical information may also help catch physician errors and omissions, say experts.

Walker says she has heard of patients in the OpenNotes project who have reviewed their doctor’s notes and realized that a test the physician called for hadn’t been ordered. Even more troubling, studies have indicated that as many as a quarter of abnormal test results don’t receive timely follow-up. If patients can look up their results online, that figure might decline.

On the other hand, increased patient access “has the potential to diffuse responsibility” for following up on test results if patients and their doctors both expect the other to check on the results, says Hardeep Singh, chief of the health policy and quality program at the Houston Veteran Affairs Health Services Research and Development Center of Excellence.

Many clinicians are troubled by the prospect that patients may get bad or confusing news without a physician or other health-care provider on hand to help put the information in context.

Patients who use the Gazelle app can’t get direct results on HIV, cancer or genetic diagnostic tests, says Cohen. There’s a 48-hour delay on releasing all other test results, to give physicians a chance to contact the patient and discuss the findings first.

Likewise, patients who participated in the OpenNotes project can’t access the visit notes until their physician has signed off on their release.

“No one wants to see their diagnosis of cancer on their own without a medical professional,” says Jonathan Darer, chief innovation officer for Geisinger Health System, which makes most patient information available online. “We try to manage that.”

At the same time, however, it’s important to ensure that patients get information promptly. “Not knowing is incredibly anxiety-provoking,” says Darer.

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

– Provided by Kaiser Health News.

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