by Anthony Robbins, MD, MPA
A recent editorial in the New York Times, “Rolling the dice on food-borne illnesses,” focused on just one of the many health dangers related to the federal government shutdown. The editorial reminded me of developments in Vermont almost forty years ago, when I was the State Health Commissioner.
Vermont’s House Appropriations Committee was threatening to cut the Health Department’s budget. After telling the Committee members that they would be hurting the Department’s ability to protect the public, including from foodborne and waterborne illness, I suggested naming any future disease outbreaks after members of the Committee. I don’t know what tipped the balance, but the Health Department budget was kept intact.
Perhaps the leaders of the Food and Drug Administration and the Centers for Disease Control and Prevention could prepare a list of the leadership in the U.S. House of Representative after whom serious disease outbreaks would be named.
Anthony Robbins, MD, MPA is co-Editor of the Journal of Public Health Policy. He directed the Vermont Department of Health, the Colorado Department of Health, the U.S. National Institute for Occupational Safety and Health, and the U.S. National Vaccine Prog
Strategies to reduce the deathly toll of prescription drug abuse are reaping positive outcomes, though not every state is taking full advantage, according to a new report from Trust for America’s Health.
Released earlier this week, “Prescription Drug Abuse: Strategies to Stop the Epidemic” found that 28 states and Washington, D.C., scored six or less out of 10 possible indicators of “promising strategies” to address prescription drug abuse, which has contributed to a startling rise in overdose deaths. Since 1999, such deaths have doubled in 29 states, four of which experienced a quadrupling of overdose deaths. In fact, deaths related to prescription drugs now outpace those from heroin and cocaine combined, with the cost of prescription painkiller abuse topping $53 billion annually in lost productivity, medical care and criminal justice services. Also, the Centers for Disease Control and Prevention notes that while men are still more likely to die from a painkiller overdose, women are quickly catching up.
“Prescription drugs can be a miracle for many, but misuse can have dire consequences,” said Jeff Levi, executive director of Trust for America’s Health (TFAH), in an official news release. “The rapid rise of abuse requires nothing short of a full-scale response — starting with prevention and education all the way through to expanding and modernizing treatment. There are many promising signs that we can turn this around, but it requires urgent action.”
The report found that while preventive strategies and policies seem to be having a positive impact — the number of Americans struggling with prescription drug abuse declined by nearly a million from 2010 to 2011 — states’ use of these strategies is mixed. Specifically, the report stated that only 17 states and D.C. have legally expanded access to naloxone, a drug that can prevent overdose deaths; the same number of states and D.C. offer some degree of legal immunity from criminal charges for those seeking help for themselves or someone else experiencing an overdose; and only 22 states legally require or recommend education for health care providers who prescribe painkillers.
In addition, only 32 states require or permit a pharmacist to check IDs, and only about half of states and D.C. are taking part in the Affordable Care Act-authorized Medicaid expansion, which will give low-income residents coverage for substance abuse treatment services, though there is some concern that there won’t be enough providers to actually meet new demands. (Click here for a tally of states that are expanding Medicaid eligibility.) Prescription drug monitoring programs — statewide systems that let prescribers check a patient’s prescription history to prevent “doctor shopping” — exist in just about every state, but vary in funding levels and capabilities. The implementation of all of these measures and programs were used to assess each state’s response to the prescription drug abuse epidemic.
In scoring states’ success, TFAH put New Mexico and Vermont at the top of the pack, with scores of 10 out of 10. Kentucky, Massachusetts, New York and Washington followed with nine out of 10. At the bottom of the pack were Missouri and Nebraska with three out of 10 and South Dakota with two out of 10. Probably not surprising to public health practitioners, prevention and a public health approach of education and linking people to treatment were singled out as top courses of action. The report states:
A range of strategies and policies can help to reduce the overall rates of prescription drug abuse in America. Curbing the epidemic requires understanding the causes behind it, identifying individuals and groups most at-risk for potentially abusing drugs, knowing the latest science about addiction, and recognizing the most effective approaches for treatment.
Prevention is “the best strategy,” according to the National Institute on Drug Abuse (NIDA), to avoid misuse in the first place.
To download a full copy of the TFAH report, click here. Also, read more about the nation’s painkiller abuse epidemic, the health and public health sectors’ response as well as the chronic pain patients caught in the middle in the Pump Handle’s four-part series found here, here, here and here.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Over the course of three days, three miners were killed on the job in West Virginia, Illinois, and Wyoming. Ken Ward Jr. describes their deaths in the Charleston Gazette:
In the recent incidents, 62-year-old Roger R. King of Moundsville was killed Friday when he was hit in the head by part of a chain being used during a longwall machine move at CONSOL Energy’s McElroy Mine in Marshall County.
On Saturday, a miner at Alliance Coal’s Pattiki Mine in White County, Ill., was killed when an underground cart rolled over and he was pinned underneath it. Local media identified the miner as Robert Smith, 47, of Norris City, Ill.
And on Sunday, a third miner was killed when his bulldozer went over a 150-foot highwall at MidAmerican Energy’s Bridger Mine in Sweetwater County, Wyo. SNL Financial News identified that miner as Chris Stassinos, who had worked at the operation for two years.
Ward notes that during the federal government shutdown, the Mine Safety and Health Administration’s contingency plan called for furloughing 1,400 of its 2,355 employees and that the agency is conducting only “targeted inspections” of “high-hazard” mines.
In a follow-up article, Ward quotes United Mine Workers President Cecil Roberts, who warned “the government’s watchdog isn’t watching,” and Senator Jay Rockefeller (D-West Virginia), who expressed “deep frustration about the misguided government shutdown that has furloughed MSHA inspectors and prevented them from conducting the regular inspections that make sure coal companies are operating their mines as safely as possible.”
In other news:
EHS Today and National Council on Occupational Safety and Health: The Occupational Safety and Health Administration has fined the parent company of the West Fertilizer Company $118,300 for 24 violations. The explosion and fire at the Texas plant killed 15 workers. National COSH notes that the government shutdown forced the US Chemical Safety Board to halt its investigation of the disaster, and urges Congress to give the CSB enforcement ability.
Dallas Morning News: Interviews with nearly a dozen firefighters and medical personnel about the fertilizer-plant explosion and fire in West, Texas reveal “the risks they faced and the horrors they experienced that night.”
Huffington Post: Many adults are exposed to dangerous levels of lead on the job, and the Occupational Safety and Health Administration’s exposure limit hasn’t been tightened even as research has shown health risks from lower levels.
Kennebec Journal (Maine): Research shows firefighters’ exposure to toxic chemicals increases their cancer risk. A 15-year study following Maine firefighters will analyze blood levels of various chemicals and aim to identify those that affect cancer development.
Reuters: A fire in a garment factory in Gazipur, Bangladesh, killed nine workers and injured 50.
Who paid for the study? That’s an important piece of information to have when considering a study’s methods and reported findings. Financial ties are the most obvious conflicts of interest, but others include pre-publication review and other requirements imposed by a study’s sponsors.
Scientists publishing papers in the leading biomedical journals have, for at least ten years, been providing readers with disclosures of real or potential conflicts. The editors of more than 1,300 medical journals require authors to comply with specific disclosure policies. Researchers from other disciplines, however, do not necessarily follow the same disclosure requirements.
Earlier this year, the Charleston Gazette’s Ken Ward, Jr. reported on studies that challenged the findings of public health researchers which found that mining operations may adversely affect a community’s health. He noted, however, that in the authors’ reports and presentations of their critiques, they were not transparent about who paid for the studies. A few of the papers offered an acknowledgement to “ARIES.” But my recollection is that some of these acknowledgements failed to let readers know that ARIES was an acronym. ARIES is the “Appalachian Research Initiative for Environmental Science (ARIES).” It took some of Ward’s own skillful digging to find out who funds ARIES. He learned and reported that the program’s initial funders, some of the biggies in the mining industry, included Alpha Natural Resources, International Coal Group, Massey Energy Co., TECO Coal, Patriot Coal and Norfolk Southern. (Following the Charleston Gazette’s April 2013 story, ARIES updated its website with a bit better disclosure.)
After reading parts of OSHA’s proposed rule to protect silica-exposed workers, my interest turned again to conflicts of interest and disclosure policies. OSHA published this proposal in September and is now seeking public comment on it.
On the very first page of the Federal Register notice, OSHA writes:
“If you submit scientific or technical studies or other results of scientific research, OSHA requests (but is not requiring) that you also provide the following information where it is available: (1) Identification of the funding source(s) and sponsoring organization(s) of the research; (2) the extent to which the research findings were reviewed by a potentially affected party prior to publication or submission to the docket, and identification of any such parties; and (3) the nature of any financial relationships (e.g., consulting agreements, expert witness support, or research funding) between investigators who conducted the research and any organization(s) or entities having an interest in the rulemaking.”
The agency’s notice continues:
“If you are submitting comments or testimony on the Agency’s scientific and technical analyses, OSHA requests that you disclose: (1) The nature of any financial relationships you may have with any organization(s) or entities having an interest in the rulemaking; and (2) the extent to which your comments or testimony were reviewed by an interested party prior to its submission. Disclosure of such information is intended to promote transparency and scientific integrity of data and technical information submitted to the record.”
This is the first time OSHA has made such a request of commenters to a proposed rule. I’m glad to see it.
Over the years, I’ve observed OSHA’s rulemaking efforts. It’s not unusual for a trade association or other interested group to submit reports or analyses that have not been published in the peer-reviewed literature. These documents are often prepared by individuals with lots of degrees and credentials after their names. Although it may be obvious that these experts are retained by a particular trade association, it’s not necessarily clear what companies paid for their work, and that information is rarely disclosed.
In this OSHA rulemaking, the agency is requesting disclosures on:
“the extent to which the research findings were reviewed by a potentially affected party prior to publication or submission to the docket, and identification of any such parties”
OSHA’s request for this information—but not requiring it—is a step in the right direction. Regulations to protect U.S. workers from serious and fatal injuries and illnesses are too important for this information not to be disclosed. Policy makers need to be able to consider all aspects of the evidence submitted in a rulemaking. This includes who paid for the evidence and their role, from start to finish, in it.
By making the request for these disclosures, an interesting chain of events may occur. Some commenters may not disclose the requested information. OSHA may decide not to press them on the matter. After all, OSHA says that it is asking for, but “not requiring” such disclosure. But OSHA’s public hearings are unique among federal regulatory agencies. OSHA allows those offering testimony to cross-examine others who are also testifying. I wouldn’t be surprised if disclosure requests are made during these cross examinations. Stay tuned. It could be quite interesting.
OSHA’s public hearings on the silica proposed rule are scheduled to begin on March 4, 2014.
The government shutdown has cut off the flow of funds from USDA to WIC, the Special Supplemental Nutrition Program for Women, Infants and Children. Some states have enough money to keep their programs running for a while, but Utah’s WIC clinic has already closed its doors to new clients as staff in the state are furloughed.
WIC serves approximately nine million low-income women and children. It provides vouchers for nutritious food (milk, cereal, vegetables, etc) and infant formula, counseling on healthy eating, breastfeeding support, and healthcare referrals. Zoë Neuberger and Robert Greenstein of the Center on Budget and Policy Priorities write of WIC:
Extensive research shows that WIC participation contributes to healthier births, higher intake of key nutrients, less consumption of sugar and fats, and a stronger connection to preventive health care. It is widely regarded as one of the most effective of all social programs.
The research they cite on the impacts of WIC participation is located on the USDA website, so an attempt to access it yields only the message “Due to the lapse in federal government funding, this website is not available.”
For Forbes, Clare O’Connor spoke to some of the people trying to assure continued services to WIC clients:
So far the situation is most dire in Arkansas and Utah, according to Rev. Douglas Greenaway, who heads up nonprofit advocacy group the National WIC Association. Utah’s WIC program, which already serves 65,000 moms and babies, has now stopped accepting new participants.
“There are health consequences when mothers cannot provide food and nutrition for their kids,” said Rev. Greenaway. “There’ll be no infant formula and no breastfeeding support. If the baby doesn’t latch, that’s it.”
On Tuesday evening directors of WIC offices around the country stressed that they’re still up and running. Margaret Saunders, who oversees the program in Chicago and surrounding Cook County, hit the phones to allay the fears of panicked women.
“We have an active case load of 50,000 moms,” she said. “That’s a lot of people to reassure.”
Saunders described the government shutdown as adding insult to injury for an already vulnerable population.
“America is not realizing how many low-income pregnant women and children we have in this country,” she said. “They have no safety net. These women are trying to have a healthy pregnancy, and they’re asking, ‘how am I going to feed my family?’ It’s a terrifying moment, and it’s beyond my control. At our agency, we have no cushion. If our funding stream stops we will temporarily suspend service.”
WIC has typically had bipartisan support in Congress, and there seems to be broad agreement that nutrition for young children during important developmental stages is something worth investing in. But until Congress starts doing its job and allowing for federal spending again, vulnerable mothers of young children will have even less of a safety net than they usually do.
Steven O’Dell, 27, went to work on November 30, 2012 for his “hoot owl” shift at Alpha Natural Resources’ Pocahontas Coal Mine. He never came home. O’Dell was fatally crushed between two pieces of mobile mining equipment. Three weeks after his death, his wife Caitlin gave birth to their son Andrew.
The young widow wants to make sure that another miner’s family doesn’t have to suffer the pain and grief that she’s endured. As reported by The Charleston Gazette’s Ken Ward, Jr. Caitlin O’Dell spoke last week before the West Virginia Board of Coal Mine Health and Safety, urging them to require mine operators to install “proximity detection” devices on mobile equipment. The devices can be programmed to give warning signals or shut down mobile equipment when it gets too close to workers. Had such a device been installed in the equipment around which Steve O’Dell had been working, his life could have been saved. At least four proximity detection systems specifically designed for underground mining equipment are commercially available.
Quoting from the Gazette’s story, Caitlin O’Dell told board members:
“I’m here to ask you to stop history from repeating itself. You have an opportunity today to change history for the next family. It’s too late for mine. “
The Board of Coal Mine Health and Safety is authorized by a West Virginia state law, and meets at least monthly. Its primary responsibility is reviewing existing regulations and promulgating new rules to enhance health and safety for the state’s coal miners. Three members of the board are appointed to “represent the viewpoint of those [mine] operators in this state” and three members “represent the viewpoint of the working mines in this state.” Currently, the three labor representatives are with the United Mine Workers and the three industry appointees are with Arch Coal, Patriot Coal and the West Virginia Coal Association.
Ken Ward, Jr. described what happened after the young widow made her case to the Board.
“Board members expressed their sympathies to Mrs. O’Dell. They admired her 9-month-old son, and they thanked her for coming to ‘put a face’ on the issue. Then, the board’s three industry representatives voted to block two different motions from their United Mine Workers counterparts to move forward with ‘proximity detection’ rules.”
“Board member Chris Hamilton, a West Virginia Coal Association vice president, said the matter needs further study and discussion.”
The three labor representatives voted down Hamilton’s proposal to conduct meetings around West Virginia to discuss the devices, as well as alternatives to them, such as reflective clothing and strobe lights. The coal industry’s excuse that more study is needed on the devices—devices that are already commercially available—is just another reason the public has little respect for the coal industry.
As Ward noted, with an equally divided Board, inaction continues by the State to require proximity detection devices. He also reminds us that federal action on this life-saving equipment is also stalled.
In August 2011, the Mine Safety and Health Administration (MSHA) in the Department of Labor published a proposal to require proximity detection devices. The agency indicated that coal miners face a “grave danger” and that these devices would prevent fatal injuries. The agency, however, has yet to finalize that rule.
Mine worker in the U.S. continue to die on-the-job after being struck by mobile equipment. Earlier this year, John Myles, 44, was killed this way at the Affinity Mine in West Virginia. So to was Nathanial Clarida, 35, at a Peabody Energy mine in Illinois.
Following MSHA’s investigation of the fatality at the Affinity Mine, the operator installed proximity detection devices on two pieces of mobile coal mining equipment. For John Myles and his family, that’s too little too late.