Wednesday, February 14, 2018

Spread the Love, Not the Disease

By Arathi Shah, MD, Dallas 
TMA Be Wise — Immunize℠ Physician Advisory Panel member

Love is in the air! It’s February, the month of celebrating love and our loved ones. We can fully embrace this caring spirit, going beyond candy and flowers, by keeping the air as free of germs as possible. The best ways: covering our coughs and sneezes, following handwashing hygiene, and staying current on our family’s vaccinations — and our own.

Vaccinations are our best allies to prevent and limit the spread of debilitating and life-threatening diseases. When we get vaccinated, we are protecting ourselves, our family, and our community. Physicians and other health experts call this “community immunity” or “herd immunity.”

When more of us are vaccinated, germs can’t spread as easily within a community, so fewer people are likely to get sick. And if someone does get sick, the chance of an outbreak is less. The goal is that vaccine-preventable diseases, like polio, can be wiped out.

Community immunity protects everyone from illness. Even people who can’t get vaccinated have some protection — such as newborns, pregnant women, elderly people, and those with weak immune systems (like people who have cancer). Community immunity also is important for a very small group of people for whom vaccines are less effective.

The vaccination rate to achieve and maintain community immunity varies by disease, but usually ranges from 83 to 95 percent. So, eight or nine out of 10 people have to be immunized.

Prevention is always better than cure. For the sake of our loved ones and our communities, we all need to stay current on our vaccinations. Consult your physician to make sure your family is up to date on recommended vaccinations.

Protecting our world from serious, vaccine-preventable diseases such as measles and whooping cough requires a community-wide effort. In this day and age, when the world has become one large family of people traveling near and far, it is important for us to remember to bring home the love, not the disease.

Be Wise — Immunize is a service mark of the Texas Medical Association.

Tuesday, February 6, 2018

Learning From the Past: The Flu at Its Ugliest

Sandra Dickerson, MD, Lubbock
TMA Be Wise — Immunize℠ Advisory Panel member

In a year when hospitals and emergency departments are overrun with patients and the news reports children dying from influenza, I cannot help but think of 15-year-old Pierpont Balderson.

Who was the young Balderson? The first person to die in Dallas — 100 years ago during the Flu Pandemic of 1918.

One-third of the world population, then estimated at 500 million, was infected with Spanish Flu, a particularly deadly strain of the flu virus, in 1918. In the span of one year, 20 to 50 million people died, mostly young people and mostly from the pneumonia that followed the flu.

This was three times the number of deaths in the “War to End All Wars,” — World War I.

1918 Spanish influenza ward at Camp Funston, Kansas. Image via U.S. Army.

Dallas was lucky. The death rate from the Spanish Flu was “only” 286 per 100,000 residents. New Orleans suffered even more fatalities, with 734 flu deaths per 100,000 people.

But the most disturbing statistic is the deaths were mostly in young people who died from pneumonia, a secondary infection that followed their infection with the flu.

Public health physicians still don’t know where this virulent virus came from, so they don’t know when it will happen again. They only know it will happen again — and that’s the bad news.

The good news is, back then we didn’t have anti-viral drugs to lessen the symptoms of the flu or antibiotics for pneumonia. And we didn’t have the influenza vaccine, nor the capability to develop one.

Now we do.

So this year as we see another scourge of flu (and every year), follow these tips to help keep yourself healthy:

  • Wash your hands.
  • Cover your sneeze or cough.
  • Don’t go to work sick.
  • Augment your immune system to fight off the virus: Get your flu shot!

By doing these simple things, you might save the world.

Be Wise — Immunize is a service mark of the Texas Medical Association.

Tuesday, January 23, 2018

CHIP Renewed For Six Years As Congress Votes To Reopen Federal Government

By Julie Rovner
Kaiser Health News

A brief, partial shutdown of the federal government ended Monday, as the Senate and House approved legislation that would keep federal dollars flowing until Feb. 8, as well as fund the Children’s Health Insurance Program for the next six years.

President Donald Trump signed the bill Monday evening.

The CHIP program, which provides coverage to children in families who earn too much to qualify for Medicaid but not enough to afford private insurance, has been bipartisan since its inception in 1997. But its renewal became a partisan bargaining chip over the past several months.

Funding for CHIP technically expired Oct. 1, although a temporary spending bill in December gave the program $2.85 billion. That was supposed to carry states through March to maintain coverage for an estimated 9 million children, but some states began to run short almost as soon as that bill passed.

The Georgetown University Center for Children and Families estimated that 24 states could face CHIP funding shortfalls by the end of January, putting an estimated 1.7 million children’s coverage at risk in 21 of those states.

Meanwhile, both houses of Congress had been at loggerheads over how to put the program on firmer financial footing.

In October, just days after the program’s funding expired, the Senate Finance Committee approved a bipartisan five-year extension of funding by voice vote. But that bill did not include a way to pay the cost, then estimated at $8.2 billion.

In November, the House passed its own five-year funding bill for the program, but it was largely opposed by Democrats because it would have offset the CHIP funding by making cuts to Medicare and the Affordable Care Act (ACA).

Prospects for a CHIP deal brightened earlier this month when the Congressional Budget Office re-estimated how much the extension of funding for the program would cost. In a letter to Senate Finance Committee Chairman Orrin Hatch (R-Utah) on Jan. 5, CBO said changes to health care made in the tax bill would result in lowering the five-year cost of the program from $8.2 billion to $800 million — effectively a reduction of 90 percent.

The reason, explained CBO, is that the landmark tax bill passed in December eliminated the ACA’s individual mandate, which would likely drive up premiums in the individual market. Those higher premiums, in turn, would increase the federal premium subsidies for those with qualifying incomes. As a result, if kids were to lose their CHIP coverage and go onto the individual exchanges instead, the federal premium subsidies would cost more than their CHIP coverage.

Driving that point home, on Jan. 11, CBO Director Keith Hall wrote to Rep. Frank Pallone (D-N.J.) that renewing CHIP funding for 10 years rather than five would save the federal government money. “The agencies estimate that enacting such legislation would decrease the deficit by $6.0 billion over the 2018-2027 period,” the letter said.

That made it easier for Republicans to include the CHIP funding in the latest spending bill. But it infuriated Democrats, who had vowed not to vote for another short-term spending bill until Congress dealt with the issue of immigrant children brought to the country illegally by their parents.

Republicans, said Senate Minority Leader Chuck Schumer (D-N.Y.) on Sunday, “were using the 10 million kids on CHIP, holding them as hostage for the 800,000 kids who were Dreamers. Kids against kids. Innocent kids against innocent kids. That’s no way to operate in this country.”

Republicans, however, said it was the opposite — that Democrats were holding CHIP hostage by not voting for the spending bill. “There is no reason for my colleagues to pit their righteous crusade on immigration against their righteous crusade for CHIP,” said Hatch. “This is simply a matter of priorities.”

The CHIP renewal was not the only health-related change in the temporary spending bill. The measure also delays the collection of several unpopular taxes that raise revenues to pay for the ACA’s benefits. The taxes being delayed include ones on medical device makers, health insurers and high-benefit “Cadillac” health plans.

The bill does not, however, extend funding for Community Health Centers, another bipartisan program whose funding is running out. That will have to wait for another bill.

Update: This story was updated at 9:15 p.m. on Jan. 22 to report that President Donald Trump signed the bill.

KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation.

Thursday, January 18, 2018

The Anti-Vaccination Movement is Fake — and Dangerous — News

By Sid Roberts, MD
Lufkin Radiation Oncologist

This blog post was originally published Jan. 14 at the Lufkin Daily News and on the Angelina Radiation Oncology Associates blog.

Most vaccine-preventable diseases of childhood are at or near record lows. Vaccines prevent the deaths of about 2.5 million children worldwide every year. Yet some highly contagious diseases like measles and whooping cough still pop up where enough people are unvaccinated.

In the United States, compliance with childhood vaccinations remains quite high overall. At least 90 percent of children are getting the recommended vaccinations on time for many diseases — but not all, and not in all locales. Maintaining a high percentage of children vaccinated is important. Herd immunity occurs when a certain threshold percent of a community (such as a school) is vaccinated, reducing the probability that those who are not immune will come into contact with an infectious individual. For highly infectious diseases like measles, 90 to 95 percent of a community needs to be vaccinated to reach herd immunity. That is why vaccinations are required for our schoolchildren.

According to the Texas Department of State Health Services, students are required to have seven vaccinations in order to attend a public or private elementary or secondary school in Texas: Diphtheria/Tetanus/Pertussis (DTaP/DTP/DT/Td/Tdap), Polio, Measles, Mumps, Rubella (MMR), Hepatitis B, Varicella (chicken pox), Meningococcal (MCV4) and Hepatitis A. Texas law allows physicians to write medical exemptions if they feel the vaccine(s) would be “medically harmful or injurious to the health and well-being of the child or household member.” All well and good.

Texas law also allows — ill-advisedly — “parents/guardians to choose an exemption from immunization requirements for reasons of conscience, including a religious belief.” The “belief” of the anti-vaccination movement is based on lies and is only “religious” in its cult-like following of a dangerous (and discredited) Pied Piper, Andrew Wakefield.

A 2017 Washington Post article states, “A leading conspiracy theorist is Andrew Wakefield, author of the 1998 study that needlessly triggered the first fears. (The medical journal BMJ, in a 2011 review of the debacle, described the paper as “fatally flawed both scientifically and ethically.”) Wakefield’s Twitter handle identifies him as a doctor, but his medical license has been revoked. The British native now lives in Austin, where he is active in the state and national anti-vaccine movement.”

The political noise made by these charlatan zealots has been difficult for legislators to ignore. This disturbing movement has been gaining traction, especially in certain private schools in Texas. In one such school, the Austin Waldorf School, reportedly more than 40 percent of the school’s 158 students are unvaccinated. This is mindboggling ignorance in a “school” where tuition ranges from $11,450 to $17,147 a year.

Baylor College of Medicine professor Peter J. Hotez, MD, Ph.D., founding dean of the National School of Tropical Medicine and director of the Texas Children’s Hospital Center for Vaccine Development, is truly on the front lines of the battle being waged by the anti-vaccination movement. The fact that Hotez is both a world authority on infectious disease and a parent of an autistic child hasn’t stopped the anti-vaccination movement from attacking him. It does, however, make their attacks even more sad; they have no facts to back up their case, so they just get mean (for example, saying he is in denial that vaccination caused his daughter’s autism).

This insidious — and disproven — idea that vaccines are linked to autism continues to rear its ugly, dangerous head, despite what Hotez calls “rock-solid proof” to the contrary published in peer-review journals like the New England Journal of Medicine, JAMA (the Journal of the American Medical Association), the British Medical Journal, and by organizations like the Institute of Medicine and the American Academy of Pediatrics. The data that originally was claimed to show a link between vaccines and autism was later found to be falsified.

In other words, the anti-vaccine crowd is fueled by conspiracy theories and truly fake news. (Though not known with certainty, it is believed genetics and environmental exposure during early pregnancy may play a role in development of autism.)

The problem with conspiracy theories is that facts don’t matter. Those who try to argue based on facts are automatically considered part of the conspiracy. Unfortunately, President Donald Trump was rumored early in his presidency to favor a proponent of this “vaccines cause autism” theory to chair a new commission on vaccines, lending credence to the lies. Thankfully, those commission efforts appear to have stalled.

Some argue against vaccinations on the basis of parental rights. I’m so sorry, but you do not have the “right” to endanger others’ children. It is a time-honored role of government to provide a safe, healthy environment for its citizens. Just look at the public health disaster in Flint, Michigan, where elected officials abdicated their responsibility.

Texas needs to stop allowing nonmedical “conscientious” exemptions in our schools. Your “right” to ignorantly and dangerously keep your child from receiving vaccinations stops at the schoolhouse door. California made it tougher for parents to opt out of vaccination compliance and vaccination rates increased. Texas should do the same.

In this New Year and upcoming legislative session, may the Texas Legislature resolve to pass legislation limiting nonmedical exemptions. Here’s hoping they can ignore the cacophony of lies and claims of “rights” of those who try to stop them. Anti-vaxxers endanger all our children, and that is not a right they should have.

Dr. Sid Roberts is a radiation oncologist at the Temple Cancer Center in Lufkin. He can be reached at Previous columns may be found at

Tuesday, January 16, 2018

Ignoring your mental health is risky business

By Greg Smith, MD
South Carolina Psychiatrist

This article originally appeared on KevinMD and on Dr. Smith's blog, gregsmithmd.

My car has one hundred seventeen thousand miles on it after just three and a half years. It has taken me back and forth from here to Atlanta more times than I can remember, to the beach, to the mountains I love to hike, and across the country in a seven thousand mile trip four falls ago. It runs well, just like new as a matter of fact. I have pushed it, driven it fast and asked it to work hard for me.

What keeps it running that way? I am a fanatic about taking it in for regular service. Tire rotation, oil and filter changes, cabin air filter changes, alignments, and battery checks. I also pay attention to what goes into it, giving it good fuel to run on and high-quality oil to protect its parts from abnormal wear and tear.

What would happen to my car and its performance if I neglected routine maintenance, filled it with cheap gas and oil and never had things aligned and replaced as needed? Would it keep running so smoothly? Would it be reliable enough to take out on the highway for a cross-country trip?

In this fast-paced world, we drive ourselves like I drive my car. We push ourselves to do more with less, compromise our recovery and rest times, and overextend ourselves. We fill our schedules. We have lots to do. We try to divide our time among our families, jobs, hobbies, church, travel, entertainment, sports and holidays. We use our phones and other tech gear to keep up with everything around us, all the time. We pay more attention to outside stimuli and less and less to our own wellbeing. Some of us already have a mental illness that we try to manage. Others of us may be prone to develop one or have a strong family history.

Ignoring our mental health is risky business.

What can we do to promote good health, both physical and mental?

If you have any kind of mental or physical illnesses, see your health care provider regularly. Your doctor cannot adequately treat you if he does not know your most recent signs and symptoms.

Take medications as prescribed. This means take your own medication as ordered by your doctor, do not share your medications with others, and never take medications that are given to you by someone else, are not labeled, or are not meant for you.

If you drink alcohol, do so in moderation.

Avoid use of illicit drugs.

Watch your diet and weight. Try to control the types of foods you eat: the portion sizes and limit processed foods and sugar. Maintain your weight as close to normal for your height as practical.

Get enough sleep. Seven or eight hours are usually enough for most people. If you want to make one simple change that will affect your overall physical and mental health for the better, go to bed an hour earlier and get those zzzs.

Take frequent breaks. This means small breaks in the course of your busy day as well as longer breaks like vacations that take you completely away from your stressful daily environment. One tip for you: no one is going to freely give you this time in the real world. You simply must decide when you are going to break, how you’ll do it and schedule the time to get away.

Develop a hobby that you enjoy, and then spend enough time on it to develop a true love for the activity. Bike, read, paint, draw, play music, watch movies, build birdhouses. Anything that takes you away from stress and focuses you on something pleasant and satisfying is good for your mental health.

Work on developing or strengthening your “real” relationships with family and friends. We have gotten so caught up in our virtual and online personas and friendships in the last few years that many of us have completely forgotten about the power of a smile, a touch, or a laugh. Being with others in a real-time situation does wonders for mood, communication skills and bonding with the ones we really care about.

Finally, turn off the excess stimuli from the wider world every once in a while. In other words, unplug. Have a quiet cup of coffee and read a real newspaper. Take a walk in the woods. Nap. You’ll be surprised at how much you see and hear when your attention is off the screen and on the reality around you.

Ignoring your mental health is risky business.

Take the time and make the effort to do the things that keep you healthy and happy.

Greg Smith is a psychiatrist who blogs at gregsmithmd.

Wednesday, January 10, 2018

Texas Physicians Inject Billions Into Lone Star State’s Economy

New study shows physicians support more than 670,000 Texas jobs, generate nearly $118 billion in economic activity

Physicians add opportunity, growth, and prosperity to the Texas economy by creating 670,172 jobs and generating $117.9 billion in state economic activity, according to a new report, The Economic Impact of Physicians in Texas, released today by the Texas Medical Association (TMA) and the American Medical Association (AMA).

“Everyone knows, whether in small towns or large cities, Texas doctors care for our communities’ health, but this study shows those same physicians are vital to the economic health of those cities, towns, and Texas as a whole,” said Carlos J. Cardenas, MD, TMA president. “Texas physicians truly improve the health of Texans, but clearly also improve the health of Texas’ growing economy. It is remarkable.”

The study quantifies the boost that Texas’ 51,333 active patient care physicians provide to the state’s economy, producing a ripple effect that is felt statewide. The study measures physicians’ impact using four key economic indicators:

  • Jobs: Physicians support 670,172 total jobs in Texas —13.1 jobs for each physician on average.
  • Economic activity: Physicians generate $117.9 billion in economic output, comprising 7.3 percent of the Texas economy. Each physician generates $2.3 million for the local and state economy on average.
  • Wages and benefits: Physicians contribute $55.4 billion in total wages and benefits paid to workers across Texas, empowering a high-quality, sustainable workforce. Each physician contributes $1.1 million to workers’ wages and benefits on average.
  • State and local tax revenue: Physicians’ contribution to the Texas economy generates $3.5 billion in state and local tax revenue for their communities — translating to $68,599 in tax revenue paid for each physician on average — helping to pay for our schools, roads, criminal justice system, and health care services for all Texans. 

“The positive impact of physicians extends beyond safeguarding the health and welfare of their patients,” said AMA President David O. Barbe, MD. “The Economic Impact Study illustrates that physicians are woven into their local communities and have a vital role in fueling state economies by creating jobs, purchasing goods and services, and supporting public services through the tax revenue they generate.”

The report found that every dollar applied to physician services in Texas generates an additional $2.13 in other business activity. An additional 7.66 jobs, above and beyond the clinical and administrative personnel that work inside physician practices, are supported for each $1 million of revenue generated by a physician’s practice. In addition, Texas physicians generate more economic output, produce more jobs, and pay more in wages and benefits than higher education, nursing and community care facilities, legal services, and home health.

Across the country, physicians add $2.3 trillion to the U.S. economy, support more than 12.6 million jobs, contribute $1 trillion in total wages and benefits paid to U.S. workers, and generate $92.9 billion in state and local tax revenue.

Wednesday, December 20, 2017

No Sweeteners Added To Tax Bill To Spread Use Of Health Savings Accounts

By Michelle Andrews
Kaiser Health News

The following article, originally published by Kaiser Health News, answers reader questions about the impact the tax bill could have on health insurance plans.

The ongoing uncertainty about congressional changes to the health law — and their impact on insurance and the online marketplaces — continues to raise questions among consumers. Here are answers to recent queries.

Q: Does the GOP tax bill affect health savings accounts?

At this time, there are no changes aimed specifically at HSAs. These are savings accounts linked to high-deductible plans and exempt from tax liability.
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Congressional Republicans have been very interested in expanding the use of these tax-free accounts, and bills to repeal and replace the Affordable Care Act last summer included provisions to increase the maximum amount people could contribute to them or to allow people to use them to pay their health insurance premiums, among other things.  The GOP promotes the plans as a way to help consumers play a larger role in controlling their health spending and says that the tax advantages help people afford care.

The GOP tax legislation doesn’t incorporate any of those changes, said Roy Ramthun, president of HSA Consulting Services.

Some analysts say it’s still possible that HSA changes could be attached to other pieces of legislation, such as a spending bill or a bill to extend the Children’s Health Insurance Program.

“The GOP would like to get some of these HSA expansion provisions into one of these bills,” said Dorian Smith, a partner at human resources consultant Mercer.

Q: Republicans are seeking to repeal the individual mandate as part of the tax bill. Would that go into effect next year? 

Probably not. The joint bill that House and Senate negotiators have agreed to doesn’t repeal the ACA’s requirement that most people have health insurance, called the individual mandate. But it does repeal the penalty for not having coverage. That change wouldn’t take effect until 2019, however.

So, assuming the bill is enacted, most people will face a penalty if they don’t have health insurance next year of the greater of 2.5 percent of household income or $695 per adult.

Many people, however, qualify for one of several exemptions to the mandate. Those include people who have suffered a hardship like eviction or bankruptcy and those whose earnings are low enough that health insurance is considered unaffordable.

In 2017, health insurance is considered unaffordable if the cheapest comprehensive coverage you can find would cost more than 8.16 percent of your household income.
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“Because premiums have gone up so high in 2017 and 2018, there will be more people who qualify for the affordability exemption,” said Timothy Jost, a professor emeritus of law at Washington and Lee University in Virginia who is an expert on health law.

If you’re pondering whether to “go bare” next year, it’s worth noting that the Internal Revenue Service won’t accept electronically filed returns unless you indicate whether you had coverage, an exemption or will pay the penalty.

Q: None of the marketplace plans in my area offer out-of-state coverage or any coverage for non-network providers. Why would an insurer limit what’s offered in that way?

Plans with broad provider networks have been steadily shrinking. Nearly three-quarters of plans sold on the ACA’s marketplaces in 2018 have restrictive networks, according to an analysis by the consulting firm Avalere Health. The percentage of such plans has steadily increased since 2015, when it was 54 percent, the analysis found.

Health maintenance organization (HMO) plans and exclusive provider organization (EPO) plans were categorized as restrictive because they typically have relatively fewer providers and don’t provide coverage for out-of-network care. Preferred provider organization (PPO) and point-of-service plans, on the other hand, were considered less restrictive because they generally have broader networks of providers and offer some out-of-network coverage.

The reason plans with restrictive networks are proliferating is because they help reduce costs, said Chris Sloan, a senior manager at Avalere.

“One of the ways to do that is to have a narrower network,” he said.

But there may be an upside for consumers. “It’s not just reducing costs for the sake of costs, it’s also to slow the premium growth,” he said.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
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