EPA Backs Off Factory Farm Regulation

Whether it’s a Democratic or a Republican administration, favoring corporate power over the well-being of the public seems to carry the day more often than not. What a disappointment this administration has been on these types of issues.

The Environmental Protection Agency is obliged under the Clean Water Act to monitor America’s waterways and shield them from the toxic runoff from factory farms. But the growth of that industry, and its courtroom tenacity, has far outstripped the E.P.A.’s efforts to restrict runoff from manure lagoons and feedlots.

Last year, the agency meekly withdrew two proposed rules. One would have gathered basic information from all factory farms. The other proposed rule would have expanded the number of such farms required to have a national pollution discharge permit. Fewer than 60 percent do now.

Then, last week, in yet another retreat, the agency announced that promised new regulations governing feedlot discharges nationally would not be forthcoming.

According to the E.P.A.’s own studies, agricultural runoff is the leading cause of impaired water quality. The amount of manure produced by factory farms is staggering. The agency estimates that those operations create between 500 million and 1 billion tons of manure, three times as much waste as humans produce in the United States. The task of keeping those hundreds of millions of tons of animal waste out of rivers, lakes and estuaries is enormous, clearly requiring a strong set of revised regulations for the handling of factory-farm waste, including provisions for tracking waste when it’s been moved offsite.

Right now, the patchwork of regulations — which assume a great deal of self-policing — suits the factory-farm industry all too well. So does the E.P.A.’s inability to gather even the most basic information about those farms.

 

Obamacare Exchanges in CA, WA, and OR Post Premiums Drastically Lower Than Many Projections

From Sarah Kliff in the Washington Post:

The Congressional Budget Office predicted back in November 2009 that a medium-cost plan on the health exchange – known as a “silver plan” – would have an annual premium of  $5,200. A separate report from actuarial firm Milliman projected that, in California, the average silver plan would have a $450 monthly premium.

Now we have California’s rates, and they appear to be significantly less expensive than what forecasters expected.

On average, the most affordable “silver plan” – which covers 70 percent of the average subscriber’s medical costs – comes with a $276 monthly premium. For the 2.6 million Californians who will receive federal subsidies, the price is a good deal less expensive, the amount noted in green below.

 

This is what is happening in the states whose governors and legislatures are not seeking to sabotage the implementation of the Affordable Care Act. California, Washington, and Oregon are showing similarly low rate offerings on the insurance exchanges, which at the beginning will apply mainly to individuals who were not previously insured.

In other words, the Affordable Care Act is providing affordable insurance to those previously unable to purchase it.

Obamacare Exchanges Already Forcing Private Insurers To Lower Their Premiums

From Oregon, which in many ways is fast becoming a model for how to do health reform right (their recently released low back pain guidelines are also excellent):

In a striking illustration of the promise that the health law holds for consumers, two Oregon private insurers vying to sell coverage on the state’s Obamacare insurance marketplace this October are reevaluating their opening bids for the plans’ monthly premiums. The reason? A side-by-side regional comparison of all proposed 2014 premiums for Oregon marketplace plans became public on Oregon’s marketplace website Thursday, and showed that the two insurers’ planned monthly premiums were far higher than other proposals. That raised fears among the companies’ officials that their plans wouldn’t be competitive on the market later this year, leading them to proactively request a rate reduction — and as more of Obamacare is implemented, state insurance commissioners expect that trend to continue:

“Posting rate comparisons company-by-company is a taste of what is to come,” says Cheryl Martinis of the Oregon Insurance Division.

Judging by the reaction, there’s already an impact.

Providence Health Plan on Wednesday asked to lower its requested rates by 15 percent. Gary Walker, a Providence spokesman, says the “primary driver” was a realization that the plan’s cost projections were incorrect. But he conceded a desire to be competitive was part of it.

A Family Care Health Plans official on Thursday said the insurer will ask the state for even greater decrease in requested rates. CEO Jeff Heatherington says the company realized its analysts were too pessimistic after seeing online that its proposed premiums were the highest.

“That was my question when I saw the rates was, ‘Can we go in and refile these?’” he said. “We’re going to try to get these to a competitive range.”

Although some insurers have been using Obamacare as an excuse to hike premiums despite record profits, such rate hikes have been rarer — and less extreme — since the law’s passage.

 

U.S. Compares Poorly to Europe on Agricultural Safety Policies

In Mother Jones, Tom Philpott flags seven food-related substances or procedures that are banned in Europe but allowed in the United States.

Here are the first three, and it doesn’t really look any brighter after that:

 1. Atrazine Why it’s a problem: A “potent endocrine disruptor,” Syngenta’s popular corn herbicide has been linked to a range of reproductive problems at extremely low doses in both amphibians and humans, and it commonly leaches out of farm fields and into people’s drinking water.

What Europe did: Banned it in 2003.

US status: EPA: “Atrazine will begin registration review, EPA’s periodic reevaluation program for existing pesticides, in mid-2013.”

2. Arsenic in chicken, turkey, and pig feed Why it’s a problem: Arsenic is beloved of industrial-scale livestock producers because it makes animals grow faster and turns their meat a rosy pink. It enters feed in organic form, which isn’t harmful to humans. Trouble is, in animals guts, it quickly goes inorganic, and thus becomes poisonous. Several studies, including one by the FDA, have found heightened levels of inorganic arsenic in supermarket chicken, and it also ends up in manure, where it can move into tap water. Fertilizing rice fields with arsenic-laced manure may be partially responsible for heightened arsenic levels in US rice.

What Europe did: According to the Institute for Agriculture and Trade Policy, arsenic-based compounds “were never approved as safe for animal feed in the European Union, Japan, and many other countries.”

US status: The drug giant Pfizer “voluntarily” stopped marketing the arsenical feed additive Roxarsone back in 2011. But there are still several arsenicals on the market. On May 1, a coalition of enviro groups including the Center for Food Safety, the Institute for Agriculture and Trade Policy, and the Center for Biological Diversity filed a lawsuit demanding that the FDA ban them from feed.

3. “Poultry litter” in cow feed

Why it’s a problem: You know how arsenic goes inorganic—and thus poisonous—in chickens’ guts? Consider that their arsenic-laced manure is then commonly used as a feed for cows. According to Consumers Union, the stuff “consists primarily of manure, feathers, spilled feed, and bedding material that accumulate on the floors of the buildings that house chickens and turkeys.” The “spilled feed” part is of special concern, because chickens are often fed “meat and bone meal from dead cattle,” CU reported, and that stuff can spill into the litter and be fed back to cows, raising mad cow disease concerns.

What Europe did: Banned all forms of animal protein, including chicken litter, in cow feed in 2001.

US status: The practice remains unrestricted. US cattle consume about 2 billion pounds of it annually, Consumers Union’s Michael Hansen told me last year.

Oregon’s Major Medicaid Experiment

As the reporters in this Washington Post article explain, the effort to get more effective health care while controlling costs is the goal of many of the health reform efforts now underway. This Oregon project may be the most of all. If it works, it can create a model for others to emulate.

So Kitzhaber did something that many before him have done in desperate times. The governor who favors cowboy boots over dress shoes made a bet that Oregon could not afford to lose.

The deal Kitzhaber struck was this: The Obama administration would give the state $1.9 billion over five years, enough to patch the budget hole. The catch: To secure that, Oregon’s Medicaid program must grow at a rate that is 2 percent slower than the rest of the country, ultimately generating $11 billion savings over the next decade. If it fails, those federal dollars disappear.

Oregon is pursuing the Holy Grail in health-care policy: slower cost growth. If it succeeds, it could set a course for the rest of the country at a pivotal moment for the Affordable Care Act. Under the law, many states will expand Medicaid programs to cover everyone below 133 percent of the federal poverty line, adding 7 million Americans to the program in 2014 and leaving states looking for the most cost-effective way to cover that influx of patients.

In Oregon alone, Medicaid is expected to enroll 400,000 new patients by 2022, nearly doubling its current numbers, according to an Urban Institute analysis.

As Oregon’s population grows, the state has come to realize that Medicaid is not a bottomless bucket of money. The state’s budget cannot sustain that. Instead, it strives to deliver what health policy experts call “the triple aim”: higher-quality care that leads to better outcomes, all delivered at a lower cost.

 

Provider Nondiscrimination Update

My editorial on the Affordable Care Act’s section that prohibits insurance companies from discriminating against classes of health care providers is now posted at Health Insights Today.

When fully implemented, this federal nondiscrimination policy will for the first time forbid any American health insurance company from refusing to cover services legally provided by a class of licensed health care practitioners (e.g., chiropractors, acupuncturists or clinical social workers) acting within the scope of their state licenses, if it covers those services when provided by a different class of practitioners (e.g., medical or osteopathic physicians). While the Affordable Care Act does not mandate equal payment for equal work (i.e., paying a chiropractor providing a service the same rate as an MD providing the same service), friend and foe alike understand that Section 2706 would make it illegal for insurers to cover any health service for one class of providers licensed to perform it while rejecting coverage for another also licensed to do so. (This nondiscrimination policy does not apply to the two largest government insurance plans—Medicare, which offers partial chiropractic coverage nationwide, and Medicaid, where coverage varies from state to state.)

This part of  the law goes into effect on January 1, 2014. Because it applies to all services that a practitioner is licensed to provide under state law, the implications are quite broad. I’ll be writing more about this in the near future, and presenting on the prevention and health promotion part of this equation at the March ACC-RAC conference in Washington, DC. (ACC-RAC is the annual Association of Chiropractic Colleges Research Agenda Conference).

Mindfulness Training for Marines

The military is pragmatic — if something works, they will use it whether it’s conventional or alternative. Over time, the evidence-based alternatives become the norm.

While preparing for overseas deployment with the U.S. Marines late last year, Staff Sgt. Nathan Hampton participated in a series of training exercises held at Camp Pendleton, Calif., designed to make him a more effective serviceman.

There were weapons qualifications. Grueling physical workouts. High-stress squad counterinsurgency drills, held in an elaborate ersatz village designed to mirror the sights, sounds and smells of a remote mountain settlement in Afghanistan.

There also were weekly meditation classes — including one in which Sgt. Hampton and his squad mates were asked to sit motionless in a chair and focus on the point of contact between their feet and the floor.

“A lot of people thought it would be a waste of time,” he said. “Why are we sitting around a classroom doing their weird meditative stuff?

“But over time, I felt more relaxed. I slept better. Physically, I noticed that I wasn’t tense all the time. It helps you think more clearly and decisively in stressful situations. There was a benefit.”

That benefit is the impetus behind Mindfulness-based Mind Fitness Training (“M-Fit”), a fledgling military initiative that teaches service members the secular meditative practice of mindfulness in order to bolster their emotional health and improve their mental performance under the stress and strain of war.

Designed by former U.S. Army captain and current Georgetown University professor Elizabeth Stanley, M-Fit draws on a growing body of scientific research indicating that regular meditation alleviates depression, boosts memory and the immune system, shrinks the part of the brain that controls fear and grows the areas of the brain responsible for memory and emotional regulation.

h/t The Schwartz Report

 

 

Supreme Court Accepts Gene Patenting Case

In the long run, this case may have greater influence than many of the higher profile cases on which the Court decides.

The U.S. Supreme Court on Friday agreed to decide whether human genes can be patented, a hotly contested issue with broad practical and ethical consequences for the future of gene-based medicine for millions of people worldwide.

The nation’s highest court in a brief order agreed to review a case over whether Myriad Genetics Inc may patent two genes linked to hereditary breast and ovarian cancer.

In a 2-1 ruling on Aug. 16, a panel of the U.S. Federal Circuit Court of Appeals in Washington, D.C., upheld the biotechnology company’s right to patent “isolated” genes that account for most inherited forms of the two cancers.

That ruling also denied Myriad’s effort to patent methods of “comparing” or “analyzing” DNA sequences.

The appeal against Myriad and the University of Utah Research Foundation was being pursued by a variety of medical associations and doctors, led by the Association for Molecular Pathology. Their case is being handled by lawyers for the American Civil Liberties Union.

There are many issues at play here. Consider this one: gene patents like these held by Myriad can be used (and are used) to deny researchers the right to conduct research related to the patented genes (i.e., breast cancer research) unless they pay the patent holder whatever fee the corporation wishes to charge.

From both ethical and economic perspectives, this is a most controversial topic. I hope the Court decides that genes are the common heritage of all humanity and are not patentable under any circumstances.

NY Times Article: Flu Shot Benefits Substantially Overrated

I have never found the hype behind flu shots convincing. Here’s new evidence supporting that skepticism.

It’s flu-shot season, and public health officials are urging everyone over 6 months of age to get one. Many businesses provide on-site flu shots, and some hospitals have told staff members that they have to wear masks if they do not get the vaccine. By 2020, United States health leaders want 80 percent of the population to get yearly shots.

For vaccine manufacturers, it’s a bonanza: Influenza shots — given every year, unlike many other vaccines — are a multibillion-dollar global business.

But how good are they?

Last month,, in a step tantamount to heresy in the public health world, scientists at the Center for Infectious Disease Research and Policy at the University of Minnesota released a report saying that influenza vaccinations provide only modest protection for healthy young and middle-age adults, and little if any protection for those 65 and older, who are most likely to succumb to the illness or its complications. Moreover, the report’s authors concluded, federal vaccination recommendations, which have expanded in recent years, are based on inadequate evidence and poorly executed studies.

“We have overpromoted and overhyped this vaccine,” said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy, as well as its Center of Excellence for Influenza Research and Surveillance. “It does not protect as promoted. It’s all a sales job: it’s all public relations.”

It’s my impression that it’s people over 65 to whom these vaccines have been most strongly promoted. And those are the folks who derive “little if any protection.”

 

 

Preventing Unintended Pregnancies and Abortions Through No Cost Contraception

Research evidence confirms beneficial effects of Obamacare’s contraception mandate.

Here’s the abstract of the article from Obstetrics and Gynecology, along with news and commentary from Think Progress Health:

A new study focusing on low-income women in St. Louis, MO concludes that expanding access to free contraception — just as the health care reform law does through its provision to provide birth control without a co-pay — leads to significantly lower rates of unintended teen pregnancy and abortion. Researchers found that when women weren’t prohibited by cost, they chose more effective, long-lasting forms of birth controland experienced much fewer unintended pregnancies as a result.

Researchers from the Washington University School of Medicine in St. Louis worked in partnership with the local Planned Parenthood affiliate to track over 9,200 low-income women in the St. Louis area, some of whom lacked insurance coverage, during a four-year Contraceptive CHOICE study. The CHOICE project simulated Obamacare’s birth control provision by allowing teens and women to select from the full range of FDA-approved contraceptive options and receive their preferred method at no cost. They found that birth rates among the teens who received free birth control in the CHOICE project were less than a fifth of the national teen birth rate — just 6.3 births per 1,000 teens, compared to 34.3 per 1,000 teens nationwide in 2010 — and abortion rates were less than half of both the regional and national rates.