Measles Outbreak Causes Vaccine Debate

vaccinesBy Steve Sack at the Star Tribune

In 2000, the Center for Disease Control said measles was completely gone from the United states. Now, according to the New York Times, the United States already has more confirmed cases of the measles in the first month of 2015 than the number of cases typically diagnosed in a full year. The CDC confirmed 102 cases of the measles, although numbers are thought to be higher. At least 40 of the people diagnosed with measles visited or worked at Disneyland, in California, although the disease has spread to 13 other states including Arizona, Colorado, Illinois, Minnesota, Michigan, Nebraska, New York, Oregon, Pennsylvania, South Dakota, Texas, Utah, and Washington.

Measles is a very serious disease, killing 1 in every 1,000 people it infects, most of them infants and young children. It is the leading cause of childhood blindness in the world.The people most vulnerable for contracting the disease are those who are not vaccinated and those who cannot be vaccinated, such as infants and young children and those with weak immune systems, such as cancer patients. The reason we are seeing an outbreak of the measles in the U.S. now is because of the new “anti-vaccine movement.” This fad began with unsubstantiated rumors being spread that the MMR vaccine caused autism.

At first, there did seem to be a correlation between the vaccine and the manifestation of autism. However, medical and scientific communities confirm that the MMR vaccine DOES NOT cause autism. In fact, the correlation exists because the age that autism normally manifests is around the same age children are able to receive the MMR vaccine. Parents who do not trust these studies, or those who are ignorant to them, still refuse to vaccinate their children. Not only does this put that child at risk, this puts everyone at risk. Especially the young who cannot yet receive the vaccine, measles can cause deafness, blindness, brain damage, and even death. Measles is extra dangerous because once someone is infected, it is estimated that 90% of people who are in contact with that person and are not vaccinated will become infected. A person does not even need to be in the same room as the infected person because the measles virus can live in the water molecules in the air for up to two hours after the infected person has left the room.

With the outbreak of measles, the question of whether or not vaccinating children should be a choice has made its way Capitol Hill. House Speaker John Boehner thinks that everyone should vaccinate their children, but there should not be a law forcing parents to vaccinate. Many other important political figures, including Obama himself, feel the same way. Obama supports vaccines and encourages parents to vaccinate their children.

Although it is unlikely congress will pass a law requiring children to be vaccinated, non-vaccinated children may not be able to go to public school and non-vaccinated people may be asked to stay away from certain public places. There is a balance between individual rights and the rights of others. For example, there is a first amendment right to free speech, however one may not defame anyone else. There is a right to bare arms, but states, cities, and even businesses can regulate whether or not the weapon is allowed in that certain place. This will, and has happened with children who are not vaccinated. The 2nd Circuit Court in New York recently ruled that, yes, people may chose to not vaccinate children, but those children must be kept away from the public schools.  Although this case may be challenged in the Supreme Court, it is likely the Court will uphold their 1905 decision that compulsory vaccines are lawful for public safety purposes.

Save American Workers Act: What’s the Magic Number?

The House of Representatives started out the new year by passing the Save American Worker’s Act with votes 252-171. Although this Act was designed by the republicans, it also has some support from the democratic party. With the exception of President Obama who has threatened to veto the bill if it comes before him.

Currently, the Affordable Health Care Act requires companies with over 50 employees to provide health insurance to all full time employees or the company will face a tax penalty. A full time work week is currently defined as working 30 or more hours per week. What this Act would do is modify the Affordable Health Care Act and change the 30 hour per week as full time requirement back to the traditional 40 hour work week as full time employment.

At first glance, this seems like a terrible idea. Those opposing SAWA argue that by extending the definition of full time employment to a 40 hour work week would significantly reduce the amount of people who are able to get health insurance through his or her employer, would increase the number of people on government funded insurances such as medicaid, and increase the amount of uninsured people.

What opponents fail to take into consideration though is that companies will and are currently cutting down their employees hours to under 30 hour per week to avoid having to pay for insurance coverage. The people most effected by this are unskilled and underpaid employees who work about 30-35 hours per week. Take the restaurant industry for example. In Ohio, even at a high end restaurant, a dish washer makes about $9.00 per hour. Even at 30-35 hours a week, this person may still qualify for government assistance, especially if the person has children. Some of these people are already getting governmental help with insurance coverage, if they have it at all. What the restaurant will do in order to save money is cut the old employees hours to about 25 hours per week and hire someone else, for under 30 hours a week as well, to take the shifts no longer covered after cutting the old employees hours.

If this act passes, this means that the vulnerable people effected by this will be able to keep his or her hours, even though they will not qualify for health insurance through his or her company. If these people are able to work, they will be able to at least get on an income based health insurance plan, whereas if their hours are cut, they may end up on medicaid where the government pays everything.

Right now, the bill is on its way to the senate where it does have some democratic support, possibly even enough to get the 60 votes needed to overcome a democratic filibusterer. Even if it passes here, the president says he will veto it as soon as it hits his desk. The argument here is that more people actually work a 40 hour work week then a 30 hour work week. If t he definition of a work week is changed from 30 to 40 hours, employers who were uncomfortable cutting employee hours from 40 to 29 would not hesitate to cut hours from 40 to 39 so people did not have to pay. Another argument is that republicans are just being republicans and want to force people to work 10 more hours a week to qualify for coverage and that they just want to undermine the AHCA.

Although I can see both sides of these arguments, I can tell you personally about the negative affects of having only a 30 hour work week. People in the service industry were seriously effected by this as I noticed both mine, my boyfriends, and all of my friend hours being slowly cut to under 30 hours per week. The restaurant became over staffed and everyone was fighting for hours. Even the older ladies in the retail store had their hours cut substantially and at least two had to find a second job, one retired, and at least one quite to try to find employment elsewhere. Although I do like the idea that employers should have to provide health insurance to employees working at least 30 hours, I think most business owners are greedy and will cut hours. The cut in hours will seriously hurt the people most in need of every hour they can work. I think though that instead of expanding the work week to 40 hours, companies should be penalized for cutting employee hours to avoid providing insurance coverage. There should even possible be a mandate as to how many employees a company must have as “full time” vs. “part time.”

Ebola Prevention in the U.S.

To date, there have been four confirmed cases of Ebola in the United States. One patient died from the disease, two recovered, and one patient is still receiving treatment in a New York City hospital. It seems like we have this disease under control. Right? Wrong. The real outbreak is occurring in West Africa, where more than 10,000 cases of Ebola have been reported. True, West Africa is all the way across the Atlantic Ocean, and far away from the United States. But what about travelers? Can we stop people from vacationing in the infected areas? What about people that must travel to these places for work, business, or family matters? Does the United States just not allow these people to return? Of course not. The federal government has actually taken a very hands on approach to stopping the spread of Ebola by attacking it at its source. The government has placed troops in the affected areas to help contain the spread of the virus.

Here in the U.S., the Department of Homeland Security has designated five airports for people returning from affected countries to be received: New York’s JFK, Newark, Dulles, Atlanta and Chicago. These people must undergo advanced screening upon arrival. Those people exhibiting symptoms of Ebola will be subjected to a 21 day post arrival monitoring , meaning for 21 days the state and/or local health care facilities will monitor the person for 21 days after their arrival in the U.S. The federal government is working to identify around 20 hospitals that will serve as Ebola referral centers. These hospitals will likely be concentrated near the five cities that are willing to except travelers from infected areas. Domestic training teams, known as FAST teams have already been deployed in four out of five of these cities. They are also currently working to put together a team of 30 health care professionals including 20 nurses, five doctors and five specialists in Infectious Disease Protocol, to serve and assist medical personal throughout the U.S. in treating Ebola patients. Some states such as New York, New Jersey and Illinois are also taking additional steps to supplement the federal response and have announced mandatory quarantines for certain health care workers returning from West Africa.

Could a vaccine be on the way? The World Health Organization (WHO) plans to start human testing of an Ebola vaccine on 20,000 health care workers and other people in the infected areas. This testing is set to take place as early as January 2015.  Researchers at the National Institute of Allergy and Infectious Disease are also working on a vaccine, VSV-ZEBOV, and hope to conduct an early phase trial to evaluate the outcome and effect of the vaccine. Many privet companies, such as Johnson & Johnson and Facebook, are donating millions of dollars to vaccine research in hopes to control the outbreak of Ebola. The best way to stop the spread of a disease is to attack it at its source. If the vaccine works, this could save numerous lives, not only from death, but from being subjected to things such as quarantines, inconvenient travel, and invasive tests.

For more information on Ebola and travel guidelines, please see:  http://www.cdc.gov/vhf/ebola/index.html and http://www.cdc.gov/vhf/ebola/hcp/index.html.

Obama Cracking Down on the Over Use of Antibiotics

The first antibiotic, penicillin, was discovered by Alexander Fleming in 1929, although its true potential for fighting disease causing bacteria was not discovered until the 1940’s. This groundbreaking discovery saved many lives that would have otherwise been lost to deadly diseases and infections caused by bacteria. Unfortunately, antibiotics are misused and over-prescribed, not only in the medical field, but also in the food we eat. Many farmers that raise food animals give them antibiotics to help them grow faster.

The problem here is, bacteria replicates and evolves quickly. Any bacteria exposed to the antibiotic, but not killed by it, will ultimately reproduce a next generation of bacteria that is resistant to the antibiotic. By ingesting unnecessary antibiotics, a host gives the bacteria an opportunity to learn, reproduce, and evolve into an antibiotic resistant strain. As early as the 1950’s and 60’s, multiple new classes of bacteria were already discovered. Today, antibiotic-resistant bacteria is a growing threat causing at least 23,000 deaths and two million illnesses in the United States alone each year.

On September 18, 2014, President Obama signed an executive order that will hopefully help stop the abuse and misuse of antibiotics. The first step is to prevent farmers from using antibiotics as growth agents for the animals. All of the major manufacturers of antibiotics for livestock already agreed to stop marketing antibiotics for animal growth purposes. The FDA will also make sure that antibiotics are only given to sick animals who need them.

Hospitals will now also be required to keep track of antibiotic prescriptions and to control indiscriminate use. There will likely be no more precautionary prescriptions for antibiotics handed out at the first sign of any sneeze or itchy throat. The administration also hopes to increase the development of new antibiotics with new incentives that might include federal financial support to manufacturers or longer market exclusivity. Hopefully with the misuse of antibiotics now in the spotlight, doctors can insure the best possible antibiotics are reserved for the treatment of life threatening diseases and help control the ammount of bacteria that is becomming resistant to antibiotics.

Brittany Maynard Dies With Dignity in Portland, OR

Brittany Maynard, age 29, was diagnosed with stage 4 glioblastoma, a type of brain cancer, last spring. Doctors told Maynard she would only have about six months to live. That is when Maynard made the decision to die under Oregon’s Death with Dignity Act by taking a lethal dose of doctor prescribed barbiturates when the suffering became too great.

Although it is completely legal for a terminally ill person in Oregon, and a couple other states, to die with dignity, it is still a controversial and highly debated topic. Many people through out the world believe that dying with dignity is a sin and should be illegal because it is the same as suicide. Maynard points out an important distinction however in her interview with PEOPLE magazine. She explains that the fact of the matter is she IS dying. No part of her actually wants to die, but that is beyond her control at this point. What is still in her control is how she would like to spend the last final moments of her life. In Oregon, she has this choice to either die naturally from the disease and suffer through the excruciating pain, only to die unexpectedly and probably alone, or to die with dignity, when the pain become unbearable, in a room surrounded by her family and loved ones on a day and at a time which she herself can choose.

Maynard decided to end her life Saturday November 1, 2014 in her own home in Portland, Oregon. In a farewell Facebook post, Maynard writes “Goodbye to all my dear friends and family that I love. Today is the day I have chosen to pass away with dignity in the face of my terminal illness, this terrible brain cancer that has taken so much from me … but would have taken so much more…The world is a beautiful place, travel has been my greatest teacher, my close friends and folks are the greatest givers. I even have a ring of support around my bed as I type … Goodbye world. Spread good energy. Pay it forward!”

For more on this story please read: http://www.people.com/article/brittany-maynard-died-terminal-brain-cancer

Dear Lunch Lady, I want more sodium and saturated fat for lunch!

The Healthy Hunger Free Kids Act (HHFKA) went into effect for the 2013-2013 school year. HHFKA is legislation authorizing funding and establishing the policy for the USDA’s core child nutrition programs-The National School Lunch Program (NSLP) and The School Breakfast Program (SBP). NSLP and SBP provides federal funded to schools for breakfast and lunch meals for America’s school children. Through this program over 30 million school children receive either free or reduced meals at school. To qualify for funding schools must serve a nutritionally balanced meal based on a USDA established meal pattern. The meal pattern followed prior to enactment of the HHFKA was last updated in 1975. HHFKA is the first major overhaul in 30 years of NSLP and SBP.

HHFKA is part of Michelle Obama’s Let’s Move! campaign. An effort to reduce childhood obesity and improve the health of America’s school aged children. The changes are a well thought out attempt to introduce a variety of healthy items to our children’s diet and change their palate in favor of healthier foods. The changes replace high fat, high sodium, empty calorie foods with fresh fruits and vegetables, whole grains, and lean proteins. As a Registered Dietitian and Health Law Attorney, I applauded the changes. Some key elements of HHFKA include:

•Established required meal components based on the age of the child and rooted in evidence based nutrition science.
•Set calorie limits per meal based on the age on the child.
•Set sodium limits per meal based on the age of the child.
•A requirement that fruits and vegetables be served at each meal. Vegetable sub groups to ensure appropriate nutrients over a weekly spread based on the age of the child.
•Whole grains with caps per meal.
•Fat free flavored milk or low fat white milk at each meal.
•100% fruit juice with limits.
•Limits on saturated fat and trans fats.

The School Nutrition Association (SNA), the national organization for school lunch professionals, first supported the changes and assisted in their design but now oppose the changes and are fighting to have them eliminated. SNA has joined forces with House Republicans and are receiving corporate lobbying help from Schwan’s Food Service, ConAgra, Domino’s Pizza, Coca-Cola, and American Frozen Food Institute. SNA’s complaint is lack of profits since implementation of the new meal pattern. SNA issued a position statement largely claiming we do not want to “gut” the program, we want help and request the following:

•Schools operating at a loss of 6+ months the opportunity to waive the improved nutrition standards.
•Eliminate the requirement for 100% whole grains and cap the whole grain requirement at 50%. This is to accommodate the palate for refined white flour, the difficulty finding certain whole grain items, and to decrease plate waste.
•Eliminate sodium restrictions. As SNA states-“there is no scientific evidence that supports reduced sodium diets for children.” The sodium restriction makes it difficult to find an appropriate pizza, mac & cheese, and deli sandwich.
•Eliminate the fruit and vegetable requirement because children should not be forced to eat what they do not want to eat.
•Eliminate the requirement for healthy foods (competitive food) in vending machines because this has reduced their sales.

I do not know where to begin with this position statement!

SNA’s vision and mission is to “be the authority and resource for school nutrition programs”, and “advance the quality of school meals through education and advocacy.” SNA wants to advance the quality of school meals- to me that is an affirmative statement in the direction of improving health. But, because some of SNA’s members have experienced decreased profits, SNA wants the healthy improvements eliminated. SNA would like to swap fruits and vegetables for high sodium, white refined flour products. SNA’s request is the exact opposite of improving health and is an exchange of child health for profits.

SNA states they do not want to “gut” the program. Instead SNA wants to eliminate whole grains, fruits, vegetables, and the sodium caps. This is the belly of the program. Filter out SNA’s request and the program is left with a calorie restriction, flavored milk, and 100% fruit juice.

The purpose of HHFKA is to work towards improving child health and combat obesity and chronic disease. Childhood obesity and chronic disease leads to adult obesity, adult chronic disease, excessively high healthcare costs, and a disabled, globally uncompetitive work force.

Some stats from the Centers for Disease Control and Prevention on childhood obesity:

•Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.1, 2
•The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to nearly 21% over the same period.1, 2
•In 2012, more than one third of children and adolescents were overweight or obese.1
•Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors.3 Obesity is defined as having excess body fat.4
•Overweight and obesity are the result of “caloric imbalance”—too few calories expended for the amount of calories consumed—and are affected by various genetic, behavioral, and environmental factors.5,6

Health Effects of Childhood Obesity
Childhood obesity has both immediate and long-term effects on health and well-being.

Immediate health effects:
•Obese youth are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. In a population-based sample of 5- to 17-year-olds, 70% of obese youth had at least one risk factor for cardiovascular disease.7
•Obese adolescents are more likely to have prediabetes, a condition in which blood glucose levels indicate a high risk for development of diabetes.8,9
•Children and adolescents who are obese are at greater risk for bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem.5,6,10

Long-term health effects:
•Children and adolescents who are obese are likely to be obese as adults11-14 and are therefore more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis.6 One study showed that children who became obese as early as age 2 were more likely to be obese as adults.12
•Overweight and obesity are associated with increased risk for many types of cancer, including cancer of the breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, and prostate, as well as multiple myeloma and Hodgkin’s lymphoma.15
Prevention
•Healthy lifestyle habits, including healthy eating and physical activity, can lower the risk of becoming obese and developing related diseases.6
•The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society, including families, communities, schools, child care settings, medical care providers, faith-based institutions, government agencies, the media, and the food and beverage industries and entertainment industries.
•Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors. Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors.

THE American Heart Association ADVOCATES
The AHA will:
•Advocate for implementation of the new evidence based USDA school meal standards.
•Continue to support robust nutrition standards for competitive foods and beverages in schools that are based on a target of less than 1500 mg sodium per day by 2020.
•Support procurement standards for foods purchased by government agencies and employers that include criteria for strict sodium limits.
•Advocate for increasing availability of fruits and vegetables in schools through commodities, food purchasing, school gardens, and the Fresh Fruit and Vegetable Program.

As shown above the key component in fighting childhood obesity is an improved healthy lifestyle. Since school aged children spend the majority of their days in school. Smart health policy demands a healthy school food environment. Many child health researchers including the American heart Association and the CDC collectively agree fresh fruit and vegetables, sodium reductions, and whole grains are key elements to improve child health and fight long term health risks.

In my practice, I’ve worked with school food manufacturers and schools to implement the HHFKA standards. In my experience many children were unfamiliar with many fruits and vegetables and low fat dairy options. For example, fresh pears, zucchini, chickpeas, lentils, and yogurt. Many children would not drink white milk, instead selecting strawberry or chocolate flavored. And I received comments like, “real food” is the frozen kind you get out of a box. Why? Because many children were not accustomed to freshly prepared meals from natural ingredients.

To combat these challenges I worked with school staff and administration to encourage the children to try the foods. This included encouraging the staff and school administration to try the foods themselves in the presence of the children. I provided education materials on the meals, the HHFKA program, and general nutrition to the children. I also prepared education materials for the parents. To further encourage embracing the changes, I administered child surveys, observed lunch periods, and incorporated the changes accordingly.

Moving a generation from processed frozen boxed foods to naturally occurring cooked foods will not happen in one school year. Lifestyle change is a process affected by many forces. Time and multi-dimensional efforts will be needed to change the palate of America’s school children. SNA holds themselves out as acting in the best interest of child nutrition. Scraping nutrient dense foods for profits is not in the best interest of school children. SNA should rethink its position and funnel its corporate dollars into professional development for its members on how to successfully implement these changes.

Statistical information taken from the following:

http://www.cdc.gov/HealthyYouth/obesity/facts.htm

http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Sodium-Salt-or-Sodium-Chloride_UCM_303290_Article.jsp

Helen Rhynard Esq., M.S., RDN
http://www.rhynardlaw.com

Ethical Considerations For Workplace Wellness Programs

The majority of Americans, 55%, receive healthcare insurance coverage from an employer sponsored plan. The average cost of coverage per active employee for the employer is $8,500, to which, is only ~76% of the cost of total coverage. As of 2012, about half of all adults, 117 million, have one or more chronic health conditions, and one in four adults has two or more chronic health conditions. The annual cost of chronic health conditions as measured in lost productive time is estimated at $2259 billion. Several studies suggest that the costs associated with employee absenteeism and presenteeism- reduced on the job productivity, due to poor health are on average two to three times more than the medical and pharmacy claims costs alone. What’s more disheartening, is that most of those medical conditions could be avoided or significantly delayed if those people could turn back the hands of time and alter the millions of small but significant daily choices that led to those unintended consequences.
To avoid any potential disaster of employers dumping millions of American into the Healthcare Market Exchange, Congress imposed the Employer Mandate. Section 4980H of 26 U.S. Code- Employer Shared responsibility, generally provides that an applicable large employer is subject to an assessable payment if either (1) the employer fails to offer to its full-time employees or fewer than 95% of them plus dependents the opportunity to enroll in minimum essential coverage (MEC) under an eligible employer sponsored plan and any full-time employee is certified to the employer as having received a cost sharing reduction, or (2) the employer offers to all or at least 95% of its full-time employees plus dependents the opportunity to enroll in MEC and one or more fulltime employee is certified to the employer as having received a cost sharing reduction because the employer failed to offer coverage to that employee or the coverage was unaffordable.
Many employers looking to trim costs and improve their employee’s health status might take advantage of the new workplace wellness options under the Affordable Care Act. The new rules allow employers to adjust premiums in exchange for adherence to a health promotion disease prevention program. The new regulations allow employers to adjust costs as much as 30% for wellness programs and 50% for smoking cessation programs. Recent news reports indicate many employers plan to take advantage of this option.
With proper legal guidance workplace wellness programs can be part of the road map to cost reduction for many employers. However there are considerations beyond the statutory requirements and return on investment dollars. Bioethicists caution against taking quick action to shift costs as a penalty for unhealthily lifestyle choices.
One reasoned thought fueling the rise of workplace wellness programs is individual accountability for unhealthy lifestyles. Popular belief assumes employees are unhealthy because of their actions or inaction. The premises behind Workplace wellness is that employees are voluntarily unhealthy. Although some behavior that increases health risk may be under a person’s full control, the ability to change behavior is often diminished in several ways. Many biological, physical, and sociological factors undermine a person’s control over his or her behavior; people are often restricted in their ability to change their behavior because of “encumbrances of the will” which “preclude or impede authentic, reasoned choice.” Consider smoking, the effects of nicotine undermine a person’s ability to follow through on a choice to quite. Thus the act of continued smoking is not fully voluntary. And, arguably, the person should not be held fully responsible. The action by which an employee should be judged is the failure to take voluntary steps to quite not actually quitting.
A second bioethics consideration is people do not voluntarily choose their health outcomes. Poor personal health is not solely a product of informed voluntary actions. Biological, environmental, and sociological factors greatly influence health regardless of how an individual behaves. Here obesity provides an example. Among the many contributing causes of obesity are, poor workplace design, work policies preventing free exercise, and community conditions that prohibit equal access to healthier foods. Holding employees responsible for biometric outcomes may not be the most ethical decision. Additionally holding employees responsible for certain biometric measures may disproportionately affect racial groups and open the door for legal liability.

Helen Rhynard Esq., M.S., RDN
Rhynard Law
http://www.rhynardlaw.com