Vaccines are Safe, Effective, & Save Lives

The state of West Virginia works to stay above other states like Alabama and Mississippi in the bottom of most health rankings. Unfortunately, we have a lot of issues where the state ranks 50th out of 50 states. One of our bright spots is childhood immunizations. It is an area we rank number one. In fact, strong immunization laws have kept measles out of the Mountain State.

The year 2019 saw measles making a comeback tour across the United States. West Virginia was lucky in missing that comeback tour, or was it great planning? The West Virginia legislature decided many years ago to ensure children in school—public and private—were up-to-date on “their shots.” The exception to that law allows children with valid medical reasons, such as those in treatment for certain cancers or with allergies to vaccine ingredients, to be granted a medical exemption.

Photo courtesy of the WV Legislature

Every year, a vocal minority advocates for what they misguidedly call healthcare freedom. Usually offering pseudo or debunked science as a reason, they don’t want to vaccinate their children before they go to school. A well-known, now infamous, United Kingdom physician, Andrew Wakefield, lost his license to practice medicine for falsely reporting injuries from vaccines. Well-meaning parents receive bad information. In today’s social-media-filled environment, they run with whatever they have.

With certain exceptions, vaccines are safe for the person taking them. Vaccines work with “herd immunity,” which keeps the incidence of disease to a minimum. Vaccines are effective when the herd immunity is in effect. Vaccines prevent diseases like measles mumps and rubella along with certain types of cancer.

cdc.gov

The best advice someone can get when looking for information is from the Centers For Disease Control and Prevention (CDC). The CDC gives patients and providers information about what vaccines to take and when. The information on the CDC website is scientific.

Helmet Laws Protect Life

Nearly every public health or medical association has shown support for universal helmet laws. I understand the arguments legislators make for freedom, but we live in a society with laws meant to protect the public. As someone who has laid a motorcycle down while riding, I can share with you a small scar on my arm and leg that still show, but I didn’t taste asphalt or even have any long term headache due to a proper DOT approved helmet with a full face shield.

Photo courtesy of Chris Yarzab via Flickr

Last week, two pieces of legislation were introduced that are meant to seem innocuous and tourism friendly. Senate Bills 153 & 154 are aimed at repealing laws that require motorcycle riders wear helmets. SB153 will permit riders in West Virignia that have held a motorcycle endorsement on their driver’s license to ride or be a passenger on a motorcycle without wearing a helmet. SB154 permits riders from other states that permit them to ride without a helmet to do so in the Mountain State. It will be called the “Motorcycle Tourism Act of 2020”.

To understand the consequences of such legislation, one shouldn’t look much further than a state a little to our north, Michigan.  The University of Michigan Injury Center has studied the repeal of a helmet law and its consequences.  The Great Lake State’s legislature introduced a bill in 2012 that partially repealed its universal helmet law for motorcycle riders.  The stipulations were for riders over the age of 21 that carried $20,000 in medical insurance and had their motorcycle endorsement for 2 years.  Before the repeal, Michiganders’ statewide helmet use was a near perfect 99.4%.  Shortly after, it noticeably dropped to 75%.  The lowest rates of helmet use (45%) were those who were found to be intoxicated.

Motorcycle related head injuries increased following the repeal and affected 50% of crash-involved riders seeking trauma care, including a greater percentage with skull fractures. The need for neurosurgical procedures almost doubled. According to the UofM Injury Center, riding without a helmet doubled the odds of a head injury and fatality. They also studied the financial implications. Roughly 1/3 of riders involved in crashes have public insurance such as Medicaid , are self payers, or are uninsured. The cost for accident related health care for non-helmeted riders is about 35% more than those riding with a helmet. This means that taxpayers will be paying the unnecessary burden in a time when we cannot afford to pay it.

I am advising the members of the West Virignia Legislature to not support this bill.  Will you contact your legislator to tell them to keep motorcycle riders safe?

Happy New Year

I remember as a child, my first grade teacher had the door of our class room at Chelyan Elementary decorated with cartoon like pictures of an old man standing next to a baby.  The imagery was to show the comparison between the old and new years.  1982 wasn’t a particularly good year for me as I had lost my grandfather in December, so the idea of a new start hit me even as a 6 year old. 

Every year, we celebrate the seemingly arbitrary beginning of the Julian calendar, which is a relic of the Roman Empire and Julius Caesar.   January 1st or New Year’s Day for some is just another day.  For many, it can be a new beginning in so many things.  People everywhere resolve to be wealthier, healthier, happier, and better for the new year.  Far too often, those resolutions go by the wayside within weeks of the new year.  People give up on the budget, the new diet, fall into traps that get in the way of their happiness and feel lesser because of it.    This year I have a few goals of my own. While trying to be healthier and happier, I hope to just realize how blessed I am each day. 

Thank you to those of you who read these posts, listen to the Appalachian Health Podcast, or watch Live Healthy, Live Well, West Virginia.  I hope the material I cover with friends, colleagues, and guests will enrich someone this year.  With a little divine intervention, everyone reading this will be a little richer, a little healthier, a little happier, and a little better.  Here’s to a great 2020.  Happy New Year.

County Health Rankings: What can we do?

In the above diagram, if you look at the left, it shows that policies & programs can influence health factors which will then influence health outcomes.  At the top, health outcomes are basically half and half length of life and quality of life.  We all want to have longer more fulfilling lives.  The thing thats missing from this is that there should be another arrow atop health outcomes.  It should say cost, because better outcomes can mean lower costs to healthcare.

The factors portion is what’s interesting.  Only about 10% of factors comes from the physical environment. In West Virignia we really get beat up on rankings of housing and transportation because we are a rural community and have a lot of poverty.  

The next section is social & economic factors.  This is 40% of the factor scores.  Educated citizens make better choices.  We should all make certain physical education & health classes are taught at a young age and continued throughout the K-12 education for our youth. It might not hurt to bring home economics back either.  Family & social support and community safety make up the rest of this.  There is nothing you can substitute for family & social support or for community safety.  Any investment in these will eventually lead to better outcomes.  And remember, better outcomes means lower costs.

Clinical care is only 20%.  Access to care is driven a great deal by employers providing health insurance and other benefits like sick leave.  Quality of care is up to providers.  We are fortunate in West Virginia to have some truly high quality providers in such a small rural state.

The last block you see going up is health behaviors.  It is 30%.  If you use tobacco, investment in a cessation program will pay you back.  Diet and exercise are also big drivers.  Having a limited use of alcohol and limiting drug use can help tremendously.  If you are sexually active, and not in a monogamous relationship there are risks that you may be taking.  Talking with your healthcare provider about the risks and how to mitigate them may save you from certain sexually transmitted infections.

More than half of the factors listed above are things you can help your employees with.  This investment in their health will pay dividends.  Keep in mind these are long term investments and they don’t happen over night.

If you’re further interested in how these are calculated or how your community is graded versus the rest of West Virginia or the rest of the county, go to https://www.countyhealthrankings.org and you can see the data in an easy to use format. 

Invest in Your Health

In 1962, economist Selma Mushkin discussed the additions to our economy by investments in health.  She discussed the effect of a reduction in the death rate on the rate of economic growth from advances in healthcare.  Fast forward to today.  The United States spends more than any other developed country on healthcare, however life expectancy at birth is 2 to 3 years lower.  Any other investments that we make, we look at the dividend paid or the final yield and wonder are we better off than where we began. Why don’t we look at our investments in healthcare?

Healthcare further complicates itself as a business. There is a third party in most of the transactions and contracts.  The third party in this transaction is your health insurance.  They negotiate rates with the employer, or more often tell the employer what they’ll pay.  Then the insurance company will negotiate rates with the health care organization that has the supply. 

Being able to change insurance companies every year, means that insurance companies see no high value investments in your health.  In their eyes, they may see an investment they make in your long term health could mean that their competitor will receive the dividend.  As patients regularly change payers, any individual third party payer has less incentive to commit to any expensive, high value treatment, as the result may mean their competition will reap the reward.  I don’t blame them for this. Often Medicaid programs and sometimes small insurers will say that short term budget constraints keep them from paying for high value therapies.  

Hospital costs are up, healthcare administration costs are up, diagnostic costs are up, pharmaceutical costs are up, and insurance companies have less incentive to control long term costs and make you healthy.  Some people have even said this was a large driver of the opioid crisis.  For example, third party payers would pay for an opioid prescription in lieu of physical therapy for an injured patient, because the negotiated rate on the 30 day supply of an opioid was much cheaper than 6 weeks of physical therapy, though PT may have been the answer.  We’ve seen multiple pieces of legislation across the country addressing this very issue.

So, the question I get asked the most about is “Is single payer the right strategy for our country?”.  People have very strong views about healthcare.  I recall working in the Governor’s office when the Affordable Care Act was passed.  We had people calling in droves to the switch board telling us to keep our government hands out of their Medicare.  They didn’t understand that Medicare is government healthcare and the Governor had little control over it.  The bottom line is, no matter what the democrats tend to trot out, I see neither an economic model, nor a political environment where that will work.  Further, we have gone down this road for so long, I can’t imagine the federal government destroying entire companies to replace them with a federalized healthcare system similar to European models.  

The next step in healthcare reforms will be focusing on value based healthcare and perhaps eventually capitation in health plans. Third party payers are going to do everything possible to limit their share of the risk involved in healthcare. The best advice anyone can get from this is to take care of his or her own health. Its the only way you can guarantee some modicum of lower healthcare costs in the near future.

Happy Thanksgiving

Over the course of a year, we experience many holidays. If you work in state government you get more than I do off from work, and I do miss that part of government work. Some of them are merely days off, some are religious in nature. Thanksgiving has come to be my favorite. We take time off solely for the purpose of giving thanks. There’s no pressure in gift giving, or the other commercial trappings of Christmas. Just plain ol’ gratification of saying thanks for all the good things we have.

I enjoy watching football as much as anyone and my favorite dessert from my time with my grandmother was pumpkin pie. I truly enjoy arguing politics and religion with any family member that dares question me at the dining room table. But, I have to say I have much to be thankful for, even in 2019.

I have a lovely wife, who is healthy and two great dogs. We live comfortably in a nice home, and have transportation. Charleston is a great community and my home state, for all its misgivings, is full of wonderful citizens. I get to work for a great group of people and have some wonderful people that work for me. Though I could stand to get back to my fightin’ weight, I’m fairly healthy and have some great friends all across the country. I have many things that can never be taken from me like a great education (earned at WV Tech and WVU).

I’m going to publish this on my blog so you can read it and I hope you get inspired a bit this Thanksgiving, but I might just look back on it to remind myself just how fortunate I am.

Happy Thanksgiving.

T21

The name T21 sounds like the subtitle to an Arnold Schwarzenegger sequel. However, its a public policy sweeping across states and has even received some support from President Trump. T21 or Tobacco to 21 is an effort to raise the legal purchasing age to 21. Over 500 city/county jurisdictions and 18 states have enacted this as a law.

Public policy advisors everywhere have worked to get this into law. A recent Gallup poll found that a majority of Americans agree. Last year, in a West Virginia legislative hearing, Bureau for Public Health Commissioner Dr. Cathy Slemp was asked about an exemption for military members. Dr. Slemp showed where even the United State DOD doesn’t want their young women and men smoking. Unhealthy behaviors are bad for military readiness.

The truth is recent studies have shown that these laws reduce smoking rates in young people age 18-20. The other thing we know, is that the longer people avoid picking up this habit, the less apt they are to be a cigarette smoker in the future, which means healthier, longer lives. And if you aren’t a smoker and wonder how this affects you, less smokers will eventually help with health insurance costs.

For more information, go to tobacco21.org.

Be Patient, Be Kind and You Can Help Someone with Substance Abuse Disorder

Last week, I had the privilege of meeting some of the finest minds in the addiction treatment and recovery world at the Appalachian Addiction and Prescription Drug Abuse Conference. This is timely, as we are in the midst of an addiction crisis. Politicians are threatening to lock up offenders and want to further regulate medication assisted treatment (MAT). This is unfortunate. Perhaps some politicians should have come to hear more about how to solve the problem.

On the AHP, I had a great time interviewing Dr. Marvin Seppala, the Medical Director at the Hazelden Betty Ford Clinic. Dr. Seppala is a brilliant man with a kind heart. He cares about the patients he’s helping. We discussed issues like Mrs. Ford coming out years ago and admitting she had a problem. That opened a door for many people that is still open today. We also talked about how to address addiction with a loved one that has a problem. (To answer the question you probably just asked yourself, you research the issue and talk to them about it. Being patient, be kind, you shouldn’t expect immediate results.)

Hazelden Betty Ford pioneered a 12-step recovery. We’ve all heard of it. Work your steps and work to stay sober in a community of your peers. Now, the group that brought you abstinence based recovery brings you MAT. What works for one person, works for one person. You can’t assume everyone will respond to treatments the same way. It’s not one size fits all. You can even take MAT while working through the 12-steps if you need to.

Since doing this, Hazelden Betty Ford has changed outcomes for the better. They are more successful which means there are more people out there under the control of substance use disorder. Patients must consider this disease all their life, but they can go on living. It was a culture change for the clinic, but one for the better.

If you know someone who you believe has a substance abuse issue, remember they are ill, not a lesser person. Research the issue and talk to them about what treatments might be available. One day we might beat addiction, until then be patient, be kind, and you might just save someone’s life.

You can hear my interview with Dr. Seppala available Monday morning on the Appalachian Health Podcast. It is available on Apple Podcast, Spotify, or at dannyscalise.com.

Appalachian Addiction & Prescription Drug Abuse Conference

This week, a diverse group of professionals in the field of addiction gathered at the Marriott in Morgantown, WV.  I began working with Dr. Brad Hall and his team a few years ago when this conference was getting bigger, and now over 500 providers, peer coaches, and others gather in the fall.  The participants learn from the best. This issue has hit this country hard, but Appalachia and West Virginia have been hit particularly hard.  We are learning more and more about addiction, how it affects people, and how to treat it.  Over the next few weeks, people who missed the conference will be able to hear from some of these experts as I interviewed them on the Appalachian Health Podcast. 

Over 500 participants listened to experts in the field of addiction and treatment.

Addiction is a health condition with a nasty reputation.  The stigma of addiction hurts.  It hits hard. It makes life difficult for the patients suffering from this disease.  At the conference Ken Rodenbaugh, a practicing nurse, told his powerful story about the stigma of addiction.  Later in the evening, Dr. Alisa Duran talked about the vulnerability of personal stories.  Being a professional and a person in recovery can be difficult.  I interviewed them together about their stories. 

The Mountain State was  blessed to have the experts discussing treatment options.  I interviewed Dr. Marvin Seppala, Chief Medical Officer of the Hazelden Betty Ford about MAT & 12-Step Programs for treatment of addiction, and Dr. Jeannie Sperry, Co-Chair of the Division of Addictions at the Mayo Clinic, about the use of Cognitive Behavioral Therapy in the treatment of pain & addiction.  

Kelly Lemon, a nurse practitioner and nurse midwife from WVU Medicine gave a timely talk on Addiction, Pregnancy, and Neonatal Abstinence Syndrome.  Kelly and I sat down for a few minutes before her presentation to discuss these issues and how they are affecting the West Virginia.  With the WV Legislature legalizing cannabis for medical use a couple years ago, Dr. Libby Stuyt, a psychiatrist from Colorado gave some great information in her talk about Fact & Fiction in marijuana and CBD.  Dr. Stuyt and I discussed her views on cannabis as well as her expertise on auricular acupuncture.  

You can hear my interviews with all of these people in the coming weeks on the Appalachian Health Podcast.  There were many others at the conference including WVU Health Sciences Dean Dr. Clay Marsh and the President of WVU E. Gordon Gee.  Other experts in the field were there, however I didn’t have time to interview them all.  I felt honored to get a few moments to talk about one of the most important health issues with some of the worlds best.  

Addiction is a disease.  It’s difficult to understand. Stigma gets in the way of people getting the treatment they need.  The professionals at this conference provided an education on the most current treatment options as well as other topics in the field.