�Թϲ�����

You might think that the kind of extreme poverty that would concern a global organization like the United Nations has long vanished in this country. Yet the special rapporteur on extreme poverty and human rights, Philip Alston, recently made and reported on an investigative tour of the United States. Surely no one in the United States today is as poor as a poor person in Ethiopia or Nepal? As it happens, making such comparisons has recently become much easier. ... Of course, people live longer and have healthier lives in rich countries. With only a few (and usually scandalous) exceptions, water is safe to drink, food is safe to eat, sanitation is universal, and some sort of medical care is available to everyone. Yet all these essentials of health are more likely to be lacking for poorer Americans. (Angus Deaton, 1/24)

The Medicaid “community engagement” waiver awarded to Kentucky, and similar waivers expected to be awarded to at least eight other states, are viewed by both advocates and critics as a form of "welfare reform" for Medicaid. They require that beneficiaries work or take steps towards work in return for Medicaid coverage. Reality check: But they do only half of what the 1996 welfare overhaul did. They provide no new federal funding for job training, job search, transportation, child care or the other support services that were the government’s part of a new two-way bargain with beneficiaries. And without that two way street, what they will mainly accomplish is to reduce the Medicaid rolls by erecting barriers to coverage. (Drew Altman, 1/25)

While a court in Washington mulls its constitutionality, lawmakers in Frankfort should nail down the practical details of Gov. Matt Bevin’s Medicaid revamp recently approved by the Trump administration.Aside from legal questions raised by a lawsuit filed against the Trump administration on Wednesday, there are a bunch of other questions that not only haven’t been answered, they haven’t been asked, starting with costs, timetable and lines of responsibility.The legislature should bring Kentucky stakeholders to the table for this discussion. (1/24)

Advances in genomics have ushered in promising therapies tailored to the individual. Personalized medicine is promoted and has begun to positively influence care. For example, medications such as trastuzumab for the 30% of breast cancers that overexpress ERBB2 and vemurafenib for patients with late-stage melanoma who carry the V600E variant have been beneficial. Despite these advances, for many sectors of the population—children, older adults, pregnant and lactating women, and individuals with physical and intellectual disabilities—limited evidence-based therapies optimized to their specific medical needs exist. Combined, these groups comprise as much as 58% of the US population. Research focusing on or at the very least includes members of these groups is critically needed. (Dr. Catherine Y. Spong and Dr. Diana W. Bianchi, 1/23)

When I was growing up, the idea of re-engineering human DNA was a staple of science fiction. Now, it’s a reality. Adult gene therapy -- editing the genome of a person -- is expected to soon be a treatment option for a number of otherwise intractable diseases. Meanwhile, scientists have successfully edited the DNA of human embryos, raising the possibility that parents might be able to modify their children’s genomes to save them from inherited diseases. Much of the change from science fiction to science fact has come from a breakthrough technique known as Crispr. Though the technique still has a number of technical snags to work out, consensus in the biology community seems to be that these problems will be overcome.This is a watershed in the history of the human species. (Noah Smith, 1/25)

Let’s talk about the presidents’ health — not only the one we’ve got now but all of them. Their aches and pains and bumps, and how they’ve tried to hide them, and how the nation spent 12 years looking at photos of Franklin Delano Roosevelt and never knew the man could barely walk. Driven in part by a desire to never be hoodwinked again, America now keeps a much closer eye on the chief executive’s corporeal being, with the concern we usually reserve for our own children.Is he sleeping enough? Getting enough exercise? Is his temperature normal? Please describe, in detail, the president’s bowels. (Monica Hesse, 1/24)

One of the areas in which HHS has most egregiously changed course is the Title X family planning program. Instead of hiring qualified public health professionals, the administration has quietly put anti-contraception political activists in charge of reproductive health care for the people who rely on Title X, with no public debate and no meaningful oversight in Congress. (Mary Alice Carter, 1/24)

Obesity is a problem in America, and it’s a problem in Maine. In 1990, my state’s obesity rate was 11%. Now it’s 30%, putting us 26th in the nation. I’d like to be in the middle of the pack when it comes to the tax burden, but not to obesity. That’s why Maine has twice asked for a federal waiver to exclude purchases of candy and sugary beverages from our state’s Supplemental Nutrition Assistance Program. The first request was denied by the Obama administration in 2016, the second by the Trump administration last week. (Paul R. LePage, 1/23)

The euthanasia of mentally ill or cognitively impaired patients is inherently controversial. Given the risk of fatal error, how many botched cases would it take to discredit the practice completely? If you said “any number greater than zero,” you would be interested in the physician-assisted death of a 74-year-old woman with dementia in the Netherlands in 2016. The circumstances were so disturbing, even the Dutch regulatory body that retrospectively reviews, and usually rubber-stamps, euthanasias could not countenance it. (Charles Lane, 1/24)

For most Americans, refilling regular prescriptions is as simple as picking up their medicine at their local pharmacy on the way home from work or while doing weekly grocery shopping. But for more than 150,000 Missouri veterans and beneficiaries of our active duty military currently insured through Tricare, the Department of Defense health insurance program, obtaining some common maintenance prescriptions can be much more complicated. (Gary Profit, 1/24)

In the early 2000s, when I was a middle schooler in Florida, I was subjected to a trauma that was meant to erase my existence as a newly out bisexual. My parents were Southern Baptist missionaries who believed that the dangerous and discredited practice of conversion therapy could “cure” my sexuality. For over two years, I sat on a couch and endured emotionally painful sessions with a counselor. I was told that my faith community rejected my sexuality; that I was the abomination we had heard about in Sunday school; that I was the only gay person in the world; that it was inevitable I would get H.I.V. and AIDS. (Sam Brinton, 1/24)

Iowa has more than four times as many large concentrated animal feeding operations (CAFOs) as it did in 2001, and over the last decade has added nearly 500 new or expanded state-permitted CAFOs annually — now an estimated 10,000 CAFOs of all sizes. This remarkable expansion is fueled by Iowa’s robust export market for slaughtered hogs, nearly $6 billion in 2016, up 7 percent in one year. ... A tipping point has been reached. Rural Iowans have every reason to be concerned. While water quality is a stated priority of Iowa lawmakers, livestock production is an important contributor to water degradation and goes unchecked. Manure leaks and spills are associated with fish kills, nitrate and ammonia pollution, antibiotics, hormones, bacterial contamination, algae blooms, water quality impairments and closed beaches and are a major contributor to the “dead zone” in the Gulf of Mexico. (James Merchant and David Osterberg, 1/24)

When will California make it a priority to protect our children from the toxic lead contamination in many schools’ water? From the looks of Gov. Jerry Brown’s proposed budget, this threat to students’ health and academic potential remains dangerously underfunded. (Chione Flegal, 1/24)