�Թϲ�����

In 2005, the FDA approved a new treatment for pain, administered through a patch on the patient’s skin. The drug’s approval coincided with a movement in the medical profession towards treating pain as the “fifth vital sign,” leading doctors to take more aggressive steps to deal with pain. By 2012, doctors were prescribing the drug, called fentanyl, over 255 million times a year throughout the U.S. For millions of Americans, these legal prescriptions intended to help their chronic pain had already pulled them into opioid dependency. The role of doctors in creating the current national crisis cannot be ignored.Fentanyl is now one of the most infamous drugs of America’s opioid epidemic, which claimed more than 30,000 lives by accidental overdose in 2016 alone. While about half of those deaths were from heroin and other illegally obtained opiates, most opiate-users started taking opiates prescribed by their doctors. Troublingly, many of these doctors — one in 12, according to Boston Medical Center researchers — received money from opioid manufacturing companies. (Albert Gustafson, 7/5)

History is repeating itself. Twenty years ago, a pain management crisis existed. As many as 70 percent of cancer patients in treatment at that time, or in end-of-life care, experienced unalleviated pain. Identified as a major medical problem, poor pain management became synonymous with poor medical care. In fact, prescribing adequate pain medication became mandatory for hospital accreditation. The medications used to treat moderate to severe pain among people with cancer are the same opioids helping fuel today’s opioid crisis. Though it has turned a much-needed spotlight on the overprescription of these medications, it is overshadowing their underprescription among people who really need them, especially those with cancer. (Sara Ray and Kathleen Hoffman, 7/6)

Gov. Matt Bevin’s decision to end dental and vision coverage for 460,000 Kentuckians is vindictive, probably illegal and also illogical because emergency-room visits for dental problems will increase. The administration’s excuse — that a federal judge’s rejection of Bevin’s Medicaid revamp necessitates the action — is ridiculous. The new payment mechanism for dental and vision coverage was to take effect July 1. The obvious answer is to keep the system that was in place June 30. (7/5)

On June 29, U.S. District Court Judge James Boasberg held that the federal Department for Health and Human Services lacked the authority to approve Kentucky’s request for a Section 1115 “demonstration waiver” to dramatically alter Kentucky’s Medicaid program. In essence, Judge Boasberg held that HHS failed to consider the impact of the probable loss of coverage for at least 95,000 Kentuckians under the waiver. Federal Medicaid law clearly obliges states to ensure that medical coverage is provided to all eligible individuals, and waiver proposals must be consistent with this objective. To approve Kentucky HEALTH, HHS must decide whether a waiver can eliminate coverage for tens of thousands of Kentuckians and still further the objective of Medicaid. That won’t be easy for Kentucky to demonstrate or HHS to approve. (Emily Whelan Parento and Nicole Huberfeld, 7/5)

Just a month has passed since the high-profile deaths of Kate Spade and Anthony Bourdain, yet suicide has already dropped off the public radar. That’s because it’s far too easy to personalize individual tragedies; far more difficult is confronting the public-health crisis at hand. Suicide claims the lives of more than 120 Americans each day. Each year, more Americans die from suicide than were killed in action during the entire Vietnam conflict. It’s time we confront this epidemic with the same determination that tamed HIV/AIDS. To do this, we must address the biology of suicide. (Jonathan Javitt, 7/5)

Beach season is officially in full swing, with Americans heading to the coast to swim, lounge, camp, party and generally cool off from the heat-drenched cities. And because we’ve been so well trained to avoid the harmful ultraviolet rays that cause skin cancer, most beachgoers will be mindful to slather on a generous coating of sunscreen. This is a sound and healthy practice for humans when they bake on the sands of California’s beaches, but it turns out it’s not so great for the health of the oceans when people covered in sunscreen take a cooling dip in the waves. A study conducted by an international team of scientists found that exposure to the two most common ingredients in sunscreen — oxybenzone, or BP-3, and octinoxate — is toxic to coral development in four ways. BP-3 in particular was correlated with bleaching, which is a sign of ill health, DNA damage and abnormal skeleton growth and deformities in baby corals (yes, there are baby corals). ...But let’s be clear: This is no call to skip the SPF 50. Skin cancer is a serious and all too common affliction; one-fifth of Americans will be diagnosed with skin cancer by the time they are 70, according to the Skin Cancer Foundation. (7/6)

Though surgery may seem a drastic step for someone who does not suffer a physical malady, such as cancer or trauma, the psychological distress caused by the transgender person’s physical state is no less lethal. Studies suggest that nearly 40 percent of the trans population have attempted suicide. This is likely underreported and much higher in at-risk populations, such as minorities and those living with HIV. (Jonathan Keith, 7/6)

Families across this country are struggling with rising prescription drug prices every day. Older Americans who rely on Medicare Part D — prescription drug coverage — take an average of 4.5 prescription medications and are hit particularly hard by these rising costs. Earlier this year, Congress took an important step to help reduce that financial burden on older Americans by passing the Bipartisan Budget Act of 2018 (BBA). The BBA closed the Medicare Part D coverage gap — known as the “doughnut hole” — in 2019, a year earlier than planned under the Affordable Care Act of 2010.It also requires brand name drug companies to pay more of the cost of their drugs for beneficiaries who are in the doughnut hole. This important change will help seniors move through the doughnut hole more quickly and into “catastrophic coverage” where they will pay less for their needed medications. (Nancy Leamond, 7/5)

Like many of my fellow Republicans, I welcome the re-examinations of policy the Trump administration is bringing to Washington. As a physician, I especially appreciate the vocal recognition by the president that for many Americans, the prices of prescription drugs are simply too high. As a former member of Congress, I agree with those who also say we must ensure pharmaceutical companies can and will continue to pioneer the development of new drugs to help improve the health and well-being of Americans with serious, life-threatening, chronic, and disabling conditions. As a conservative Republican, however, I have to call the administration’s position on the 340B Drug Pricing Program the equivalent of an own goal in soccer. (Former Rep. Phil Gingrey, 7/5)

Bipartisan legislation aimed at creating a national registry to collect data on the incidence of cancer among firefighters is awaiting the president’s signature. If signed into law, H.R. 931, the Firefighter Cancer Registry Act of 2018, could take effect in the next few weeks. This new law is expected to provide improved resources for research into the occupational hazards faced by approximately one million professional and volunteer firefighters in the United States. (Susan Olivo-Marston, 7/5)