Sally Greenberg: Fluoridated water is essential for public health, not a danger

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Sally Greenberg: Fluoridated Water is Essential for Public Health, Not a Danger

Media contact: National Consumers League – Lisa McDonald, lisam@nclnet.org, 202-207-2829

Washington, DC— In response to recent media coverage about Robert F. Kennedy Jr. and Florida Surgeon General Joseph A. Ladapo campaigning against water fluoridation, Sally Greenberg, CEO of the National Consumers League (NCL), issued the following statement:

“Robert F. Kennedy Jr.’s statements on fluoride could jeopardize a proven public health measure. Consumers are best served by reliable, evidence-based health information, not alarmist misinformation.”

The comments made by Kennedy and Ladapo echo similar claims from the 1960s, when groups like the John Birch Society suggested that fluoridation of drinking water was a “communist plot.” Today’s anti-fluoride activists point to a 2019 Canadian study that found that pregnant mothers exposed to higher fluoride levels during pregnancy, gave birth to baby boys with slightly lower IQ’s, as measured at ages 3-4. In this study, mothers were asked to self-recall beverage consumption per day and did not take into account the children’s fluoride exposure in early childhood.

The Center for Disease Control and Prevention (CDC) calls fluoridated drinking water one of the most successful public health interventions in U.S. history, with its origins dating back to 1945 in Grand Rapids, Michigan. Since then, water fluoridation has been proven to significantly reduce rates of tooth decay, especially in economically disadvantaged and vulnerable populations. The CDC estimates that fluoridated drinking water reduces tooth decay by approximately 25% in children and adults. Health authorities, including the American Dental Association and World Health Organization, affirm that fluoride is safe at the levels currently used in the U.S.

“Fluoridated water is a vital measure to protect public health and reduce health disparities in dental care,” says Greenberg. Recent examples of removing fluoride from water, such as Calgary, Canada (2011) and Juneau, Alaska (2007), resulted in an explosion of dental decay. In both cities, the absence of fluoride in the drinking water corresponded with an increase in cavities and dental surgeries, particularly among children. For more information, visit CDC’s resources on fluoride.

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About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Nonprescription Analgesic/Antipyretic drug development in children 2 to less than 12 years of age

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November 15, 2024

Media contact: National Consumers League – Lisa McDonald, lisam@nclnet.org, 202-207-2829

WASHINGTON, DC – Sally Greenberg, NCL CEO testifies at the FDA about Nonprescription Analgesic/Antipyretic Drug Development in Children 2 to less than 12 Years of Age.

A full video of the U.S. Food and Drug Administration meeting can be found here:

Nonprescription Analgesic/Antipyretic Drug Development in Children 2 to less than 12 Years of Age

Sally Greenberg, CEO of the National Consumers League, testifies at 1:32:24.

Trump’s nomination of Robert F. Kennedy Jr. for Secretary of Health and Human Services threatens public health

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November 15, 2024

Media contact: National Consumers League – Lisa McDonald, lisam@nclnet.org, 202-207-2829

WASHINGTON, DC– President-elect Trump’s decision to nominate Robert F. Kennedy Jr. as Secretary of Health and Human Services (HHS) is a grave error, prioritizing conspiracy theories over evidence based science and medical research that is a foundation of our public health system.

The nomination is a staggering blow to the integrity of our nation’s healthcare delivery system. Kennedy, one of the loudest anti-vaccine voices during the COVID-19 pandemic, has been vocal about his theory that vaccines cause autism, a theory unsubstantiated by medical research. Vaccines are one of the most significant achievements in modern medicine, virtually eradicating childhood diseases such as smallpox and polio, saving millions of lives, and ensuring that our children grow up healthy and safe. The World Health Organization has repeatedly affirmed that vaccines are a cornerstone of public health, drastically reducing child mortality and preventing devastating diseases.

Parents across the nation, regardless of their political affiliations, share the same goal: to see their children grow up healthy and strong. By advancing vaccine skepticism, Mr. Kennedy jeopardizes not only children’s health but also public confidence in science, medicine, and the agencies tasked with protecting public safety—a foundation that has taken over a century to build.

If he is confirmed for the position, Mr. Kennedy, an environmental lawyer by training with no experience in the health or medical community, would oversee critical agencies such as the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH). His anti-science stance raises serious concerns about his ability to lead a department responsible for infectious disease control, food and drug safety, Medicare and Medicaid policy, and life-saving medical research.

In addition, Mr. Kennedy has proposed drastic changes to the FDA, including loosening regulations on raw milk and eliminating the user fees that fund the oversight of drugs and medical devices. These fees are essential for ensuring timely reviews and approvals for medical devices and drugs. Eliminating them delay the availability of new medical innovations and treatments that serve public health.

This is not the first time that Trump has recommended an unqualified individual for Secretary of Health and Human Services. In 2016, President Trump selected Tom Price, whose tenure ended after just three months due to ethical issues and misuse of taxpayer funds.

The Department of Health and Humans Services deserves a leader committed to advancing science, protecting public health, and upholding the integrity of the nation’s healthcare systems. With this nomination, President-elect Trump is proposing putting the fox in the henhouse, essentially putting our public health under an unsuitable leader who would dismantle the very programs that protect our health and the nation’s food supply.

The National Consumers League calls on the U.S. Senate to reject this nomination. Furthermore, we urge President-elect Trump to withdraw this appointment and select a candidate who will champion science, uphold public trust, and protect the health of the nation.

Medical debt, a growing crisis for Americans, and the Biden Administration’s bold moves to tackle it

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By Sam Sears, Health Policy Associate, National Consumers League

Consumers, unfortunately, accrue debt quite often throughout their lives – be it a mortgage, a car loan, credit cards, or even student loans. However, there is one type of debt that consumers have no way of knowing when it will be incurred – medical debt.

At the National Consumers League (NCL), we have been fighting to protect consumers from the unfair burdens of medical debt, both as it relates to access to care and exposing the inadequacy of the 340B Drug Pricing program. However, medical debt as a whole has a moment in the spotlight this October as the Biden Administration tackles the issue.

As I’m sure consumers have noticed, the cost of everything has gone up– groceries, rent, and even healthcare. Many families are forced to make tough decisions between putting food on the table or paying their medical bills. For some, it means putting off medical care to avoid the cost of the visit.

Medical debt now plagues more than 100 million Americans across the nation. As KFF Health News found, 1 in 7 people with debt shared that they’ve been denied access to a hospital, doctor, or other healthcare provider, and two-thirds have put off care they or a family member needs because of the cost. Shockingly, nearly 50% of those Americans have medical debt reported on their credit report, and over 40 million people owe around $88 billion, which has been sent to collections. This makes medical debt the single largest source of debt in collections, outpacing auto loans and credit cards.

The harsh reality is medical debt doesn’t just linger on a credit report; it devastates lives and can have lasting consequences. NCL has previously covered how medical debt collection practices can leave consumers in a “never-ending spiral of debt.” Hospitals across the nation are suing patients over their medical debt, and patients may not know that they must go to court or have the resources to hire a lawyer to protect themselves. As a result, creditors may seek default judgements in which a court authorizes them to garnish a patient’s wages as part of a payment plan, or place a lien on their home, cars, or other property.

Over the past few weeks, the issue of medical debt has been highlighted in the national conversation. A new proposed rule from the Department of Defense would introduce a sliding-scale discount program for civilians who receive care at a military medical treatment facility (MFT). Health and Human Services Secretary Xavier Becerra also announced that the Center for Medicare and Medicaid Services (CMS) will be adding questions about medical debt to the Medicare Current Beneficiary Survey (MCBS), an annual survey of Medicaid beneficiaries used to understand their health needs. These new questions will allow CMS to further understand the impact of medical debt on the day-to-day lives of seniors and people with disabilities.

Recently, the White House held a pivotal event hosted by the Consumer Financial Protection Bureau (CFPB), where individuals directly impacted by medical debt shared their heartbreaking stories. In tandem, the White House released a *fact sheet unveiling the Administration’s new actions to address and reduce medical debt for consumers. Following these actions, the CFPB has taken several steps to protect consumers experiencing medical debt.

In his remarks, CFPB Director Rohit Chopra stated that the agency “has been laser-focused on dealing with the growing burdens of medical debt.” NCL commends CFPB and Director Chopra for their ongoing efforts to address the impact of medical debt on patients. Back in June, CFPB issued a proposed rule that would ban unpaid medical bills from being included on credit reports, and prevent the repossession of medical devices. The public comment period for this proposed rule closed on August 12. During the White House event, Director Chopra stated that CFPB is “working to finalize our credit reporting rule now.” But, with nearly 75,000 comments, NCL anticipates that it may take the agency some time to issue a final rule.

Given the complexities of medical bills, the CFPB has also been urging and requiring transparency from hospitals and debt collectors. New guidance was issued to crack down on deceptive medical billing practices, including the illegal collection of medical bills that are false, inflated, or not actually owed. CFPB has received several complaints from patients and consumers over medical debt collections, particularly for bills that the patient does not owe, were already paid by the consumer, insurance, or a government program (such as Medicare or Medicaid), or for debts that are covered by insurance, hospital assistance programs or other programs. More than ever, hospitals and healthcare providers are subcontracting medical billing and collection activities to third parties, who have legal obligations under the Fair Debt Collection Practices Act. CFPB has issued guidance to further clarify these legal obligations as they relate to medical debt and collection practices.

And let’s not forget the shameful practices of some nonprofit hospitals. As tax-exempt institutions, nonprofit hospitals are legally required to provide financial assistance to offset healthcare costs for low-income patients and consumers —yet many fall woefully short. In early October, CFPB published a comprehensive blog post drawing attention to billing and debt issues arising from nonprofit hospitals, many of which provide inadequate financial assistance. Often referred to as ‘charity care,’ federal regulations do not provide further guidance on the eligibility of patients or spending standards for hospitals. Thus, financial assistance policies are left to the hospitals themselves. While some states have intervened in an increasingly bipartisan manner, there are still too few regulations governing what financial assistance should look like or how it should be administered. NCL supports and recognizes the critical role hospitals, particularly nonprofit hospitals, play in their communities. However, the lack of transparency, as well as the predatory practices of some, need to change. NCL applauds CFPB for the spotlight they’ve put on these practices as a driver in the medical debt crisis.

CFPB has also taken steps to remove all medical collections under $500. This last step went into effect on April 11, 2023, and with this change, it’s estimated that roughly half of those with medical debt on their reports will have it removed from their credit history. If you find a medical collection under $500, a paid medical collection, a collection less than a year old, or errors on your report, you can dispute that information with the credit reporting company.  One of the first steps you can take is to check your credit reports for any outstanding medical bills.

NCL stands in strong support of the efforts of the CFPB and the Biden Administration as they work to safeguard consumers and bring transparency to the healthcare and credit reporting systems. NCL shares CFPB’s concerns regarding how consumers accrue these inaccurate, undue bills in the first place. The Biden-Harris Administration continues to prioritize consumers’ access to healthcare and a commitment to protecting vulnerable populations from the unfair consequences that arise from an illness or medical emergency. NCL applauds Director Chopra, the Biden-Harris Administration, and federal agencies for their leadership in addressing the burden of medical debt.

We look forward to the CFPB’s final ruling on medical debt and credit reporting, which could be a game-changer for millions of Americans.

To learn more about your rights, and actions you can take, if you have medical debt on your credit report or need to dispute a medical bill, visit *CFPB.

*Links are no longer active as the original sources have removed the content, sometimes due to federal website changes or restructurings.

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About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization.  Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad.  For more information, visit nclnet.org.

NCL issues statement on New York Times health article on Alzheimer’s trials

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October 29, 2024

Media contact: National Consumers League – Melody Merin, melodym@nclnet.org, 202-207-2831

WASHINGTON, DC – NCL’s Health Director, Robin Strongin, released the following statement regarding Walt Bogdanich and Carson Kessler’s October 23 article, Health Section, New York Times, “What Drugmakers Did Not Tell Volunteers in Alzheimer’s Trials,” which reported that pharmaceutical companies withheld genetic testing information from volunteers in Alzheimer’s trials putting them at risk for brain bleeds.

“Medical research is complex and by its very nature involves risk. For a devastating disease like Alzheimer’s, consumers may be willing to take more of a risk in the hope of finding a treatment or a cure – if not for themselves, then for future generations.

We appreciate that researchers don’t know the full risk of a drug until tested, we are aware that genetic information can lead to certain types of discrimination, and we also understand that standards of care to disclose and not disclose information depend on multi-faceted decision points. Consumers have an absolute right to know what risks they face, including what information may be withheld, so they can make an informed decision before participating in a clinical trial—including when to opt out.

The scientific advances we witness today bring hope. Along with that hope comes the responsibility to be vigilant and assess and reassess what these advances mean for those willing to participate in clinical trials. It is imperative that we balance the integrity of clinical trials with the safety and protection of research participants.

NCL is increasingly concerned about the outsized role private equity plays in the sacred trust relationship between the research subject and the researcher. Institutional Review Boards must strive to regularly revisit their practices to reassure consumers that they, and the institutions in which research is conducted, are ethical and safe and provide all the information necessary to make truly informed decisions. It is never acceptable to put profits before safety. Clinical trials require numerous parties to come together and tackle the most vexing research challenges.

NCL calls upon all of those involved, including journalists, to provide balanced information that genuinely educate, and not terrify, the public. The last thing we want to happen is to further erode the public’s trust in science. We must all work together to safely, and ethically, find cures to dreaded diseases.”

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About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

As election looms, regulators can act now to help consumers save at the pharmacy counter

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By Sally Greenberg, Chief Executive Officer, National Consumers League

Now that we are a mere 15 days away from the election, all attention is unsurprisingly laser-focused on the outcome of the general election. Surprisingly, however, both candidates have made it clear that one of the leading healthcare issues on the ballot is the future of the Affordable Care Act (ACA). Ten years after its enactment, the ACA has become intertwined with the very fabric of the healthcare landscape in the US and thus requires federal agencies to regularly revisit the statutes to ensure it is fulfilling its original intent.

Now that the current administration has released proposed rulemaking on core provisions of the ACA, it has become more important than ever to add statutes to address a loophole in the essential health benefits (EHB) provision of the ACA. There is no better time for three federal agencies – the Department of Treasury, Department of Labor, and Department of Health and Human Services – to change language in the ACA that is constantly exploited by profit-seeking insurers, producing severe access and affordability barriers for patients and undermining the original intent of the ACA.

The loophole goes something like this: Essential health benefits are a central pillar of the ACA and provide affordability protections to Americans by ensuring that everyone in the individual and small group health insurance markets has access to coverage that actually covers the services they need. These essential health benefits fall into ten categories, one of which is prescription drugs.

If a patient pays out-of-pocket for their prescription (an essential health benefit), that dollar amount counts towards their out-of-pocket maximum. Once they hit the out-of-pocket cost maximum set by the ACA, insurance kicks in and covers the remainder of their out-of-pocket costs. However, insurers and pharmacy benefit managers (PBMs) are designating some specialty prescriptions to be “non-essential” – regardless of whether a patient needs them to stay alive. Once labeled “non-essential,” the patient is no longer protected by the out-of-pocket maximum set by the ACA.

What does this look like in practice? A patient may spend money on lifesaving medications that don’t count toward their out-of-pocket maximum. All year, a patient could pay out-of-pocket for prescriptions but never reach their maximum and see their insurance kick in. This saves a few bucks for insurers and PBMs but imposes massive financial burdens for patients who would otherwise be protected under the ACA. The EHB loophole forces patients to pay more out-of-pocket, a situation that circumvents the original intent of the law — which, as a reminder, is to keep drug costs affordable for consumers.

How can we close this loophole? The Department of Treasury, Department of Labor, and Department of Health and Human Services could act now. The tri-agencies can integrate language to close the EHB loophole into the Notice of Benefit and Payment Parameters (NBPP) to clarify that any service covered by a health plan is defined as an EHB.

Both of the frontrunners of the 2024 presidential election have signaled their intent to find solutions that lower prescription drug costs for Americans. While the country braces for the ripple effects of a new administration regardless of the results, regulators should close the EHB loophole to protect consumer access to treatments in line with the original intent of the ACA – affordable and accessible care for patients.

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 About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

National Consumers League statement on FTC action against Big Three PBMs

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September 20, 2024

Media contact: National Consumers League – Melody Merin, melodym@nclnet.org, 202-207-2831

WASHINGTON, DC – The National Consumers League (NCL), America’s pioneering consumer advocacy organization, today applauds the Federal Trade Commission (FTC) for bringing action against the three largest prescription drug benefit managers (PBMs) and affiliated group purchasing organizations (GPOs). The FTC’s administrative complaint states that PBMs have engaged in anticompetitive and unfair rebate practices, inflating the list prices of insulin, lining their pockets, and transferring the costs to patients.

The following statement is attributable to NCL’s Chief Executive Officer Sally Greenberg:

“We applaud the FTC for its continued actions and investigation into PBMs. This latest action reinforces the role PBMs play in creating consumers high out-of-pocket costs of medicines consumers face. Caremark Rx, Express Scripts, and OptumRX administer four-fifths of all prescriptions within the states, and prioritizing their profits over the patients’ wellbeing directly impact why 25 percent of insulin patients are unable to afford their medication.”

The FTC’s press release about the administrative complaint can be read here.

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 About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Nancy Glick

The Obesity Bill of Rights: Priorities for government action

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Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

Americans need and now have an Obesity Bill of Rights for a reason: People with obesity do not receive the same concern, level of attention, and quality care as those with any other serious chronic disease.  

Put into real-life terms: Though the adult obesity rate now exceeds 42 percent – the highest level ever recorded – obesity is still viewed as a problem of lack of willpower; too many health professionals act in discriminatory ways based on people’s size; and those seeking obesity care often face exclusions in insurance plans, restrictive practices that delay or deny treatment, or are not factored into decisions regarding medicine use.   

The consequence is that only 10 percent of people with obesity get help from medical professionals and only 2 percent of those eligible for treatment with Food and Drug Administration (FDA)-approved anti-obesity medicines (AOMs) have been prescribed these drugs, meaning the disease remains undiagnosed and undertreated. Compounding the impact, untreated obesity worsens the outcomes of more than 230 other chronic diseases, which is why obesity is responsible for as many as 400,000 Americans dying from obesity annually and costs the nation $1.72 trillion a year  in direct and indirect health expenditures – more than what Social Security paid in retirement benefits in 2022. 

It does not have to be this way. 

And this is where the Obesity Bill of Rights enters the picture. Developed by the National Consumers League (NCL) and the National Council on Aging, in consultation with leading obesity specialists, the bill of rights establishes eight essential rights with the core requirements so adults will receive the same person-centered, quality care for obesity as those with other chronic conditions. As such, the bill of rights serves as a blueprint for necessary changes in medical practice and government policy, starting with actions that can happen now. 

One immediate action item is pressing Congress to pass the Treat and Reduce Obesity Act (TROA), an important legislation that will allow more seniors to be treated with FDA-approved anti-obesity medications under the Medicare program. This matter is a high priority because obesity rates have nearly doubled among older adults to include two in every five Americans ages 65 and older. 

Another priority is ensuring that health professionals have the prescribing information to effectively treat people with obesity when they are taking drugs for other conditions, such as depression, schizophrenia, infections, and cancer. The simple fact is that certain drugs work differently in people with obesity and the consequences can be underdosing, a delay in response time, or the drug remaining in the body too long, potentially causing side effects. For example, studies show the drug brexpiprazole (Rexulti®), which treats depression and schizophrenia, takes significantly longer to reach effective levels in people with obesity – and some patients never reach these levels. Fortunately, the same research provides an improved dosing regimen so all patients with obesity can achieve efficacy. 

A different challenge involves drugs like posaconazole (Noxafil®), an antifungal often prescribed by oncologists to prevent infections. Two separate clinical trials show that obesity significantly increases posaconazole’s “half-life” – a term reflecting the amount of time it takes to rid the drug from the body. Half-life is an issue with posaconazole because many oncology medications must be delayed until the drug is out of the body’s system. Thus, if the package insert does not flag this matter when patients have obesity, doctors prescribing posaconazole may not know about the increase in half-life and start using oncology medicines too soon.  

These problems are not rare, but drug labels to guide safe and effective prescribing are dismissing people with obesity. For this reason, the Obesity Bill of Rights includes language to make accurate prescribing a requirement for receiving person-centered obesity care. Moreover, because increasing research validates the consequences of “flying blind” when drugs behave differently in the bodies of people with obesity, the obesity community is raising alarm bells, supported by a position statement from the American College of Clinical Pharmacology (ACCP), which urges FDA to close gaps in the testing and approval process for new drugs intended for use by people with obesity.  

However, because more immediate action is needed, five leading obesity organizations – American Society for Metabolic and Bariatric Surgery, the Obesity Action Coalition, the Obesity Medicine Association, the STOP Obesity Alliance, and The Obesity Society – issued a joint statement calling on drug manufacturers to update their labeling immediately to provide correct usage instructions for people with obesity when there should be a difference in dosing.  

NCL stands with the obesity community in calling for this sensible action and urges FDA to be a catalyst in ensuring that health professionals have the prescribing information needed for their patients with obesity to take important therapeutics safely and achieve the maximum benefit. For more information, visit right2obesitycare.org.

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 About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

NCL and the National Council on Aging worked with health leaders and obesity specialists to establish a set of rights for people with obesity.

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PBMs are driving the increase in out-of-pocket healthcare costs for consumers, says NCL

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July 23, 2024

Media contact: National Consumers League – Melody Merin, melodym@nclnet.org, 202-207-2831

WASHINGTON, DC – The National Consumers League (NCL) today submitted a letter to both the Republican and Democratic chairs of the House Committee on Oversight and Accountability expressing concerns about pharmacy benefit managers (PBMs) driving the increase in out-of-pocket healthcare costs for American consumers. The letter was submitted just as the committee was conducting a hearing with top executives from Express Scripts, CVS Caremark, and Optum Rx.

The following statement is attributable to NCL’s Chief Executive Officer Sally Greenberg:

“We are concerned that these anti-consumer practices are putting the profits of insurance companies and their PBMs before patients, local pharmacies, employers, and state governments. Congress has an opportunity to review these corporate practices and work to ensure a reduced market power, thus minimizing the incentives for PBMs to steer patients towards higher-priced medicines, claim higher and higher rebates to fatten their bottom line, and ultimately driving independent pharmacies out of business.”

The full letter can be accessed here.

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About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.