New study reveals promising progress in fight against cancer

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Nissa Shaffi

A recent study released by the American Cancer Society (ACS) shows that breakthrough treatments for lung cancer have resulted in a 26-year record low for cancer mortality overall. Cancer-related deaths have dropped at an average rate of 1.5 percent from 2008 to 2017 and between 2016–2017, cancer mortality rates dropped to 2.2 percent. This translates to nearly three million fewer American cancer-related deaths than would have occurred if mortality had remained stagnant.

ACS revealed that much of this success is due to declines specifically in lung cancer mortality. This is a promising development as lung cancer leads to more cancer-related deaths than colorectal, breast, and prostate cancers combined. Steady reductions in smoking and advancements in early-detection practices have created the perfect environment for dramatic drops in lung cancer rates. Technologies like video-assisted surgeries have enabled doctors to more clearly scan stages of tumor growth, providing patients with higher eligibility for operations and more targeted radiation treatments. Additionally, groundbreaking immunotherapies for both lung cancer and melanoma have acted as a catalyst for an expanding area of research, providing renewed hope to cancer patients with metastatic disease.

Despite the welcome decline in deaths associated with lung cancer, the death rates of breast, colorectal, and prostate cancers have plateaued. Progress for the treatment of prostate cancers has been especially compromised due to growing skepticism from health officials regarding prostate-specific antigen (PSA) screenings. While the original intent of reducing PSA screenings was to prevent over-diagnosing and unnecessary treatments for potentially benign tumors, fewer treatable cancers are being detected as a result.

The National Consumers League (NCL) lauds this truly welcome progress in reducing cancer deaths. At the same time, we would like to echo ACS’s call for better testing, which will lead to accurate and better screening of cancers. It takes a village to see progress of this magnitude in public health. Doctors, researchers, advocacy groups, drug companies, and access to life-saving preventive care afforded by the Affordable Care Act can all take credit for this very good report. NCL recognizes the many factors that helped to reduce the incidence of a terrible disease that takes the lives of more than 600,000 people a year. Let’s keep the progress going into 2020 and beyond!

The troubling rise of maternal deaths in America

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Nissa Shaffi

According to the Centers for Disease Control and Prevention (CDC), 700 women die annually from complications related to pregnancy or childbirth. The World Health Organization (WHO) estimates that 45 percent of maternal deaths occur approximately six weeks postpartum, and nearly 60 percent of all maternal deaths are preventable. These deaths have doubled in the past 20 years, which prompted the passage of the Preventing Maternal Deaths Act (H.R. 1318) in December 2018.

Prior to the Preventing Maternal Deaths Act, we lacked data necessary to help providers mitigate the risk of maternal deaths. This critical law aims to increase transparency regarding maternal death rates in states and will provide federal grants to investigate the deaths of women who died within a year of being pregnant.  

Medically unnecessary C-sections

One of the factors responsible for the rising rate of maternal deaths is complications resulting from unnecessary cesarean sections (C-sections). Since the 1970s, there has been a 500 percent increase in the utilization of C-sections, making it the most commonly performed surgical procedure in the U.S.

C-sections are an important and effective life-saving measure for mothers and infants, but only when there is an explicit medical need. When performed without established need, they can increase patients’ risk for life-threatening adverse events. Dr. Neel Shah, Assistant Professor at Harvard Medical School, states that unnecessary C-sections may be responsible for up to 20,000 major surgical complications a year, some of which include:

  • increased risk of infections;
  • increased risk of sepsis resulting from infections;
  • excessive postpartum bleeding;
  • blood clots;
  • complications with future births;
  • and maternal death.

A 2017 Consumer Reports investigation discovered that C-section rates for low-risk deliveries vary dramatically from hospital to hospital, ranging from 7 percent to 70 percent across America. Factors from hospital location, convenience, or reimbursement rates are all responsible for the rise in medically unnecessary C-sections. Dr. Shah believes these factors have created a culture that places less value on maternal and child health, and instead prioritizes the hospital and providers where the delivery occurs.

Medically unnecessary C-sections have become a matter of contention among health professionals across the country, as well as a critical blind spot for patients. While patients can take measures to avoid unnecessary C-sections, many simply do not have the option to make changes in their birth plan.

Black maternal death is more than just a statistic

The most sobering reality of the maternal death crisis is that black women are 243 percent more likely to die from pregnancy or childbirth-related causes than women from any other racial or socioeconomic category.

In California, black women undergo C-sections at five percentage points higher than any other racial or ethnic group. In addition to higher C-section rates, black women often fall victim to bias when receiving medical care, where their symptoms are often treated less seriously and with less urgency.

In the case of Kira Johnson, racial bias and negligent postpartum care are believed to have played a critical role in her tragic death. After a routine C-section at Cedars-Sinai Hospital, Johnson experienced severe internal bleeding for over 10 hours before receiving medical attention. Since Johnson’s passing, her husband Charles has advocated on Capitol Hill urging Congress to address the maternal healthcare crisis.

From 2014 to 2016, the District of Columbia had the highest maternal mortality rate in the country–and 75 percent were black women. These staggering figures prompted healthcare providers in the city to create the Maternal Mortality Review Committee (MMRC). Before the MMRC, there was no data available explaining how these women died or the symptoms they presented that could have alerted physicians to their compromised state. The MMRC will work with multiple stakeholders in the city to establish transparency for maternal mortality trends and create interdisciplinary solutions to foster change and accountability.

The call for increased data collection and dissemination

In the United States, maternal death statistics are currently collected by states independently, but in most countries, the federal government assumes that role. The Preventing Maternal Deaths Act will provide the U.S. with data on practices that contribute to maternal deaths throughout the country.

The National Consumers League applauds Congress’ continued efforts to help mitigate the troubling increase in maternal mortality across the country.

Senate HELP Committee’s hearing on vaccines

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Nissa Shaffi

On March 5, 2019, the Senate Health, Education, Labor, and Pensions (HELP) Committee held a hearing on vaccines and their critical role in halting preventable disease outbreaks. The hearing featured a witness panel consisting of experts from various disciplines, such as public health officials, specialists in pediatric medicine, epidemiology, and the primary immunodeficiency space, as well as Ethan Lindenberger, a high school student who recently obtained vaccinations against the wishes of his parents.

The hearing was noteworthy in that every member of the HELP committee–both liberal Democratic and conservative Republican–supports routine vaccinations. The only hesitation came from Senator Rand Paul (R-KY)–who supports other vaccinations and vaccinates his kids and himself–on flu vaccinations. He was roundly corrected by a doctor-Member of the HELP Committee, Senator Bill Cassidy (R-LA), who said that while flu vaccines aren’t always hitting the right strain, they always lessen the symptoms. 

Recommendations from the Centers for Disease Control (CDC), National Institutes of Health (NIH), and National Academies of Sciences, Engineering, and Medicine were confirmed to be “the gold standard” and got kudos from everyone on the panel. In the face of a very anti-science administration, good medicine and good science overwhelmingly prevailed and won the day.

The hearing also drove home the importance of increasing the dissemination of factual, evidence-based research about the safety of vaccines to consumers. Confirming previous research, a new 10-year study conducted in Denmark found that there is no correlation between autism and the measles, mumps, and rubella (MMR) vaccine. Researchers studied 657,461 Danish children between 1999-2010, and discovered that the MMR vaccine did not increase the risk for autism or trigger autism in susceptible children.

Below are some of the highlights of the witnesses’ testimony:   

Public health burden from outbreaks

The resurgence of measles is not only detrimental to affected individuals, but it also presents an incredible burden on public health infrastructure as communities struggle to contain an incredibly infectious disease outbreak.

Dr. John Wiesman, Secretary of Health, Washington State Department of Health, stated that while the MMR vaccine costs $20 per dose, the current outbreak has cost the state of Washington approximately $1 million — as well as the time investment of more than 200 individuals contributing more than 10,000 hours of work to help contain the outbreak and investigate the trajectory and sources of possible contamination. Dr. Wiesman also mentioned that every dollar spent on vaccines generates a cost savings of $10.

Vaccine hesitancy

Officials credit the proliferation of measles across the country to growing anti-vaccine sentiments. HELP Committee Chairman Lamar Alexander (R-TN) stressed that low immunization rates destroy herd immunity and that annual child and adult vaccine schedules help to ensure individual and community safety.

Mr. Lindenberger explained how the Internet was instrumental in both spreading misinformation regarding vaccines to his parents, and conversely, how crucial it was to helping him obtain factual data on the safety of vaccines — and convincing him he needed to get vaccinated. Lindenberger stressed the importance of education to help stem the tide of misinformation surrounding the safety and efficacy of vaccines.

The witnesses also stated that vaccine confidence is built through physician consultation. Parents have been known to reverse their anti-vaccine stance when physicians provide counseling, allowing for an objective, judgment-free space for parents to ask questions. Healthcare provider counseling not only assuages looming doubts regarding vaccine safety but helps to protect the entire community in the process.

Vaccine regulation, research, and funding

Several witnesses from the HELP hearing emphasized the importance of building vaccine confidence through sound research, dissemination of factual information, policy implementation, and funding.

John Boyle, president and CEO of the Immune Deficiency Foundation, expressed how important vaccines have been to his survival as an individual with a primary immunodeficiency disease. For individuals like Boyle, survival is contingent on herd immunity, as he is not able to get vaccinated himself.

Dr. Wiesman joined with other advocacy organizations in calling on Congress to increase the budget of the CDC by 22 percent by 2022. Dr. Wiesman also requested that the federal government launch a national vaccine education campaign, similar to the anti-tobacco Truth campaign.

Dr. Saad B. Omer, professor of epidemiology and pediatrics at Emory University, recommended that Congress make physician vaccine counseling reimbursable, as providers are often overburdened and this could aid in their efforts. Dr. Omer also recommended the continued prioritization of vaccine safety research and greater investment in vaccine acceptance and communication research.

NCL thanks the Senate HELP Committee and other Members of Congress for shining a light on the importance of vaccination, and NCL will continue our work to dispel the myths and educate the public on the safety and effectiveness of vaccines.

Make a New Year’s resolution to get vaccinated against shingles

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Nissa Shaffi

Shingles (herpes zoster) is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. Once a person recovers from chickenpox, the virus lays dormant in the body’s nerve cells, while the host remains asymptomatic. While scientists are not sure what causes the virus to reactivate in the form of shingles, it can present in individuals who are elderly or those who have compromised immune systems in general, due to medication or health conditions.

Shingles is a painful rash that usually develops on one side of the body, often the face or torso. The rash consists of blisters that typically scab over in seven to 10 days and clears up within two to four weeks. Even long after the rash has healed, shingles can lead to long-term complications in the form of postherpetic neuralgia (PHN)—severe nerve pain— at the site of the rash.  Although shingles is not contagious, VZV can spread from a person with active shingles to cause chickenpox in someone who has either never had chickenpox or has never received the chickenpox vaccine. The virus spreads through direct contact with the blisters, and a person is not infectious before the blister phase.

The only way to lower the risk of developing shingles is to get vaccinated. The Centers for Disease Control and Prevention (CDC) recommends that healthy adults 50 years and older get two doses of the new shingles vaccine called Shingrix to protect against the disease. The new vaccine is administered in a two-dose series, and the second dose is administered two to six months following the first dose. According to the CDC, it is imperative that patients complete the vaccine series as it provides greater protection than its predecessor Zostavax, which is a single-shot vaccine.

According to reports, a surge in demand for the shingles vaccine following the recommendations has led to a national shortage, leaving consumers searching far and wide for available doses. While news of the vaccine shortage is certainly unfortunate, the silver lining in this situation is that patients are taking proactive measures to protect themselves from illness.

NCL strongly advocates for the use of vaccines as a safe and effective preventive public health measure to protect against debilitating illnesses. A survey conducted by NCL in 2014 revealed that due to prevalent anti-vaccine rhetoric, nearly 33 percent of American consumers are misinformed about the benefit of vaccines. Vaccines are essential to public health as they protect vulnerable populations with diverse health needs. Adults and children who are not able to receive vaccines due to certain conditions rely on the general population for protection against disease, also known as herd immunity.

Consumers should feel at ease knowing that while shingles is a serious condition, your odds of developing the disease before the shortage ends are low. The CDC recommends that consumers call their local pharmacies or use Vaccine Finder to find their nearest available dose. If Shingrix is unavailable in your area, the CDC recommends that consumers 60 and older get the Zostavax vaccine.

If you have gone more than six months since your initial dose, the CDC states that you do not have to start the vaccine course over, but should instead promptly get the second dose to ensure maximum immunity. If you have already received your first dose of the vaccine, you can sign up for text, voice, or email reminders for your second dose. For more information on the causes and risk factors associated with shingles, please click here.

The need for increased funding for Alzheimer’s research

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Nissa ShaffiOn November 28, in collaboration with Biogen and Eisai, The Hill hosted Preparing for a Treatment – Alzheimer’s Diagnosis and Care, which featured Senator Ed Markey (D-MA) and Senator Thom Tillis (R-NC), along with experts throughout the memory care and Alzheimer’s space. Senators Markey and Tillis discussed the vital need and urgency in funding for Alzheimer’s research and the need for a bipartisan effort towards a cure.

Senator Markey stated that more than five million Americans currently live with Alzheimer’s, and by 2050 that figure could triple to 16 million. Alzheimer’s remains one of the most underfunded and underdiagnosed chronic illnesses, despite having devastating effects equivalent to that of cancer or diabetes. Senator Markey reminisced on the Apollo moon landing in the ‘60s, recalling that the journey to the moon was an impressive feat for our nation and that we must now venture into the journey of the mind, a similarly vastly unexplored area.   

Senator Tillis emphasized the importance of continued development of new treatments for Alzheimer’s. He warned against disengaging in collaborative efforts with pharmaceutical companies on account of a few bad actors, as diminished engagement with pharmaceutical and biotech companies could have devastating effects on risk–taking and innovation.  

Experts from the panel agreed with the Senators that there is a great need for increased research in the biotechnology, pharmaceutical, and primary care spaces. The panelists stated that Alzheimer’s is currently the only disease that has no cure, methods of prevention, or strategies to slow down progression. However, there have been significant advancements made in the detection of Alzheimer’s in the form of amyloid positron emission tomography (PET) scans.  

Amyloid PET scans allow physicians to detect the development of amyloid plaques, which are clumps of insoluble plaques in the brain that destroy connections between nerve cells. These images can afford physicians the ability to detect Alzheimer’s in patients 10-15 years before a diagnosis, potentially transforming primary care delivery and forging a path towards prevention.   

The panelists also discussed the Bold Infrastructure for Alzheimer’s Act (S.2076), which would expand the public health infrastructure to support patients, caregivers, and communities in the Alzheimer’s space. Additionally, the bill would require greater reporting and analysis of state and national data on cognitive decline, caregiving, and health disparities. Introduced by Senators Susan Collins (R-ME), Shelley Moore Capito (R-WV), and Catherine Cortez Masto (R-NV), S. 2076 now enjoys 57 bipartisan co–sponsors, including Senators Markey and Tillis.     

The National Consumers League supports efforts such as S. 2076 that would make strides in addressing Alzheimer’s disease. NCL is also proud to be a partner in WomenAgainstAlzheimer’s We Won’t Wait Campaign, which seeks to unite women in a widespread effort to define Alzheimer’s as the 21st Century’s primary economic justice issue and health crisis for women. The Campaign promotes advocacy, education, and action on five key pillars: public funding, sex-based research, economic justice, diagnosis and treatment, and brain health. 

Gray market erectile disfunction medications pose risk to consumers

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Did you know the vast majority of online pharmacies are illegitimate? A review by the National Association of Boards of Pharmacy (NABP) found that only 2.4 percent of online pharmacies comply with U.S. pharmacy laws and practice standards. This alarming statistic sheds light on the growing threat of illegal, online pharmacies – a component of the gray market – to consumer health. While many online pharmacies may present themselves as a legal, safe, and/or cheaper option, purchasing medicines from these websites could come at the cost of safety and security if consumers do not take the appropriate precautions. 

Medications for erectile dysfunction (ED) – which affects 24 percent of men in the United States over the age of 18 – are among the most commonly sold medications on the gray market. Due to a number of factors including the stigma some consumers experience around sexual health conditions and treatments, many patients suffering from ED don’t talk to their doctors or have prescriptions filled. This creates an environment where consumers may instead seek out unsafe, illegitimate online pharmacies to get these prescription medicines.

In accordance with our mission to ensure all Americans have access to safe, effective medicines, the National Consumers League (NCL) partnered with Bayer to develop a white paper, Increased Consumer Risk from Erectile Dysfunction Medication Advertised and Sold on the Gray Market, to analyze the possible dangers consumers face by purchasing ED medications from illegal online pharmacies. NCL presented the paper’s findings in November at the Alliance for Safe Online Pharmacies (ASOP) Global Foundation’s Spotlight on Illegal Online Drug Sales Research Symposium in Washington, DC.

Based on the research, the white paper recommends five concrete policies to improve consumer safety, including:

  • Enhancing consumer awareness about the gray market and promoting health literacy;  
  • Encouraging healthcare providers to talk about the risks of illegal online pharmacies with their patients;  
  • Supporting collaborative law enforcement actions to combat illegal sales on the gray market; 
  • Increasing access to ED medicines by making them available over-the-counter, with robust consumer education and information programs; and
  • Adding to the body of evidence on the dangers of the gray market.     

To learn more about the research and the dangers of the gray market, read the full white paper here.

What California is doing to lower maternal mortality

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Nissa ShaffiThe United States currently has the worst maternal mortality rate in the developed world, at 26.4 deaths per 100,000 live births, compared to 9.2 in the United Kingdom, 8 in France, and 5.5 in Australia. To put this in perspective, the United States currently has a higher maternal mortality rate than Saudi Arabia and Libya and is barely better than Mexico, Iran, and Russia. An even more devastating reality is the maternal mortality rate among black women, who are 243 percent more likely to die from pregnancy- or childbirth-related causes than women of any other race in America.

There is some good news amid these grim numbers. The state of California has successfully worked in collaboration with public and private healthcare stakeholders to decrease the maternal mortality rate to seven deaths per 100,000 live births.

In 2006, the California Department of Public Health (CDPH) and the California Maternal Quality Care Collaborative (CMQCC) worked together to assemble a multidisciplinary committee of clinical experts to investigate this epidemic. This committee’s focus was to determine the causes of maternal deaths and the demographics of women most affected, along with identifying opportunities to turn the numbers around.

Within the first two years of its launch, the committee was able to identify placenta accreta and preeclampsia (pregnancy-induced high blood pressure) as the two most preventable causes of maternal mortality.  Placenta accreta is a condition in which the placenta affixes to the uterine wall and fails to separate postpartum, which results in severe obstetric hemorrhaging. Upon discovering a correlation between the rise in cesarean sections (C-sections) and placenta accreta cases, the CMQCC sought to reduce the number of C-sections that were medically unnecessary.

Additionally, the CMQCC revamped California’s hemorrhage guidelines to help make childbirth safer for mothers in the state. As a result, California has created a state model that has resulted in a dramatic decrease in maternal mortality, while the rest of the country continues to experience an increase in rates.

California has set an example for the rest of the country. Other states would do well to take a page from its example and turn around this alarming trend of increased maternal fatalities. In addition, a bill currently being voted on in Congress, the Maternal Health Accountability Act (S.1112), would be a federal remedy to help address this issue. The bill would require states to monitor and assess pregnancy-associated deaths and develop appropriate measures to improve the quality of maternal care. We should all ask our members of Congress to help pass the Maternal Health Accountability Act (S.1112), a bipartisan bill that could potentially save countless lives and reverse the damaging trend of maternal mortality in the United States.

Healthcare Open Enrollment starts today

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Nissa ShaffiOpen Enrollment is back! From November 1, 2018 to December 15, 2018, consumers will be able to shop for insurance coverage options through the individual health insurance marketplace. Even if you are currently insured, you can still take advantage of the Open Enrollment period to compare plan options and select a plan that better suits your budget and needs.

The Centers for Medicare & Medicaid Services (CMS) recently announced that marketplace premiums have dropped by 1.5 percent nationally. With regard to pre-existing conditions, all marketplace plans sold through HealthCare.Gov are required to provide comprehensive coverage to consumers and cannot discriminate against enrollees on the basis of health status. In addition, when you apply for insurance via the marketplace, you will be able to determine if you qualify for a premium tax credit. To find out if your monthly income range qualifies for a premium tax credit, please click here.

The National Consumers League encourages consumers to seek coverage via the Affordable Care Act (ACA) compliant plans offered on the marketplace. These plans are required to cover the essential health benefits mandated by the ACA, ensuring that you have access to comprehensive care.

If you need assistance navigating the marketplace, you can find a healthcare navigator in your area to help in comparing coverage options that meet your needs. To find a navigator in your area, please click here. Most importantly, in order to have coverage that is effective by January 1, 2019, you must sign up by December 15, 2018.

Time to talk about women’s sexual health

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Sexual health is an integral part of overall health and wellbeing. Research has found that good sexual health offers a host of positive benefits, including improving social and emotional health. But far too often, women’s sexual health concerns are not addressed by healthcare professionals.

 

Although a survey of U.S. women found that seven in 10 have experienced a sexual health issue, a culture of discomfort around women’s sexual health often inhibits open conversation about women’s sexual health concerns even between clinicians and their patients.

In fact, surveys of U.S. women and healthcare professionals have found that each group often looks to the other to start a conversation about sexual health. A poll of U.S. healthcare providers by the Association of Reproductive Health Professionals (ARHP) and HealthyWomen found that 74 percent of providers rely on their patients to initiate a discussion about sexual health, while a survey of U.S. women found that 73 percent preferred for their clinician to broach the subject.

There are many reasons for this disconnect – from patients’ lack of awareness that their symptoms can be treated, to a lack of training or time for healthcare professionals to address their patients’ concerns, to a general discomfort with women’s sexual health among all parties. The end result is that women often don’t receive adequate care for important sexual health issues.

To help break down these barriers, NCL has joined together with other leaders in the field of women’s and sexual health to launch the Alliance for Advancing Women’s Health. The Alliance is committed to working together to help women advocate for their sexual health during clinical visits and to give clinicians the tools they need to ask about and address their patients’ sexual health concerns.

Over the course of the coming year, we’ll be working to raise awareness about the barriers to open conversations about women’s sexual health, and we’ll develop a discussion guide and user-friendly tools to help women and clinicians start and sustain conversations about sexual health concerns. In the meantime, you can find helpful resources from our member organizations at www.advancingwomenshealth.org.

We believe a sea-change is needed to make sure women of all ages and backgrounds have their concerns heard without feeling judged or ashamed. By raising awareness of sexual health issues and working to normalize these conversations, we hope to improve women’s sexual health and overall quality of life.

National Prescription Drug Take Back Day

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Nissa ShaffiThis Saturday, October 27, 2018, is the Drug Enforcement Administration’s (DEA) National Prescription Drug Take Back Day. This initiative is a national effort that aims to provide consumers with safe and convenient avenues to dispose of their expired or unused prescription medications. Failure to properly dispose of medications can lead to devastating consequences, as medications can become misplaced, stolen, or misused.

 

National Prescription Drug Take Back Day ensures that used, expired, and potentially highly addictive prescription medications such as opioids do not end up in the wrong hands. In April 2018 alone, national take back efforts were able to collect close to 474.5 tons of prescription medications.

The National Consumers League encourages consumers to clean out their medicine cabinets and participate in National Prescription Drug Take Back Day this Saturday, October 27, 2018. To find a drug take back location near you, please click here. Drug take back efforts will run from 10 am to 2 pm. To make phone inquiries, call 1-800-882-9539.

In addition to National Take Back Day, consumers can also dispose of unused and expired prescription medications in the following ways:

  • Contact your local pharmacy to see if they offer programs like in-store kiosks to collect unwanted prescription drugs.
  • Use a drug disposal pouch, such as the Deterra pouch, that contain solutions that nullify active ingredients in medications when mixed with water and sealed for disposal.
  • Mix expired and unused drugs with cat litter or old coffee grounds, seal them in an airtight container, and throw it into the garbage.
  • As a last resort, consumers can flush their medications down the toilet, but this method is generally not recommended as the ingredients in some medications can potentially corrupt community water supplies. The Food and Drug Administration (FDA) has issued a list of medications approved for disposal by flushing when other safe disposal options are not readily available.

For more resources on how to safely and effectively dispose of prescription medications, please click here.