California Watch - Health and Welfare

US guidelines on food marketing to kids stalls

Bernice Yeung — Fri, 27 Jan 2012 08:05:02 +0000

Bernice Yeung

Simon Miller/Flickr

According to a recent analysis of medical costs in the research journal Obesity, California spends an estimated $15.2 billion on obesity-related health problems each year – the most in the country.

The California Department of Public Health’s Obesity Prevention Plan seeks to reduce obesity rates among Californians, calling for strategies ranging from easing access to fruits and vegetables to building roads and sidewalks to make walking easier.

It also wants to limit children’s exposure to “unhealthy” food and beverage advertising. One in nine California kids is obese or overweight, and a disproportionate number are minority and low-income children, according to the state Department of Public Health.

“California and the nation face a growing obesity epidemic that threatens the life expectancy gains of past decades and portends greater increases in health care costs,” the plan states.

The new federal nutritional rules for government-subsidized school-based meals that were announced this week are being hailed by public health advocates as a strong obesity prevention measure. But federal efforts to address the connection between obesity and food marketing to children recently stalled, when funding for a set of proposed national marketing standards became contingent on a cost-benefit analysis mandated through an appropriations bill passed in mid-December.

Much of the national attempt to address food advertising to children has been focused on these proposed marketing standards, drafted by the Interagency Working Group on Food Marketed to Children. The group was created by Congress in 2009 to recommend standards for advertising food to kids. About $1.6 billion is spent annually on ads targeting kids through TV commercials, social media, mobile phones and recently via computer-based "advergames," or food company-branded online games.

Public health and child advocates argue that advertising by fast food and junk food companies encourages poor eating habits and puts children at risk for obesity. A recent study by researchers at Yale University’s Rudd Center for Food Policy & Obesity, for example, found that “after playing unhealthy food advergames, children consumed more nutrient-poor snack foods and fewer fruits and vegetables” and concluded that restrictions should be placed on food-related advergames.

Last year, the working group – made up of the U.S. Department of Agriculture, Food and Drug Administration, Centers for Disease Control and Prevention, and Federal Trade Commission – issued draft voluntary guidelines [PDF] that call on the food industry to reformulate some products to meet specific nutritional guidelines if they are to be advertised to children.

It was met with opposition from food, advertising and media companies.

“We felt the guidelines were overly restrictive and inappropriate,” said Dan Jaffe, executive vice president of government relations for the Association of National Advertisers. “For the 100 most popular foods in this country, 88 would not have made the cut, including whole wheat bread, most yogurts, virtually all cereals and many things that parents would be thrilled for their kids to be asking to eat, particularly those who are health conscious.”

The Sensible Food Policy Coalition, made up of the country’s largest food manufacturers, launched a “Keep the Government Out of Your Kitchen” media campaign. Food manufacturers also argued that the industry already self-regulates its advertising to children through organizations like the Council of Better Business Bureaus' Children's Food and Beverage Advertising Initiative.

“Industry has gone to great lengths to improve its products,” said C. Lee Peeler, an executive vice president for the council. “Look at what has happened in the fast food industry, where fast food products that are advertised to kids are now low-calorie and a fruit or a vegetable is included. These improvements are driven by the marketplace. Self-regulation on this issue has been successful, and it will continue to grow.”

But public health advocates say there are too many loopholes to the Council of Better Business Bureaus' self-regulation.

“Part of it is that the food and beverage companies want to say that they are changing the way they market to kids without really having to change their marketing in any meaningful way,” said Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest. “The guidelines would help to show how weak their current self-regulation efforts are.”

The proposed guidelines also have sparked a legal debate: Food industry representatives have resisted the draft guidelines because they argue that limitations placed on advertising violate food companies' First Amendment rights to free speech.

“By using the coercive force of government agencies to suppress truthful advertising about a broad range of healthy, legal products for every segment of the public, the proposal clearly violates the First Amendment rights of both marketers and consumers,” the Association of National Advertisers' Jaffe told legislators in October.

But Public Health Law & Policy’s Samantha K. Graff called the argument “ridiculous.”

“They are voluntary guidelines from the U.S. government and do not violate the First Amendment,” she said. “Agencies do this kind of thing all the time; it’s basic government doing its job. They are trying to distort the First Amendment and throw it into the mix to intimidate lawmakers.”

A paper to be published in February's American Journal of Public Health by Graff and the Rudd Center’s Jennifer L. Harris further argues that federal policymakers have the ability to regulate food marketing aimed at children without violating free speech laws through “carefully tailored government actions.”

Public health advocates said food and beverage industry lobbyists pushed for the delay of the final marketing report and guidelines through the December bill, which made funding contingent on additional analysis of the suggested standards. The top 10 industry donors made about $2.3 million in political contributions in 2011.

“There was so much momentum and support for the guidelines, and yet it’s been really difficult to get these published,” said Juliet Sims of Oakland's Prevention Institute, a health organization. “We will continue to really push for the guidelines to not be held up, so we have a scientific baseline. I think it’s just an indication of the fact that Congress is putting the industry’s interests before children and family health.”

An ongoing campaign by the Prevention Institute urges the federal government to take stronger actions on what it has dubbed "deceptive" advertising by junk food and fast food companies. It has launched its own campaign to appeal to President Barack Obama and federal lawmakers, arguing that food and beverage companies claim to “have our kids' best interest at heart, so why are they doing things like launching marketing campaigns disguised as charities right in our schools?”

In California, addressing “unhealthy” food and beverage marketing continues to be one prevention strategy.

"We have learned from our successful work on tobacco control that the social environment and social norms are very important in shaping behavior," Ken August, a California Department of Public Health spokesman, wrote in an e-mail. "It is important to provide balance in the messages that young people receive. ... The California Obesity Plan is not just a plan for CDPH or state government. Our vision for the Plan is to engage all aspects of our communities – from health care to employers, child care and schools, community organizations, the food and entertainment industries, and professional sports."

Disbanding of nursing board raises questions about public protection

Christina Jewett — Wed, 25 Jan 2012 08:05:03 +0000

Christina Jewett

ideabug/istockphoto.com

The state Board of Registered Nursing ceased to exist this year due to an October veto by Gov. Jerry Brown, and now stark disagreement is emerging over whether the public is adequately protected from nurses who need drug treatment or limits on their practice or to be stopped altogether.

Brown vetoed the bill that would have extended the board’s charter to 2016 after balking over possible pension obligations. In doing so, he dissolved the board after 106 years of operation.

Employees charged with overseeing the licensing of more than 350,000 nurses are now part of the state Department of Consumer Affairs, where they continue the administrative work, such as processing applications for would-be nurses and investigating complaints, department spokesman Russ Heimerich said.

“This shouldn’t be a concern to the public at all. It’s business as usual. The public shouldn’t even notice this is happening,” said Melissa Figueroa, a spokeswoman for the State and Consumer Services Agency, which oversees the Department of Consumer Affairs.

Figueroa said her agency, which works closely with the governor’s office, is in talks with the Legislature to quickly reconstitute the board, possibly through a bill moored to the state budget, known as a trailer bill.

However, Jeannine Graves, who was president of the nursing board just before it folded, said she voted against an interagency agreement that granted the Department of Consumer Affairs authority over board functions late last year.

She said it creates a “legal fiction” and does not provide protection to the public or due process to nurses guaranteed by the appointed board of five nurses and four public members. The board's staff investigates about 8,000 cases each year.

“We all have our boots on the ground,” Graves said. “We’re very in tune with what makes safe nursing care in California.”

Graves said she was appointed by former Gov. Arnold Schwarzenegger to a slate of board members assigned with fixing shortcomings identified by a ProPublica investigation into board discipline.

Graves said her group accomplished much, and she was disappointed when the governor's office dismissed her from her position, the day after her vote against the current interagency agreement. Her board position ended last summer but could have extended to this summer, she said.

"I took a sword for the board," she said. "We did a lot of good and I'm sorry to have to leave."

The board’s dissolution plunges the state into uncharted waters, said Julie D’Angelo Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego.

She said that in the past, a board that was not reconstituted by its “sunset” date automatically became a bureau, a similar entity. She said that provision of law no longer exists, so it’s unclear how the interagency agreement between the board and Department of Consumer Affairs will stand up to challenges.

“I just think this was all unnecessary, and it’s thrown a monkey wrench into public protection from some very bad nurses,” D’Angelo Fellmeth said.

Richard Rice, a former senior adviser to Schwarzenegger, said that as a public member of the just-dissolved board, he also voted against the agreement.

He said it brings to a halt policy work the board was performing to improve nursing care, including an effort to strengthen laws requiring nursing schools to teach clinical skills in addition to classroom skills.

“Very serious issues that come before the board are not being dealt with,” he said.

In vetoing the legislation to continue board operations until 2016, Brown took a strong stance against pension obligations for a new class of board investigators who would have had law enforcement status.

His veto message [PDF], dated Oct. 9, says, “This makes no sense fiscally and flies in the face of much needed pension reform.”

Figueroa said the new legislation re-creating the board likely will be similar to what was most recently in place.

Heimerich emphasized that the board’s work is still being done. The board typically adopts, amends or rejects proposed decisions by administrative law judges who hear cases over nurse discipline, Heimerich said. Now, judges’ decisions will automatically take effect if no board action is taken in 100 days.

Also, the board tends to approve or reject settlements reached between attorneys representing nurses accused of misconduct and deputy attorneys general representing the board. Heimerich said those cases also will be subject to approval by administrative judges, whose decisions are final if the board takes no action in 100 days.

Lynda Gledhill, spokeswoman for Attorney General Kamala Harris, said cases that deputy attorneys general prosecute on behalf of the board are moving forward.

“We’re working with the former board staff, people at the Department of Consumer Affairs, to make sure everything runs as smoothly as possible,” she said.

Resistant bacteria found in US pork products

Susanne Rust — Tue, 24 Jan 2012 08:05:03 +0000

Susanne Rust

milanfoto/istockphoto.com

Researchers have found higher-than-expected levels of deadly bacteria in what is considered the largest sampling of raw retail meat products in the United States.

A team of researchers at the University of Iowa collected 256 samples of pork from 35 retail stores in Iowa, Minnesota and New Jersey. Samples included pork chops, ground pork, riblets, ribs, sausage, blade steak, cube steaks, pork loin, pork roasts and pork cutlets.

The researchers found that nearly 7 percent of the products tested contained methicillin-resistant Staphylococcus aureus, or MRSA.

Researchers from the National Pork Board were quick to point out that not all MRSA strains are harmful to people. Indeed, livestock strains of the bacteria show little effect, if any, on people.

"Their results are not unexpected," said Jennifer Koeman, director of public health for the National Pork Board. "The prevalence is comparable or less than seen in other countries."

But while nearly a quarter of the MRSA strains identified in the study were of the livestock variety, 50 percent were human strains, said Tara Smith, lead author of the study and an epidemiological researcher at the University of Iowa.

"These are common human strains," Smith said. "These strains do cause infections in people."

Staphylococcus aureus bacteria is one of the leading agents of food poisoning in the U.S., causing an estimated 185,000 cases every year. The bacteria has been associated with serious, sometimes deadly blood, skin and other organ infections in people. Research indicates that a growing number of these bacterial infections are resistant to standard antibiotic treatment.

MRSA, the antibiotic-resistant form of Staphylococcus aureus, was once associated only with hospital infections. But a growing number of cases are being found outside of hospitals, and community-associated MRSA is now considered the leading cause of skin and soft-tissue infections treated in emergency rooms.

Smith, who is also the interim director of the University of Iowa's Center for Emerging Infectious Diseases, said she was surprised at the prevalence of staph bacteria found in their samples.

Nearly two-thirds of the samples contained some form of the staph bacteria.

However, the researchers found no difference between the incidence of MRSA – the antibiotic-resistant form of staph – in conventionally produced pork products and those produced without the use of antibiotics.

“We were surprised to see no significant difference in antibiotic-free and conventionally produced pork,” Smith said. “Though it’s possible that this finding had more to do with the handling of the raw meat at the plant than the way the animals were raised, it’s certainly worth exploring further.”

According to Smith, unlike products that are stamped with the organic label, products with the label "raised without antibiotics" are not routinely verified by an independent third party. In addition, pork produced conventionally and alternatively can be processed at the same plants and, therefore, contamination can occur.

"It's hard to say, just taking the end product, where the contamination came from," she said.

She said she worries that consumers may become too complacent with food handling when they see a product stamped with organic or antibiotic-free, because it doesn't mean it is free of bacterial contamination.

Liz Wagstrom, a scientist with the National Pork Producers Council, said that regardless of the health risk posed by some of these strains, it is "always a good idea to wash your hands."

Mexican cultural festival thrives in Marin County

Patricia Leigh Brown — Mon, 23 Jan 2012 08:05:03 +0000

Patricia Leigh Brown

Courtesy of Lourdes FigueroaEugenio Martinez and Maria Guadalupe Martinez, members of Danza Azteca Tonantzin, dance at the Virgin of Guadalupe celebration in Marin County.

On a cool, bright day last month, a party tent set up at a working ranch in west Marin County was transformed into a Mexican basilica, the scent of dozens of roses brought as an offering to the Virgin of Guadalupe infusing the air.

They came from as far as 40 miles away – dairy hands, waiters, maids, nannies, welders, busboys and hundreds of other Mexican and Mexican-American laborers who make up the working backbone of Marin County, one of the most affluent counties in the United States.

Each year on Dec. 12, the faithful make a pilgrimage to Lafranchi Ranch, rolling pastureland founded by Swiss-Italian immigrants. They come to honor the Virgin of Guadalupe, the Roman Catholic icon of the Virgin Mary considered the Empress of Mexico and the Americas. The Virgin is the most popular cultural and religious symbol in Mexico, and her celebration, including a Mass and feast, is one of the most important dates on the Mexican calendar.

“It is a joy,” said Maria de la Cruz, wearing a ubiquitous ruffled Mexican apron as she stood watch over huge pots of posole, a traditional pork and hominy stew.

The liveliness of the event – in which posole was accompanied by a wedge of lime and live mariachi music – stands in stark relief to many of the participants’ grueling lives. Many ranch hands rise at 2:30 in the morning to milk or feed cows – the unseen force behind Marin County’s famously pastoral landscape.

In a place synonymous with the good life, where the median home price is roughly $740,000, the Latino community “tends to be invisible,” said Dr. Michael Witte, founder and medical director of the nonprofit Coastal Health Alliance, which operates three clinics serving low-income patients in Marin, one-third of them Latino. Many suffer from chronic diseases such as diabetes, high blood pressure and obesity.

“A lot of it is generated by circumstance – isolation, poverty, eating an American diet,” Witte said. “In Mexico, they gardened and walked everywhere. Here, they can’t walk to a neighbor’s house or over to the next village.”

Many develop ulcers and other stress-related problems, including insomnia. Severe arthritis and back pain are common.

“It’s really a high-stress group of folks,” Witte said. “Their lives are centered around constant work with little breaks. So celebrations are an important release for them.”

The Lafranchi Ranch, which also operates the Nicasio Valley Cheese Company, is now in its third generation. Only six employees live on the property full time, said Randy Lafranchi, who runs the ranch.

For those working in Marin County, finding an affordable place to live is a major challenge: Two-thirds of employees earn less than $55,000 a year, the minimum necessary to afford a median-priced one-bedroom apartment. Sixty percent in the Marin workforce commute, driving farther than others in the Bay Area to live in more affordable housing, according to a report [PDF] by Live Local Marin, published by the Non-Profit Housing Association of Northern California and the Greenbelt Alliance.

Although many celebrants live far away, the homegrown festival, now more than 30 years old, draws more than 300 people to Nicasio, a village perhaps best known as the home of George Lucas’ Skywalker Ranch. Eugenio Martinez, produce manager for the nearby Point Reyes Farmers Market, always brings his troupe of Aztec dancers, who convert the parking lot into a makeshift dressing room as they change into elaborate feathered headdresses, seed-pod leg rattles and other costumes.

Courtesy of Lourdes FigueroaFrancisco Fletes, a member of Mariachi mi Tierra Linda from Oakland, serenades the image of the Virgin of Guadalupe.

What began as a tiny procession by ranch hands at the local church has turned into a greatly anticipated fiesta, for which funds are raised months in advance. Most participants are originally from Jalisco, including 70-year-old Esther Vidrio Tejeda Martinez, who works as a house cleaner and is the event’s only living founder. Today, her long braided hair cascades down nearly half of her 5-foot frame, echoing a photograph of her younger self at the fiesta in a flowing red velvet dress. The festivities were inspired by her grandfather, Santiago Vidrio Castro, who would pray the rosary every day.

“We were a very small community but didn’t want to lose our traditions,” she explained.

For those of Mexican origin, public celebrations like this one, announced by the blowing of a conch shell, represent “the participatory culture of everyday life,” said Eugene Rodriguez, a founder and executive director of Los Cenzontles, a nonprofit educational organization in San Pablo dedicated to authentic Mexican art forms.

“When the community of Marin talks about culture and the arts, they’re not talking about this,” he added, speaking of the festival. “But they should be.”

Despite the local reputation for tolerance and open-mindedness, the Mexican community is “little understood by non-Mexicans,” Rodriguez said. His organization is working with the Marin Community Foundation to document cultural practices, including the Virgin of Guadalupe festival, and collaborate with local Latino artists.

“Americanos, sí!” said Martinez, asked by a visitor if anyone could learn Aztec dancing.

And with that, he disappeared into the swirl of celebrants in the tent, lit like a beacon in the night.

State hearings explore health of minority males

Bernice Yeung — Fri, 20 Jan 2012 08:05:03 +0000

Bernice Yeung

arieliona/istockphoto.com

When it’s 17-year-old Eric Gant’s turn to testify today at an Oakland legislative hearing on the health and welfare of California’s minority men and boys, he will ask for a safe way to get to school.

“Students deserve a safe path to school, like an adult wants a safe path to work,” Gant, who is African American, told California Watch. “A safe pathway is so that you can walk down the street and nothing would happen, so you can get an education and make it home OK.”

An outgoing and ambitious teen, Gant rattles off a few examples where he or students he knows have been targets of theft or violence on their way to school. “You think about it all day,” he said of the threats. “You think about it the whole school year, maybe.” He added that Oakland students need a safe place to do their homework.

Gant’s experience hints at one of the concerns that youth advocates have for this population: overlooked trauma related to violence in their neighborhoods. Nationally, Latino boys and young men are more than four times as likely to have post-traumatic stress disorder [PDF] as whites. African American boys are 2.5 times as likely.

Today's hearing is being convened by the Assembly Select Committee on the Status of Boys and Men of Color in California. Assemblyman Sandré Swanson, D-Oakland, said he formed the committee to examine the adverse conditions that some black, Latino and Asian boys experience and their effects on state resources and agencies. It also will look at the connections among issues like health, foster care, truancy, school dropouts, unemployment and incarceration.

“We are being holistic in what we are trying to do here,” he said.

Youth advocates say the needs of this group must be addressed for the overall benefit of the state.

“If you have a segment of the population that is consistently failing and consistently incarcerated and marginalized and excluded, you can’t have a state population that is thriving,” said Marc Philpart, a senior associate with PolicyLink, which is coordinating a network of statewide nonprofits and researchers on the topic. “The good thing about the select committee is that it’s an institutional mechanism for getting greater attention on the policy side of these particular issues, because there’s no way that we can service our way out of these problems.”

African American and Latino boys have higher odds of not having access to health care and experience higher rates of poverty, homicides and incarceration than their white counterparts, according to a 2009 statewide study [PDF] produced by the RAND Corp.

The RAND study documented various health and welfare concerns related to unemployment and incarceration among California’s minority men and boys. A 2010 national report [PDF] on the same topics found that, among other things, “when it comes to health and other outcomes, the odds for boys and men of color are more than two times worse” than for their white counterparts.

“There’s a lot of qualitative data on how young boys of color are faring emotionally,” said Cassandra L. Joubert, director of the Central California Children’s Institute, who has researched minority youth. “It suggests that they are under a lot of stress and are exposed to a lot of trauma because their neighborhoods are unsafe, they face a lot of life challenges, their parents are having difficulties, or their friends are being murdered. It’s a whole host of things.”

Community organizations and academics in Fresno, Oakland and Los Angeles also are examining these issues.

In Fresno, researchers confirmed many of the RAND findings. They also found that black and Latino boys had higher rates of emergency room visits for asthma and sexually transmitted diseases than whites. Nearly 45 percent of Fresno County's HIV cases are among Latino men, compared with 32 percent among whites and 3 percent among Asians. Only half of Fresno’s African American boys and 60 percent of Latino boys had a stable source of health care.

Joubert of the Central California Children’s Institute said these statistics can be partially explained by poverty and a lack of awareness of health issues in Fresno. "A greater appreciation for how and where you live, and the resources in your community that are there or not there, or the dangers in your community and the role of place in health would help,” said Joubert, who conducted the Fresno study.

Oakland health, safety and other demographic data culled by the Urban Strategies Council found that African Americans were most likely to be victims of homicide and had the highest mortality rate, at 962 deaths per 100,000 people, compared with a countywide rate of 630 deaths per 100,000. Thirty-two percent of African American men had high blood pressure, compared with 26 percent for all males, and 31 percent were obese, compared with 19 percent overall.

The Los Angeles report has not yet been released.

Today's hearing in Oakland is one in a series that will be held across the state; similar events will be held in Los Angeles on March 2, Fresno on April 13 and Sacramento on Aug. 3.

Swanson said the hearings will help legislators generate new policy ideas. Those under consideration are support for school-based health clinics and an examination of the relationship between truancy and incarceration.

Gant, the Oakland student, decided to bring his safe pathways to school idea to legislators after he participated in an event for youth and community members Saturday at the Oakland Museum of California in preparation for the hearing today.

Students at last week's event said they were concerned with gangs and police brutality; they also worry that there are “no grocery stores in the ‘hood” and that there “are not many safe places where you can just hang out.”

Gant participates in a number of youth organizations, including a leadership program through Kids First Oakland, and he said he thought that the research showing that minority boys and men had poorer health “could be true,” but he thought it had more to do with money and resources. One of his personal mottos is “rich will thrive” because “money has a lot of power in the world, and the rich will survive and strive,” he said.

“It depends on your circumstances and what you can afford,” he said. “My mom, she tries to make healthy food, but I have friends who only eat ramen and McDonald's. It depends on what your job is, what your money situation is, or if you have five people living in one home and they’re only making $48,000 a year. You can only do so much.”

Stanford doctor in birth control vote had ties to pill's maker

Erica Perez — Fri, 20 Jan 2012 08:05:02 +0000

Erica Perez

pixeljuice/istockphoto.com

A watchdog group is calling on the Food and Drug Administration to throw out a joint committee's vote in support of a controversial oral contraceptive because four members of the committee – including a Stanford University professor of obstetrics and gynecology – had ties to the maker of the birth control pill that were not disclosed to the public during the meeting.

Two FDA committees met Dec. 8 to discuss the benefits and risks of the oral contraceptives Yaz and Yasmin and related contraceptives containing the drug drospirenone.

The meeting came amid mounting evidence that drospirenone-containing birth control pills, including bestseller Yaz, have a higher risk of causing potentially dangerous blood clots.

The committee discussed and compared the results of 10 epidemiologic studies of women taking oral contraceptives. Ultimately, the members voted [PDF] 15 to 11 that the benefits of drospirenone-containing oral contraceptives outweighed the risks.

But four of the members who cast crucial votes in support of the contraceptives had ties to Bayer HealthCare Pharmaceuticals Inc., the manufacturer of Yaz and Yasmin, according to public documents unearthed by the Project On Government Oversight and detailed in its Jan. 11 letter to the FDA.

That included Dr. Paula Hillard of Stanford’s School of Medicine. Hillard is listed on the medical school’s website as a paid consultant receiving $5,000 or more annually from a division of Bayer in 2010. Hillard was selected as a temporary voting member for the FDA committee in 2011.

In addition, former FDA Commissioner Dr. David A. Kessler described Hillard as a Yasmin advocate with a long relationship with Bayer in a Dec. 26 expert witness report he filed as part of an ongoing class-action lawsuit against the pharmaceutical company claiming that Bayer over-promoted Yaz's efficacy.

In 2008, Kessler noted, a Bayer Corporate Account Update announced: “New west coast speaker … Paula Hillard, MD recently relocated from Cincinnati, OH to Stanford – this enables us to now have another huge Mirena and Yasmin advocate here in Nor Cal – she will be well utilized!”

Kessler also said Bayer’s plan involved talking to Hillard about the risk of venous thromboembolism, the potentially lethal disorder in which clots that form abnormally in veins may dislodge suddenly and travel to the lungs, where they can cause serious injury or death.

A Bayer Tactical Brief from January 2010 describes a video shoot with Hillard to “illustrate patient counseling techniques on the safety of YAZ.”

Nick Schwellenbach, director of investigations for the Project On Government Oversight, said Hillard clearly had a conflict of interest.

“We believe, given her very specific work on drospirenone with Yaz and Yasmin for Bayer up until November 2010, we think that constitutes a conflict of interest, and she should have been barred from being a voting member on that committee,” he said.

In a written response, Stanford spokeswoman Margarita Gallardo wrote that Hillard had “fully disclosed to the best of her recollection all required information regarding potential conflicts of interest to the FDA.”

In her disclosure, Gallardo said, Hillard told the FDA that she attended two Bayer meetings in 2010. The first, in October, discussed a range of oral contraceptives that contain drospirenone. A second meeting in November was related to the use of the levonorgestrel intrauterine system, a device not under consideration by the panel.

Gallardo said Hillard's reimbursements from Bayer for consulting in 2010 were less than $10,000. She said Hillard did not consult for Bayer in 2011.

The Project On Government Oversight is pushing the FDA for greater public disclosure of committee members’ financial arrangements in general. The agency requires committee members to fill out a form that gives specific information about current and past financial arrangements, said Ned Feder, staff scientist for the Project On Government Oversight. But the forms are not public documents.

If the FDA decides that something on a member’s form poses a possible conflict of interest, the agency can allow the person to participate in a meeting by granting a waiver. The conflict-of-interest waiver document makes public the person’s financial arrangements.

But in the case of Hillard and three other reviewers on the joint committee studying contraceptives, the FDA did not issue any such waivers.

“The whole issue could be taken care of if the FDA simply took the information it got from reviewers and made it public,” Feder said.

Calif. hospital infection rates look low, but may be incomplete

Christina Jewett — Wed, 18 Jan 2012 08:05:02 +0000

Christina Jewett

José Goulão/Flickr

California public health authorities released a ream of documents reflecting reports by hospitals on infections that crop up during patient stays. The reports are part of a nationwide effort to shed light on the deadly – but preventable – infections that are estimated to occur in 5 percent of hospitalizations.

And the news seems great for the Golden State: Rates of infections that crop up as a result of catheters placed to deliver fluids or medications to critical care patients are nearly 50 percent lower than the national average.

But if the experience of several other states that have done truth-in-reporting reviews applies here, the latest reports might reveal only half or more of infections cropping up in California, which is just now truth-squadding hospital reports. That means that hospitals now registering as the state's worst performers might, in fact, just be the most forthcoming.

Connecticut and Colorado are two states that took a closer look at hospital-generated reports and discovered that facilities underestimate central-line infection rates by 34 to 50 percent. And a review by New York infection-control authorities showed that states – like theirs – with strict data-checking programs tend to report higher infection rates than others, including California.

California authorities say they are reviewing results of an in-depth infection-reporting audit of four types of infections reported by 100 hospitals. The Department of Public Health says it plans to use the results to educate hospitals on infection surveillance. But the state lacks the funding needed to keep a steady eye on hospital-generated reports.

“Moving forward, the department will continue to evaluate potential resources that could be used to efficiently identify underreporting,” said department spokesman Ralph Montano.

Lisa McGiffert, director of the Consumers Union Safe Patient Project, has led the charge in encouraging states to mandate that hospitals publicly report on infections that crop up during hospital stays. She said the organization has urged transparency first, but also wants to see bulletproof data.

“The validation studies and validation practices that are going on in the various states make it clear that this is an essential element to getting accurate info out to the public,” she said.

A report [PDF] issued last week in Colorado illustrates why, McGiffert said.

There, inspectors pored over the medical records of 527 patients treated in critical care and long-term acute care hospital units. They focused on patients who were found to have organisms growing in the blood.

They wanted to find out if the infections arose at home or in the community, or cropped up as a result of a central line or intravenous catheter placed at the hospital.

They found that of those 527 patients, 56 had infections that should have been reported as “hospital-acquired.” Among those 56 infections, 37, or 66 percent, were reported; 19 infections that should have been reported, or 34 percent, were not.

The 2012 report by Colorado authorities says the 34 percent underreporting rate was due to confusion over the definition of a “central line” and mix-ups over which hospital unit or health care facility should report a case.

As in California, Colorado does not have money set aside to keep doing the checks. “It is anticipated that with future funding, ongoing validation studies will occur,” the report states.

Researchers in Connecticut also reviewed hospital-reported central-line infections, which, according to the Centers for Disease Control and Prevention, are deadly in 12 to 25 percent of cases.

They reviewed 476 cases in which patients developed bodywide infections known as septicemia. They determined that 48 cases should have been reported in a CDC National Healthcare Safety Network database.

Yet only 23, about half, had been publicly reported. As in Colorado, researchers found that Connecticut hospital staff were confused about reporting criteria, according to a 2010 report published in the American Journal of Infection Control.

New York has been a leader in validating data reported by hospitals about infections. Annual reports issued there since 2008 remind readers that states with aggressive audit and validation systems report higher rates of central-line infections, saying comparisons between states “may be misleading.”

A 2010 report by New York state public health authorities describes a national report on state-specific central-line infections. The CDC report compared data from the first half of 2009 to baseline data from 2006 through 2008.

The New York report [PDF] says states with strict auditing reported infection rates in 2009 that were 8 percent above the national baseline, and 12 states without data validation programs had rates that were 29 percent lower than the baseline.

New York authorities visit a majority of the state’s hospitals each year and review medical records to check accuracy in reporting, according to the 2010 state report. They also scour a variety of data reported by hospitals each month and make phone calls and send e-mails to check into apparent inconsistencies.

The results, though perhaps not flattering, are thorough. In 2010, New York reported about 2 central-line infections per 1,000 central-line days. That was higher than the most recent national estimate, from 2009, which the CDC reports at 1.65 infections per 1,000 central-line days.

In California, the April 2010-to-March 2011 rate was closer to 1 in intensive care units, a rate that's about 50 percent lower than the national rate.

The data would suggest that California, which just issued its first thorough public report, is doing far better than New York, which has been issuing reports since 2008.

Yet California authorities do not seem to be overly eager to declare victory. In the 2012 report about central-line infections, the California Department of Public Health warns that low central-line infection rates may reflect effective prevention or underreporting. High rates might be a sign of lapses in infection prevention practices – or more faithful reporting.

UC Davis study links traditional arts to health

Patricia Leigh Brown — Tue, 17 Jan 2012 08:05:03 +0000

Patricia Leigh Brown

L. Kharrazi/Alliance for California Traditional ArtsWomen and girls teach and learn traditional Triqui backstrap weaving techniques in Greenfield, Calif.

Before she died last month at age 70, the respected Pomo basket weaver and activist Luwana Quitiquit was asked by a researcher for her personal definition of wellness.

“Storytelling is wellness,” she said. “And the reason it is wellness for my family is because it puts my kids back in touch with my grandmother, of people they never get to see. It inspires them to carry on their culture. That’s wellness.”

The link between traditional artistic practices and mental and physical health is explored in “Weaving Traditional Arts Into the Fabric of Community Health,” a study [PDF] by the UC Davis Center for Reducing Health Disparities. The report was commissioned by the Alliance for California Traditional Arts, a nonprofit in Fresno that provides support for folk and traditional artists, the majority of whom are immigrants and Native Americans. In these often-overlooked minority communities, the arts tend to be passed down from one generation to another as collective wisdom, rather than as a personal statement.

“Part of what makes a healthy community is having a vibrant cultural life,” said Amy Kitchener, executive director of the Alliance for California Traditional Arts. “Native Americans have always made a strong connection between cultural practices and health. Unlike the western idea of art in a gallery, for traditional artists, it is embedded in everyday life, in ceremonies and family rites of passage. But objectively evaluating the impact of the arts on health is challenging.”

The study, published in October, was based on a non-scientific hunch: that immigrants and others who maintain and cultivate their traditional cultural practices reap positive health benefits. The alliance, founded in 1997, provides grants and apprenticeships to “tradition-bearers” – the state’s living cultural treasures, many of them elderly, as well as organizations that help foster traditional arts. Among their eclectic ranks are Yurok dugout canoe makers, Persian drummers, Laotian textile embroiderers, Spanish flamenco dancers and an annual Polynesian fire knife dance competition in Anaheim sponsored by Fire Knife of Samoa, a group founded to preserve and perpetuate Pacific Island culture.

Not surprisingly, perhaps, interviews by UC Davis researchers revealed that the practice of traditional arts has manifold positive effects: contributing to spiritual and emotional growth; physical vigor; strengthening of personal and community identity; and mitigation of historical trauma, especially for Native Americans and refugees. The arts also provide a welcome distraction from illness and an enhanced respect for elders.

The preliminary findings echo those of a 1996 UC Davis mental health study of the Mexican population in Fresno, said Dr. Sergio Aguilar-Gaxiola, director of the university’s Center for Reducing Health Disparities. That study found a strong correlation between acculturation and mental health, with second-generation children of Mexican origin born in the U.S. having higher rates of mental disorders and alcohol and drug dependency than their Mexican-born parents.

“People who were more assimilated into the mainstream, in terms of language, the types of television and radio they listen to and so forth, tended to have worse mental health patterns,” Aguilar-Gaxiola said. “Those born in Mexico who remained identified with their language and traditions tended to have better mental health.”

Hugo Morales, founder of Radio Bilingüe, the country’s only public, non-commercial Spanish-language radio network, has called this phenomenon the “culture cure.” The California study is part of a broader national research effort to further examine the social determinants of health.

In Washington, D.C., for instance, the National Endowment for the Arts recently announced the formation of a federal interagency task force to investigate the effect of the arts on quality of life throughout a person’s lifespan. The initiative, a partnership with the U.S. Department of Health & Human Services, focuses on the arts as “part of the portfolio for a community,” said Sunil Iyengar, the endowment’s director of research and analysis.

“We’re moving away from a narrow, rabbit-hole definition of the arts toward the human development side,” he said. “We’re looking at the impact on well-being and social cohesion – values that resonate.”

Aguilar-Gaxiola of UC Davis called the preliminary study of California traditional artists “heartening.”

“It taps into what we identify as protective factors, especially in terms of intergenerational relationships, “ he said. If the lessons of the study “could be replicated and disseminated,” he added, “it could potentially reverse a lot of strains.”

Above all, dance, song, storytelling and other traditional art forms bring people together, fostering resilience, Kitchener notes. ”When you identify with community, you’re not alone,” she said. “That’s a basic human need.”

California Lost is an occasional series examining challenges facing neglected communities around the state.

Prime-managed hospital draws potential buyer

Christina Jewett — Fri, 13 Jan 2012 08:05:02 +0000

Christina Jewett

Monica Lam/California Watch

A San Bernardino County hospital managed by Prime Healthcare Services is considering a purchase offer from a nonprofit Catholic health system, possibly signaling an end to a long and rocky bankruptcy.

Orange County-based St. Joseph Health System has offered $35 million to buy Victor Valley Community Hospital, with the promise of $25 million in upgrades over five years.

Last year, state Attorney General Kamala Harris denied a sale of the hospital to Ontario-based Prime, concluding that it was not in the public interest. Since then, Prime and the hospital board reached a loan and management consulting agreement that went forward over Harris’ legal objections.

The chain has been the subject of a yearlong California Watch investigation. The FBI has begun interviewing former workers and at least one patient over the chain's billing matters.

While the Victor Valley Community Hospital board reviews the offer, St. Joseph and its local facility, St. Mary Medical Center in Apple Valley, are examining the books of the financially troubled hospital.

St. Joseph owns 14 general hospitals in California and Texas, as well as home health agencies and nursing homes. Randy Bevilacqua, St. Mary Medical Center's vice president of strategic services, said the purchase might relieve crowding at its busy facility and ensure that community residents have access to the care they need.

“We know that medical center takes care of a significant population of poor and vulnerable, that’s part of our mission,” he said.

An attorney for the Victor Valley Community Hospital board said the top priority is to get the hospital in the hands of an operator with the financial resources to make improvements.

“Time is not on our side at Victor Valley,” said attorney Charles Slyngstad. “We have to do something as soon as we can do it – whether it's a resolution with Prime or St. Mary, whatever is needed to get the hospital in financially stronger hands.”

A spokesman for Prime declined to comment on the possible sale, deferring to Victor Valley hospital leaders.

Initially, the hospital was approved for sale to a group including Hemet physician Kali Chaudhuri, but the deal did not close within an agreed-upon timeline. Prime brought a second offer of $35 million, and chain chief executive Lex Reddy called for approval of the deal during a divisive August hearing before deputy attorneys general.

Harris did not approve the sale, citing the potential impact [PDF] on patients' access to care. It was the second time the attorney general’s office denied a nonprofit hospital sale to Prime. In the first case, Prime tried to buy Anaheim Memorial Medical Center.

During hearings convened by the attorney general’s office in mid-2007 in Orange County and in August in Victorville, speakers aired concerns about the chain’s tendency to eschew contracts with insurers, thus limiting in-network choices for covered patients.

Most hospitals agree to bargain over prices with insurers, knowing they will see a steady flow of patients. Prime, in many cases, has avoided such contracts and charged higher prices to insurers that cover the patients who end up in its emergency rooms.

The practice has been particularly controversial with insurers such as Kaiser Permanente, which has accused the chain in court of “capturing” its patients in the interest of profit. Prime has denied the allegations, which are being deliberated in ongoing litigation.

If Victor Valley and St. Joseph leaders arrive at a deal, it would require the approval of the bankruptcy court and attorney general.

Bevilacqua said the attorney general has not, to his knowledge, denied a sale to the health system. And he said staff, patients and the community have reacted favorably to news of the possible sale.

Study: Bay Area's urban planning must address public health

Bernice Yeung — Wed, 11 Jan 2012 08:05:03 +0000

Bernice Yeung

jdnx/FlickrResidents living near the Port of Oakland face health risks due to toxic air.

For nearly four years, Cassandra Martin lived in West Oakland, a few blocks from two freeways and the city’s port. This has made her an accidental expert on air pollution.

“I used to wonder what that black stuff was on the windowsill,” said Martin, who was diagnosed with asthma in 2009. “I would constantly wipe the walls and windowsills, but it would get so caked with soot. That’s a reason I was wondering about particulate matter.”

Martin now works part time collecting air-quality data for a West Oakland environmental group.

As the hub of a busy port and freeways, much of West Oakland has been designated by the Bay Area Air Quality Management District as a Community Air Risk Evaluation site, which means residents living there face some of the greatest health risks due to toxic air.

West Oakland also has been identified as a priority development area under a 2008 state law that requires regional agencies to draft urban plans aimed at reducing greenhouse gases. Public meetings are being held in the Bay Area this year to draft its plan, which could be finalized by 2013.

But according to a recent analysis by Oakland’s Pacific Institute and a group of public health and air-quality advocates known as the Ditching Dirty Diesel Collaborative, California’s efforts to build sustainable communities as mandated by the state law could unintentionally threaten the health of Bay Area residents.

“Unless health-protective measures are incorporated into infill and transit-oriented development policies, these forms of development may actually exacerbate the adverse impacts of freight transport on community health and quality of life,” the report said.

According to the Pacific Institute analysis, about a quarter of Bay Area land prioritized for smart-growth development under the 2008 law intersects with the air district’s high health risk communities.

“Infill development could reduce greenhouse gas emissions by locating more housing near job centers and public transportation, making it easier for people to avoid driving long distances to meet their everyday needs,” the report stated. “However, infill development could also expose more people to toxic air pollution if more housing is sited near freeways and other freight-related land uses without accounting for the risks that this poses to human health.”

It’s a scenario that has created unexpected tensions between public health advocates and smart-growth- oriented urban planners.

“What we’re faced with are some difficult tradeoffs between short-term respiratory health concerns and concerns related to the long-term habitability of our earth,” said Gabriel Metcalf, executive director of the San Francisco Planning + Urban Research Association.

East Bay neighborhoods along the I-880 corridor and near Port of Oakland activities are among the Bay Area communities that face the most severe air quality-related health risks, according to the air district.

“There is a far-reaching impact from freight transportation in these neighborhoods,” said Catalina Garzón of the Pacific Institute. “Toxic diesel pollution is a harmful substance that has been shown to contribute to additional cancer risk in these communities and which has contributed to respiratory conditions like asthma.”

To address these air-quality concerns, the Pacific Institute recommended building new Bay Area housing and schools “far away from polluting land uses to protect the health of current and future residents,” said Garzón, lead author of the report. In cases in which housing is built near freeways or freight-related industry, Garzón said, “potential health impacts should be assessed and mitigation measures should be included in the design,” such as the installation of indoor air filtration systems.

Increasingly, modern urban design is seen as playing a crucial role in improving public health.

“We’ve built places that are designed for disease,” said Robert S. Ogilvie, program director of the Planning for Healthy Places initiative of Oakland-based Public Health Law & Policy. “Kids can’t walk to school; people have a hard time accessing healthy food. We’ve designed places like this, and it’s up to us to undo it, and the only way is through urban planning.”

Some land-use experts, however, say the Pacific Institute report doesn’t fully acknowledge some of the realities of Bay Area development.

“Here’s the dilemma: There is an urban ring around the Bay Area where all of the jobs are concentrated, all of the houses are concentrated, and from a land use, transportation and greenhouse gas reduction perspective, what we want to do is direct new growth into the existing urban footprint,” Metcalf said. “I don’t know the right way to resolve all of these tradeoffs. I do know it will not be a good outcome if we unintentionally push new growth into the suburban fringe in the name of promoting public health."

Kate White, executive director of Urban Land Institute San Francisco, said the report also failed to consider the air-quality benefits to creating dense and walkable developments.

She added that public health advocates should target the source of pollution, not developers – especially those building low-income housing.

“It’s backwards to regulate the developers and the community development nonprofits and building professionals who are trying to build good communities that are mixed-income and vital communities,” she said.

But the Pacific Institute’s Garzón said the report does not advocate against infill development.

“It shouldn’t be an either/or,” she said. “We can still reduce greenhouse gases and encourage infill development in these areas and do it in such a way that it creates healthy living conditions for residents. When you look at it in big-picture terms, you can pay on the front end so that there are healthy living conditions for residents, or you can wait until these kinds of living conditions make people sick and you pay in terms of hospitalizations or missed days of work and school.”

Martin, the former West Oakland resident, moved to Alameda last week, but she still spends most of her week working at the West Oakland Environmental Indicators Project. Although she no longer lives in the community, she thinks air quality should be considered when new housing and schools are built in West Oakland.

“That would make a lot of sense,” she said. “You see, a lot of low-income residents live near where all of these things are. They don’t think about the impacts, or they should do a better study of the impacts to know if this stuff is harmful before they build residences there.”

Martin said that as she walks through the community to collect air-quality data, she routinely sees five-axle trucks idling in parking lots and on residential streets.

“There is a danger out there, a hidden danger,” she said of the contaminants in diesel exhaust. “Particulate matter, you can’t see it and you’re breathing it. You don’t know it’s there unless it’s brought to your attention.”