Category Archives for Healthcare

E-cigarette Legislation to Get Make Over

Published in Pawtucket Times, May 3, 2013

Just weeks ago, health advocacy organizations found themselves in an awkward, uncomfortable situation at the Rhode Island General Assembly. Although they supported the stated intent of House and Senate bills (H 5876 and S 622) that blocked the sale of electronic cigarettes (or e-cigarettes) to minors, they were forced to oppose these legislative proposals because of troubling provisions they believe were embedded within these bills.

When introducing his Senate proposal, e-cigarettes, says Senate Majority Leader Dominick J. Ruggerio, are proof that not all technological advances are good things. This led the Senator, representing Providence and North Providence, to become the Senate’s lead sponsor. House Finance Committee Chair Helio Melo, whose legislative district covers East Providence, jumped in as prime sponsor in his chamber, because of his desire to get the debate started on this relatively new public health issue.

E-cigarettes contain nicotine, a highly addictive substance. According to the U.S. Federal Drug Administration, the safety and efficacy of e-cigarettes have not been fully studied, consumers of e-cigarette products currently have no way of knowing whether e-cigarettes are safe for their intended use, how much nicotine or other potentially harmful chemicals are being inhaled during use, or if there are any benefits associated with using these products.

Additionally, it is not known if e-cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death.

The FDA warns that more research needs to be done on the health risks of inhaling liquid nicotine, and has announced its intent to assert regulatory authority over electronic cigarettes.

New Technology in Smoking

Although the first patent on e-cigarettes was filed in 1963, the smoking device became readily available in the United States by 2007. E-cigarettes are electronic nicotine delivery systems. Often shaped like cigarettes or cigars, they deliver nicotine to a user in the form of vapor. E-cigarettes ordinarily consist of battery-operated heating elements and replaceable cartridges that contain nicotine or other substances, and an atomizer that, when heated, converts the contents of the cartridge into a vapor that a user inhales. The nicotine in these products is derived from tobacco, but unlike cigarettes and cigars, there is no tobacco in e-cigarettes, and hence no smoke.

Ruggerio noted that his legislative proposal would prohibit the sale of e-cigarettes to minors, along with expanding the statutory definition of “tobacco products” to include “tobacco-derived products” and “vapor products.” “Vapor products,” as included in these bills, would refer to any non-combustible tobacco-derived product containing nicotine, such as an electronic cigarette, that employs a mechanical heating element, battery or electronic circuit, regardless of shape or size that can be used to heat a liquid nicotine solution contained in a vapor cartridge. The term would not include any product regulated by the U.S. Food and Drug Administration under the Food, Drug and Cosmetic Act.

“Those who say these products are designed for adults who want to quit smoking real tobacco products are ignoring the fact they are marketed to be appealing to youngsters, offered in flavors such as bubblegum and chocolate,” observed Ruggerio. “Kids may see these as fun things, but as adults, we should know better and take action to keep our children safe.”

Health Advocates Rally to Oppose E-cigarette Proposal

At a first read, Director Karina Holyoak Wood, of the Rhode Island Tobacco Control Network (RITCN), saw the e-cigarette legislation proposal as positive step toward keeping the new smoking technology out of the hands of minors. However, once Wood, whose anti-smoking network includes 55 groups (including the American Lung Association, American Cancer Society, American Heart Association and the Campaign for Tobacco Free Kids), looked over the bills she found it embedded with provisions that could potentially undermine future regulation of e-cigarettes and create regulatory loopholes.

Wood and colleagues discovered that the e-cigarette bill was being promoted by RJ Reynolds, a major tobacco company. She believed that while the legislative sponsors’ intent was to prohibit youth access to e-cigarettes, a laudable goal, she feared that RJ Reynolds might be utilizing the bill as “a Trojan horse to establish their own business agenda for this emerging and currently unregulated smoking device.”

Suspicions were confirmed, says Wood, when a lobbyist from R.J. Reynolds Tobacco company came to the Ocean State to support Ruggerio’s and Melo’s e-cigarette bills at the Senate and House Finance Committee hearings on April 9 and April 23, respectively. She also became aware that similar legislative proposals were popping up all over the country, with the Winston-Salem, North Carolina tobacco company lobbying for their passage.

Wood, and 17 health advocacy organizations gave the bills the thumbs down at both panel hearings, while the tobacco industry endorsed the measure wholeheartedly.

In her written statement, Dr. Patricia Nolan, former director for the RI Health Department, who now co-chairs the RITCN’s Policy Committee, warned the Senate Finance Committee members that the bill would define “a ‘new’ tobacco product and exempt it from some of the controls that currently apply to all tobacco products. She charged that it would define these products in ways that actually might undermine Rhode Island’s ability to effectively regulate and control them.

According to Nolan, the bill’s definition of tobacco products may not include all e-cigarette and vapor products, leading to confusion. The new products regulated by laws concerning indoor air pollution and worker safety, she charged. “The safety of e-cigarettes and vapor devices for users or for indoor air quality is not known,” she said.

With the State scrambling for tax revenue, S 622 and H 5876 are silent on the issue of taxation of the e-cigarette product. “Having the definition in the tax section of the law could facilitate either taxing or exempting these ‘new’ products,” she told the House panel.

Nolan also noted that the bills create obstacles to enforcing penalties against merchants which violate the Youth Access Law by eliminating the requirement for courts to maintain records of penalties and fines imposed for violations not requiring that the Division of Taxation be notified about the disposition of the violation.

Other opponents and critics included the RI Department of Health’s Tobacco Control Program, the City of Providence and East Providence Prevention Coalition, and several local retailers, including Barrington-based, Ecig Shed came and Cigotine, LLC, in Providence, who came to share their concerns, both owners threatening to leave the Ocean State if the measure was enacted. Melo’s e-cigarette bill would greatly reduce their sales by restricting online sales of nicotine-containing products by treating the smoking device the same as traditional tobacco products, noted the business owners..

Specifically, e-cigarette bills would require a retailer conducting an online sale to obtain a copy of the buyer’s driver’s license along with a statement from the buyer affirming that they are the person pictured. The purchased product must be sent through a service that checks the ID of the buyer at delivery. Retailers would be required to perform this check every time a consumer places an order.

Finally, e-cigarette retailers in Rhode Island would be required to obtain a tobacco license and only buy their e-cigarettes from licensed wholesalers or distributors.

At the hearing, Lobbyist Jack Hogan, of R.J. Reynolds’s Tobacco Company, noted that his company’s support of the General Assembly’s cigarette legislation, and proposals being considered by other state legislatures, was to keep tobacco, including e-cigarette products out of the hands of minors under age 18. In countering the concerns of the health advocates, “there is no hidden agenda [in supporting the e-cigarette legislation]. It is the right thing to do,” he said.

Voices Heard

With the effective mobilization of health advocacy organizations to oppose H 5678 at the April 23 House Finance Committee, Wood and some of her network partners and the Health Department would meet one week later with Melo to discuss their strong opposition to his e-cigarette bill. As a result, he offered to withdraw his bill for further study, effectively killing it. He invited the health advocates to work with him on a new bill, comprehensively defining e-cigarettes and vapor products and prohibiting their sale to minors, will be reintroduced next year, he says.

The saga of the e-cigarette legislative proposal is a good example that participating in the legislative process can go a long way especially for those who put the energy and effort into it. Sound testimony combined with bringing in your supporters to the table will most certainly get the attention of lawmakers. Yes, that’s Democracy in action.

Herb Weiss, LRI ’12, is a Pawtucket-based freelance writer who covers aging, health care and medical issues. He can be reached at hweissri@aol.com.

Aging Groups Consider Obama’s Fiscal 2014 Budget Proposal a “Mixed Bag”

Published in Woonsocket Call, April 21, 2013

President Barack Obama, missing the federal mandated budget submission deadline by over two month, finally unveils his fiscal blueprint on April 10, giving Capitol Hill a peek as to how he would fund the nation’s federal agencies, programs and services.

The President proposed a $3.8 trillion budget plan for fiscal 2014, that seeks to slash the huge federal deficit by a net $600 billion over 10 years, raises taxes on the wealthy, and puts the breaks to rising costs of two very popular senior programs, Social Security and Medicare.

Senior groups call President Obama’s the first budget proposal of his second presidential term, a “mixed bag.” His fiscal blueprint would eliminate the draconian cuts of the sequester, that is the arbitrary, across the board cuts Congress imposed this year. However, Obama seeks to reduce the federal deficit by calling for another $200 billion in cuts to discretionary programs – half from defense programs and half from domestic programs.

Braking the Rising Costs of Social Security Despite the Social Security Trustee’s 2012 Annual Report that the entitlement program has the financial resources to pay all benefits through 2033 (see my June 1, 2012 Commentary in Pawtucket Times), Social Security benefits are targeted in the recently released budget plan for substantial cuts by adopting the “chained” consumer price index (CPI) for the purpose of calculating Social Security cost-of-living adjustments, or COLAs.

According to the Washington, D.C.-based, National Committee to Preserve Social Security and Medicare (NCPSSM), the Obama Administration sees this switch as “a technical adjustment.” Aging group warn that using the “chained” CPI will substantially reduce the Social Security benefits of current and future beneficiaries. “If it is adopted, a typical 65 year-old would see an immediate decrease of about $130 per year in Social Security benefits. At age 95, the same senior would face a 9.2 percent reduction—almost $1,400 per year,” notes NCPSSM.

While all beneficiaries will feel the impact of this change, its effect will be greatest on those who draw benefits at earlier ages (e.g., military retirees, disabled veterans and workers) and those who live the longest, says NCPSSM, especially “women who have outlived their other sources of income, have depleted their assets, and rely on Social Security as their only lifeline to financial stability.”.

With Republican Congressional lawmakers generally supportive of Obama’s push to rein in Social Security costs, through the use of the “chained” CPI, liberal Democratic lawmakers, including Rep. David Cicilline, representing Rhode Island’s 2nd Congressional District, strongly oppose the President or any Congressional efforts to cut Social Security to lower the nation’s federal deficit.

Rep. Cicilline calls for reforming the nation’s tax code by ending subsidies for “Big Oil,” along with “making responsible target spending cuts,” to slash the nation’s huge federal deficit .

AARP Poll Says, Keep Your Hands Off Social Security
In a statement, AARP Executive Vice President Nancy A. LeaMond, quickly reacted to the Democratic President’s efforts to use the “chained” CPI to control rising Social Security program costs.

While AARP recognizes the need for the President and Congress to confront budget challenges facing the nation, the nation’s largest aging advocacy group calls for “responsible solutions, not harmful proposals” that would hurt older beneficiaries or threaten the retirement security of the generations that follow, says LeaMond.

LeaMond said, “AARP is deeply dismayed that President Obama would propose cutting the benefits of current and future Social Security recipients, including children, widows, veterans and people with disabilities, to reduce the deficit. Social Security is a self-financed program that doesn’t contribute to the deficit, so it shouldn’t be cut to reduce it.”

AARP’s polls indicated that older Americans, across the political spectrum, agree with nonprofit group’s opposition to the “chained” CPI. LeaMond, notes. The recently released national survey found that “fully 84% of voters age 50 and over oppose cutting Social Security benefits to reduce the deficit.”

“Instead of making harmful cuts to Medicare or shifting additional costs onto beneficiaries, we need to look for savings throughout the health care system, including Medicare,” suggests LeaMond. She says that also “lowering the costs of prescription drugs, innovations that promote better care, reward improved outcomes and make health care programs more efficient and less wasteful have the potential to hold down systemic high health care costs, including costs in Medicare.”

Finally, LeaMond adds, “We know that prescription drugs are one of the key drivers of escalating health care costs, so we appreciate the President’s inclusion of proposals to find savings in lower drug costs. And we applaud his plan to accelerate closure of the ‘donut hole’ in Medicare Part D by 2015, which would reduce seniors’ often burdensome out-of-pocket health care expenses.”

A Snap Shot of Other Aging Budget Issues
Howard Bedlin, Vice President for Public Policy and Advocacy at the National Council on Aging (NCOA), in a written statement calls Obama’s budget proposal a “mixed-bag” when it comes to seniors.”

Bedlin acknowledges that the recently released Obama budget eliminates the sequester cuts to critical programs like Meals on Wheels and other Older Americans Act services, elderly housing, and other vital senior services. “It is unfortunate that cuts are proposed for low-income energy assistance and senior job training and placement programs,” he says.
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According to Bedlin, the President’s budget also protects SNAP (Food Stamps) and Medicaid, in sharp contrast to the drastic cuts approved in the Republican-controlled House budget proposal. “Cuts in Medicaid would be devastating to the millions of vulnerable seniors who rely on the program for long-term care and Medicare low-income protections,” he says.
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Meanwhile, a major concern for NCOA with the President’s budget surrounds Medicare and Social Security. While the organization supports some of the Medicare reductions, the proposed $370 billion in additional cuts are “excessive and several will harm” beneficiaries (more than half having incomes below 200 percent of the poverty line), says Bedlin, these cuts in addition to the $716 billion in Medicare cuts under health reform and significant reductions in spending growth over the past three years.

Also, the proposed new home health co-payment will fall primarily on lower-income older women with multiple chronic health conditions, and lead to premature nursing home placement, predicts Bedlin. “The proposed increase in the Medicare Part B deductible would be especially harmful and unaffordable to millions of seniors with incomes just above the federal poverty line ($958 per month),” he says.

Finally, Bedlin notes that the proposed Medigap surcharge would penalize seniors for decisions made by their doctors, cause major market disruption, and seriously confuse many current policy holders. The proposal to further increase Medicare premiums based on income could result in those with incomes of about $47,000 being forced to pay more.

NCOA joined AARP and NCPSSM and virtually every other national aging organization in opposing the President’s proposal to cut the Social Security Cost of Living Adjustment (COLA) through the use of a “chained” CPI.

A Final Note… With Obama’s proposed budget now thrown in the ring with the House and Senate budgets already drafted and voted on, will Congressional gridlock keep the Democratic President, the GOP-Controlled House and Democratic Senate from working together to hammer out a consensus, bipartisan compromise? Only time will tell if elected lawmakers clearly get the message from the American people, “put the people first and not your political party.”

Herb Weiss, LRI ’12, is a Pawtucket-based freelance writer covering aging, health care and medical issues. He can be reached at hweissri@aol.com.

When its Time to Take Away Mom and Dad’s Car Keys

Published in Pawtucket Times, April 12, 2013

On May 2, 2003, Rhode Island State Rep. Mabel Anderson was looking to buy her husband George a surprise birthday present from one of his favorite stores, Home Depot. As she was walking and pushing a shopping carriage near the front entrance of the huge box store located in the Bristol Place Shopping Center in South Attleboro, Massachusetts, an 86-year old driver getting ready to exit his parking space, accidently shifted his vehicle into ‘reverse’ rather than ‘drive,’ stepped on the gas peddle. This jolted the vehicle in the wrong direction, running over Anderson. She was transported to the nearby hospital, where hours later, she would be pronounced dead. Anderson’s tragic death almost a decade ago continues to be played out today in communities across the nation.

Aging baby boomers, coping with a decline in their driving skills because of the aging process, keep driving well into their twilight years, when for safety’s sake, they should just retire the keys.

Driving Skills Decline in Later Years

According to the National Highway Safety Administration, in 2010, older individuals made up 17 percent of all traffic accidents and 8 percent of all people injured in crashes during that year. Compared to 2009, fatalities among this age group increased by 3 percent, 1 percent for these older persons being injured.

Meanwhile, John Paul, Manager of Public Affairs and Traffic Safety at AAA Southern New England, details research findings indicating that driving can be dangerous in your very later years. The report released by Carnegie Mellon University in Pittsburgh and the AAA Foundation for Traffic Safety, found the rate of deaths involving drivers 75 to 84 “is about three per million miles driven – on par with teen drivers,” says Paul. But, once they pass age 85, vehicular fatality rates jump to nearly four times that of teens, he says.

Older motorists lose their ability to drive when the aging process kicks in. For these individuals, driving skills lessen because of poor vision caused by cataracts, glaucoma and macular degeneration, compounded with poor hearing, lack of flexibility, limited range of motion and reduced reaction time make the complex tasks associated with driving more difficult. Oncoming cognitive impairments, such as Alzheimer’s Disease and dementias, can also impact one’s ability to drive safely.

As older driver fatalities increase and the death toll tied to older-driver accidents skyrocket, a growing number of states are looking at licensing restrictions as a way to delicately approach this complicated issue.

Like many aging advocates, Gerry Levesque, AARP’s State Coordinator for Driver Safety Program, states that not all seniors are equally affected as they age. “One may lose the necessary skills needed to drive safely at age 60, while another will not lose those skills until 90”, states the 66-year-old Coventry resident.

“For older adults, losing driving privileges can be translated as a loss of independence,” notes Levesque. If this occurs, family or public transportation may not be available to replace the lack of transportation. “Older people may feel stranded or abandoned when they give up their keys,” says Levesque, noting that driving allows an older adult to pick up their prescriptions, shop for groceries or get out to socialize at the bridge club, bingo parlor or simply to be with family and friends.

“One thing that seniors have that the younger generation does not is a lifetime of driving. While they are losing physical abilities, they do have a wealth of experience from their years of driving,” adds Levesque.

Coping with an Aging Population that Drives

Over the years, states have grappled with the age-charged issue of restricting licenses of seniors not wishing to stir up their wrath. Aging advocates oppose any “blanket” solution to this problem that calls for licensing restrictions, rather it be made on a case-by-case basis. They say age should not be used as a “predictor” of unsafe driving.

In Rhode Island, the Division of Motor Vehicles (DMV) prorates its license renewal cycle for person’s age 71 and older. If you are 75 years of age or older, you license will be valid for two years. At license renewal time, the older person is required to pass a vision test or provide a valid medical examination certificate. A person’s physical or mental fitness to operate a motor vehicle is reviewed by DMV’s Medical Advisory Board whenever a case is brought to its attention by law enforcement, a physician or a family member.

With a growing aging population, Rhode Island’s Department of Transportation (RIDOT) has moved to tackle senior driving issues head-on. Two years ago, this state agency began to install a series of reflective markers or “roadside delineators” installed on the sides of roads as well as mounted on small posts and on top of concrete barriers. Especially geared for older drivers, these improvements were made to assist in making night-time driving easier and safer, while also aided driving during adverse weather

In addition to these improvements, RIDOT has installed cable guard rails along narrow medians on the Interstate where none previously existed. This safety feature significantly reduces the occurrence of head-on impacts with opposing traffic. State transportation officials have also made improvements to rural roads, by adding rumble strips, signing and roadside reflectors to help reduce road departure crashes.

Sharpening Your Driving Skills

AARP along with the AAA Southern New England recognized the thorny issues surrounding restrictive licensing and have developed special training courses to help older motorists freshen their skills to help them drive more safety, thus reducing the their risk of having their licenses revoked by state authorities.

AAA’s Senior Defense Driving Program (www.seniordriving.aaa.com) provides information about the aging process and its impact on a person’s ability to drive. The program gives tips on how a person can compensate for these changes and drive safer for a longer period of time. Additionally, a self-administered program, called “Roadwise Review” provides confidential and instant feedback on performance in key areas, allowing individuals to see how changing visual, mental and physical conditions do impact driving. In addition, the Auto Club’s “Roadwise RX” allows older drivers to look at the interaction between medications and driving.

AARP’s Safe Driving Program, (http://www.aarp.org/home-garden/transportation/driver_safety) the nation’s first and largest refresher course for drivers age 50 and older, has helped millions of drivers sharpen their driving skills. The four-hour program teaches defensive driving techniques, new traffic laws and rules of the road, as well as (and more importantly) how to adjust your driving style to those age-related changes to vision, hearing and reaction time. After successfully completing the Aging Group’s Safe Driving Program held in Rhode Island, the attendee is awarded a certificate of completion. The state mandates that the insurance carrier give a discount on their liability coverage to the policy holder with this certificate.

Surrendering the Keys

Ultimately, the burden may well fall on the family or the older motorist’s physician who must take the keys away from the driving-challenged senior for not only the driver’s safety, but for the safety of those sharing the road as well.

In the late 1990s my mother began exhibiting signs of dementia, and yet my father could not stop my mother from driving. The only solution appeared to come from making a call to the Texas Department of Motor Vehicles (TDMV) for help.

Several times mother got lost driving around our neighborhood, a once familiar area for her, ultimately ending up on the dangerous LBJ Freeway, miles from home and confused. With her driving skills rapidly deteriorating, my siblings took on the task of making that hard decision of taking the car keys away from her. After several meetings with TDMV officials, the agency finally took away her driver’s license.

As difficult as this decision was for my family to make, ultimately for my mother who was in the mid-to-late stages of dementia, did not realize that she had lost her driving privileges and her precious keys.

Kristi Grigsby, Vice President of Content of AgingCare.com, agrees that taking the keys away from an elderly parent is one of the most difficult decisions that family caregivers must make. “The loss of independence can be traumatic for a senior,” she says, noting that some elderly parents can accept the life-altering change; others understandably can not.

Grigsby warns that the consequences of doing nothing far outweigh the wrath of an angry parent. “Stories of tragedies that could have been avoided had those keys been taken away are sometimes all the inspiration needed to stand firm and make a painful decision with confidence,” she says.

For more information about taking the keys away from an elderly parent go to http://www.agingcare.com/Articles/Taking-the-Keys-What-To-Do-If-Mom-or-Dad-Won-t-Give-Them-Up-112307.htm. Information on this web site, AgingCare.com,
connects people caring for their elderly parents with experts on aging issues and caregivers who visit this site help family members make the best care decisions for older loved ones.

Herb Weiss, LRI ’12, is a Pawtucket-based freelance writer who covers aging, health care and medical issues. He can be reached at hweissri@aol.com.