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Medical Association Unveils ‘Your Care is at Our Core,’ Emphasizing Personal Connection in Health Care

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Medical Association Unveils ‘Your Care is at Our Core,’ Emphasizing Personal Connection in Health Care

83% of Alabamians Agree: Doctor-Patient Relationship is ‘Central’ to Health

A strong bond between doctors and patients leads to better health care, say Alabama doctors. A new awareness campaign launched by the Medical Association of the State of Alabama called “Your Care is at Our Core” reinforces this important message.

A doctor-patient relationship based on mutual trust allows doctors to help patients navigate what can be complex health challenges. It is a responsibility doctors say they don’t take lightly.

“From the moment that you begin training to become a doctor, it’s made very clear and apparent to you that people are going to place their trust in you. They’re placing their lives in your hands so you have to take that very seriously,” said Dr. Hernando Carter, a doctor of internal medicine in Birmingham. “It has to be the most important thing to you.”

Building Trust
Trust is essential because patients are more inclined to share crucial information about their health concerns and personal circumstances when they feel a genuine connection with their doctor.

This honest exchange of information enables doctors to make informed decisions, tailor treatment plans and provide care that aligns with each patient’s unique needs and preferences.

A Collaborative Approach to Wellness
Moreover, a strong doctor-patient relationship fosters a supportive environment where patients feel empowered and engaged in their healthcare journey. When patients feel heard and valued, they are more likely to adhere to treatment regimens, follow medical advice and actively participate in the shared decision-making process.

“I tell my patients all the time that I can’t make you well on my own. It’s a team effort, something that we have to work together on and I think that resonates well with patients,” said Dr. Brittney Anderson, a family physician in Demopolis.

‘Be a Good Listener’

Physicians recognize that effective communication and empathy are vital in fostering positive patient outcomes. By building rapport and understanding their patients’ concerns, doctors deliver patient-centered care and uphold the sanctity of the doctor-patient relationship as a cornerstone of healthcare excellence.

“One of the most important things when I train medical students and residents is I teach them to sit down with the patient,” said Dr. William Admire, a doctor of internal medicine in Mobile. “The most important thing about being a doctor is to be a good listener, show respect, show empathy, compassion.”

Statewide Consensus
According to a statewide survey conducted in March on behalf of the Medical Association, 83 percent of Alabamians agree “the doctor-patient relationship is central to health care.” The poll also showed that 83 percent agree with the statement: “It is crucial for physicians to be involved in my care so that I have the best outcomes.”

To watch a video of Alabama physicians discussing why they view the doctor-patient
relationship as sacred, click here.

To view the “Your Care is at Our Core” video message, click here.

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Dr. Regina Benjamin: A Trailblazer in Medicine Honored with the Samuel Buford Word Award

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Dr. Regina Benjamin: A Trailblazer in Medicine Honored with the Samuel Buford Word Award

In the realm of healthcare, the name Dr. Regina Benjamin resonates as a beacon of inspiration and change. As the first African American President of the Medical Association of the State of Alabama and the 18th Surgeon General of the United States, Dr. Benjamin’s illustrious career is marked by a profound commitment to service, advocacy, and addressing healthcare disparities. This year, she is set to be presented with the esteemed Samuel Buford Word Award at the Medical Association’s Annual Meeting.

Trailblazing Leadership

Dr. Regina Benjamin’s journey to becoming a trailblazer in the medical field began in Mobile, Alabama, where she was raised in an environment that valued community service and compassion. Her early exposure to the healthcare profession, through the stories of her grandfather’s dedicated service as a country doctor, ignited a passion that would shape her illustrious career.

After earning her medical degree from the University of Alabama at Birmingham, Dr. Benjamin returned to her hometown, establishing a clinic that catered to the needs of underserved communities. Her dedication to addressing healthcare disparities at the grassroots level earned her widespread recognition and paved the way for her ascent into leadership roles.

Surgeon General of the United States

In 2009, Dr. Regina Benjamin made history as the 18th Surgeon General of the United States, breaking barriers as the first African American woman to hold this prestigious position. During her tenure, Dr. Benjamin focused not only on traditional public health issues but also on the social determinants of health. Recognizing that health outcomes are influenced by factors beyond clinical care, she advocated for holistic approaches that addressed the root causes of disparities, including poverty, education, and access to essential resources.

Her leadership in the face of challenges, such as the H1N1 pandemic and the Deepwater Horizon oil spill, showcased her resilience and commitment to public health. Dr. Benjamin’s tenure as Surgeon General left an indelible mark, emphasizing the importance of preventive care, health promotion, and community engagement.

Samuel Buford Word Award: A Legacy of Service

This year, Dr. Regina Benjamin will be honored with the Samuel Buford Word Award at the Medical Association’s Annual Meeting. Established in 1971, the award is named in memory of Samuel Buford Word, M.D., a distinguished physician and former president of the Medical Association of the State of Alabama. The award recognizes individuals who have demonstrated exceptional service to humanity beyond the typical scope of medical practice, often at personal sacrifice.

As the highest honor presented by the Medical Association, the Word Award symbolizes a commitment to the values upheld by its namesake. Dr. Benjamin’s receipt of this award not only acknowledges her outstanding achievements in medicine but also underscores her profound dedication to service and the betterment of human health.

A Legacy of Service and Inspiration

Dr. Regina Benjamin’s journey from a community clinic in Mobile to the highest echelons of medical leadership is a testament to her unwavering commitment to service and advocacy. Her groundbreaking achievements have not only paved the way for future generations but have also significantly impacted the trajectory of healthcare in the United States.

As she prepares to receive the Samuel Buford Word Award, Dr. Benjamin’s legacy serves as a reminder that true leadership in medicine extends beyond clinical expertise—it encompasses a passion for equity, a commitment to service, and a tireless pursuit of a healthier and more just society. In honoring Dr. Regina Benjamin, the Medical Association celebrates not only an individual but a legacy that continues to inspire and shape the future of healthcare.

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POTENTIAL PART 2 CHANGES ON THE HORIZON

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POTENTIAL PART 2 CHANGES ON THE HORIZON

by Lindsey Phillips with Burr & Forman, LLP

On November 28, 2022 the Office for Civil Rights (“OCR”) at the United States Department of Health and Human Services (“HHS”) announced proposed changes to the regulations at 42 CFR Part 2 (“Part 2”). Part 2 protects the confidentiality of medical records related to treatment for substance abuse disorders and was first promulgated in 1987 to address concerns that relaxed access to these types of records would promote fear of discrimination and deter individuals from seeking help and treatment for substance abuse disorders. While the rationale supporting Part 2 is good in theory, it has presented practical challenges for patients and healthcare providers alike because its protections and provisions often conflict those afforded by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and other medical record privacy laws.

The proposed changes, which are set out in the Notice of Proposed Rulemaking (“NPRM”), are part of a broader initiative to promote value-based care, enable better coordination among healthcare providers, facilitate patient autonomy and engagement, and protect the privacy of patients’ medical records. Upon announcement of the NPRM, Secretary Xavier Becerra noted that “varying requirements of privacy laws can slow treatment, inhibit care, and perpetuate negative stereotypes about people facing substance use challenges.” He went on to say that the changes proposed in the NPRM would “improve coordination of care for patients receiving treatment while strengthening critical privacy protections to help ensure individuals do not forego life-saving care due to concerns about records disclosure.” OCR’s Director expressed similar sentiments and further noted that the HHS “understands how critical it is for patients to better align the Part 2 rules and program with HIPAA” and that the changes would decrease the burdens on both patients and providers “while protecting confidentiality of treatment records.”

This article briefly identifies some of the proposed changes contained in the NPRM. The proposed changes are loosely separated into two categories. The first category outlines the proposed changes that appear to relax the current provisions found in Part 2; the second category outlines the proposed changes that purport to create protections and enforcement mechanisms for violations of Part 2.

Proposed Changes Relaxing Current Requirements Found in Part 2

  • Permitting Part 2 programs to use and disclose Part 2 records based on a single prior consent signed by the patient for all future uses and disclosures for treatment, payment, and health care operations;
  • Permitting the redisclosure of Part 2 records as permitted by the HIPAA Privacy Rule by recipients that are Part 2 programs, covered entities under HIPAA, and business associates under HIPAA; and
  • Modifying the Part 2 confidentiality notice requirements to mirror those found in HIPAA.


Proposed Changes Creating Patient Protections and Enforcement Procedures

  • Creating two patient rights that parallel those afforded to patients under HIPAA:
    • The right to an accounting of disclosures, and
  • The right to request restrictions on disclosures for treatment, payment, and health care operations;
  • Requiring disclosures to the Secretary for enforcement;
  • Applying HIPAA penalties to Part 2 violations;
  • Requiring Part 2 programs to establish a process for receipt of complaints of Part 2 violations; and
  • Prohibiting Part 2 programs from requiring patients to waive the right to file a complaint as a condition of eligibility and providing treatment

While HHS has stated that the proposed modifications will not only increase coordination among providers but also afford more protections for patients, the proposed changes do present some concerns and tensions among stakeholders. Accordingly, all stakeholders are encouraged to participate in the public comment and feedback process. Stakeholders have 60 days after the publication of the NPRM in the Federal Register to provide commentary. The NPRM was published in the Federal Register on December 2, 2022, so stakeholders have until January 31, 2023 to provide comments. 

Lindsey Phillips is an associate at Burr & Forman LLP practicing exclusively in the firm’s Healthcare Industry Group. Lindsey may be reached by telephone at (205) 458-5370 or by e-mail at lphillips@burr.com.

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Breaking Down the New Telehealth Law

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Breaking Down the New Telehealth Law

Questions and answers to the new Telehealth Law that was sponsored by Sen. Dan Roberts and carried by Rep. Paul Lee in the House – ACT 2022 – 302.

What is its purpose?

The stated legislative intent of the law is to expand access to healthcare through the use of electronic devices and technology. It provides regulation for physician use of telehealth, and also repeals laws providing for a special license for out-of-state physicians to practice through telehealth in Alabama. The new Act requires a full and active Alabama medical license to provide telehealth services to Alabama patients. It does retain the exception for irregular or infrequent telehealth medical services (less than 10 days in 1 year or less than 10 patients in one year)

Does the law also govern telemedicine, and is there a difference in telehealth and telemedicine?

The law defines both telehealth and telemedicine. Telehealth is more of an umbrella term, encompassing the use of electronic and telecommunication technology to support medical care. Telemedicine is defined as the provision of medical services by a physician to a patient when they are not at the same site, using electronic technology. Because telehealth encompasses telemedicine, the two may be used interchangeably, but for purposes of the Act, telemedicine is specific to an electronic communication or encounter between physician and patient.

Does the new law provide a different duty of care?

The law provides that physicians providing telehealth medical services owe the same duty of care to patients as they would providing care in an in-person visit. A physician must establish a diagnosis, disclose that diagnosis and provide a visit summary after providing care by telehealth medical services if he or she would be required to provide those things after an in-person visit. The location of care provided by telehealth medical services is designated as the site where the patient is within the state.

Must a physician establish a relationship with a patient in-person before providing telehealth medical services?

A physician does not have to establish a physician-patient relationship in person prior to providing telehealth medical services, but a physician cannot solicit patients by or for telehealth medical services. Either the patient must initiate the relationship or the patient must be referred by a physician with whom he or she already has an established relationship. A physician is also required to obtain consent from a patient to use telehealth medical services, including the specific mode of communication to be used, prior to the provision of those services. That consent must be documented in the patient’s record. Also prior to delivering telehealth services, a physician must verify the patient’s identity, the patient’s location by city and state, and his or her own credentials to the patient.

Is there a limit on the number of times a patient can be seen by telehealth?

The law does not limit the number of telehealth visits for patients. However, if a physician or someone in his or her practice group has seen the same patient for the same condition using telehealth more than four times in one year without resolution of the problem, then the physician must see the patient in-person or refer the patient to another physician for an in-person visit within one year. The in-person visit requirement can be satisfied using telehealth services as long as there is at least one licensed physician or licensed nurse with the patient at the patient’s site to provide assistance if needed.

Are there any exceptions to the in-person visit requirement after four telehealth encounters?

The in-person visit requirement after four telehealth encounters does not apply if the physician providing the telehealth services is in active consultation with a physician providing in-person care. It further does not apply to the provision of mental health services as defined under Alabama law. The Board of Medical Examiners has the authority to provide further exemptions by Rule.

Is prescribing through telehealth allowed?

A prescriber may prescribe legend drugs, medical supplies or controlled substances through telehealth, if he or she is authorized by law to prescribe them otherwise, as long as there is an established legitimate medical purpose. For prescribing controlled substances by telehealth, a prescriber must also have seen the patient in-person once in the 12-months prior, have established the legitimate medical purpose in the 12-months prior, and have used “real time” technology for the telehealth encounter with the patient when issuing the prescription. The law contains an exemption to these requirements if the prescriber is prescribing a controlled substance to treat a medical emergency, to be defined by the Board of Medical Examiners.

How does this law affect non-physicians who provide telehealth medical services?

This law does not prohibit non-physician health professionals from providing telehealth services as long as those services fall within their particular scope of practice.

Does the law require anything about records or documentation?

Any physician providing telehealth medical services must keep accurate records in accordance with the Rules of the Board of Medical Examiners and Medical Licensure Commission. Physicians must also be able to access those records and provide the Board of Medical Examiners and Medical Licensure Commission access to them upon request. The law further requires physicians providing telehealth medical services to take reasonable cautions to protect the privacy of communications with patients in accordance with state and federal laws, including HIPAA.

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American Rescue Plan Offers $940 Million for Medicaid Expansion and Other Benefits for Healthcare

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American Rescue Plan Offers $940 Million for Medicaid Expansion and Other Benefits for Healthcare

The American Rescue Plan Act of 2021, signed by President Biden on Thursday, includes a number of key provisions that strengthen both public and private health insurance coverage. Among its Medicaid and the Children’s Health Insurance Program (CHIP) provisions, the American Rescue Plan encourages states to finally take up the Medicaid expansion by offering even more favorable financial incentives than those already in place and allows states to provide longer postpartum health coverage for new mothers.

Right now, some 300,000 Alabamians living in the health coverage gap. They earn too much to qualify for Medicaid under the state’s stringent income limit but too little to qualify for subsidized ACA marketplace plans. If Alabama were to expand Medicaid and provide much-needed healthcare coverage for these individuals, the state would receive an estimated $940 million over two-years for doing so. 

A complete analysis of the Act and its potential impact is below. 

HEALTHCARE PROVISIONS

Additional Federal Funding to States that Newly Adopt the Medicaid Expansion

  • Newly expanding states would receive a 5-percentage-point increase in their FMAP for all non-expansion enrollees, who account for most of a state’s Medicaid enrollees and costs. The increase would begin the first day of the quarter that expansion begins and last for two years. Not only that, this increase is on top of the 6.2-percentage-point FMAP increase that all states will receive for the duration of the public health emergency under last year’s Families First Act, which will provide $86 billion in additional federal Medicaid dollars in 2020 and 2021. 
  • According to the Center for Budget and Policy Priorities (CBPP), Alabama would receive an estimated $940 million in federal funds for expanding. 

New Medicaid and CHIP Option for States to Extend Postpartum Coverage for 12 Months

  • The American Rescue Plan offers states a new “state plan” option to provide pregnancy-related Medicaid and CHIP coverage for one year after the end of pregnancy, extending coverage well beyond the current cutoff of 60 days. States can take up this option starting in the first calendar year quarter one year after enactment, which is April 1, 2022. The option, however, is temporary and will be available to states for five years unless Congress acts to extend it at a later time.
  • The Congressional Budget Office (CBO), for example, estimates that about 45 percent of women covered by Medicaid on the basis of pregnancy now become uninsured after the end of the 60-day postpartum coverage period. Alabama is no different, and this new option would directly help address our current maternal mortality statistics. 

Expansion of the State Medicaid Option for Coverage of COVID-19 Testing for the Uninsured to Include Coverage for COVID-19 Vaccines and Treatment

  • The Families First legislation included a Medicaid option for states to cover COVID-19 testing for the uninsured through the duration of the public health emergency. The federal government picks up 100 percent of the cost. The American Rescue Plan expands this fully federally-funded option to cover COVID-19 vaccines and their administration, and treatment, including prescription drugs, and treatment for conditions that complicate COVID-19 treatment.

Policies to Improve the Affordability and Access of Private Insurance Coverage

  • COBRA Coverage: Premiums for COBRA coverage for individuals who are laid off or leave their jobs because of the pandemic will be subsidized at 100% through September 30, 2021. The employer or health plan could claim a refundable tax credit against its Medicare payroll tax liability for the cost of the premiums.
  • Affordable Care Act (ACA) Marketplace Subsidies: Refundable credits for households with income between 100% to 400% of the federal poverty level (FPL). For 2021 and 2022, premiums for individuals with income at 150% of the FPL will be eliminated, while premiums for all other households will be capped at 8.5% of their income.
  • Health Insurance Marketplace: $20 million in grants to states to modernize and update health insurance marketplace systems, programs, or technology.

Public Health Provisions

  • $7.66 billion to expand the public health workforce, including grants to state, local, and territorial health departments that increase the number of contact tracers, social support specialists, community health workers, public health nurses, epidemiologists, lab personnel, disease intervention specialists and communications personnel.
  • $7.6 billion for testing and vaccinations at community health centers (CHCs).
  • $3 billion for block grant programs under the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide community mental health services and prevention and treatment of substance abuse.
  • $800 million for the National Health Service Corps, as well as $100 million reserved for state student loan repayment programs, $200 million for the Nurse Corps Loan Repayment program, and $330 million for teaching health centers that operate graduate medical education.
  • $250 million for states to establish “strike teams” that could be deployed at skilled nursing facilities (SNFs) with high rates of COVID-19.
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Reducing Physician Burnout Focus of New Study at UAB

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Reducing Physician Burnout Focus of New Study at UAB

BIRMINGHAM – A program to study and reduce physician burnout amongst residents will be introduced at the University of Alabama at Birmingham, along with three other hospitals around the nation. The five-year, $1.8 million grant is funded by the American Medical Association.

UAB’s Tinsley Harrison Internal Medicine Residency Program shares the grant with Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center and Stanford University School of Medicine. The award supports the study of key factors that contribute to the well-being and clinical skills of internal medicine residents across different training programs.

“We are excited to be a part of this important study,” said Lisa Willett, M.D., professor of medicine at UAB and program director of the Tinsley Harrison Internal Medicine Residency Program. “The learning environment is critical to the professional development of physicians in training. With this study, we hope to identify the key elements of the learning environment that shape the professional development of residents, while ensuring they are able to spend meaningful time at the bedside caring for patients.”

Information gathered from the early years of the study will help educators better understand that training environment. Once factors that affect the residency training environment are identified, new techniques to reduce physician burnout and improve clinical skills will be tested. The final years of the study aim to improve resident wellness and clinical skills.

Working with the residency program to implement the AMA “Reimagining Residency” grant will be Stephen W. Russell, M.D., associate professor of internal medicine and pediatrics, and KeAndrea Titer, M.D., assistant professor of internal medicine.

“The Tinsley Harrison residency program is already taking steps to enhance the clinical skills of residents by offering formative skills assessments with real-time feedback,” Dr. Russell said. “The hope is that by collaborating with other leading universities, UAB will continue to investigate and implement the best practices of resident education and that knowledge can be generalized to other programs.”

Dr. Russell will represent UAB on the grant’s executive committee as well as oversee the outpatient formative assessments of clinical skills. As a recent chief medical resident at UAB and new faculty in the Division of General Internal Medicine, Dr. Titer will oversee the bedside rounding initiative at UAB as well as lead local resident engagement.

“This grant, along with graduate medical education leadership, will not only serve to increase wellness in our trainees,” Dr. Titer said, “but also continually improve upon the delivery of excellence in patient care that they provide each day.”

The Tinsley Harrison Internal Medicine Residency Program serves as one of more than 20 residency programs within UAB graduate medical education. The residency program comprises 116 categorical residents and 16 combined Medicine-Pediatrics residents, providing care at UAB Hospital and the Veteran’s Administration Medical Center (BVAMC). During training, residents acquire clinical acumen for the diagnosis and management of common acute and chronic medical illnesses as well as rare diseases that involve complex clinical reasoning. This grant will aid in the continual development of physicians who demonstrate excellence in clinical skills and compassion in patient care.

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Report: Overall Cancer Mortality Continues to Decline

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Report: Overall Cancer Mortality Continues to Decline

The latest Annual Report to the Nation on the Status of Cancer finds that, for all cancer sites combined, cancer death rates continued to decline in men, women and children in the United States from 1999 to 2016. Overall cancer incidence rates, or rates of new cancers, decreased in men from 2008 to 2015, after increasing from 1999 to 2008, and were stable in women from 1999 to 2015. In a special section of the report, researchers looked at cancer rates and trends in adults ages 20 to 49.

The annual report is a collaborative effort among the National Cancer Institute (NCI), part of the National Institutes of Health; the Centers for Disease Control and Prevention (CDC); the American Cancer Society (ACS); and the North American Association of Central Cancer Registries (NAACCR). The report appeared in the Journal of the National Cancer Institute on May 30, 2019.

“We are encouraged by the fact that this year’s report continues to show declining cancer mortality for men, women, and children, as well as other indicators of progress,” said Betsy A. Kohler, executive director of NAACCR. “There are also several findings that highlight the importance of continued research and cancer prevention efforts.”

The special section shows a different picture of cancer incidence and mortality among men and women ages 20 to 49 than among people of all ages. In the main report, from 2011 to 2015, the average annual incidence rate for all cancer sites combined was about 1.2 times higher among men than among women, and from 2012 to 2016, the average annual death rate among men (all ages) was 1.4 times the rate among women. However, when the researchers looked only at men and women ages 20 to 49, they found that both incidence and death rates were higher among women.

The authors reported that, in the 20–49 age group from 2011 to 2015, the average annual incidence rate for all invasive cancers was 115.3 (per 100,000 people) among men, compared with 203.3 among women, with cancer incidence rates decreasing an average of 0.7% per year among men and increasing an average of 1.3% per year among women. During the period from 2012 to 2016, the average annual cancer death rate was 22.8 (per 100,000 people) among men and 27.1 among women in this age group.

The most common cancers and their incidence rates among women ages 20 to 49 were breast (73.2 per 100,000 people), thyroid (28.4), and melanoma of the skin (14.1), with breast cancer incidence far exceeding the incidence of any other cancer. The most common cancers among men ages 20 to 49 were colon and rectum (13.1), testis (10.7), and melanoma of the skin (9.8).

“The greater cancer burden among women than men ages 20 to 49 was a striking finding of this study,” said Elizabeth Ward, Ph.D., lead author of the study and a consultant at NAACCR. “The high burden of breast cancer relative to other cancers in this age group reinforces the importance of research on prevention, early detection, and treatment of breast cancer in younger women.”

In studying this age group, the authors also found that, from 2012 to 2016, death rates decreased 2.3% per year among men and 1.7% per year among women.

“It is important to recognize that cancer mortality rates are declining in the 20-to-49-year-old age group, and that the rates of decline among women in this age group are faster than those in older women,” said Douglas R. Lowy, M.D., acting director of NCI.

The authors also reported in the special section that the incidence rates of in situ breast cancer and nonmalignant central nervous system tumors among women and men ages 20 to 49 are substantial. They wrote that some of the most frequent malignant and nonmalignant tumors that occur in this age group may be associated with considerable long-term and late effects related to the disease or its treatment. The authors conclude that access to timely and high-quality treatment and survivorship care is important to improve health outcomes and quality of life for younger adults diagnosed with cancer.

This year’s report found that, among all ages combined, existing incidence and mortality trends for most types of cancer continue. Rates of new cases and deaths from lung, bladder, and larynx cancers continue to decrease as a result of long-term declines in tobacco smoking. In contrast, rates of new cases of cancers related to excess weight and physical inactivity—including uterine, post-menopausal breast, and colorectal (only in young adults)—have been increasing in recent decades.

Several notable changes in trends were observed in the report. After decades of increasing incidence, thyroid cancer incidence rates in women stabilized from 2013 to 2015. The authors wrote that this could be due to changes in diagnostic processes related to revisions in American Thyroid Association management guidelines for small thyroid nodules.

The report also shows rapid declines in death rates for melanoma of the skin in recent years. Death rates, which had been stable in men and decreasing slightly in women, showed an 8.5% decline per year from 2014 to 2016 in men and a 6.3% decline per year from 2013 to 2016 in women.

“The declines seen in mortality for melanoma of the skin are likely the result of the introduction of new therapies, including immune checkpoint inhibitors, that have improved survival for patients diagnosed with advanced melanoma,” said J. Leonard Lichtenfeld, M.D., M.A.C.P., interim chief medical officer of ACS. “This rapid change shows us how important it is to continue working to find effective treatments for all kinds of cancer.”

Other notable findings about cancer mortality from the report include that from 2012 to 2016:

  • Overall death rates decreased 1.8% per year in men and 1.4% per year in women.
  • Among men, death rates decreased for 10 of the 19 most common cancers but increased for 6 cancers, with the steepest increases for liver cancer, oral cavity and pharynx cancer, and non-melanoma skin cancer.
  • Among women, death rates decreased for 13 of the 20 most common cancers, including the 3 most common cancers (lung and bronchus, breast, and colorectal), but increased for 5 cancer types, with the steepest increases for cancers of the uterus and liver.

For cancer incidence, from 2011 to 2015:

  • Incidence rates for all cancers combined were stable in women and decreased 2.1% per year in men.
  • Among men, rates of new cancers decreased for 8 of the 17 most common cancers, increased for 7 cancers, and were stable for 2 cancers.
  • Among women, rates of new cancers decreased for 6 of the 18 most common cancers, increased for 9 cancers, and were stable for 3 cancers.

The report also shows continuing racial and ethnic disparities in cancer mortality and incidence. When data for people of all ages were combined and compared by sex, across racial and ethnic groups, black men and black women had the highest cancer death rates, both for all cancer sites combined and for about half of the most common cancers in men and women. Black men and white women had the highest overall cancer incidence rates, and Asian/Pacific Islander men and women had the lowest overall rates. Non-Hispanic men and women had higher overall incidence rates than Hispanic men and women.

“Major declines overall in cancer mortality point in the right direction, yet significant differences remain in cancer cases and deaths based on gender, ethnicity, and race,” said CDC Director Robert R. Redfield, M.D. “A better understanding of these discrepancies improves cancer diagnosis and recovery for all patients and is vital to our public health mission.”

For more about the report, see: https://seer.cancer.gov/report_to_nation/

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Study: Kids Distracted By Misleading Warnings in E-Cigarette Ads

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Study: Kids Distracted By Misleading Warnings in E-Cigarette Ads

E-cigarettes and vape companies are courting smokers and non-smokers alike, and they have the advertising to match. Some of the ads from one company, Blu, included “fake” advisories like “WARNING: Contains flavor.” A new study published in the journal Tobacco Control found that boys who saw ads with that type of fake warning were less likely to recall information in the ad about possible health impacts.

“The ads we found from Blu in 2017 had these fake warnings at the top that really adhered to the warning messages requirements that are now required on e-cigarette ads by the FDA,” says Brittney Keller-Hamilton, the study’s lead and a researcher at Ohio State University’s College of Public Health.

“They said things like, ‘Important: vaping Blu smells good’ and ‘Important: less harmful to your wallet,'” she says. “And we know that these messages are likely to resonate well with adolescents,” she said.

But it wasn’t just that those messages would entice the boys. Keller-Hamilton and her team found that they also distracted the readers from the actual health advisories.

“Boys who were randomly assigned to view ads with fake warnings were less likely to recall the actual warning on the advertisement or to remember health risks conveyed in that actual warning,” she said.

The FDA now requires large warnings on the ads, which Keller-Hamilton believes will make this sort of campaign harder to replicate. But it could have implications for the rest of the industry.

“This is a really big concern for cigarette ads, for instance, because those still have smaller warnings,” she said. “And cigarette ads could put fake warnings at the top of their advertisements to even further reduce the impact of their actual warnings for adolescents.”

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New Study Inspires Researchers to Hit the Road

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New Study Inspires Researchers to Hit the Road

A new $21.4 million RURAL study will examine rural, southern U.S. communities to find out why people there have more disease, shorter lives. Traveling in a mobile examination van, researchers will examine 4,000 study participants over the course of six years in 10 rural counties across Kentucky, Alabama, Mississippi and Louisiana.

Vasan Ramachandran, who leads the Framingham Heart Study at Boston University, is about to embark on the ultimate road trip with 50 other scientists. But this is not for adventure and sightseeing. The research team is part of a new study led by Ramachandran, called the Risk Underlying Rural Areas Longitudinal (RURAL) study, which has the goal of discovering why people in rural areas of the southern United States tend to live shorter, less healthy lives compared to the rest of the country.

With $21.4 million in funding from the National Heart, Lung, and Blood Institute, Ramachandran and his team plan to use their know-how from the Framingham Heart Study—the longest-running heart disease study in the country—to ask the question, “What causes the high burden of heart disease, lung disease and stroke in the rural South?”

To find out the answer, the researchers will travel by custom van, built as a “mobile examination unit,” to examine 4,000 study participants over the course of six years in 10 counties across Kentucky, Alabama, Mississippi, and Louisiana. Throughout the entire US, heart disease is the number-one killer of both men and women, but rates are even worse in southern states. People living in these areas also have higher rates of lung, blood, and sleep disorders compared to the national average.

“We hope that what we do [in RURAL] changes the lives of common human beings who live in these communities, who are robust individuals like you and me,” says Ramachandran, a BU School of Medicine professor of medicine and epidemiology and chief of preventive medicine and epidemiology. “The burden of [health] risk is high, in part because of geospatial characteristics that we don’t fully understand.”

The most crucial aspect of the study, Ramachandran explains, is going to be listening. Partnering with 16 institutions, including universities in all four states, the researchers will work with participating communities to organize active discussions, working groups, listening groups, and community advisory boards. Their plan is to take the “science to the people and study these health issues at their doorstep,” Ramachandran says.

The mobile exam unit will be constructed after carefully consulting with community partners and participants, long before the examination process begins. Ramachandran says this will ensure that the space will be comfortable, accessible, and customized to the needs of specific areas. The van, once fully operational, will spend time in each county over the next few years. Counties in Alabama will be the group’s first stop to conduct baseline examinations.

“We do hope to build relationships within these communities to understand them better beyond the 4,000 people [who will participate] in RURAL,” Ramachandran says.

Six years might seem like a long time, but this is only the first step toward a much longer process and larger goal. Once the RURAL van completes its trip through all 10 counties, the cohort will continue working with the communities through advisory boards and participant networks. After the data is collected and analyzed, the team intends to share the results with district health officials and provide health recommendations based on their findings.

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Can We Overhaul Our ‘Broken’ Health Data System?

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Can We Overhaul Our ‘Broken’ Health Data System?

COLUMBUS, Ohio – Our system for protecting health data in the United States is fundamentally broken, and we need a national effort to rethink how we safeguard this information, according to three experts in data privacy.

“Data scandals are occurring on a regular basis, with no end in sight,” said Efthimios Parasidis, a co-author of the NEJM article and a professor at the Ohio State University’s Moritz College of Law and College of Public Health. “Data privacy laws for health information don’t go far enough to protect individuals. We must rethink the ethical principles underlying collection and use of health data to help frame amendments to the law.”

Parasidis wrote the article with Elizabeth Pike, Director of Privacy Policy in the Office of the Chief Information Officer at the U.S. Department of Health and Human Services; and Deven McGraw, chief regulatory office at Citizen, a company that helps people collect, organize and share their medical records digitally. Previously, McGraw was Deputy Director for Health Information Privacy at the Office of Civil Rights in the U.S. Department for Health and Human Services, and Acting Chief Privacy Officer at the Office of the National Coordinator for Health Information Technology.

Parasidis said a process analogous to the Belmont Report would be a good blueprint to follow today. The Belmont Report is one of the leading works concerning ethics and health care research. Its primary purpose is to protect subjects and participants in clinical trials or research studies. This report consists of three principles: beneficence, justice, and respect for persons.

The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research produced the 1979 Belmont Report, which resulted in Congress passing laws to protect people who participated in medical research.

“Indignities in human subjects research compelled the government to create a commission to propose ethical guidelines for new laws. We are experiencing a rerun of what was happening then, with the scandals involving use of health data now rather than the use of human subjects,” Parasidis said. “We need an equivalent response.”

Currently, the Health Insurance Portability and Accountability Act (HIPAA) is the main law protecting the data of patients. But it doesn’t apply to many of the new companies and products that regularly store and handle customer health information, including social media platforms, health and wellness apps, smartphones, credit card companies and other devices and companies.

“All of this data held by digital health companies raises a lot of ethical concerns about how it is being used,” Parasidis said.

For example, some life insurers are offering contracts that have policyholders wear products that continuously monitor their health, and the information can be used to increase a customer’s premiums.

Most regulations require only that consumers be notified about how their information is used and give their consent.

“That system doesn’t work. Very few people read the notice and most people just click agree without knowing what they’re agreeing to,” he said.

So how can health data privacy be fixed?

One idea would be to establish data ethics review boards, which would review projects in which health data are collected, analyzed, shared or sold, according to the authors of the NEJM article.

Parasidis said such boards could function as safeguards required in both public and private settings, from university medical centers to private life insurance companies.

These boards could consider the benefits and risks of the proposed data use and consider policies governing data access, privacy and security. Members could include project developers, data analysts and ethicists, as well as people whose data would be collected.

“Right now, everything is about compliance. Companies and institutions check the boxes, fill out the forms and don’t really think about whether they’re doing the right thing,” Parasidis said.

“Deliberations about use of health data should take the ethical obligations to individuals and society into account. The law should mandate that this occurs.”

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