FDA approves fast, take-home test that detects HIV

A model demonstrates how to use the OraQuick test, which
detects the presence of HIV in saliva.
AP photo by Chuck Zovko.

Soon, taking an HIV test will be no more complicated than swabbing one's mouth and waiting for the results. The Federal Food and Drug Administration last week approved the OraQuick test, which detects HIV antibodies and gives a result in 20 to 40 minutes. 

Orasure plans to start selling the test in October at local pharmacies and online, reports Matthew Perrone for The Associated Press. It is expected to cost less than $60 but more than the one used by health professionals, which costs $17.50.

About 240,000 of the 1.2 million people who are suspected of carrying the HIV virus don't know they are infected. 

The FDA says the test is not 100 percent accurate, but a trial conducted by Orasure showed it only detected HIV in people who have the virus 92 percent of the time. It was 99.9 accurate ruling out HIV in people not carrying the virus. People who test negative should re-test after three months because it can take time for the HIV antibodies to appear. (Read more)

Tensions mounting as implementation of prescription drug bill nears on July 20

House Speaker Greg Stumbo, D-Prestonsburg,
sponsored the prescription drug bill.
(Courier-Journal photo)

A controversial bill aimed at curbing prescription drug abuse, which was considered by many as the hallmark of the 2012 General Assembly, is creating tension as its implementation draws nearer. It takes effect July 20.

House Bill 1 puts more restrictions on pain clinics to prevent so-called pill mills from setting up shop in the state. It also requires doctors who prescribe controlled substances to use the state's drug-monitoring system known as KASPER. It further requires licensing boards to set up standards to increase oversight and spell out how doctors should be using KASPER. "But many of the details remain uncertain — including how frequently doctors must run searches of patients — and several areas are poised to drive a wedge between the medical industry and lawmakers in the coming months," reports Mike Wynn for The Courier-Journal.

The Kentucky  Board of Medical Licensure has written a draft proposal with dozens of new rules that have prompted confusion and anger among physicians. House Speaker Greg Stumbo, the bill's sponsor, has questioned the move. "What it appears to me they are doing is almost making it over burdensome to practitioners, and one might argue that is an attempt to make the entire system fail," he said.

Given the anticipated impasse, some expect Gov. Steve Beshear "to sign emergency regulations that will achieve at least some of the goals of HB 1, but those would expire within six months and wouldn't be subject to a prior review process," Wynn reports. (Read more)

After losing weight, get the same number of calories from fat and carbs to maintain weight loss, study suggests

Subjects on a low-fat, high-carbohydrate diet did not do
as well when it came to keeping weight off, a study
has found. (Photo by Tetra Images)

All calories may not be equal when it comes to weight loss, the results of a small study show. It found that people who ate a diet of an even amount of carbohydrates and fat were the winners when it came to shedding pounds.

The study, which was published in the Journal of the American Medical Association, involved 21 overweight men and women. After following a 12-week weight-loss regimen in which they lost 10 to 15 percent of their body weight, the subjects were divided into three groups and fed a different kind of diet. One diet was low-fat (60 percent carbohydrates, 20 percent fat and 20 percent protein). A second was low in carbohydrates: 10 percent carbs, 60 percent fat and 30 percent protein. The third was called a "low glycemic index diet," with 40 percent carbs, 40 percent fat and 20 percent protein.

In all three diets, while the subjects were at rest, they burned fewer calories than before they lost weight. "But over the course of the day, the subjects burned more than 300 additional calories on average when on the very low-carbohydrate diet compared with the low-fat diet," reports Eryn Brown for the Los Angeles Times. However, "blood samples drawn from the participants in the low-carb diet phase contained elevated levels of the stress hormone cortisol as well as C-reactive protein, which signals chronic inflammation in the body and has been linked to cardiovascular disease."

Subjects on the low glycemic diet burned 200 more calories than those on the low-fat diet and did not have the problems associated with the high-carb diet, prompting the study's senior author, Dr. David Ludwig, to recommend it as the best course of action. (Read more)

If Kentucky expands Medicaid, no other state would have a larger percentage drop in the uninsured, Kaiser Commission says

"Kentucky will benefit most from the expansion of Medicaid under the Affordable Care Act, according to an analysis by the Kaiser Commission on Medicaid and the Uninsured," Lorie Hailey writes for The Lane Report, a Lexington-based business publication.

The law calls for expanding Medicaid to people who earn less than 133 percent of the poverty threshold, or 138 percent if a fudge factor is included. If Kentucky accepted the expansion, its number of uninsured adults under the 133 percent line would decrease 57.1 percent, more than any other state, the commission says, based on 2010 data.

From 2014 to 2019, the commission reports that the federal government’s spending on Medicaid in Kentucky will be $11.8 billion, while the state will spend $515 million," Hailey reports. From 2014 to 2016, the federal government would pay the entire cost of the expansion; after that, the state would have to pay 10 percent. The normal Medicaid funding formula is 30 percent state, 70 percent federal.

For the Kaiser news release, click here. For the full report, go here. An executive summary is here.

As Beshear and Williams equivocate, Hoover and McConnell say state should not expand Medicaid under health reform

Kentucky Health News

The Republican leader of the state House said today that Kentucky should not take advantage of an expansion of Medicaid under federal health reform because it would cost too much once the state starts paying 10 percent of the cost.

The U.S. Supreme Court last week said the states could refuse to expand the program without risking loss of their current Medicaid money, as the reform law prescribed. For adding people with incomes up to 133 or 138 percent of the federal poverty threshold, the federal government would pay the entire cost in 2014-16. For other recipients, the feds would continue to pay 70 percent of the cost.

House Minority Floor Leader Jeff Hoover of Jamestown said that would be "financially devastating" because nearly 400,000 uninsured Kentuckians have incomes under 138 percent of the poverty line. "Other estimates put the number of people eligible for Medicaid under the new rules at fewer than 350,000," reports Beth Musgrave of the Lexington Herald-Leader. More than 700,000 are already on Medicaid.

Hoover's comments were directed at Democratic Gov. Steve Beshear, who has equivocated on the question. A Beshear spokeswoman told Musgrave, “We will continue to work with our federal partners and the [Cabinet for Health and Family Services] to get a fuller picture of this policy and determine the best course for the state after we have gathered the facts.” In his re-election campaign against state Senate President David Williams, Beshear voiced misgivings about the costs.

Mugsrave notes that Williams, R-Burkesville, "said in a statement late Thursday that he is concerned about the growing costs of the program, but he stopped short of calling on Beshear to opt out of the expansion." (Read more) However, U.S. Senate Republican Leader Mitch McConnell, who has vowed to repeal the reform law, has called on Beshear to reject the expansion.

House Speaker Greg Stumbo, D-Prestonsburg, endorsed the expansion, saying, “I think that Americans have a right to accessible and affordable healthcare, and the more we expand coverage to meet that goal, the lower healthcare costs will be for all of us.” For coverage from Tom Loftus of The Courier-Journal, click here.

Hospitals could lobby for the expansion. "Hospital associations agreed to help fund the law by accepting various cuts to their reimbursement rates with the expectation that they would be more than compensated by money from patients newly insured through Medicaid," The Washington Post reports. "Now they worry that they will be stuck with only the downside of that bargain."

Robert Laszewski, a health-care consultant and former insurance executive, told the Post that governors wary of the expansion's cost "could push Obama for permission to privatize parts of their Medicaid programs or to open eligibility only to those with incomes up to 100 percent of the poverty level instead of 133 percent. They also could request that the federal contribution to Medicaid be sent to them as a block grant without strings attached, Post reporters N.C. Aizenman and Sandhya Somashekhar write. Are those the sorts of things Beshear has in mind to limit costs?

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Most Ky. nursing homes give more antipsychotic drugs to non-psychotic patients than U.S. median, but get little attention so far

Most Kentucky nursing homes exceeded the national average of the share of residents without psychosis or a related condition who nevertheless received antipsychotic drugs, according to federal data gathered by The Boston Globe and distributed by Kentuckians for Nursing Home Reform.

The data from the Centers for Medicare and Medicaid Services showed that 16.7 percent of patients fell into that category, and that 161 of the 280 Kentucky nursing facilities for which data were available exceeded the national average. Twenty had percentages more than double the national average, and three were more than triple: the Glasgow State Nursing Facility, at 62 percent; Arbor Place of Clinton, 61 percent; and the nursing home at Western State Hospital in Hopkinsville, 60 percent.

The data are for 2010. Nursing homes were not included if there were no data on antipsychotic drug use. Some data were taken from 2009 because no 2010 data were available. The Globe put the data into an easily reviewable database, available here, the Kentucky reform group issued a press release about it on June 14, and Kentucky Health News reported it on June 22.

However, only two Kentucky newspapers have reported on the survey and a local facility that exceeded the national average, according to our limited subscriptions and the news-clipping service subscribed to by the Foundation for a Healthy Kentucky and shared with Kentucky Health News. Those were the Kentucky New Era in Hopkinsville, which mentioned several facilities in its area (Western State's director said state policy prevented him from commenting), and The Anderson News of Lawrenceburg. Its June 20 edition had a story focusing on Heritage Hall in Lawrenceburg, where 20 percent of non-psychotic patients received antipsychotic drugs.

A spokesman for Heritage Hall's operator, Elmcroft Senior Living and Memory Care of Louisville, told Anderson News Editor Ben Carlson that physicians "may choose to prescribe a medication such as antipsychotics without a diagnosis of psychosis or related condition such as controlling a patient's anxiety over a specific disease process."

Bernie Vonderheide, spokesman for the reform group, told Carlson that it suspects that many nursing homes use the drugs to keep patients under control and to avoid hiring more staff. "That is the single biggest problem in nursing homes, the lack of caregivers." (Read more; the New Era's story is behind a pay wall.)

Besides the Glasgow, Clinton and Hopkinsville facilities, the following had a percentage of non-psychotic patients receiving antipsychotic drugs that was more than double the national average:

Dawson Pointe, Dawson Springs 49%
Dover Manor, Georgetown, 49%
Edgemont Health Care, Cythiana, 46%
Pineville Community Hospital, Pineville, 44%
Edgewood Estates, Frenchburg, 42%
Wesley Manor Nursing Center, Louisville, 42%
Wellington Parc of Owensboro, 42%
Stanton Nursing Center, Stanton, 41%
Shady Lawn Nursing Home, Cadiz, 41%
Charleston Health Care Center, Danville, 37.5%
Breckinridge Memorial Nursing Facility, Hardinsburg, 37%
Cedar Ridge Health Campus, Cynthiana, 37%
Brighton Cornerstone Health Care, Madisonville, 36%
Carmel Home, Owensboro, 36%
Ridgeway Nursing and Rehabilitation Facility, Owingsville, 36%
J.J. Jordan Geriatric Center, Louisa, 35%
Medco Center of Henderson, 35%
Wolfe County Health and Rehabilitation Center, Campton, 34%
(Figures are rounded to the nearest percentage unless .5)

Kentuckians support goals of reform law, foundation head says

While politicians say President Obama's health-care reform is not popular in Kentucky, polls show that nine out of 10 adult Kentuckians favor its goals, the president of the Foundation for a Healthy Kentucky noted after the law passed its final court test.

"Thursday's Supreme Court decision affirms the constitutionality of the Affordable Care law and moves the United States and Kentucky children and adults one step closer to assured access to affordable insurance and care," Susan Zepeda said. "Our Kentucky Health Issues Poll found that regardless of their views on the Affordable Care law, the vast majority . . . of Kentuckians believe that all Americans should have access to affordable, quality health care." She said Kentuckians "expressed strong support for key provisions of the law already in effect: tax breaks for small employers, no co-pay on key preventive services, access to insurance for children with pre-existing health problems."


Looking forward, "Kentucky leaders need to be sure our residents are aware of the provisions of this law," Zepeda said. "As individuals and as a state, we need to take advantage of opportunities and resources the law makes available, even as we continue to work to improve access to quality care throughout Kentucky. The Foundation stands committed to addressing the unmet health care needs of Kentuckians, informing health policy and investing in communities, to increase access to care, decrease health disparities, and advance health equity in the Commonwealth." (Read more)