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Health Med Fit Science

    Health leaders say they are alarmed about a report that officials at the nation's top public health agency are being told not to use certain words or phrases in official budget documents, including 'fetus,' ''transgender' and 'science-based.'The health community was reacting to a story in The Washington Post published late Friday citing an anonymous source who said the prohibition was made at a recent meeting of senior budget officials at the U.S. Centers for Disease Control and Prevention. The seven words and phrases — 'diversity,' ''entitlement,' ''fetus,' transgender,' ''vulnerable,' ''evidence-based' and 'science-based' — were not to be used in documents that are to be circulated within the federal government and Congress in preparation of the next presidential budget proposal, the paper reported.On Saturday a CDC official confirmed CDC officials were given 'feedback' from higher ranks of the federal government at a recent meeting to reconsider certain language in draft budget documents. But she said she did not know if there was any specific prohibition about using those seven words. She spoke on condition of anonymity, saying she was not authorized to talk about what happened.A spokesman at the U.S. Department of Health and Human Services, which oversees CDC, said in a statement that it's a mischaracterization to say the CDC was banned from using certain words. But HHS officials did not clarify or answer any other questions.In an email to the agency's employees on Saturday night, CDC Director Dr. Brenda Fitzgerald noted the media report and wrote; 'I want to assure you that CDC remains committed to our public health mission as a science- and evidence-based institution. As part of our commitment to provide for the common defense of the country against health threats, science is and will remain the foundation of our work.'The Atlanta-based CDC is in charge of responding to infectious disease outbreaks, like Ebola and Zika, and tracking a wide range of chronic diseases and other health problems.For decades, the agency has had a mostly sterling reputation as a source of scientific information. That the agency could be censoring certain language sparked alarm and anger from some science and public health experts.'Here's a word that's still allowed: 'ridiculous,'' said Rush Holt, chief executive officer of the American Association for the Advancement of Science, in a statement reacting to the report.Dr. Sandro Galea, dean of Boston University's School of Public Health, says these things matter 'because the words that we use ultimately describe what we care about and what we think are priorities.'If you are saying you cannot use words like 'transgender' and 'diversity,' it's a clear statement that you cannot pay attention to these issues.'The CDC official who spoke to The Associated Press said the feedback to reconsider budget language came from 'higher-ups' in the federal government, and not from anyone at the CDC. She said she was informed of the meeting but she was not there, and did not know who made the language suggestions.Since President Donald Trump took office, a number of federal agencies have moved to downscale data collection on topics like climate change and homeless people who are gay, lesbian, bisexual and transgender and to remove information on such topics from some government websites.The CDC has in the past seemed to signal an interest in less talk and data on certain subjects. Earlier this year, for example, the HHS proposed deleting a question of sexuality from a federal data-collecting survey. It was restored after an outcry by advocates for the LGBT community.In a statement responding to the Post story, HHS spokesman Matt Lloyd said; 'The assertion that HHS has 'banned words' is a complete mischaracterization of discussions regarding the budget formulation process. HHS will continue to use the best scientific evidence available to improve the health of all Americans. HHS also strongly encourages the use of outcome and evidence data in program evaluations and budget decisions.'An HHS official did not respond to any additional questions. A White House official referred questions to HHS.The CDC is in a sensitive position. The White House and some Republican lawmakers have proposed dramatic reductions to the agency's $7 billion discretionary budget.'Everybody in the public health community recognizes that there is a slowly growing timidity by colleagues whose budgets are dependent on the federal government. I have a deep sympathy for the predicament that they are in,' Dr. Galea said.One medical leader from an outside agency, who works closely with CDC employees, said a CDC ban on certain words and terms may not be limited to budget documents. He said two CDC employees told him agency workers have been told not to use the term 'health equity' in presentations or public talks. The term refers to a goal of removing obstacles like poverty and racial discrimination in making sure people have an equal chance to be healthy.There's no written directive about not using the term; it's only been communicated verbally, said the medical leader, who spoke on condition of anonymity because he did not want to jeopardize a working relationship with CDC officials.'What is clearly happening is those people are afraid to use those words in any talks or papers. Everybody's afraid to do their job right now,' he said.A CDC spokeswoman said she is not aware of any guidance that prohibits CDC scientists from using 'health equity' or any other words or phrases in presentations or talks.
  • After a rush of last-minute sign-ups, the Trump administration says it's extending the deadline for some people to finish health insurance applications for next year under the Affordable Care Act.Callers to the HealthCare.gov service center on Saturday morning got a recorded message saying 'don't worry' — if they'd called and left their phone number before the deadline, they'll get a call back and still can enroll for 2018.HealthCare.gov issued similar extensions previously under the Obama administration.Although the deadline has passed for most consumers in the 39 states served by HealthCare.gov, several states running their own enrollment websites have longer deadlines.Also, longer sign-up periods are available on HealthCare.gov for people in special circumstances, including those affected by this year's hurricanes.The HealthCare.gov call center is at 800-318-2596.
  • Republicans didn't get their wish to repeal former President Barack Obama's health care law, but the tax bill barreling toward a final vote in Congress guts its most unpopular provision, the requirement that virtually all Americans carry health insurance.Politically, the move is a winner for Republicans, who otherwise would have little to show for all their rhetoric about 'Obamacare.'But if estimates by the nonpartisan Congressional Budget Office are right, it will lead to more people being uninsured and higher premiums for those buying individual health insurance policies.And Congress may then find itself considering other ways to nudge people to get health insurance.The CBO estimates that repealing the requirement would lead to more people taking a gamble on going without coverage, raising the number of uninsured Americans by 4 million in 2019 and by 13 million a decade from now. The federal government would save about $338 billion over a decade because fewer people would seek subsidized coverage under the Affordable Care Act. But premiums for individual plans would go up about 10 percent because the people left behind would tend to be sicker.Independent experts debate the precise impact, noting that with about 28 million people still uninsured, the so-called individual mandate doesn't seem to have worked very well in the first place.'The data is very murky on how much of an effect the individual mandate has had,' said Larry Levitt of the nonpartisan Kaiser Family Foundation. 'I think it's likely that millions more people will be uninsured with the individual mandate repealed but not to the extent that CBO projected. Insurance premiums will certainly go up.'Other major elements of 'Obamacare' would remain in place, including its subsidies for premiums, protections for people with pre-existing medical conditions and its requirement that insurers cover a broad range of 'essential' benefits. Little impact is seen on employer plans, the mainstay for workers and their families.The insurance requirement is enforced through fines collected by the IRS. Anecdotal evidence suggests that many of the people who have been paying the fines are workers with modest incomes — the group that the health law was supposed to help in the first place.Health economist Gail Wilensky said repealing the mandate might take some of the political steam out of the health care debate. It may even point to a path for lawmakers of both major parties to consider measures that would help stabilize insurance markets for people who don't get coverage on the job.It 'may be enough to take away what has been the single most hated part of the ACA for both Republicans and Democrats,' said Wilensky, who served in a previous Republican administration.But that won't solve the problem of providing affordable coverage for people who don't qualify for subsidies through 'Obamacare.'President Donald Trump's administration is working on another track: regulations that would allow broader sale of lower-cost plans with limited benefits.How much consumer appeal that alternative will have remains to be seen.
  • A deadline burst of sign-ups is punctuating a tumultuous year for former President Barack Obama's health care law.The strong finish for HealthCare.gov reveals continued consumer demand for the program's subsidized individual health plans.But troubles aren't over for the Affordable Care Act. Actions by the Republican-led Congress and the Trump administration could undermine the ACA's insurance markets.On the plus side for the ACA, official numbers show a sizable share of first-time customers — 36 percent — among people rushing to finish applications ahead of Friday's enrollment deadline.Final national numbers aren't expected until next year, since some states extend sign-ups to Jan. 31.Still, it was only a year ago that 'Obamacare' seemed headed for oblivion as President Donald Trump swept into the White House.
  • France gave the world butter croissants and foie gras, yet it has often been a place where being overweight was seen as almost sinful.Now, after taking a hard look at the contradictions in the mirror, its capital has launched a campaign to counter sizeism, an often disregarded kind of discrimination in the image-conscious city known for luxury fashion brands and tiny waists.Paris anti-discrimination chief Helene Bidard began the initiative after falling victim to weight-related insults and noticing how bias against French people who are overweight went unnoticed, never mind unpunished.'We see fat people as ugly and even stupid, lacking hygiene and in bad health,' Bidard said.As part of its annual week devoted to raising awareness about discrimination, Paris on Friday unveiled its 'Fatphobia, stop! Taking action together' campaign with a plus-size fashion show and panels featuring bloggers from the 'body positive' movement. Fifty thousand leaflets with legal advice and helpline numbers are set to be distributed at sports centers, night clubs, swimming pools and bistros.The effort, which is aimed at countering both casual and institutionalized discrimination, comes amid rising obesity rates in France. The National Institute of Health and Medical Research reported that nearly 16 percent of the adult population was obese last year, compared to 6 percent in 1980. But thinness ideals persist.'There's this French paradox where you're supposed to eat foie gras, but you're not supposed to get fat,' said curvy French blogger Daria Marx.Marx said that while a 2011 French law prohibits job discrimination based on physical appearance, employers often get around it by prioritizing job applications that contain candidates' photos.Calling it 'discrimination,' she cited research that concluded that fat people are 15 times less likely to be called back for interviews if they include their photos.Doctors also can deny in vitro fertilization to women who are deemed overweight.To challenge the images of small-sized beauty propagated by fashion houses such Paris-based Chanel, Louis Vuitton and Dior, organizers of Friday's event put on a big-is-beautiful runway show with plus-size clothes specially made by designers such as Ewa Minge.'In France, it's very difficult (to buy clothes.) I only shop on the internet' or shops in London, Marx said.French luxury giants recently woke up to the potential dangers of encouraging excessive thinness. Since Oct 1, French fashion conglomerates LVMH and Kering stopped hiring excessively thin models and now require models to provide medical certificates to prove they are healthy before they can work. The companies said they hoped to set a new global standard for the fashion industry.The move garnered praise at Paris Fashion Week, including during the show for the collection by Stella McCartney, whose house is owned by Kering.'The community in fashion needs to look after these young women ... whether that be their emotional health, their mental health or their physical health,' McCartney told The Associated Press.The French law initially included a minimum body mass index requirement, but it was removed after lawmakers deemed the doctor's certificate an adequate safeguard.Though discrimination against fat people is a real documented problem in France— a book about growing up fat in France entitled 'You're Not Born Fat' became an unexpected sensation — some remain skeptical.'There is no problem of sizeism in Paris,' image consultant Emery Dolige said. 'Does eating well make you fat? No. On the contrary. Our American friends often demonstrate that.'___Thomas Adamson can be followed at Twitter.com/ThomasAdamson_K
  • When California rings in the new year with the sale of recreational pot for the first time, Texas will be tiptoeing into its own marijuana milestone: a medical cannabis program so restrictive that doubts swirl over who will even use it.Texas is the last big state to allow some form of medical marijuana, albeit an oil extract so low in the psychoactive component, THC, that it couldn't get a person high. Though it might seem that Texas policymakers have softened their attitude toward the drug, bringing them more in line with the U.S. population as a whole, they have not. A joint could still land you in jail in Texas, and the state's embrace of medical marijuana comes with a heavy dose of caution.Among the concerns are the license fees to grow marijuana in Texas — which are the highest in the U.S., at nearly $500,000 — and that the program is rolling out with just eight participating doctors in a state of 27 million people. And, like other states, access is limited to a small pool of patients who have been diagnosed with intractable epilepsy and tried at least two other treatments first.'It's heartbreaking. Being able to say, 'Yes, you can get it,' but reading over the whole law there is still some things we have to jump over,' said Cristina Ollervidez, 31, who lives near the Texas-Mexico border and is three hours from the closest participating doctor. Her 7-year-old daughter, Lailah, has a type of epilepsy called Lennox-Gastaut syndrome and is in a wheelchair.Her daughter isn't listed as having intractable epilepsy but still has days when she gets several seizures.'Seeing Texas put limitations, I do get that part,' Ollervidez said. 'But I don't think they did their exact research.'The frustration over access is similar in other states that have also passed restrictive medical marijuana laws. One Georgia legislator goes so far as to have low-dose cannabis oil shipped to his office from Colorado as a workaround to his own bill, which allows people to possess marijuana but doesn't give them a legal way to obtain it.Texas is similar to more than a dozen states that restrict access to a low-THC cannabis oil. However, Texas — which is 800 miles (1,300 kilometers) wide — licensed just three dispensaries, none of which are in the western half of the state or in fast-growing cities along the border with Mexico. And the Republican who won over skeptical conservatives to pass her law in 2015 is noncommittal about expanding the program.That leaves Morris Denton, who runs the Compassionate Cultivation dispensary near Austin, looking far down the road.'If you're willing to take a long-term view and you're willing to suffer a few scars along the way, that success will come,' Denton said. 'The lessons themselves represent a barrier to entry for others who may come in. But I think it's hard to pinpoint how, where and when to start a legal medical cannabis industry.'Texas has also placed tighter control on marijuana growers. The licensing fee is 80 times more than originally recommended. The Texas Department of Public Safety once proposed a fee as high as $1.3 million to help offset the costs of state troopers patrolling the dispensaries, although that recommendation was later dropped.Growers are required to have surveillance video of every square foot of their facility and to preserve recordings for two years, which is longer than some police dashcam footage must be retained in Texas. They also aren't allowed to bring in a third-party to test the quality of their product.The driver behind the Texas law is Republican Stephanie Klick, a Christian conservative who strongly opposes the recreational use of drugs and who didn't support expanding her law this spring. She said it took her 18 months to round up enough votes in the Legislature and convince skeptics that patients weren't going to abuse the cannabis oil.'There was one sheriff that thought these kids were going to be juvenile delinquents and end up in his jail. And these are really sick kids,' Klick said, noting that lawmakers will consider expansion only after they've seen the results of the current framework.Only four states — Kansas, South Dakota, Nebraska and Idaho — have no form of medical marijuana on the books. Seventeen others, including Texas, allow only low-THC medical cannabis, according to research from the National Conference of State Legislatures.Kristen Hanson, a program director for NCSL, said Texas is unusual for requiring that a doctor 'prescribe' the cannabis oil instead of using the word 'referral' like most states. The distinction is blamed for dissuading more Texas doctors from signing up, because under federal law, marijuana is classified as a Schedule 1 drug with no medical use and therefore can't be prescribed.Dr. Paul Van Ness, a neurologist at the Baylor College of Medicine in Houston, is one of the few doctors who have registered with state to participate in the program. He said he supports the restrictive nature of the Texas program, though he concedes the downside is limited access.He said he already has patients smoking marijuana, some of whom have been arrested because of it.'They didn't belong in jail, but that's what happens in Texas,' Van Ness said. 'So if they can do it legally, that's a lot safer.'___Follow Paul J. Weber on Twitter: https://twitter.com/pauljweberFollow Claudia Lauer on Twitter: https://twitter.com/claudialauer___Sign up for the AP's weekly newsletter showcasing our best reporting from the Midwest and Texas: http://apne.ws/2u1RMfv
  • President Donald Trump's mining regulators are reconsidering rules meant to protect underground miners from breathing coal and rock dust -- the cause of black lung -- and diesel exhaust, which can cause cancer. An advocate for coal miners said Friday that this sends a 'very bad signal.'The Mine Safety and Health Administration has asked for public comments on whether standards 'could be improved or made more effective or less burdensome by accommodating advances in technology, innovative techniques, or less costly methods.'Some 'requirements that could be streamlined or replaced in frequency' involve coal and rock dust . Others address diesel exhaust , which can have health impacts ranging from headaches and nausea to respiratory disease and cancer.'Because of the carcinogenic health risk to miners from exposure to diesel exhaust, MSHA is requesting information on approaches that would improve control of diesel particulate matter and diesel exhaust,' the agency said.The Trump administration has said many federal regulations, including pollution restrictions, have depressed the coal industry and other sectors of the economy.'President Trump made clear the progress his Administration is making in bringing common sense to regulations that hold back job creation and prosperity,' Labor Secretary Alexander Acosta said Thursday in releasing his agency's regulatory and deregulatory agenda. 'The Department of Labor will continue to protect American workers' interests while limiting the burdens of over-regulation.'The notices on coal dust and underground diesel exhaust had few details. Both were described as 'pre-rule stage.'MSHA in 2014 had promised to conduct a retrospective study of the new dust rule, spokeswoman Amy Louviere said Friday. The current notice seeks comments on that and also on whether existing standards and regulations could be made more effective or less burdensome, she said.'I think it's a very bad signal for coal miners that MSHA is wanting to revisit the issue of coal dust and rock dust as well as diesel exhaust,' said attorney Tony Oppegard, who represents miners in safety cases. 'I don't think the Trump administration has coal miners' best interests at heart. They're aligned with coal mine operators as opposed to miners, and the only reasons they would want to reopen these rules or revisit these rules are to weaken them.'The Obama administration, through a lengthy rulemaking process, lowered the allowable limit for miners' dust exposure three years ago, Oppegard said. The industry and its mine operators opposed that for years, he said.At the National Mining Association, which represents mine operators, spokesman Luke Popovich said Friday they believe a review of the dust-exposure rule 'might shed valuable information on ... ways it might be improved to provide further protection for miners while eliminating unnecessary implementation requirements for operators.'David Zatezalo, a retired West Virginia coal mining executive chosen by Trump to head MSHA, said at his November confirmation hearing that the U.S. industry is safer and healthier than ever before. He said progress is needed, including technology for real-time monitoring of silica dust blamed for a virulent variation of the black lung disease that has afflicted even some younger coal miners.
  • President Donald Trump's administration says it is trying to accommodate consumers as hold times grow for those seeking to enroll in insurance under the federal health care law.The Centers for Medicare and Medicaid Services said Thursday that some callers to HealthCare.gov are being asked to leave their contact information. A spokeswoman says operators will call them back and they'll be able to get coverage effective Jan. 1.Sign-up season is half as long this year, but consumer interest has been strong. As of Dec. 9, about 4.7 million people had enrolled in the 39 states served by HealthCare.gov. That's roughly 17 percent more customers than at the same time last year.Friday at midnight Pacific time is the deadline to enroll in most states.
  • California, flush with cash from an expanding economy, would eventually spend $1 billion a year to provide health care to immigrants living in the state illegally under a proposal announced Wednesday by Democratic lawmakers.The proposal would eliminate legal residency requirements in California's Medicaid program, known as Medi-Cal, as the state has already done for young people up to age 19.It's part of $4.3 billion in new spending proposed by Assemblyman Phil Ting, a San Francisco Democrat who leads the budget committee. Assembly Democrats also want to expand a tax credit for the working poor, boost preschool and child care, and increase college scholarships to reduce reliance on student loans.They also would commit $3.2 billion more than required to state budget reserves.The proposal marks the Assembly's opening volley in six months of budget negotiations with the Senate and Democratic Gov. Jerry Brown, who has been reluctant to commit to new ongoing spending on social services.California has significantly reduced its rate of uninsured people since former President Barack Obama's health care law took effect, but about 7 percent of residents still lack coverage. Many are people living in the country illegally, who are ineligible for U.S.-funded health care assistance.While federal funds cover at least half — and as much 95 percent — of the cost for citizens and legal U.S. residents on Medi-Cal, the state would have to pick up the cost on its own for people living here illegally.Expanding access to health care has been a contentious issue for California lawmakers, who targeted last year by protests from liberal activists who want the Legislature to provide state-funded coverage to everyone, regardless of immigration status.A measure promoting that principle was sidelined when Assembly Speaker Anthony Rendon said it lacked specifics, including a plan for the $400 billion it would cost.The Assembly's latest proposal is narrower, only extending the state Medicaid program to all low-income adults.Brown, who is often more conservative in his own revenue forecast, will release his budget proposal next month.H.D. Palmer, spokesman for the Department of Finance, said Brown wants to boost state reserves and avoid committing to unsustainable spending.'We want to be able to provide as much budgetary protection as we can to protect or insulate the state from the potential effects of a downturn in the state's fiscal fortunes,' Palmer said.Ting, the head of the Assembly budget committee, said lawmakers were exploring ways to restructure the state tax code if Congress approves a proposed U.S. tax overhaul. California leaders have warned that the measure could harm taxpayers by restricting a federal deduction for state and local taxes, which is especially lucrative in high-tax states like California.'I'm very concerned that this tax cut is a tax increase for middle-class and working-class Californians,' Ting said. 'So we are looking at ways that we can help mitigate that.
  • Italy's Senate gave final approval Thursday to a law allowing Italians to write living wills and refuse artificial nutrition and hydration, the latest step in the Roman Catholic nation's long-running and agonizing debate over euthanasia and end-of-life issues.As soon as the 180-71 vote was tabulated, cheers erupted outside parliament among a small group of right-to-die activists who saw the bill as a victory after several high-profile euthanasia cases prompted criminal prosecutions.'Of course, we are still missing the legalization of euthanasia that we'll propose to the next parliament,' said spokesman Marco Cappato of the right-to-die movement.Cappato is currently on trial in Milan for having helped bring Fabbio Antoniani, a well-known Italian disc jockey known professionally as DJ Fabo, to Switzerland earlier this year to die in an assisted suicide clinic. Antoniani was left paralyzed, blind and unable to breathe on his own after a 2014 car accident.A day before the Senate passed the bill, the Milan courtroom heard Antoniani's pre-recorded anguished testimony of how he couldn't bear to live another day, comments that reportedly brought even the prosecutor to tears.The law's passage Thursday comes as the Vatican itself has taken up end-of-life issues anew. A series of conferences have emphasized the need for palliative care and reinforced Catholic doctrine, which requires only 'ordinary' care be provided to the dying, not 'extraordinary' care that extends life at all costs.In a November speech taken by Italians as an endorsement of the pending legislation, Pope Francis repeated the church's opposition to euthanasia but also rejected the 'therapeutic obstinacy' sometimes practiced by doctors even when the benefits of heroic therapies for patients are debatable, negligible or non-existent.While church teaching considers artificial nutrition and hydration to fall under the 'ordinary care' that must be provided to the dying, the parliamentary debate over the living will and its provision that Italians could refuse food and water generated relatively little Catholic opposition.The absence of unified Catholic criticism was notable, given the Vatican had previously been vocal in criticizing cases of assisted suicide — most significantly when the Italian church refused to give a Catholic funeral to Piergiorgio Welby, a poet whose 2006 assisted suicide helped galvanize the right-do-die movement in Italy.There was, however, opposition. Lawmakers from the center-right Forza Italia party voted against the bill, with Sen. Maurizio Gasparri saying it essentially introduced euthanasia into Italy.Proponents said the bill merely entitled Italians to determine their own end-of-life care.