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Posts Tagged ‘Flint water crisis

Science Policy Around the Web – April 13, 2018

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By: Maryam Zaringhalam, Ph.D.

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Public Health

Flint school children to be screened for effects of lead after agreement

April 25th will mark four years since Flint, Michigan had clean drinking water. In that time, the water has been contaminated with lead at levels above hazardous waste and with pathogens like Legionnaires’, which resulted in an outbreak that left 12 dead. The mishandling of Flint’s water crisis has resulted in a number of lawsuits and several felony convictions, with charges ranging from conspiracy to involuntary manslaughter.

Most recently, a judge approved a $4 million legal agreement on Thursday to screen children for exposure to lead poisoning and evaluate their cognitive development, memory, and learning. The lawsuit was first filed in 2016 by a coalition of local and national groups sued the Michigan Department of Education and school districts in Flint. Exposure to lead — a neurotoxin — during childhood can have long-term adverse health effects on cognitive and physical development. As a result, children exposed to lead may require special education services. The results of these evaluations, which will begin in September, will be used to better provide services to the children affected by lead exposure. Dr. Mona Hanna-Attisha, director of the Michigan State University-Hurley Children’s Hospital Pediatric Health Initiative and an early advocate for the Flint community, will oversee the program. The lawsuit will continue in Michigan federal court to increase special education services and reforms with representation by the ACLU of Michigan.

The Flint water crisis began in 2014 when the city switched its water supply from Lake Huron to the Flint River, which had long been polluted by industrial byproducts. Flint residents immediately reported poor-tasting water, however, their complaints were ignored by government officials despite robust community advocacy efforts. Finally, in September 2015 scientists at Virginia Tech published an extensive report (made possible by collaboration with members of the Flint community) documenting dangerous levels of lead in Flint residences, followed by a report from the Environmental Protection Agency (EPA). Pollution in the river had created a fertile breeding ground for bacteria, so the river was treated with chlorine, making the water acidic, in turn leaching lead from Flint residents’ plumbing. The crisis could have been prevented if appropriate corrosion control measures were taken.

On April 6, Michigan Governor Rick Snyder announced Flint’s water is once again safe for drinking, terminating the free bottled water program designed to give Flint residents safe water as part of a $450 million state and federal aid package. Nevertheless, mistrust remains.

(Alex Dobuzinskis, Reuters)

Healthcare

Trump administration rewrites ACA insurance rules to give more power to states

After several unsuccessful Congressional attempts to repeal the Affordable Care Act (ACA) last year, the Trump administration has taken steps to roll back ACA regulations with 523 pages worth of new and revised rules. The new regulations will take effect for ACA health plans sold this fall for 2019 coverage.

Perhaps the most significant change comes from a new rule aimed at shrinking the authority of the individual mandate — the ACA provision that every individual must have healthcare or face a penalty. Individuals can seek exemption from that requirement through one of two broad channels. On Monday, April 9, the Centers for Medicare & Medicaid Services issued a final notice that individuals living in counties with only one or no ACA insurers qualify for a “hardship exemption” because the marketplace is not competitive in their region. Notably, in 2018, around half of US counties had only one or ACA insurers. Individuals opposing abortion can also qualify for exemption if their only ACA provider options cover abortion. In November, the Congressional Budget Office projected that a straight repeal of the individual mandate would increase premiums by ten percent; so even a partial effective repeal could lead to increased premiums for customers opting to stay on ACA plans.

The new rules also grant states much more authority and flexibility when determining whether healthcare plans meet ACA standards. The old ACA rules required insurers provide a standard set of ten essential health benefits to ensure customers had access to the same core set of benefits and allow them to comparison shop. Before, states were required to base these ten categories on the same benchmark plan within state borders. The rule has now been changed so that states can select different benchmark standards across state lines a la carte (i.e. a maternity care standard from New Jersey paired with a laboratory services standard from Arkansas).

CMS Administrator Seema Verma told reporters: “Ultimately the law needs congressional action to repeal.” But in the meantime, the above examples are only two of several changes that will reign in the ACA’s powers.

(Amy Goldstein, The Washington Post)

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April 13, 2018 at 4:02 pm

Science Policy Around the Web – November 17, 2017

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By: Janani Prabhakar, PhD 

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Public Health

The ‘Horrifying’ Consequence of Lead Poisoning

Changes in water treatment practices in Flint, Michigan in 2014 resulted in large levels of lead in the water supply, and eventually culminated to a state of emergency in January 2016. The supply affected over 10,000 residents, forcing these individuals to refrain from using the city’s water supply until 2020. Because state officials may have been aware of lead contamination in the water supply for months before it became public, these officials are now facing criminal charges. This negligence is particularly troubling given recent evidence that shows persisting effects of lead contamination on health outcomes in Flint residents. In a working paper by Daniel Grossman at West Virginia University and David Slusky at the University of Kansas, the authors compared fertility rates in Flint before and after the change in water treatment practices that led to the crisis, and compared post-change fertility rates in Flint to those of unaffected towns in Michigan. They found that the fertility rate declined by 12 percent and fetal death rate increased by 58 percent. These reductions in rate have been witnessed in other cities after similar incidents of lead contamination in the water supply. Furthermore, given that the number of children with lead-poisoned blood supply doubled after changes to the treatment practices, the long-term effects on cognitive, behavior, and social outcomes of this contamination are only beginning to be examined and understood. The circumstances in Flint are an example of how misplaced focus of high-level policy decisions can negatively impact local communities, particularly low-income black neighborhoods. Black neighborhoods are disproportionately affected by lead contamination, but the lack of sufficient attention as well as the false suggestion that effected individuals were to blame propagated by industry leaders and policy makers have deterred progress in addressing critical issues in at-risk and underserved communities.

(Olga Khazan, The Atlantic)

Climate Change

Why China Wants to Lead on Climate, but Clings to Coal (for Now)

In a country of 1.4 billion people, China is one of the world’s largest coal producers and carbon polluters. However, it aims to spearhead the international agreement to address climate change. Despite this contradiction, China is already on track to meet its commitment to the Paris climate accord. This move towards reducing its dependence on coal comes as a necessity to China because of internal pressure to curb air pollution. But, according to NRDC climate and energy policy director Alvin Lin, given its size and population, phasing out coal dependence will not only be a long process for China, but one that has lots of ups and downs. For instance, while China has shown progress in meeting its commitments, a recent report shows higher emission projections this year may reflect an uptick in economic growth and reduction in rains needed to power hydroelectric technologies. While Lin portrays this uptick as an anomaly, competing interests in the Chinese government make the future unclear. In efforts to increase its presence abroad, China has built coal plants in other countries. But, China is also the largest producer of electric cars. President Xi Jinping has derided the United States for being isolationist and reneging on the Paris climate accord, but how his Government plans to hold its end of the deal has not been revealed. An important revelation is the fact that even if every country achieves their individual Paris pledges, the planet will still heat up by 3 degrees Celsius or more. Given that this increase is large enough to have catastrophic effects on the climate, adherence to Paris pledges serves only as a baseline for what is necessary and sufficient to combat global warming.

(Somini Sengupta, The New York Times)

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November 17, 2017 at 4:51 pm

Science Policy Around the Web – December 23, 2016

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By: Joel Adu-Brimpong, BS

Source: Flickr, by Ben Gordon, under Creative Commons

Public Health

Looking Beyond Flint

All eyes turned to the city of Flint, Michigan as it burst onto the national scene after reports revealed that children were being exposed to dangerously high levels of lead in their drinking waters. Although shocking, a recent study shows that the Flint narrative is no abnormality. “In fact, it doesn’t even rank among the most dangerous lead hotspots in America,” states Reuters, an international news agency and investigative body that conducted the study.

In this Reuters report, it was discovered that almost 3000 areas in the country had at least twice the lead poisoning rates of the infamous Michigan city, with much less press coverage. In some areas, such as Baltimore, Cleveland and Philadelphia, areas with multigenerational lead poisoning, about 40 to 50 percent of children had elevated levels of lead. Nationwide estimates by the Centers for Disease Control and Prevention (CDC) purport that approximately 2.5 percent of small children, children between ages one and five, present highest levels.

For this study, Reuters obtained lead poisoning data from state health departments and the CDC. But rather than peruse and detail state or county-level data, Reuters pursued more granular results; testing for lead poisoning at the neighborhood-level. Altogether, Reuters observed 2,606 census tracts, or small county subdivisions, and 278 zip codes across the country with at least twice the prevalence rate of lead poisoning as Flint. It was noted that while poverty remains an integral predictor of lead poisoning, victims span the American tapestry of rich and poor, urban and rural and black and white.

Federal aid to assist states in lead poisoning management is quite limited. After the Flint debacle, Congress delivered $170 million in aid to Flint. However, the budget allocated to the CDC to assist states in lead poisoning control is only a fraction of the Flint package. With the 21st Century Cures Act set to withdraw approximately 3.5 billion from the Prevention and Public Health Fund, a fund established under Obamacare, and a pervasive political rhetoric regarding the repeal of Obamacare, lead poisoning may return to its obscure position in the public sphere. (M.B. Pell and Joshua Schneyer, Reuters)

Drug Policy

When Drug Prices Rise, Americans Turn Outward?

A recent study revealed that 70 percent of Americans take at least one prescription drug a day. And if you are among this group, or care for someone on medication, you are most likely aware that drug prices have been rising. In fact, a 2015 poll by the Kaiser Family Foundation (KFF) found that roughly 80 percent of Americans deemed costs of prescription drugs ‘unreasonable.’ A report by the IMS Institute for Healthcare Informatics earlier this year indicated that, after accounting for estimated reimbursements, net medication spending for the 2015 year was roughly $310 billion. So what happens when drug prices exceed affordability in the U.S.?

A poll by KFF last month found eight percent of survey respondents, or roughly 19 million adults in the U.S., had or knew someone in their household who had imported a drug at some point. Drug prices when obtained outside the country (i.e., Canada, Mexico, etc.) may be half the sticker price in the U.S., or even cheaper. This finding comes on the heels of recent spikes in prescription drug prices such as that of Daraprim, a life-saving drug often prescribed for AIDS patients, Cycloserine, a drug used to treat tuberculosis, Epipen, an injection device for patients with severe allergies, and others which have caused national outrage.

Although illegal for Americans, in most instances, to import drugs into the U.S. for personal use due to safety and effectiveness concerns, experts contend that eight percent is a conservative number. Some respondents may be reluctant to report violations of the law or are uncomfortable with talking about daily struggles with drug affordability. Demographics of individuals who imported prescription drugs ranged from young adults in college to elderly retirees, with prescription drugs imported spanning treatments for chronic and acute conditions.

Earlier this week, Senate Democrats sent a letter to Donald Trump urging the President-elect to effect bipartisan support to curb rising drug prices. But with no assurances in sight to curtail the epidemic of rising drug costs, will even more Americans turn outward in order to meet their prescription needs? If so, how might this affect the quality of circulating drugs and medication adherence practices? (Rachel Bluth, Kaiser Health News)

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December 23, 2016 at 9:00 am

Science Policy Around the Web – February 9, 2016

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By: Cheryl Jacobs Smith, Ph.D.

Photo credit: Contains LEAD via photopin (license)

Health Policy

What the Science Says About Long-Term Damage From Lead

Almost two years since the city of Flint, MI switched from Detroit water to their local water supply, the citizens are finally being listened to in regards to their drinking water. Time and time again, citizens and researchers were ignored when they tried to alert local officials to their poor water quality conditions. Finally, Flint residents and researchers were able to get the message out: not only is their local water undrinkable, it is contaminated with lead.

Lead intoxication or lead poisoning does not necessarily lead to seizures, hospitalizations or medical events. However, health care professionals are still alarmed because lead levels in children reached 5 micrograms per deciliter (5 ug/dL). The percentage of children in Flint, MI under the age of 5 with lead levels that high have now since doubled (2.4 percent to 4.9 percent). Furthermore, in areas with the highest levels of lead, more than 10 percent of children have lead levels that are at least that high.

The most worrisome statistics are the long-term and lasting effects due to lead poisoning. A study published in Pediatrics examining more than 3,400 children in Rhode Island identified that children with blood lead levels between 5 to 9 micrograms per deciliter (5-9 ug/dL) fell below reading readiness for kindergarten. Additional studies examining lead levels and child development also report increase likelihood to engage in risky behaviors such as smoking or drinking at an early age.

Now that attention is centered on Flint, MI and its trouble with lead in the water, focus needs to turn to mitigating any long-term damage children and adults may have as a result of lead poisoning. Historically, lead has been used ubiquitously in manufacturing. Not only used for pipes, lead has been an additive in gasoline, in paint and has also accumulated in soil. We should take a lesson from Flint and analyze the state of lead poisoning in our own communities. As Aaron E. Carrol comments, “Until we solve the lead problem for good, we may be condemning children to a lifetime of problems.” (Aaron E. Carroll, The New York Times)

Public Health and Infectious Disease

Governor, health officials sued over Ebola quarantines

During the Ebola epidemic in 2014, several people coming back to the United States from West Africa were quarantined: meaning they could not return back to their normal lives for at least 20 days. For several of these people, they felt the quarantine was akin to imprisonment and now have filed a lawsuit.

The lawsuit was filed by Yale Law School students against Connecticut Governor Dannel P. Malloy and state health officials on behalf of ex-quarantined plaintiffs or those plaintiffs still in West Africa. The plaintiffs who were quarantined claim that they had no Ebola symptoms that warranted their isolation upon their return. The lawsuit seeks monetary damages and an order preventing any future quarantines. Plantiffs say, “Being quarantined made me feel like a criminal.” “There was no scientific reason to confine me to my apartment, with no visitors and a police officer parked outside my door.”

Like other governors of New York or New Jersey who issued quarantines to health workers returning from areas in Africa endemic with Ebola, Governor Malloy adopted the same stringent policies. Not only did health care workers feel undue prejudice or discrimination as a result of traveling to West Africa, but so did Liberians living in Connecticut. It will be interesting to see what the court rules.   (Dave Collins, The Washington Post)

Drug Policy

Cancer drug’s usefulness against Alzheimer’s disputed

A study described in the top biomedical journal, Science, in 2012 observed that bexarotene, an FDA-approved cancer drug, was able to clear a protein, A-beta, from the brains of mice. This reduced plaque formation and smaller forms of the protein which in essence reduced the pathology of Alzheimer’s disease which is known to accumulate proteins that form plaques in the brain that reduce brain function. Excitingly, the mice treated with bexarotene showed signs of improved learning and memory—a reversal of Alzheimer’s symptoms. However, a year after their work appeared, four reports, also in, Science, disputed some of those findings.

In tests on rats, Amgen, a pharmaceutical company, found that bexarotene didn’t drop levels of plaques or smaller forms of the protein, A-beta. The author of the original Science paper, Dr. Landreth, argued that the present study did not use a formulation of the drug that would persist at high enough levels in the brain to be useful.

“Larger trials would be more informative”, says Landreth, who stands by his group’s original findings. “When we published our Science paper, it took us five years and we did the best science we could,” Landreth says. “And I am convinced that we are right.” (Laura Sanders, Science News)

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February 9, 2016 at 9:00 am

Science Policy Around the Web – February 2, 2016

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By: Agila Somasundaram, Ph.D.

Map representing scientific collaborations from 2005 to 2009 using data from Scopus. International cooperation. Credit: Computed by Olivier H. Beauchesne and Scimago Lab

Science Policy on a Global Scale

Global science engagement

The American Association for the Advancement of Science (AAAS) will have its annual meeting in Washington DC, from 11 to 15 February 2016. World leaders in science and policy will discuss major challenges, such as food security and health, facing the global community. Dr. Geraldine Richmond, President of the AAAS, says that nations need to employ ingenious ways to find solutions to the ever-increasing demands for food, energy, water, and a healthy environment, which are complex and interconnected problems. Dr. Richmond emphasizes the importance of international research partnerships and innovative approaches that assimilate perspectives and lessons from all over the world, including the developing countries. Such ‘Global Science Engagement’ will be the focus of this year’s AAAS meeting. Dr. Richmond cautions that isolationist views that undervalue international initiatives are unwise. For example, the United States spends billions of dollars providing clean drinking water to its people, but 90 percent of that water is flushed down the drain. Valuable lessons could be learnt from countries such as Namibia where recycled water has been consumed since 1969 with no adverse health consequences. Diversity in opinions, ideas, and experiences is essential to furthering creativity and innovation that is required to solve complex global problems. But scientists in developing countries face difficulties connecting with their peers in more advanced nations, for e.g. due to limited journal access, and people in the United States who are interested in global engagement have limited ways to do so. While commending the efforts of AAAS and other scientific societies in facilitating international engagements, Dr. Richmond calls for more efforts and commitment to strengthen such collaborations. (Geraldine Richmond, Science)

Zika Virus

New Weapon to Fight Zika: The Mosquito

The Zika virus is rapidly spreading in the Americas, and has been linked to a severe defect in brain development, microcephaly, in babies. The Zika virus is spread by mosquitoes, mainly the Aedes aegypti species, which also transmits deadly infections such as chikungunya, yellow fever and dengue fever. Efforts to develop vaccines against the virus are underway, but it may take many years, even a decade, before an effective vaccine can be given to the public. Experts argue that new methods are needed since the traditional ones, involving insecticides and reducing stagnant water to prevent mosquito breeding, aren’t enough.

The British company Oxitec has developed genetically engineered mosquitoes that transmit a lethal gene to their progeny, which die before reaching adulthood. These engineered mosquitoes have been successfully used to lower mosquito populations by more than 80 percent in certain parts of Brazil. Oxitec says this is an ecologically friendly approach because only one species is targeted, as opposed to chemical spraying that affects many organisms. But the release of genetically modified organisms into the environment has met with opposition. Another approach is to infect the mosquitoes with the bacterium Wolbachia, which makes it harder for the mosquitoes to transmit viruses. The bacteria can be passed through eggs, making this a self-sustaining method. Initial results in Brazil appear promising, encouraging trials on a larger scale. A third powerful approach is the use of gene-drives. Gene-drives allow for the propagation of a desired trait, for e.g. sterility, through a wild population. Though gene-drives have been tested in laboratory scales, it might be not so easy to deploy it in public yet, mainly because of concerns that it would be very difficult to reverse things if something undesirable happens.

Remarking on the three approaches, Dr. Peterson, Centers for Disease Control and Prevention, said, “We don’t know about the efficacy of any of them on a wide enough scale… For now, we’ve got to deal with what we have.” Experts say that the traditional methods of mosquito control need to be intensified, till we have proven the large-scale efficacies of the new approaches and/or developed an effective vaccine. (Andrew Pollack, The New York Times)

Scientific Integrity

How cases like Flint destroy public trust in science

While the Flint water crisis is being investigated, disturbing reports emerge about how studies that showed a problem in Flint’s drinking water were dismissed. In Fall 2015, a team of researchers in Virginia Tech, led by Dr. March Edwards, examined the lead content of drinking water in Flint homes. The study revealed that the 90th percentile reading was 27 parts per billion. The Environmental Protection Agency considers 5 parts per billion a cause for concern, and 15 parts per billion as the limit above which the problem should be fixed. However, tests conducted by the city showed lead levels within safe limits. The Michigan Department of Environmental Quality responded saying that the state was perplexed by the study results, but not surprised, given that Dr. Edwards’ “group specializes in looking for high lead problems.” According to reports, the city’s water testing results had been “revised by the Michigan Department of Environmental Quality to wrongly indicate the water was safe to drink.” The state officials attempted “to use power instead of logic and scientific reasoning to defend and hide their actions,” says Dr. Edwards. Similarly, studies done by Dr. Mona Hanna-Attisha, pediatrics program director at Michigan’s Hurley Medical Center, were also initially criticized. Her study showed that the percent of children with elevated blood lead levels doubled, or tripled in some areas, after the change in water source. When the state later analyzed its data using the same approach as Dr. Hanna-Attisha, the results matched.

Dr. Naomi Oreskes, science historian at Harvard University, says that though these events may not classify as “science denials,” they constitute a less-defined category of “no one likes bad news.” “Why didn’t government officials take it seriously when scientists tried to raise an alarm?” she asks. When government officials responsible for people’s safety commit acts like these, it crushes the public’s faith in science, and exacerbates problems such as denial of climate change or the safety of vaccination. How do we prevent problems like Flint from reoccurring? The answer is not clear yet, but some suggestions include conducting better checks and balances by independent researchers not affiliated with the government, and not overlooking the role of universities in protecting public welfare. According to Dr. Aron Sousa, the work by Edwards and Hanna-Attisha should reinforce the public’s faith in good science. (Chelsea Harvey, The Washington Post)

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February 2, 2016 at 9:00 am