States call for tougher E cigarette regulation

Calls for E cigarette Regulation Intensifies

Tougher e cigarette regulation needed

Tougher e cigarette regulation needed

I applaud the efforts of more than two dozen state attorneys efforts to have the FDA impose tougher restrictions on e-cigarettes, outlined in the August 9, 2014 Wall Street Journal article, “States Urge Tougher Curbs on E-cigarettes.”

The 33 page letter sent to the Federal Drug Administration (FDA)  last week was submitted by the group representing 29 states and proposed tougher restrictions on matters such as, marketing of e-cigarettes, characterization of flavors and sale of tobacco products (including e-cigarettes) over the Internet. These restrictions are tougher than those proposed by the FDA in April of this year.

Also, over the past two weeks, several members of Congress also sent a letter to the FDA calling for restrictions on marketing to children, flavored e-cigarettes and online sales. Numerous other groups, including the AMA, have called for greater restrictions prior to the recent end of the FDA public comment period on the e-cigarette restrictions proposed in April.

However, e-cigarette proponents, including tobacco companies, are also bombarding the FDA to stop them from adding restrictions, claiming — erroneously — that e-cigarettes have health benefits (for example, help with smoking cessation).

While the FDA proposed restrictions in April are a first step toward regulation of the burgeoning e-cigarette industry, we need to keep the pedal to the metal on this issue to pressure the legislature and the FDA to implement greater restrictions on e-cigarettes as a matter important to public health and safety. We need to have our voice heard over the intense clout of the e-cigarette industry.

 

Information about E-cigarettes (and AMA Council on Science and Public Health) can also be found at scienceandyourhealth.com

Houston Facial Plastic Surgeon, Russell Kridel, MD, is currently a member of the AMA Board of Trustees and the immediate past chair of the AMA Council on Science and Public Health.

Any views expressed on this blog should be considered personal views of Dr. Kridel and are not official statements of AMA policy (which is set by the AMA House of Delegates) nor are they official descriptions of actions of the AMA Board of Trustees.

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E cigarette health concerns are serious

Significant E cigarette health concerns

E cigarette health concerns are serious

E cigarette health concerns are serious

There is virtually no scientific evidence that E-cigarette use is safe and harmless.  On the contrary. The March, 2014 article in the New York Times, Selling a Poison by the Barrel”, highlighted the fact that the “e-liquids” used as the key ingredient in e-cigarettes is a powerful neurotoxin.  This liquid is nicotine in its potent, liquid form and it is easy to obtain with virtually no restrictions. Tiny amounts, such as a teaspoon, of even highly diluted e-liquid can kill a small child.  And the fact that this liquid can be flavored and colored raises many alarms about the use and abuse of the substance by children. E-cigarette use among high school students in the U.S. more than doubled from 4.7% in 2011 to 10% in 2012, according to the Centers for Disease Control and Prevention’s National Youth Tobacco Survey.  At least 160,000 students who never tried traditional cigarettes, used e-cigarettes.

Wild Wild West

Unlike nicotine gums and patches, e-cigarettes, as well as their ingredients, are NOT regulated. The Food and Drug Administration has yet to impose rules on e-liquids’ sale. Without regulations, it continues to be the Wild West for e-cigarette companies.  They continue to roll out more brands in many different varieties and flavors and advertise heavily on high profile television shows, like the Super Bowl.

Buyer Beware

As early as 2010 the AMA Council on Science and Public Health (CSAPH) recognized the hazards of E-cigarettes to public health and recommended the following:

  • E-cigarettes be classified as (nicotine) drug delivery devices and should be subject to FDA 49 regulation with appropriate standards for identity, strength, purity, packaging, and labeling with instructions and contraindications for use, including age of the user.
  • State legislatures prohibit the sales of e-cigarettes and all other nicotine devices that are not FDA-approved
  • As currently marketed, e-cigarettes be included in smokefree laws but separately from defined from tobacco products

E-cigarette Regulation is needed — now!

American Medical Association (AMA) has taken an even more aggressive stance recently.  In June, 2014 the AMA made the following recommendations in regard to E-cigarette regulation:

  • Minimum purchase age restrictions
  • Disclosures regarding the design, content and emissions;
  • Child-proof and tamper-proof packaging and design;
  • Enhanced product labeling;
  • Restrictions related to flavors that appeal to minors; and
  • Prohibition of unsupported marketing claims as a tobacco cessation tool.
  • Further development of strategies to prevent marketing of electronic cigarettes and nicotine delivery systems to minors and stem the negative health effects of nicotine on minors.

As the debate rages on, big tobacco investors are buying up e-cigarette companies. The are now more than 100 e-cigarette companies jockeying for market share of both smokers and non-smokers.  As stated in the May, 2014 article published in Scientific American, Smoke Screen: Are E-cigarettes safe?” — the success of all these companies rests on the claim that e-cigarettes are healthier than traditional cigarettes. And, that simply has not been proven.

Something has to be done now, before the ship has sailed too far down what is now an open channel.  The government needs to pass legislation regarding the sale and consumption of e-cigarettes.  And, the FDA needs to step in and put regulations into place to protect the safety of public health including imposing rules on the sale of e-liquid.

Information about CSAPH and E-cigarettes can also be found at scienceandyourhealth.com

Houston Facial Plastic Surgeon, Russell Kridel, MD, is currently a member of the AMA Board of Trustees and the immediate past chair of the AMA Council on Science and Public Health.

Any views expressed on this blog should be considered personal views of Dr. Kridel and are not official statements of AMA policy (which is set by the AMA House of Delegates) nor are they official descriptions of actions of the AMA Board of Trustees.

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Personal responsibility and healthcare

Personal Responsibility and Healthcare:  Behavior can make a big difference

Part of the cost control contemplated in the Affordable Care Act (ACA) is holding physicians accountable for cost and quality. But how can physicians be held accountable for non-compliant patients or patients who do not take responsibility for their own health? personal responsibility in healthcare Personal responsibility and healthcare costs are inextricably linked. It is estimated that more than half of our health care expenditures are for self-induced medical problems. Smoking, drug and alcohol addiction, lack of exercise, noncompliance with prescribed medical treatment plans, and lack of caution to prevent potential injuries, all add billions of dollars to medical costs yearly. Obesity alone has taken on epidemic proportions, with the United States spending $174 billion a year to treat diabetes, and at least $147 billion on health problems related to overweight and obesity. Tobacco still costs this nation more than $150 billion a year. 
According to the Centers for Disease Control and Prevention (CDC), nearly 75 percent of Americans report they do not always take their medications as directed; one in three never fill their prescriptions; and proper adherence approaches only 50 to 65 percent in patients with chronic conditions, such as diabetes and hypertension An article in the New England Journal of Medicine (NEJM) reported that poor medication adherence contributes significantly to medication-related hospital admissions in the United States, at an estimated cost of at least $100 billion annually. Lifestyle behaviors are difficult to change, and solutions to effect behavioral modification have been largely unsuccessful to date, despite huge community efforts and even legislation. Some patients have developed a sense of entitlement of care, taking no responsibility for abusing their health but expecting every conceivable means of treatment be used to cure them, no matter the expense. They, in turn, blame the health care delivery system for its high costs. This is unfortunate, since there likely would be more than enough money in our health care system to help patients with illnesses that could not be prevented if the rest of our population practiced healthy living. Other patients would like to change but need to be taught what to do. Others face economic and cultural obstacles that prevent wellness, which we must address. As physicians, no matter what our specialty, we do have a strong role to play in every one of our patient encounters, because if we don’t discuss healthy living with our patients, who will? Only the individualized approach will work along with peer and affinity group influence. We physicians alone cannot accomplish this. We need the collaborative effort of community, parents, schools, hospitals, insurance companies and businesses.

Houston Facial Plastic Surgeon, Russell Kridel, MD, is currently a member of the AMA Board of Trustees and the immediate past chair of the AMA Council on Science and Public Health.

Any views expressed on this blog should be considered personal views of Dr. Kridel and are not official statements of AMA policy (which is set by the AMA House of Delegates) nor are they official descriptions of actions of the AMA Board of Trustees.

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Taking The Wheel for The Future of Medicine

Physicians Taking The Wheel for The Future of Medicine

Physicians taking the wheel

As physicians we cannot view the future of medicine and the role we have to play by looking through the rear view mirror of yesterday. The view ahead belongs to those who face the fact of change, grab the wheel and move forward to shape it. And change is here, often obstructing our progress forward and causing many detours, which frustrates physicians as we try to provide the best care for our patients and advance science.

We used to be solely in the driver’s seat, helping our patients arrive at healthy destinations. But now, the person paying for the gas is no longer the patient, having been replaced by the government and third-party payers; they used to be just back seat drivers, annoyingly telling us where to make our turns. But more recently, they have made passengers of physicians; and they are behind the wheel. Unfortunately for patients and physicians alike, they don’t have a license and haven’t even had drivers’ education. Your leaders in organized medicine will be working harder than ever to put you back in the driver’s seat to lead the health care car safely in the right direction.

As leaders in medicine, we need to engage and work with all parties in our efforts to improve our healthcare system for the greater good. However, we cannot leave our patients’ destiny and that of medicine in the hands of others. Physicians may not be able to reform our health care system overnight, but we must prevent the health care system from destroying medicine. Remember that our patients look to physicians as trusted leaders for health care solutions, not to the government.

 

Russell Kridel MD is a Houston-based Facial Plastic & Reconstructive Surgeon in private practice in the Texas Medical Center. He is also currently the Chair of the AMA Council on Science and Public Health (CSAPH) which provides information and recommendations on medical, scientific, and public health issues which are published in their entirety here.

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Government red tape

Excessive Government Red Tape Gets in the Way of Delivering Quality Patient Care

Dr. Russell Kridel in DC to meet with members of Congress

Russ Kridel, MD goes up to capital hill to meet with members of Congress

This past year, fighting the burgeoning regulatory burdens and government red tape that contract the time physicians can spend with patients, was one of the top priorities of the Harris County Medical Society during my tenure as president.

We spent substantial time educating our U.S. Congressmen and Texas Legislators about the accumulation of compliance issues that are overwhelming physicians’ offices. They all seemed receptive, but Representatives Brady and Poe have particularly embraced our causes. The opening of health insurance marketplaces and all the new rules and regulations under the Affordable Care Act (ACA) have increased our challenges. Physicians are right in the center of the paths of multiple, colliding fronts in the form of more federal and state regulatory requirements. Physicians are caring for patients and managing the piles of paperwork that the government and other healthcare organizations and executives have created for them. Doctors are now consumed with checking boxes, implementing EMRs and transitioning to a new coding system for billing—all while seeing increasing patient loads and meeting increasingly steep clinical demands.

U.S. physicians commit about 20 percent of their time to administrative tasks and the number is growing. Wouldn’t that time be better spent delivering health care?

Russell Kridel MD is a Houston-based Facial Plastic & Reconstructive Surgeon in private practice in the Texas Medical Center. He is also currently the Chair of the AMA Council on Science and Public Health (CSAPH) which provides information and recommendations on medical, scientific, and public health issues which are published in their entirety here

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The Not Sustainable Sustainable Growth Rate (SGR)

SGR: The Not “Sustainable Growth Rate”

capital hill

In 1997, Congress created the Sustainable Growth Rate (SGR), a system that pegged the amount of money budgeted for Medicare payments to projected growth of the economy. However, in just a few short years, health-care costs far outpaced economic growth, which created a multi-billion dollar shortfall in funding for Medicare payments. Since 2003, Congress has approved “doc fix” bills that appropriate more money to Medicare funding in order to avoid cuts in the Medicare reimbursement rates for doctors. Recently, Congress passed a ‘doc fix’ bill for the 17th time in 11 years.  In essence, kicking the can down the road once again.

The Medicare Sustainable Growth Rate (SGR) payment system to physicians was never sustainable, never a growth rate and always unfairly discriminatory against physicians. How physicians have been able to keep their doors open to Medicare patients for so long while under a 13-year price freeze when practice expenses have skyrocketed is only answerable by the altruism and personal commitment that doctors have for their patients.

The problem going forward with Congressional compromise and wheeler-dealer arrangements in replacing the SGR is simply that future reimbursements may be based on compliance requirements and so-called quality measures that have unproven clinical relevance and may be more costly than helpful. It is laudable that when Congress passed the Medicare Act (Title XVIII) in the 1960s, the original language specifically said: “Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee.” It is distressing to see the absolute disregard of that principle as Congress and the Executive Branch take every opportunity to interpose themselves between the patient and the doctor. Those who have neither a license to practice medicine nor the education to deliver medical care seem to take pleasure in the erosion of physician autonomy and medical decisions, which should be based on the individual needs of the patient rather than on a bureaucratic practice or cost parameter.

While progress has been made in reaching a bipartisan agreement to repeal the Sustainable Growth Rate (SGR), Congress must continue to work to resolve outstanding issues.  Congress needs to treat physicians fairly and stop undervaluing our needed services to patients.  And we, as physicians, need to continue to fight, to be vocal and to take a leadership role in SGR reform.

Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.

Click here for additional comments on SGR and government red tape from one of Dr. Kridel’s HCMS president’s editorial.

 

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Shut Out Sugar Program Addresses Obesity

Shut Out Sugar Campaign On A Roll

Shut Out Sugar brochure

HCMS sponsored Shut Out Sugar brochure

Not only is excessive sugar in the diet dangerous to overall health, it contributes immensely to the obesity epidemic we now face and has led to the huge increase in Type II diabetes we see in younger ages.  Sugar sweetened beverages have been found to make up half of the increased sugar in our diet, and drinking one less sugar sweetened beverage a day, such as a cola, would dramatically improve our health. During my tenure as president of the Harris County Medical Society (HCMS) in 2013, one of my key initiatives  was to create the Personal Responsibility Committee.  This committee developed the Shut Out Sugar program, which included a brochure and website, to increase patients’ awareness of how sugar-sweetened drinks increase their risk of diseases, as well as adding to the waistline. The brochures have been distributed Inside Shut Out Sugar Brochureto physicians, schools and many government related agencies and non-profit groups helping to battle the obesity epidemic and is available through HCMS. HCMS was fortunate to receive grant funding from the Texas Medical Association Foundation to assist with the Shut Out Sugar campaign. I am so pleased to see physicians and other members of our community embrace the Shut Out Sugar campaign.  It is gaining some great momentum. Please check out the Shut Out Sugar educational video done by Dorothy Cohen Serna, MD and North Cypress Wellness posted on YouTube.  Feel free to share the YouTube video and Shut Out Sugar website links with your entire social media Shut Out Sugar Brochure Photocommunity.  The more people that get exposed to our message, the greater the positive impact on the health of the members of our community.

We need to drink more water and not supersize sweetened beverages!

— Russ Kridel, MD

Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.

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Affordable Care Act Flaws Revealed in Recent Study

 Affordable Care Act Flaws Unveiled in ACEP Study

Emergency Room

As reported in the Wall Street Journal today in a front section article titled, “ER Visits Rise Despite Law“, once again the Affordable Care Act (ACA) has not lived up to promises made prior to passage.

The April 21, 2014, WSJ article discussed the recently released email survey of 1,845 American College of Emergency Physicians (ACEP) members conducted in April, 2014 which stated over half of ER doctors say they are seeing more patients since key provisions of the ACA took effect on January 1 and 86% expect visits to rise over the next 3 years.

This is in contrast to the government’s argument to help sell passage of the ACA that ER visits would go down.  Supporters had predicted that expanding insurance coverage would reduce costly emergency room visits because people would go to primary care doctors and not emergency rooms, for medical concerns that could more efficiently be delivered in a doctor’s office or other setting, especially for patients who previously were uninsured.

Based on the ACEP survey and other articles, including an Oregon study published in January, 2014 in the journal, Science, clearly Obamacare has not fulfilled the promise that ER visits, and therefore costs, would be reduced.Affordable Care Act (ACA)

The online poll follows ACEP’s 2014 State-by-State Report Card released in January, 2014, which gave the nation a dismal D+ grade for its lack of support of emergency patients.  Forty percent of emergency physicians polled say their state policymakers are doing a poor job of addressing the issues raised in their state’s recent Report Card, which looked at the issues of Access to Emergency Care, Quality and Patient Safety, Medical Liability Environment, Public Health and Injury Prevention and Disaster Preparedness.

In a separate but related article in the April 21, 2014 issue of the LA Times, the Obama administration has quietly adjusted key provisions of the ACA healthcare law to potentially make billions of additional taxpayer dollars available to the insurance industry if companies providing coverage through the Affordable Care Act lose money. The move was buried in hundreds of pages of new regulations issued late last week. But, there is no provision to assist physicians and health care providers who are overburdened by regulations, red tape and paperwork taking care of all the additional patients thus, effecting quality care and the patient physician relationship.  It is time for Congress to take action to resolve the effects of the law’s impact, including the deleterious effect on emergency rooms.

Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.

 

 

 

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Texas Bluebonnet Award Given To Dr Kridel

Texas Bluebonnet Award Given to Dr Kridel For Contributions to Community Health

Dr Kridel given Texas Bluebonnet Award

Texas Bluebonnet Award Given to Dr Kridel

At a ceremony in Corpus Christi at the Omni Hotel on April 25th, the Texas Academy of Nutrition and Dietetics Foundation presented Dr. Russell Kridel with the prestigious Texas Bluebonnet Award.

Dr. Kridel received the award for his contributions to health care, including his efforts to reduce obesity throught the Shut Out Sugar campaign developed during his tenure as President of the Harris County Medical Society.

Dr. Kridel created the HCMS Personal Responsibility Committee dedicated to helping address the obesity epidemic. The committee provides physicians across all specialties with tools to communicate the importance of diet and nutrition to their patients to prevent obesity, diabetes and other diseases, with emphasis on sugar sweetened beverages. Through Dr. Kridel’s leadership, the committee developed a brochure called “Shut Out Sugar” for physicians and health providers.  The brochure clearly outlines simple and easy steps people can take to reduce consumption of sugar-sweetened beverages to improve their health. He also participates in key roles at the state and national level on health care issues that positively promote the role of diet and nutrition in the ever-changing landscape of health care.

TX Academy of Nutrition and Dietetics

Texas Academy President, Carol Bradley, PhD, RDN, LD presented the Texas Bluebonnet Award to Dr. Kridel along with Jennifer Cash, MS, RDN, LD, the Texas Academy Nominating Chair.

Dr. Kridel also received the local Houston Academy of Nutrition and Dietetics Foundation Bluebonnet Award in 2013.

Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.

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Government Regulatory Madness: ICD-10 Transition

ICD-10 Transition is just one example of Government Regulatory Madness

Also looming over physicians’ heads is the transition of our diagnosis coding from ICD-9 (13,000 codes) to ICD-10 (68,000 codes) or face payment disruption in government and commercial payments.

ICD-9 to ICD-10 transition

Some of these codes are quite absurd  — but, the real issue is how is this ICD-10 transition making us better physicians and increasing access to care? The transition will be costly in upgrading systems and substantial physician and staff training. In February, 2014 the AMA published a report updating cost data for physicians to comply with ICD-10. The study updates costs from an earlier study done in 2008. The report showed new cost estimates for the ICD-10 transition that range from $56,639 to $226,105 for small practices; $213,364 to $824,735 for medium-sized practices; and about $2 million to more than $8 million for large practices. The new estimates include the costs associated with purchasing new software in order to accommodate the new codes.  Needless to say, these costs can be debilitating to a practice to the point of placing practice viability in danger. In addition, the focus on implementation of this ill-thought out mandate also places what should be most paramount — the patient physician relationship — in peril.

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014.  The primary focus of the law is to provide a temporary patch to the Sustainable Growth Rate (SGR) for physician payment.  However, Section 212 of the new law establishes a delay for the implementation of ICD-10.  The language states that the Secretary of Health and Human Services (HHS) may not adopt the ICD-10 code sets prior to October 1, 2015 rather than the previous effective date of October 1, 2014.

The AMA spoke out against the proposed legislation before it was passed due to its opposition to a temporary fix for the SGR. Dr. Hoven, AMA President, stated, “The AMA and other physician organizations strongly agree that while a delay in ICD-10 implementation provides welcomed temporary relief, it does not offset the continued harm caused by keeping the SGR formula on life support and further delaying badly needed Medicare physician payment reforms. The AMA remains committed to relieving physicians of the crushing administrative burdens and practice disruptions that are anticipated during the scheduled transition to ICD-10.”

Physicians cannot leave our patients’ destiny and that of medicine in the hands of those who have neither a license to practice nor the education to deliver medical care. Physicians may not be able to reform our health care system overnight, but we must prevent the health care system from destroying medicine. Remember that our patients look to physicians as trusted leaders for health care solutions, not to the government.  

 

Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.

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