Capital News Service

of the Michigan State University School of Journalism

Push on to cut diesel exhaust

Capital News Service

LANSING — Its smell is suffocating. It makes eyes water and throats itch.

Breathing diesel exhaust is unhealthy, and it does more harm than simply irritate organs.

According to a new study, it is increasing the risk of cancer at an alarming rate, and the Michigan Diesel-Clean Up Campaign wants the state to do something about it.

“There are few things that we can instantaneously clean up when it comes to the environment,” said Susan Harley, policy director of Michigan Clean Water Action, the parent group of the Diesel Clean-Up Campaign.

She said that diesel exhaust is a serious problem with a relatively easy fix. Her group is pushing to get control technologies, like filters, required on all diesel engines and to limit the amount of time diesel vehicles can idle.

Since the economy is the biggest obstacle to new diesel regulations, Harley said her organization is pressing for policies that are feasible in the current economic climate. Requiring filters on diesel engines is expensive, so this year the Clean-Up Campaign is focusing on idling restrictions.

Harley said that more than half of the states have local or statewide limits on engine idling time. She said that there has been momentum behind legislation that would most likely set a 5 minute-per-hour limit.

“This is a very lost-cost thing that we could move forward and still see really great reductions,” she said.

Harley said her organization is working with several lawmakers to get this legislation introduced in the coming weeks.

Last year, however, a similar bill died in committee.

Walter Heinritzi, executive director of the Michigan Trucking Association, said he does not comment on legislation until it has been introduced. He said that his organization did not oppose similar legislation last year, but that there were concerns with the language involving alternative power units, or substitute power sources, for idling engines.

If the proposal becomes law, the number of premature deaths and asthma attacks in the state wouldn’t decrease as fast as they would if more dramatic changes were enacted, Harley said.

According to the Clean-up Campaign, 443 people died prematurely due to diesel exhaust in 2010, 648 suffered nonfatal heart attacks and 15,004 suffered asthma attacks.

Cancer risk is also a major health threat posed by diesel fumes, according to the Clean Air Task Force (CATF).

Nationwide, the average lifetime cancer risk from diesel exhaust exposure is 159 times greater than the Environmental Protection Agency’s acceptable level, according to the task force, a national group that advocates reducing air pollutants.

The task force also found the risk to be more than three times greater than the risk of all types of toxins tracked by the EPA combined.

CATF estimated the cancer risk with data from the EPA’s most recent National Air Toxics Assessment and a cancer risk factor developed by the California Air Resources Board.

Harley said some people don’t understand the full implications that diesel exhaust has for their health.

“Instinctively you look at a truck that’s billowing black smoke and you think that can’t be good for me, but you don’t always think that’s raising my cancer risk by an unacceptable level. If I have asthma or if I have some other cardiovascular issue, it’s really putting me at risk of death,” she said.

According to the Diesel Clean-Up Campaign, diesel contains carcinogens such as benzene, formaldehyde and acetaldehyde.

Shelly Kiser, advocacy director for the American Lung Association in Michigan, said that while the carcinogens in diesel exhaust are harmful, particulate pollution from burning diesel is one of the most dangerous air pollutants.

Particulate matter, or very tiny particles, can easily invade the body and get deep into the lungs and cause serious damage, Kiser said. Often those particles carry other toxins from the exhaust, according to the Clean-Up Campaign.

“There are so many people that are in the groups that are immediately affected by particulate matter. If you consider everyone in Michigan that is elderly, that is young, that has lung disease or heart disease — that’s a huge amount of people,

“It’s not something that they have to be exposed to for an extended amount of time, like with cancer. Particulate matter immediately impacts people and causes hospitalization and death,” she said.

© 2011, Capital News Service, Michigan State University School of Journalism. Not to be reproduced without permission.


Filed under: Health Care

Counties confront rising prescription costs


Capital News Service

LANSING – The bill for for prescription drugs for jail inmates has increased in the past year.

Counties are paying more for prescriptions despite efforts to reduce costs, experts say.

Terrence Jungel, the executive director of the Michigan Sheriffs’ Association, said jails negotiate with health care providers to lower costs when buying in bulk.

He said health care costs are hard to quantify because jails can get reimbursed and contracting with outside medical facilities can save millions of county dollars.

Mark Sabin, Montcalm County jail administrator, said about 30 of 205 inmates take medication for everything from diabetes to mental illness to multiple sclerosis.

To save costs, 85 percent of medications are generic.

Sabin said starting April 4, Montcalm will contract with Independent Health Services, a corrections medication management company in Rainsville, Ala., to cut Montcalm’s pharmaceutical budget by 35 to 50 percent.

Ben Bodkin, legislative director of the Michigan Association of Counties, said many state felons are held in county jails if their sentence is 24 months or less.  Counties pay for their medical bills including prescription drugs.

Bodkin said as soon as someone is incarcerated in a county jail, Medicare and Medicaid benefits stop and health care bills are sent to the county.

When an inmate is released, there’s a period when they are still not back on Medicare or Medicaid, so counties may pay for prescriptions for 30, 60 or even 90 days, Bodkin said.

Bodkin said he would like coverage to pause instead of completely stop. That way when an inmate is released, the coverage resumes.

Eric Lambert, the Wayne State University criminal justice department chair, said the government is responsible for prisoners’ reasonable medical care, including prescription drugs that can cost up to hundreds of dollars per dose.

And counties end up paying for inmates’ medical costs.

Lambert said, “The expenses for health care keep increasing, which should come as no shock for why jails and prisons have to spend more of their budget on health care.”

Lambert said some jails have released well-behaved, nonviolent inmates to community supervision – probation or out-of-jail housing—so medical care can be paid for by Medicaid or Medicare and not counties.

“For example, an 83 year-old being charged with a crime had a heart attack while in jail and needed surgery. The jail paid for his surgery, but after surgery they put him under house arrest so the sheriff’s department would not pick up further costs,” Lambert said.

Costs are rising for prescription drugs faster than the inflation rate for their jail services, Lambert said.

On the flip side, there are many ways jails are cost-efficient, he said.

To avoid expensive emergency care, routine checkups are done for prevention.

For example if someone’s heart isn’t beating properly, he or she is put on medicine to prevent a heart attack, Lambert said.

© 2011, Capital News Service, Michigan State University School of Journalism. Not to be reproduced without permission.


Filed under: Health Care

Doctors advocate less invasive ways to diagnose breast cancer

Capital News Service

LANSING – Surgically removing a lump in the breast may seem like the best first course of action when it’s detected but it isn’t always necessary, new research shows.

A national study by doctors from University of Florida, Gainesville, indicates that the rate of open surgery biopsies – surgically removing lumps – remains higher than appropriate despite many advantages associated with less surgically aggressive procedures.

But that may not be the picture in Michigan.

“Needle biopsies dominate in major medical institutions in Michigan,” said Vincent Cimmino, professor of surgery at the University of Michigan Health System in Ann Arbor.

Cimmino said that minimally invasive procedures are the  widely accepted standards of practice in larger hospitals in the state.

“Even when a lump that cannot be detected by routine examination is found during mammography, the general practice is to use X-rays to identify and lead to the lesion, using a thin hollow needle and a wire to extract tissue samples for diagnosis,” he said.

But certain situations call for open surgery.

When a lump is detected near the chest wall or around the nipples, surgeons follow medical guidelines that require open surgery biopsies, Cimmino said.

E. J. Siegl, a senior nurse consultant with the  state’s Breast and Cervical Cancer Control Program, has been involved with breast cancer management for several years.

“We’re seeing a trend moving toward minimally invasive procedures,” she said.  “Most of our surgeons are recommending needle biopsies as the first step towards cancer management.”

The program is run by the Department of Community Health and funded by the federal Centers for Disease Control and Prevention.

Siegl said times have changed and all women don’t have to undergo the unnecessary pain and discomfort caused by open surgery.

Minimally invasive breast biopsies are cost-efficient, less painful and disrupt patients’ lives less, according to the Florida study.

Patients’ preferences sometimes trump medical advice.

“Many times we suggest one way but the patient may say, ‘I just want the lump out,’ and we have to accommodate their wishes,” Cimmino said.

He also said some patients are uncomfortable with lumps in their breasts, even when tests for cancer cells come out negative.

In such cases, surgeons must do open surgery to remove the lumps.

Siegl said those are unnecessary because most benign lumps are normal parts of a woman’s body.

The study also called for more training and changes in existing practices.

Cimmino said that’s not so necessary, however.

“I’m not sure that more training is the answer,” he said.  “You cannot apply training without commensurate technology.”

He said that improved regionalization of services might be a better solution.

“This way, physicians with less technology or equipment can send their patients to better-equipped institutions,” he said.

But that alternative isn’t possible if patients aren’t willing to travel, Cimmino said.

The state program refers women to surgeons depending on where they live, and professionals like Siegl have noticed one trend cited in the study.

“We are seeing more open surgery procedures done in medical institutions not affiliated with academic institutions,” she said.

The study said the use of minimally invasive biopsies is more common at academic hospitals compared to non-academic ones.

Medical institutions like U-M’s Comprehensive Cancer Center, where Cimmino practices, are better equipped with technology and expertise, said Christina Jacobs, a breast imaging radiologist with the Bronson Advanced Radiology Services in Kalamazoo.

Jacob also practices at the Michigan State University-affiliated Bronson Methodist Hospital in Kalamazoo where she said surgeons prefer minimally invasive procedures.

She said about 30 to 40 percent of their patients test positive for cancer cells and that’s when they undergo surgical biopsies.

Jacob often encounters situations where patients fear that needle biopsies will spread cancer cells into their bloodstream.

“Needle biopsies have been done for 15 to 20 years in this country and nothing shows that there’s increasing spread of cancer cells in the body,” she said.

Cimmino said that most patients are more knowledgeable than in the past although the study recommends more efforts to educate women about their options.

“There’s a lot of information today available for women and they’re coming to us better informed about their options,”  he said.


Filed under: Health Care

Health care access under scrutiny

Capital News Service

LANSING—Access to affordable health care remains a problem in Michigan.

Advocacy groups are looking at ways to improve access to affordable health care and offer contrasting opinions on whether current laws are enough.

Gov. Rick Snyder briefly mentioned health care in his State of the State address, emphasizing wellness programs and preventive care.

“All of our citizens need access to preventive care from primary care providers,” Snyder said. “We will look to build a system that encourages all of us to have an annual physical to reduce obesity and encourage a healthier, active lifestyle in our state.”

Rob Fowler, Small Business Association of Michigan president, calls health care one of the biggest issues affecting small business owners and says the 2010 federal law fails to address a key problem for employers: “It doesn’t deal with the cost.”

According to Fowler, the law makes it more difficult for small businesses to purchase health insurance because it’s caused prices to rise.

Fowler said that another flaw in the federal law is that it may be cheaper for some employers to pay a penalty than to provide insurance coverage.

However, a recent report by the Public Interest Research Group in Michigan (PIRGIM) said repeal of the federal law would increase costs by 14 to 20 percent and that more than 125,000 small businesses in Michigan would lose tax credits that can cover up to 35 percent of their health care costs.

PIRGIM, which is based in Ann Arbor, recommended steps that Michigan could take “which the federal law failed to take to address our health care issues.”

Like SBAM, it suggested more electronic record keeping, saying, “Accelerating greater administrative streamlining and reducing health care paperwork can lower costs for consumers, providers and insurers.”

The report called for more state-level support for medical research and “limiting the worst marketing practices of the drug and medical device industries,” which it said would make medical treatments “more affordable.”

The Michigan League for Human Services, another advocacy group, said Michigan ranked first among the states in the number of people who lost employer-sponsored health care between 2000 and 2009 — more than 1 million people.

“Thousands of residents have gained new coverage or peace of mind from provisions of the law that have been implemented,” league President Gilda Jacobs said. “Hundreds of thousands more will gain coverage by 2014 when the federal law is fully implemented.”

Lary Wells, chief operating officer of the league, said that the organization would like Michigan to work with the federal government to expand access to health care.

“We would like to see a working system that includes the uninsured without forcing them to use a very expensive emergency room,” Wells said.

© 2011, Capital News Service, Michigan State University School of Journalism. Not to be reproduced without permission.


Filed under: Health Care

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