The Washington Post <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=001-05b&t=c>  (3/25, Millman) “Wonkblog” reports that a research letter <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=002-61a&t=c>  published March 24 in “JAMA Internal Medicine found that use of e-cigarettes was not associated with ‘greater rates of quitting cigarettes or reduced cigarette consumption’ after one year.” The study “authors reached the conclusion based on self-reported data from 949 smokers, which included 88 who used e-cigarettes.”

The Los Angeles Times <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=003-eff&t=c>  (3/25, MacVean) “Science Now” blog reports that “researchers from the Center for Tobacco Control Research and Education and the Department of Medicine at” the University of California-San Francisco “noted that e-cigarettes are ‘aggressively promoted as smoking cessation aids.’” But, given the findings of the study, “‘regulations should prohibit advertising, claiming or suggesting that e-cigarettes are effective smoking cessation devices until claims are supported by scientific evidence,’ the researchers…wrote.”

Still, the Boston Globe <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=004-9e5&t=c>  (3/25, Kotz) points out that the study’s “small sample size makes it difficult to draw firm conclusions, admits study leader Dr. Pamela Ling, an associate professor of medicine at” UCSF.

Newsday <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=005-fac&t=c>  (3/25, Ricks) points out that “earlier this month,” researchers “found in a study of thousands of youths that the addictive nicotine in e-cigs may lure teens to more potent sources of the substance.”

According to MedPage Today <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=006-083&t=c>  (3/25, Phend), an accompanying editorial <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=007-dd6&t=c>  written by JAMA Internal Medicine editor Mitchell Katz, MD, “further advocated FDA regulation” of e-cigarettes “as drug-delivery devices.” MedPage Today added that the FDA “has regulations in the works that are expected to generally bring the same kind of restrictions to e-cigarettes as to other tobacco products.” Some of the data for the study came from National Cancer Institute-funded research.

Also covering the story are Reuters <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=008-ce9&t=c>  (3/25, Seaman), the Minneapolis Star Tribune <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=009-7df&t=c>  (3/25, Stoxen) “Health Check” blog, the CBS News <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=00a-437&t=c>  (3/25, Jaslow) website, Time <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=00b-84b&t=c>  (3/25, Sifferlin), HealthDay <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=00c-77b&t=c>  (3/25, Reinberg), Medscape <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=00d-b1f&t=c>  (3/25, Cassels), and a Modern Healthcare <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=00e-767&t=c>  (3/25, Johnson, Subscription Publication) blog.

From ATS

Members Convene in Washington for World TB Day 2014; More are Encouraged to Send Letters

The global health and scientific community commemorated World TB Day on Monday, the day in 1882 when Dr. Robert Koch announced that he had discovered the cause of tuberculosis, the TB bacillus. The ATS continues to lead efforts to raise awareness of the need to increase funding for global and domestic TB programs with a series of events in Washington, D.C., including educational briefings in the House and Senate for congressional members and staff.

What you can do to help end TB?

Urge your House representative to join the bipartisan TB Elimination Caucus. Co-chaired by Reps. Eliot Engel (D-NY), Gene Green (D-TX) and Don Young (R-AK), the caucus has 19 members. Many more are needed to ensure that the caucus can protect global and domestic TB funding. Ask your representative to join through the ATS Advocacy webpage <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=00f-ba6&t=c> . The Society also provides a sample letter to the editor <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=010-819&t=c>  that you can send to your local newspaper to raise awareness about TB in your area.

Also, be sure to tune in to the Senior Voice America radio program Health, Wealth & Wisdom <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=011-1ce&t=c>  on 1250 AM WHNZ at 8:40 p.m. EDT with hosts Evan Gold and Deb Goldman who will discuss TB with ATS Past President and Annals of the American Thoracic Society Senior Deputy Editor Dean Schraufnagel, MD.

Clinical Care

Fauci: Cause Of 20-30% Of Adult Common Colds Still Unidentified.

On the front of its Personal Journal section, the Wall Street Journal <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=012-f09&t=c>  (3/25, D1, Reddy, Subscription Publication) reports that according to the National Institutes of Health, the number one cause of visits to a physician is the common cold. Colds, which may be caused by any of some 200 known viruses, may last for up to two weeks. It is possible for people to get colds back-to-back, particularly during cold weather when people are stuck inside, or to confuse symptoms of a sinus infection or allergies with those of a cold. Some cold symptoms may be also caused by respiratory syncytial virus, the coronavirus and the enterovirus. The piece quotes Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, who said, “The most confounding thing of all is that we still haven’t identified the cause of 20% to 30% of adult common colds.”

Research

Smoking Rates Falling Unevenly Across US.

The New York Times <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=013-dec&t=c>  (3/25, Tavernise, Gebeloff, Subscription Publication) reports that smoking rates vary widely across the country, with people living in low-income areas demonstrating a greater tendency to smoke. The paper notes that an analysis of Minnesota Population Center data shows the US adult smoking rate has fallen 27% since 1997, but that among poor people, it has fallen only 15%. This trend has led to significant health outcome disparities, with health experts calling for refocused anti-smoking efforts toward working class citizens and people on low incomes.

TIME <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=014-d1a&t=c>  (3/25, Sifferlin) quotes Institute for Health Metrics and Evaluation Director Dr. Christopher Murray as stating, “We know what works in tobacco control. It’s taxation. It’s smoking bans. It’s advertising bans, among other measures,” adding that, “We now need to understand what is happening on the ground in these counties that is leading to such great success in parts of New York, Iowa, and Texas, and near total stagnation in parts of Montana, Oklahoma, and Mississippi.”

Local Smoking Rates Vary Between Rural, Urban Areas. The Augusta (GA) Chronicle <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=015-a82&t=c>  (3/25, Corwin) reports county-level data for the state of Georgia shows rural areas within the state have been struggling with smoking rates. While the Atlanta area accounts for much of the state’s decrease in smoking over the past 15 years, Augusta has seen an increase in smoking among women. University of Washington data published in the journal Population Health Metrics shows the state’s worst counties nearly doubled the most successful counties in smoking rates. The paper also notes that smoking bans tend to influence these rates.

The Des Moines (IA) Register <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=016-027&t=c>  (3/25, Leys) reports smoking rates in Iowa counties vary between approximately 10-20%. While Dallas County was listed among the top 10 counties nationwide for its smoking reduction of 8.5% reduction between 1996 and 2012, rural counties have demonstrated a slower decline among smoking rates on average. University of Washington researcher Dr. Ali Mokdad attributes this disparity to higher education and incomes among urban residents, along with greater presence of anti-smoking campaigns and greater likelihood of knowing other people who do not smoke or are in the process of quitting.

Air Pollution Responsible For More Deaths Than AIDS, Diabetes: WHO.

Bloomberg News <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=017-b89&t=c>  (3/25, Bennett) reported air pollution was responsible for the deaths of “7 million people in 2012, more people than AIDS, diabetes and road injuries combined.” One out of eight deaths “worldwide can be attributed to breathing tainted air, making it the world’s largest environmental health risk,” a WHO report noted today, “doubling its previous estimates for pollution fatalities.” Bloomberg noted, citing the report, that the new estimates suggest “a stronger link between air pollution and cardiovascular disease such as stroke and heart ailments,” along with the “known connection with respiratory disease.”

The AP <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=018-668&t=c>  (3/25, Cheng) provided additional data, noting WHO estimated “that there were about 4.3 million deaths in 2012 caused by indoor air pollution,” mainly people cooking inside their houses “using wood and coal stoves in Asia.” The report also noted “there were about 3.7 million deaths from outdoor air pollution in 2012, of which nearly 90 percent were in developing countries,” according to the AP.

NBC News <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=019-7a3&t=c>  (3/25) also covered the news on its website.

Study: Smoking Doubles Chances Of Recurring TB.

The Wall Street Journal <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=01a-f6e&t=c>  (3/25, McKay, Subscription Publication) reports a recent study published in the International Journal of Tuberculosis and Lung Disease indicates heavy smoking doubles a tuberculosis patient’s risk of redeveloping the disease. Moreover, the second instance tends to be more difficult to treat and demonstrate greater drug resistance. After observing adults who had completed TB treatment, researchers found the risk of the disease returning increased 2.04 times among patients who smoke over 10 cigarettes each day than those who had never smoked.

International News

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China Says It Has Reduced Its Rate Of Tuberculosis By More Than Half Over The Past Two Decades.

The New York Times <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=01c-37f&t=c>  (3/25, McNeil, Subscription Publication) reports that China has reduced “its rate of tuberculosis by more than half over the” past two decades, “according to health officials there.” According to the Times, this “shows that the tuberculosis-fighting strategy endorsed by the World Health Organization in 1995 works well if it is rigorously applied.” That “strategy – called DOTS, for directly observed therapy, short course – requires that every case be diagnosed by sputum sample, and every patient be given a standard regimen of four antibiotics to take daily for about six months, and be watched taking the” medications daily.

Dr. Schraufnagel Discusses Continuing Burden Of TB. In an article and video clip, Voice of America <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=01d-c8c&t=c>  (3/25) discusses the threat that tuberculosis still poses to the world. “In Chicago, Dr. Dean Schraufnagel,” a past president of the American Thoracic Society, “treats about 200 TB patients a year.” According to Dr. Schraufnagel, who is featured in the video, “Treatment is really prevention.” He said that when “you treat a single case, then that person is no longer able to spread it to anyone else.”

Saudi Man Dies Of SARS-Like Disease.

The AP <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=01e-591&t=c>  (3/25) reports a Saudi man has died from a respiratory virus resembling SARS, marking the 64th fatality stemming from this new disease. According to the country’s Health Ministry, the man was 86 years old and already chronically ill.

UN Envoy: Haiti Cholera Outbreak Worst In World, But Improving.

The AP <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=01f-91e&t=c>  (3/25, Spielmann) reports that on Monday, UN envoy Sandra Honore announced that the Haiti cholera outbreak remains the world’s worst. The epidemic that began in 2010 killed over 8,000 people and the country “still has the highest number of cholera cases in the world.” She did concede, however, that “progress is being made,” as 2013 saw only 6% of the number of cases in 2010 and the fatality rate has fallen below 1%.

General Medical News

OSU Mumps Outbreak Patient Total Increases To 63.

Reuters <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=020-3c9&t=c>  (3/25, Palmer) reports the state of Ohio has confirmed 63 mumps cases following an outbreak that began at the Ohio State University. While 45 patients are OSU students or staff members, an additional 18 appear to be from the Columbus area and have no ties to the institution. Moreover, according to Columbus health department spokesman Jose Rodriguez, most of the people infected have received at least one round of the measles, mumps, and rubella (MMR) vaccine.

CBS News <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=021-d99&t=c>  (3/25, Jaslow) adds on its website that four patients have already been hospitalized. Also, despite the fact that many patients appear to have acquired the disease despite being vaccinated, local officials still urge community members to obtain vaccinations if they have not done so.

CNN <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=022-f18&t=c>  (3/25, Hayes) adds on its website that the health department is recommending that students and staff wash their hands, cover their coughs, and stay home if they feel sick.

        TIME <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=023-3f8&t=c>  (3/25, Sifferlin) also reports on this story.

Law and Policy

White House, Stakeholders In Final Week Of ACA Push.

With less than a week left until the deadline to purchase insurance under the Affordable Care Act’s first open enrollment period, the White House and other stakeholders are attempting to encourage enrollment in several ways.

        In an 1,200-word article, the New York Times <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=024-887&t=c>  (3/25, Abelson, Thomas, Subscription Publication) examines the efforts health insurance companies are making in the final week of the Affordable Care Act’s first open enrollment period. According to the piece, many “are concentrating on hard-to-reach groups,” most notably the young. The piece also points out that insurers, with just days left to reach their enrollment goals for 2014, are “quicker to mention the possible penalties faced by those who don’t enroll.”

        The Hill <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=025-aee&t=c>  (3/25, Viebeck) “Healthwatch” blog calls the final week “crunch time,” noting that the Administration “is pulling out all the stops to encourage people to sign up for insurance through ObamaCare.”CQ <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=026-6ac&t=c>  (3/25, Reichard, Subscription Publication) calls this week a “mad dash,” but points out that trying to get “at least 6 million people in exchange plans before open enrollment ends on March 31” is easier compared to the efforts supporters will have to launch to hit 13 million in November.

        In a high-profile effort to get the word out to the key “young invincible” demographic, USA Today <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=027-f45&t=c>  (3/25, Baig) reports that President Obama has joined the “question and answer website” Quora to promote the ACA this week, offering “written answers to previously submitted questions” about the law.

        TIME <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=028-c50&t=c>  (3/25, Sifferlin) adds that President Obama is Quora’s first “verified” user, with the White House confirming his participation, saying: “As we continue our efforts to enroll as many Americans as possible for quality, affordable health insurance ahead of the March 31st deadline, the President’s goal is to meet people – especially young adults – where they are.” The Los Angeles Times <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=029-a3d&t=c>  (3/25, Guynn) also reports.

        In another example of one of the groups the law’s supporters have honed in on, the Washington Examiner <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=02a-a51&t=c>  (3/25, Drucker, Crabtree) examines an effort aimed to promote the ACA to veterans, facilitated by the Department of Veterans Affairs.

        Additional coverage of the last week of this year’s open enrollment period is offered by Fox Business <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=02b-657&t=c>  (3/25, Rogers), again by Fox Business <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=02c-72c&t=c>  (3/25, Rogers), The State (SC) <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=02d-56c&t=c>  (3/25, Holleman), the Appleton (WI) Post-Crescent <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=02e-067&t=c>  (3/25, Collar), the Lafayette (LA) Daily Advertiser <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=02f-24d&t=c>  (3/25, Goff), the Indianapolis Star <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=030-84d&t=c>  (3/25, Groppe), and the Charleston (WV) Daily Mail <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=031-e6d&t=c>  (3/25, Quinn).

        Latinos Remain “On The Sidelines” Of ACA Enrollment Efforts. The AP <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=032-35b&t=c>  (3/25, Alonso-Zaldivar) reports that Latinos, “the nation’s largest minority group,” appear at risk of “being left behind” as the Affordable Care Act’s first open enrollment period nears its end. The article says the group is staying “on the sidelines” while the White House “races to meet a goal of 6 million sign-ups by March 31.” According to experts, this is “a loss both for Latinos who are trying to put down middle-class roots and for the Obama administration”

        In light of this, Modern Healthcare <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=033-1df&t=c>  (3/25, Landen, Subscription Publication) examines several “strategies” the White House is considering for the next enrollment period, which begins in November of this year. ,

US Navy Considers Banning Tobacco Sales On All Bases, Ships.

The Military Times <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=034-dc3&t=c>  (3/25, Jowers) reports Defense Department sources have confirmed the US Navy is considering prohibiting tobacco sales on all bases and ships. Concerns include losses in revenue that “would reduce the flow of dividends that help fund morale, welfare and recreation programs on installations.” However, the department cites its desire to “maximiz[e] the readiness” of Marines and sailors.

Practice Management

GAO Sees Problems Hindering Shift To E-Records.

The Washington Times <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=035-487&t=c>  (3/25, Howell) reports that a GAO report released Monday finds that “unclear standards and funding problems are thwarting medical providers from shifting to electronic health records and sharing their data,” which is a priority of the ACA. While HHS has “issued guidelines for the development and exchange of electronic health information in an increasingly digital world,” according to GAO, the “HHS strategy does not specify any such actions, how any actions should be prioritized, what milestones the actions need to achieve, or when these milestones need to be accomplished.” The GAO reports notes that the “lack of care coordination ‘can lead to inappropriate or duplicative tests and procedures that increase health care spending’ that can range from $148 billion to $226 billion per year.” The full report is available online with the title “HHS Strategy to Address Information Exchange Challenges Lacks Specific Prioritized Actions and Milestones <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=036-ea5&t=c> .”

Patient Resources

E-Cigarette Liquid Poisonous Enough To Kill If Ingested.

The Huffington Post <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=037-419&t=c>  (3/25, Thomas) reports in continuing coverage that e-cigarette liquid can cause seizures and potentially be fatal for people who ingest it or absorb through in their skin. The article notes that poison control officials across the country are seeing a substantial increase in e-cigarette-related cases, especially among children.

        The Newser <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=038-033&t=c>  (3/25, Seamons) adds that labels conveying fruit flavor may be attractive to young children while teenagers may intentionally mix the liquid with energy drinks to get high. According to a California’s Poison Control System director, “It’s not a matter of if a child will be seriously poisoned or killed. It’s a matter of when.” Forbes <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=039-a90&t=c>  (3/25, Glatter) and the Pittsburgh Post-Gazette <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=03a-897&t=c>  (3/25, Payne) also report on this story.

Monday’s Lead Stories

 • Study Finds One Million Children Develop TB Annually. <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=03b-242&t=c>

 • Lung Ultrasound May Quickly Spot Respiratory Failure Risk In Pregnant Women With Preeclampsia. <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=03c-03d&t=c>

 • Study: Smoking Rates Falling, But A Few Counties May Be Driving The Trend. <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=03d-41d&t=c>

 • Device To Improve Lung Transplant Success Gets Backing From FDA Panel. <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=03e-a56&t=c>

 • Researchers Face Difficulties Getting Marijuana For Studies. <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=03f-05c&t=c>

 • Amid Controversy And Facing Major Deadline, ACA Marks Fourth Anniversary As Law. <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=040-24d&t=c>

 • Patient Requests For Specific Medications May Influence What Is Prescribed By Physicians. <http://mailview.bulletinhealthcare.com/mailview.aspx?m=2014032501ats&r=6037840-e8c6&l=041-b18&t=c>

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