Day: April 28, 2018

Facing a rising death toll from drug overdoses, state lawmakers across the United States are testing a strategy to boost treatment for opioid addicts: Force drug manufacturers and their distributors to pay for it.

Bills introduced in at least 15 states would impose taxes or fees on prescription painkillers. Several of the measures have bipartisan support and would funnel millions of dollars toward treatment and prevention programs.

In Montana, state Senator Roger Webb, a Republican, sees the approach as a way to hold drugmakers accountable for an overdose epidemic that in 2016 claimed 42,000 lives in the U.S., a record.

“You’re creating the problem,” he said of drugmakers. “You’re going to fix it.”

Opioids include prescription painkillers such as Vicodin and OxyContin as well as illegal drugs such as heroin and illicit versions of fentanyl. Public health experts say the crisis started because of overprescribing and aggressive marketing of the drugs that began in the 1990s. The death toll has continued to rise even as prescribing has started to drop.

Pennsylvania bill

A Pennsylvania opioid tax bill was introduced in 2015 and a federal version was introduced a year later, but most of the proposals arose during the past year. The majority of them have yet to get very far, with lawmakers facing intense pressure from the pharmaceutical industry to scuttle or soften the legislation.

Drugmakers and distributors argue that it would be wrong to tax prescription drugs, that the cost increases would eventually be absorbed by patients or taxpayers, and that there are other ways to pay for addiction treatment and prevention.

“We have been engaged with states to help move forward comprehensive solutions to this complex public health crisis and in many cases have seen successes,” Priscilla VanderVeer, a spokeswoman for Pharmaceutical Research and Manufacturers of America, said in a statement. “However, we do not believe levying a tax on prescribed medicines that meet legitimate medical needs is an appropriate funding mechanism for a state’s budget.”

Two drug companies that deployed lobbyists — Purdue Pharma and Pfizer — responded to questions with similar statements.

A spokesman for the Healthcare Distribution Alliance, which represents drug distributors, said a tax would mean that cancer patients and those in end-of-life care might not be able to get the prescriptions they need.

The pharmaceutical industry has emphasized that the name-brand drug companies that make up its members already give rebates to states for drugs funded by Medicaid. Those rebates amount to billions of dollars nationwide that states could use to address opioid addiction, the trade group says.

State legislation to tax opioids comes as manufacturers and distributors are defending themselves in hundreds of lawsuits filed by state and local governments seeking damages for the toll the overdose epidemic has taken on communities.

​Delaware effort

David Humes, whose son died from a heroin overdose in 2012, has been pushing for an opioid tax in Delaware, which did not increase funding for addiction treatment last year as it struggles to balance its budget.

“When you think about the fact that each year more people are dying, if you leave the money the same, you’re not keeping up with this public health crisis,” he said.

Humes, a board member of the advocacy group atTAcK Addiction, supports legislation that would dedicate opioid tax revenue for addiction services.

The lead sponsor of an opioids tax bill, state Senator Stephanie Hansen, said drug companies told her they already were contributing $500,000 to anti-addiction measures in Delaware, where there were 282 fatal overdoses from all drugs in 2016, a 40 percent increase from the year before.

“My response is, ‘That’s wonderful, but we’re not stopping there,’ ” said Hansen, a Democrat.

She said if her tax measure had been in place last year, it would have raised more than $9 million.

The drug industry’s current spending on anti-addiction programs has been a point of contention in the Minnesota Legislature. There, the overdose rate is lower than it is in most other states, but opioids still claimed 395 lives in 2016, an increase of 18 percent over the year before.

State Representative Dave Baker, a Republican whose son died of a heroin overdose after getting started on prescription painkillers, said opioid manufacturers and distributors should pay for drug programs separately. He said the rebate — about $250 million in 2016 in Minnesota — is intended to make up for overcharging for drugs in the first place.

Drugmakers not ‘part of the solution’

Another Republican lawmaker, state Senator Julie Rosen, said she walked out of a meeting this month with drug industry representatives, saying they were wasting her time.

“They know that they’re spending way too much money on defending their position instead of being part of the solution,” she said.

Representatives of the pharmaceutical industry say they have met with Rosen multiple times and are “committed to continue working with her.”

Drug companies have a history of digging in to defeat measures that are intended to combat the opioid crisis. A 2016 investigation by The Associated Press and the Center for Public Integrity found makers of opioids and their allies spent $880 million on politics and lobbying from 2006 through 2015.

The industry so far has succeeded in stalling the Minnesota legislation, which would charge opioid manufacturers by the dosage. With the bill facing resistance, Rosen and a Democratic co-sponsor, state Senator Chris Eaton, said they were considering changing tactics and amending it.

That could include raising the $235 annual licensing fee on opioid manufacturers or requiring drugmakers and distributors to pay $20 million a year based on the proportion of opioids they sell in the state. That approach is based on one adopted earlier this spring as part of the budget in New York — the only state to implement an opioid tax so far.

Eaton, whose daughter died from a heroin overdose in 2007, said her goal is to find a way to create and fund a structure that will ensure addiction treatment is “as routine as treating diabetes or cardiac arrest.”
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The 4-year-old Cote d’Ivoire boy couldn’t walk, speak or feed himself. He was so unlike most other kids that his grandparents hesitated to accept him. The slightly older Kenyan boy was so restless that his primary-school teachers beat him, until they discovered he was a star pupil.

The two children reveal different faces of autism — and how society sometimes reacts to the condition.

Videos of the boys appear in “Autism: Breaking the Silence,” a special edition of VOA’s weekly Straight Talk Africa TV program. It was recorded Wednesday before a small studio audience of people who live with the condition or deal with it professionally.

About 45 minutes into the program, Benie Blandine Yao of Cote d’Ivoire holds her 4-year-old son, who has autism.

The program’s goal: to help demystify and deepen understanding of autism spectrum disorder. It affects the brain’s normal development, often compromising an individual’s ability to communicate, interact socially or control behavior. The condition can range from mild to severe.

New CDC findings

New findings released this week by the Centers for Disease Control and Prevention indicate an increase in autism’s prevalence in the United States.

The agency estimates it affects 1 in 59 children, up from 1 in 68 several years ago and 1 in 150 almost two decades ago. The research is based on studies of more than 300,000 8-year-olds in 11 U.S. states.

Globally, one out of every 160 children has an autism spectrum disorder, the World Health Organization reports. Rates of autism are harder to determine in low- and middle-income countries, including those in sub-Saharan Africa with limited access to clinicians.

Everywhere, “poor people get diagnosed later,” Scott Badesch, president of the Autism Society of America, said in a video overview that set the stage for discussion. “… There’s more services today than ever before but there’s nowhere near the services needed for all who need help.”

A complex condition

Stigma and superstition can heighten the challenges.

In parts of Africa, youngsters with autism “are labeled as devils and they’re not diagnosed and they are not given treatment,” Bernadette Kamara, a native of Sierra Leone who runs BK Behavioral Health Center in a Washington suburb, commented from the audience.

Some people believe the disorder is punishment for a parent’s bad behavior or an affliction that can be prayed away, said Mary Amoah, featured with 15-year-old daughter Renata in a related VOA video. 

“They don’t understand this is purely a medical condition. It can happen to anyone regardless of your background,” said Amoah, coordinator at a treatment center in Accra, Ghana, for children with disabilities. “A lot needs to be done in our part of the world in terms of education, acceptance and understanding.”

Causes

Researchers haven’t determined the exact cause of autism, though they cite genetic and environmental factors. 

Panelist Susan Daniels, who directs the office of autism research coordination for the National Institute of Mental Health, part of the U.S. National Institutes of Health, stressed that research supported by the NIH and CDC shows no link to childhood vaccines.

Though the condition has no cure, early intervention can improve the quality of life for people with autism and their families.

Parents need to observe their children closely from infancy, advised Dr. Usifo Edward Asikhia, clinical director of the International Training Center for Applied Behavior Analysis in Lagos, Nigeria.

“When you have a baby at the age of 12 [months] that cannot babble, that’s a signal,” he said. Another is an inability to grasp objects, a sign of low muscle tone common in autism.

Other hallmarks include lack of eye contact or sensitivity to sounds, Daniels said. She added that a definitive diagnosis “can’t really be done accurately until age 2. But most kids aren’t diagnosed by then.”

“Children with autism in Africa tend to be diagnosed around age 8, about four years later, on average, than their American counterparts,” the Spectrum Autism Research News site reported in December.

​Call for cultural sensitivity

Some of those indicators could mislead when assessing African children, said panelist Morenike Giwa Onaiwu, a Texas-based member of the Autism Women’s Network.

“In a lot of African cultures, it’s customary not to make direct eye contact. That’s not a red flag,” said Onaiwu, whose parents came from Nigeria and who learned she was autistic only when two of her own six kids were positively identified with autism. “In terms of not babbling? We speak when we have something to say. … Certain things culturally may be missed because of the way diagnostic criteria are viewed through Western standards.”

While autism generally is associated with low IQ, the condition also affects people with high mental abilities. 

If they can “express themselves in some way, they’re actually geniuses,” said panelist Tracy Freeman, a Washington-area physician who has an autistic child. “Their challenge is neurodiversity and getting people to recognize their intelligence.”

At one point in the discussion, moderator Linord Moudou noticed Onaiwu twisting a metal coil in her hands. Onaiwu explained that the repurposed Christmas ornament is a “stimming” device for repetitive motion that provides relaxing sensory stimulation.

“It helps to calm me,” Onaiwu said. She has other strategies: “Sometimes you might see me rocking. … This kind of helps me to navigate in the neurotypical world.”

Growing role for governments?

Asikhia said families dealing with autism had few public supports in Nigeria or elsewhere in Africa. Most schools lack training in developmental delays that should be flagged for physicians, he said. 

“Those teachers just don’t know what to do,” he added.

Many African countries lack laws ensuring public education or health interventions for youngsters with autism or other developmental disorders.

But Chiara Servili, a child neuropsychiatrist and WHO technical adviser on mental health, sees rising interest. Representatives of more than 60 countries supported a 2014 WHO resolution urging member nations to develop policies and laws to ease “the global burden of mental disorders” and to devote “sufficient human, financial and technical resources.”

Many governments once focused just on improving child mortality rates, she said in a phone interview. Now, there’s “much more awareness not only that they survive but thrive. There is a new focus on early childhood development.”

The WHO is trying to improve supports for family caregivers as well as for teachers, social workers and other professionals in positions to encourage clinical evaluation, Servili said.

With international partners, the organization has developed a guide for caregivers, usually parents, to nurture children with developmental issues. For instance, “we teach them strategies so they can better engage children in play. Sit down at the level of the child. Provide some toys or some object from the house, observe what the child is doing and try to follow the lead,” Servili said. “… Reinforce any attempt to communicate.”

For a copy of the WHO Caregiver Skills Training program, contact Servili at servilic@who.org.
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Thousands of years of sediment carried by the Mississippi River created 25,000 square kilometers of land, marsh and wetlands along Louisiana’s coast. But engineering projects stopped the flow of sediment and rising seas thanks to climate change have made the Mississippi Delta the fastest-disappearing land on earth. Louisiana State University researchers created the river system in miniature to try to stop the erosion and rebuild the delta. Faith Lapidus narrates this report from Deborah Block.
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A new approach for detecting food poisoning is being used to investigate the recent outbreak of E.coli bacteria in romaine lettuce grown in the U.S. state of Arizona. The tainted produce has sickened at least 84 people in 19 states. The new method, used by the Centers for Disease Control and Prevention, relies on genetic sequencing. And as Faiza Elmasry tells us, it has the potential to revolutionize the detection of food poisoning outbreaks. VOA’s Faith Lapidus narrates.
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U.S. officials will not restore federal protections for Yellowstone-area grizzly bears, despite a court ruling that called into question the government’s rationale for turning grizzly management over to states that are now planning public hunts for the animals, according to an announcement Friday in in the Federal Register.

The disclosure from the Interior Department follows a months-long review of a decision last year to lift protections in place since 1975 for about 700 bears in and around Yellowstone National Park.

That review was launched when a federal appeals court said in a case involving gray wolves in the Great Lakes that the Interior Department needed to give more consideration to how a species’ loss of historical habitat affects its recovery.

Like wolves, grizzly bears in some parts of the U.S. have bounced back from widespread extermination, yet remain absent from most of their historical range.

Public hunts proposed

Interior officials said in Friday’s filing that they disagreed with the ruling in the wolf case. 

They said Yellowstone’s grizzly bear population has recovered and noted that other populations of the animals living outside the three-state Yellowstone region remain protected as a threatened species.

Wyoming and Idaho have proposed limited public hunts for grizzlies this fall. Hunters would be allowed to kill as many as ten male bears and two females in Wyoming and one male and no females in Idaho.

Final decisions on the hunts are pending. Montana officials decided against a hunt this year.

Tribes challenge move

Legal hunting of Yellowstone-area grizzlies last occurred in the 1970s.

Conservation groups and Native American Indian tribes have challenged the lifting of protections in federal court. They argue that killing grizzly bears would diminish the chances of Yellowstone’s bears re-populating other areas where grizzlies once roamed.

Andrea Santarsiere with the Center for Biological Diversity, one of the plaintiffs in that case, said Friday’s announcement reflects a belated attempt by federal officials to justify last year’s decision.

“They still occupy less than 5 percent of their historical range. That’s just not recovery,” she said.

Safari Club supports decision

Pro-hunting groups including the Safari Club intervened in the lawsuit on the side of the Interior Department’s Fish and Wildlife Service.

Safari Club attorney Doug Burdin said the agency’s decision was appropriate and that there were significant distinctions between the government’s distinctions between the wolves and the bears. 

Chief among those, he said, was the fact that grizzly bears outside Yellowstone will remain protected in the Lower 48 U.S states while the Great Lakes gray wolves represented the last significant population of that species still under federal protection.

An estimated 50,000 Grizzlies once roamed much of North America. Most were killed off by hunters in the 19th and early 20th centuries.
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Archaeologists in northern Peru say they have found evidence of what could be the world’s largest single case of child sacrifice.

The pre-Columbian burial site, known as Las Llamas, contains the skeletons of 140 children who were between the ages of five and 14 when they were ritually sacrificed during a ceremony about 550 years ago, experts who led the excavation told The Associated Press on Friday. 

The site, located near the modern day city of Trujillo, also contained the remains of 200 young llamas apparently sacrificed on the same day.

The burial site was apparently built by the ancient Chimu empire. It is thought the children were sacrificed as floods caused by the El Nino weather pattern ravaged the Peruvian coastline.

“They were possibly offering the gods the most important thing they had as a society, and the most important thing is children because they represent the future,” said Gabriel Prieto, an archaeology professor at Peru’s National University of Trujillo, who has led the excavation, along with John Verano of Tulane University.

“Llamas were also very important because these people had no other beasts of burden, they were a fundamental part of the economy,” Prieto said, adding that the children were buried facing the sea, while the Llamas faced the Andes Mountains to the east.

Excavation work at the burial site started in 2011, but news of the findings was first published on Thursday by National Geographic, which helped finance the investigation.

Prieto said researchers did not find just bones at the site but also footprints that have survived rain and erosion. The small footprints indicate the children were marched to their deaths from Chan Chan, an ancient city a mile away from Las Llamas, he said.

Verano said the children’s skeletons contained lesions on their breastbones, which were probably made by a ceremonial knife. Dislocated ribcages suggest that whoever was performing the sacrifices may have been trying to extract the children’s hearts.

Jeffrey Quilter, the director of the Peabody Museum of Archaeology & Ethnology at Harvard University, described it as a “remarkable discovery.” 

In an email, Quilter told the AP the site provides “concrete evidence” that large scale sacrifices of children occurred in ancient Peru.

“Reports of very large sacrifices are known from other parts of the world, but it is difficult to know if the numbers are exaggerated or not,” Quilter wrote.

Quilter is heading a team of scientists who will analyze DNA samples from the children’s remains to see if they were related and figure out which areas of the Chimu empire the sacrificed youth came from. 

Several ancient cultures in the Americas practiced human sacrifices including the Maya, the Aztec and the Inca, who conquered the Chimu empire in the late 15th century. But the mass sacrifice of children is something that has rarely been documented.

The Las Llamas site is located in a shantytown, and has been fenced off to stop illegal developers from building homes on it.

Prieto says the site shows how in Peru history can be just around the corner.

“This site surrounded by houses in a working class neighborhood can tell us a lot about a macabre event that is perhaps one of the darkest moments in our history,” Prieto said. “But this is also part of our cultural heritage.”
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