Tips for Marylanders suffering from chronic pain / Public News Service

Just a few weeks ago, the Food and Drug Administration approved Journavix, a new non-opioid painkiller.

It’s seen as good news for the nearly one in four Americans who suffer from chronic pain, but not all of them want to rely on medication to control it.

Chronic pain costs more than $600 billion annually, according to the University of Maryland-Baltimore’s Center to Advance Chronic Pain Research.

David Starbuck Smith, a DMV exercise therapist and former tennis coach, said there are a number of reasons some people are unable to shake chronic pain.

“We are so much more than our physical part,” said Smith. “We are spiritual, we’re emotional, we’re mental. And so when you look at the overall treatment protocol, we’re looking at just one aspect of us. There’s so many more parts to us than that. And the other part is that we’re trained and we’re conditioned to treat the symptom, not the cause.”

Smith added that, when one part of the body struggles, other parts compensate. So, a pain in the knee, for instance, might be connected to problems with shoulder joints or hip joints.

He said regular exercise can help with chronic pain. Studies have also shown a link between Vitamin D deficiency and chronic pain.

Smith said when the body isn’t properly aligned, the pain can cause mental or emotional stress, which can lead to more pain and even injury.

He advised people to monitor their stress level and learn some simple breathing techniques. He said healing takes place best when a person is relaxed.

“You can monitor your own stress,” said Smith. “Notice that when you’re feeling stressed, angry, hurt, confused, lost, upset in any way – then this emotional stress is going to compound and add to the postural stress, the postural misalignment.”

It’s estimated U.S. workers lose more than $200 billion a year due to chronic pain.

A bill introduced with bipartisan support in Congress a year ago would have prioritized funding for chronic pain research, but didn’t make it out of committee.

get more stories like this via email

By Grace Hussain for Sentient.
Broadcast version by Shanteya Hudson for Georgia News Connection reporting for the Sentient-Public News Service Collaboration

Robert F. Kennedy Jr.’s confirmation as Director of Health and Human Services — the government department that oversees the Food and Drug Administration and the Center for Disease Control among others — could be another damper for the plant-based food market. Through his “Make America Healthy Again” campaign, Kennedy has repeatedly argued that processed foods are poisoning the country, a stance he maintained throughout his confirmation hearings. And because processed foods aren’t well defined, any efforts by RFK to restrict ultra-processed foods could end up inadvertently discouraging U.S. consumers from eating plant-based foods. That would be bad news for the already-struggling plant-based industry, but also for climate change and the environment.

Though he did not support an all-out ban on processed foods during his confirmation hearing, Kennedy expressed his support for restricting school purchasing and limiting SNAP beneficiaries’ ability to purchase processed foods. While both SNAP and federal school purchases are managed by the U.S. Department of Agriculture and thus would be outside of Kennedy’s direct control, the Department of Agriculture and the Department of Health and Human Services both work closely on food policy.

Now that he’s approved, Kennedy could push for a range of policies for reducing the country’s consumption of processed foods, including the FDA’s labeling requirements.

“Warning labels and taxes tend to change people’s behavior. So if you put a warning label on a product, people, on average, are a little bit less likely to buy that product. If you tax a product, people are a little bit less likely to buy it. It’s because it’s a little bit more expensive, so I would expect that those policies, if implemented, would reduce how much we eat those products,” Anna Grummon, who runs the Stanford Food Policy Lab, tells Sentient.

Defining Ultra-Processed Foods Proves Difficult

One of the factors that makes legislating processed foods difficult is the fact that not all processed foods are created equal. Some processed foods, such as sugary beverages like soda, have been linked to various health issues including diabetes and obesity. But that’s not the case for all processed foods, including plant-based meats.

The expansive category that is “processed foods” is why some policymakers and activists zeroed in on a new label: ultra-processed foods. But here too, there’s no single definition of what exactly constitutes an ultra-processed food. “That’s a challenge for making policy around ultra-processed foods,” says Grummon. “We have to have a definition we agree on, and that can be implemented by policymakers and by companies.”

Currently, the most prominent definition comes from the NOVA Food Classification System, which was proposed by researchers at the University of São Paulo. Under the system, ultra-processed foods are combinations of ingredients that are not whole foods themselves, or are “synthesized in laboratories.”

Another definition, appearing on the conservative organization Center for Renewing America’s website, notes a few factors in its definition of ultra-processed foods, including “packaged foods containing added preservatives,” and “manufactured ingredients…that extend the shelf-life of a product, enhance the taste of the product, and often result in habit-forming cravings…” (The founder of the organization was part of the first Trump Administration, and previously signaled his intent to defund the EPA, while also pushing transphobic rhetoric.)

The specific definition RFK Jr. prefers, and which would likely be replicated by the FDA, remains unclear. Regardless of the specifics of the definition, it’s unlikely to cleanly identify the least healthy foods, simply because all ultra-processed foods are not the same.

Some policies have addressed this problem by regulating nutrients, rather than the level of processing. For example, in Chile, products high in calories, sodium, sugar or saturated fat are required to have warning labels on the front of their packaging, and can’t be sold or served in schools. The approach has significantly cut how often those foods are purchased, though it doesn’t seem to have curbed obesity rates. In fact, the BBC reports obesity has increased among school children slightly since 2016 (though this may be attributable to an increase in sedentary lifestyles during COVID-19).

Policies focused on nutrient content “gets at ultra-processed foods indirectly,” says Grummon. The FDA is currently considering a rule that would require most foods to sport front-of-package nutrient labeling, ultra-processed or not.

Potential Health & Environmental Impacts of Ultra-Processed Labeling

Warning labels on ultra-processed foods sound like a good idea, but when it comes to plant-based meat, these labels could indirectly lead to negative environmental and public health impacts if consumers were to cut back on their plant-based eating habits as a result. Potential taxes that increase the cost of ultra-processed plant-based meats, like Impossible and Beyond products, are also likely to reduce the amount of those products consumers purchase, says Grummon.

“A key question is what do people switch to? Do they switch back to beef? Or do they switch to something else?,” she says. “That’s really important for understanding whether those policies would be good or bad for public health or good or bad for carbon footprint. I think if people switch back to beef, that’s not going to be good for carbon emissions, because, of course, beef has a much higher carbon footprint than Beyond and Impossible products.”

The average person in the United States already eats far more meat than the global average. For that reason and because of beef’s massive greenhouse gas emissions impact, climate research groups like the World Resources Institute include the recommendation that U.S. (and other global north) consumers eat less beef as part of their climate action plan for food-related emissions.

When researchers compare beef to plant-based alternatives, the alternatives consistently rank better, using less water and land and emitting far fewer greenhouse gasses. Other types of meat — like poultry and pork — are more moderate for greenhouse gas emissions, yet both are associated with poor animal welfare and polluting the air and water of communities that live near factory farms.

Even when looking at personal health, plant-based alternatives tend to perform as well as or slightly better than meat. Despite being categorized as ultra-processed, plant-based alternatives tend to be a little lower in fat and calories, and sometimes have more fiber than meat. On the other hand, meat tends to have less sugar and more protein per serving, and of course, individual products do vary.

If policies aimed at rolling back consumption of ultra-processed foods are enacted, many plant-based alternatives will likely be impacted, given that they’d be considered ultra-processed under the most prominent definition. “You can imagine some things being bad for sustainability, like people might eat fewer meat mimic[king] products, like Beyond and Impossible, because those are ultra-processed,” says Grummon.

A representative of The Plant Based Foods Association declined to comment for this article, stating, “given the potential regulatory outcomes are still unknown, we’d prefer not to comment at this time.”

The Bottom Line

It is possible that new policies targeting ultra-processed foods could persuade consumers to opt for more legumes over plant-based burgers or conventional meat. But given how often most U.S. consumers regularly eat lentils these days, it seems unlikely.

A new food labeling scheme could also make no difference at all. One study found that Swiss consumers already view meat substitutes as processed, regardless of the form they take; so it’s also a possibility that consumers willing to purchase plant-based alternatives won’t be swayed by new policies.

Ultimately, what policies RFK and the Trump Administration might pursue on processed and ultra-processed foods remain hard to predict, Grummon says. But many plant-based products are categorized as ultra-processed under any definition. Even if plant-based foods aren’t a particular target of policies aimed at sugary beverages or candy bars, regulatory language that focuses on the processing — instead of nutrient content — would likely end up including plant-based alternatives. These sorts of policies then could spell more trouble ahead, both for the plant-based market and the planet.

Grace Hussain wrote this article for Sentient.

get more stories like this via email

By Phil Galewitz for KFF Health News.
Broadcast version by Trimmel Gomes for Florida News Connection reporting for the KFF Health News-Public News Service Collaboration

Just a few years ago, children with Type 1 diabetes reported to the school nurse several times a day to get a finger pricked to check whether their blood sugar was dangerously high or low.

The introduction of the continuous glucose monitor (CGM) made that unnecessary. The small device, typically attached to the arm, has a sensor under the skin that sends readings to an app on a phone or other wireless device. The app shows blood sugar levels at a glance and sounds an alarm when they move out of a normal range.

Blood sugar that’s too high could call for a dose of insulin – delivered by injection or the touch of a button on an insulin pump – to stave off potentially life-threatening complications including loss of consciousness, while a sip of juice could remedy blood sugar that’s too low, preventing problems such as dizziness and seizures.

Schools around the country say teachers listen for CGM alarms from students’ phones in the classroom. Yet many parents say that there’s no guarantee a teacher will hear an alarm in a busy classroom and that it falls to them to ensure their child is safe when out of a teacher’s earshot by monitoring the app themselves, though they may not be able to quickly contact their child.

Parents say school nurses or administrative staff should remotely monitor CGM apps, making sure someone is paying attention even when a student is outside the classroom – such as at recess, in a noisy lunchroom, or on a field trip.

But many schools have resisted, citing staff shortages and concerns about internet reliability and technical problems with the devices. About one-third of schools do not have a full-time nurse, according to a 2021 survey by the National Association of School Nurses, though other staffers can be trained to monitor CGMs.

Caring for children with Type 1 diabetes is nothing new for schools. Before CGMs, there was no alarm that signaled a problem; instead, it was caught with a time-consuming finger-prick test, or when the problem had progressed and the child showed symptoms of complications.

With the proliferation of insulin pumps, many kids can respond to problems themselves, reducing the need for schools to provide injections as well.

Parents say they are not asking schools to continuously monitor their child’s readings, but rather to ensure that an adult at the school checks that the child responds appropriately.

“People at the [school] district don’t understand the illness, and they don’t understand the urgency,” said Julie Calidonio of Lutz, Florida.

Calidonio’s son Luke, 12, uses a CGM but has received little support from his school, she said. Relying on school staff to hear the alarms led to instances in which no one was nearby to intervene if his blood sugar dropped to critical levels.

“Why have this technology that is meant to prevent harms, and we are not acting on it,” she said.

Corey Dierdorff, a spokesperson for the Pasco County School District, where Luke attends school, said in a statement to KFF Health News that staff members react when they hear a student’s CGM sound an alert. Asked why the district won’t agree to have staff remotely monitor the alarms, he noted concerns about internet reliability.

In September, Calidonio filed a complaint with the U.S. Justice Department against the district, saying its inability to monitor the devices violates the Americans with Disabilities Act, which requires schools to make accommodations for students with diabetes, among other conditions. She is still awaiting a decision.

The complaint comes about four years after the Connecticut U.S. attorney’s office determined that having school staffers monitor a student’s CGM was a “reasonable accommodation” under the ADA. That determination was made after four students filed complaints against four Connecticut school districts.

“We fought this fight and won this fight,” said Jonathan Chappell, one of two attorneys who filed the complaints in Connecticut. But the decision has yet to affect students outside the state, he said.

Chappell and Bonnie Roswig, an attorney and director of the nonprofit Center for Children’s Advocacy Disability Rights Project, both said they have heard from parents in 40 states having trouble getting their children’s CGMs remotely monitored in school. Parents in 10 states have filed similar complaints, they said.

CGMs today are used by most of the estimated 300,000 people in the U.S. with Type 1 diabetes under age 20, health experts say. Also known as juvenile diabetes, it is an autoimmune disease typically diagnosed in early childhood and treated with daily insulin to help regulate blood sugar. It affects about 1 in 400 people under 20, according to the American Academy of Pediatrics.

(CGMs are also used by those with Type 2 diabetes, a different disease tied to risk factors such as diet and exercise that affects tens of millions of people – including a growing number of children, though it is usually not diagnosed until the early teens. Most people with Type 2 diabetes do not take insulin.)

Students with diabetes or another disease or disability typically have a health care plan, developed by their doctor, that works with a school-approved plan to get the support they need. It details necessary accommodations to attend school, such as allowing a child to eat in class or ensuring staff members are trained to check blood glucose or give a shot of insulin.

For children with Type 1 diabetes, the plan usually includes monitoring CGMs several times a day and responding to alarms, Roswig said.

Lynn Nelson, president-elect of the National Association of School Nurses, said when doctors and parents deem a student needs their CGM remotely monitored, the school is obligated under the ADA to meet that need. “It is legally required and the right thing to do.”

Nelson, who also manages school nurse programs in Washington state, said schools often must balance the students’ needs with having enough administrative staff.

“There are real workforce challenges, but that means schools have to go above and beyond for an individual student,” she said.

Henry Rodriguez, a pediatric endocrinologist at the University of South Florida and a spokesperson for the American Diabetes Association, said remote monitoring can be challenging for schools. While they advocate for giving every child what they need to manage their diabetes at school, he said, schools can be limited by a lack of support staff, including nurses.

The association last year updated its policy around CGMs, stating: “School districts should remove barriers to remote monitoring by school nurses or trained school staff if this is medically necessary for the student.”

In San Diego, Taylor Inman, a pediatric pulmonologist, said her daughter, Ruby, 8, received little help from her public school after being diagnosed with Type 1 diabetes and starting to use a CGM.

She said alerts from Ruby’s phone often went unheard outside the classroom, and she could not always reach someone at the school to make sure Ruby was reacting when her blood sugar levels moved into the abnormal range.

“We kept asking for the school to follow my daughter’s CGM and were told they were not allowed to,” she said.

In a 2020 memo to school nurses that remains in effect, Howard Taras, the San Diego Unified School District’s medical adviser, said if a student’s doctor recommends remote monitoring, it should be done by their parents or doctor’s office staff.

CGM alarms can be “disruptive to the student’s education, to classmates and to staff members with other responsibilities,” Taras wrote.

“Alarms are closely monitored, even those that occur outside of the classroom,” Susan Barndollar, the district’s executive director of nursing and wellness, said in a statement. Trained adults, including teachers and aides, listen for the alarms when in class, at recess, at gym class, or during a field trip, she said.

She said the problem with remote monitoring is that staff in the school office doing the monitoring may not know where the student is to tend to them quickly.

Inman said last year they paid $20,000 for a diabetes support dog trained to detect high or low blood sugar and later transferred Ruby to a private school that remotely tracks her CGM.

“Her blood sugar is better controlled, and she is not scared and stressed anymore and can focus on learning,” she said. “She is happy to go to school and is thriving.”

Some schools have changed their policies. For more than a year, several parents lobbied Loudoun County Public Schools in Northern Virginia to have school nurses follow CGM alerts from their own wireless devices.

The district board approved the change, which took effect in August and affects about 100 of the district’s more than 80,000 students.

Before, Lauren Valentine would get alerts from 8-year-old son Leo’s CGM and call the school he attends in Loudoun County, not knowing if anyone was taking action. Valentine said the school nurse now tracks Leo’s blood sugar from an iPad in the clinic.

“It takes the responsibility off my son and the pressure off the teacher,” she said. “And it gives us peace of mind that the school clinic nurses know what is happening.”

Phil Galewitz wrote this story for KFF Health News.

get more stories like this via email

Proposed Medicaid cuts could seriously impact New York hospitals and health-care workers. President Donald Trump and congressional Republicans are proposing $880 billion in cuts, ending health-care access for around 73 million Americans. More than a quarter of New Yorkers use Medicaid for their insurance.

Amy Lee Pacholk, a surgical and trauma critical-care nurse at SUNY Stony Brook Hospital, said losing these funds means hospitals can’t maintain proper staffing levels to care for patients.

“Corners are often cut with staffing,” she said. “For a long time, we have been working toward minimum staffing standards and safe patient ratios so that nurses can take care of patients at safe environments both for themselves and for the patients.”

But, a New York State Nurses Association report finds between January and October 2024, hospitals failed to staff intensive-care units and critical-care patients at state-mandated ratios more than 50% of the time. These cuts will pay for extending Trump’s first administration tax cuts. The Economic Policy Institute notes that private-market health plans can cost 20-percent of families more than their yearly earnings.

Statewide, hospitals are projecting zero operating margins. Although it’s a mild improvement, it’s insufficient for hospitals to handle patient care. But, Medicaid’s low reimbursement rates are responsible for SUNY Downstate’s financial issues. 90% of the hospital’s patients use Medicaid or don’t have insurance. Pacholk said because of reimbursement structure, the hospital hasn’t gotten its due.

“Just because of the population that goes there doesn’t mean they should close the institution down,” she explained. “It just means that you should facilitate the money flow in a different way to continue to serve the people who live in the community.”

Part of the Medicaid cut proposal would involve adding work requirements to the program. But, this is part of a common misconception about Medicaid users, that they don’t work. Pacholk said these programs are too important to cut for the sake of slash-and-burn style budget cutting.

“Isn’t this why we pay taxes? Isn’t this why we pay Medicare insurance,?” she said. “Isn’t it to protect people or to help us out in the future if something happens and we become financially destitute? Isn’t that the rationale? Isn’t the goal to help people here? Why do we have to take things away that are actually helping people?”

get more stories like this via email