EARLY DIAGNOSIS of cancer focuses on detecting symptomatic patients as early as possible so they have the best chance for successful treatment. When cancer care is delayed or inaccessible, there is a lower chance of survival, greater problems...

Santo Domingo.- The Dominican Republic’s Ministry of Public Health (MSP) revealed the significant impact of its “Health Route, Change your Lifestyle” initiative, having completed 30 interventions across the country. Health Minister Dr. Daniel Rivera highlighted the initiative’s success in benefiting over 1,451 thousand families, stemming from the findings of the Overweight, Hypertension, and Obesity Study.

Dr. Rivera elaborated on the broad reach of the program, noting its contribution to reducing the country’s blood donation deficit, early detection of breast cancer, hypertension in pregnant women, and encouraging Dominicans to embrace healthier lifestyles. The program positively impacted 21,796 pregnant women, 10,187 older adults with health preservation guidance, and 215,740 families in total.

The Health Minister expressed gratitude for the public’s enthusiastic participation and acknowledged the support of both public and private organizations in achieving these milestones. First Lady Raquel Arbaje also thanked those involved, including Health Minister Dr. Rivera and Dr. Gina Estrella, for their efforts in executing the initiative.

President Luis Abinader’s government considers the comprehensive health of the population a top priority, as highlighted by Arbaje, who also mentioned the School Health program, a collaboration involving various ministries and health organizations. She proudly referenced the “Take care of your mental health” telephone line, another Public Health initiative.

Dr. Gina Estrella credited the success of the Health Route to teamwork and community commitment. The event also included recognition of various provincial directorates for their outstanding contributions to the initiative, as well as acknowledgment of the First Lady, private companies, departmental managers, and Dr. Estrella for their roles in the program.

Originally inspired by President Abinader’s concern about the post-COVID-19 increase in chronic diseases, the Health Route started in provinces with high rates of hypertension, diabetes, and obesity. To date, it has integrated about 35 services in different health areas.

Spearheaded by the county’s Medi-Cal plans — which provide health insurance to low-income residents — in collaboration with its Office of Education and Department of Mental Health, the LA school program relies on teletherapy services provided by Hazel Health, one of a clutch of companies that have sprung up to address a nationwide shortage of mental health services that grew much worse during the covid-19 pandemic.

The teletherapy effort is one of four LA County projects that will collectively receive up to $83 million from the state’s Student Behavioral Health Incentive Program, one component of the Democratic governor’s “master plan” to address gaps in youth mental health care access.

LA’s Hazel Health contract is aimed at helping overburdened schools cope with a surge in demand for mental health services. It promises to be a telling case study in both the efficacy of virtual therapy for students and the ability of educators and administrators to effectively manage a sprawling and sensitive program in partnership with a for-profit company.

For some Los Angeles County educators and families, the initial results are promising.

Anjelah Salazar, 10, said her Hazel clinician has helped her feel a lot better. After the fifth grader switched to a new school this year, Stanton Elementary in Glendora, she started having panic attacks every day.

Her mom, Rosanna Chavira, said she didn’t know what to do — even though she’s a clinical coordinator for a company that treats mental health conditions — and worried she wouldn’t be able to find an affordable therapist who accepted their insurance. Once Chavira learned about Hazel, she jumped at the opportunity.

“This being free and having a licensed professional teaching her coping skills, it just means the world,” Chavira said. “You can already see changes.”

Salazar said she’s met with her virtual therapist five times so far. One coping technique that she especially appreciates is a tapping exercise: Every night before bed, she taps her eyes, her cheeks, her chest, and her knees. With each tap, she recites the same affirmation: “I am brave.”

Christine Crone, parent of seventh grader Brady, said she has yet to see if the sessions have been effective for her son, who attends Arroyo Seco Junior High in Santa Clarita, but she knows he enjoys them.

“He struggles normally with being on time and prepared, but with these sessions, he always stops what he is doing and makes sure he is logged in on time,” Crone said. “He says that his therapist is nice, fun, and easy to talk to.”

Jennifer Moya, a mental health counselor at Martha Baldwin Elementary in Alhambra, a city east of Los Angeles, said her students like the flexibility of teletherapy, which allows them to meet with clinicians anytime between 7 a.m. and 7 p.m.

“This generation of kids has grown up digital,” said Moya, who is in charge of referring students to Hazel at her school. “They love that this is easy.”

Pablo Isais, a mental health counselor at Alhambra’s Granada Elementary School, said the services can also be a stopgap while a student waits for an in-person appointment, which can take six to eight weeks.

“To be able to let them know that there are services available that they can access within the next week is amazing,” Moya said.

Thus far, early in the rollout, only 607 Los Angeles County students have participated in Hazel sessions since they were first offered, in Compton, in December 2022, said Alicia Garoupa, chief of well-being and support services for the Office of Education. She acknowledged some bumps in the rollout but said Hazel is “another tool in our toolbox.”

State Relies on For-Profit Ventures

Teletherapy is playing an increasingly important role in schools across the nation as educators and social workers face pressure to address growing mental health issues. According to an April Chalkbeat report, 13 of the nation’s 20 largest school districts, including Los Angeles Unified, have added teletherapy since the pandemic began.

LA County’s deal with Hazel calls for the company to be paid up to $20 million through the end of 2024. In addition, Hazel can bill students’ insurance.

The San Francisco-based company, founded in 2015, has raised $112.5 million from investors and has contracts in 15 different states. Other companies chasing youth mental health dollars include another San Francisco startup, Daybreak Health, a graduate of the prestigious Y Combinator tech incubator, along with BeMe, Brightline, and Kooth.

California chose Brightline and Kooth for a 2024 $532 million statewide initiative on virtual youth behavioral services, another important component of Newsom’s master plan. There is some overlap between the state and local programs, Brightline co-founder and CEO Naomi Allen acknowledged, but she said the Brightline offering is broader than what Hazel is doing in schools, with services including everything from coaching sessions for caregivers to meditation resources.

“The state is funding free access to services for every child in the state, which is just a remarkably ambitious program,” said Allen.

Still, many questions remain about the efficacy of teletherapy for students. It’s also proving to be no surefire moneymaker for the companies thus far: Brightline laid off 20% of its staff last spring, the second round of layoffs in six months.

Supplement, Not Solution

Chelsy Duffer-Dunbar, who at the time worked for Los Angeles Unified as a psychiatric social worker, told KFF Health News in October that she hadn’t yet worked with Hazel, but noted that the county requires that a member of staff stay within eyesight of the student during their appointments and assist if tech issues arise.

“It is still taking up staff time,” Duffer-Dunbar said. “My day is already so stressful. I can’t imagine having a threat assessment and a suicide assessment at work and then trying to scramble around to find someone to sit in on this therapy session with the kiddo and their iPad.”

Duffer-Dunbar said she wants the district to prioritize in-person clinicians who are immersed in the local community, especially for younger kids who have trouble engaging with teletherapy.

Duffer-Dunbar has since left the district in response to budget cuts that forced her into a more burdensome role.

Hazel emphasized that teletherapy is not a one-size-fits-all solution.

“It’s an opportunity to expand access,” said Andrew Post, chief of innovation at the company.

Education and Health Care Working Together

It took a complicated collaboration between school districts, county agencies, and the two Medi-Cal plans, L.A. Care Health Plan and Health Net, to set up the school therapy program. The state funding rules were designed to push the entities to work together.

“This program has helped us get closer to school districts,” said Michael Brodsky, senior medical director for community health at L.A. Care Health Plan. “If we can catch kids while they’re at school and refer them to get treatment while they’re in school, that’s good.”

Hazel provides primarily short-term one-to-one therapy sessions with clinical social workers or other licensed counselors, 40% of whom are bilingual. They are best suited to provide temporary support to those with mild to moderate needs, such as students struggling with academic stress or starting at a new school, but they can also make referrals for long-term care.

The largest district enrolled in the program, Los Angeles Unified, accounts for 41% of the county’s students, but not all districts are ready to take the leap. Four in 10 districts have opted to not offer Hazel’s services, which Garoupa attributes partially to data-sharing concerns.

The contract with Hazel ends in December 2024, but Garoupa said the Office of Education and its partners intend to maintain services through June 2025. Any extension beyond that will depend on the results.

Sonya Smith, a colleague of Garoupa’s, said the Office of Education will be continuously evaluating Hazel’s effectiveness through an annual survey, monthly impact reports, and weekly meetings.

“The number of students that are using Hazel is obviously going to be a key metric,” Smith said. “Hazel’s historic utilization rate is 3% to 8%. We’ll be evaluating if those numbers hold up, if students are accessing care in a timely manner, and if it’s lightening the burden for school staff and community-based providers.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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onomist at the RAND Corporation, told Healio. “They are much less likely to be directly exposed to prescription or illicit opioids, but having a parent die of an overdose

View the full post Transforming creative tools into instruments of empowerment on NOW Grenada.

The drug for which spending increased the most due to a price increase was Humira, which is used to treat rheumatoid arthritis, plaque psoriasis, and other disorders. AbbVie raised the wholesale price by 7.1%. The net price — after rebates and discounts — rose by 1.9%, most likely because the company offered more concessions than previously.

Consequently, spending for this drug climbed by $386 million, according to the report issued by the Institute for Clinical and Economic Review, a nonprofit that assesses the cost-effectiveness of medicines. The report noted that the manufacturer disputed the findings, calling the methodology “flawed” and arguing that the analysis was “subjective.”

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Ahmedabad: Zydus Worldwide DMCC,
a wholly owned subsidiary of Zydus Lifesciences Ltd and Daewoong Pharmaceutical Co., Ltd. has announced that they have entered into an exclusive licensing agreement to co-develop and
commercialize Leuprolide Acetate for Depot Suspension (RLD: Lupron Depot, AbbVie) in
six dosage strengths for the United States (US) market.

Under the terms of the agreement, Zydus will assume full responsibility for the clinical
development and commercialization in the US market, and Daewoong will be responsible for
the pre-clinical studies, production and supply of the product. Daewoong, utilizing its
proprietary technology, will produce Leuprolide Acetate for Depot Suspension in its
manufacturing facilities located in Osong, South Korea.

The exclusive agreement also includes
development, regulatory, and commercialization milestone payments based on the successful
outcome. Additionally, this agreement also includes a profit share on future sales between the
two companies.

Speaking about the development, Managing Director of Zydus Lifesciences Ltd., Dr. Sharvil
Patel said, “Enabling access to affordable generic versions for patients in the US has been our
ongoing commitment. This is an important milestone and we are happy to work with Daewoong
for generic version of Lupron Depot, empowering patients with the access to a critical therapy.
This is yet another step to strengthen the Zydus’ complex injectable portfolio.”

“Given the complexity, complex generic drug products like Lupron Depot do not exist to date
and we aim to be the first company in manufacturing the generic version of this complex, longacting injectable Lupron Depot product,” said Sengho Jeon, Chief Executive Officer,
Daewoong Pharmaceutical. “We are delighted to enter into this exclusive licensing agreement
with Zydus as part of our plan to develop and commercialize long-acting injectable of
Leuprolide Acetate.”

Leuprolide acetate for depot suspension is a gonadotropin-releasing hormone (GnRH) agonist,
a long-acting injectable product in a kit with a prefilled dual-chamber syringe, used for the
treatment of advanced prostatic cancer, endometriosis, and uterine leiomyomata (fibroids)
depending on its dosage regime. Leuprolide acetate for depot suspension had annual sales of
approximately $671 million in the US with a growth rate of 10%, according to IQVIA data
MAT Oct-2023.Read also: Zydus Lifesciences US arm concludes asset transfer of CUTX-101 for Menkes disease from Cyprium Therapeutics

However, in many countries including ours it has remained popular for recreational, medical, and religious uses. More recently there has been a trend worldwide towards legalising the use of marijuana for personal consumption. Along with this change studies have found medical uses for marijuana and proven it's relative safety for recreational consumption particularly when compared to other drugs of abuse. There have, however, been signals of potential harm for the heart and vascular system from the use of marijuana. It's important to note that given the grey legal status of marijuana use at the federal level in the United States and in many European countries, it is difficult for researchers to conduct large safety studies as with legal drugs. However, large-scale observational studies involving thousands of patients have begun to appear and have been presented at cardiology meetings this year.

When we speak of the use of marijuana, we are not referring to one chemical agent but rather hundreds of chemicals that are present in the plant which have the potential to cause physiological effects. Currently cannabinoids are thought to be responsible for most of the effects on the brain and more than 100 of these compounds have been identified. The two most well studied are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC appears to be responsible for more of the psychoactive effects of marijuana while CBD is thought to help with relaxation and pain control. Marijuana can be cultivated to have higher or lower absolute and relative levels of THC and CBD which can influence the overall effect of the plant on the user.

Beneficial effects of marijuana

Multiple studies have documented that the use of marijuana can have beneficial effects. These include pain relief, particularly in neuropathic pain, cancer-related pain and fibromyalgia. Marijuana also improves symptoms of nausea and vomiting and can be useful in patients who are receiving chemotherapy. It has been used in the treatment of spasticity in multiple sclerosis and for some types of epilepsy. Our own University of the West Indies developed a medicine for glaucoma using extracts from the marijuana plant. There is some evidence that marijuana may be useful in the management of opioid withdrawal. The use of marijuana has been proposed in several other diseases for which the evidence of significant benefit is not clear cut, including anxiety/depression, Alzheimer's disease, cancer, inflammatory bowel disease, Parkinson's disease, and sleep disturbances.

Physiological effects of marijuana on the heart and vascular system

The chemicals in the marijuana plant have many effects on the heart and vascular system. It is important to realise that most of the data that we have in this regard comes from the study of THC and CBD. The effects of the other cannabinoids are not well understood. Our bodies produce several cannabinoids that have physiological effects and thus we have receptors through which these endogenous cannabinoids act. These receptors can be affected by THC and CBD. The interactions can be quite complex with THC acting directly on receptors and CBD playing more of a regulatory role and modifying the effect of THC or other cannabinoids that are produced in the body. Cannabinoid receptors are present in many tissues including the heart and vascular system, the gastrointestinal tract, the immune system, and the brain. The effects on the heart and vascular system can be quite varied depending on the route of administration. (smoking vs ingestion), the relative ratio of THC vs CBD that is absorbed and the potency or the amount of cannabinoids that are taken.

A variety of physiological and pathological effects have been described because of the binding of THC and CBD. THC has been noted to activate the fight or flight system, cause abnormal growth in heart muscle and vascular cells, increase inflammation in heart vessels and to increase toxic chemicals in the heart and blood vessels. Whereas CBD has been noted to suppress the activation of inflammatory cells and chemicals. These somewhat antagonistic effects have led some to hypothesise that THC increases the risk of heart and vascular disease while CBD attenuates it.

Acute clinical effects of marijuana use on the heart

Aside from the psychological effects, marijuana has acute effects on the heart and vascular system which can be complicated given the different effects of THC and CBD. When the effect of THC predominates (as in most patients who are using marijuana for its euphoric effects), there is an increase in heart rate and blood pressure. The amount of oxygen required by heart muscle increases and there is evidence for an increase in abnormalities in the vessel walls with greater risk of clot formation. In patients using marijuana with higher CBD effects the heart rate and blood pressure fall and blood vessels dilate. In some diabetic models the CBD effect results in reduced vessel inflammation.

General concerns for the heart and blood vessels

The absence of large gold standard studies, the multiple ways in which marijuana is used and the fact that there is a great variety of strains with differing levels of THC and CBD along with limited data on other cannabinoids present in the plant make definitive general statements challenging. One trend that has been clear is the rise in the amount of THC which is present in marijuana plants. This has been well documented in the studies in the United States. Data from a study in Colorado found that in the 1970s the average THC concentration in the marijuana plant was less than three per cent. Currently levels of 14 per cent can be found in some varieties. Given the cardiac and vascular effects of THC this potentially may be a clinical issue. Another concern is the effects of combustion on the chemicals in the marijuana plant in those who smoke marijuana. It has been documented that the amount of carboxyhemoglobin (a protein that interferes with the distribution of oxygen throughout the body) increases by five-fold after smoking. Tar, which is a chemical produced by combustion of plant materials and which has been well studied in cigarettes, is also present in smoking marijuana rising by three-fold from baseline. Tar has been associated with lung damage, vascular damage and cancer risk in cigarette smokers and may well be an issue in those who smoke marijuana.

Aside from these general concerns, studies have been done over many years raising the question of heart and vascular damage in those who smoke marijuana. These initial reports were generally small and short term. However, larger observational studies are now being conducted and reported. We will review these clinical studies in our article next week.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to info@
caribbeanheart.com
or call 876-906-2107.

IRDAI has also been directed to reimburse the insurance amount on equal scales for both branches of medicine. "There shall be a direction to the third respondent to act upon the suggestion made by this Court to place AYUSH treatment on par with alopathic treatment and direct the insurance companies to reimburse the insurance amount on equal scales," ordered the HC bench comprising Justice N. Anand Venkatesh.

The HC bench also referred to the COVID-19 pandemic and pointed out that during the pandemic, traditional medicines were recommended for the infected persons. Effective treatment was provided under AYUSH, which provided substantial relief to the patients, noted the HC bench.

"In such circumstances, it will not be reasonable to restrict the cap and thereby deprive the policy holders to get reimbursement of the amount, which was spent by them in AYUSH hospitals," opined the Court.

At this outset, the court also reminded the IRDAI that patients can choose the type of treatment that is required for them and they have an option to either choose alopathic medicines or go for traditional medicines provided by AYUSH.

Therefore, the court opined that whatever expenses are incurred for either of these treatments must be placed on equal scales. "It will be discriminatory to give preference to allopathy as against AYUSH treatment. This must be kept in mind by the third respondent whenever the policies are drafted and sent for approval," it noted.

The Court also expressed its opinion that traditional treatment in India, which falls under the head of AYUSH treatment must also be encouraged and it must get the same weightage as is given to allopathic treatment. Therefore, a person , who chooses to undergo AYUSH treatment should be entitled to receive the insurance amount towards the expenses incurred by him, as is done to a patient who undergoes allopathic treatment. "This has to be implemented by the third respondent in all future policies," the Court noted in its order.

These observations were made by the High Court while considering two petitions seeking full reimbursement of the amount claimed by the petitioners under their respective Insurance Policies.

One of the pleas was filed by an Advocate who had taken a policy for a sum of Rs 5 lakhs and the other one was filed by a clerk who took a policy for a sim of Rs 4 lakhs.

Both of them got infected with COVID-19 and sought treatment at Siddha Hospital. Both of them sought a reimbursement of Rs 52,250 each which was incurred in treatment. However, only Rs 15,000 and Rs 10,000 were reimbursed to them.

They submitted that when they took the policies in the year 2009, it did not provide for any separate cap for reimbursement towards treatment taken in AYUSH Hospital, and the same was treated on par with Allopathy treatment. Therefore, it was contended that whatever amount was spent towards the treatment in Siddha Hospital must be reimbursed by the Insurance Company.

On the other hand, the insurance company submitted that the Policies are governed by the regulation issued by IRDA from time to time and as per the same, a maximum cap is fixed on the maximum amount of reimbursement for AYUSH treatment.

As per the Insurance Company, IRDAI policy states, that for a sum of Rs 5 lakh, a maximum of Rs 15,000 and for a sum of Rs 4 lakhs, a maximum sum of Rs 10,000 can be reimbursed. Referring to these, the company submitted that the said amount had already been reimbursed to the petitioner.

While considering the policies, the HC bench noted that under the policy, the expenses incurred for the treatment under the system of medicines other than allopathy were excluded. The court also took note of the fact that the maximum amount of reimbursement allotted to the petitioner under the respective caps for AYUSH treatments had been disbursed to the petitioners and no further directions could be given to the Insurance Company.

However, the Court took note of a larger issue and highlighted the discrimination in the policies in respect of AYUSH and allopathic treatment. Highlighting the service provided by AYUSH treatment during COVID-19 pandemic, the bench noted, "During Covid-19 pandemic, it is the traditional medicines that were recommended for the infected persons and the hospitals were only attending to emergency cases by providing support system, obviously, since allopathy did not have any medicine to treat covid-19 patients. It is true that such an eventuality would not have been anticipated at the time of finalizing the policy. That is the reason why the maximum cap was fixed under the policy. However, it came to light that the effective treatment was also given to the infected persons under AYUSH and it provided substantial relief to the patients. In such circumstances, it will not be reasonable to restrict the cap and thereby deprive the policy holders to get reimbursement of the amount, which was spent by them in AYUSH hospitals."

"The IRDAI must take into consideration the fact that patients can choose the type of treatment that is required for them and they have an option to either choose alopathic medicines or go for traditional medicines provided by AYUSH. Whatever expenses are incurred for either of these treatments must be placed on equal scales. It will be discriminatory to give preference to allopathy as against AYUSH treatment. This must be kept in mind by the third respondent whenever the policies are drafted and sent for approval," the Court further noted.

Directing IRDAI to draft future policies while giving equal importance to AYUSH treatment, the bench noted, "The third respondent must bear in mind that the traditional treatment in India which falls under the head of AYUSH treatment must also be encouraged and it must get the same weightage as is given to alopathic treatment and a person, who chooses to undergo AYUSH treatment should be entitled to receive the insurance amount towards the expenses incurred by him, as is done to a patient who undergoes alopathic treatment. This has to be implemented by the third respondent in all future policies."

At this outset, the bench recorded the submission by the Insurance Company that it has now come up with a new policy called as AYUSH plan policy, wherein even AYUSH treatment is covered and the expenses incurred for the treatment get reimbursed.

"By virtue of this new policy, AYUSH treatment has been brought on par with the alopathic treatment," noted the court while directing IRDAI to act upon the suggestion of the bench to place AYUSH treatment on par with Allopathic treatment and direct the insurance companies to reimburse the insurance amount on equal scales.

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/madras-hc-reimbursement-227200.pdf

Also Read: HC upholds distinction between AYUSH, MBBS Doctors on basis of duties assigned for grant of honorarium