Water fluoridation not enough to shrink dental health inequalities, study finds | Dentists

Water fluoridation provides a modest benefit for children’s teeth in an era of fluoride toothpastes, but does not shrink inequalities in dental health between rich and poor communities, research has revealed.

Fluoride, a naturally occurring mineral, has been added to drinking water for decades in areas where natural levels are low in a bid to tackle tooth decay.

Water fluoridation occurs in about 25 countries, according to the UK government, and encompasses about 6 million people in England, largely in the West Midlands and the north-east.

Among areas currently looking at introducing the approach are County Durham, Sunderland, South Tyneside and Teesside.

But while water fluoridation is supported by all of the UK chief medical officers, it has proved controversial. What’s more, many studies examining the impact of water fluoridation were conducted before fluoride toothpaste became a household staple.

Now researchers say that while water fluoridation appears to bring benefits, these are much smaller than earlier research suggested.

“We’re aware of a number of different areas that are looking at implementing water fluoridation, so it’s very much a live issue at the moment,” said Dr Michaela Goodwin, senior investigator on the Catfish study, from the University of Manchester.

The team, which published its findings in the journal Public Health Research, focused on two areas of Cumbria, one without water fluoridation and one where fluoridation had only recently restarted.

In both areas they recruited children aged around five years old when fluoridation restarted in parts of the county in 2013, and hence had not previously been exposed to fluoridated water – as well as babies who were conceived after this point in time.

Experts examined the milk teeth of the younger group at three and five years of age, and newly erupting adult teeth for the older group at ages five, seven and 11 years old.

The results from 1,444 children in the younger cohort reveal that 17.4% of those living in fluoridated areas had decayed milk teeth, compared with 21.4% for those in areas without water fluoridation.

After taking into account factors such as age, sex and deprivation, the team found the odds of decay for those in the water fluoridation group compared with the no fluoridation group were 26% lower.

There was no clear evidence of an effect for the 1,192 older children. While the team say this may suggest an important role for fluoride exposure in the womb, they add it could be that not enough time had passed for cavities to develop in the adult teeth.

The team added that the number of teeth that were decayed, missing or filled was lower in fluoridated

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Medical debt soars for consumers with hospital credit cards : Shots

Many hospitals are now partnering with financing companies to offer payment plans when patients and their families can’t afford their bills. The catch: the plans can come with interest that significantly increases a patient’s debt.

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Many hospitals are now partnering with financing companies to offer payment plans when patients and their families can’t afford their bills. The catch: the plans can come with interest that significantly increases a patient’s debt.

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Patients at North Carolina-based Atrium Health get what looks like an enticing pitch when they go to the nonprofit hospital system’s website: a payment plan from lender AccessOne. The plans offer “easy ways to make monthly payments” on medical bills, the website says. You don’t need good credit to get a loan. Everyone is approved. Nothing is reported to credit agencies.

In Minnesota, Allina Health encourages its patients to sign up for an account with MedCredit Financial Services to “consolidate your health expenses.” In Southern California, Chino Valley Medical Center, part of the Prime Healthcare chain, touts “promotional financing options with the CareCredit credit card to help you get the care you need, when you need it.”

As Americans are overwhelmed with medical bills, patient financing is now a multibillion-dollar business, with private equity and big banks lined up to cash in when patients and their families can’t pay for care. By one estimate from research firm IBISWorld, profit margins top 29% in the patient financing industry, seven times what is considered a solid hospital margin.

Hospitals and other providers, which historically put their patients in interest-free payment plans, have welcomed the financing, signing contracts with lenders and enrolling patients in financing plans with rosy promises about convenient bills and easy payments.

For patients, the payment plans often mean something more ominous: yet more debt.

Millions of people are paying interest on these plans, on top of what they owe for medical or dental care, an investigation by KHN and NPR shows. Even with lower rates than a traditional credit card, the interest can add hundreds, even thousands of dollars to medical bills and ratchet up financial strains when patients are most vulnerable.

Robin Milcowitz, a Florida woman who found herself enrolled in an AccessOne loan at a Tampa hospital in 2018 after having a hysterectomy for ovarian cancer, said she was appalled by the financing arrangements.

“Hospitals have found yet another way to monetize our illnesses and our need for medical help,” said Milcowitz, a graphic designer. She was charged 11.5% interest — almost three times what she paid for a separate bank loan. “It’s immoral,” she said.

Robin Milcowitz signed on to a no-interest payment plan to pay off $3,000 she owed for a hysterectomy in 2017. When the medical center switched her account to AccessOne, she began receiving late notices, though she was making payments. Turned out her payments were only being applied to the surgery, leaving an account for medical appointments past-due.

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Medicare Advantage plans overcharged Medicare, audits show : Shots

Eric Harkleroad/KHN /Getty Images/ Unsplash/ Centers for Medicare & Medicaid Services Data

A photo illustration shows four images separated by bars. The first image is of money and a Medicare card, the second is an older man sitting in a chair, the third is a closeup of money, the fourth is of a spreadsheet of overpayments totaling over $8 million.

Eric Harkleroad/KHN /Getty Images/ Unsplash/ Centers for Medicare & Medicaid Services Data

Newly released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans, with some plans overbilling the government more than $1,000 per patient a year on average.

Summaries of the 90 audits, which examined billings from 2011 through 2013 and are the most recent reviews completed, were obtained exclusively by KHN through a three-year Freedom of Information Act lawsuit, which was settled in late September.

The government’s audits uncovered about $12 million in net overpayments for the care of 18,090 patients sampled, though the actual losses to taxpayers are likely much higher. Medicare Advantage, a fast-growing alternative to original Medicare, is run primarily by major insurance companies.

Officials at the Centers for Medicare & Medicaid Services have said they intend to extrapolate the payment error rates from those samples across the total membership of each plan — and recoup an estimated $650 million from insurers as a result.

But after nearly a decade, that has yet to happen. CMS was set to unveil a final extrapolation rule Nov. 1 but recently put that decision off until February.

Ted Doolittle, a former deputy director of CMS’ Center for Program Integrity, which oversees Medicare’s efforts to fight fraud and billing abuse, said the agency has failed to hold Medicare Advantage plans accountable. “I think CMS fell down on the job on this,” said Doolittle, now the health care advocate for the state of Connecticut.

Doolittle said CMS appears to be “carrying water” for the insurance industry, which is “making money hand over fist” off Medicare Advantage plans. “From the outside, it seems pretty smelly,” he said.

In an email response to written questions posed by KHN, Dara Corrigan, a CMS deputy administrator, said the agency hasn’t told health plans how much they owe because the calculations “have not been finalized.”

Corrigan declined to say when the agency would finish its work. “We have a fiduciary and statutory duty to address improper payments in all of our programs,” she said.

Enrollment in Medicare Advantage plans has more than doubled in the last decade

The 90 audits are the only ones CMS has completed over the past decade, a time when Medicare Advantage has grown explosively. Enrollment in the plans more than doubled during that period, passing 28 million in 2022, at a cost to the government of $427 billion.

Seventy-one of the 90 audits uncovered net overpayments, which topped $1,000 per patient on average in 23 audits, according to the government’s records. Humana, one of the largest Medicare Advantage sponsors, had overpayments exceeding that $1,000 average in 10 of 11 audits, according to the records.

CMS paid the remaining plans too little on average, anywhere from $8 to $773 per patient.

What constitutes an overpayment?

Auditors flag overpayments when a patient’s records fail to document that the person had the medical condition the

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Legal and Ethical Use of Complementary and Alternative Medicine Interventions in Oncology

A dangerous trend is emerging to force physicians to provide unproven drugs to patients with COVID-19. It could spill over into oncology.

Posted: 10/31/2022 12:39:00 PM

Last Updated: 10/31/2022 1:47:35 PM





In addition to, or instead of, receiving therapies that are the standard of care, patients with cancer sometimes request to receive complementary (therapies used in conjunction with standard cancer treatment) and alternative (nonstandard treatments used in place of standard cancer treatment) medical treatments, despite limited evidence of their efficacy. Some examples of complementary and alternative therapies include mind/body practices (such as meditation and yoga); biologically based practices (such as dietary and herbal supplements and cannabis); manipulative and body-based practices (such as massage, chiropractic therapy, and reflexology); biofield therapy (such as Reiki and therapeutic touch); and treatments from traditional medical systems (such as ayurvedic or traditional Chinese medicine).1

In this column, I discuss the ethical and legal issues presented by patient requests to include complementary and alternative medicine in their cancer treatment plan.

Govind Persad, JD, PhD

Govind Persad, JD, PhD

The Allure of Complementary and Alternative Medicine

Despite research showing that patients with cancer who solely use alternative therapies instead of standard cancer treatments have much higher mortality rates, nearly 40% of Americans surveyed by ASCO believe cancer can be cured solely through alternative medicine.2 Cancer is a disease that poses particularly fertile ground for complementary and alternative medicine requests from patients. For some cancers, existing treatments may not offer high expectations of cure or multiyear survival, making complementary and alternative medicine therapies particularly attractive to patients. And treatments for cancer usually carry burdensome side effects that patients want to avoid, including financial toxicity.

Some complementary methods, such as prayer, spirituality, and mind/body practices, can easily coexist with recommended cancer interventions, presenting few ethical and legal problems. These interventions, even when they have not been proven to benefit patients, are unlikely to interfere directly with cancer treatments or present other risks of medical harm.

Nearly 40% of Americans surveyed by ASCO believe cancer can be cured solely through alternative medicine.

— Govind Persad, JD, PhD

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Other complementary and alternative treatments, such as dietary supplements and herbal medicines, can also often coexist with recommended cancer interventions, but they present greater potential for conflict. Some potential conflicts involve interactions between these biologically active medicines and standard cancer therapies, which may interfere with the effectiveness of cancer therapies, and patient refusal to receive surgery, radiation, chemotherapy, or other traditional treatment because they believe complementary and alternative medicine therapies alone will cure them.

Although competent adults always have the ethical and legal right to refuse recommended treatments, often clinicians can work with patients to offer information that may mitigate these conflicts. For example, oncologists may suggest complementary practices that do not pose a risk of harmful drug interactions and that help patients cope with the side effects of cancer and its treatment, including nausea, pain, and fatigue.

A Dangerous Legal Trend to Override Medical Decisions

At times

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