Viewpoints: Social Media Has Strong Links To Violence; Juul’s Dangers Rising Among Teen Users

Bloomberg: Facebook, Twitter And Violence Are All Linked
There is a direct link between the prevalence of social networks — specifically Facebook and Twitter — and hate crime. That conclusion, from two recent papers by researchers at the University of Warwick, England, may not in itself require swift policy action. But the methods used to reach it could be used to answer other questions about the relationship between social media and the real world — such as how much Russia’s Facebook and Twitter trolling affects election results. (Leonid Bershidsky, 8/22)

New England Journal of Medicine: Adolescents’ Use Of “Pod Mod” E-Cigarettes — Urgent Concerns
Adolescents’ use of electronic cigarettes initially took the public health community by surprise. In 2011, less than 2% of U.S. high school students reported having used e-cigarettes in the previous month. But by 2015, the percentage had jumped to 16%. The following year, the U.S. Surgeon General issued a report concluding that e-cigarette use among young people was “a public health concern.” Ensuing public education campaigns and policies helped bring the prevalence of past-month e-cigarette use among U.S. high school students down to 11% in 2016. A recent evolution in technology and marketing may threaten this progress. A new product class called “pod mods” — small, rechargeable devices that aerosolize liquid solutions containing nicotine, flavoring, and other contents encapsulated in cartridges (see image) — appears to be gaining traction. Media stories about Juul, a popular pod mod brand, highlight anecdotal reports from students, parents, teachers, and school superintendents indicating that use of these products is rampant among young people. (Jessica L. Barrington-Trimis and Adam M. Leventhal, 8/22)

New England Journal of Medicine: Radical Changes For Reproductive Health Care — Proposed Regulations For Title X
On June 1, 2018, the Department of Health and Human Services (HHS) proposed new regulations for the Title X Family Planning Program. If enacted, these regulations will radically alter the mix of health care providers and the range, quality, and effectiveness of services offered to support the reproductive health and childbearing decisions of low-income women, men, and adolescents in the United States. In addition, the new regulations will constrain the ability of clinicians within the system to follow professional recommendations for respecting patients’ autonomy and ability to make informed choices about childbearing and health care. The American Medical Association, the American College of Physicians, and eight specialty physician, nursing, and physician assistant organizations have issued statements opposing the proposed regulations. (Janet M. Bronstein, 8/23)

Real Clear Health: Drug Importation Is Fraught With Peril
As a licensed pharmacist, I’m all too familiar with patients’ difficulties getting medications they need and their physician has prescribed. As baby boomers age, pharmacists see more patients at our counters unable to obtain needed treatments for heart disease, high blood pressure, diabetes, and other chronic illnesses. This issue is now being acknowledged and a healthy debate has begun over possible solutions. But one idea policymakers shouldn’t pursue is opening up our country’s secure drug supply to medicines coming from outside our borders. (Kenneth McCall, 8/23)

Columbus Dispatch: Ohio Healthier, More Prosperous With Expanded Medicaid
A new report on Ohio’s Medicaid expansion gives more support for what was a controversial move by Gov. John Kasich four years ago. More low-income Ohioans can see health-care providers regularly and more can get treatment for addiction or mental illness, helping thousands get jobs or promotions that pay enough money so that they no longer need Medicaid. (8/23)

Missoulian: Montana Needs Affordable Health Care Coverage
Montana State Auditor Matt Rosendale wants the Affordable Care Act (ACA) gone. Rosendale doesn’t want to take responsibility for what his position means to the 425,900 Montanans who have pre-existing conditions, the 49,007 Montanans enrolled in the current ACA marketplace, or the 79,700 who would lose coverage if current attempts to dismantle the ACA succeed. Auditor Rosendale has claimed that the ACA is “causing tremendous pain for folks across the state.” In reality, the ACA opened the door for 58,100 Montanans to enroll in healthcare through Montana’s Medicaid. (Katie Mazurek and Amy Coseo, 8/22)

New England Journal of Medicine: The Republican War On Obamacare — What Has It Achieved? 
The ACA is stuck in purgatory, beyond comprehensive repeal but subject to a war of attrition that jeopardizes its gains. Such a campaign poses risks for Republicans. The politics of health care have fundamentally changed. Tens of millions of Americans are ACA beneficiaries; taking away their coverage and consumer protections is difficult. And as the party in power, Republicans are now responsible for Obamacare’s problems, which the Trump administration’s policies may worsen. Whereas resisting the ACA previously produced political benefits for the GOP, continued opposition could exact a price in coming years. The 2018 elections could further alter the political calculus, leading Republicans to either revive or retreat from repeal efforts. Yet the more the ACA is undermined, the further left U.S. health politics seem to shift. Threats to repeal Obamacare have increased Democrats’ support for single-payer health care and Medicare expansion. Thus, Republicans’ campaign against Obamacare could produce a transformation in U.S. health policy — just not the one that they envisioned. (Jonathan Oberlander, 8/23)

New England Journal of Medicine: A Remembrance Of Life Before Roe V. Wade
Jane did what thousands of young women were forced to do in the 1960s — she underwent a back-alley abortion. Though she had worried about going through with it, other young women she knew had used the same abortion doctor and had been fine. She went for the procedure with fear but determination. Unfortunately, afterward Jane was not fine at all: she developed sepsis and multiorgan failure. She survived after weeks of hospitalization and near-death episodes, along the way enduring a hysterectomy and severe acute kidney failure, with bilateral cortical necrosis. Acute dialysis saved her life. However, Jane’s kidney function thereafter was essentially nil, and she continued on thrice-weekly dialysis, donated as compassionate care by the hospital. Jane and her fiancé married while she was in the hospital, hoping that she would gradually improve, receive a transplant, and resume her studies. She told me she was sad that she would never have a biologic child, but she was full of plans for the future. A few weeks later, another complication developed — acute bleeding, with a hemothorax. I was the medical student on that dialysis shift, too. Jane was too ill to speak, though she was conscious and nodded hello, offering a weak smile. I chatted with her at the start of the dialysis run, but her status deteriorated, rapidly. There was a code. Though the team tried everything they could to resuscitate and stabilize her, she did not make it. We all cried. (Julie R. Ingelfinger, 8/23)

New England Journal of Medicine: Tickborne Diseases — Confronting A Growing Threat
The burden of tickborne diseases seems likely to continue to grow substantially. Prevention and management are hampered by suboptimal diagnostics, lack of treatment options for emerging viruses, and a paucity of vaccines. If public health and biomedical research professionals accelerate their efforts to address this threat, we may be able to fill these gaps. Meanwhile, clinicians should advise patients to use insect repellent and wear long pants when walking in the woods or tending their gardens — and check themselves for ticks when they are done. (Catharine I. Paules, Hilary D. Marston, Marshall E. Bloom and Anthony S. Fauci, M.D., 8/23)