Gun Violence Awareness Month

June is Gun Violence Awareness Month. In 2017, there were 39,773 deaths in the United States involving guns; 23,854 were suicides. This is almost 3,000 more people killed with guns than the previous year ⁠— it is an increase of 10,000 from 1999 and the highest it has been since gun mortality data was first recorded in 1979. Nearly 109 people died every single day from gun violence in 2017. For Gun Violence Awareness Month we are highlighting the public health crisis and the barriers that are keeping effective prevention from being implemented.

 

Before 1996 the Center for Disease Control & Prevention (CDC) was charged with researching gun violence, much in the way that the CDC researched deaths from car crashes and the life-saving effects of seatbelts and child car seats. Following a 1993 study that connected gun ownership with a higher risk of being the victim of a homicide by a family member or intimate acquaintance, the National Rifle Association (NRA) responded by lobbying for the elimination for the CDC’s Center for Injury Prevention. While the Center for Injury Prevention remained, the 1996 federal budget included an amendment proposed by Rep. Jay Dickey forbidding the CDC from “advocating or promoting gun control” as well as cutting their budget by the exact amount the CDC had spent on firearm injury research the year prior. While not explicitly barring the research of gun violence, the language of the Dickey amendment and budget cuts created an environment where few within the CDC were willing to risk their careers by pushing for research that could be misinterpreted as advocating for gun control laws as opposed to advocating for public health. Last year, the CDC has called its information about gun injuries “unstable or potentially incorrect” by its own standards.

Independent researchers have found Americans are more likely to die by an assault with a firearm than riding inside an automobile, and only marginally more likely to die from an accidental gunshot as opposed to being the victim of a mass shooting. Any death by firearm is more likely in the U.S. than the combined risks of drowning, fire and smoke, stabbing, choking on food, airplane crashes, animal attacks, and natural disasters including hurricanes, tornadoes, earthquakes, floods, or lightning strikes. Children in the U.S. are twice as likely to be killed with a gun than to die from cancer.

 

Gun violence appears to be a unique problem to the United States among countries not in open warfare or deeply corrupted by criminal organizations. There are those that blame gun violence on depictions in movies or video games despite these same forms of entertainment being available throughout the developed worldThe United States consists of less than 5% of the world’s population, though has more than 42% of the civilian-owned guns on Earth. When comparing crime on a whole, the United States has an average amount compared to similar countries; the only outlier in U.S. crime is gun violence.

Gun violence is a public health crisis in the United States. The price of lives lost and the consequences for the victims’ families, friends, and communities is truly immeasurable. The economic cost, however, can be measured: $229 billion every year; $12.8 million every day. These costs include medical treatment, long-term medical and disability expenses, mental health care, emergency services, legal fees, long-term prison costs, police investigations, and security enhancements. Even students and teachers who participate in active shooter drills can experience profound mental or emotional distress.

 

Gun violence is preventable, but requires a comprehensive public health approach to keep families and communities safe. Research can garner insight into the causes of gun violence and assess the impact of interventions; identify risk factors associated with gun violence and protective factors that protect against it; develop, implement, and evaluate interventions to reduce risk factors; and institutionalize successful prevention strategies. Doctors are advocating for the use of hard nonpartisan data to ground policy instead of rhetoric.

The debate on gun rights in the United States is fraught with complexities and strong emotions from all points of view. As a nonprofit healthcare information resource, it is not appropriate for us to comment on all aspects of the debate. We at NeedyMeds prefer to remain apolitical — we work in a diverse office with people of varying backgrounds and views — however, NeedyMeds does support the open and effective research into gun violence and for recommendations to be made in the interest of public health. Without research, any governmental proposals to fix or prevent the gun violence issue in the United States could be formed by baseless conjecture or discouraged altogether. Jay Dickey, the author of the 1996 amendment barring the CDC from “advocating” gun control, later worked with Mark Rosenberg, the author of the 1993 study that incited the NRA lobbying against studies into gun violence, regretting his addition to the legislation and intimated that “We won’t know the cause of gun violence until we look for it.”

NeedyMeds encourages Americans to be active in the legislative process: If you have an opinion on important public health issues in the United States, call 202-224-3121 to reach the U.S. Capitol switchboard; from there you can be connected to your elected House Representative or Senator’s office.

 

For those who have been the victim of a violent crime in the United States, there are victim compensation programs in all 50 states and Washington, D.C. These programs help victims of rape, assault, child sexual abuse, drunk driving, domestic abuse, as well as families of homicide victims. Compensation programs can cover medical bills, mental health treatment, and often includes crime-scene cleanup, travel costs to receive treatment, moving expenses, or even the cost of housekeeping or child care if the victim is unable to do so. The programs are often flexible with their eligibility, though most require reporting the crime to police within a specified time frame and cooperating with the investigation. You can find NeedyMeds’ listings for the crime victim compensation programs in our Diagnosis-Based Assistance Database under Violent Crimes. For more help finding information, call our toll-free helpline Monday-Friday 9am-5pm Eastern Time at 1-800-503-6897.

Men’s Health Week 2019

Last month, we had National Women’s Health Week. For the month of June there is Men’s Health Week, designed to encourage men to make their health a priority. The Center for Disease Control and Prevention (CDC) has many tips for men to improve their health, and we at NeedyMeds have resources for a number of conditions that predominantly affect men.

The CDC offers many ways to observe National Men’s Health Week, such as taking a bike ride, aim to eat healthier, or quit unhealthy habits. Men can improve their health by getting a good night’s sleep, quitting tobacco and avoiding second-hand smoke, being more active in daily life, eating healthier, and managing stress. Being aware of your own health is important as well. Be sure to see your doctor for regular check-ups and get tested for diseases and conditions that may not have symptoms until there is an imminent health risk. Testicular and prostate cancers are easily detected with regular checks. Men are encouraged to begin yearly screenings at 40-50 years of age, especially if you have a family history.

 

For men over 45 years of age, the most common causes of death are heart disease and cancer. Heart health is important for men and women of all ages and cancer can affect different parts of the body, including those that may appear atypical — 1% of breast cancer diagnoses are found in men, and transgender men are at risk for ovarian or cervical cancer.

For men younger than 45, the most common causes of death are accidental injuries and suicide. As with heart health, mental health is important to people of all ages and gender. Men are affected by a cultural/traditional portrayal of masculinity that can be detrimental. Toxic masculinity is often associated with a culture that negatively affects women, but men also suffer while traditional thinking discourages them from displaying any emotion other than anger. Even as children, young boys are told to “man up” and “not cry like a girl.” When feelings are dismissed and gender-defining thinking is promoted, a young person learns to avoid expressing themselves in a healthy way. Over time such behavior can lead to a dysfunctional emotional expression, which can be isolating especially for young people. Coupled with the traditional idea of men as the dominant sex can lead to unnecessary violence when they become emotional. Toxic masculinity can dissuade a man with serious mental illness from seeking help. Men should be shown empathy and encouraged to be sincere with their feelings and mental health. The idea that showing emotion is weak is false and unhealthy, but there is only so much that can be done short of a societal shift in how men think about mental health. If you or someone you know are experiencing a mental health crisis or suicidal feelings, call or text Samaritans at 877-870-HOPE (4673) any time if you need help.

 

NeedyMeds has information for many programs and clinics that offer assistance to men in need. There are several organizations offering varying kinds of assistance to men with prostate cancer and other diagnoses in our Diagnosis-Based Assistance area of our website. There are also free or low-cost clinics that offer men’s health services. Search your local area on our website and look for “Men’s Health” listed with Services. We also have listings for mental health clinics. For more help finding information, call our toll-free helpline Monday-Friday 9am-5pm Eastern Time at 1-800-503-6897.

Migraine and Headache Awareness Month

June is Migraine and Headache Awareness Month. A vital part of awareness is knowing that migraines are much more than just a bad headache. Migraine is a neurological disease with incapacitating neurological symptoms that affects over 39 million men, women, and children in the United States. Most people who experience migraines get them once or twice a month, but more than 4 million are affected by daily chronic migraine with at least 15 days of debilitating symptoms every month.

Everyone has headaches, but not everyone has migraines. Migraine involves nerve pathways, brain chemicals, and often runs in families but also has environmental factors. There are four stages of migraine: prodrome, aura, headache, and postdrome. It is possible to cycle through all the phases in an episode, or only experience one, two, or three of them. Each attack can vary from the ones before it.

 

The prodrome is also known as “preheadache” and can last several hours or even days. Most people with migraine experience this phase but may not be aware at the time. The symptoms include irritability, depression, increased urination, food cravings, sensitivity to light or sound, difficulty concentrating or sleeping, yawning, fatigue and muscle weakness, and nausea. It is possible to take steps to lessen the severity or prevent altogether the oncoming headache by taking medication, minimizing/avoiding triggers, or biobehavioral techniques such as meditation or relaxation therapy.

Up to one-third of people with migraine experience an aura which presents with blurry vision, the appearance of geometric patterns, flashing or shimmering lights, blind spots in one or both eyes, or tunnel vision. Aura symptoms usually gradually appear over five minutes to an hour, and may serve as another warning of an impending headache. About 20% of migraine sufferers can have an aura last longer than 60 minutes, or occur with the headache instead of before.

The headache phase of a migraine attack is usually characterized by severe throbbing recurring pain on one side, though a third of attacks affect both sides of the head. A migraine headache can last from a few hours to several days. The severity of the headache can vary from person to person and episode to episode, with some causing only mild pain while others are truly incapacitating. Besides the pain, symptoms of the headache phase include nausea, inability to sleep, anxiety, and sensitivity to sound, light and smell. Any amount of physical activity can exacerbate the symptoms in this phase, making everyday activities difficult if not impossible.

The postdrome is also known as the “migraine hangover.” This final stage affects most people after the headache phase, though it may not follow every migraine attack and the length may vary. Symptoms of this phase include fatigue, body aches, trouble concentrating, dizziness, and sensitivity to light. Even though the headache is over, the postdrome can be equally as debilitating. People in the postdrome phase are still experiencing a migraine attack and can benefit from avoiding triggers and find some relief in relaxing activities, drinking water, and avoiding stress.

 

Every 10 seconds someone in the U.S. goes to the emergency room complaining of head pain, with acute migraine attacks being the cause of 1.2 million ER visits every year. Migraines affect 18% of women, 6% of men, and 10% of children. Before puberty, boys are affected more than girls, but during adolescence the risk of migraine and its severity rises in girls. Half of all migraine sufferers have their first attack before the age of 12. Migraine has even been reported in children as young as 18 months. Infant colic has even been found to be associated with childhood migraine and may even be an early form of migraine.

Healthcare and lost productivity costs associated with migraine are estimated to be as high as $36 billion annually in the United States. Healthcare costs are 70% higher for a family with a migraine sufferer than a non-migraine affected family; nearly 25% of U.S. households includes someone affected by migraine. Migraine sufferers, like those who suffer from other chronic illnesses, experience the high costs of medical services, too little support, and limited access to quality care. In 2018, there were about 500 certified headache specialists in the U.S. and 39 million sufferers. The vast majority of migraine sufferers do not seek medical care for their pain.

 

NeedyMeds has a database of over 17,000 free, low cost, or sliding scale clinics. Search your ZIP code for clinics in your area. Assistance for sufferers of chronic migraine and pain can be found in our Diagnosis-Based Assistance Database database. We also have a database of Patient Assistance Programs (PAPs) that provide prescription medications at low- or no cost. Search your medication (brand name or generic) and see if there are any programs available. Check our website at Needymeds.org for more resources or call our toll-free helpline at 1-800-503-6897, 9am to 5pm Eastern Time Monday through Friday.

Are the Health Risks of Smoking Reversible?

by Mark A. Kelley

This blog originally appeared on HealthWeb Navigator.

As a lung specialist, I am often asked whether the body can recover from many years of smoking. Based on decades of research, the answer is a resounding “Yes” … but only if you quit smoking — completely.

 

What Are The Risks of Smoking?

Cigarette smoking kills over 480,000 Americans each year — more than the combined deaths from alcohol, illegal drug use, homicide, suicide, car accidents, and AIDS combined.

Cancer – Before cigarette smoking became widespread in the twentieth century, lung cancer was a rare disease. However, as smoking became popular, lung cancer rose to become a leading cause of death. Scientific research demonstrated that the toxic chemicals in cigarette smoke are carcinogenic. Smoking is also associated with cancers of the throat and digestive tract.

Heart and Vascular Disease – There is a strong association between smoking and the development of atherosclerosis, the “hardening of the arteries” that causes heart attacks, strokes and aneurysms. These conditions are among the major causes of death in smokers. A heart attack is 2-4 times more likely in a smoker than a non-smoker. Quitting smoking is the single most effective way to reduce the risk of a future heart attack.

Lung Injury and COPD  – A person’s first puff from a cigarette invariably causes coughing. This is the body’s warning sign that inhaled smoke is damaging the lungs. Cigarette smoke irritates the lung’s bronchial tubes, causing mucus production. The smoke also paralyzes the cells that clear mucus and debris out of the lung. Over time, cigarette smoke causes mucus plugging, swelling and, sometimes, destruction of the bronchial tubes. This makes the lung more vulnerable to infections. When bronchial tubes are blocked or distorted, it is also much harder to move air in and out of the lung. This condition, called chronic obstructive pulmonary disease (COPD), is a leading cause of death and disability.

Nicotine Addiction – Nicotine is one of the most addictive substances known — often compared to heroin. Nicotine withdrawal produces symptoms similar to opiates, which is why is it so difficult to quit smoking. Cigarette smoke delivers nicotine immediately to brain areas associated with pleasurable sensations. Nicotine also increases heart rate and blood pressure, and constricts blood vessels.  This puts strain on the heart and promotes vascular disease.

 

If You Quit Smoking, Health Risks Fall Dramatically.

Cancer – Smoking cessation for 10 years cuts the risk of lung cancer in half. The reason is that the lung is no longer exposed to the carcinogens in cigarette smoke. With continued abstinence from smoking, the risk continues to decline. Similar results have been seen with laryngeal and other forms of cancer.

Heart and Vascular Disease – For someone with known coronary artery disease (CAD), smoking cessation reduces the risk of a future cardiac event by 50%. For someone without CAD, quitting smoking for one year reduces the risk of CAD by 50%. If abstinence continues for 15 years, the risk of future heart events is almost the same as a lifetime non-smoker. The same is true for the risk of stroke.

COPD – Smokers expose their lungs to the constant irritation of cigarette smoke, and have a faster decline in lung function than non-smokers. This decline occurs slowly and is not noticeable until the lung function is so low that it affects everyday activity. At that point, smoking cessation will reduce lung irritation but the chronically diseased lung cannot repair years of damage. The best strategy is to stop smoking before significant damage has occurred. The good news is smoking cessation can halt the rapid decline in lung function before more damage occurs.

Nicotine Addiction – Most smokers want to quit smoking but nicotine withdrawal is a major obstacle. As the old saying goes, “if it were easy, everyone would do it.” Most smokers who try to quit fail multiple times. However, the encouraging statistic is that millions of Americans have kicked the habit. The best results come from planned programs to break the nicotine addiction and eliminate lifestyle habits associated with smoking.

 

In summary, smoking has life-threatening health care risks.  Once a person stops smoking, these risks decline significantly over time. While kicking the habit is challenging, the health benefits are enormous. It is never too late to quit.

For more information about smoking and health risks,  see the Centers for Disease Control (CDC) and the American Lung Association.

Meeting the Medicine Information Needs of Americans with Vision Loss  

The Facts

Photo by Nathan Dumlao

More than 3.4 million (3%) Americans aged 40 years and older are either legally blind (having visual acuity [VA] of 20/200 or worse or a visual field of less than 20 degrees) or are visually impaired (having VA of 20/40 or less). The Federal Interagency Forum on Aging Related Statistics estimates that 17% of the age 65 and older population report “vision trouble.” Twenty-one million Americans report functional vision problems or eye conditions that may compromise vision. Older people are more likely to experience vision loss because of age-related eye diseases.

Prevalence of Visual Disability

The following estimates (for adult’s age 16 and older reporting significant vision loss, who were in the non-institutionalized, civilian population) are derived from the American Community Survey results for 2016, as interpreted by Cornell University’s Employment and Disability Institute (EDI), unless otherwise credited.  

The number of non-institutionalized, male or female, ages 16 through 75 +, all races, regardless of ethnicity, with all education levels in the United States reported to have a visual disability in 2016:

  • Total (all ages): 7,675,600 (2.4%)
    • Total (16 to 75+): 7,208,700 (2.83%)
      • Women: 3,946,300 (3.01%)
      • Men: 3,262,300 (2.65%)
      • Age 16 to 64: 4,037,600 (2.0%)
      • Age 65 and older: 3,171,100 (6.6%)

According to the American Foundation for the Blind (AFB), a rapidly increasing proportion of the aging adult population experiences eye problems that make simple daily tasks difficult or impossible, even when wearing glasses or contact lenses.  The risk of severe eye problems has been found to increase significantly with age, particularly in those over age 65. More alarmingly, the trend is expected to continue to grow significantly as the baby boom generation continues to age. Experts predict that by 2030, rates of vision loss will double along with the country’s aging population.

The leading cause of vision impairment and blindness among older adults in the U.S. is age-related eye disease, including macular degeneration, cataracts, diabetic retinopathy, and glaucoma. Physiologic changes in vision that occur with age, such as loss of near focus, reduced contrast sensitivity, decreased color vision and some loss of peripheral (side) vision compound a reduction in visual acuity.

 

There are many medication safety issues associated with vision loss.  Low vision and blindness affect a person’s ability to read prescription labels and information sheets about medications, determine the color and markings distinguishing a medication, and see gauges on testing devices. People who cannot read prescription labels or distinguish among different medications must rely on memory or depend on someone else for help, and may not take their medications correctly or at all.  Not all vision loss is the same and the issues differ depending on the nature of the visual impairment. For example, the needs of people with glaucoma who have tunnel vision are different from those with macular degeneration who have central vision loss. Also, individuals who are blind have different issues from individuals with low vision. Individuals who are blind may need audible devices, tactile devices, or Braille.

 

Addressing a Growing Problem

In response to a federally-mandated effort to increase access to medications for all populations, in 2013, the U.S. Access Board created a series of recommendations focusing on adults who are blind or visually impaired and especially older adults many of whom are older than 60 years and may be more likely to take multiple medications and have caregivers or family members helping administer their prescriptions. The recommendations are contained in a report, “Best Practices for Making Prescription Drug Container Label Information Accessible to Persons Who are Blind or Visually-Impaired or Who are Elderly.” This guidance is advisory only and not mandatory. Pharmacies are not obligated to follow the best practice recommendations.

  • Here are a few other tips to share:
    • Safely dispose of medication once it is expired. This will help reduce the number of bottles sitting around unnecessarily and can help cut down on drug diversion.
    • Use dark trays, as they provide the best contrast against most medications. 
    • Keep a light or magnifying glass near where you take your medicines each day.  

 

 

(With permission from the American Pharmacists Association, this blog was adapted from “Counseling patients who are blind or visually impaired,” Pharmacy Today, Page 26, March 1, 2014)

BeMedWise

BeMedWise was launched in 2017 by the National Council on Patient Information and Education (NCPIE). NCPIE was established in 1982 in Washington, D.C. as one of the original patient safety coalitions. It became recognized as a trusted source of educational resources for patients, caregivers, healthcare professionals and the general public.

In July 2018, the operation of NCPIE and its programs, including ground-breaking research on patient-healthcare provider engagement and medicine communication, were assumed by NeedyMeds. Harnessing the expertise and reach of the BeMedWise partners, committed stakeholder groups and program sponsors, BeMedWise will sustain the NCPIE mission to improve health and stimulate high-quality medicine safe use conversations between healthcare professionals, patients, and caregivers.