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Health care bill vote - latest developments

House Republican leaders are supposed to be voting on their


Common sciatica pain drug no better than placebo

The widely prescribed pain drug pregabalin (brand name: Lyrica) may be no better than a placebo when it comes to treating the back and leg pain known as sciatica, a new clinical trial suggests.

The study , published March 22 in the  New England Journal of Medicine , found that sciatica patients improved to the same degree whether they were given pregabalin or placebo capsules.

Sciatica refers to pain that radiates along the sciatic nerve, which branches from the low back through the hips and down each leg, according to the U.S. National Institutes of Health. The pain typically shoots down the back of the leg, and some people also have numbness, tingling or muscle weakness.

The problem is caused by compression of the sciatic nerve — possibly from a herniated spinal disc.

Pregabalin is prescribed to treat various forms of nerve-related pain. In the United States, it’s officially approved for nerve pain related to diabetes or shingles, and certain other conditions.

Doctors also commonly prescribe pregabalin for sciatica. But the new study calls that practice into question.

“We do not recommend the use of pregabalin in people with sciatica,” said researcher Christine Lin, of the George Institute for Global Health and the University of Sydney in Australia.

Not everyone agreed, however.

Dr. Houman Danesh is director of integrative pain management at Mount Sinai Hospital in New York City. He said doctors should “be aware” of the study findings. But he was not ready to dismiss pregabalin as a sciatica option.

Most of the study patients had “acute” sciatica — which means they’d had symptoms for less than three months. Most people in the acute phase will, fortunately, improve with time.

“So these are the patients who are probably on their way to getting better anyway,” Danesh said.

It might be better, he said, to focus on patients who don’t improve and progress to chronic sciatica.

The study’s findings are based on more than 200 sciatica patients who were randomly assigned to take either pregabalin or placebo capsules for up to eight weeks. The starting dose of pregabalin was 150 milligrams per day. That dose was adjusted up to 600 mg daily, the study said.

At the outset, the intensity of their leg pain was just over a 6, on a scale of 0 to 10. That’s “severe” pain, Lin said.

At the end of the eight-week treatment period, patients in both groups were faring better. The average pain score in the placebo group had dipped to 3.1, versus 3.7 among pregabalin patients — a difference that was not statistically meaningful.

After one year, their pain was still hovering around a 3.

Pregabalin patients did, however, have more side effects while they were taking the drug. The main problem was dizziness, which affected 40 percent of people taking the drug.

What does it all mean for sciatica patients?

According to Lin, people who are already on pregabalin should talk to their doctor about what to do next.

“It is important


Eraser challenge social media dare dangerous to kids

It’s spreading via social media : A “dare” where kids use erasers to rub away the skin on their arms, often while reciting the alphabet or other phrases.

Players compare the resulting injuries, and the most injured player is the “winner.”

The so-called “eraser challenge” has been circulating for about a year — but it’s no joke, doctors warn.

“The eraser challenge may cause pain, burns to the skin, scarring, local infections,” said Dr. Michael Cooper, who directs the Burn Center at Staten Island University Hospital, in New York City.

With such injuries, “in severe though rare cases, life-threatening sepsis , gangrene and loss of limb may occur,” he noted.

East Iredell Middle School in Statesville, N.C., recently posted a warning on Facebook about the eraser challenge.

“Kids are rubbing an eraser across their skin while having to do or say something,” the school said in its post. “It’s causing serious burns and we’ve seen several cases of this.”

Parents! Do your children have any burn marks? The latest internet challenge is the "Eraser Challenge." Kids are rubbing...

Cooper concurred.

“The eraser challenge may appear harmless and an innocent show of bravado,” Cooper said. “However, the consequences may be lifelong disfigurement and even death, and like other ‘challenges,’ should be avoided.”

Dr. Robert Glatter is an emergency physician at Lenox Hill Hospital, also in New York City. He stressed that the risk of severe infections from the eraser challenge is a concern.

“Bacteria and dead skin cells can colonize erasers which have been rubbed on skin,” he explained. “Erasers, which can be made of synthetic materials such as vinyl, plastics and synthetic rubber, have crevices that provide a warm and moist environment for bacteria to thrive. People also put erasers in their mouths, making them a set-up for polymicrobial infections that may be challenging to treat.”

What to do? Glatter says parental monitoring and intervention is key .

“Parents need to have a frank discussion with their children about the dangers associated with the eraser challenge,” he said. “If you find unexplained abrasions or wounds on your child’s arms or legs, it’s vital to ask them if they have been engaged in this challenge.”

In one YouTube video, a boy shows viewers marks on the tops of both of his hands where he has rubbed his skin raw. He laughs, yells and winces as he pours antiseptic onto one of the injuries. At one point in the video, it appears that an adult walks by, looks at him and keeps walking.

Cooper noted that the eraser challenge isn’t the only harmful social media trend out there.

“The advent of social media, and the endless search for recognition and attention has made posting videos while performing dangerous and senseless acts both commonplace and widespread,” Glatter said.

“The ‘fire challenge’ causes self-inflicted , life-threatening flame burns from igniting lighter fluid or alcohol poured on the skin,” Cooper explained. “And, recently, a


Obamacare's essential health benefits could be in jeopardy

WASHINGTON  — Scrambling to nail down votes for the House health care bill , Republicans are considering ways to ease federal requirements that insurers cover such basic services as prescription drugs, maternity care and substance abuse treatment.

Lawmakers emerging from a meeting late Wednesday of the conservative Freedom Caucus said “essential health benefits” are in play as party leaders and the White House explore ways to advance the House legislation . But undermining the Affordable Care Act’s benefits is likely to trigger a backlash from patient groups and doctors.

It’s also a tricky proposition for Republican lawmakers, because Democrats are certain to challenge any such move as out-of-bounds under special budget rules that would allow the GOP health bill to clear the Senate with just 51 votes. Until now, the ACA’s benefit requirement had not been considered a budgetary issue.

Traditionally, states have regulated the benefits that health insurers offering plans to individual consumers must provide. But the Obama-era health care law set a minimum floor for the whole nation.

The ACA’s “essential benefits” include outpatient care, emergency services, hospitalization, pregnancy, maternity and newborn care, mental health and substance abuse treatment, prescription drugs, rehabilitation, laboratory and diagnostic tests, preventive and wellness services, and pediatric care, including dental and vision services for kids.

In a letter to congressional leaders early this year, organizations representing nearly 400,000 doctors said “all health insurance products should be required to cover evidence-based essential benefits” in any new health care legislation. The letter was signed by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American College of Physicians. Many other organizations have taken a similar stance.

The required benefits are considered especially significant for women, since birth control and other routine women’s health services are now covered at no charge to patients.

Some White House officials have also acknowledged privately that essential health benefits are among the list of potential changes under discussion. While declining to elaborate on specifics, spokeswoman Sarah Huckabee Sanders said, “We’re open to changes that help make the bill better.”

Republican advocates of undoing the federal benefits requirement say it drives up the cost of insurance. For example, before the ACA, a married couple in their early 60s might be able to purchase a policy that did not include maternity benefits. Now, the cost of caring for pregnant women and newborns is spread among the entire pool of people purchasing individual policies.

Doctors say plans with cherry-picked benefits have a way of backfiring on consumers, because you can never tell in advance what kind of medical care you might need.

“We need benefits to make insurance meaningful,” said Dr. John S. Meigs Jr., president of the family physicians association. “I’m afraid if they get rid of the essential benefits, you’ll have meaningless insurance. Meaningless coverage.” He practices in Centreville, Alabama.

But Republicans say consumers should have a choice of the benefits they purchase, and the entire issue is best left


GOP health care bill: Why some Republicans are opposing it

House Republican leaders are putting their health care bill to a vote Thursday evening, but it is at this point not evident that they have the votes they’ll need to pass the bill. They can lose up to 22 members, assuming that no Democrats will support the bill. Here’s the most current count of the “no” votes , according to CBS News. 

Both conservative and moderate Republicans oppose the bill, though their reasons for their planned votes against the American Healthcare act vary -- these are some of the problems they’ve cited:

It’s not a full repeal

Conservatives are angry that the measure isn’t a full repeal of Obamacare and have dubbed it “Obamacare lite.” Groups like Americans for Prosperity (AFP) and FreedomWorks have announced that they are “key voting” against lawmakers who vote in favor of the bill, that is, they will count the votes against those lawmakers in their conservative ratings.

“Republicans in Congress promised a full repeal of Obamacare, but the current plan falls far short. It leaves intact some of the most harmful aspects of the law, including burdensome regulations that send insurance costs spiking and federal subsidies rebranded as tax credits,” said AFP’s Chief Government Affairs Officer Brent Gardner.

In an interview last week with Fox Business’ Maria Bartiromo, Speaker Paul Ryan, R-Wisconsin, said, “We don’t have the votes for just a full repeal because so many of our members and the president included said repeal and replace. And if we just did a repeal with reconciliation -- meaning 51 votes -- and not replace, then we wouldn’t be able to get a replacement passed because they can filibuster a replace.”

Under a certain rule within the budget reconciliation process, a full repeal of President Obama’s signature healthcare law would be difficult to achieve anyway.

It won’t lower insurance premiums

This may be the most oft-cited reason for opposing the GOP bill -- the claim that it will do nothing to lower insurance premiums for most Americans. This is true at least in the short term.

In fact, the Congressional Budget Office estimated that average premiums for single policy holders would rise 15 to 20 percent under the new law in 2018 and 2019. It’s worth noting that the increases would only be for the first few years of the new law: starting in 2020 they will begin to decline, the CBO projects, and would be an estimated 10 percent lower than current premiums by 2026.

However, some Republicans -- including Sen. Ted Cruz (R-Texas) have said even the short-term increase in premiums is unacceptable. Cruz told CBS’ “Face the Nation” on Sunday that he wouldn’t vote for the bill as it stands for one main reason: “premiums, premiums, premiums.”

“I’ve got to tell you, if Republicans hold a big press conference and pat ourselves on the back that we’ve repealed Obamacare and everyone’s premiums keep going up, people will be ready to tar and feather us in the streets,” he said. “And quite rightly.”

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