Are Yearly Body Exams An Answer To Rising Skin Cancer Rates?

Date:April 29, 2017

Source:University of California, Los Angeles (UCLA), Health Sciences

photo of DermatologistAs rates of skin cancer, or melanoma, rise for men and women in the United States, health experts are debating the effectiveness of annual total body examinations in helping to detect the disease in its earlier stages. Skin cancer is the most common form of cancer in the United States.

Routine full body exams for skin cancer are not usually part of the annual physical exams performed by primary care providers and non-dermatology specialists. Last year, the U.S. Preventive Services Task Force, an independent panel on preventive and primary care, concluded that there is insufficient evidence to recommend routine full body skin examinations for adult patients.

However, a group of dermatologists and oncologists published an article in the March issue of the journal Future Medicine asking the preventive task force to revise its stance on full body skin inspections. In the journal article, the authors disagreed with the task force’s findings and the physicians who authored the article stated that routine body screening of “high risk” individuals could help reduce skin cancer deaths.

As summer nears and more people prepare to go out in the sun, Dr. Philip Scumpia, a dermatologist and dermatopathologist, says there are conflicting recommendations over full body skin inspections.


Negotiating Drug Prices: Should CA State Agencies Band Together?

California Drug Price Relief Bill, logoCiting budget-busting drug costs, a California lawmaker wants state health programs to band together to negotiate better prices with drug companies.

Assembly member David Chiu (D-San Francisco) has introduced a bill that would strengthen intra-agency collaboration on drug cost-saving strategies. Lawmakers will consider the bill at an Assembly Health Committee hearing on Tuesday.

“Californians and Americans are frustrated with the lack of progress around drug prices,” Chiu said, citing the uproar over EpiPen and hepatitis C medications.

He said state agencies should pool their efforts “so that we can leverage that consumer power and get the best deal for our money.”

While the proposed California Drug Costs Reduction Act does not mandate that various California health programs such as Medi-Cal or Covered California purchase drugs together, it would require administrators of those programs and 17 other state agencies to convene twice a year to strategize about ways to keep costs down.Through the California Pharmaceutical Collaborative (CPC), state officials would consider a uniform state drug formulary and look at paying for drugs based on the value they bring to the health system.

A pharmaceutical collaborative by that name already exists within the California Department of General Services and purchases drugs for state prisons, hospitals and universities. This bill would expand on those efforts.

Chiu says it’s unclear what the current program is doing, and if it has been successful in bringing down drug costs. The 2002 legislation that created the collaborative required only a few agencies to participate, and only one report back to the legislature in 2005.

Continue reading Negotiating Drug Prices: Should CA State Agencies Band Together?

6 Steps to Identify and Address Mental Health Challenges Early

April 20, 2017 by Leave a Comment

mental health issues at workThe days of focusing solely on an injured worker’s physical injuries are over. Savvy employers and payers are finding that ignoring behavioral issues can end up costing a boatload of money in delayed recoveries. Early intervention, good communication and worker advocacy are among the best practices to use.

Injured workers who have, or develop undiagnosed and untreated behavioral health issues are more likely to fall into the ‘creeping catastrophic’ claim pool; a simple meniscus tear that degenerates into a months- or years-long claim with multiple treatments and medications — and exorbitant costs.

Identifying and treating these issues is tricky. The stigma attached to mental health issues prevents many people from seeking treatment; providers and claims handlers are often unfamiliar with signs and symptoms; and payers may be reluctant to pay for something they believe is unrelated to the actual injury. However, it behooves employers and other payers to at least consider ways to target behavioral health issues among their injured workers.

Behavioral Health Issues

Behavioral health issues — also called mental health or psychosocial — include a variety of diagnoses. Anxiety and depression are the ones more commonly seen among injured workers.

In addition to an extended duration of the claim, some signs that may indicate a psychosocial issue is present include:

  • Pain develops due to non-medical issues.
  • Function does not improve.
  • Multiple providers are involved.
  • Visits to the emergency room with drug seeking behavior.
  • Overutilization of treatments.
  • Catastrophic thinking.
  • Perceived injustice, toward the employer or others.

There are myriad reasons why some injured workers develop psychosocial issues, related to such things as adverse childhood experiences, environmental stimuli or genetics. The important thing is to identify them and intervene as early as possible.


Workers’ Compensation in the Agriculture Industry

September 12, 2012 by

sign that reads, "I'm making agricultural safety and health part of my lifestyle."Workers’ compensation insurance for employers in the agriculture field is normally provided by insurance carriers who market to this field. The cost of coverage is about average (except for livestock farms and stables which runs about double other farming operations). The frequency and severity of claims is comparable with other industries.

Agriculture operations are found in every state with most businesses tending to be small in the number of permanent employees, but with some large operations with large payrolls. Among the large operations are agri-businesses. These are very different than family farm-type operations.

  • Physical hazards include machinery, exposure to insecticides and herbicides, various types of manual labor and heavy lifting.
  • Safety issues include those related to working with equipment and/or machinery with moving parts, using proper protective gear and knowing proper lifting techniques.
  • Occupational illnesses do occur when proper protective gear is not used with the application of insecticides and herbicides.

The workforce of permanent employees is normally stable with experienced long-term employees. The cost of work comp coverage is impacted by the number of seasonal employees who are employed for short periods of time for planting in the Spring and harvesting in the Fall. Most seasonal employees have low levels of education, little or no understanding of workers’ compensation, and no loyalty to the employer due to the short duration of employment. In approximately half of the states seasonal employees are excluded from work comp coverage unless the business purchases a rider or endorsement adding coverage for seasonal employees.


Is PSA Now “OK”?

What the task force really said about the evidence on prostate cancer screening

by Kathlyn Stone  |  An associate editor with You can find her tweets at @KatKStone

illustration of PSA test, to screen or not to screenReading the headlines on the US Preventive Services Task Force’s (USPSTF) update to its prostate cancer screening guidelines, you might come away with the idea that the task force has completely reversed its 2012 recommendation against broad-based prostate-specific antigen (PSA) screening.

But that would be the wrong impression.

What the revised guideline does is make a slight change. It changes the recommendation for routine prostate cancer screening from a “D” (which discourages the service since “There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.”) to a “C (which means that physicians should “Offer or provide this service for selected patients depending on individual circumstances,” and that “There is at least moderate certainty that the net benefit is small.”)

The main point is that men who are candidates for testing (ages 55 to 69) should discuss the benefits and harms of the test with their doctors and make a personal decision about whether to take it.

Some news outlets engaged in grade inflation contributor Saurabh Jha, MBBS suggested, somewhat cheekily, that some urologists might want to temper their jubilation over this modest adjustment:


The prize for most misleading framing of this news comes from the Washington Post whose headline proclaimed: “The federal panel that opposed prostate cancer screening just changed its mind.”


What Do Changing Demographics Mean for Workplace Health and Safety?

04/13/17  | Terry Bogyo

Graph of estimated median age of workers in selected countriesIf you knew your workforce was going to experience changing risks, increased exposure, longer recoveries from injury and greater effects associated with co-morbidities, you would act! The fact is, our workforce is changing and few organizations are even aware of the change let alone the consequences.

[This post contains slides and content arising from my presentation to the Occupational and Environmental Medicine Association of Canada (OEMAC) Scientific Conference September 2016].

The aging population is not just a North American problem.
The median age of the population in most industrialized countries is projected to rise dramatically. I adapted the following Pew Institute graphic to include Canada and Australia but its message is clear: over the next few decades, the median population age of many of the most important economies in the world is going to rise.

For Canada, the US and Australia, this shift to an older population will not be limited to the median age. Populations of older people are growing while birth rates are low or falling and immigration levels stagnant. Because demographics drives the demand for goods and services and provides the supply of workers, changing demographic patterns are altering the character and needs of the population, the labour force, the economy and more.

Continue reading What Do Changing Demographics Mean for Workplace Health and Safety?

Spinal Manipulation Can Alleviate Back Pain, Study Concludes

illustraion of x-ray style view of lower back pain

A study suggests spinal manipulation can reduce lower back pain for some people.

One of the most common reasons people go to the doctor is lower back pain, and one of the most common reasons doctors prescribe powerful, addictive narcotics is lower back pain.

Now, research published Tuesday in the Journal of the American Medical Association offers the latest evidence that spinal manipulation can offer a modestly effective alternative.

Researchers analyzed 26 studies involving more than 1,700 patients with lower back pain. The analysis found spinal manipulation can reduce lower back pain as measured by patients on a pain scale — like this one — from zero to 10.

Spinal manipulation, which is typically done by chiropractors, physical therapists, osteopaths, massage therapists and some other health providers, involves applying pressure and moving joints in the spine.

Patients undergoing spinal manipulation experienced a decline of 1 point in their pain rating, says Dr. Paul Shekelle, an internist with the West Los Angeles Veterans Affairs Medical Center and the Rand Corp. who headed the study.

“So if it had been a 7 it would be a 6, or if it had been a 5 it would be a 4,” Shekelle says. That’s about the same amount of pain relief as from NSAIDs, over-the-counter nonsteroidal anti-inflammatory medication, such as ibuprofen.

Continue reading Spinal Manipulation Can Alleviate Back Pain, Study Concludes

Studies Show Working Overtime Is Basically Pointless

How many hours per week do you work? If you run a business, there’s a good chance you’re putting in more than 40 hours. My guess is you’re working 50 or more hours per week — maybe more.

Don’t feel bad, you’re not alone. Despite the recent popularity of passive income and business automation, most entrepreneurs still work irregular hours and put in at least 60 hours per week.

For some of you, it may be tough to even answer the question about hours, because your workday blends seamlessly with the rest of the day. You’re at a point where you don’t even know what to call the part of the day you’re not working. (Maybe you just call it the “rest of the day.”)

It’s a sad reality, but somehow we’ve come to believe that it’s not only okay to work all the time, but that successful people actually strive to put in endless work hours. After all, opportunity never sleeps, right?

Opportunity does sleep.

Well, as it turns out, opportunity does sleep. It also takes breaks. It knows when it’s time to turn work off and it prefers that you do too. Researchers have found that putting in all those extra hours of work, specifically more than 50 hours, can end up being a waste of time from a productivity standpoint.

Here’s what research from IGDA says: “Productivity drops immediately upon starting overtime and continues to drop until, at approximately eight 60-hour weeks, the total work done is the same as what would have been done in eight 40-hour weeks.”

So, if 60 hours is too much, how many hours per week should we strive for? Well, a Stanford study found that when people worked more than 50 hours, output…


Smokers Have Help to Kick the Habit as Tobacco Tax Increases

Date: 3/28/2017

Contact: Ali Bay or Corey Egel | 916.440.7259SACRAMENTO 

Cigarette Tax Increases $2 on April 1

poster with the benefits of quiting smokingIn light of the new tobacco tax going into effect this week, the California Department of Public Health (CDPH) reminds Californians that resources are available to help them kick the habit.

On April 1, the tax on a pack of cigarettes will increase $2, from $0.87 to $2.87. This increase is a result of Proposition 56, the California Healthcare, Research and Prevention Tobacco Tax Act, which was approved by voters last November.

Californians who want help to quit smoking can call the California Smokers’ Helpline at 1-800-NO BUTTS. The helpline provides smokers free telephone counseling and plans to help them quit. The Helpline is staffed with trained counselors who are fluent in English, Spanish, Mandarin, Cantonese, Korean and Vietnamese. Additional resources and materials are available at

“We know most smokers want to quit, and paying more for their habit could be the extra motivation they need to make an important life-saving step,” said CDPH Director and State Public Health Officer Dr. Karen Smith. “Quitting smoking helps protect your physical and financial health. A smoker who quits today could save nearly $1,500 in just one year.”

Continue reading Smokers Have Help to Kick the Habit as Tobacco Tax Increases

WC Prescription Drug Spending Decreased 7.6% in 2016

photo of pills pouring out of pill bottle wraped in roll of $20 billsSt. LOUIS, Apr. 4, 2017 – Express Scripts (NASDAQ: ESRX) lowered prescription drug spending for workers’ compensation payers by 7.6 percent in 2016, according to the 11th edition of its Workers’ Compensation Drug Trend Report.

“In a year when many payers wrestled with drug price increases that dominated the news, Express Scripts protected clients from this impact,” said Dr. Brigette Nelson, senior vice president of workers’ compensation clinical management at Express Scripts. “By practicing pharmacy smarter, we helped clients balance appropriate care for injured workers while keeping costs down.”

Decrease in Opioid Use Drives Down Trend

 In 2016, opioids remained the most expensive therapy class at $391.35 per user per year (PUPY). Thirteen of the top 25 workers’ compensation medications were opioids.

However, for the sixth year, overall opioid trend decreased. In 2016, trend decreased 13.4 percent due to a combination of Express Scripts’ clinical solutions, aggressive client management, and state and federal opioid regulatory trends. Continue reading WC Prescription Drug Spending Decreased 7.6% in 2016