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After their younger son was bitten by a rattlesnake and ended up in the pediatric intensive care unit, a San Diego couple received a huge bill. Listen to hear why antivenom is so expensive.
This spring, a San Diego toddler spent two days in a pediatric intensive care unit after a rattlesnake bit his hand in his family’s backyard.
The bills that followed were staggering, with the lifesaving antivenom the 2-year-old needed accounting for more than two-thirds of the total cost — $213,000.
Why is antivenom so expensive? One explanation is the markup hospitals add to balance overhead costs and make money. Another explanation is a lack of meaningful competition. There are only two rattlesnake antivenoms approved by the Food and Drug Administration.
Stacie Dusetzina, a professor of health policy at Vanderbilt University Medical Center, said it can be difficult to sort out drug pricing because a hospital bill is often an instrument insurers and hospitals use to negotiate prices. Patients such as the Pfeffers often get stuck in the middle.
“When you see the word ‘charges,’ that’s a made-up number. That isn’t connected at all, usually, to what the actual drug cost,” Dusetzina said.
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You might notice a connection between headaches and your period or between migraines and birth control use. Fortunately, there’s help.
Many things can contribute to headaches, including family history and age. But people often notice a link between headaches and hormonal changes.
The hormones estrogen (ES-truh-jen) and progesterone (pro-JES-tuh-rohn) play key roles in the menstrual cycle and pregnancy. Hormones also may affect headache-related chemicals in the brain.
Having steady estrogen levels can improve headaches. But drops or changes in estrogen levels can make headaches worse.
However, you’re not completely at the mercy of your hormones. Your healthcare professional can help you treat or prevent hormone-related headaches.
The drop in estrogen just before your period may cause headaches. Many people with migraines report that they have migraines before or during their periods, also known as menstruation.
You can turn to proven treatments for migraines related to hormone changes. These treatments include:
If you have several very bad headaches a month, your healthcare professional may recommend taking NSAIDs or triptans before a headache begins. This may mean taking a headache medicine a few days before your period if you have regular menstrual periods. Then continue taking it during your period.
If you have migraines throughout the month, your healthcare professional may recommend that you take medicines every day. This also may be recommended if your periods aren’t regular. Daily medicines might include beta blockers, antiseizure medicines, calcium channel blockers, antidepressants or magnesium.
Your healthcare professional also might recommend monthly injections of a calcitonin gene-related peptide monoclonal antibody. The injections may help prevent headaches, especially if other medicines haven’t worked.
To decide which medicines may be right for you, your healthcare professional also reviews any other medical conditions you have.
Lifestyle changes also may help you have fewer headaches. These changes can shorten the headaches or help make them less painful. Lifestyle changes include reducing stress, not skipping meals and exercising regularly.
Hormonal contraception can change headache patterns. It can improve headaches in some people but might make them worse in others. Hormonal contraceptives include birth control pills, patches or vaginal rings.
Birth control may help relieve headaches by minimizing the drop in estrogen that happens during a period. You may have fewer migraines. Or your migraines may be less painful.
Using hormonal birth control to prevent migraines may be right for you if you don’t smoke and if you don’t have migraine with aura. But if you smoke or experience aura, talk with your healthcare professional before starting birth control that contains estrogen.
Migraine with aura means having nervous system symptoms before or during a migraine. You might see flashes of light or notice blind spots in your vision. Or you may have other vision changes. You might feel tingling in your hands or face. Rarely, migraine with aura can cause trouble speaking, problems using language or weakness on one side of the body.
Talk with your healthcare professional if you have migraine with aura. If you have new bouts of vision changes, sensory changes, weakness or trouble speaking without a migraine, seek medical care right away. This is true especially if you haven’t experienced these symptoms before.
If you have a history of migraine with aura, it’s important that you don’t take estrogen if you smoke. Smoking while taking birth control that contains estrogen puts you at higher risk of having a stroke.
While birth control can help relieve headaches for some, it may trigger headaches for others. But headaches might only occur during the first month of taking birth control. Talk with your healthcare professional if birth control triggers your headaches.
If birth control seems to cause your headaches, your healthcare professional might recommend:
Migraines often improve or even stop during pregnancy. This may be because estrogen levels rise quickly in early pregnancy and stay high throughout pregnancy. However, tension headaches usually won’t improve, as they aren’t affected by hormone changes.
If you have regular headaches, it’s important to talk with your healthcare professional about medicines that are safe during pregnancy. Have this conversation before getting pregnant. Many headache medicines can have harmful effects on a developing baby or their effects are not known.
If your headaches go away during pregnancy, they might return after delivery. This is because of the sudden drop in estrogen levels that happens after giving birth. It also may be due to stress, a change in eating habits and lack of sleep.
If headaches return while you’re breastfeeding, talk with your healthcare professional about which medicines are safe to take.
Hormone-related migraines may become more frequent and painful during the years leading up to your last period, known as perimenopause. This is because hormone levels rise and fall as you approach your last period. You’ve reached menopause once you don’t get any more periods.
For some people, migraines improve once periods stop. But tension headaches often get worse. If your headaches continue, you likely can stay on your medicines or use other therapies.
Hormone replacement therapy, also known as HRT, is sometimes used to treat perimenopause and menopause. HRT may worsen headaches in some people, and it may improve headaches in others. Or it may cause no changes. If you’re taking HRT, your healthcare professional might recommend an estrogen skin patch. The patch provides a low, steady supply of estrogen.
If HRT makes your headaches worse, your healthcare professional might lower the estrogen dose. Or you might try a different form of estrogen or stop the hormone replacement therapy.
Talk with your healthcare professional if you’re considering taking HRT and you smoke.
Some people are more sensitive to the effects of hormones. If headaches are affecting your daily activities, work or personal life, ask your healthcare professional for help.
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Nov. 20, 2024
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The London Clinic and Northwestern Medicine are teaming up for a strategic international collaboration that seeks to expand both organizations’ commitments to advancing healthcare delivery and improving patient outcomes.
WHY IT MATTERS
The London Clinic is one of the U.K.’s largest independent charitable organizations. Al Russell, CEO of the London Clinic, called the partnership with the Chicago-based health system a “defining moment” in the independent hospital’s history.
“Not only have we found a partner that shares the same not-for-profit values, but one with the scale that will give our charity access to the resources we need.”
While the clinic said it will draw on Northwestern’s healthcare innovation, technology experience and research to improve patient outcomes and increase its community impact, the nonprofit academic health system said it is also seeking to build partnerships with other international healthcare organizations.
In addition to a shared commitment to expanding community outreach and access to care, the collaborators will combine clinical expertise to deliver better care through innovative and advanced treatment and share best practices to optimize operational efficiencies.
THE LARGER TREND
Northwestern Medicine has leveraged cutting-edge technologies in its focus to improve clinical decision-making and increase access to care.
Through partnerships with Dell’s AI Innovation Lab and Dell Technologies, the health system has helped to develop artificial intelligence to advance the practice of medicine in working to develop generative multimodal large language models that can be integrated into hospital workflows, such as evaluating chest X-rays.
“When we think about what AI can do, we don’t just see the technology itself; we see the many patients and lives it will positively impact,” Dr. Mozziyar Etemadi, Northwestern’s medical director of advanced technologies, said in a statement in August.
ON THE RECORD
“Driven by our Patients First mission, we believe this strategic collaboration has the potential to redefine patient care and accelerate our ability to learn and share from a like-minded organization with an exceptional reputation for clinical care,” said Dr. Howard Chrisman, Northwestern’s president and CEO, in a statement.
“Leveraging the expertise of both organizations will enhance our collective ability to implement innovative healthcare solutions and drive breakthrough research for the betterment of all patients.”
I have skin in this game – my dad is the president of St Austell Wheelers cycle club in Cornwall. Over the years, I have bought him everything from a Bart Simpson bicycle bell (which he selflessly attached to his Ribble road bike) to a myriad of jerseys, to Rouleur mugs with his favourite riders’ faces on them. I have got it right and disastrously misjudged it (that bell – sorry, dad).
This year, he says, “There are two things on my wishlist: a new pair of legs, or an electric bike!” He’s in good company; commentating legend Phil Liggett is also a fan of e-bikes. “Young and old alike are discovering the freedom of the roads, lanes and tracks by pedalling with a little assistance,” he says.
Clearly, there are mountains of options out there, so we’ve spoken to a whole host of two-wheeled enthusiasts to find the gifts that cyclists really want for Christmas.
Buff Snood, from £20.95
buff.com
£15.99
amazon.co.uk
Laura Laker, cycling journalist, co-host of the Streets Ahead podcast and author of Potholes and Pavements, says protective neckwear is a great gift “because the weather can be unpredictable, and snoods don’t flap around like a scarf”.
Pulsio Air Massage gun, £69.99
decathlon.co.uk
Bodi-Tek deep tissue massage gun, £59.99
argos.co.uk
Opti foam roller, £15
argos.co.uk
Maximo foam roller, from £13.99
amazon.co.uk
Massage stick, £13.99
decathlon.co.uk
Muscle roller stick, £10.99
amazon.co.uk
Massage ball, £4.99
decathlon.co.uk
Massage ball set, £9.99
amazon.co.uk
“It’s common for cyclists not to stretch enough, and even commutes can tighten muscles over time,” says Laker. “There’s good evidence that foam rollers reduce muscle soreness after an intense effort (like chasing a rain cloud home), while massage sticks and massage balls are good stocking fillers.”
Neal’s Yard lavender bath salts, £17
nealsyardremedies.com
£14.45
amazon.co.uk
Neal’s Yard geranium and orange bath oil, £19
nealsyardremedies.com
£16
amazon.co.uk
“On returning from a ride covered in muck, luxurious-feeling bath products can work wonders, physically and mentally,” says Laker. “Bath salts soothe aching muscles, while oils help get some of the stickier splashes off – and they’re kinder than Swarfega. Neal’s Yard offers some great options.”
Cycling UK membership, £52 a year
my.cyclinguk.org
“For the cyclist who has everything,” Laker suggests supporting a cycling charity. “Cycling UK’s staff and volunteers are superheroes, fighting for cycling day in, day out. You get free third-party insurance with membership, plus a regular members’ magazine and bike shop discounts.”
Oakley Sphaera sunglasses, £191
oakley.com
100% Slendale sunglasses, £84.99
silverfish-uk.com
£67.99
tweekscycles.com
Are you even a cyclist if you aren’t wearing Oakley glasses? Sam Challis, tech editor at Cyclist magazine, suggests the Sphaera because they have “an oversized lens for an expansive field of view and frames that have been shaped to play nicely with modern helmets”.
A more affordable option, Challis says, is the 100% Slendale glasses. These are a “toned-down update on one of [former Slovak cyclist] Peter Sagan’s favourite models – slimmer, and therefore lighter, with cut-outs in the lens for ventilation”.
Silca Mattone seat pack, £39
saddleback.co.uk
£45
sigmasports.com
A seat pack is an overlooked accessory, according to Challis, but this one will “protect multitools from rust, and there’s space for everything you’d need”. Neat.
7iDP Project 23 ABS full face helmet, £129.95
skatehut.co.uk
£79.99
amazon.co.uk
Triple Eight knee pads, £20.95
skatepro.uk
Triple Eight elbow pads, £18.95
skatepro.uk
Stay Strong body armour, £119.99
sourcebmx.com
Do you have a child who’s into BMX? Ken Floyde, chair and founder of the Brixton BMX Club, suggests a BMX race bike, a full-face BMX helmet, knee and elbow pads, or body armour, as “once they have these, they can go ride at a BMX track”. Floyde’s track in Brockwell Park will be open on Christmas Day for eager riders.
Kush 2+ BMX bike, £249
mafiabike.com
The alternative is a BMX Street Bike with stunt pegs, which they can ride at a skatepark, says Floyde, who “would dearly love the [1984] book BMX from Start to Finish by Ken Evans and Andy Ruffell”.
Coffee First, Then the World by Jenny Graham, £10.44
guardian.bookshop.com
£6.98
amazon.co.uk
Martine Tommis, a cyclist with the women’s club Team Glow in Manchester, suggests the book Coffee First, Then the World by cyclist Jenny Graham about her round-the-world cycle.
OS Maps Premium, £39.99 for 12 months subscription with gift card
shop.ordnancesurvey.co.uk
Chris Boardman, former Olympian turned cycling advocate and National Active Travel commissioner, says: “My ideas of fitness and health now are exploring by bike in the Cairngorms.” He suggests Ordnance Survey mapping software as a gift because it gives him “the confidence to explore widely”.
Quad Lock phone case, from £25.99
quadlockcase.co.uk
From £31.49
amazon.co.uk
Stem Cap Mount, from £39.99
quadlockcase.co.uk
£34.99
amazon.co.uk
Boardman suggests a phone holder and mount so you can safely attach your phone to the stem of the handlebars for “practical visibility of where I am”.
Berghaus Men’s Paclite waterproof trousers, £150
berghaus.com
£104.99
amazon.co.uk
For all-weather cycling, whether commuting or for pleasure, waterproof over-trousers are a must. While most have a waterproof jacket, these “complete the coverage and stop the weather being a barrier”, says Boardman.
Mud Hugger mudguards, from £25
themudhugger.co.uk
£37.99
amazon.co.uk
Boardman says these are essential, as “it makes such a difference to have a dry backside!”
Omnium Cargo V3 bike, £2,895
paradisecycles.co.uk
Short Haul D8, £1,100
ternbicycles.com/uk
Marlon Plein, of BabyLDN, builds custom bikes from recycled, unloved, discarded bicycles and runs a community bike repair and spares shop in south-east London. He would love a cargo bike. “An Omnium would be a godsend, so I can carry large items and large quantities from A to B with ease. They’re light, sturdy and super-practical.”
Endura Men’s GV500 insulated jacket, £179.99
endurasport.com
£99.99
amazon.co.uk
Uniqlo ultra light down jacket, £69.90
uniqlo.com
Professional photographer Juan Trujillo Andrades has travelled all over Europe photographing cycling and is a keen rider himself. He loves gravel riding and suggests an “insulated or down jacket that’s warm, comfy and looks the part when going through muddy lanes or hopping around town”.
The Handmade Cyclist Monuments prints, £230
thehandmadecyclist.com
Do you struggle to get out in bad weather? “Sometimes a bit of inspiration is what you need,” says Trujillo Andrades, who suggests “a collection of prints from the Handmade Cyclist dedicated to the five ‘monuments’”.
Wizard Works Lil Presto barrel bag, from £52
wizard.works
For those who take a more relaxed approach, a handlebar bag is perfect “to carry not just essentials like tools and your phone, but also a sandwich or some homemade biscuits. They are easily removed if you want to lock your bike somewhere and take your valuables with you,” says Trujillo Andrades.
Muc-Off pressure washer starter kit + 30l dry bag, £100
muc-off.com
£130
amazon.co.uk
Fran Brown, a nine-time world champion in paracycling, recommends a bike-specific pressure washer as “the easiest and quickest way to clean your bike and kit after messy winter rides without ruining any of the components”.
Deboyo Race stainless steel thermal bottle, £24.99
decathlon.co.uk
£27.99
amazon.co.uk
“An insulated flask-style drink bottle can turn a miserable winter ride into a far nicer experience,” says Brown. She also says that an Audible subscription is perfect for entertainment as you pedal on a turbo on days when outdoor rides are out of the question.
Veloforte starter pack, £20.89
veloforte.com
Veloforte protein bars variety pack, from £16.82
amazon.co.uk
Emily Chappell, winner of the 2016 ultra-endurance Transcontinental Race and author of Where There’s A Will, recommends stuffing a stocking with Veloforte energy bars as “unlike most sports nutrition, they’re actually enjoyable to eat”.
Lezyne micro pump, £61.99
allterraincycles.co.uk
amazon.co.uk
“This is simply the best portable pump I’ve come across,” says Chappell. “A foldable foot peg turns it into a track pump, and it’s more comfortable to use than any other I’ve tried, meaning you don’t find yourself giving up before the tyre’s properly inflated.”
Petzl Bindi 200 headlamp, £47.99
ultralightoutdoorgear.co.uk
£30.99
amazon.co.uk
For bikepacking, “the beam can be red or white, meaning that [this headlamp] can make a good addition to – or emergency substitute for – regular bike lights. They’re tiny and lightweight, and the drawstring means they attach easily to almost anything; body, bike or bag,” says Chappell.
Wahoo Elemnt Rival smart sports watch, £199.99
wahoofitness.com
£158.99
amazon.co.uk
Garmin Edge 530 GPS cycling computer, £189.99
tredz.co.uk
£199.99
decathlon.co.uk
St Austell Wheelers member Dave Bulled started cycling two years ago. “To begin with, I only went on short 10km rides, but I enjoyed it so much that I joined a club and started to record my rides on my smartwatch, which was super useful for keeping track and improving my fitness,” he says.
Proviz gloves, £34.99
provizsports.com
£39.99
amazon.co.uk
Sealskinz socks, from £30
sealskinz.com
£24.99
amazon.co.uk
Pedaled Odyssey women’s base layer, £70
uk.pedaled.com
Clare Taylor, a fellow St Austell Wheelers club member and GP, wants accessories to keep warm on winter rides, so suggests waterproof gloves, overshoes, warm waterproof Sealskinz socks and merino wool base layers.
Muc-Off ladies chamois cream, £11.49
planetx.co.uk
£14.49
amazon.co.uk
In her stocking, Taylor would love “a big pot of the ultimate chamois cream, an essential for a comfortable ride as it minimises chafing between your skin and the pad in your cycling shorts. This brand is known to be a cyclist’s favourite.”
Kryptonite Evolution Mini-5 lock, £74.99
condorcycles.com
£35.99
amazon.co.uk
Taylor is also after a decent “coffee lock”, cycling lingo for a lock to secure your bike while you enjoy a reviving shot of caffeine mid-ride. “After all, cycling is all about the cake and coffee stops,” she says.
Zwift Ride indoor bike with Wahoo Kickr Core, £1,199.99
uk.zwift.com
Wahoo Kickr Core Zwift One indoor turbo trainer, £449.99
uk.wahoofitness.com
For Mani Arthur, founder of the Black Cyclists Network, a “Zwift indoor bike is the best way to get you through the winter”. The Wahoo Kickr Core Zwift One indoor turbo trainer is a cheaper option.
Sealskinz Upwell waterproof heated cycle glove, £175
sealskinz.com
For those whose extremities run cold, whether on the road or up a mountain, heated gloves may be the ultimate luxury. This pair has leather palms, breathable insulation, a waterproof layer and a rechargeable battery with up to six hours of toasty time.
For more gear to keep you safe and cosy, see our guide to winter cycling essentials.
Trenta 3K Carbon Mips helmet, £290
sigmasports.com
£221.19
amazon.co.uk
Every cyclist needs a helmet, but for Arthur, it has to be this one, which is “currently worn by [Slovenian cyclist] Tadej Pogačar”, who won the Giro d’Italia, Tour de France and the men’s elite race at the Road world championships in 2024. I think we can call that tried and tested.
Topeak Mini P20 multi-tool, £36.99
merlincycles.com
£26.52
amazon.co.uk
This nifty piece of kit “will get you out of most emergencies”, says Arthur. It includes various allen and torx keys, Phillips and flat-head screwdrivers, a chain split link breaker, spoke keys and a small knife with a part-serrated blade.
Name decals, £6.99
namedecals.com
Finally, Arthur says you can “make your loved one feel like a pro by decorating their bike with a personalised sticker”.
CHICAGO — Secondhand permanent pacemaker use in poorer countries, following thorough cleaning and repackaging, has not resulted in patient harm so far, according to the My Heart Your Heart trialists.
In patients who could not afford new devices on their own, use of so-called “reconditioned” pacemakers met criteria for non-inferiority on the basis of infections at 90 days compared with new devices (1.5% vs 2.9%), reported Thomas Crawford, MD, of University of Michigan Health in Ann Arbor, at the American Heart Association (AHA) annual meeting.
The randomized trial’s preliminary results from 90 days also showed similarly low complications at 90 days between new and used pacemaker recipients, respectively (P>0.1 for all comparisons):
“There were no observed malfunctions or failures of the pulse generator in either new or reconditioned pacemakers. Longer-term follow-up will be necessary to confirm the safety and efficacy of reconditioned pacemakers,” Crawford told the audience. The study’s full 12-month report is still pending, with audit of the clinical data entry ongoing at some sites.
Crawford explained the rationale for testing the postmortem reuse of pacemakers: without a truly low-cost pacemaker on the market, many patients in low- and middle-income countries would have no access to this therapy. Compared with a $2,000 device sold new in these countries, the off-label reuse of pacemakers could make devices available for $50 to $100 each to patients who need them (with additional leads costing $50 to $200 separately), he estimated during an AHA press conference.
When it comes to promoting equitable access and social justice in medicine, “this is a great example of walking the walk and not just talking the talk,” commented Miguel Leal, MD, of Emory University in Atlanta, discussing My Heart Your Heart during the press conference.
“It’s great that we have these no-inferiority endpoints met, because now we have momentum to stimulate this type of science to be reproduced in many centers, hopefully with bigger numbers of patients and also longer-term follow-up,” Leal added.
My Heart Your Heart is a randomized single-blind trial conducted in Venezuela, Nigeria, Paraguay, Kenya, Mozambique, and Mexico. Participating sites have to demonstrate qualified physicians and facilities. Among the ethical, legal, and regulatory obstacles investigators faced were obtaining an FDA export permit and foreign government approvals. Devices picked for reprocessing in the trial all have to have at least 4 years of remaining battery life.
“Collaboration between centers of excellence in the U.S., charitable organizations, and foreign entities may allow safe and effective large scale pacemaker reconditioning,” Crawford suggested.
“We were able to establish relationships with physicians there who had the implementation skills and who also were able to access the government to allow this process to happen … Understandably, institutions are risk averse, and so it’s not something that’s legal anywhere in the world, even though it happens in those countries,” he added.
Leal said the ability to expand the My Heart Your Heart program relies on local infrastructure.
“We have to identify certain metropolitan areas in these countries and make them centers for dissemination of technique and knowledge,” he said. “We produce in the United States approximately 120 electrophysiologists per year. More than 150 countries in the world have zero electrophysiologists. So there’s also that big gap that needs to be addressed as well, but it starts with this type of initiative.”
My Heart Your Heart was conducted by volunteers and companies providing free services. At seven sites in six countries, there were 298 people randomized to a new pacemaker or a reconditioned device from 2022 to 2024. Both groups were around age 70 and roughly evenly split between men and women.
Patients had to have a class I indication for de novo bradycardia pacing and no financial means of buying a new pacemaker. Those deemed ineligible for the study — having severe comorbidities, age younger than 18 years, or pregnancy, among other criteria — could be offered devices as part of a registry.
The trial was designed with the primary endpoint being freedom from procedure-related infection at 12 months. A key secondary endpoint is freedom from pacemaker software or hardware malfunction or unexplained death at 12 months.
By 90 days, when there was infection in a patient, it had occurred about 20 days from implant of a new device versus 41.5 days from implant of a reconditioned device.
Study authors acknowledged that a larger sample size may be needed to show differences in device failure or other rare events.
Crawford cautioned that besides device cost, plenty other barriers stand in the way of pacemaker adoption in low- and middle-income countries, including limited diagnostic tools, a lack of properly equipped facilities and trained staff, and patient education.
“In many of these countries, the physician has to kind of break the concept out of the blue and say, ‘Hey, there’s such a device that can actually make you feel better, can make you live longer. You’ve never heard of it, but we got one from a deceased person in the United States here,'” he said. “There’s a lot of work that needs to be done in actually disseminating the knowledge about what this technology can do for a patient.”
Disclosures
The My Heart Your Heart trial was funded by charitable giving.
Crawford disclosed no relationships with industry.
Leal disclosed a relationship with Medtronic.
Primary Source
American Heart Association
Source Reference: Crawford T, et al “Preliminary results of randomized trial of new versus reconditioned pacemakers for patients unable to obtain a new device in low and middle-income countries: the My Heart Your Heart Randomized Controlled Trial (MHYH-RCT)” AHA 2024.
President-elect Donald Trump’s incoming administration could try to remove fluoride from drinking water, according to Robert F. Kennedy Jr.
Kennedy, who was tapped last week by Trump to lead the Department of Health and Human Services, called fluoride an “industrial waste” and linked it to cancer and other diseases and disorders while campaigning for Trump.
“On January 20, the Trump White House will advise all U.S. water systems to remove fluoride from public water. Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease,” Kennedy wrote Nov. 2 on X. Kennedy linked to a video from an attorney who recently successfully sued the Environmental Protection Agency to take additional measures to regulate fluoride in drinking water.
Kennedy, who has long advocated ending water fluoridation, persisted with his pledge following Trump’s election win. When asked before the election whether his administration would remove fluoride from drinking water, Trump said, “Well, I haven’t talked to him about it yet, but it sounds OK to me. You know it’s possible.”
Kennedy is an influential vaccine skeptic whose campaign of conspiracy theories earned PolitiFact’s 2023 “Lie of the Year.”
Longtime research has found that adding fluoride to U.S. drinking water is a safe way to boost children’s oral health. Since 2015, the recommended level in the U.S. has been 0.7 milligrams per liter. Public health organizations, including the American Dental Association, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention, support the practice.
Recent studies, however, have shown possible links between fluoride and bone problems and children’s IQs, particularly when fluoride is above the U.S. recommended levels.
“There is evidence that fluoride exposure has been associated with the diseases [and] disorders that RFK listed, but with caveats,” said Ashley Malin, who is an assistant professor in the University of Florida’s Epidemiology Department and has studied fluoride’s effects in pregnant women.
Malin referred to studies showing that higher fluoride exposure, particularly during pregnancy, is associated with reduced child IQ, and that prenatal exposure also is linked to decreased intellectual functioning and executive function. For high exposure in pregnancy, the studies showed symptoms associated with other neurobehavioral issues, such as attention-deficit/hyperactivity disorder.
However, many of these studies took place in countries other than the U.S. and looked at fluoride in drinking water at sometimes twice the United States’ recommended level. Also, some of the other ailments that Kennedy listed, such as an association with bone cancer, have less robust evidence and need more study.
“Aside from fluoride’s impacts on neurodevelopment, I think that there is more that we don’t know about health effects of low-level fluoride exposure than what we do know, particularly for adult health outcomes,” Malin said.
David Bellinger, a Harvard Medical School neurology professor and professor in Harvard School of Public Health’s Environmental Health Department, said the risk-benefit calculation of added fluoride differs depending on whether typical fluoride exposure levels cause health problems, or if problems occur only when recommended levels are exceeded.
“In toxicology, ‘the dose makes the poison’ is a long-standing principle,” he said. “So a general statement that fluoride is associated with diseases X, Y, and Z is not very helpful unless the dose that might be responsible is specified.”
PolitiFact contacted Kennedy through his Children’s Health Defense organization but received no reply. The organization sued PolitiFact and Meta related to a 2020 fact check. That lawsuit was dismissed by a federal court. The dismissal was upheld on appeal, and the case is pending a possible appeal to the U.S. Supreme Court.
What Is Fluoride and What Are Its Benefits?
Fluoride is a mineral naturally occurring in soil, water, and some foods that helps prevent tooth decay and cavities. It strengthens tooth enamel that acid from bacteria, plaque, and sugar can wear away.
Water fluoridation has been happening in the U.S. since 1945.
The federal Public Health Service first recommended fluoridation of tap water in 1962, but the decision still lies with states and municipalities. Around 72% of the U.S. population, or about 209 million people, had access to fluoridated water in 2022, the CDC reported. Fluoride also has been added to oral care products such as toothpaste and mouth rinse.
In 2015, U.S. health officials lowered the recommended amount of fluoride in drinking water to 0.7 milligrams per liter, saying a higher level was less necessary given other sources of fluoride, and that the lowered amount would still help protect teeth without staining them.
Pediatric dentists note that applying fluoride with toothpaste and rinses is beneficial, but small amounts circulating in the body via water consumption helps younger children who still have their baby teeth, because it can benefit the developing permanent teeth.
The American Dental Association says studies have shown that fluoride in community water systems prevents at least 25% of tooth decay in children and adults and that “for more than 75 years, the best scientific evidence has consistently shown that fluoridation is safe and effective.”
The association says on its website: “It’s similar to fortifying other foods and beverages — for example, fortifying salt with iodine, milk with vitamin D, orange juice with calcium, and bread with folic acid.”
According to the CDC, health experts and scientists from the U.S. and other countries have so far “not found convincing scientific evidence linking community water fluoridation with any potential adverse health effect or systemic disorder such as an increased risk for cancer, Down syndrome, heart disease, osteoporosis and bone fracture, immune disorders, low intelligence, renal disorders, Alzheimer’s disease, or allergic reactions.”
The agency says risks of water fluoridation are limited to dental fluorosis, which can alter dental enamel and cause white flecks, spots, lines, or brown stains on the teeth when too much fluoride is consumed.
Do Studies Show Fluoride Posing Any Other Risks?
Some studies have said that excess fluoride exposure, often at higher levels than the recommended U.S. limit, can harm infants’ and young children’s developing brains and that higher levels of fluoride exposure during pregnancy were associated with declines in children’s IQs.
A study published in May that Malin led with University of Southern California and Indiana University researchers suggested that fluoride exposure during pregnancy was linked to an increased risk of childhood neurobehavioral problems and said more studies were “urgently needed to understand and mitigate the impacts in the entire U.S. population.”
Experts noted prenatal fluoride exposure is most strongly linked to children’s IQ loss, and said timing of fluoride consumption might need to be considered when making recommendations.
A federal review of dozens of studies published in August by the Department of Health and Human Services’ National Toxicology Program concluded that higher levels of fluoride exposure were linked to lower IQs in children. But the report was based primarily on studies in countries such as Canada, China, India, Iran, Mexico, and Pakistan and involved fluoride levels at or above 1.5 milligrams per liter, twice the recommended U.S. limit. The authors said more research is needed to understand whether lower exposure has any adverse effects.
In the report, researchers said they found no evidence that fluoride exposure adversely affected adult cognition.
Bellinger, of Harvard, pointed to the review as an example of how the amount of fluoride matters. He noted how researchers concluded that a very small percentage of people in the U.S. are exposed to levels that correlate with IQ loss.
“Second, the fact that there are now multiple pathways of exposure to fluoride besides fluoridated water (toothpaste and other dental products, etc.) makes it really difficult to attribute a particular adverse effect to the fluoride added to the water,” he wrote via email. “It is the cumulative exposure from all sources that contribute to any adverse health effects.”
In September, a federal judge ordered the Environmental Protection Agency to further regulate fluoride in drinking water because of the potential risk that higher levels could affect children’s intellectual development.
U.S. District Judge Edward Chen wrote that the court’s finding didn’t “conclude with certainty that fluoridated water is injurious to public health,” saying it’s unclear whether the amount of fluoride typically added to water is causing children’s IQs to drop. But he wrote that there was enough risk to warrant investigation and that the EPA must act to further regulate it. The ruling did not specify what actions the agency should take, and the EPA is reviewing the decision.
After the ruling, the American Association of Pediatrics issued a statement that fluoride in drinking water is safe for children and said the policy is based on a robust foundation of evidence.
Besides dental fluorosis, experts say that fluoride exposure over many years above the U.S. recommended amount can cause skeletal fluorosis, a rare condition that causes weaker bones, stiffness, and joint pain. Although the Public Health Service recommends a fluoride concentration of 0.7 milligrams per liter for community water systems, the EPA, under the Safe Drinking Water Act, sets enforceable standards for drinking-water quality. Currently, to prevent skeletal fluorosis, the EPA requires that water systems not exceed 4 milligrams of fluoride per liter of water.
Malin said she and her research team are investigating a potential link between fluoride and bone fractures. She said that although several studies have found high fluoride exposure associated with increased risk of bone fractures, and some have linked fluoride with thyroid disease, rigorous, U.S.-based studies haven’t been done.
The CDC concluded that recent research found no link between cancer risk and high levels of fluoride in drinking water.
The American Cancer Society reviewed a possible link between water fluoridation and cancer risk. An organization spokesperson pointed PolitiFact to its review and said it has no data showing a definitive answer.
Quinoa cakes
Serves 14
Tip: These golden-brown cakes are packed with nutrients and protein. Serve with a side salad.
Created by the executive wellness chef and registered dietitians at the Mayo Clinic Healthy Living Program.
Blooms The Chemist implements booking platform
Pharmacy chain Blooms The Chemist has adopted Healthengine’s booking platform to streamline appointment management and enhance scheduling.
It now allows customers to book pharmacy services, including vaccinations, via Healthengine round the clock and with real-time availability.
The booking platform also features voucher management and consult room service setups, which also integrate with the pharmacy chain’s system.
In August, Healthengine integrated with Core Practice‘s dental practice management software, allowing the latter’s users to make their appointments visible via the booking platform directly.
Healthengine recently introduced a new waitlist functionality on its platform, providing consumers with the ability to add themselves to an online waitlist and allowing practices to turn cancellations into appointments.
VVED patient portal goes live
Northern Health has recently introduced a new patient registration portal for the Victoria Virtual Emergency Department (VVED).
The said portal, which went live in August, includes a comprehensive dashboard for registering patients into EMR systems, said Northern Health, a major healthcare provider in Melbourne.
Developed in-house by the organisation’s Digital Health team, the patient portal has enabled a “faster” registration process by enhancing data capture and validation. “In its first 15 days, the portal assisted in the reduction of duplicate patient records by 10% and increased Medicare number capture compliance from 73% to 88%,” shared HIS Manager Nicholas Caruana.
Anthony Gust, executive director of Northern Health’s digital health division, disclosed that they plan to “reuse” the portal for residential-in-reach and outpatients.
Early this year, it was announced that the VVED will double its capacity, targeting to accommodate over a thousand patients per day, with new state funding.
Peninsula Health to roll out cancer IMS
Peninsula Health, another healthcare provider in Melbourne, has recently digitised medication management in oncology.
It will be rolling out an oncology information management system provided by Magentus, doing away with the current paper-based workflow.
Peninsula Health’s cancer service receives over 400 referrals each year. It hopes to improve patient safety and free up more staff time by implementing the IMS, which also directly integrates with its existing systems and My Health Record.
About 250 users across the service will be utilising the system, Peninsula Health said in a statement.
The same cancer IMS was also rolled out at Fiona Stanley Hospital in Western Australia in June as part of a broader contract to deploy the solution across South Metropolitan Health Service. Over a year ago, the private Catholic healthcare group St John of God Health Care signed a deal to implement the Magentus solution in its hospitals nationwide.