Posts in category: Health

A draft food safety law proposing several changes to current requirements has been presented to government officials in Singapore.

The Ministry of Sustainability and the Environment introduced the Food Safety and Security Bill for its first reading in Parliament earlier this week. The draft law will be debated at the second reading, which is planned for January 2025.

The bill aims to consolidate and refresh existing food-related legislation and strengthen Singapore’s food safety controls to better protect consumers and public health. The Singapore Food Agency (SFA) plans to implement the new requirements in phases over the next few years, starting in 2025.

As an example of consolidation, importers will only need to refer to the bill governing the requirements for importing food commodities instead of looking at different acts.

Selected changes

The law will not prescribe operational details but require licensees to maintain food control plans. Currently, businesses must comply with pre-licensing requirements and conditions that describe how they should carry out operations to ensure food is safe.

Coverage of food safety legislation will be extended beyond the sale of food to its supply, which includes donations and free distribution. Requirements will be based on the food safety risk of the activity.

Key food distribution players will be required to keep records for traceability and recalls so that unsafe food and food-contact articles can be removed from the market in a timely manner and minimize the impact on human health.

Companies must provide records relating to recalled food within 24 hours when requested. Businesses will continue to have up to 48 hours to remove implicated products from retail shelves. A company must inform SFA if a food safety concern is due to a withdrawal.

Penalties will be tiered based on the severity of offenses. Higher penalties will apply for repeat offenders and corporate entities, offenses involving unsafe food that causes illness, harm, and physical injury, and offenses committed knowingly. A disqualification framework prescribes a period of up to three years. Disqualification will only apply to operators and traders who had their licenses revoked and will not cover other outlets if multiple licenses are held.

Local farms will need to develop and implement a Farm Management Plan to mitigate risks to food safety.

Received feedback

Proposed provisions have been consulted with various industry stakeholders since August 2023, and public consultations were also conducted between March and September 2024.

Feedback was received from 112 respondents and 260 participants who attended an in-person engagement session.

Most respondents supported new provisions related to food firms, such as the requirement for selected licensable businesses to keep records on food manufactured or supplied.

Most respondents supported the new Farm Management Plan and Food Control Plan requirements, which allow businesses to implement preventive measures tailored to their operational needs.

SFA will continue to have a pre-market approval process and update safety assessment guidelines on its website related to novel foods, genetically modified foods, and insects to help adopt up-to-date food safety assessment processes.

(To sign up for a free subscription to Food Safety News, click here.)

Many scientists at the federal health agencies await the second Donald Trump administration with dread as well as uncertainty over how the president-elect will reconcile starkly different philosophies among the leaders of his team.

Trump has promised he would allow Robert F. Kennedy Jr. to “go wild” on medicines, food, and health. With that, a radical antiestablishment medical movement with roots in past centuries could threaten the achievements of a science-based public health order painstakingly built since World War II, some of these scientists fear.

If Kennedy makes good on his vision for transforming public health, childhood vaccine mandates could wither. New vaccines might never win approval, even as the FDA allows dangerous or inefficient therapies onto the market. Agency websites could trumpet unproven or debunked health ideas. And if Trump’s plan to weaken civil service rights goes through, anyone who questions these decisions could be summarily fired.

“Never has anybody like RFK Jr. gotten anywhere close to the position he may be in to actually shape policy,” said Lewis Grossman, a law professor at American University and the author of “Choose Your Medicine,” a history of U.S. public health.

Kennedy and an adviser Calley Means, a health care entrepreneur, say dramatic changes are needed because of the high levels of chronic disease in the United States. Government agencies have corruptly tolerated or promoted unhealthy diets and dangerous drugs and vaccines, they say.

Means and Kennedy did not respond to requests for comment. Four conservative members of the first Trump health bureaucracy spoke on condition of anonymity. They eagerly welcomed the former president’s return but voiced few opinions about specific policies. Days after last week’s election, RFK Jr. announced that the Trump administration would immediately fire and replace 600 National Institutes of Health officials. He set up a website seeking crowdsourced nominees for federal appointments, with a host of vaccination foes and chiropractors among the early favorites.

At meetings last week at Mar-a-Lago involving Elon Musk, Tucker Carlson, Donald Trump Jr., Kennedy, and Means, according to Politico, some candidates for leading health posts included Jay Bhattacharya, a Stanford University scientist who opposed covid lockdowns; Florida Surgeon General Joseph Ladapo, who opposes mRNA covid vaccines and rejected well-established disease control practices during a measles outbreak; Johns Hopkins University surgeon Marty Makary; and Means’ sister, Stanford-trained surgeon and health guru Casey Means.

All are mavericks of a sort, though their ideas are not uniform. Yet the notion that they could elbow aside a century of science-based health policy is profoundly troubling to many health professionals. They see Kennedy’s presence at the heart of the Trump transition as a triumph of the “medical freedom” movement, which arose in opposition to the Progressive Era idea that experts should guide health care policy and practices.

It could represent a turning away from the expectation that mainstream doctors be respected for their specialized knowledge, said Howard Markel, an emeritus professor of pediatrics and history at the University of Michigan, who began his clinical career treating AIDS patients and ended it after suffering a yearlong bout of long covid.

“We’ve gone back to the idea of ‘every man his own doctor,’” he said, referring to a phrase that gained currency in the 19th century. It was a bad idea then and it’s even worse now, he said.

“What does that do to the morale of scientists?” Markel asked. The public health agencies, largely a post-WWII legacy, are “remarkable institutions, but you can screw up these systems, not just by defunding them but by deflating the true patriots who work in them.”

FDA Commissioner Robert Califf told a conference on Nov. 12 that he worried about mass firings at the FDA. “I’m biased, but I feel like the FDA is sort of at peak performance right now,” he said. At a conference the next day, CDC Director Mandy Cohen reminded listeners of the horrors of vaccine-preventable diseases like measles and polio. “I don’t want to have to see us go backward in order to remind ourselves that vaccines work,” she said.

Exodus From the Agencies?

With uncertainty over the direction of their agencies, many older scientists at the NIH, FDA, and Centers for Disease Control and Prevention are considering retirement, said a senior NIH scientist who spoke on the condition of anonymity for fear of losing his job.

“Everybody I talk to sort of takes a deep breath and says, ‘It doesn’t look good,’” the official said.

“I hear of many people getting CVs ready,” said Arthur Caplan, a professor of bioethics at New York University. They include two of his former students who now work at the FDA, Caplan said.

Others, such as Georges Benjamin, executive director of the American Public Health Association, have voiced wait-and-see attitudes. “We worked with the Trump administration last time. There were times things worked reasonably well,” he said, “and times when things were chaotic, particularly during covid.” Any wholesale deregulation efforts in public health would be politically risky for Trump, he said, because when administrations “screw things up, people get sick and die.”

At the FDA, at least, “it’s very hard to make seismic changes,” former FDA chief counsel Dan Troy said.

But the administration could score easy libertarian-tinged wins by, for example, telling its new FDA chief to reverse the agency’s refusal to approve the psychedelic drug MDMA from the company Lykos. Access to psychedelics to treat post-traumatic stress disorder has grabbed the interest of many veterans. Vitamins and supplements, already only lightly regulated, will probably get even more of a free pass from the next Trump FDA.

‘Medical Freedom’ or ‘Nanny State‘

Trump’s health influencers are not monolithic. Analysts see potential clashes among Kennedy, Musk, and more traditional GOP voices. Casey Means, a “holistic” MD at the center of Kennedy’s “Make America Healthy Again” team, calls for the government to cut ties with industry and remove sugar, processed food, and toxic substances from American diets. Republicans lampooned such policies as exemplifying a “nanny state” when Mike Bloomberg promoted them as mayor of New York City.

Both the libertarian and “medical freedom” wings oppose aspects of regulation, but Silicon Valley biotech supporters of Trump, like Samuel Hammond of the Foundation for American Innovation, have pressed the agency to speed drug and device approvals, while Kennedy’s team says the FDA and other agencies have been “captured” by industry, resulting in dangerous and unnecessary drugs, vaccines, and devices on the market.

Kennedy and Casey Means want to end industry user fees that pay for drug and device rules and support nearly half the FDA’s $7.2 billion budget. It’s unclear whether Congress would make up the shortfall at a time when Trump and Musk have vowed to slash government programs. User fees are set by laws Congress passes every five years, most recently in 2022.

The industry supports the user-fee system, which bolsters FDA staffing and speeds product approvals. Writing new rules “requires an enormous amount of time, effort, energy, and collaboration” by FDA staff, Troy said. Policy changes made through informal “guidance” alone are not binding, he added.

Kennedy and the Means siblings have suggested overhauling agricultural policies so that they incentivize the cultivation of organic vegetables instead of industrial corn and soy, but “I don’t think they’ll be very influential in that area,” Caplan said. “Big Ag is a powerful entrenched industry, and they aren’t interested in changing.”

“There’s a fine line between the libertarian impulse of the ‘medical freedom’ types and advocating a reformation of American bodies, which is definitely ‘nanny state’ territory,” said historian Robert Johnston of the University of Illinois-Chicago.

Specific federal agencies are likely to face major changes. Republicans want to trim the NIH’s 27 research institutes and centers to 15, slashing Anthony Fauci’s legacy by splitting the National Institute of Allergy and Infectious Diseases, which he led for 38 years, into two or three pieces.

Numerous past attempts to slim down the NIH have failed in the face of campaigns by patients, researchers, and doctors. GOP lawmakers have advocated substantial cuts to the CDC budget in recent years, including an end to funding gun violence, climate change, and health equity research. If carried out, Project 2025, a policy blueprint from the conservative Heritage Foundation, would divide the agency into data-collecting and health-promoting arms. The CDC has limited clout in Washington, although former CDC directors and public health officials are defending its value.

“It would be surprising if CDC wasn’t on the radar” for potential change, said Anne Schuchat, a former principal deputy director of the agency, who retired in 2021.

The CDC’s workforce is “very employable” and might start to look for other work if “their area of focus is going to be either cut or changed,” she said.

Kennedy’s attacks on HHS and its agencies as corrupted tools of the drug industry, and his demands that the FDA allow access to scientifically controversial drugs, are closely reminiscent of the 1970s campaign by conservative champions of Laetrile, a dangerous and ineffective apricot-pit derivative touted as a cancer treatment. Just as Kennedy championed off-patent drugs like ivermectin and hydroxychloroquine to treat covid, Laetrile’s defenders claimed that the FDA and a profit-seeking industry were conspiring to suppress a cheaper alternative.

The public and industry have often been skeptical of health regulatory agencies over the decades, Grossman said. The agencies succeed best when they are called in to fix things — particularly after bad medicine kills or damages children, he said.

The 1902 Biologics Control Act, which created the NIH’s forerunner, was enacted in response to smallpox vaccine contamination that killed at least nine children in Camden, New Jersey. Child poisonings linked to the antifreeze solvent for a sulfa drug prompted the modern FDA’s creation in 1938. The agency, in 1962, acquired the power to demand evidence of safety and efficacy before the marketing of drugs after the thalidomide disaster, in which children of pregnant women taking the anti-nausea drug were born with terribly malformed limbs.

If vaccination rates plummet and measles and whooping cough outbreaks proliferate, babies could die or suffer brain damage. “It won’t be harmless for the administration to broadly attack public health,” said Alfredo Morabia, a professor of epidemiology at Columbia University and the editor-in-chief of the American Journal of Public Health. “It would be like taking away your house insurance.”

Sam Whitehead, Stephanie Armour, and David Hilzenrath contributed to this report.

Healthbeat is a nonprofit newsroom covering public health published by Civic News Company and KFF Health News. Sign up for its newsletters here.

Atrial fibrillation — also called AFib — is a common heart rhythm disorder. If you have AFib, you may have some concerns about traveling with your condition. But taking a few steps to prepare may help you have an enjoyable and worry-free trip.

Before you travel, ask your healthcare professional any questions you have about traveling with AFib. Ask if there is anything you need to consider before and during your trip.

Travel tips with atrial fibrillation

Remember these helpful tips:

• Bring your medicines. Bring all of the medicines you’ll need for your trip. Keep them in your carry-on luggage.
• Carry a list of your medicines. Having a list of your medicines will make it easier to refill them if you run out of them or lose them.
• Take your time. Get to the airport early to give yourself plenty of time before your plane is due to depart. Anxiety can sometimes trigger irregular heartbeats.
• Bring your healthcare professional’s phone number. Write the number on a piece of paper. Also store the number in your phone when you travel.
• Ask about a medical alert bracelet. Your healthcare professional may recommend that you wear a medical alert bracelet that has information about your condition on it.
• Take steps to prevent blood clots. During your flight, stand and walk when you can to prevent blood clots in your legs. Your healthcare professional also may recommend that you wear compression stockings.
• Find medical centers close to your travel destination. Before your trip begins, learn where the closest hospital or doctor’s office is at your destination. Find out what services your health insurance will cover. This can help prepare you in case of an emergency.
• Check the contact information for embassies. If you’re traveling internationally, bring the address and contact information of the U.S. embassies or consulates in the countries where you’ll be staying. They can help with medical care in the area and offer general advice.
• Buy travel health insurance. Buy travel health insurance and medical evacuation insurance before your trip in case of an emergency while traveling overseas.
• Watch for side effects of blood thinners. If you’re taking warfarin (Jantoven), you need regular blood tests to monitor its effects. Check with your healthcare professional to see if you need blood tests while you’re away. If you take other types of prescription blood thinners, continue to take the medicine as directed.
• Ask about high altitudes.If you’re going to visit a high-altitude location, such as the mountains, check with your healthcare professional first. High altitudes may worsen some irregular heart rhythms. Your healthcare professional may suggest that you rest and lower your activity level for several days after arriving at a high altitude. Also, watch for any new or unusual symptoms of your condition or of altitude sickness.
• Get recommended vaccines. Know which vaccines are required at your destination.

It’s important to follow your atrial fibrillation treatment plan. If AFib isn’t well controlled, it may lead to complications, including strokes and heart failure. With some planning, you can enjoy your travels and live an active life with atrial fibrillation.

The Joint Public Health Cybersecurity Task Group, the Healthcare and Public Health Sector Coordinating Council and the Healthcare and Public Health Sector Joint Cyber Working Group are evaluating the current state of readiness within this essential subsector to identify avenues for enhancing its resilience against evolving cyber threats.

WHY IT MATTERS

The anonymous survey, administered through a partnership with the University of Texas at Austin, will require approximately 15 minutes to complete. 

The findings will inform grant funding recommendations and shape public health sector policies, according to Bob Bastani, senior cybersecurity advisor for critical infrastructure protection for the Administration for Strategic Preparedness and Response, and Dr. Leanne Field, chair of the HSCC’s public health subsector and executive committee member of the Cybersecurity Working Group and faculty member at UT Austin.

Among the questions, the survey asks if a cyber event interrupted normal health department processes, what would be the most damaging loss of public health services to the community served?

“The insights obtained from a diverse array of public health officials, decision-makers, practitioners and information technology leaders across SLTT communities are crucial in informing our collective strategy for cybersecurity,” they wrote in their announcement.

High levels of participation in the survey are crucial, said Greg Garcia, executive director of the HSCC Cyber Working Group. 

“In light of the increasing cyber threats faced by the sector, this voluntary survey presents a vital opportunity to evaluate current readiness levels and pinpoint areas that require enhancement,” he said in his correspondence to health officials posted by the National Association of County and City Health Officials on its website.

Bastani and Field also requested assistance in promoting the online survey, which will remain open until Monday, December 2, to public health leaders and practitioners at all levels.

THE LARGER TREND

The U.S. Department of Health and Human Services, the parent agency of ASPR, centralizes cybersecurity resources provided by it and other federal agencies for the healthcare and public health sector to help address cybersecurity threats that have reached epidemic proportions.

Public health agencies are far from immune to healthcare cyberattacks, as government agencies are a target of cyber adversaries bent on financial gain, service disruption or both.

In June, the Los Angeles County Department of Public Health said it experienced a phishing attack on February 19 and 20, during which a hacker gained the login credentials of 53 Public Health employees. The brief attack compromised the personal information, including first and last names, dates of birth, diagnoses, prescriptions, Social Security Numbers and financial information of more than 200,000 people, the county said.

The cybersecurity preparedness of public health could also be compromised by the advance of digital tools like artificial intelligence.

“What happens if a chatbot from a well-respected institution starts propagating misinformation during a future public health emergency?” pondered Brian R. Spisak, a healthcare digital transformation consultant, researcher and educator in a June opinion piece in Healthcare IT News.

While Spisak was writing about the potential dangers of the World Health Organization’s generative AI chatbot Sarah introduced in April, AI and cybersecurity are closely intertwined and public health use of AI technologies presents risks.

Technology risk management and threats to patient safety “aren’t mutually exclusive, they’re mutually inclusive,” noted Atlantic Health System Chief Information and Digital Officer Sunil Dadlani at the HIMSS cybersecurity forum in September.

ON THE RECORD

“Understanding that many SLTT communities may not have previously engaged with initiatives of this nature, we are reaching out to encourage widespread participation of the public health community,” Bastani and Field said in the survey announcement.

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.

I am desperate to help my 80-year-old dad, JF, and his partner who have been left without a landline for more than two months by BT.

This is especially difficult as my dad has relatives in Canada that he usually phones every weekend, and his partner is Japanese. Both need a landline to call their families so as to not feel  isolated.

Despite numerous promises, more than 10 hours of phone calls to the company, booked and missed appointments, and two complaints being raised, nothing has happened.

Six months ago my dad and his partner moved closer to me so I could help them more. They had not moved in nearly 40 years and found the process stressful. Now to be left with no way of phoning family is adding to this.

I just want to know what I need to do to get my dad a landline. BT has taken his money and made lots of promises. I have explained numerous times about his age and that he is vulnerable, but no one is listening.

HF, Wokingham

BT makes semi-regular appearances in this column owing to its sometimes shoddy treatment of landline customers. But even with the bar set low, the company surpassed itself in its dealings with your father, as the longer account you sent me details a comedy of errors including two engineer no-shows and a £53 bill for a router that said: “Sorry to see you go.” When you tried to log a complaint on its website, it did not recognise the account number on the bill!

I asked BT to sort this out, and I’m pleased to report that your dad can now make calls again. Apparently there were multiple failed orders in his name that should have led to it being escalated. BT told me: “We’re very sorry that JF’s experience fell below the high standards we always strive to provide to our customers. JF has accepted our offer of goodwill and his complaint has been resolved.”

Your father is grateful for the £400 compensation, but you remain concerned about the way he was treated and that it could happen to other vulnerable people, as none of BT’s safeguards or complaint escalation routes seemed to work.

We welcome letters but cannot answer individually. Email us at consumer.champions@theguardian.com or write to Consumer Champions, Money, the Guardian, 90 York Way, London N1 9GU. Please include a daytime phone number. Submission and publication of all letters is subject to our terms and conditions.