Public Health

Putting the squeeze on Lap-Band ads

County supervisors squared off Tuesday with promoters of the Lap-Band, featured on billboards all over Southern California but drawing increasing attention from officials concerned that the publicity blitz is obscuring a wide range of medical dangers.

After a series of sharp exchanges with representatives of 1-800 GET THIN, supervisors approved a motion by Supervisors Mark Ridley-Thomas and Zev Yaroslavsky to bring greater scrutiny to Lap-Band marketing and procedures. They directed county staff to, among other things, “develop a plan to identify medical products and services that are being marketed in a dangerously misleading manner.”

The supervisors’ action comes after the U.S. Food and Drug Administration recently sent letters to eight Southern California weight loss clinics and the 1-800 GET THIN marketing firm, warning that the company’s ubiquitous advertisements do not provide enough information about the risks of gastric bypass surgery or about the need to change eating behavior to lose weight over the long term.

“The FDA’s warnings raise significant concerns about the vulnerability of all County residents to these advertisements, particularly those who suffer from morbid obesity and wish to find a cure,” the motion said. “Medical experts and the FDA agree that the Lap-Band procedure is an aggressive treatment for obesity and should only be considered in clinically severe obesity cases.”

Robert Silverman, the president of 1-800 GET THIN, told supervisors that his firm is taking steps to bring its billboards and radio and TV spots into compliance with the FDA requirements. An attorney for the company said its surgery centers “have a better track record than just about anybody else.”

But supervisors were openly frustrated as they tried to find out more about how 1-800 GET THIN operates, in terms of referrals to clinics and responsibility for disclosing risks to potential clients.

“It’s been a long time since a witness or member of the public has come to that table and has obfuscated as consistently and persistently as you have today,” Yaroslavsky told the 1-800 GET THIN representatives. “I did not come here as a person who had any fundamental suspicion one way or the other about what you were doing. I leave here now thinking you are hiding something.”

The FDA’s action was prompted by Dr. Jonathan E. Fielding, the county’s top public health official, who last year asked the agency to investigate whether widespread Lap-Band promotion by 1-800 GET THIN was misleading.

The motion approved by supervisors Tuesday directed the Public Health Department to report back on what it is doing to get the word out about “safe and effective alternative methods to achieve and maintain a healthier weight.”

“There is no panacea for obesity, including the Lap-Band weight loss procedure,” the motion said. “However, there are proven strategies, when sustained over time, which can help people achieve a healthier weight, and decrease the risk for diabetes, heart disease and other chronic diseases.”

The motion also directed the County Counsel to provide legal options on steps the county could take to “ensure truthful advertising of aggressive obesity treatment procedures in unincorporated areas.”  And it instructed the Chief Executive Office to pursue legislation to increase supervision and oversight of clinics that perform “aggressive and invasive obesity treatment cosmetic procedures.”

Posted 12/20/11

 

Backpack? Pencils? Pertussis vaccine?

As September approaches, health officials are reminding parents that a new state law requires proof of a pertussis, or whooping cough, booster for students entering the 7^th through the 12^th grades.

The law was passed last year after a dramatic increase in pertussis cases sent the incidence of the disease soaring in California to the highest levels since 1958. More than 9,000 cases were reported, including 10 deaths, most of which were among infants who had not yet been vaccinated.

According to the Los Angeles County Department of Public Health, four of those babies were in Los Angeles County, where the number of reported pertussis cases quintupled to nearly 900. In normal years, no one dies of the disease.

More commonly called whooping cough, pertussis is a serious and highly contagious respiratory infection that causes violent, uncontrollable fits of coughing and can lead to pneumonia and brain hemorrhages, among other complications.  Although most children receive a vaccination, known as Tdap, before kindergarten, the immunization can wear off, and children can remain susceptible into adulthood without booster shots in adolescence.

The incidence of pertussis has risen nationally in recent years along with measles, mumps and a number of other potentially lethal childhood illnesses. To complicate matters, unfounded fears about vaccine safety have been fueled by internet rumors, leading some states to make it easier for parents to opt out of vaccinations that used to be an iron-clad requirement for school enrollment. This, in turn, decreases resistance in the general population, as the proportion of the community immunized against these dangerous, but preventable, diseases falls below the required critical mass.

The new law does allow very limited exemptions, and includes a 30-day grace period allowing schools to let students attend classes if they don’t have their paperwork in order by the first day of class.  But the school district still has to work with the family to get the child vaccinated before the final deadline because even if an unvaccinated child survives an infection, he or she can pass it to more vulnerable people, such as infants, the elderly and the ill.

Although 2011 rates have dropped and no deaths have been reported so far this year, the California Department of Public Health reports that whooping cough remains at higher-than-average levels in the state—and higher than the last record year, in 2005.

Parents whose middle- and high-school children have not yet been vaccinated should contact their health care provider. The Los Angeles Unified School District has been offering free vaccines this month, along with a number of community groups. For a list of places to go in Los Angeles County for free and low-cost immunizations, click here and here. For more information from the county Department of Public Health, click here. For information in Spanish, click here.

Posted 8/16/11

Food trucks start making the grade

You follow them on Twitter and dine on their increasingly eclectic curbside offerings, from Cuban medianoche sandwiches to passionfruit-flavored Hawaiian shaved ice.

Now you can be the first one on the block to spot that bright new letter grade in the window.

In January, Los Angeles County’s new letter-grading system took effect for mobile food vendors with the goal of making it easy for curbside diners to find out whether their favorite truck is passing muster with the Public Health department.

Today, public health officials demonstrated what goes into an inspection, using the popular Grilled Cheese Truck as an example. (It passed with a perfect 100%.)

“Once again, Los Angeles County is at the vanguard of the food safety industry,” Supervisor Zev Yaroslavsky said in helping to kick off the demonstration. (See press conference here.)

The ordinance to extend restaurant-style letter grades to food trucks, the first of its kind in the nation, was approved by the Board of Supervisors last October.

There are currently about 6,000 permitted food trucks in the county. From their construction site and factory yard origins, the trucks in recent years have expanded to serve a new clientele hungry not just for tacos and hot dogs but also for more exotic delights like Indian snacks served “desi” (curbside) style or Asian fusion plates.

Still, one of the trucks’ major assets—mobility—had also posed a potential headache for customers wondering who owns and operates the trucks, who inspects them, and whether their food is safe to eat.

Even before the advent of letter-grading, food trucks—like other restaurants in Los Angeles County—were subject to inspection and evaluation by public health authorities. (Here’s the detailed food-truck inspection guide, and all inspection records must be made available to customers upon request or posted online here.)

County officials worked closely with the Southern California Mobile Food Vendors Association in refining the new program; here’s the list of their members. Many of them have websites, Facebook pages and Twitter feeds to keep current and potential new customers up to date on schedules and routes.

Meanwhile, as food trucks’ visibility has increased, conflicts have sometimes cropped up between the mobile facilities and brick-and-mortar restaurants.

A task force convened last fall recently offered a series of recommendations to address concerns on both sides.

At today’s demonstration, Dr. Jonathan E. Fielding, the county’s director of Public Health, said the new food truck letter-grading program builds on the public popularity of the county’s restaurant program, which went into effect in 1998.

He said the program had proven extremely effective in reducing foodborne illness in the county—a benefit that now has wheels attached.

The video below is from today’s Press Conference – Mobile Food Facility Grading Program Launches in LA County:

Posted 2-3-11

Top county doc wants lap band ad probe

L.A. County’s top public health official wants to put the squeeze on those ubiquitous LAP-BAND ads.

In a Dec. 7 letter to the U.S. Food and Drug Administration, Dr. Jonathan E. Fielding asks the agency to investigate whether widespread promotion of the LAP-BAND by the 1-800-GET-THIN weight loss clinics is misleading the public by failing to disclose enough about the potential risks of such surgery.

Fielding, the county’s director of public health, said while bariatric surgery can be appropriate for some severely obese patients, it’s not for “the vast majority of individuals, and should be reserved for those who have failed other approaches.”

He also took aim at the assertion in the advertising campaign that “Diets fail!” which he said undercuts the importance of healthy, common-sense lifestyle choices.

“Misleading advertisements erode the ability of the majority of the public, who are currently either overweight or obese, to fairly consider alternative weight management options, and for ‘normal’ weight individuals to be concerned about behavior that increases risk of weight gain,” Fielding said in the letter.

Fielding’s letter comes as Allergan, which manufactures the LAP-BAND system, is seeking approval to broaden the use of its product by allowing less obese people to use it. Lowering the standards to include people with a body mass index of 35, or 30 if they have other conditions, could mean more than 2 million people in L.A. County would be eligible for such surgery, Fielding said. Currently, most patients must have a body mass index of at least 40, or 35 with certain other conditions, or be more than 100 pounds overweight, to be considered eligible for LAP-BAND surgery.

An FDA advisory panel last week voted in favor of the proposed expansion to less obese patients.

Anyone who’s driven or watched television in Los Angeles County has likely seen the billboards and bus ads touting LAP-BAND and heard the 1-800-GET-THIN jingle. A sampling of the ads were included with Fielding’s letter to the FDA.

Misleading promotional messages, especially if the device becomes available to more people, may prove to be a disincentive to maintaining a healthy lifestyle because they create the “false impression that there is a very simple, fast, effective and permanent fix” for weight loss, Fielding said

In an interview, Fielding said one purpose of his letter is to have the FDA clarify who bears responsibility for fully disclosing any potential risks associated with a medical device.

A spokeswoman for Allergan said her company had no role in the billboard and current TV advertising campaigns. “Allergan doesn’t control, manage or have any input on those ads,” said spokeswoman Cathy Taylor, who said her company would not comment on others’ promotional efforts involving the device.

Representatives for 1-800-GET-THIN could not be reached.

Fielding’s letter was directed to Dr. Herbert Lerner, acting director of the FDA’s Reproductive, Gastro-Renal and Urological Devices Center for Devices and Radiological Heath.

Fielding urges Lerner to take steps to ensure that the LAP-BAND promotional campaign “does not constitute misbranding of a restricted device.”

Fielding is not alone in voicing concerns about the potential expansion of the device’s use. Others, including the National Women’s Health Network, a nonprofit advocacy group, and the National Research Center for Women and Families also have raised questions. Before voting in favor of the proposed expanded use for the LAP-BAND, the FDA advisory panel heard testimony from New York attorney Stephanie Quatinetz, whose 27-year-old daughter died after LAP-BAND surgery.

Posted 12/8/10

Coliseum rave continues—with strings

Responding to wide concerns over the safety of raves, the Los Angeles Memorial Coliseum Commission this week told event promoters they must seek the panel’s approval at least 60 days before their next scheduled show at the historic facility.

The commission action came in lieu of reinstating a ban on the highly popular electronic music festivals that was put in place after the overdose death of a 15-year-old girl at last June’s Electric Daisy Carnival at the Coliseum. The two-day event, which drew 185,000 fans, prompted emergency medical officials to call for an end to the shows because of the high numbers of Ecstasy-related drug overdoses.

Following the girl’s death, the nine-member joint county, city and state commission adopted a moratorium on raves, proposed by County Supervisor Zev Yaroslavsky, a member of the panel. Yaroslavsky on Wednesday proposed that the board require the Coliseum staff and Electric Daisy Carnival promoter to seek the commission’s approval at least 60 days before the next show in June.

The commission will examine plans to ensure the safety and health of attendees. Many of those measures are detailed in a series of recent recommendations by the county’s public health department.

The commission will also study the impact of the festival in determining how to move forward. “If we can’t control it,” Yaroslavsky said, “then the promoters are going to have to find another place.”

On Tuesday, the Board of Supervisors is expected to vote on a motion by Yaroslavsky and Supervisor Don Knabe to adopt the series public health department recommendations, the product of a multi-jurisdictional task force.

You can read more about the Coliseum Commission’s action in these accounts from the Daily Breeze and the Los Angeles Times.

Posted 12/2/10

Hepatitis A alert for deli patrons

Public health officials are urging shots for anyone who ate a sandwich from Jerry’s Deli in Westwood on certain dates in November, after an employee there came down with hepatitis A.

The dates are November 18, 21, 23 and 24. The public health department said those who may have been exposed should get an immune globulin shot or a hepatitis A vaccination no later than 14 days after their exposure to prevent or reduce illness.

People who ate food other than sandwiches aren’t considered to be at risk. Only the Westwood branch of Jerry’s Deli is affected.

Affected diners should contact their personal physician promptly about getting a shot. If that’s not possible, immune globulin and hepatitis A vaccine are also available at some county clinics through Dec. 8. For more information, call 211 or click here. The Department of Public Health also has compiled this Q&A.

Posted 12/2/10

Before you tuck into turkey, read this

Jean Tremaine would like to interrupt the coming feeding frenzy with a public service announcement:

Thanksgiving dinner is a meal, “not an all-you-can-eat buffet that starts in the morning and goes through the weekend.”

Not that Tremaine, director of the county’s public health nutrition program, wants to be a turkey day buzz-kill.

By all means, she says, enjoy those once-a-year specialties. (Especially if depriving yourself at dinner means you’ll make up for it with a chocolate binge at home later.)

But come in with a game plan. Eating strategically is more than just a way to strike a blow for eating sanity at a meal that can easily weigh in at 3,000 calories or more.

It’s also a chance to create a healthy eating pattern for all of the holiday temptations ahead.

“Heading into the overeating season, it’s a good opportunity to set the tone and come out of this relatively unscathed,” says Tremaine, a 23-year county veteran whose department oversees nutritional education programs, helping to translate healthy eating practices into individualized approaches for L.A.’s ethnically diverse communities.

Otherwise, if you don’t watch it, “you’re in a food coma for the months of December and January.”

To stay out of that state—and to do your part to combat America’s obesity epidemic—here are a few of Tremaine’s tips for navigating the Thanksgiving bounty.

1. Know your must-have dish, and then take it easy on the rest.

“The most important thing to me is the pumpkin pie. My sister makes it. It’s just the classic recipe off the can, with a little more spices.”

2. Concentrate on the people around the table.

“Enjoy the socializing and not focus so much on the food. It’s called thanks giving. Think about what’s good in your life.”

3. Divide and conquer your dinner plate.

Load half your plate with vegetables (preferably not the kind that come doused in canned soup and topped with fried onions.) Leave one-quarter of the plate for turkey (no skin, please) and the rest for a starch of your choice. “Because there are so many simple carbohydrates, I skip some of them. I don’t need stuffing and mashed potatoes and a roll.”

4. Make the pre-dinner nibbles healthy.

“Normally, a Thanksgiving dinner starts hours before dinner.” Instead of “high fat dip, pretzels and peanuts,” offer guests seasonal fruit like sliced Fuyu persimmons, or a bowl of Satsuma tangerines.

5. Take it easy on the alcoholic beverages.

“Limit the booze. It’s high in calories and it lowers your eating inhibitions.” If you do imbibe, alternate your drinks with glasses of water.

None of this should make you think that Tremaine is some kind of joyless anti-food crusader. On the contrary, she’s the kind of person who enjoys seafood-eating vacations in places like Sicily or Sardinia. But, as a longtime Weight Watcher, she has learned how to combat a holiday tradition of “eat until you hurt.”

“A couple of decades ago, I stopped doing that,” says Tremaine, 63. “It’s a wonderful feeling not to eat until you hurt.”

And she thinks a less gluttonous approach can help people find more meaning in the holiday along the way.

“It’s really an occasion for reflection,” she says, “to ask ‘What am I grateful for?’ ”

For some other helpful hints, check out this turkey-carving video and make sure you’re up to speed on how to cook and serve your feast safely.

Posted 11/18/10

A new tack on raves and drugs [updated]

At 63, John Viernes admittedly didn’t blend into the crowd. For one thing, he was wearing more clothes.

But there he was, director of Los Angeles County’s substance abuse and prevention office, positioned at the entrance of the Sports Arena, handing out 3-by-5 cards about the drug Ecstasy to the throngs at last month’s Monster Massive electronic music festival.

“This is really cool,” Viernes says he was told by a number of concertgoers, who actually kept the material. That included the scantily clad girl who gave him a high-five.

The cards—among dozens of recommendations offered this week by a task force on “rave” safety—represent a departure of sorts for the public health department as it experiments with a more credible way to connect with and influence its target audience.

The glossy, colorful cards carry the inherent message that public health officials know that some concertgoers are going to take Ecstasy and want to help them “minimize potential harms” by offering guidance on, among other things, the signs of an overdose, how to keep properly hydrated and the potentially lifesaving importance of keeping doses low and infrequent.

Viernes said some attendees seemed taken aback by the county’s open-minded approach. “I told them to read all the way to the bottom,” Viernes says, where the cards (which were funded by concert promoters) state: “The only way to completely avoid the risks is to avoid the drug, enjoy the music and dancing instead.”

Since the overdose death last summer of a 15-year-old girl who’d attended the annual Electric Daisy Carnival at the Coliseum, these huge electronic music festivals have come under intense scrutiny from health and public safety officials. Emergency room doctors have said that they prepare for concert nights as they would for such “multi-casualty incidents” as earthquakes because of the number of Ecstasy overdoses. Some critics called for an outright ban of raves at public venues, which reap considerable income from renting their facilities to concert promoters.

In the wake of the Electric Daisy Carnival, which drew a stunning 185,000 people during its two-day run in June, the Board of Supervisors unanimously approved a motion by Supervisors Zev Yaroslavsky and Don Knabe to create a task force comprised of public and private sector representatives to take a deeper look at the issues and come up with ways to enhance safety and educate the public on the perils of Ecstasy, a synthetic amphetamine that has become the drug of choice among a growing number of young teens.

In fact, last year the Los Angeles Unified School District sent an “information alert” to principals warning of a “sharp rise in the incidents of ecstasy use in our middle schools and high schools” that led some campuses “to call paramedics for students passed out at school.”

On Monday, the task force submitted to the board 42 recommendations encompassing such areas as emergency medical services, health precautions, law enforcement activities, alcohol policies, venue restrictions and public education campaigns. Participants, including concert promoters, have praised the effort for getting everyone in the same room and giving the issue the high priority that it deserves.

In a statement, a spokesman for Electric Daisy Carnival promoter Insomniac said: “We look forward to implementing these recommendations, in conjunction with Insomniac’s existing safety and security measures, to enhance the safety of events throughout the county while preserving the quality and fun of music fans’ experience.”

Already, some of the recommendations have been piloted at two festivals at the Sports Arena, where the crowds are a fraction of those at the Coliseum. Perhaps most significant for the moment, no one under 18 was allowed to attend the events and a medical station with a physician and nursing staff was set up inside the venue.

Cathy Chidester, director of the county’s emergency medical services agency, says the medical station eliminated the need for many people to be transported to overburdened emergency rooms, a significant change from the past.

Chidester, who attended the last two raves at the Sports Arena, says roving paramedics and emergency medical technicians brought a variety of ailing concertgoers to the physician, most of whom were “slightly altered and needed to be watched until the drug levels [in their systems] went down.” In the past, she says, these people would be transported to hospitals.

Meanwhile, outside the arena, another substantial change had taken root: the number of Los Angeles Police officers deployed in the parking lot had soared to 450 from the 250 assigned to the Coliseum’s Electric Daisy Carnival.

LAPD Deputy Chief Patrick Gannon says most everyone on the task force wanted to keep the raves alive so people could enjoy themselves. “But I don’t want to sanction a drug party either,” says Gannon, who is not happy about using officers “who are normally patrolling the streets of South L.A.”. The goal, he says, is to deter gate crashers and try to shut down drug sales outside so it becomes less problematic on the inside.

Because of the burden on the system, Gannon says he thinks concert promoters should be forced to pick up the tab. “I’ve had conversations with Councilman [Bernard] Parks. We don’t come close to agreeing.” Gannon says the former LAPD chief “thinks I over-deploy. I respectfully disagree. It’s been a long time since he’s deployed officers.”

Parks says he does, in fact, believe that deployment levels at the electronic music festivals have been disproportionate to the problems. He says Gannon’s desire to dry up parking lot drug sales is commendable. “But he should probably call in the Sheriff’s Department, the National Guard and the military if that’s his goal. There’s been drug usage at concerts since before his birth.”

Parks says that festival promoters at the Coliseum and Sports Arena should not be forced to pay for unnecessary officers outside the facility. “The fact that they [LAPD] have chosen to over deploy is on their dime not the dime of the promoter.”

Meanwhile, work continues on the educational component of the campaign. A public service announcement on the dangers of Ecstasy is being prepared for airing at venues and possibly on ticket services.

Financed by promoters, it’ll include such big-name DJ’s as Will.i.am and Tommie Sunshine, who looks into the camera and says: “Rolling on Ecstasy can cause heart problems, brain damage, stroke and possibly death.”

The task force, led by Public Health Director Dr. Jonathan E. Fielding, is asking the Board of Supervisors to adopt the recommendations as “general policy direction” for electronic music festivals countywide and to encourage promoters and sponsoring entities to get on board, too.

Posted 11/9/10

Updated 12/7/10: The Board of Supervisors, acting on a second motion by Supervisors Yaroslavsky and Knabe, unanimously adopted the task force’s key recommendations as general policy direction for all electornic music festivals in Los Angeles County. Those key recommendations include, among other things, ensuring the presence of onsite medical and health personnel, requiring attendees to be 18 or older, creating a threat assessment and action plan for each event and distributing harm reduction materials to concertgoers.

The board also directed the Department of Public Health to report back by the end of September, 2011, with an evaluation of the succcess or failure of health and safety measures implemented at all major electronic music festivals in L.A. County between June of this year and August, 31, 2011.

 

Getting the lead out for healthy kids

If you haven’t checked your home for sources of lead exposure, this would be a good week to start. The county Department of Public Health, in observance of National Lead Poisoning Prevention Week, is putting out the word about common sources of lead that can cause health problems, especially for children.  The main cause of lead poisoning in Los Angeles County children is exposure to peeling lead-based paint, which is commonly found in houses, apartments, and buildings built before 1978.  Other sources of lead exposure include contaminated ground soil, lead dust from work clothes, folk remedies like Azarcón and Greta, and imported toys and candy.

“In 2009, 671 children in Los Angeles County had seriously elevated blood-lead levels, which is entirely preventable,” said Jonathan E. Fielding, the county’s director of public health. “Lead can seriously affect a child’s brain and nervous system and may cause learning and behavioral problems.” A blood lead test is the only way to identify and confirm elevated lead levels in children.

Parents who are concerned about their children’s exposure to lead are urged to ask their child’s doctor about lead testing.  Free materials in many languages, as well as answers to questions on lead poisoning prevention, are available by calling 1-800-LA-4-LEAD or online here. Parents who do not have a doctor for their child can also call the hotline for referrals to free and low-cost health services for children and teens.

Posted 10/29/10

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