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

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