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Vaping sector uses Big Tobacco tactics to protect itself
 Samir Soneji had no idea what he was getting into when he agreed to talk about the potential risks of vaping at the first US E-Cigarette Summit in Washington, DC this past May. His first clue was the booing.

As a professor at the Dartmouth Institute for Health Policy and Clinical Practice, Soneji studies how gaps in tobacco regulation affect health. Two years before the conference, he’d reported in JAMA Pediatrics that young people who smoke hookah or use “snus,” a form of moist smokeless tobacco, are twice as likely to try cigarettes as kids who don’t. He suspected that e-cigarettes, with kid-friendly flavors like “Cinnamon Roll” and “Peanut Butter Cup,” carried a similar risk. And that’s exactly what he and several colleagues discovered in a recent review of studies that tested that possibility.

Evidence that tobacco companies targeted teens and nonsmokers with candy- and fruit-flavored cigarettes prompted the Food and Drug Administration to ban them in 2009 under the Family Smoking Prevention and Tobacco Control Act. But those restrictions do not apply to e-cigarettes and hookahs, even though the FDA extended its authority in August 2016 to include all forms of tobacco.

Key points The e-cigarette market is expected to be worth $34 billion by 2021, and is increasingly dominated by tobacco companies such as Reynolds American and Altria (formerly known as Philip Morris).

Studies into the argument that vaping leads to smoking cessation continue to have mixed findings. Meanwhile, studies on the health risks of vaping have different results based on whether they were funded by tobacco companies, or non-affiliated public researchers.

Big Tobacco has been developing e-cigarette devices since the early 1960s, but eventually avoided marketing them because, according to executives, smokeless tobacco “complicates our efforts to resist the FDA’s attempts to regulate the tobacco industry.”

Major tobacco companies co-opted and heavily invested in the promotion of the concept of “harm reduction,” as opposed to smoking cessation, as a means of gaining access to public health experts and casting themselves as socially responsible corporations. It is the same argument vaping promoters use today.

E-cigarette manufacturer NJOY and importer Smoking Everywhere have hired the same firms that previously helped the tobacco industry evade regulation and defeat smokers’ liability claims for years. Their allies have hired law firms that have successfully defended major tobacco companies from class action lawsuits.

Philip Morris, Reynolds American, and its allies paid lobbyists nearly $1.2 million to fight a California bill to prohibit the sale of e-cigarettes in vending machines and regulate them like any other tobacco product.

Tobacco and vaping industries spent nearly $10 million to fight regulations on e-cigarettes and related legislation in California since 2009.

Soneji figured that people who came to a conference about the science and regulation of e-cigarettes actually wanted to hear the latest science, whatever the data showed. So he told the audience what he and others had found: youth who vaped were more likely to start smoking cigarettes than those who didn’t. What’s more, kids who made the leap from e-cigs to cigarettes probably wouldn’t otherwise have started smoking, he explained, because they didn’t suffer from anxiety or depression or use alcohol or drugs — risk factors associated with youth smoking. He also shared evidence that “fun” candy-flavored e-cigarettes attract kids, just as flavored cigarettes did, and that, because labels often misrepresent nicotine levels in the devices, even kids who think they’re vaping only flavors could be inhaling nicotine.

The booing was not the only sign to Soneji that this was not a typical scientific conference. He later joined a Q&A panel before the morning break. There, a Johns Hopkins researcher who said he consults for pharmaceutical companies and Reynolds American — which makes VUSE, the top-selling e-cig brand in the US — asked the panel when public health officials were going to communicate positive messages about how vaping reduces harm, like they do about using clean needles and condoms to stem the spread of disease. Soneji said it would be premature and dangerous to recommend e-cigarettes to help smokers quit, given the lack of rigorous scientific evidence to support it. Minutes later, the head of an anti-smoking organization rose from the audience to dismiss his call for more evidence as “rubbish.” The crowd laughed and cheered.

Many people in the audience, Soneji would discover, had an emotional or financial interest in vaping — and they didn’t pay up to $1,100 a ticket to hear anyone question the benefits of e-cigarettes. “I didn’t realize just how many people would be from the industry, and whose job and livelihood is [tied] to e-cigarettes,” he says. “Hearing about the harms of vaping came across as threatening to their existence.”

Many people Soneji spoke to after his talk argued that e-cigarettes save lives. They told him it’s the tar in cigarette smoke that causes lung cancer, and since e-cigarettes don’t have tar, there’s nothing to worry about. An ex-smoker-turned-vaper who had opened a vape shop to help others quit smoking told Soneji that his products were safer because they don’t produce cancer-causing tar. While that’s true, Soneji says, “he was very dismissive of any cardiovascular effects around vaping and nicotine, and around the chemical by-products of heating the e-juice.”

“Hearing about the harms of vaping came across as threatening to their existence.”

Public health campaigns have so successfully tied smoking to lung cancer that people often don’t realize more smokers die of cardiovascular and metabolic diseases than of lung cancer. Soneji tried to tell the shop owner, and many others at the summit, that smoking significantly increases the risk of cardiovascular disease and that recent studies suggest e-cigarettes also increase heart attack risk. But they didn’t listen to him. They didn’t understand how anyone could question the value of a product they believe helps people quit one of the world’s deadliest habits.

Online forums are filled with stories from ex-smokers who saw striking health improvements after switching to vaping. “I no longer wake up coughing and hacking up gunk for the first two hours of my day. I'm no longer getting winded doing the smallest things,” reported a member of the E-Cigarette Forum, which calls itself “the voice of vaping since 2007.”

Ex-smokers offer similar testimonials on vaping forums, blogs, and social media groups. The vaping advocacy group Consumer Advocates for Smoke-free Alternatives Association, or CASAA, sells a T-shirt to drive home the point: “Vaping saves lives.”

After the e-cigarette summit, a media outlet called Vaping360 described Soneji as “the speaker with the most tedious and pedestrian boilerplate anti-vaping agenda,” and attacked him and his co-authors as “a who’s who of terrible vaping researchers.”

The attacks on Soneji are similar to those lobbed at any individual who speaks out about the possible harms of vaping. On the Facebook page for the 2016 pro-vaping movie A Billion Lives, a woman who described herself as a tobacco treatment specialist dared to say, “We don’t know yet the exact repercussions of vaping because it hasn’t been around long enough. But we do know it causes [scarring] in the lungs.”

The attacks on Soneji are similar to those lobbed at any individual who speaks out about the possible harms of vaping

Within minutes, a man who’d just posted about how vaping helped him quit smoking told her: “STFU you are an idiot and a moron. Clearly you don’t know wtf to say cause you would rather people smoke.” The next comment is too profanely misogynistic to print.

It’s hard to overestimate the power of personal experience. But personal anecdotes, no matter how plentiful or powerful, are no substitute for scientific evidence derived from rigorously designed studies that test alternate hypotheses and control for confounding factors. Scientists are just beginning to test the effects of vaping on the human lung. A recent review of studies concluded that e-cigarette use may cause “significant” toxicity to the lung, but noted that more research is needed. Long-term studies clearing e-cigarettes as reasonably safe alternatives to cigarettes have not been done. But that hasn’t stopped some vaping advocates from claiming they have.

Studies across diverse subjects show that industry-funded research tends to favor the study’s sponsor

Just a decade ago, the vaping industry — which includes devices that typically heat nicotine-containing liquids to produce inhalable vapors — was largely the province of small businesses. Today, the market, which is valued at over $10 billion and expected to be worth $34 billion by 2021, is increasingly dominated by tobacco companies such as Reynolds American and Altria (formerly known as Philip Morris).

Many vaping advocates say they’re competing with Big Tobacco, which they fear will stifle innovation. They say that taxes on e-cigarettes will penalize smokers trying to quit and that regulations requiring companies to disclose the ingredients in e-juice and conform to quality standards will bankrupt small entrepreneurs. Some may well be trying to put the tobacco industry out of business. But others have joined forces with some of the same actors and have deployed the same tactics the tobacco industry used to stoke doubts about smoking’s dangers while marketing “safer” delivery systems. They’re enlisting veteran tobacco industry law firms to contest federal oversight in court and partnering with tobacco-funded libertarian groups to fight regulation in states and cities, and they’re rallying armies of ex-smokers who believe vaping saved their lives.

Turning Public Health Experts into the Enemy

For decades, tobacco control experts worked together to counter marketing campaigns that made smoking sexy. Hard-hitting TV spots featuring smokers disfigured by cancer and speaking through voice boxes, or hooked up to oxygen tanks and gasping for air helped drive a decline in smoking that had begun in the 1960s. But health alliances forged to stop smoking began to crumble in the mid-2000s with the advent of campaigns to promote “reduced harm” products like smokeless tobacco and e-cigarettes. While some of these products — including nicotine patches, lozenges, and gums — have received FDA approval to treat nicotine addiction after clinical trials showed they were safe and effective, others, including smokeless tobacco and e-cigarettes, have not.

E-cigarettes are theoretically safer than cigarettes because they don’t burn tobacco, which produces a noxious mixture of toxic and cancer-causing substances, such as polycyclic aromatic hydrocarbons, aldehydes, and heavy metals like cadmium and arsenic. Instead, the battery-powered devices produce an aerosol mist by heating “e-juice,” which typically contains flavors and nicotine dissolved in solvents (propylene glycol or vegetable or both) that minimize evaporation until the cocktail is inhaled. Proponents of harm reduction, who advocate offering reduced-risk products to those who can’t stop smoking, argue that giving e-cigarettes to smokers is like providing clean needles to IV drug users: individuals can satisfy their craving while reducing their overall disease burden.

Proponents of harm reduction argue that giving e-cigarettes to smokers is like providing clean needles to IV drug users

But for a harm-reduction argument to be valid, policy makers need strong evidence that vaping improves smokers’ health without creating a new set of risks — to both users and nonusers. So far, the evidence for quitting is mixed, while long-term safety remains unknown. A systematic review of studies of e-cigarettes and smoking cessation published last year reported that two clinical trials offer evidence that vaping leads to quitting, but cautioned that they were too small to have confidence in the results. Meanwhile, another review published last year, which included a broader range of studies, concluded that people who used e-cigarettes were actually less likely to quit smoking.

Assessing risks to vapers and bystanders associated with chemicals in e-cigarette vapor has proven difficult because manufacturers keep changing the devices, which now come in over 460 brands and close to 8,000 different flavors.

Some vaping advocates insist that e-cigarettes emit only harmless water vapor — echoing marketing claims — and propylene glycol, the same ingredient used in fog machines. The FDA has deemed e-cigarette flavorings and the solvents propylene glycol and glycerin “generally recognized as safe” for use in food, but that has little bearing on whether they’re safe to inhale. Several studies have detected a range of toxic chemicals in e-cigarette vapor, including diacetyl, which is associated with the severe respiratory disease known as “popcorn lung”; aldehydes, which are probable carcinogens; acrolein, a potent irritant often found in air pollution; and the cancer-causing tobacco-specific nitrosamines that are also found in cigarette smoke. The few studies of people working with theatrical fog machines found that those working closest to the machines had reduced lung capacity — and they weren’t repeatedly sucking propylene glycol into their lungs like vapers do. What’s more, several studies report that heating propylene glycol and glycerin under normal vaping conditions can produce an array of toxic chemicals, including benzene, a known human carcinogen, and fine particles, which can cause heart disease.

Levels of toxic chemicals found in e-cigarette vapor are typically far lower than those found in tobacco smoke, but no one knows the long-term effects of inhaling them.

To figure out whether e-cigarettes reduce harm to smokers, the devices would have to undergo rigorous testing in several clinical trials, just as other nicotine-replacement therapies have. That hasn’t happened. When the Public Health England panel concluded that e-cigarettes are 95 percent safer than cigarettes, it relied on assumptions about risks, not on data derived from carefully controlled studies.

“Theoretical benefits are not evidence,” says Jonathan Klein, scientific director for the American Academy of Pediatrics Julius B. Richmond Center of Excellence, which studies tobacco. To get evidence on relative risks, at a minimum you’d need to track the disease rates of separate groups of people using different products to see if vaping reduces disease outcomes, Klein says. And if you want to protect public health, you’d prevent nonsmokers and young people from getting addicted, he says. “But that’s not the way it’s been approached.”

“Theoretical benefits are not evidence.”

Soneji says you could classify e-cigarettes as a net population benefit if the devices were better than cold turkey at helping adult smokers quit, and they didn’t attract children. Then they’d resemble conventional nicotine-replacement therapy, otherwise known as NRT (think Nicorette gum or Chantix pills). “No kids are really interested in NRT,” Soneji says. “And NRT is better than cold turkey for smokers interested in quitting.”

And though e-cigarette lobbyists compare vaping to needle exchange or methadone treatment, there’s a critical difference, Soneji says: unlike e-cigarettes, methadone isn’t designed to attract people who aren’t already addicted. “It’s not like you can buy mint-flavored methadone.”

E-cigarettes, by contrast, are mass-marketed in flavors that appeal to kids, who can buy them online by clicking a link that says they’re 18 or older. In 2011, at least four years after e-cigarettes hit the US market, just over 3 percent of 6th through 12th graders had tried e-cigarettes. By 2013, over 8 percent had tried vaping. More than a quarter-million kids who’d never smoked cigarettes had tried vaping that year, researchers reported in Nicotine and Tobacco Research; they were nearly twice as likely to start smoking conventional cigarettes as kids who didn’t vape. By 2015, e-cigarette use among teens had skyrocketed to 27 percent, surpassing the use of every other tobacco product. In 2017, e-cigarette use among teens dropped for the first time, according to the latest survey by the Centers for Disease Control and Prevention, though e-cigarettes are still the most favored tobacco product.

Alarmed by the uptake among kids, former surgeon general Vivek Murthy called the devices a “major public health concern” in a report on e-cigarettes last year, which the vaping industry and its allies roundly condemned. William Godshall, a longtime anti-smoking activist who promotes vaping as harm reduction, accused Murthy of lying about vapor research and threatening the lives of vapers and smokers on eJuiceMonkeys.com, which posts his newsletter. The site also posted similar reprisals from the vaping industry and its allies.

former surgeon general Vivek Murthy called e-cigarettes a “major public health concern”

Pro-vaping blogs and online forums regularly praise studies that serve their aims and condemn those that don’t. And that’s where many of the roughly 8 million vapers and owners of the rapidly rising number of vape shops and lounges — at 8,500 last year and counting, according to the CDC journal Preventing Chronic Disease — get their information. They’re also exchanging information at the growing number of meet-ups and conventions where enthusiasts can mingle with like-minded souls, geek out over the latest gear, and watch “cloud chasers” compete to blow the most impressive vapor plumes. At conventions like VapeCon, they can stock up on free samples or take a selfie with a seductively dressed Miss VapeCon. For many, vaping isn’t just a habit, it’s a way of life.

So when The Simpsons mocked industry claims that they didn’t market to kids a few years ago, many vapers weren’t amused. In the episode, Bart goes to the Kwik-E-Mart to buy e-cigs, and Apu tells him that while they’re legal for children in their state, “this is not kid stuff.” Then Apu asks, “Now would you like bubble gum flavor, strawberry shortcake, or watermelon dream?” A writer for Vaping360 complained that the show played to “common fears and misconceptions.”

Lying about Nicotine to Avoid Regulation

Vaping advocates often describe e-cigarettes as revolutionary technology that competes with Big Tobacco, and was patented in 2003 by Hon Lik, a Chinese pharmacist who wanted to quit smoking. Yet, internal industry documents released through litigation show that tobacco companies created prototypes of electronic cigarettes decades before Lik introduced his product.

The idea then, as now, was to develop a product that reduced the harm of smoking. And as part of that effort, the tobacco industry then, like the vaping industry today, denied the harmful effects not just of tar — which is not present in e-cigarettes — but also of nicotine, which is.

In 1962, British American Tobacco-contracted scientists began work on a “smoking device”

In April 1994, two months after the FDA announced it would study nicotine’s effects, the chief executives of the seven largest US tobacco companies, including Philip Morris and Reynolds, lied under oath before a congressional subcommittee to deny that nicotine is addictive, even as they manipulated nicotine levels to promote addiction. These deceptions came to light in July 1995, when tobacco control researcher Stanton Glantz and his colleagues published the first in a series of papers that analyzed thousands of formerly confidential industry documents.

The next month, President Bill Clinton proposed sweeping regulations to curb teen smoking, noting that the FDA’s 14-month study confirmed that “cigarettes and smokeless tobacco are harmful, highly addictive and aggressively marketed to our young people.” Cigarettes and smokeless tobacco “fall well within the definitions of drug and device,” the FDA had explained, because they deliver nicotine, a drug that affects the body partly by creating and sustaining addiction as tobacco companies intended.

Philip Morris, Reynolds, and a coalition of tobacco interests wasted no time filing lawsuits, using an argument that vaping interests would later tweak. Cigarettes aren’t drugs or devices, they argued, but tobacco products, which the agency has no authority to regulate. The Competitive Enterprise Institute — which now runs interference for the vaping industry — quickly stepped in to ridicule the proposed rules. Caffeine and nicotine affect the same organs, argued Competitive Enterprise Institute general counsel Sam Kazman in a petition, so the agency may as well regulate caffeinated beverages as drugs and devices. Kazman acknowledged the petition was a stunt, but tobacco executives took his ploy a step further to argue in court that nicotine is no more harmful than caffeine — a canard promoted by vaping advocates today.

Philip Morris paid the Competitive Enterprise Institute $200,000 that year as part of its public policy program, and would pay the think tank an additional $445,000 over the next six years. Reynolds also funded the institute, which in turn joined Americans for Tax Reform and the Heartland Institute in a Reynolds-backed front group called “Get Government Off Our Back” (GGOOB) to fight indoor smoking laws and other federal tobacco regulations.

As GGOOB vowed to “protect Americans from the regulators’ heavy-handed tactics,” tobacco companies hashed out what would be the largest civil litigation settlement in US history. Forty-six state attorneys general, five US territories, and the District of Columbia sued the companies for deceptive and fraudulent practices under consumer protection and antitrust laws to recover the substantial health care costs associated with smoking. The so-called Master Settlement Agreement dismissed existing and future suits against the companies in exchange for billions in annual payments to compensate the states.

Tobacco companies co-opted “harm reduction” from an Institute of Medicine report

Toward that end, they hired PR firms to create divisions among tobacco control experts and weaken public health policy by identifying moderates who might promote “safer” products while attacking the credibility of moralistic “extremists” who wouldn’t.

It’s impossible to tell whether the tobacco industry’s efforts to cause dissension among tobacco control experts accounts for the polarized debate on vaping today. The industry has a history of destroying documents that might have revealed whether they carried out their plans. What’s clear, however, is that the industry continued to call on “credible third parties” like the Competitive Enterprise Institute and Americans for Tax Reform to fight regulations by attacking inconvenient research results and highlighting “abuses” of government-funded anti-tobacco programs. And now the same third parties are helping vaping interests protect e-cigarettes.

Tobacco-funded Libertarians Lend a Hand

As of September 2017, eight states and the District of Columbia have passed laws to tax e-cigarettes. Every state except Michigan has at least one law on the books specifically regulating e-cigarettes, and in many states, including Michigan, local governments have adopted stronger rules. Where public health experts see taxes and regulations as proven strategies to reduce the use of tobacco and its alternatives, vaping advocates view the measures as an assault on their livelihood and individual rights. Their campaigns to fight taxes and regulations have been taken up by far-right libertarian activists like Grover Norquist, founder of Americans for Tax Reform, which has received over $1 million from Philip Morris and Reynolds since the mid-1990s. Norquist praised vapers on his podcast for helping to defeat the 2014 reelection bid of a New Mexico state representative who proposed taxing e-cigarettes as tobacco products, and for beating back tax increases in 26 states.

Last year, Americans for Tax Reform’s Paul Blair joined the Consumer Advocates for Smoke-Free Alternatives Association and the American Vaping Association on a multi-state “Right to Vape” tour to “raise awareness” that the FDA’s proposed regulations on e-cigarettes would destroy the industry. At a stop in Wisconsin, the rally’s emcee introduced an “activist and warrior for the cause,” Aaron Biebert, director of the cinematic valentine to vaping A Billion Lives. In the movie, named for cigarettes’ projected death toll over the next century, Biebert lays out a conspiracy to discredit vaping among puritanical “prohibitionists” who insist smokers “quit or die,” corrupt federal health officials addicted to revenues from tobacco industry taxes and lawsuits, and drug companies intent on quashing their competition.

Glosses on this theory echo across blogs, social media, vaping forums, and right-wing media channels. Biebert’s vilification of the federal government earned him spots on the Herman Cain Show, hosted by the 2012 Republican presidential candidate and Tea Party favorite, and the podcast of the Heartland Institute, the free-market think tank that took money from Exxon while attacking the science of climate change. Perhaps less well-known is that the Heartland Institute, which took at least $325,000 from Philip Morris in the 1990s, also helped the tobacco industry deny the evidence that secondhand smoke harms bystanders — and that Philip Morris targeted kids with its Joe Camel cartoons.

On Cain’s show, Biebert explained his movie’s central premise: e-cigarettes would save a billion lives if not for corrupt public health officials who lie about the risks of nicotine and vaping to promote innovation-destroying regulations that will kill an industry. “You can tell it’s kind of crooked, because it just doesn’t make sense,” Biebert said. “There’s no science to back it up and here they are shutting down 20,000 businesses, and they don’t care.” (Vapers’ estimates of vape shops tend to run higher than public health officials’.) Biebert went on to say that, time and again, studies show that the air around vapers is no different from “regular air.” Cain, who fought indoor smoking restrictions and took money from Reynolds as head of the National Restaurant Association, wrapped up the interview saying, “Big Brother has lied again to the American people.”

A Billion Lives calls on veteran anti-smoking activists to attack the “anti-tobacco industry” for not promoting vaping as a public health “miracle.” By presenting an alternative to cigarettes, contends David Sweanor, adjunct professor at the Centre for Health Law, Policy and Ethics at the University of Ottawa, vaping offers the “opportunity to do something that would rival the eradication of smallpox.” Godshall, an ardent defender of vaping, describes his idea of the perfect solution to the cigarette epidemic: it would be 99 percent less hazardous than cigarettes, wouldn’t be addicting nonsmokers, wouldn’t encourage anyone to switch to cigarettes, and would help lots of people quit smoking. “And it’s called vaping.”

Both Sweanor and Godshall, who broke with mainstream tobacco control experts over a decade ago, have long promoted alternative tobacco products to reduce the harm associated with smoking (see “A History of Promoting Reduced Harm,” above).

Sweanor told me he believes vaping could force the tobacco industry to stop selling cigarettes. “If the vast majority of the risk is from the smoke, and you can deliver what consumers would like without the smoke in a far less addictive way so you can greatly reduce their health risk and you can facilitate them getting off the product entirely if that's what they want to do,” he asks, “then how do you justify selling cigarettes?”

Sweanor believes officials should inform smokers that different tobacco products carry different risks, rather than telling them to quit tobacco. “We've got 6 million plus deaths per year, virtually all because of a dirty delivery system,” he told me.

“Maybe e-cigarettes are 50 percent safer, or 25 percent safer, or maybe they are just as bad as cigarettes in ways that we do not know.”

But are e-cigarettes a clean nicotine delivery system? That’s not what the scientific evidence shows, Soneji says. “Maybe e-cigarettes are 50 percent safer, or 25 percent safer, or maybe they are just as bad as cigarettes in ways that we do not know.”

The concerted efforts to discount evidence from studies finding cause for concern about vaping echo the tactics of tobacco industry-funded scientists who questioned the link between cancer and smoking, Soneji notes. They sowed confusion and skepticism to undermine a growing body of evidence of smoking’s harms, which helped delay regulations on cigarettes for decades. The research on e-cigarettes is just beginning, he says, yet advocates are simply dismissing potential harms while cheerleading the benefits of vaping far beyond what the science supports.

Godshall, in contrast, insists the science is settled. He blames the “left-wing” media and government-funded scientists for spreading misinformation about the benefits of vaping. “The headlines and the news are confusing and deceiving the public about the science,” he says. “Many of the people who are being paid to conduct the science have been knowingly and intentionally manipulating their results, omitting results, selectively cherry picking and basically misrepresenting their own findings because they’re getting federal funding.”

Where did Godshall get the evidence that vaping is 99 percent safer than smoking? “Basically every study that’s ever been published,” he told me.

Recycling Old Claims

Long before scientists began studying vaping’s potential harms and benefits, distributors marketed e-cigarettes as a “healthier way to smoke.” Ads featuring scantily clad women claimed e-cigarettes could help smokers “stop the habit” and get “real nicotine in a harmless water vapor that you can smoke...virtually anywhere!” Where smokers saw a new gadget to satisfy their nicotine cravings, the FDA saw companies peddling a drug with unsubstantiated health claims. And in the spring of 2009, the agency blocked imports of e-cigarettes made by three Chinese manufacturers as unapproved drug delivery devices.

Smoking Everywhere, which imported and distributed the Chinese products, promptly sued the FDA, tweaking the argument tobacco companies had made a decade earlier: e-cigarettes are not nicotine or drug delivery devices, but tobacco products and therefore outside the agency’s jurisdiction. E-cigarette distributor NJOY soon joined the lawsuit, and CASAA, Godshall, and several other vaping advocates later filed a supporting brief.

Several months after seizing the products, the FDA announced that its scientists had detected tobacco-related carcinogens and toxic chemicals in some of the samples. The industry’s libertarian allies quickly rose to its defense. The American Council on Science and Health condemned the FDA for needlessly scaring the public, while Brad Rodu and Joel Nitzkin of the R Street Institute cast doubt on the agency’s science. Godshall for his part urged the FDA to consider a test by e-cigarette manufacturer Ruyan, which he said found “no product hazards.”

Godshall also actively partnered with vaping companies. “I was the person who got the two owners of NJOY and Smoking Everywhere together and helped coordinate their legal team,” he told me. NJOY and Smoking Everywhere hired the same firms that helped the tobacco industry evade regulation and defeat smokers’ liability claims for years. And their allies, including CASAA and Godshall, hired law firms that had successfully defended tobacco companies Brown & Williamson and Philip Morris against class action lawsuits brought by smokers seeking compensation from an industry they said lied about its products’ lethal nature.

Bringing in veteran tobacco industry lawyers paid off. Nine months after Smoking Everywhere filed suit, a federal judge ordered the FDA to stop seizing e-cigarette shipments.

“There is no smoke associated with e-cigarettes. So to call them smoking devices is ridiculous.”

In the absence of federal oversight, state and city officials proposed their own measures to regulate vaping. In spring 2014, the Philadelphia City Council proposed adding e-cigarettes to indoor smoking laws and prohibiting their sale to minors. CASAA quickly issued a call to action and distributed talking points to help vapers oppose the measures. CASAA describes itself as a grassroots organization devoted to ensuring the availability of reduced harm alternatives to smoking. Yet former board members have received research grants from Philip Morris, R.J. Reynolds, British American Tobacco, US Smokeless Tobacco Company, and Swedish Match, which also makes smokeless tobacco.

Godshall, Gilbert Ross, then-executive director of the American Council on Science and Health, and R Street Institute’s Nitzkin also showed up to defend vaping. Defining e-cigarettes as smoking devices is “a major distortion of the truth,” Nitzkin told the city council. Godshall urged the council to reject the bills, saying the vaping ban “deceitfully defines smoke-free e-cigarettes as electronic smoking.” Ross offered his own variation on the vaping isn’t smoking trope. “There is no smoke associated with e-cigarettes,” Ross said. “So to call them smoking devices is ridiculous.”

Yet that’s exactly what the vaping companies and their supporters called e-cigarettes in their FDA lawsuit. Smoking Everywhere — as its name suggests — described itself as a “corporation that has pioneered the marketing and importation of electronic smoking devices...marketed, labeled, and sold solely to provide adult consumers with alternative ‘smoking’ pleasure, without the inconveniences of traditional tobacco smoking.”

Godshall also resurrected the argument Kazman of the Competitive Enterprise Institute used to ridicule the FDA’s first attempt to regulate nicotine as a drug. “So, I mean, why don’t you ban coffee?” Godshall asked. “It’s got carcinogens in it, toxic chemicals.”

The Philadelphia City Council, supported by the local health department, didn’t buy his argument. Both bills passed in a unanimous votes in March 2014, a month before the FDA finally proposed its “deeming” rule to regulate e-cigarettes as tobacco products.

States have had less success than cities in passing e-cigarette legislation. In California, then-state Senator Ellen Corbett introduced a bill in 2013 to prohibit the sale of e-cigarettes in vending machines and regulate them like any other tobacco product. CASAA again rallied its base to fight the measure, arguing that e-cigarettes aren’t tobacco products, exactly the opposite of what the group claimed in a brief supporting Smoking Everywhere’s lawsuit.

In the past, cigarette companies had to create phony grassroots smokers’ rights groups to take their case to the public, says UCSF’s Stanton Glantz. “Now there are grassroots groups that popped up on their own that tobacco companies hide behind.”

And as vaping advocates fight regulations in public hearings, tobacco companies work the halls and back rooms of the capitol. Philip Morris, Reynolds American, and its allies paid lobbyists nearly $1.2 million over the 2013–14 election cycle to fight Corbett’s bill and other tobacco legislation, a review of campaign filings shows, while NJOY kicked in an additional $88,105. When the bill emerged from the Assembly Governmental Organization Committee — which tobacco control advocates call the “place where tobacco control bills go to die” — e-cigarettes were no longer defined as tobacco products. The bill died after many health advocates reluctantly withdrew their support.

Former California state Senator Mark Leno also tried to regulate e-cigarettes as tobacco products in 2015. This time, the Northern California chapter of the Smoke-Free Alternatives Trade Association (SFATA) mobilized vapers. In opposing the bill, former Norcal SFATA director Stefan Didak told legislators he’s never taken money from the vaping or tobacco industry. He didn’t mention that SFATA’s board members included a former senior marketing executive for Philip Morris and a National Tobacco Company executive who claimed to have shredded a million incriminating documents for the tobacco industry in the 1990s and founded a company that makes synthetic nicotine.

Altria and its allies paid their lobbyists over $908,700 to fight Leno’s measure, while NJOY and SFATA spent $67,500. And again, the Governmental Organization Committee changed the bill’s language to say that e-cigarettes are not tobacco products. “The chair of the Assembly committee attempted to completely hijack our bill by creating a new definition of e-cigarettes, which was exactly what the tobacco industry wanted,” Leno told me. “We had to walk away from our own bill.”

The tobacco and vaping industries have spent nearly $10 million to fight regulations on e-cigarettes and related legislation in California since 2009, state records show. Altria and Reynolds American spent over $70 million in 2016 alone to fight taxes on tobacco and e-cigarettes in California. It took a special session called by Governor Jerry Brown to get around the Assembly Governmental Organization Committee. Leno reintroduced his original bill, which passed last year along with what health advocates call the most wide-reaching package of tobacco control legislation in decades.

Recent research shows that e-cigarette users have more carcinogens in their urine than nonusers

The scope of tobacco industry spending to influence policy is no surprise to Samir Soneji, who’s well-versed in the industry’s tactics. He remains troubled that tobacco-control allies who once exposed the tobacco industry’s deceptions seem to accept the same actions by the e-cigarette industry. “It might be the same playbook but they don’t make that connection.”

Even so, the summit made him think differently about the concerns of people whose lives and livelihoods are tied to vaping. It helped him understand why adult smokers who can’t quit despite repeated attempts are willing to try e-cigarettes before there’s conclusive evidence that they work. He’s even thinking of returning to the meeting next year so he can "rile up some more animosity,” he says, recalling the boos his last appearance provoked. He’s curious if anyone will change their view of vaping in light of new studies, which are “coming out constantly." Recent research shows that e-cigarette users have more carcinogens in their urine than nonusers, for example, in contrast to studies presented at the summit that “heavily discounted” their toxicity.

Vaping interests, meanwhile, continue to discount e-cigarettes’ harms as they’ve redoubled efforts to fight restrictions on the devices. After the FDA finalized its rule to regulate e-cigarettes as tobacco products last year, vaping companies and their allies again tapped tobacco industry lawyers to fight the FDA. Nicopure, which makes e-liquids and e-cigarettes, hired the same law firm that ran Philip Morris’ Whitecoat operation to cast doubt on the dangers of secondhand smoke. The suit again challenged the agency’s jurisdiction and argued that the rule violated companies’ constitutional rights to free speech by preventing e-cigarette manufacturers from making truthful statements about its products. “Notwithstanding plaintiffs’ rhetoric,” a federal judge wrote in rejecting the claims in July, “this provision does not ban truthful statements about health benefits or reduced risks; it simply requires that they be substantiated.”

“Banning e-cigarettes would actually increase transportation-related deaths by driving nicotine-dependent passengers to drive rather than fly,” their opening brief argued

The industry tried a more creative approach last year, when CASAA and the Competitive Enterprise Institute sued the Department of Transportation to overturn a rule extending the smoking ban on airplanes to e-cigarettes. “Banning e-cigarettes would actually increase transportation-related deaths by driving nicotine-dependent passengers to drive rather than fly,” their opening brief argued, “and would undermine rather than promote passenger comfort by subjecting passengers to nicotine withdrawal symptoms that are a common cause of “air rage.” A federal appeals court rejected their argument in July.

Tobacco control advocates scored another win during the summer, when San Francisco passed an ordinance banning the sale of flavored tobacco products. Within weeks, a group called Let’s Be Real, heavily promoted by by SFATA’s Didak, launched a voter petition to repeal the ban. The Competitive Enterprise Institute, R Street, and other tobacco industry allies also attacked the ban, which suggests that they fear other cities will follow suit. Let’s Be Real announced in August that it had collected far more than the required number of signatures to force a referendum on the flavor ban.

Where things get real is on the bottom line. San Francisco’s strict campaign disclosure laws require petitioners to reveal their benefactors. And the first part of that disclosure offers voters plucky, grassroots appeal: “Paid for by Let’s Be Real San Francisco, A Coalition of Concerned Citizens Supporting Freedom of Choice, Adult Consumers, Community Leaders, and Neighborhood Small Businesses.”

If that seems rosy, the punchline is somewhat more worrying: “with Major Funding by R.J. Reynolds Tobacco Company.”

Output: The vaping industry is using tactics similar to those previously deployed by the tobacco sector in order to create doubts about the dangers of e-cigarettes and to fight regulation, according to an article in The Verge. The vaping market is currently valued at over $10bn, expected to rise to $34bn by 2021. Tobacco firms including Reynolds American and Altria (formerly Philip Morris) have taken over from small companies. The vaping and tobacco industries have spent almost $10m fighting e-cigarette regulation in California since 2009. Vaping firms have also used law firms that formerly protected the tobacco industry from litigation.


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UK and Canada launch alliance to phase out coal by 2030
 BONN, Germany — One of the biggest announcements at this year's United Nations climate talks came on Thursday, when Canada and Britain began a new global alliance aimed at phasing out the use of coal power by 2030. But so far, the countries, states and provinces that have joined the “Powering Past Coal Alliance” account for less than 3 percent of coal use worldwide.

Many of the alliance’s key members — including Denmark, France, Finland, Italy, Austria, Mexico, and the Netherlands — were already on their way to retiring what little coal power they had left.

Opponents of coal, the most carbon-intensive of all fossil fuels, were feeling triumphant in Bonn. This week, the International Energy Agency declared that coal's “boom years” were over, as China’s once-insatiable appetite for the fuel has waned and countries like the United States have been closing their coal plants in favor of cheaper and cleaner sources like natural gas, solar, and wind.

“The market has moved on, the world has moved on, and coal is not coming back,” said Catherine McKenna, Canada’s minister of environment and climate change.

Yet coal still provides roughly 40 percent of the world’s electricity, and many countries aren’t willing to commit to a total phase-out just yet. A number of developing countries in Asia — including India, Vietnam and Bangladesh — are still looking to build new coal plants to bring electricity to those who don't have it.

For the world to meet its climate goals, the coal landscape would have to change drastically — and soon. A recent report from the United Nations Environment Program warned that keeping global warming below 2 degrees Celsius, or 3.6 degrees Fahrenheit, would require either shutting down nearly every coal plant in the world before 2050 or outfitting the plants with technology to capture emissions and bury them.

The new anti-coal alliance, which is made up of 19 countries and six states, provinces and cities, has one notable omission: Germany, which still generates 40 percent of its electricity from coal. On Wednesday, Chancellor Angela Merkel acknowledged at the Bonn climate talks that Germany would most likely miss its goals for reducing greenhouse gas emissions by 2020 because of its continued consumption of lignite, a particularly dirty, low-grade form of coal.

While many environmentalists had hoped that Ms. Merkel would use the climate talks to set a timetable for the elimination of coal in Germany, she merely said that she was engaged in “tough discussions” on the issue as she sought to form a new government.

Output: Canada and the UK launched a new global alliance designed to phase out the use of coal power by 2030 at the United Nations climate talks last week. However, the 19 countries, and six cities, provinces and states that have committed to the “Powering Past Coal Alliance” account for under 3% of global coal use. Key members of the group, including Austria, Denmark, Finland, France, Italy, Mexico and the Netherlands had also already committed to retiring their remaining coal power. The alliance also does not include Germany, which still uses coal to generate 40% of its electricity.


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Ethereum to pioneer lower blockchain energy consumption
 This piece appears in our new twice-weekly newsletter, Chain Letter, which covers the world of blockchain and cryptocurrencies. Sign up here – it’s free!

Before we get to that, though, let’s talk about miners. Blockchains get a lot of love, but they are only shared sets of data. What brings cryptocurrencies like Bitcoin and Ethereum to life is the way all the computers in their networks agree, over and over, that what a blockchain says is true. To do this, they use an algorithm called a consensus mechanism. You’ve probably heard it called “mining.” (See: “What Bitcoin Is, and Why It Matters”)

Cryptocurrency miners do much more than unlock new coins. In the process, they check the blockchain to make sure people aren’t spending coins fraudulently, and they add new lists of transactions—the blocks—to the chain. It’s the second step, meant to secure the blockchain from attacks, that guzzles electricity.

Ultimately, the miners must transform each list of most recent transactions into a signature that can serve as proof that the information is true. All miners can do this, using a cryptographic tool that takes any input and spits out a string of seemingly random characters. But Bitcoin’s creator, Satoshi Nakamoto, made this part particularly difficult.

Nakamoto set up a competition, the object of which is to be the first to determine a very specific signature based on three inputs: the signature of the preceding block, the list of new transactions, and a random third number. Since miners don’t know the third number, they must generate signatures repeatedly until one guesses correctly. This expends an immense amount of energy, signaling to the rest of the network that a miner’s accounting can be trusted.

But while this particular method of reaching agreement—known as “proof of work”—is the most established, it isn’t the only one. A growing number of technologists are exploring different avenues, and some smaller cryptocurrencies already employ alternative means.

The one in the best position to supplant proof of work is called “proof of stake.” Whereas proof of work rewards participants for spending computational resources, blockchains that use proof of stake would select validators based in part on the size of their respective monetary deposits—their stake. This would be massively more energy efficient, but the concept is still unproven at a large scale and has a number of kinks that need working out.

Still, if all goes as planned, Ethereum will transition to proof of stake relatively soon, perhaps as early as the end of this year. That would be hugely impressive, given that its creator Vitalik Buterin has called devising an effective consensus algorithm “one of the hardest problems in cryptocurrency development.”

The reality is that we are probably stuck with energy-guzzling cryptocurrencies, at least for a while. In the meantime, maybe true believers would be wise to invest their digital coins in renewable electricity sources.

Output: The ethereum blockchain is set to introduce changes to its technology that could significantly reduce its energy use. At present, blockchains use vast quantities of energy, mainly through the production of digital signatures that protect them from attack through a process known as “proof of work”. An alternative “proof of stake” process, which validates blockchains on the basis of monetary deposits, is more energy efficient and could be adopted by ethereum as early as the end of this year.


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Jotun launches coatings that can withstand 1,000-degree heat
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Jotun meets extreme demands of onshore oil, gas and chemical industries with new Thermosafe range providing better corrosion protection, hence less maintenance for the operators (photo: Jotun)

The onshore oil, gas and chemical industries are evolving, and they need protective coating solutions to keep pace with ever more extreme demands. That’s the message from Jotun, one of the world’s leading global paints and coatings provider, which launches the unique Thermosafe range, enabling customers operating at higher temperatures, with enhanced safety, efficiency and productivity.

With the long life of a coating system and effective protection of facility assets growing in importance, Thermosafe was developed to enhance operational efficiency, cut costs, reduce maintenance and increase on-site safety. Thermosafe compromises five products created to suit specific extreme environments – including temperature ranges from -196C to 1000C, thermal exposure, corrosion, fire, cryogenic spills and heat enabling better corrosion protection and reduced maintenance needs.

This, Miles Buckhurst, Global Concept Director HPI at Jotun, explains, is exactly what the industry needs: “We work hand-in-hand with our global customer base in order to gain an intimate understanding of their operations,” he notes. “That insight tells us that the shift to higher temperatures, to help optimise processing and productivity, requires a new generation of coating. Thermosafe is a direct response to that demand.”

“The unbeatable protection these products deliver will allow customers to reduce material and maintenance costs, enhance safety standards, increase efficiency, and boost earnings by decreasing the amount of maintenance needed, and by bringing facilities back online faster after shut downs. We also understand that this is not a ‘one size fits all’ industry, so have utilised our established expertise to tailor solutions specifically for individual customer requirements.”

This is clearly demonstrated across the Thermosafe range. For example, Jotatemp 250 provides anti-corrosive protection for continuous operations of up to 250 degrees, providing optimal cost efficiency for customers operating within this threshold. However, those with the potential to experience anything from the lowest liquid gas temperatures up the extremes of burning hydrocarbons can choose Jotatemp 1000 Ceramic for optimum protection up to 1,000 degrees.

The full Thermosafe range, which also features mesh free epoxy passive fire protection (PFP) solutions and thermal insulation for cryogenic spills, safeguards against a comprehensive spectrum of threats, from thermal exposure, to corrosion, fires and heat.

“We have used a significant amount of resources to develop unique solutions catering for the needs of this fast-growing segment,” Buckhurst concludes. “The onshore oil, gas and chemical industries are some of the most demanding in the world, and they deserve coatings that can help them fulfill their potential. We are dedicated to delivering unrivalled performance – in our products and, as a consequence, for our customers’ operations worldwide.”

The Thermosafe range consists of:

Output: Paint and coating provider Jotun has launched its Thermosafe range, offering coatings that can withstand extreme temperatures, for oil, gas and chemical facility assets. The Thermosafe range includes five products for particular conditions: thermal exposure, corrosion, cryogenic spills, fire, and heat from -196 to 1,000 degrees Celsius. The products should help facilities to lower costs, increase safety standards and boost efficiency. The range includes Jotatemp 250; Jotatemp 540 Zinc; Jotatemp 1000 Ceramic; Jotachar 1709; and Jotatherm TB550.


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Sensirion develops low-power natural gas detection tech
 New environmentally friendly technologies, such as power-to-gas and biogas production systems, will change requirements for the entire natural gas industry, including gas metering. Due to these trends, future gas metering will be confronted with new mixtures of natural gas, including those that contain significant amounts of non-conventional fuel gases such as hydrogen or carbon dioxide. These new gas mixtures present a challenge for technologies that are currently used in natural gas metering.

Sensirion has been working on the above for many years and developed a microthermal gas metering method using a new technology to measure thermal gas characteristics. The company plans to commercialise this technology by adding the tehnology to its current product portfolio of SGM6000 modules.

The SGM6200 series is expected to fulfil both current and future market requirements. One module covers natural gases in groups H and L and E (as defined in EN437), as well as natural gas mixtures, including non-conventional fuel gases with up to 25% hydrogen content. The series will output temperature-compensated volumes of natural gas, aligned with today’s most widely used natural gas billing systems. The meters are also competitively priced, with ultra-low current consumption of 10 µA.

Output: Environmental sensor provider Sensirion has created a microthermal gas metering method to detect thermal gas, including non-conventional gas types that may be used in future, such as power-to-gas and biogas production systems. Sensirion plans to add its new method to its existing SGM6000 module range. The modules will encompass natural H, L and E gases, alongside natural gas mixtures with a maximum of 25% hydrogen content. Each device only consumes up to 10 µA.


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CIMC's Blue Whale II rig can operate in 12,000 ft of water
 CIMC Raffles started the final series of sea trials for the ultra-deepwater drilling rig Blue Whale II in preparation for its delivery later this year.

Together with its award-winning sister rig Blue Whale I, which was completed in February, the two rigs are among the most advanced offshore drilling rigs in the world – designed to operate in 12,000 feet of water and drill to a depth of 50,000 feet.

The rigs were constructed based on the Frigstad D90 design and are equipped with a dynamic positioning 3 system.

They were originally ordered by Frigstad Offshore, but in 2016 the company decided to sell the newbuilds to a subsidiary of CIMC amid the prolonged downturn in the offshore oil and gas industry.

Blue Whale I recently finished drilling its first successful deep-water well for methane hydrate in the South China Sea on behalf of China National Petroleum Corporation.

Output: Shipyard builder CIMC Raffles has initiated final sea trials for the ultra-deepwater drilling rig, the Blue Whale II, due to be launched in late 2017. The first rig in the series, the Blue Whale I, was completed in February this year, and both rigs can operate in 12,000 ft of water, and are able to drill to a depth of 50,000 ft. The rigs were designed using the Frigstad D90 design as a base, and are equipped with a dynamic positioning 3 system. Frigstad Offshore had ordered the rigs initially, but the builds were sold to a CIMC subsidiary in 2016. Blue Whale I has been used in the South China Sea for the China National Petroleum Corporation, drilling for methane hydrate in its first deepwater well.


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Senators Clash Over Last Minute Changes to Tax Bill
 WASHINGTON — Uncertainty gripped the Senate on Wednesday over efforts to pass a sweeping $1.5 trillion tax cut after a Wisconsin Republican became the first senator in his party to declare that he could not vote for the tax bill as written, and other senators expressed serious misgivings over the cost and effect on the middle class.

The House is set on Thursday to pass its own version of the tax bill, which would cut taxes by more than $1.4 trillion over 10 years and broadly rewrite the business tax code. But as with the health care debate earlier this year, the Senate emerged as the inconstant ally in President Trump’s pursuit of a major legislative accomplishment in his first year.

Senator Ron Johnson, Republican of Wisconsin, came out against both chambers’ tax plans on Wednesday, saying that the bills favored corporations over small businesses and other so-called pass-through entities, whose owners pay taxes on profits through the tax code for individuals.

“These businesses truly are the engines of innovation and job creation throughout our economy, and they should not be left behind,” he said in a statement. “Unfortunately, neither the House nor Senate bill provide fair treatment, so I do not support either in their current versions.”

Output: A conflict has arisen between Republican and Democratic senators over the changes that Republican officials have made to their proposed tax legislation. Votes are due in both chambers of Congress shortly on the proposed overhaul, but Democrats have taken issue with the insertion of a repeal of the Affordable Care Act’s mandate that most people to have health insurance, which has been replaced with a 2025 expiration date for individual tax cuts. Corporate tax cuts have been made permanent. The changes will allow the Republican party to save over $300bn over a decade, but the Congressional Budget Office has said that 13m fewer people would have insurance after a decade without the ACA mandate, and insurance premiums would rise approximately 10%. The Republicans have insisted that the individual mandate is a tax, and is a legitimate modification. The proposed legislative changes will theoretically add over $1.4tn to the federal debt over a 10 year period. The tax bill will also be merged with legislation that will allow the Alaskan Arctic National Wildlife Refuge to be opened to oil and gas drilling. The Republicans plan to protect that law from Democratic filibustering in the Senate, and when combined with the tax reform legislation, the two proposed laws would both be protected. The Trump administration has pushed Congress to resolve its differences to push the tax bill through, though, at present, there is a large divide between the House and Senate tax bills.


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50% of seniors visit the dentist annually – How to treat the rising geriatric population
 As the geriatric population continues to increase, dentists are changing their approach to dental care. Karen Becerra, DDS, CEO of Gary and Mary West Senior Dental Center in San Diego discussed the challenges and opportunities for dentists when treating seniors.Despite major advances in dentistry and the ability to prevent many oral healthcare issues, dental disease in seniors is one of the most significant and widespread public health problems in America, due to the costs of care and a lack of dental insurance.Data shows that fewer than half of seniors visited a dentist in the previous year, and most of our patients are dual eligibles for both Medicare and Medicaid and can’t afford to pay for dental care. They have trouble finding dentists that will even accept Denti-Cal, California’s Medicaid program.You’d be amazed at how many people don’t realize the Medicare coverage they get when they turn 65 has no coverage for dental care. Transportation is a major issue too, so our facility is co-located within a very popular senior wellness center in Downtown San Diego that sees almost a thousand clients a day.You need to think of a patient’s overall needs – from mental, social, medical and dental – so we are constantly consulting with physicians, families and social workers to address all of the patient’s needs. You have to customize the treatment plan based on the patient’s needs and circumstances. A 99 year old is going to get a different treatment plan than a 65 year old, because their ability to tolerate the stress of treatment varies. For example, a recent 99 year old woman had a broken tooth, that after careful consideration and discussion with her primary care physician, we decided it would be better to keep it in her mouth rather than extract it. If she had been 65, we most likely would have taken it out. While every case is different, we always try to keep in mind the patient’s broader health aspects when we consider their treatment.According to the CDC, about one-in-five people 65 and older have untreated tooth decay, and they may even experience new tooth decay at higher rates than children. Seniors are also more prone to issues like dry mouth, tooth loss and periodontal disease – the prevalence and severity of which increases with age.In addition, oral cancer is seven times more common in people 65 years of age and older, as compared to younger adults, and more older adults die from oral cancer than from skin cancer in America. Research has also shown infections in the mouth may be associated with heart disease, stroke, diabetes, pneumonia and other health problems.As an industry, dentistry is always changing. New technologies and ways to treat patients and improve their experience to make them more comfortable with the dental process are always emerging. Fear is a big aspect of treating seniors, because many of them have had poor experiences in the past, so anything that can help alleviate that is helpful. For example, new high-resolution cameras let us show a patient what is happening in their mouths quickly and help us educate them on the importance of the issues in their mouth and how they need to take care of their teeth. With all of these changes, though, the basics remain the same for seniors and any other patient. If they don’t brush and improve their home care, we’re going to be limited on what I can do to help them, and the oral diseases will reoccur. Prevention stays the same regardless of how old you are.We approach the patient as whole person, looking at their social, medical, mental and dental needs. The mission of the Gary and Mary West Senior Dental Center is to provide affordable, high-quality oral healthcare with comprehensive education, clinical, and wellness services for seniors in need, enabling them to live healthy and productive lives. The Senior Dental Center links high-quality and affordable oral healthcare with a suite of nutrition, case management and wellness services offered through the Gary and Mary West Senior Wellness Center , creating a one-of-a-kind, integrated community-based system of care for older adults. We’re focused on integrating medical and dental care for a seriously underserved population of low-income seniors so oral care isn’t an isolated silo.I think it’s essential. You can’t be in good general health if you have poor oral health, and vice versa. Care has to be looked at holistically. This is a care model we’ve adopted at the Senior Dental Center, where seniors can access a variety of health and wellness services all under one roof. Health navigators are able to collect and share important health information among providers and social services professionals. Our initial intake looks at the whole person – from traditional healthcare indicators like medical, dental and psychological, but we also really focus on social issues like nutrition and housing, because if those basic needs aren’t met, patients aren’t going to be able to improve their healthcare.Every senior who comes to us with a dental issue first gets a Comprehensive Geriatric Assessment (CGA) where we evaluate overall health, dental and mental status, as well as functional ability and his or her living situation. This enables us to develop a coordinated care plan that encompasses dental, medical and supportive social services all together. The CGA allows us to understanding the holistic need of a patient so we can prioritize their needs and get them ready to be seated in one of the dental chairs. If at any point during the appointment, any social, medical or mental needs become evident, then we do a direct referral to the other social services co-located at the senior wellness center where we’re located, and we work with regularly.Yes, we expect to see improvements in access as the community at large gets educated in the importance of addressing the oral-health needs of vulnerable seniors. We expect more collaboration, engagement and action from dentists and other health professionals, as well as engagement from community leaders, advocates, insurers and seniors themselves to help address these access issues. We believe the data we are collecting and analyzing at the Senior Dental Center will demonstrate the positive health outcomes and potential cost savings of providing dental care to seniors so that more communities will develop integrated models and more seniors have access to affordable coverage. As a non-profit, we’re always trying to raise funds to support these access efforts, so please visit www.seniordentalcenter.org to see how you can donate to support this cause so we can continue to shine a light on this issue to take all of our learnings and share them with others at the state and national level to proactively address this problem.

Output: With the rise in geriatric Americans, dentists are taking a new approach to providing care for oral health. Seniors face barriers to dental care, with dental disease in older adults being one of the most prevalent public health issues in the country because of the expense of care and a lack of basic dental insurance. Less than half of all US seniors saw a dentist for a check-up in the past 12 months, and most patients are eligible for both Medicare and Medicaid, but are still unable to pay for oral care. Denti-Cal, the Californian state Medicaid program, is difficult to use for many dentists. Medicare coverage at present does not cover dental issues; transportation to facilities is also difficult, causing further problems for older adults. Common dental problems include untreated tooth decay; dry mouth; tooth loss; and periodontal disease, all of which can be exacerbated with age. The CDC has said that one in five of those aged 65 and over have untreated tooth decay problems, possibly having new issues of decay at a higher rate than children. Oral cancer is seven times more likely for this demographic than it is for younger adults, and more adults die from the disease than from skin cancer. Mouth infections may also be linked to serious issues such as heart disease, diabetes, stroke, pneumonia and more. Aside from using traditional prevention techniques, helping to reduce older patients’ fear of the dental check process can be helpful, and technology such as high-resolution cameras that speed up the process make it easier. Integrating oral health care with general health care can help older citizens to avoid issues worsening and spreading to other parts of the body, as well as meeting seniors’ dental, medical and psychological needs. Using a Comprehensive Geriatric Assessment, healthcare providers can evaluate patients’ health, dental and mental needs, and provide a care plan that spans all support and social services. Coverage for senior citizens will likely improve over time as further data is collected and analyzed, and as collaborative efforts to improve access succeed.


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Caring for those senior citizens who cared for us
 Nearly 10,000 seniors will turn 65 today and every day in America through 2019. The U.S. Census Bureau reported Californians 65 years of age and older accounted for 13.6 percent of the state’s population in 2016. Sadly, however, California also leads the nation in the number of older adults living in poverty.

I am privileged to serve as a member of the California Commission on Aging where I continue my advocacy work on behalf of these constituents, a focus I also championed when I chaired the Assembly Committee on Long-Term Care and Aging.

Seniors’ needs expand with age and those living in poverty often go without. Many depend on family members, government resources, community outreach and non-profit organizations to fill the gap. Yet surprisingly, as great as the needs of these vulnerable residents are, many will be surprised to learn that of the nearly 100,000 foundations spread across the country, only six are fully dedicated to serving seniors.

This week, I had an opportunity to learn more about one of these six foundations and the great work it does on behalf of older Americans. For more than a decade, the Gary and Mary West Foundation has worked at the national, state and local (San Diego) levels to enable seniors to successfully age in place with access to high-quality, affordable healthcare and other support services designed to preserve and protect their dignity, quality of life and independence. Its founders, Gary and Mary West, are working to transform the way healthcare is delivered to an aging population.

Efforts like those of the Gary and Mary West Foundation are enhanced by works of groups like the Frame Works Institute, an organization dedicated to enhancing how non-profit organizations communicate as a way to better frame public discussion on social concerns like the rapidly expanding senior population.

The group is a partner in the Reframing Aging Project, working with aged-focused organizations from all over the country to create a better understanding of the needs of older adults and their contributions to society. In addition, they are working to use communications and outreach efforts to drive a more informed conversation about aging and its implications for our communities.

Anyone who knows me, knows when I speak about seniors/older adults, I talk about the “Silver Tsunami.” I like what the sense of urgency the term implies. However, in the reframing discussion, it was determined such phrases are negative and should not be used. So, beginning today, I will start speaking in more positive terms, hoping it will have better results. Experts believe, this reframing effort will take about 15 years to change perception regarding how aging is perceived in this country.

For far too long, growing old has been viewed as a negative experience; however, people should not fear growing old. Rather than viewing this natural process as a time of declining health and increased dependency, the Reframing Aging Project is working to change this in hopes of creating a better understanding of older adults and their contributions.

We must unite at the local, state and federal levels to assure older adults can remain in their homes, healthy, independent, connected, productive and most importantly, cared-for regardless of their income. Their needs can range from food insecurity to mental health issues to physical and/or oral problems to just plain loneliness. Exploring new models of care is one way to address these concerns.

We are changing the way advocates talk about aging and it is important that when we look at seniors, we see the whole person — not just their age. We must continue to find better ways to care for those who cared for us.

Cheryl Brown of San Bernardino represented the 47th District in the California Assembly from 2012-2016.

Output: Between now and the end of 2019, almost 10,000 senior US citizens will reach 65 every day, but of the nearly 100,000 foundations in the US, only six are aimed at helping seniors. Californians aged 65 and older representing 13.6% of the entire state’s population last year, with the state having the highest rate of older adults living in poverty. The Gary and Mary West Foundation is a Californian initiative aimed at helping seniors to age in place with better quality and more reasonably priced healthcare, which works alongside organization the Frame Works Institute to improve interoperability between non-profits. The Gary and Mary West Foundation has joined the Reframing Aging Project, designed to better understand older citizens’ needs and to improve outreach efforts. The organization believes that reframing the process of growing old will take approximately 15 years to help it be seen as a positive experience, and to help others see older Americans as worthwhile contributors to society.


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Opinion: Let’s Put Some Teeth into Veterans’ Healthcare Coverage
 By Shelley Lyford

When Brian parachuted onto the Korean Peninsula with the 187th Airborne in September of 1950, his teeth were the last thing he worried about. His primary concerns were, first, that his chute would open, second, that he wouldn’t get shot out of the sky by the enemy or tangled up with one of the thousands of other paratroopers jumping out of the “Flying Boxcar” transport planes, third, that he’d land in the jump zone clearing and not in the trees, and fourth, that he wouldn’t break his leg or become separated from his company once he landed.

Brian managed to survive that jump, as well as months of fierce combat against Chinese and North Korean troops during the freezing winter of 1951. But sixty years later, he literally didn’t have a leg to stand on. Like a lot of paratroopers, Brian had developed osteoarthritis in his knees as a result of the repeated impact of parachute landings with a heavy pack and rifle bag strapped to his body.

Brian was a good candidate for double knee replacement which would allow him to walk again, and would relieve the pain of the degenerative arthritis that had wrecked his joints. And since his disability was directly related to his wartime service, it was covered by his veteran’s benefits — which was good news indeed, because Brian was flat broke by then and just getting by on Social Security. For years after his service, Brian owned a successful restaurant in downtown San Diego. But he fell on hard times, lost his business and couldn’t keep up with his bills.

While the U.S. Department of Veterans Affairs continued to cover his medical care, routine dental care is generally only covered for veterans on 100% disability or with service-related dental problems, so he couldn’t keep up with his basic dental needs. Ten years of going without dental care had taken their toll on his mouth. Most of his teeth were rotted and his gums were badly infected. So badly, that the orthopedic surgeon couldn’t operate on his knees, for fear Brian’s gum infection might spread through his bloodstream to his knee joints during surgery. So his knee replacement had to be put on hold until he could get his mouth treated. Brian didn’t have coverage for the thousands of dollars’ worth of dental work he needed to extract his rotten teeth and treat his infected gums. And because of the patchwork nature of dental coverage for seniors in California and in most states, he didn’t qualify for coverage under Medicaid, while Medicare doesn’t cover dental care.

These kinds of coverage gaps in veterans’ healthcare are all too common. It’s unconscionable that our lawmakers have failed to take care of our Veterans’ needs by ensuring they receive basic dental care.

In the past decade, we’ve come to understand that the mouth is not only the gateway to the body, but also the gateway to chronic disease. Research has uncovered consistent and strong associations between gum disease and systemic conditions such as cardiovascular disease, type 2 diabetes mellitus, and osteoporosis — and it’s suspected to cause many other serious conditions including stroke and depression.

While gum disease is more often a byproduct of old age, poverty and oral healthcare neglect than of battlefield injuries, those risk factors are increasingly common among the aging population of Korean and Vietnam War veterans. Almost half of our country’s 20 million veterans are over the age of 65. California is home to more vets than any other state: 1.8 million, and more than 800,000 of them are over 65.

Here are the hard facts about the oral health of our seniors overall:

7 in 10 suffer from gum disease

1 in 5 have untreated cavities

Nearly 1 in 5 have no teeth at all

Only 28 states include adult dental benefits under Medicaid, and those benefits cover only certain services and finding a dentist to treat a Medicaid patient can be extremely difficult, if not impossible. In 2009, facing a severe budget shortfall, California eliminated its adult dental care benefit. The state restored some of the benefit in 2014, but Denti-Cal payments are so limited that most dentists don’t see Medicaid patients. And since 70 percent of seniors have no dental insurance, low-income seniors are mostly going without basic dental care.

For seniors like Brian, “going without” can have far-reaching consequences. Fortunately, caseworkers at the VA were eventually able to get him the dental care he needed to proceed with his knee replacement surgery.

Veterans like Brian can’t wait for legislators to provide more funding to the VA and Medicaid so they can get critically needed dental care. His story shows how important it is for the whole community to step up and bridge the gaps in veteran’s care. That includes the public and the private sector, as well as private philanthropy.

I’m the Chair of the Board of the Gary and Mary West Senior Dental Center in downtown San Diego, an integrated, community-based model of care tailored to the special needs of seniors. In the year since it opened, our clinic has hosted more than 4,200 dental visits from low-income seniors, who also receive a spectrum of coordinated medical and social supports services under one roof.

All seniors should be able to age with dignity, and oral health is a big part of that equation. Without healthy teeth, seniors can’t eat a nutritious diet, or even engage in everyday social interaction. Our clinic has tapped into an enormous pent-up demand for affordable dental care for seniors, including veterans. Meanwhile, tens of thousands of other seniors, including veterans, are still “going without” dental care.

In addition to Gary and Mary West, visionary philanthropists and dentists in other communities have begun to create model programs to assist veterans. Aspen Dental has 450 offices across the country that have provided free dental care to more than 17,000 veterans and people in need since 2014. Meanwhile, a retired periodontist in Washington state, Theresa Cheng, was inspired by the story of a local Iraq veteran, gravely injured by an IED, to start Everyone for Veterans, a nonprofit that now works with 300 dentists to provide free dental care to veterans in need.

By working together in our communities — in coordination with state and federal agencies — for-profits and nonprofits can close the gaps in healthcare funding for veterans. It’s the least we can do to repay our debt to the brave men and women who have put their lives on the line in defense of our nation. Veterans like Brian deserve a special measure of gratitude and care. Not just today, but every day.

Shelley Lyford is President and CEO of San Diego-based West Health and the Gary and Mary West Foundation, nonprofit organizations that enables seniors to successfully age in place with access to high-quality healthcare and supportive services.

Output: The U.S. Department of Veterans Affairs provides veterans with coverage for medical care, but routine dental care only garners partial coverage, being available only to those veterans on 100% disability or with oral health problems related their service. The lack of full dental care from both the Department of Veterans Affairs, Medicare and Medicaid causes issues for veterans in need. Research supports the provision of dental as well as general health care, given that gum disease and systemic conditions are strongly correlated. Type 2 diabetes mellitus, cardiovascular disease, and osteoporosis have all been linked to oral issues, with strokes and depression potentially also related. The risk factors for these diseases are increasingly higher for the older population of Vietnam and Korean War veterans, and as nearly half of the 20m US veterans are over the age of 65, the problems will continue to worsen without intervention. For senior citizens, seven in ten have gum disease; one in five have untreated cavities, and almost one in five have no teeth remaining. Despite these facts, only 28 states offer adult dental benefits through Medicaid, and even this coverage only covers particular services, with few providers willing to offer them. As it stands, 70% of seniors do not have dental insurance, and low-income seniors generally go without basic care for their oral health.


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Two-thirds of rental properties sell to cash buyers: Countrywide
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Record numbers of landlords are now building their buy-to-let portfolios using cash, Countrywide claims.

Analysis by the agent shows that over the past 12 months, 65% of all homes bought by a landlord were paid for in cash, surpassing the previous high of 60% set in 2011.

It is the highest figure since Countrywide’s records began in 2007, a year when 60% of buy-to-let purchases were paid for with a mortgage.

Landlords buying with cash bought £21bn worth of homes which is £0.2bn more than in 2016 and a 32% increase on 2007 when they spent £15.9bn.

The research also showed that the annual rate of rental growth slowed from 1.1% in September to 0.5% in October, with the cost of the average new let in Britain at £958 per month.

Excluding London, however, where rental growth dipped back into negative territory, down 0.9%, rents rose 1.2% over the 12 months to October.

The midlands and Wales continued to be the drivers of rental growth, where rents rose 2.2% and 2.6% over the last year to £677 and £658 a month respectively.

Johnny Morris, research director at Countrywide, said: “Landlords have increased their housing wealth considerably over the last 10 years. This means cash purchases are steadily becoming a bigger part of the market.

“But a landlord buying with cash will often have a mortgage either on their personal home or other properties in their portfolio. Rising prices have allowed landlords to take equity out of both their personal or other rental homes to expand their portfolios.

“Rental growth across northern England has slowed under pressure from record numbers of new landlords. But it’s a different story across the midlands and parts of the south where rents are once again nudging upwards.

“It looks like the last effects of the investor Stamp Duty surcharge have finally worked their way through the system.”

Output: Estate agent Countrywide has found that large numbers of landlords are paying for buy-to-let properties in cash. Over the past year, 65% of all homes bought by a landlord were purchased with cash, up from 60% in 2011. The figure is the highest since 2007 when Countrywide began keeping records. Over the past year landlords paying with cash bought £21bn of homes, spending £200m more than in 2016, and 32% more than in 2007. The annualised rate of rental growth dropped to 0.5% in October, from 1.1% in September, with the average British new let being £958 a month.


Instruction: create a high quality summary of the given input

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Microfluidic droplets used to create liquid-repellent materials
 Professor Wang Liqui (left) and Dr Zhu Pingan from HKU Mechanical Engineering Department showcase the liquid repellent material they innovated. Credit: The University of Hong Kong

On liquid-repellent surfaces, liquid droplets bounce away instead of being stuck. These surfaces are important in many fields, such as water-repellent clothes and anti-fouling kitchenware. Used as drag-reduction coatings for water vehicles, these surfaces can even help with speeding up cargo ships and military equipment so as to save energy. The dream of research and development on liquid-repellents is a structure that has robust liquid repellency, strong mechanical stability, and is inexpensive to produce on a commercial scale. However, the functional outcomes of existing liquid-repellent surfaces have not been satisfactory, because of inadequacies of conventional structural design and fabrication approaches in engineering microstructures and properties of such surfaces.

The challenge was recently overcome by breakthrough research led by Professor Wang Liqiu at the Department of Mechanical Engineering, Faculty of Engineering, the University of Hong Kong (HKU) through the development of a robust liquid-repellent structure and the fabrication of porous surfaces by an innovative microfluidic-droplet-based technique. Materials such as textiles, metals, and glasses covered by a layer of this robust porous surface can then become liquid-repellent. The paper was recently published in academic journal Nature Communications (Zhu P. A., Kong T. T., Tang X. and Wang L. Q. 2017. Well-defined porous membranes for robust omniphobic surfaces via microfluidic emulsion templating, Nature Communications 8, 15823). With the new technology developed by the team, clothes would never get wet on rainy days in the future.

The team resolves effectively the conflict between liquid-repellency and mechanical stability by the springtail-cuticle-inspired design of liquid-repellent structures. Springtails are soil-dwelling arthropods whose habitats often experience rain and flooding. As a consequence, springtails evolve their cuticles with strong mechanical durability and robust liquid repellency to resist friction from soil particles and to survive in watery environments, respectively. Inspired by springtail cuticles, the research team designed porous surfaces composed of interconnected honeycomb-like micro-cavities with a re-entrant profile: interconnectivity ensures mechanical stability and re-entrant structure yields robust liquid-repellency. Ideal liquid-repellent surfaces developed by HKU scientists Credit: The University of Hong Kong

Robust liquid-repellent structure shows a 21-fold enhancement in mechanical stability

The robust liquid-repellent surfaces repel at least 10 types of liquid, including water, surfactant solutions, oils, and organic solvents and show an astounding over 21-fold enhancement in mechanical stability compared with discrete structures. The porous surfaces are capable of recovering their non-wetting state as well even if micro-cavities are partially wetted by water. The flexible surfaces can also be readily coated onto various objects for liquid-repellency.

Soil-dwelling springtails with dew (body length: ~2.5 mm). Credit: Brian Valentine

Porous surface material just costs about HKD1 per square metre

The research team also developed an innovative microfluidic-droplet-based technique for the fabrication of porous surfaces which is very much similar to shaped-cookies made by baking molds. Here the molds are uniform micron-sized droplets that are produced by microfluidics technology with precise control over their size, structure, and composition. Molded by microfluidic droplets, commercial-scale uniform microstructures are produced at low cost. The material cost is in a range of HKD 0.7 to 1.3 per square metre, only one thousandth of that in purchasing commercialized products such as PTFE water-repellent film. This technique has high accuracy and effectiveness in engineering surface structures, ensured by the precision and controllability of microfluidic-droplet generation that is low in cost and readily scaled up as well.

Bio-inspired design of liquid-repellent structures with robust liquid-repellency. Schematic (a) and image (b) of the designed porous surface. (c) Photo of a water drop suspended on top of the porous surface. (d) repellency of 10 different liquids by the porous surface. Credit: The University of Hong Kong

The breakthrough will change the way liquid-repellent surfaces are fabricated for robust liquid-repellency, strong mechanical stability, and economical production at a commercial scale. It has also paved the way for further progress in creating surface structures by design, and in tailoring their morphology, repellency and mechanical stability to suit a desired application in various fields, including energy, buildings, automobiles, chemical engineering, electronics, environments, bio-medical industry, advanced manufacturing, water vehicle and military equipment.

Bio-inspired design of liquid-repellent structures with enhanced mechanical stability. (a) Intact structure of interconnected porous surface. (b) Intact discrete structure. (c-d) Damaged interconnected structures at (c) 8.6 kPa (kilopascal, the unit of pressure) and (d)11.5 kPa respectively. (e-f) Damaged discrete structures at (e) 0.4 kPa and (f)2.9 kPa respectively. Credit: The University of Hong Kong

Fabrication of bioinspired liquids-repellent surfaces by microfluidic method. (a) Process of microfluidic fabrication method, involving emulsion deposition, solvent evaporation, and template removal. (b) Droplet assemblies after emulsion deposition. (c) Dry film after solvent evaporation. (d) Porous surface after template removal. (e-f) Images of porous surfaces with different pore sizes. (g) Transparency of porous surfaces. (h) Wafer-scale fabrication of the porous surface. Credit: The University of Hong Kong

Output: Researchers led by Professor Wang Liqiu at the Department of Mechanical Engineering, Faculty of Engineering at the University of Hong Kong have created a super-effective liquid-repellent surface, based on a new microfluidic droplet-based method. The new technique can make metals, glass and textiles liquid-repellent by adding a coat of the porous surface, which could lead to clothing being water repellent but flexible in future. The technique was based on the anatomy of springtails, arthropods that live in soil and have liquid-repellent cuticles with strong mechanical capabilities that translate well for human needs.


Instruction: create a high quality summary of the given input

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Cash buyers see bitcoin price double on local Zimbabwe exchange
 Bitcoin is apparently surging in Zimbabwe after the military seized power in an apparent coup. Bloomberg reports that bitcoin is trading in Zimbabwe at over $13,000, nearly double the global price of bitcoin. But that’s not quite the whole picture.

The price that Bloomberg and other media have quoted comes from a cryptocurrency exchange in Zimbabwe called Golix. The Golix website shows a wide spread between bids and asks, with the current price settling at around $13,500. But go to another marketplace for bitcoin in Zimbabwe and you will see much lower prices.

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Golix appears to be the sole cryptocurrency exchange in Zimbabwe. But most markets that aren’t well served by exchanges, like Zimbabwe, usually have a thriving peer-to-peer scene. That’s what you see when you go to LocalBitcoins, the biggest global platform for peer-to-peer bitcoin trading. Zimbabwe’s LocalBitcoin brokers are quoting prices around $7,000, which is in line with the global price of bitcoin.

It’s the brokers who offer to settle transactions in cash, instead of online payemnts or via bank transfers, who are demanding a steep premium in Zimbabwe. They are asking for $17,000 to $20,000 a coin from buyers who pay them in physical US dollars.

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So what explains the inflated prices on Golix? It’s probably just low liquidity. Golix’s website shows that it traded just over 7 bitcoins in the last 24 hours, and about 147 coins over the last 30 days. That’s in contrast to tens of thousands of bitcoins traded over LocalBitcoins globally each month, or tens of thousands per day on the biggest US dollar exchanges, like Coinbase or Bitfinex.

LocalBitcoins, in fact, has been rocketing in popularity over the years. It doesn’t show data for Zimbabwe, but volumes on the platform have risen significantly around the world in recent months.

Output: The price of Bitcoin has risen sharply on Zimbabwe's only cryptocurrency exchange, after the apparent coup by the country's military. The Golix exchange recorded an average price of over $13,000 for bitcoin in the wake of the confused political developments, however, the surge appears to be limited to this exchange, and in particular to transactions with cash buyers. By contrast, the price quoted on global peer-to-peer platform, LocalBitcoins, by Zimbabwe brokers appeared to be in line with the global price of bitcoin. at around $7,000.


Instruction: create a high quality summary of the given input

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Hospital Elder Life Program (HELP) lowers 30-day readmission rates
 The Hospital Elder Life Program, or HELP, is an evidence-based treatment plan developed in the 1990s to prevent hospitalized older adults from developing delirium (the medical term for sudden confusion). Delirium can cause people to be either aggressive and agitated or sleepy and inactive—sometimes even a combination of the two. Delirium is also the most common complication older adults experience after surgery.

Delirium has many causes, including infection, excess time in bed, and an imbalance in electrolytes (important minerals dissolved in bodily fluids). Older adults with delirium have longer hospital stays, higher care costs, and increased rates of death and institutionalization.

In a new study published in the Journal of the American Geriatrics Society, researchers examined the HELP program. They wanted to learn how effective it was at preventing older people from being readmitted to the hospital within 30 days, which is often harmful for patients and costly for hospitals.

HELP consists of one or more in-hospital teams, which include an Elder Life Specialist, an Elder Life Nurse Specialist, a geriatrician, and trained volunteers. The team works together to reduce an older person's risk of developing delirium through simple strategies that target specific risk factors. For example, team members help keep patients moving and orient them as to where they are and what the time and day is The team members engage the older adults socially, and provide eyeglasses and hearing assistance as needed. HELP units also use alternatives to medication to ease insomnia and anxiety, and to make sure that older adults who might be at risk for developing delirium eat well and stay hydrated. Since it was developed, HELP has now been implemented in more than 200 hospitals across the United States and around the world.

The research team studied eight medical and surgical units with HELP programs at the University of Pittsburgh Medical Center Shadyside. During the study period (2013 to 2014), the HELP units had 4,794 patients over the age of 70. Researchers compared these older people to 2,834 similar individuals who were cared for in non-HELP units during the same period.

The researchers learned that the differences in hospital readmission rates between the HELP units and non-HELP units translated into 100 fewer readmissions during the year-long study.

The researchers said that on a national scale, HELP could potentially reduce hospital readmissions for older adults by 40,000 cases each year, potentially saving nearly $500 million dollars annually.

More information: Fred H. Rubin et al, Effect of the Hospital Elder Life Program on Risk of 30-Day Readmission, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15132 Journal information: Journal of the American Geriatrics Society

Output: The Hospital Elder Life Program (HELP) a treatment scheme created in the 1990s to help older adults avoid delirium, could potentially reduce hospital readmissions by approximately 40,000 incidents per year, according to research published in the Journal of the American Geriatrics Society. The addition of HELP programs could save almost $500m annually, as delirium – or sudden confusion that is likely to occur after surgery – was reduced. The research team examined eight surgical and medical units equipped with HELP programs at the University of Pittsburgh Medical Center Shadyside between 2013 and 2014, studying 4,794 patients aged over 70. Their data was compared to 2,834 similar patients in non-HELP facilities across the same period. The team found that there were 100 fewer readmissions in the first 30 days post-stay in the HELP units per year, as delirium was less likely to occur. HELP prevents delirium by providing an elder life specialist, an elder life nurse specialist, a geriatric doctor, and volunteers who have been trained for elderly care. The team offers social assistance and guidance, as well as eyeglasses and hearing assistance, to patients to help reorient them. The system is currently used in more than 200  hospitals globally.