Friday, March 30, 2018

Rural weekly editors' perspective on the gun debate

Following our recent item about the difference between a March for Our Lives rally in rural Kentucky and those in more urban areas, we wondered what the nation's rural newspapers had to say about the debate on guns and school violence. Here are examples from a few rural weeklies:

Editor Anthony Campbell of the Advertiser-Gleam in Guntersville, Ala. (pop 8,197), said he had "conflicted feelings" about a state House bill to allow teachers to carry guns. As a hunter and avid recreational shooter, he says he is pro-Second Amendment, but abhors open-carry laws because he doesn't know how much training a gun owner has had. "Bearing arms is a right," he writes. "But it is also a big responsibility." He likes that the proposed bill would require 40 hours of training and a mental evaluation. Read him here.

John Newkirk of the Canyon Courier in Evergreen, Colo. (pop. 9,038), says the problem goes deeper than the National Rifle Association or gun manufacturers: "By all means, let’s get out there and protest: let’s protest the Hollywood hypocrites who sanctimoniously stand against gun violence but then strap on multiple assault weapons for their latest 'action-adventure' film. Let’s protest the purveyors of ultra-violent video games that normalize killing and give first prize for the highest body count. Let’s protest a system that won’t hesitate to politicize our students yet spends little if any time on character development." Read it here.

The Blackshear Times (motto: "Liked by many, cussed by some, read by them all") in a Georgia town of 3,445 remonstrated readers for spreading unfounded rumors on social media after an alleged local school-shooting threat. "You very likely do not know as much information about the situation as do your school officials and our law enforcement. There is a reason for that: They are trained and given the direct responsibility to deal with such situations . . . Stop: Don’t get swept away in fits of hysteria. Look: Check other trusted, more reliable, sources before you spread information. Listen: We all have a voice inside our heads that begs us not to react too quickly, to be careful, to use good judgment. Listen to that voice." Read more here.

Mike Buffington of the Jackson Herald in Jefferson, Ga. (pop. 9,432), writes that it wasn't unusual for high-school students to have a rifle in their cars in the school parking lot in his youth, "but the world has changed a lot since then. As the recent events in Florida demonstrate, there is no reason anyone under the age of 21 should be able to buy a gun, especially a high-capacity rifle. Raising the purchase age to 21 should be a no-brainer." An avid recreational shooter and antique gun collector, Buffington also says we must stop viewing guns as a form of political expression. "A gun is a gun; it's not the national symbol."

The Perry County News in Tell City, Ind. (pop. 19,388), focused on school safety rather than guns, saying that local efforts to fund the hiring of more resource officers were "a step in the right direction" and noted that "87 percent of school resource officers report confiscating knives from students, with two-thirds of officers saying they’ve prevented assaults on faculty. That is of the more than 7,000 officers patrolling schools across the nation." Read more here.

In the twice-weekly Cody Enterprise (in the Wyoming town of 9,500 founded by gunslinger William "Buffalo Bill" Cody), Editor Amber Peabody acknowledged that the gun debate is contentious, but said that there are many common-sense steps local schools can take and have taken to reduce students' risk. She applauded students in the nearby Riverton school district who had told the school board they felt unsafe. "The students demanding action in Riverton and throughout the nation deserve credit. We can’t expect any one change to eliminate shootings, but as the Riverton students’ mentioned, lets not fail them. This is not about politics, it's about collaborating and even compromising for the safety of our students." Read more here.

Do states regret expanding Medicaid? Not much if at all

Congress has suspended efforts to repeal or replace the Patient Protection and Affordable Care Act, giving the 18 states that haven't expanded Medicaid more time to consider it. "The ACA’s established funding will pay for 90 percent of the costs of expanding Medicaid to cover people in households with incomes at or below 138 percent of the federal poverty level," Mark Hall writes for the Brookings Institution. "Previously, these 18 states declined to expand, in part because of concerns about their ability to predict and afford their 10 percent share of the costs." All the states are controlled by Republicans.

But with the ACA in its fifth year, states that didn't expand Medicaid can now see how it has performed in states that did expand. Hall curates a wide range of independent and government studies debunking arguments that Medicaid is a greater financial burden than the expansion states expected, and that Republican governors in at least five expansion states (Arkansas, Arizona, Michigan, Nevada and Ohio) continue to support expansion, "and several openly opposed recent congressional efforts to repeal expansion," Hall writes. And some states that haven't already expanded Medicaid may be tempted to do so with Republican-friendly provisions such as work requirements.

Medicaid is particularly critical to rural areas, though the low reimbursement rate for complicated obstetrical cases has contributed to many rural hospitals shuttering OB services and increased the risk to rural women and their babies.

Partisan divide on climate change grows; EPA administrator pushes talking points that downplay humans' role in it

"Fewer Republicans say they believe that there is a scientific consensus on climate change or that the effects of global warming have already begun, according to a new Gallup poll, which showed a widening partisan gap near record levels," reports Steven Mufson of The Washington Post. Meanwhile, "an increasing number of Democrats believe that the effects of global warming have already begun and that warming will pose a 'serious threat' in their lifetimes. As in earlier surveys, an overwhelming portion of Democrats are worried about climate change and link it to human activities."

Ninety percent of Democrats said they worry about global warming and think it's caused by humans, while only a third of Republicans do. Seventy percent of Republicans think the threat of global warming is "generally exaggerated," but only one in 25 Democrats do.

There was a total 16-percentage-point swing between Republicans' and Democrats' beliefs on whether climate change has already begun affecting the environment. This year 34 percent of Republicans said it was, down from 41 percent in 2017. This year 82 percent of Democrats said it was, up from 73 percent in 2017.

"Gallup asked whether people agreed that most scientists believe global warming is occurring, and 42 percent of Republicans said yes, down from 53 percent a year earlier and back to a level last seen in 2014," Mufson reports. "Just 35 percent of Republicans said that they believe global warming is caused by human activities, down from 40 percent."

Of those surveyed March 1-8, 45 percent overall said global warming would be a serious threat within their lifetimes, the highest level since Gallup began asking the question in 1997. Majorities said most scientists agree that global warming is happening, that it is caused by humans and that it has already begun affecting the planet. Those are facts.

Independents may have become slightly less persuaded that global warming is caused by human activities; the poll showed 62 percent believe that, down from 70 percent last year. However, that drop is not statistically significant, and may not have even been a drop, because the error margin for the sub-sample of independents is larger than the overall poll's error margin of plus or minus 4 percentage points for each number.

The Trump administration seems eager to encourage doubts about climate change; Environmental Protection Agency Administrator Scott Pruitt sent staffers an email this week telling them to use terms that downplay or cast doubt on human contribution to climate change, the Post's Dino Grandoni reports.

Soybean planting tops corn in U.S. for first time in decades

For the first time in 35 years, American farmers say they plan to plant more soybeans than corn. According to the annual prospective planting report the U.S. Department of Agriculture released yesterday, farmers say they intend to plant 89 million acres in soybeans and 88 million acres in corn.

"The primary reason is profitability," David Pitt reports for The Associated Press. "Corn costs much more to plant because of required demands for pest and disease control and fertilizer. When the profitability of both crops is close, farmers bet on soybeans for a better return."

The last time soybeans beat out corn, in 1983, the government encouraged farmers to plant fewer acres to increase prices because of the farm crisis at the time.

Thursday, March 29, 2018

Congress boosts black lung treatment funding by millions

"Rural medical clinics that are struggling to respond to an epidemic of a fatal lung disease plaguing coal miners received a 40 percent boost in federal funding with the passage of the omnibus spending bill last week," reports NPR's Howard Berkes, who can claim some credit for the increase. Twenty-eight black lung clinics in 15 coal states will get a $10 million bump in funding, up from $2.7 million.

The funding, sought by a bipartisan group in Congress, will be a critical tool in treating a disease some government officials thought was close to being eliminated but has made a comeback in the last decade, perhaps because coal companies increasingly mine thinner seams and excavate a larger proportion of other rock, which creates a different kind of dust but one that causes progressive massive fibrosis of the lungs.

Despite a decline in approved claims for black-lung benefits, Berkes' research showed about 2,000 cases of progressive massive fibrosis, diagnosed in Appalachia since 2010. The National Institute for Occupational Safety and Health had only reported 99 new cases in the same time period, but bumped the number up to 416 after NPR's research was published. The agency confirmed NPR's findings last month.

The drive for more funding was spearheaded by Virginia Reps. Bobby Scott, ranking Democrat on the House Committee on Education and the Workforce, and H. Morgan Griffith, a Republican. They and four other members wrote an open letter to President Trump last year in which they noted that black-lung clinics "have faced a substantial increase in demands from coal miners for screening, diagnosis, and pulmonary rehabilitation" and that "some clinics are so underfunded that they are operating with obsolete and inefficient diagnostic equipment, which is needlessly increasing miners' radiation dose when they receive a chest X-ray."

Griffith said, "Coal miners are proud of the work they do, but should they develop black lung, they also want to be taken care of, and I agree."

Half of U.S. coal-fired power plants were unprofitable in 2017, study says; rate regulation helped them stay open

Monthly operating margins for the average coal plant. (Bloomberg graph)
About half of U.S. coal-fired power plants didn't earn enough revenue in 2017 to cover their operating expenses, according to a Bloomberg New Energy Finance study. "The problem is particularly bad in Florida, Georgia and elsewhere in the Southeast, where the distance from major coal mines drives up prices. The study examined the monthly economic performance of every U.S. coal plant in operation since 2012," Joe Ryan reports for Bloomberg.

Plants that didn't make enough money were able to stay open because most were located in areas where rates were determined by regulators rather than market forces. Regulators and utilities often keep struggling plants open to ensure stability of the electricity grid, but grids may face upheaval as more unprofitable plants close and natural gas continues to have a price advantage over coal.

The report's authors, William Nelson and Sophia Lium, wrote in the study that they were "awestruck by the resilience of U.S. coal . . . Plants persist even when they cost more to run than replace."

Study: annual oxygen-starved Gulf of Mexico dead zone, caused by farm fertilizer runoff, will persist for decades

According to a study published in the journal Science, the annual "dead zone" in the Gulf of Mexico will persist for decades, which could hurt fishing industries and the communities that rely on them.

The 2017 Gulf of Mexico dead zone (NOAA map)
A dead zone is an oxygen-deprived area at the bottom of a body of water that appears after fertilizer runoff spurs the growth of algae. After the algae die, their decay uses oxygen faster than it can be brought down from the surface, possibly suffocating marine life. Last year's Gulf dead zone was a record 8,776 square miles, the size of New Jersey. It has appeared in the Gulf every summer since the National Oceanic and Atmospheric Administration began measuring it in 1985, and a similar one also forms in Chesapeake Bay.

"The study said that even if the runoff was completely eliminated, which isn't likely, it would still take at least 30 years for the area to fully recover. According to the study, nitrogen can move very slowly through soil and groundwater systems, meaning runoff from agriculture can take decades to eventually reach the ocean," Doyle Rice reports for USA Today.

FarmTownStrong website, created by Farm Bureau and National Farmers Union, aims to fight rural opioid addiction

The American Farm Bureau Federation and its sometime adversary, the National Farmers Union, have created campaign to provide rural communities with resources to address opioid addiction, according to a Farm Bureau podcast.

The campaign is anchored with a website, FarmTownStrong.org, with confidential hotline numbers, links to local treatment programs and centers, and physicians authorized to treat addiction. There are also addiction prevention resources and information on how and where to dispose of medication.

Though opioids affect communities of all sizes, resources are often harder to access in rural areas. "Three in four farmers are, or have been directly impacted by opioid abuse, and three in four say it would be easy for someone in their community to access prescription pain killers illegally," Farm Bureau Director of Strategic Communications Ray Atkinson said.

Blue Cross and Blue Shield advises acetaminophen or ibuprofen for primary pain treatment instead of opioids

The Blue Cross and Blue Shield Association now recommends using acetaminophen or ibuprofen instead of opioids as the first or second choice for managing pain. Opioids may be best for things like cancer treatment or palliative care, but "in most cases, ibuprofen and acetaminophen can treat pain more effectively than opioids, said Dr. Trent Haywood, chief medical officer for Blue Cross, which has about 106 million members," Alex Kacik reports for Modern Healthcare. "It's important that physicians understand that alternatives like medication-assisted treatment exist, which pairs medication with behavioral counseling, he said."

According to its internal analysis, 21 percent of the Blues' commercially insured members filled at least one opioid prescription in 2015, and the number of Blue members with an opioid-use disorder diagnoses increased 493 percent from 2010 to 2016.

Haywood says opioids are half as effective as over-the-counter pain medications, but two to four times more harmful. Doctors may not be aware of that, partly because of misleading marketing campaigns by pharmaceutical companies. In 2007 Oxycontin maker Purdue Pharma reached a $635 million settlement with the federal government over claims that Purdue downplayed the addictive nature of the drug. Several states and tribes have filed similar claims against several drug firms.

Another possible reason doctors prescribe opioids so much is that they, and hospitals, used to get performance incentives based on how much pain their patients reported. And there may be a more sinister reason: An analysis by CNN and Harvard University found that doctors who prescribe more opioids get speaking or consulting fees from drug manufacturers.

Insurers, pharmacies, distributors and providers have restricted the number and size of opioid prescriptions they give out, "but physicians worry that reducing the supply could cut off access to patients who need the potent drugs," Kacik reports. "Also, insurers have been slow to cover alternatives to opioids. Prior authorization for medication-assisted treatment is another big roadblock."

Wednesday, March 28, 2018

Active ingredient of herbicide Roundup linked to shorter pregnancies, and thus 'lifelong adverse consequences'

More than 90 percent of a group of pregnant women in central Indiana had detectable levels of the active ingredient in the popular herbicide Roundup in their urine, according to researchers at Indiana University and the University of California San Francisco. The levels of glyphosate were higher in rural areas. The study, recently published in the journal Environmental Health, is the first to examine glyphosate exposure in pregnant Americans, Rich Schneider reports in an IU press release.

Researcher Shahid Parvez (IUPUI photo)
The glyphosate levels correlated significantly with shortened pregnancies, and "There is growing evidence that even a slight reduction in gestational length can lead to lifelong adverse consequences," said principal investigator Shahid Parvez, an assistant environmental health science professor at IU-Purdue University Indianapolis.

The researchers thought public drinking water supplies was the primary source of glyphosate exposure, but none of the tested water samples showed glyphosate residue. Rather, the main source of glyphosate intake seemed to be consumption of genetically modified food items and caffeinated beverages. "Use of glyphosate is heaviest in the Midwest due to corn and soybean production," Schneider reports. "Its residues are found in the environment, major crops and food items that humans consume daily."

Researchers found that 66 of the 71 women in the study, 93 percent, had glyphosate in their urine. "We found higher urine glyphosate levels in women who lived in rural areas, and in those who consumed more caffeinated beverages," Parvez said. The samples were obtained while the women received routine prenatal care.

County-level interactive map shows job trends in 2017; rural America gained 154,000 jobs but most gains were in cities

Map by The Daily Yonder; lick on the image to view a larger version; click here to view the interactive version.
In the first year of President Trump's tenure, the job trend of recent years continued, with job gains mainly in large cities. Almost 70 percent of the nearly 2.3 million jobs gained in the U.S. in 2017 went to metropolitan areas of more than 1 million people.

"Rural America gained 154,000 jobs, but that wasn’t enough to keep up with the urban centers," Bill Bishop reports for The Daily Yonder. "Rural America had about 13 percent of the nation’s jobs in January 2017, but garnered only 6.8 percent of the jobs added during last year. Job growth was considerably stronger in rural counties that were adjacent to metro areas. Those counties gained 121,000 jobs. Rural counties that weren’t adjacent to metro areas gained just 33,000 jobs." Meanwhile, the size of the workforce in rural America declined by 40,000 in 2017.

Click here to see the Yonder's interactive map with employment stats on every county in the U.S.

Tele-pharmacy can help rural towns with no drugstore

Maintaining access to pharmacy services is critical in rural communities; without it, chronically ill, and aging residents have a harder time getting medications, which makes it more difficult for them to stay in their homes and hometowns. But changes in the health-care system and deep cuts in reimbursement rates by companies known as "pharmacy benefit managers" have left many small towns without a pharmacy.

"A Rural Policy Research Institute study published in 2014 noted that 924 independently owned rural pharmacies (12 percent of the total) had gone out of business in the previous 10 years. A similar survey is currently ongoing to update the status of pharmacies in rural America," Kevyn Burger reports for Next Avenue, a Twin Cities PBS-sponsored nonprofit national news service that covers America's seniors.

Keith Mueller, director of the RUPRI Center for Rural Health Policy Analysis, told Burger: "These pharmacies work with a small customer base so they have no way to drive up the volume to cover their costs. They can’t negotiate lower rates with pharmacy benefit managers, drug companies or health insurance companies."

The loss of a rural pharmacy disproportionately hurts senior citizens, since people age 65 and over take three times more prescriptions than the average American, and are usually the customers most in need of guidance from a pharmacist.

Tele-pharmacy is an increasing popular option for rural residents who don't have a drugstore nearby. North Dakota first regulated the technology in 2002, and today there are 81 sites throughout the state serving about 80,000 rural residents. The tele-pharmacy in the 600-person town of New England, N.D., is one. Customers can have face-to-face conversations via HD video interface with licensed pharmacist Jody Doe, who works 95 miles away. Using the video connection, Doe can also monitor and supervise the on-site pharmacy technician who counts out the pills for New England customers. He can also send medications by mail. "Without this, people would have to get in the car and drive miles and miles down the road," Doe told Burger. "For older folks in the winter, that can be a real hardship."

April 13 deadline for journalists to apply for expenses-paid expedition to learn about Upper Mississippi River issues

The Institute for Journalism and Natural Resources is accepting applications for the Upper Mississippi River Institute, a expenses-paid week in June for 15 to 20 journalists to learn about the issues that originate in and affect a watershed that drains nearly 40 percent of the contiguous United States.

Selected journalists will meet with local citizens, elected officials, business owners, resource managers and scientists to explore topics such as:
  • The 2018 Farm Bill and how activities and incentives it promotes on land will shape the river from its headwaters to the Gulf of Mexico.
  • The connections between domestic oil and gas, Midwest agriculture and the loss of Minnesota forests and wetlands.
  • A new vision for the Mississippi River and a push to connect more communities in the Twin Cities to it.
  • "Soil health," the latest science in soil conservation, and community efforts to reduce runoff on Minnesota farms.
  • Federal and state efforts to restore habitat, rebuild islands and reintroduce endangered freshwater mussels below Lock and Dam 7 on the Mississippi.
  • Mining for sand in Minnesota and Wisconsin and different approaches to local control of zoning and resource extraction.
  • Industrial-scale agriculture, nitrate pollution and mounting difficulties for utilities trying to provide safe drinking water to rural communities.
  • Efforts to prevent the spread of invasive species and exotic pathogens.
  • The Mississippi's long history of human development and attempts to control floods and keep the river on an "acceptable" course.
  • The river’s big economic impact as a main artery of commercial shipping.
Applications will be accepted through April 13. Click here to learn more or apply.

Forum on news coverage of Appalachia to be held in Whitesburg, Ky., on Saturday from 11:30 to 2:30

Since national and international news media rediscovered Appalachia in the 1960s, residents of the region have complained about depictions of their region, and some have tried to build their own regional narrative. This weekend there will be a public conversation about such things.

Appalshop's WMMT-FM and nonprofit journalism magazine Scalawag are hosting a community discussion about news coverage of Appalachia from 11 a.m. to 2:30 p.m. Saturday, March 31 at Appalshop in Whitesburg, Ky.

Organizers say participants will "share ideas and examples of ethical, accountable, community-led media projects in the region, discuss some less-ideal national coverage Central Appalachians are well acquainted with, and create a guide for journalists on what to do and what NOT to do when covering our mountain communities."

The forum will be followed by a screening of "Stranger with a Camera," a film by Appalshop's Elizabeth Barrett about a Canadian photographer who was murdered in near Whitesburg in 1967, and a question-and-answer session with author Elizabeth Catte about her new book What You Are Getting Wrong About Appalachia.

Click here to learn more about the event and register for it.

Tuesday, March 27, 2018

Hospital owner may have defrauded insurers by running tests through rural facilities that get higher reimbursements

Heard of a rural hospital in danger of closing being rescued by a buyer when no one else seemed willing to buy it? It may be a scam. Some rural hospitals "have become gold mines for enterprising health-care executives looking to quietly make a quick buck" by exploiting a reimbursement advantage to net big money from insurance companies, Jim Axelrod reports for CBS News.

Photo: GeorgiaHospitalJobs.com via WDUN
Insurance providers reimburse rural hospitals at higher rates to help them stay open. One is Chestatee Regional Hospital, a 49-bed facility in Dahlonega, Ga., whose owners had been trying to sell it for years. In 2016 a man named Aaron Durall bought it for $15 million, a startlingly large sum. Durall owned a drug screening lab in Florida called Reliance Laboratories and had never owned a hospital.

After the sale, Durall moved part of the billing operation to Florida, and soon afterward huge reimbursement checks from insurance companies began coming in, some for as much as half a million dollars. "Records showed the money was being paid out for drug screens – toxicology tests on urine samples collected from all over the country. Some of the testing was conducted at Durall's lab, Reliance, in Sunrise, Fla., but everything was billed through Chestatee," Axelrod reports.

Former Chestatee billing clerk Kelly Smallwood told Axelrod that Durall got much higher reimbursement rates by billing through the hospital. Chestatee wasn't his only operation: "Documents show Durall's lab made $67 million billing tests through another rural hospital in Graceville, Fla. A similar deal Durall made with a hospital in northern California has generated more than $31 million in the last eight months. Last year, Durall bought two more rural hospitals in Georgia and Alabama," Axelrod reports.

Patients from all over the country began calling clerk Smallwood soon after Durall bought Chestatee. One was Sonya Hribal of Tyler, Tex. A toxicology billing pro herself, Hribal said Chestatee had been billing her insurance $2,700 a pop for drug tests on her son who was in in a rehabilitation program in Michigan, adding up to nearly $20,000 for mere urinalysis. "I knew what they were doing right from the get go," Hribal told Axelrod. "They were defrauding my insurance company."

Hribal said people should care because insurance companies can increase premiums to avoid losing money on the huge payouts. "They're going to pay for it, you're going to pay for it," she said.

Durall told Axelrod that all the billing at his rural hospitals was done properly. Last month, Anthem, the nation's largest private health insurer, sent a letter to Durall's California hospital alleging $13 million had been improperly billed. The hospital has temporarily suspended its lab program.

Rural populations underrepresented in clinical trials; communication seems to be a major part of the problem

Clinical trials can help patients who haven't been cured with permanently approved treatments, but new research proves what many medical researchers have long known: People in medically under-served areas, mainly rural, appear to not know how to find out more about clinical trials, and community physicians reported not having appropriate information to give them, Kristie Kahl reports for Cure, a publication about cancer updates, research and education.

According to the study, to be presented at the American Association for Cancer Research's annual meeting in April, rural patients are often underrepresented in clinical trials and biobanking, in which samples of bodily fluids or tissue are collected for medical research. That means researchers don't understand as much as they could about rural populations.

Terry Davis, professor of medicine and pediatrics at Louisiana State University and co-author of the study, said it's a communication problem: "Researchers often assume that patients and community providers know more than they do about clinical trials and understand all of our jargon."

One recurring problem was differences in terminology. Researchers might say "clinical trials" whereas patients might call them "studies." And while researchers say "biobanking," the patients Davis and her colleagues surveyed better understood them saying "your blood or tissue will be stored in a bank."

Effort to fully legalize hemp gets big push from McConnell, who says it can be distinguished from marijuana

Senate Majority Leader Mitch McConnell announced yesterday that he will introduce legislation to legalize hemp as an agricultural product, remove it from the federal list of controlled substances, and shift regulatory authority mostly to states. The Hemp Farming Act of 2018 will be co-sponsored by fellow Kentucky Republican Sen. Rand Paul and Democratic Sen. Ron Wyden of Oregon, the second largest hemp producer; U.S. Rep. James Comer, R-Ky., is sponsoring a companion House bill, reports WKYT-TV of Lexington, Ky.

McConnell, Commissioner Ryan Quarles (Ky. Dept. of Agriculture)
"We all are so optimistic that industrial hemp can become, sometime in the future, what burley tobacco was in Kentucky's past," McConnell said at a national hemp roundtable in Lexington with Kentucky Agriculture Commissioner Ryan Quarles. Kentucky once had more tobacco farmers than any other state, but McConnell helped wean them off tobacco in 2004 with a bill that ended federal support for the crop and compensated them for their federal production quotas. He noted that land, buildings and equipment used for tobacco can easily be used to grow and harvest hemp.

Attorney General Jeff Sessions is strongly opposed to the legalization of marijuana, and some law-enforcement leaders oppose hemp legalization, saying the crops are indistinguishable. But McConnell said, "Most members of the Senate understand that these are two very different plants," and said he would stress that to Sessions, a former Senate colleague.

A 2015 study identified a gene that distinguishes hemp from marijuana, "likely due to the breeding of the plants for radically different uses." There are three species of cannabis, the scientific name of the plant; "hemp" and "marijuana" describe the crops produced from cannabis sativa, Business Insider reports. Marijuana producers generally remove male plants to force females to produce more buds, which have the highest concentration of delta-9 tetrahydrocannabinol, the main psychoactive ingredient. Current law says the plant is marijuana, not hemp, if it is more than 0.3 percent THC.

McConnell's efforts to increase hemp production may help persuade doubters that he will seek re-election in 2020, which he has said he is doing. "Several GOP senators said privately that they believe McConnell is far more likely than not to run again," Burgess Everett reports for Politico. The Farm Bill expires this year, and McConnell's hemp proposal could be included in a new one. It would also allow hemp researchers to apply for grants through the U.S. Department of Agriculture.

McConnell has gradually ramped up his supporter of hemp, following the lead of Paul, who was elected in 2010, and Comer, who was elected agriculture commissioner in 2011 and ran for governor in 2015. McConnell saw that the 2014 Farm Bill allowed state agriculture departments to undertake experimental hemp projects, and that helped put his state at the forefront of hemp's comeback. "It's now time to take the final step and make this a legal crop," McConnell said. "We're going to give everything we've got to pull it off."

So far, 34 states have authorized hemp research and 19 have production programs, Bruce Schreiner reports for The Associated Press. Kentucky planted 3,100 acres in 2017, third among the states. Oregon was second with 3,469 acres and Colorado first with 9,700, according to Vote Hemp. Nationally, there were 25,541 acres in 2017, more than double the 9,770 of 2016.

Vote Hemp map; click on the image for a larger version.

Wells Fargo, top gun-industry financier, follows other big banks' lead in dealing with increasing concern about guns

Wells Fargo stagecoach in lobby of one of its banks in Sacramento
Wells Fargo & Co., the descendant of a stagecoach company that needed firearms for protection and is now the nation's third-largest bank and No. 1 financier of the U.S. gun industry, is thinking about guns “and talking to gunmakers who are its clients,” The Charlotte Observer reports. CEO Tim Sloan “did not outline any actions Wells Fargo might take, and he declined to name the gunmakers citing client confidentiality. But he said the bank is providing those clients with feedback it is hearing from Wells employees, investors and others,” the Observer reports.

"Some of our team members are concerned about who can buy semiautomatic weapons in this country, and they're concerned about various laws and the like," Sloan said in an interview with  Deon Roberts and Rick Rothacker during a trip to Charlotte, where the San Francisco-based bank has its largest employee hub. "What we find is absolutely consistent whether you are a gunowner or not: You want your children to be safe, they should be safe when they go to school, they should be safe when they're walking down the street. That's consistent. How we go about that is more complicated."

The Observer notes, "The bank helped two of the biggest U.S. firearm and ammunition firms attain $431.1 million in loans and bonds since December 2012, a time when gun control issues re-ignited following the school shooting in Newtown, Conn., Bloomberg reported. Wells has also provided a credit line to the National Rifle Association, the pro-Second Amendment rights group, according to Bloomberg." (North Carolina-based Remington Outdoor Co., parent firm of Remington Arms, the oldest U.S. gun maker, filed yesterday for protection under federal bankruptcy laws.)

Wells Fargo is following the lead of other big banks. Last week, No. 4 Citigroup announced that its retail clients must  not sell firearms to someone who hasn’t passed a background check, or to individuals under 21, or sell bump stocks or high-capacity magazines. "Charlotte-based Bank of America, the No. 2 U.S. bank, said in February that it’s reaching out to clients that manufacture assault weapons for non-military use "to understand what they can contribute to this shared responsibility," the Observer reports.

Ban on methadone vans seen as barrier to treatment

A patient talks to a nurse and the driver of a methadone
van parked in Baltimore. (Pew Charitable Trusts photo)
Mobile methadone vans have served people with opioid addiction in rural areas and inner-city neighborhoods for nearly 30 years, but federal reluctance to approve new vans is hampering agencies' ability to fight the current opioid epidemic.

"The U.S. Drug Enforcement Administration, which regulates dispensing of the FDA-approved addiction medicine, has refused to license any new methadone vans since 2007 over concerns about potential diversion of the medication," Christine Vestal reports for Stateline, the news service of the Pew Charitable Trusts.

The federal Substance Abuse and Mental Health Services Administration and some state and local addiction agencies are asking the DEA to lift the moratorium. Mark Parrino, head of the methadone industry's professional organization, the American Association for the Treatment of Opioid Dependence, questioned the ban, saying that no security breach of a methadone van licensed before the moratorium was ever reported. Regulations that would allow methadone vans to be licensed is months away from completion, DEA official James Arnold said at a recent AATOD meeting.

Of the three medications used to treat opioid addiction, methadone is the oldest, most researched, most widely used, and the most tightly regulated. Unlike buprenorphine and naltrexone, which can be prescribed and taken at home, methadone must be taken at one of about 1,500 dispensing locations. Seattle area behavioral health official Brad Finegood told Vestal, "Mobile treatment vans are critical to addressing the opioid epidemic . . . As this epidemic grows and changes, concentrations of people who are affected by it can be found in shifting locations within the city and county. If we’re going to be effective, we need to be nimble and bring the medication to them instead of asking everybody to trudge across town to get their daily dose at a fixed facility." Many opioid addicts seeking treatment say they can't find a treatment program within commuting distance, according to Pew research.

Officials in Connecticut, Maryland, New Jersey, New York and Washington state want new methadone vans but have been blocked by the moratorium. Parrino said Puerto Rico needs vans badly, since Hurricane Maria destroyed most of the island's transportation infrastructure and medical facilities.

Rural newspaper's chair-and-cigar-box 'news rack' should 'end up in the Smithsonian or Newseum,' professor writes

"The Evergreen Courant's famous chair-and-cigar-box newspaper honor system ought to end up in the Smithsonian or Newseum someday," retired Auburn University journalism professor Ed Williams writes for Connecting, a subscription-only newsletter for retirees of The Associated Press and others. He is a native of Conecuh County, home of the paper.

"No story about this South Alabama county-seat weekly paper would be complete without mention of the old wooden chair that has 'sold' thousands of newspapers for decades from its spot just outside the Courant's office on Rural Street in Evergreen," Williams writes, including a couple of photographs.

Evergreen postal worker Gilbert Harden
buys a Courant as the stack gets low.
No one recalls when the chair was first used as the Courant's news rack, but most agree it's been doing the job for the paper since World War II. Third-generation owner Robert Bozeman III told Williams, "All I know is that the chair was there when I was born and before so I would say it's at least 60 to 70 years old."

Williams reports that someone suggested to Bozeman that he place "a recliner next to the stack of weekly papers for eager Conecuh Countians who can't wait to get home to read their hometown paper. Alabama newspaper man Bill Beckner even suggested adding a coffee pot."

Beckner, former senior vice president of Boone Newspapers, told Williams, "Nothing better than a weekly newspaper hot off the press."

Monday, March 26, 2018

Decline in maternity care creates risks in rural America

The years-long trend of rural hospital closures has led to worse health outcomes for mothers and their babies, according to a recently published study by the University of Minnesota's Rural Health Research Center. Though experts have long suspected this, the study is the first to provide proof, Katrina Pross reports for the Minnesota Daily.

Fewer than half of rural counties have a hospital where a woman can deliver a baby; the study found that between 2004 and 2014, 179 rural counties lost hospital-based obstetric services. It's one of the first departments struggling hospitals eliminate because of its expense and potential liability. According to Diane Calmus, government affairs and policy manager for the National Rural Health Association, the large proportion of births covered by Medicaid in rural areas is part of the reason, since Medicaid doesn't fully reimburse hospitals for expensive births.

Because of this lack of maternity services, pregnant women in rural areas sometimes have to travel hours to receive the routine maternal care that can catch problems like pre-eclampsia or gestational diabetes, and bad weather can prevent them from getting to the hospital in time to give birth. They may be forced to give birth at a local hospital that doesn't have the proper equipment to care for a newborn in distress. Researchers found that in the year after a county lost hospital-based obstetric services, there is a significant increase in emergency births at hospitals without OB services. The study also found delays in starting prenatal care, and more pregnancy-based hospitalizations, premature births, low-birthweight babies, and infant mortality.

"The NRHA is lobbying for a federal bill that would improve hospital reimbursement rates. The bill has already been passed by the House of Representatives but still needs to be passed by the Senate," Pross reports. One of the study's authors also recommended financial incentives to increase the number of health care workers trained in obstetrics in rural hospitals, as well as training local law enforcement and EMS workers in basic maternity care and implementing services to transport expectant mothers safely to hospitals.

Rural Kentucky community, site of recent school shooting, holds March for Our Lives rally, calls for gun safety

Saturday's March for Our Lives was one of the biggest youth protests since the Vietnam War, with at least 1.2 million participants across the U.S. and other countries protesting gun violence and school shootings. Rural kids marched too, but some focused more on gun safety rather than gun control.

The March for Our Lives rally in Marshall County, Kentucky
(Photo by WKMS-FM, Murray, Ky.)
Marshall County High School in Western Kentucky was the site of a deadly school shooting in January; students at the school organized a march and several spoke. Other speakers included Alonzo Pennington, a musician and hunting guide running for Congress as a Democrat. He opposes bump stocks because it "makes your gun inaccurate and it makes it malfunction," he told Camila Domonoske of Murray's WKMS-FM. He thinks restrictions on high-capacity magazines are sensible because "If you're too lazy to load a smaller clip, then you don't need to be taking the time out there and hunt anyhow."

One student who spoke was Makayla Wadkins, who said that society's propensity for blaming the mentally ill for school shootings makes it less likely for people struggling with mental illness to get the help they need. Other students called for legislative change. "After the shooting, Gov. Matt Bevin called for a day of prayer. President Donald Trump said his 'thoughts and prayers' were with the victims. Students at the rally said that's not enough," WKMS reports.

Chinese retaliate against Trump's tariffs on steel and aluminum with levies on pork, fruit, wine, ethanol, ginseng

DTN/The Progressive Farmer photo
After President Trump imposed tariffs on $60 billion in Chinese steel and aluminum exports last week, China immediately responded with tariffs on $3 billion in U.S. exports that could hurt rural Americans, Jerry Hagstrom reports for DTN/The Progressive Farmer.

China will impose tariffs on more than 100 products, including a 25 percent tariff on pork, and 15 percent on fresh fruit, dried fruit, nuts, wine, modified ethanol and American ginseng. "Missing were vulnerable prey like aircraft and soybeans, which experts say may come next if tensions continue to build," Natalie Kitroeff reports for The New York Times. "China is the United States’ third-largest export market, and a top destination for agricultural goods harvested in Trump strongholds."

National Pork Producers Council president Jim Heimerl of Johnstown, Ohio, told Hagstrom that "We sell a lot of pork to China, so higher tariffs on our exports going there will harm our producers and undermine the rural economy . . . No one wins in these tit-for-tat trade disputes, least of all the farmers and the consumers."

"Worries over a looming trade war have already hit Iowa pork producers' pocketbook to the tune of $240 million from falling prices, and the damage will likely grow," Donnelle Eller reports for the Des Moines Register.

Treasury Secretary Steve Mnuchin and Trade Representative Robert Lighthizer sent a letter to their Chinese counterparts last week suggesting that they were willing to negotiate on tariffs, if China agrees to cut the tariff on U.S. autos, buy more U.S. semiconductors, and give U.S. firms more access to the Chinese financial sector, Reuters reports. Word of that helped stock markets open higher today.

Monday, April 2 is deadline for nominations for Gish Award for courage, integrity and tenacity in rural journalism

Tom and Pat Gish
Nominations are due April 1 for the Tom and Pat Gish Award, which annually recognizes the courage, integrity and tenacity that is so often necessary to provide good journalism in rural areas. The award, named for the crusading couple who published The Mountain Eagle in Whitesburg, Ky., for more than 50 years, is given by the Institute for Rural Journalism and Community Issues, which publishes The Rural Blog. (When we set the deadline, we didn't realize it was Easter Sunday, so as long as we get a nomination by Monday, it will be considered.)

Nominations should measure up, at least in major respects, to records of earlier winners, available at www.RuralJournalism.org. For example, the Gishes withstood advertiser boycotts, business competition, declining population, personal attacks, and even the burning of their office to give their readers the kind of journalism often lacking in rural areas, and were the first winners of the award named for them. The most recent winners, the Cullen family of Iowa's Storm Lake Times, overcame obstacles to persevere in covering and commenting on water-pollution issues in Iowa, often to the dislike of agribusiness interests that are sources of much of the pollution.

Other winners have been the Ezzell family of The Canadian (Tex.) Record, in 2007; James E. Prince III and the late Stanley Dearman, current and former publishers of The Neshoba Democrat of Philadelphia, Miss., in 2008; Samantha Swindler of The Oregonian in 2010 for her work as editor of the Corbin, Ky., Times-Tribune and managing editor of the Jacksonville (Tex.) Daily Progress; in 2011, Stanley Nelson and the Concordia Sentinel of Ferriday, La.; in 2012, Jonathan and Susan Austin of the Yancey County News in Burnsville, N.C.. in 2014, the late Landon Wills of Kentucky's McLean County News; in 2015, the Trapp family of the Rio Grande Sun in EspaƱola, N.M.; and in 2016, Ivan Foley of the Platte County Landmark in Missouri.

Nominators should send detailed letters to Institute Director Al Cross, explaining how their nominees show the kind of exemplary courage, tenacity and integrity that the Gishes demonstrated in their rigorous pursuit of rural journalism. Detailed documentation does not have to accompany the nomination, but is helpful in choosing finalists, and additional documentation may be requested or required. Questions may be directed to Cross at 859-257-3744 or al.cross@uky.edu.

U.S. News issues its list of 100 healthiest rural counties

Routt County, Colorado (Wikipedia map)
U.S. News & World Report, which draws up many lists, has released its annual list of the 100 healthiest rural communities, ranked according to performance in 10 categories that drive health outcomes: population health, equity, education, economy, housing, food and nutrition, environment, public safety, community vitality and infrastructure.

Colorado figured prominently on the list, scoring five of the top 10 communities, including Routt County in the No. 1 spot. Western states such as Wyoming, Utah, Idaho, and Montana also made several appearances on the list, along with a smattering of counties in New England and elsewhere. No counties in Appalachia or the Deep South were on the list. How did your county stack up?