Doctors’ Lounge
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own health benefit exchange and website,
Kynect. The Kentucky website has fared far
better than the federal site. As of December
5, Kynect.gov could boast of these numbers.
•
•
•
•
The site had nearly 575,000 unique
visitors viewing nearly 16.7 million
web pages
Nearly 72,000 had enrolled in new
insurance including Medicaid and
private insurance - approximately
56,500 in Medicaid and 15,500 in
private insurance plans
More than 28,000 had been found
eligible for a subsidy to purchase a
qualified private health plan, although
many had not yet picked a specific plan
Nearly 11,500 people in Louisville had
enrolled in new insurance
Kentucky has consistently ranked at or
near the bottom of all states in the nation
on most health indicators. One sixth of
Kentucky’s citizens are uninsured. It’s
refreshing to see Kentucky leading the way
in its commitment to providing citizens long
overdue health coverage.
It’s also refreshing to hear the governor,
talking about his decision to expand
Medicaid and to open the Kentucky
health benefit exchange saying, “[These]
are not political decisions. They are
moral decisions…Taking these steps will
mean that, for the first time, every single
Kentuckian will have access to affordable
health care. Over the next generation, this
will change the course of Kentucky’s history.”
So as I’m out holiday shopping hearing
incessant carols and insipid jingles wishing
me a Happy New Year and even when I’m
back home, channel surfing between the
talking heads on FOX and MSNBC a slightly
different version of the Elvis Costello song
is boring its way into my head. Over and
over I keep hearing him sing:
As I walk through
This wicked world
Searchin’ for light in the darkness of
insanity.
I ask myself
Is all hope lost?
Is there only pain and hatred, and misery?
And each time I feel like this inside,
There’s one thing I wanna know:
What’s so funny ‘bout peace, love,
understanding – and Obamacare? ohhhh
What’s so funny ‘bout peace, love,
understanding – and Obamacare? LM
Note: Dave Langdon is the director of
public information for the Louisville Metro
Department of Public Health and Wellness.
Fracking: A medical-environmental conundrum
Thomas James III, MD
T
he jagged
mountains
and rolling
hills of rural western Pennsylvania remind me very much
of Eastern Kentucky.
So does the poverty.
For the people of that
land the chance to grab onto any legal economic stimulus drives hope over reason.
As small industries left central and western
Pennsylvania people rapidly reached out to
embrace the new money found in extracting
oil and natural gas from the Marcellus Shale
that covers nearly sixty percent of Pennsylvania. Hydraulic Fracturing, termed fracking, is a relatively new method of extracting
these fossil fuels from within the shale. A
whole new industry thus promised to improve the wealth and the lives of the people
in these rural communities.
At a time of concern for U.S. dependence
on foreign oil reserves, the ability to access
the oil and gas trapped within the soft shale
of the region has been viewed positively by
many as a way to provide both new sources
of oil and natural gas and to provide many
new on-shore jobs. On the surface, this
sounds like a win-win opportunity. Companies engaged in fracking have brought
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LOUISVILLE MEDICINE
people to the area and helped to build more
schools, improve the roads needed for their
trucks, and created more demand for goods
and services in communities where fracking is found,
To get to these reserves the exploration
companies drill holes sometimes thousands
of feet deep to reach the shale substrate. A
mixture of sand, millions of gallons of water, and proprietary mixtures of chemicals
are pumped through the drilled shaft to
fracture the shale and release the oil and
gas. The mixture is forced out of the shaft
so that the oil and gas may be captured. The
companies all try to contain the exuded
mixture; but there are no guarantees that
heavy rains, breaches in the containment
systems, or other unexpected events may
allow the water-sand-chemical mixture
into the water supply. Further, the solvents
used are proprietary mixtures which the
companies do not want to share externally,
even if knowledge of the chemicals used
were to help the clinician in diagnosing an
unusual toxicity. Typically these mixtures
may contain methanol, benzene, naphthalene, trimethylbenzene and other organic
solvents. Since each company has its own
mixture, and keeps it secret, the impacts on
humans in the area may be variable. Physicians from western Pennsylvania have now
described seeing patients who have shown
signs of toxicity from organic solvents.
Because of the concerns for physical
harm caused by the fracking process, the
Community Health Committee of the
Philadelphia Medical Society introduced
a resolution into the House of Delegates
of the Pennsylvania Medical Society last
October, calling for a moratorium on new
drilling for oil and natural gas extraction
through hydrolytic fracturing i.e. fracking.
Philadelphia County is in the Delaware Valley watershed—a geographical area that is
not a part of the Marcellus Shale region, so
is not directly impacted by fracking. This
set up a classic conundrum. The Philadelphia County Medical Society , though not
directly impacted by fracking, was yet the
county medical society raising the issue. It
did so because its Community Health Committee viewed fracking as an existing public
health issue for the entire Commonwealth.
As with the Kentucky House of Delegates,
the work of investigating resolutions comes
from the several Reference Committees. The
committee hearing this proposed resolution
heard impassioned pleas from both sides
of the fracking issue. Those opposed to the
proposed policy argued that the economic
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