Feb. 1, 2025 – The family of porn star Emily Willis is suing the rehab center where she was found unconscious resulting in her sustaining permanent brain damage while at the facility for treatment for her ketamine addiction. Summit Malibu and its parent company Malibu Lighthouse Treatment Centers allegedly committed adult abuse, negligence and unlawful, unfair or fraudulent business practices resulting in Willis’ vegetative state, The 26-year-old, whose real name is Litzy Lara Banuelos, entered the rehab center for her addiction to the dissociative anesthetic drug, which she was taking 5 to 6 grams of per day, her family alleges. Yesenia Lara Cooper – Willis’ mother, conservator and plaintiff in the lawsuit, allegedly noted that the adult film star looked underweight, weighing in at 100 pounds, but claims a consultation was never made with a dietician.
Newswise — WASHINGTON, DC — A new editorial in the BMJ suggests that a 22% decrease in overall U.S. drug overdose deaths over 2023/2024 signals that investments in overdose prevention and substance use disorder treatment are working. In Avoiding a new US “war on drugs”: Declining US drug overdose deaths show that evidence-based public health approaches work (Vincent Guilamo-Ramos, Adam Benzekri, Loftin Wilson, and Marissa D. Abram), the authors call for more investment in treatment and prevention to accelerate progress — and to reject calls for a return to “War on Drugs” tactics that bipartisan experts believe didn’t work.
“Evidence-based prevention and treatment are working in communities across the entire country. There’s also a growing sense across the ideological divide that this is the smartest approach, while the ‘War on Drugs’ simply wasn’t — because it was law enforcement-focused, disproportionately harmed communities of color, was a waste of money, and it just didn’t work. In an era of increased appetite for criminalizing health and social problems, we have already learned that addiction is best addressed with care, not convictions. Bottom line: a return to ‘War on Drugs’ tactics could reverse the progress made in the overdose crisis and make the situation much worse,” said Dr. Vincent Guilamo-Ramos, IPS Executive Director and the Leona B. Carpenter Chair in Health Equity and Social Determinants of Health at Johns Hopkins School of Nursing.
The editorial explores what is most likely driving the welcome decline in deaths – and why in some states overdoses are rising. It looks at how more “tough on crime” messaging could lead to a more law enforcement-driven response to drug taking and overdoses – pushing back progress, especially in communities of color where the decline has been slower. It explores existing prevention and treatment successes – such as major changes in opioid medication prescription policies and practices, expanded access to opioid use disorder medications, and the scaling-up of community-based harm reduction services. Finally, it notes promising new strategies to further eliminate substance related prevention and treatment inequities such as: community and family-based models of prevention and treatment service delivery in marginalised communities and achieving a health workforce more representative of the populations served.
“Making the right call at this moment-of-opportunity is key to save and improve more lives. The wrong call is for approaches that are ineffective and unjust; this would fail all US communities — especially those in which overdose deaths continue to rise. It’s time to get tougher FOR prevention and treatment, for MORE targeted investment in prevention and treatment – and not to repeat the mistakes of the past,” Guilamo-Ramos stressed.
ENDS
Notes to editors
A: Overdose Death Rate per 100,000 (age-adjusted)
B: Number of Overdose Deaths
More on IPS
The Institute for Policy Solutions (IPS) at Johns Hopkins School of Nursing ends health inequities through evidence-based policy solutions. IPS is focused on nurse-driven solutions to solve one of the country’s most alarming and unsustainable problems: health inequities. Nurses bring novel solutions to health system reform that optimize health for all — no matter who you are or where you live. Our expertise and insight into the systems that deliver care and impact health, as well as what matters to patients, families, and communities, uniquely position the nursing profession to transform health care delivery to prioritize health and well-being. Through nurse leadership, the Institute drives collaborations with interdisciplinary and cross-sectoral partners in dialogue, discovery, and the adoption of solutions for making optimal health attainable for all. Details at ipsnow.org
Jan. 30, 2025 – It’s the first new pharmaceutical approach to treating pain in more than 20 years, offering an alternative to both opioids and over-the-counter medications like ibuprofen and acetaminophen. Two studies in more than 870 patients with acute pain following foot and abdominal surgeries showed Vertex’s pill provided more relief than a dummy pill but didn’t outperform a common opioid-acetaminophen combination pill.
“It’s not a slam dunk on effectiveness,” said Michael Schuh of the Mayo Clinic
Vertex began researching the drug in the 2000s, when drug overdoses were rocketing upward, principally driven by mass prescribing of opioid painkillers for common ailments like arthritis and back pain. Prescriptions have fallen sharply in the last decade and the current wave of the opioid epidemic is mainly due to illicit fentanyl, not pharmaceutical medicines.
Opioids reduce pain by binding to receptors in the brain that receive nerve signals from different parts of the body. Those chemical interactions also give rise to opioids’ addictive effects.
Vertex’s drug works differently, blocking proteins that trigger pain signals that are later sent to the brain.
The Appalachian region continues to experience disproportionately higher opioid overdose rates and related fatalities. According to the most recent Center for Disease Control and Prevention, fully one-half of the 16 states with the highest overdose death rates are Appalachian states. West Virginia tops the list, and is joined by, in descending order, Tennessee, Kentucky, Ohio, South Carolina, North Carolina, Pennsylvania, and Maryland. And although the CDC’s data shows a 4% overall overdose death rate decline, the statistics for Appalachia remain stubbornly high.
A Philadelphia-based non-profit foundation is combating the opioid addiction epidemic at the source by educating frontline allied health professionals on various aspects of the nation’s opioid crisis, specifically in Pennsylvania and the Appalachian region.
The Rothman Orthopaedic Institute Foundation for Opioid Research and Education (aka, Rothman Opioid Foundation) is a leader in opioid-related research and education. Thanks to a three-year grant from the federal Appalachian Regional Commission and support from the Pennsylvania General Assembly, the Foundation has used its expertise to educate allied health professionals in Pennsylvania and the broader Appalachian region on proper opioid prescribing and use.
Rothman Opioid Foundation has created and distributes opioid education curricula at no cost for the 75 allied healthcare professional training programs, such as nurse practitioners and physician assistants, at collegiate institutions across the Appalachian Region. In particular, the Foundation has produced an 8-module online pain management curriculum designed to complement any training program focusing on evidence-based pain management using opioid-sparing strategies.
“Physician assistants and nurse practitioners are valued professionals and are often on the front line of primary care and pain management, and they will greatly benefit from formal training in opioid pharmacology, use, abuse, and safe evidenced-based pain management strategies,” says Dr. Asif Ilyas, MD, MBA, FACS, President of the Rothman Opioid Foundation in Philadelphia, PA. The Foundation has developed its curriculum as a prescriber-training program and is offering this eight-hour course free of charge. It is an online, self-paced certificate program designed to effortlessly complement students’ current curriculum in the clinical phases of their training and prescribers in practice. The targeted allied health professionals include nurse practitioners (NPs) and physicians’ assistants (PAs). The curriculum’s training includes, but not be limited to, opioid prescribing guidelines and indications, pain management alternatives to opioids, identification of potential opioid abuse, and intervention strategies. Additional educational programs will include online webinar series and in-person events when feasible. The curriculum is designed to complement the clinical phase of NP and PA training programs but can be implemented at any stage in training. While designed specifically for NP and PA students, the Rothman Opioid Foundation submitted the course material to a rigorous national accreditation process. As a result, the curriculum has been accredited for up to 13.5 Continuing Medical Education (CME) credit hours. It satisfies the Federal Drug Enforcement Agency Medication Assisted Treatment Education (DEA MATE) Act 8-hour training requirement on the treatment and management of patients with opioid or other substance use disorders. That means any licensed prescriber, physician, NP, or PA can obtain the required CME or DEA MATE opioid training through this vital course material. While most opioid-related education currently targets physicians, Ilyas says, NPs and PAs often interact more with individuals who are suffering from or are susceptible to opioid misuse.
“NPs and PAs have prescribing rights. They are vital physician extenders who need to be educated and recruited in the fight against the opioid addiction crisis across the Appalachian region,” says Ilyas. “This information will be tailored specifically to these allied health professionals to mitigate the rate of opioid addiction at the source by teaching proper opioid use and early symptoms of misuse to decrease the risk of opioid dependency and abuse. “The Rothman Opioid Foundation plans to partner with colleges and universities to distribute this information to as many healthcare students as possible in the Appalachian Region. This project’s ultimate goals are to ensure that PAs and NPs have the proper resources and education to advise on proper opioid use and its alternatives, recognize the initial symptoms of opioid misuse and abuse, and understand when and how to intervene when substance abuse occurs.“The opioid addiction crisis has taken a drastic toll on the Appalachian region and the country. To lower the chance of misuse and overdose in patients, it is imperative that our local frontline healthcare workers are adequately trained and educated in the pathophysiology of opioid addiction, and they have resources available to guide effective and safe pain management,” says Ilyas.
According to the Centers for Disease Control and Prevention (CDC), 130 Americans die every day from opioid overdose. This includes prescription and illicit opioids. Low-income and rural areas are among the most likely to experience the opioid addiction crisis’s adverse effects, as evidenced by data published by the Appalachian Regional Commission. Rural residents are at greater risk in part due to a lack of resources or healthcare services to address their addiction. These regions often lack accessible health services, especially those considered “specialized” services, such as addiction treatment.In addition, communities with a high uninsured population are at greater addiction risk as individuals without healthcare insurance are much less likely to receive treatment than those who are insured. These individuals are more likely to seek primary care through an urgent care setting, generally staffed by a physician extender (PAs and NPs).
As noted above, these allied health professionals have not always received the opioid-related education that their physician counterparts have.“Therefore, it is essential that professional education, designed to provide allied health professionals with the tools necessary to both manage pain in an evidenced-based opioid-sparing manner as well as screen for and identify addiction in the primary care setting visit, is available across Appalachia’s rural regions,” says Ilyas. Rothman Opioid Foundation is committed to providing the educational tools needed by our allied health professionals across the Appalachian region as they serve and treat on the front line of the opioid crisis. Information on the curriculum is found here: https://www.rothmanopioid.org/opioids-pain-management
About the Rothman Orthopaedic Institute Foundation for Opioid Research and Education.
The Rothman Orthopaedic Institute Foundation for Opioid Research & Education, www.rothmanopioid.org , is a non-profit 501c3 organization dedicated to raising awareness of the risks and benefits of opioids, educating physicians/physicians/policymakers on safe opioid use, and supporting research and education aimed to advance innovate pain management strategies that can decrease opioid use. The Foundation supports and advances the highest quality research on opioids and alternative pain modalities to yield findings that can better inform patients, physicians, and the greater healthcare community in the most evidenced-based pain management strategies.
Rutgers Health researchers have discovered that brain immune cells from people with a high genetic risk for alcohol use disorder (AUD) behave differently than cells from low-risk people when exposed to alcohol.
Their study in Science Advances could help explain why some people are more susceptible to developing drinking problems and potentially lead to more personalized treatments.
“This is the first study to show how the genetic variations that increase the risk of AUD affect the behavior of some brain cells,” said Zhiping Pang, a professor of neuroscience and cell biology at Robert Wood Johnson Medical School and a resident scientist at the Child Health Institute of New Jersey and a core member at the Rutgers Brain Health Institute.
“We started with a simple model, but as the models get more complex, we’ll learn more about what’s happening in the brain,” said Pang, the senior author of the study. “Hopefully, our discoveries will suggest treatment approaches because we don’t currently have great treatments for AUD.”
The research team took blood samples from two groups of people: those with both high genetic risk for AUD and diagnosed alcohol problems and those with low genetic risk and no alcohol problems. They transformed these blood cells into stem cells and made them develop into a type of brain-based immune cell called microglia.
They then exposed these two groups of cells, one from the people with a high genetic risk for AUD and one from the people with a low risk of AUD, to alcohol levels that mimicked those seen in the blood following alcohol use.
“The microglia with the high genetic risk scores were far more active than the microglia with the low genetic risk scores after the alcohol exposure,” said Xindi Li, lead author of the study, a postdoctoral fellow at the Child Health Institute of New Jersey.
The highly active cells engaged in more “synaptic pruning” – removing connections between neurons in the brain. This increased pruning activity could have significant implications, the researchers said.
“After many years of drinking, people with these genetics may have a greater risk of dementia because the microglia pruned so many more connections,” Li said. “Their overactivity could make neurons less functional.”
The study drew on expertise throughout Rutgers University, involving scientists from multiple labs and departments, including Ronald Hart and Jay Tischfield. This interdisciplinary approach brings together experts in genetics, neuroscience, and addiction research to tackle the complex challenge of understanding how genetic risk factors influence alcohol use disorder at the cellular level. This has been the long-term theme of the Rutgers component of the long-term NIH-funded Collaborative Study on the Genetics of Alcoholism (COGA).
While previous studies have identified genetic variants associated with increased risk, it has been challenging to see how these differences affect brain cell function.
Although this study focused on a single type of brain cell in a flat environment, the team is developing more sophisticated models for their research.
“We’re going from the cell cultures in a 2D situation to the brain organoids,” Pang said. “So we can study something more like a mini brain-structure, to understand how the cells interact with alcohol, and then to see how the genetic risk factors play a role in that response.”
This work could eventually lead to better treatments for alcohol use disorder. The results suggest that if different genetic variations lead to different cell behavior in the brain, people with different genetic signatures may need different treatments, for example targeting the microglia in some people at high risk.
That said, the researchers stressed that much work remains to be done to translate these cellular findings into clinical applications.
Max Schachter wanted to be close to his son Alex on his birthday, July 9, so he watched old videos of him.
“It put a smile on my face to see him so happy,” Schachter said.
Alex would have turned 21 that day, six years after he and 16 other children and staff at Marjory Stoneman Douglas High School in Parkland, Florida, were shot and killed by a former student in 2018. In the years before the shooting, that former student had displayed concerning behavior that elicited dozens of calls to 911 and at least two tips to the FBI.
“Alex should still be here today. It’s not fair,” Schachter said.
After two weeks of grieving Alex’s death, Schachter, propelled by anger and pain, began advocating for school safety. In part, he wanted to ensure his three other children would never be harmed in the same way. He joined the newly formed Marjory Stoneman Douglas High School Public Safety Commission to improve the safety and security of Florida’s students. And he launched a nonprofit bearing Alex’s name, which advocates for school safety.
Doing that work, he learned about threat assessment teams, groups of law enforcement and school officials who try to identify potentially dangerous or distressed kids, intervene, and prevent the next school shooting. Florida is one of about 18 states that require schools to have threat assessment and intervention teams; a national survey estimates 85% of public schools have a team assigned to the task.
Max Schachter with his son Alex.(Max Schachter)
The teams, whose mission and operational strategies often are based on research from the FBI and the Secret Service’s National Threat Assessment Center, or NTAC, have become more common as the number of school shootings has increased. Despite their prevalence for almost 25 years, some of the teams have developed systemic problems that put them at risk of unfairly labeling and vilifying children.
States vary widely in their requirements of threat assessment teams and there isn’t a nationwide archetype. Few school districts and states collect data about the teams, little is known about their operations, and research on their effectiveness at thwarting mass shootings and other threats is limited. But a 2021 analysis by the NTAC of 67 plots against K-12 schools found that people “contemplating violence often exhibit observable behaviors, and when community members report these behaviors, the next tragedy can be averted.”
“School shooters have a long thought process. They don’t just snap. They have concerning behavior over time. If we can identify them early, we can intervene,” said Karie Gibson, chief of the FBI’s Behavioral Analysis Unit.
Yet, Dewey Cornell, a forensic clinical psychologist who in 2001 developed one of the first sets of guidelines for school threat assessment teams, said there have been problems. In many cases, he said, threats have been deemed not serious “but parents and teachers are so alarmed that it is difficult to assuage their fears. The school community gets in an uproar and the school administrators feel pressured to expel the student.”
And in other cases, a school doesn’t do a threat assessment and assumes a student is dangerous when somebody else reports them as a threat, and they may take a zero tolerance approach and remove them from the school, said Cornell, the Virgil S. Ward professor of education at the University of Virginia.
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A task force convened by the American Psychological Association found little evidence that zero tolerance policies have improved school climate or school safety and said they may create negative mental health outcomes for students. The task force cited examples of students who were expelled for incidents or school rule violations as minor as having a knife in their lunch box for cutting an apple.
Marisa Randazzo, a research psychologist and the director of threat assessment for Georgetown University, said she has also seen “hyperreactions,” especially among school communities that have experienced a mass killing.
“It’s understandable. People who have been close to an event like this are on higher alert than other people,” said Randazzo, who previously worked for the Secret Service and co-founded Sigma Threat Management Associates.
Threat assessments are supposed to be a graduated process calibrated to the seriousness of a problem, since the majority of student threats are not credible and can be resolved through supportive interventions, according to research from the Secret Service.
Stephanie Crawford-Goetz, a school psychologist and the director of mental health for student support services in the Douglas County School District in Colorado, where a shooting occurred at a charter school in 2019, said her district’s threat assessment process emphasizes a proactive, rehabilitative approach to managing potential threats, as the NTAC suggests.
Crawford-Goetz said her district interviews students before convening the team to assess whether a threat is a misguided expression of anger or frustration and if the student has a plan and means to carry out violence.
Students whose threats are deemed transient receive support, such as help with coping skills, and they may meet with a mental health provider.
If the threat is credible, a student may be temporarily removed from the classroom or school.
Randazzo said the vast majority of kids who make threats are suicidal or despondent: “The process is designed primarily to figure out if someone is in crisis and how we can help. It is not designed to be punitive.”
Crawford-Goetz tells parents about her district’s threat assessment team at the beginning of the school year. Some districts report keeping their teams a secret from parents, which is not how they were designed to operate, said Lina Alathari, chief of the NTAC. Her team encourages schools to educate the whole community about the threat assessment process.
Some advocacy groups contend that threat assessment teams have perpetuated inequities. There has also been widespread concern that children with disabilities can easily get swept into a threat assessment.
In a 2022 report, the National Disability Rights Network, a nonprofit based in Washington, D.C., said some threat assessment teams have become “judge, jury, and executioner,” going beyond assessing risk of serious, imminent harm to determining guilt and punishment.
Expanding their scope allows threat assessment teams to get around civil rights protections, the report says.
Cornell disputed the disability rights group’s conclusion. “This has not been corroborated by scientific studies and is speculative,” he said.
Some states, such as Florida, mandate that threat assessment teams determine whether a student’s disability played a role in their behavior and recommend they include special education teachers and other professionals in their evaluation.
In Texas, which has mandated threat assessment teams, a third of students subjected to threat assessments in the Dallas Independent School District receive special education services.
Yet, the district doesn’t have a special education staff representative on its threat assessment team, according to a March 2023 report by Texas Appleseed, a nonprofit public interest justice center.
Many school districts are developing their own models in the absence of national standards for threat assessments.
Florida revamped its threat assessment system in January 2024 to improve response times, provide consistent data collection, and build in more checks and balances and oversight, said Pinellas County Sheriff Bob Gualtieri, who is also chair of the Marjory Stoneman Douglas High School Public Safety Commission.
The new model requires the teams to work quickly and file uniform, electronic summary reports of threat assessment findings. Those results follow students throughout their school years.
The adjustments are intended to eliminate the risk of not knowing about a student’s past troubling behavior if they change schools, as occurred with the Parkland shooter and a student who shot and killed classmates at a high school near Winder, Georgia, in September, said Gualtieri.
“As parents, you never stop worrying about your kids,” Schachter said.
Virginia mandates that all public schools and higher education institutions, including colleges, have threat assessment teams. In Florida, where one of Schachter’s daughters attends college, threat assessment teams are mandated in all public schools, including charter schools.
“There’s more work to be done,” Schachter said.
Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management Foundation.
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
SALINAS — This coastal valley made famous by the novelist John Steinbeck is sometimes known affectionately as “America’s salad bowl,” though the planting and harvesting is done mostly by immigrants from Mexico.
For Taylor Farms, a major global purveyor of packaged salads and cut vegetables, that’s made it a logical place to pioneer a novel type of health care for its workforce, one that could have broad utility in the smartphone era: cross-border medical consultations through an app.
The company is among the first customers of a startup called MiSalud, which connects Spanish-speaking Taylor Farms employees to physicians and mental health therapists in Mexico. Providers aren’t licensed in the U.S. and can’t prescribe medications but instead serve as health coaches who can dispense advice and work with a U.S.-based doctor if needed.
Amy Taylor, who has led the company’s wellness initiative since 2014 and is the daughter-in-law of company founder Bruce Taylor, said about 5,600 of Taylor Farms’ 6,400 employees who work where MiSalud is currently available have signed up for the app, and 2,300 have used the app at least once. The service is free for employees and up to three family members.
Amy Taylor said the company hopes the app, which is part of a broader wellness program, can help employees stay healthier while keeping health care and other labor costs in check. She plans a full evaluation once the program has been in place for two years.
The health of farmworkers is a major concern for the state’s agricultural economy. A 2022 study led by researchers from the University of California-Merced evaluated the health of more than 1,200 farmworkers and found that 37% of men and 47% of women reported having at least one chronic condition, including common conditions such as diabetes, high blood pressure, and anxiety.
Taylor said her company’s employees, ranging from fieldworkers and drivers to retail packaging and office staff, mirror the study’s findings. She said predominant health concerns among workers include obesity, high blood pressure, diabetes, and mental health.
“These are the people who are feeding America healthy food,” Taylor said of the company’s employees. “They should also be healthy.”
A produce giveaway at Taylor Farms in Salinas, part of a company wellness program that also includes the MiSalud app.(Victoria Clayton for KFF Health News)
MiSalud — or “My Health” — was the inspiration of Bismarck Lepe, a serial entrepreneur and Stanford graduate, who hails from a migrant farmworker family. Until age 6, when his family settled in Oxnard, they would travel between Mexico, California, and Washington state to harvest fruit. He saw that family and friends often delayed health care until they could return to Mexico because the U.S. system was too difficult to navigate, and insurance coverage too expensive or hard to find.
“My mother still prefers to get her health care in Mexico,” Lepe said. “It’s easier for her.”
Lepe and co-founders Wendy Johansson and Cindy Blanco Ochoa launched MiSalud Health in 2021 with $5 million from a venture capital fund backed by Melinda French Gates’ Pivotal Ventures, which focuses on social-impact investing. It has since added Samsung Next and Ulu Ventures as investors.
MiSalud started out by offering consultations with Mexican physicians for individuals who downloaded the app, Johansson said. But people keen enough to find the app, download it, and sign up for the program themselves weren’t ultimately those who needed it most, and in 2023 the company pivoted to offering its service to companies as an employee benefit. (Individuals can still use it too.)
Besides Taylor Farms, the company counts the city of Lynwood among about a dozen other clients, according to Johansson. MiSalud touted that nearly 40% of employees served by its platform say that without the app they would either have ignored their health concerns or waited until they could travel to Mexico to see a doctor.
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Paul Brown, a UC-Merced professor of health economics who contributed to the university’s farmworker health study, warned that telehealth consultations aren’t adequate substitutes for in-person care by a primary care physician or a specialist. However, “to the extent that these types of programs can kind of link people into more standard care, that’s good,” he added.
Brown said MiSalud’s approach could be more effective if policies changed to allow Mexican doctors to more easily treat patients in the U.S. A California program begun in 2002 allows Mexican doctors to travel to the Salinas Valley and other heavily Latino communities and treat patients, but cross-border telemedicine, even between states, remains limited.
Even so, Taylor Farms employees say the app has been helpful. Rosa “Rosita” Flores, a line supervisor with the company’s retail operations, said she decided to give MiSalud a try after co-workers raved about it.
A recent company wellness fair, partly sponsored by MiSalud, had alerted her to the importance of monitoring her blood sugar and blood pressure levels, so she booked an appointment on the app to discuss it. “The app is very easy to use,” she said in Spanish. When she had to cancel a video chat after her daughter got sick, the health coaches followed up by text.
Proponents of cross-border medicine say the approach helps bridge linguistic and cultural barriers in health care. Almost half of all U.S. immigrants — about two-thirds of whom are native Spanish speakers — have limited proficiency in English, and research has repeatedly shown that language barriers often discourage people from seeking care.
For example, Alfredo Alvarez, a MiSalud health coach who is a licensed physician in Mexico, pointed to belief in el mal de ojo, or the “evil eye” — the idea that a jealous or envious glance by someone can cause harm, especially to children. An American doctor might be dismissive of the notion, but he understands.
“This isn’t uncommon here,” he said of Mexico. “It’s a belief in traditional medicine.”
It’s not that Alvarez encourages his socios, or members, to pass an egg over the child or make the child wear a special bracelet — traditional ways of diagnosing and treating el mal de ojo. Rather, he acknowledges their traditions and steers them to evidence-based medicine.
Sam Chaidez, the son of fieldworkers and now director of operations for a Taylor Farms location in Gonzales, said the company’s wellness program helped him lose 150 pounds.(Victoria Clayton for KFF Health News)
MiSalud’s coaches can try to break stereotypes as well. For example, Alvarez said, a Mexican reverence for machismo can translate to the idea that “men don’t do doctor visits.” Meanwhile, he said, women may overlook their health in prioritizing other family members’ needs.
Coaches also try to remove the stigma around seeking mental health treatment. “A lot of our socios have been extremely uncomfortable with or wary of mental health professionals,” said Rubén Benavides Crespo, a MiSalud mental health coach who is a licensed psychologist in Mexico.
The app tries to break through by making it easy to book counseling appointments and asking questions such as whether someone has trouble sleeping, rather than invoking more worrisome or potentially stigmatizing terms like anxiety or depression.
MiSalud representatives say the app saw a 50% increase in requests for mental health support following the November presidential election. A more common request, however, is grief counseling, often following the loss of a loved one.
“Loss requires adaptation,” Benavides said.
For Sam Chaidez, director of operations for a Taylor Farms location in Gonzales, MiSalud is a welcome addition for weight management. The son of fieldworkers, Chaidez graduated from UC-Davis and returned to the Salinas Valley to work for the company in 2007.
In 2019, Chaidez, a new parent at the time, began to understand his risk for diabetes and other health problems because of Taylor Farms’ wellness program. Through diet and exercise and, more recently, coaching by MiSalud, Chaidez has shed 150 pounds.
Chaidez encourages co-workers to walk with him at lunch, and he credits MiSalud coaches for helping him keep the weight off and stay healthy. “It’s been a great help,” he said.
SALINAS, California. — Este valle costero, que se hizo famoso gracias al novelista John Steinbeck, a veces se conoce cariñosamente como “la ensaladera de Estados Unidos”, aunque la siembra y la cosecha las realizan principalmente inmigrantes de México.
Para Taylor Farms, que es uno de los principales proveedores mundiales de ensaladas envasadas y verduras cortadas, esto lo ha convertido en un lugar ideal para implementar un innovador modelo de atención médica para sus empleados.
Este método, que podría llegar a tener gran utilidad en la era de los teléfonos inteligentes, es una aplicación que permite efectuar consultas médicas transfronterizas.
Taylor Farms es uno de los principales clientes de una startup llamada MiSalud, que pone en contacto a los empleados hispanohablantes de la empresa con médicos y terapeutas de salud mental en México.
Estos profesionales no tienen licencia en Estados Unidos y no pueden recetar medicamentos, pero actúan como consejeros de salud, colaborando, si es necesario, con un médico estadounidense.
Amy Taylor, que dirige esta iniciativa de promoción de la salud de la empresa desde 2014 y es la nuera de su fundador, Bruce Taylor, dijo que unos 5.600 de los 6.400 empleados de Taylor Farms se han registrado en MiSalud y 2.300 han utilizado la aplicación por lo menos una vez.
El servicio es gratuito para los empleados y hasta tres miembros de su familia.
Amy Taylor explicó que la empresa espera que la aplicación, que forma parte de un programa de bienestar más amplio, pueda ayudar a los empleados a mantenerse saludables y, al mismo tiempo, controlar tanto los gastos de la atención médica como otros costos laborales.
Está previsto realizar una evaluación completa de este programa una vez que haya estado en funcionamiento dos años.
La salud de estos trabajadores es una de las principales preocupaciones de la economía agrícola del estado.
Un estudio de 2022, dirigido por investigadores de la Universidad de California-Merced, evaluó la salud de más de 1.200 trabajadores agrícolas y descubrió que el 37% de los hombres y el 47% de las mujeres informaron que padecían al menos una enfermedad crónica, incluidas afecciones comunes como diabetes, hipertensión y ansiedad.
Taylor explicó que los empleados de la empresa, que abarcan desde trabajadores del campo y choferes hasta personal de empaque y empleados de oficina, tienen los mismos problemas que los participantes del estudio. Destacó que las principales preocupaciones de salud entre los trabajadores incluyen la obesidad, la hipertensión, la diabetes y la salud mental.
Entrega de productos agrícolas en Taylor Farms en Salinas, California, parte de un programa de bienestar de la empresa que también incluye la aplicación MiSalud. (Victoria Clayton for KFF Health News)
“Estas son las personas que alimentan a Estados Unidos con comida saludable”, dijo Taylor refiriéndose a los trabajadores de la compañía: “También deberían estar sanos”.
MiSalud fue resultado de la inspiración de Bismarck Lepe, un emprendedor de múltiples proyectos, graduado de la Universidad de Stanford, que proviene de una familia de trabajadores agrícolas migrantes.
Hasta los 6 años, cuando finalmente se estableció en Oxnard, California, toda la familia Lepe viajaba entre México, California y el estado de Washington para cosechar fruta.
Lepe observó que tanto su familia como los amigos a menudo retrasaban la atención médica hasta que podían regresar a México. El sistema de salud estadounidense les resultaba demasiado complicado y el seguro demasiado costoso o de difícil acceso.
“Mi madre sigue prefiriendo recibir atención médica en México”, dijo Lepe. “Para ella es más sencillo”.
Lepe y las cofundadoras Wendy Johansson y Cindy Blanco Ochoa lanzaron MiSalud Health en 2021 con $5 millones de un fondo de capital de riesgo respaldado por Pivotal Ventures, la firma de Melinda French Gates que se enfoca en inversiones de impacto social. Desde entonces, han sumado dos nuevos inversores, Samsung Next y Ulu Ventures.
MiSalud comenzó ofreciendo consultas con médicos mexicanos para las personas que descargaban la aplicación, contó Johansson.
Pero los que podían bajar la aplicación y registrarse por sí mismos no eran, en última instancia, los que más la necesitaban. Por eso, en 2023, la compañía dio un giro para ofrecer su servicio a las empresas como beneficio para los empleados. (Aunque los individuos también pueden seguir utilizándolo).
Además de Taylor Farms, MiSalud tiene entre sus clientes a la ciudad de Lynwood, en California, y a otra docena de empresas. La compañía asegura que casi el 40% de los empleados atendidos por su plataforma admiten que, sin la aplicación, hubieran ignorado sus problemas de salud o hubieran esperado hasta viajar a México para buscar atención médica.
Paul Brown, profesor de economía de la salud de la UC-Merced, colaboró en la investigación sobre el estado físico y mental de los trabajadores agrícolas que efectuó la universidad. Advirtió que las consultas de telemedicina no sustituyen adecuadamente la atención presencial de un médico de atención primaria o un especialista.
Sin embargo, agregó: “En la medida en que este tipo de programas puedan conectar a las personas con una atención más estándar, son beneficiosos”.
Brown comentó que el enfoque de MiSalud podría ser más eficaz si se modificaran las políticas para permitir que los médicos mexicanos puedan atender a pacientes en Estados Unidos con más facilidad.
Un programa de California iniciado en 2002 permite que los médicos mexicanos viajen al Valle de Salinas y a otras comunidades con gran presencia de población latina para atender pacientes, pero la telemedicina transfronteriza, incluso entre estados, sigue siendo limitada.
Aun así, los empleados de Taylor Farms afirman que la aplicación ha sido útil. Rosa “Rosita” Flores, supervisora de línea de las operaciones minoristas de la empresa, dijo que decidió probar MiSalud después que sus compañeros de trabajo le hablaran bien de la aplicación.
En una reciente feria de bienestar de la empresa, patrocinada en parte por MiSalud, le hicieron notar la importancia de monitorear sus niveles de azúcar en sangre y la presión arterial, por lo que reservó una cita en la aplicación para hablar del tema.
“La aplicación es muy fácil de usar”, dijo. Cuando tuvo que cancelar una videollamada porque su hija se enfermó, los asesores de salud hicieron el seguimiento por mensaje de texto.
Los defensores de la medicina transfronteriza afirman que este enfoque ayuda a salvar las barreras lingüísticas y culturales en la atención médica.
En el país, casi la mitad de los inmigrantes —de los cuales aproximadamente dos tercios son hispanohablantes nativos— tienen un dominio limitado del inglés, y las investigaciones han demostrado muchas veces que las barreras lingüísticas a menudo disuaden a las personas de buscar atención médica.
Sam Chaidez, hijo de trabajadores de campo y ahora director de operaciones de una sucursal de Taylor Farms en Gonzales, California, dijo que el programa de bienestar de la compañía lo ayudó a perder 150 libras.(Victoria Clayton for KFF Health News)
Por ejemplo, Alfredo Álvarez, asesor de salud de MiSalud que es médico certificado en México, mencionó la creencia en el “mal de ojo”, la idea de que una mirada envidiosa o celosa de una persona puede causar daño, especialmente a los niños.
Un médico estadounidense podría descartar esa idea, pero Álvarez la comprende.
“Esto no es raro aquí”, dijo refiriéndose a México. “Es una creencia de la medicina tradicional”.
No es que Álvarez anime a sus los usuarios de la aplicación a pasar un huevo por encima del niño o a hacer que el niño lleve una pulsera especial, formas tradicionales de “diagnosticar” y tratar el mal de ojo. Más bien, reconoce sus tradiciones y los orienta hacia la medicina basada en la evidencia.
Los asesores de MiSalud también pueden intentar romper con estereotipos.
Por ejemplo, Álvarez dijo que la arraigada cultura machista de México puede traducirse en la idea de que “los hombres no van al médico”. Mientras tanto, agregó, las mujeres pueden descuidar su salud porque priorizan las necesidades de otros miembros de la familia.
Los asesores también intentan eliminar al estigma que rodea a la búsqueda de tratamiento de salud mental. “Muchos de nuestros ‘socios’ se han sentido extremadamente incómodos o recelosos ante los profesionales de salud mental”, dijo Rubén Benavides Crespo, asesor de MiSalud en este campo y psicólogo titulado en México.
La aplicación intenta romper el hielo facilitando la reserva de las consultas de asesoramiento y haciendo preguntas del estilo de si alguien tiene problemas para dormir, en lugar de invocar términos más preocupantes o potencialmente estigmatizantes como ansiedad o depresión.
Los representantes de MiSalud informaron que la aplicación experimentó un aumento del 50% en las solicitudes de apoyo para la salud mental tras las elecciones presidenciales de noviembre. Sin embargo, una solicitud más común es el asesoramiento para el duelo, a menudo tras la pérdida de un ser querido.
Para Sam Chaidez, director de operaciones de una planta de Taylor Farms en Gonzales, California, MiSalud es un apoyo adicional para el control de peso.
Hijo de trabajadores del campo, Chaidez se graduó en la Universidad de California en Davis y regresó al Valle de Salinas para trabajar en la empresa en 2007.
En 2019, Chaidez, que acababa de ser padre, empezó a comprender el riesgo de padecer diabetes y otros problemas de salud gracias al programa de bienestar de Taylor Farms. A partir de la dieta y el ejercicio y, más recientemente, al asesoramiento de MiSalud, Chaidez ha perdido 150 libras (68 kilos).
Ahora anima a sus compañeros de trabajo a caminar con él a la hora de comer, y atribuye a los asesores de MiSalud el mérito de haberlo ayudado a no recuperar el peso perdido y a mantenerse sano. “Ha sido una gran ayuda”, señaló.
What is Secular AA? Who is it for? What use is it? Is it a threat to traditional AA? It’s an odd thing to review your own book, but thanks to Roger at aaagnostica.org for the challenge and I’ll try to step away for an objective perspective. There is no official connection of the book to the Secular AA organization, but I am a member of Secular AA and have been since its inception. So you could say that my book is an inside job.
Secular AA includes a history of the Secular AA wing of AA from its foundation in Santa Monica on 6-8 November 2014 with the WAFT convention.
Secular AA includes sections on meetings, steps and “How AA Got Religion” which is a repeat of a chapter in An Atheists Unofficial Guide to AA. However, sympathetic readers, and especially new ones, will hopefully enjoy another airing.
Secular AA covers the ground where members write their own programs. It aims to provide the tools and inspiration for a truly personal journey in recovery where the travellers can take pride in their own work.
There is no suggestion that they do it alone. There is plenty of help available from members willing to make suggestions and nudge new members here and there in the right direction if they are going off piste. My own greater powers comprise all the people who have helped me along the way; all the people I have helped; and a few things at first sight less tangible like evolution and nature.
However, I throw my hands up when I hear some guru-type say “there is only one program … mine – or the Big Book way.” Or a well-meaning Joe Soap might say “I only know one way to do the program – the way I was taught – so you’ll have to do it that way, too.” My idea of a sponsor is someone who helps other members to construct their own programs.
But Secular AA does not rubbish traditional AA. I ‘did the steps’ in the Big Book before embarking on an independent voyage and the experience provided an ideal benchmark against which to measure my own ideas.
Secular AA includes a foreword where the honest admission is made that a secular meeting we started in Valencia, Spain, folded after six years. It touches real life where we can learn from past experience and move on. I’m reminded of the NA preamble which refers to the ‘spiritual’ principles of honesty, open-mindedness and willingness.
Secular AA takes a look at spirituality. “People in the secular camp are at odds with each other about whether there can be non-religious spirituality or whether the word is synonymous with religion. People in the religious camp are equally at odds with each other along the same lines. So there are four groups. Religious people of either standpoint and non-religious people of either standpoint. I used to think the only answer was to delete the word from the English language! However, I have recently come across the acronym SBNR. Spiritual But Not Religious. This is used by people describing themselves to potential mates on dating sites. For me it ends discussion about whether ‘spiritual’ is only synonymous with religion or whether there exist various kinds of secular spirituality. The traditional AA program could be spiritual without being religious.”
Who is this work aimed at?
“It is aimed at alcoholics put off traditional Alcoholics Anonymous by the god content of its literature and paraphernalia at its meetings like the banners on the wall showing the AA Twelve Steps.
“It suggests that members forge their own programs. It assumes that members can decide for themselves whether to adopt a step-based program and how they define spirituality. There are as many ways of dealing with the program as people doing it. So this is a secular version of the program. The object is purely to widen the net which catches the imagination of people who have been attracted into AA’s ambit so that a greater number can get the program, giving up alcohol happily and becoming contented, decently functioning human beings.
“First, this book helps a newcomer to address the essential question: am I an alcoholic? For those deciding in the affirmative or continuing to ponder the question we move on to the basic premise of accepting the need for change and stopping drinking as in step 1. Then we have to deal with the withdrawals, a process which can take up to two years like dealing with any post traumatic stress disorder.
The timetable is adaptable just like everything else in AA but, if the individual chooses to work through a series of steps of their own devising, or choice, it would seem advisable to stick to the order of steps laid down.
“I worked on traditional steps 1–3 over and over again in the early days while I went through the worst of the withdrawals. But right from the off I rewrote parts that didn’t fit. Then, when ready, a member should get a sponsor or sponsors and embark on remedial action followed by clearing away the wreckage of the past. Later comes daily self-improvement and, finally, helping others.
“Then this book addresses people outside AA: the family of a recovering alcoholic and the connections of an alcoholic who still drinks – family and employer. The A–Z explains terms in AA that a newcomer or connections of an alcoholic might hear without at first understanding what they mean.
“Sections of the Big Book to which I refer readers directly are Chapters 3 more about alcoholism and 10 to employers, parts of Chapter 2 there is a solution and Chapter 5, and the Doctor’s Opinion which is a foreword. Readers wishing to check out AA co-founder, Bill W’s story will find that it forms Chapter 1 of the Big Book. Dr Bob’s story (AA’s other co-founder) and those of other early members are in the back of the Big Book.
“I do not refer atheists or agnostics to Chapter 4 of the Big Book, We Agnostics, but suggest readers who hold a religious belief refer to it. Ultimately this chapter does not accept agnostic views, let alone atheist ones: it implies that eventually, if one works the program properly, one is bound to share the god-based views of the majority of AA’s founding members. I reject this idea unequivocally.
“Nevertheless, while there are parts of the Big Book that are unashamedly religious, or dated, when it is filleted of these old bones much remains on the plate that is still helpful. I have paraphrased some of this helpful content or pointed out where readers can find it. Many ideas come from other sources and a good deal of it is even original.”
Nowadays, with the Secular AA option, there is no longer an absolute need to progress through the twelve steps. Many members do so, but now it is possible to construct your own program and if this is the course you decide to take, you will need to seek support from more experienced members who are sympathetic to the route you have decided to take.
What of the steps? There are 12 steps in AA, but I believe they can be whittled down to four.
Abstention: this is the crux. The rest is a distraction from the withdrawals to enable one to stop drinking.
A self-appraisal to enable DIY self-improvement and the emergence of a contented, useful, human being.
Amends to anyone you’ve harmed in the past to help get rid of guilt and shame and improve self-esteem.
‘Maintenance’ including calming mechanisms like meditation and daily personal inventory, apologising where appropriate and helping others.
The original Alcoholics Anonymous was published in 1939, written by Bill Wilson who I believe was an agnostic. Nevertheless he borrowed heavily from the Oxford Group. AA and the Oxford Group were ships that followed a similar course for a few short years. Then they went their separate ways, but the influence of the Oxford Group from those days has remained set in stone in the Big Book.
From its Christian roots the Oxford Group is now an informal, international network of people of many faiths and backgrounds seeking world peace. Now known as Initiatives of Change, it encourages the involvement of participants in political and social issues. One of the Oxford Group’s core ideas was that change of the world starts with seeking change in oneself.
While AA also acknowledges the importance of change, ironically this does not apply to its basic textbook.
So, what use is Secular AA? It fills in the void of change that traditional AA has failed to make. Is it a threat to traditional AA? Not at all, it’s just helping to nudge AA into the modern world. Did you know that Secular AA has even booked a hospitality suite to show itself at the AA world convention in Vancouver in July. Books like mine will not be on sale there, but that’s another story … …
Secular AA will be my final addiction book because I’ve had too many birthdays, both belly button and AA, and if I write any more it will be fiction to add to my one masterpiece to date in that area Trader Bob. An Atheists Unofficial Guide to AA came out in 2011; the daily reader Everyone’s An Addict (or As Vince Sees It) in 2018. And slotted in between is the currently best selling An Atheists Twelve Steps to Self-improvement – To Accompany Any Program which came out in 2012. They’re all still in print on Amazon and Kindle.
It may also be worth a visit to vincehawkins.com for those who haven’t already been there.
For a PDF of this article, click here: Secular AA.
KFF Health News senior correspondent Arthur Allen discussed what to watch for in Robert F. Kennedy Jr.’s confirmation hearings for secretary of Health and Human Services on CBS News Chicago on Jan. 29.
KFF Health News editor-at-large for public health Céline Gounder discussed why the CIA has “low confidence” in its assessment of the origins of the covid-19 virus on CBS News 24/7 on Jan. 27.
KFF Health News senior correspondent Noam N. Levey discussed the Consumer Financial Protection Bureau’s final rule to remove medical debt from consumer credit reports on PBS’ “PBS News Weekend” on Jan. 25.
KFF Health News contributor Sue O’Connell discussed Montana’s mental health facilities on Billings’ KTVQ on Jan. 24.
KFF Health News senior correspondent Renuka Rayasam discussed bird flu in Georgia on WUGA’s “The Georgia Health Report” on Jan. 24.
KFF Health News chief Washington correspondent Julie Rovner discussed the nomination of Robert F. Kennedy Jr. for secretary of Health and Human Services on CBS News on Jan. 22.
KFF Health News correspondent Molly Castle Work discussed mental health specialists’ role in the Los Angeles wildfire response on America’s Heroes Group on Jan. 22.
