Legislature(2013 - 2014)CAPITOL 106
02/21/2013 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Alaska Brain Injury Network | |
| Presentation: Key Coalition | |
| HB90 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HB 90 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 90-VITAMIN D SUPPLEMENTS
3:58:22 PM
CHAIR HIGGINS announced that the final order of business would
be HOUSE BILL NO. 90, "An Act establishing a temporary program
in the Department of Health and Social Services for testing
newborns for baseline vitamin D levels."
3:58:46 PM
REPRESENTATIVE KELLER moved to adopt the proposed committee
substitute (CS) for HB 90, labeled 28-LS0376\U, Mischel,
2/14/13, as the working draft. There being no objection, it was
so ordered.
REPRESENTATIVE SEATON, as the sponsor of the proposed bill,
offered some background, referring to a handout titled Vitamin
D-HCR 5 [Included in members' packets]. He declared that this
legislation had been unanimously passed by both the House and
the Senate during the 27th Legislature. He explained that this
resolution promoted "vitamin D supplements for pregnant women
and infants to prevent pregnancy complications, preterm births,
type 1 diabetes, and rickets." He pointed out that all of the
studies referred to by the resolution were available through
links on his website. He noted that there was now published
research, February 2012, on an Australian study of 743 mother
and infant pairs, measuring the vitamin D levels from the second
trimester of pregnancy until the children were 17 years of age.
4:01:40 PM
REPRESENTATIVE SEATON directed attention to slide 1, page 11 of
the HB 90 Study-Australia [Included in members' packets] which
identified children ages 5 and 10 in each of four quartiles for
nanograms per liter (ng/ml) of vitamin D. He explained that
Quartile 1 was pregnant women testing below 18 ng/ml of Vitamin
D, while Quartile 4 was women testing above 29 ng/ml of Vitamin
D during pregnancy. He pointed out that the women in Quartile
4, with children age 5, only had 3 percent of children with
moderate to severe language impairment, while women in Quartile
1 had 13 percent of the same age children with this level of
language impairment. He then directed attention to the same
quartiles for children age 10, and noted that the children of
mothers with lower vitamin D during pregnancy had more than
twice as many children with language impairment.
4:04:26 PM
REPRESENTATIVE SEATON directed attention to slide 2, HB 90
Study-Australia page 12-12 of the handout. He explained that
almost all vitamin D was processed through the skin from midday
sun exposure, as the Ultraviolet B was absorbed later in the
day. He noted that there was more overhead sun when closer to
the equator.
4:05:50 PM
REPRESENTATIVE SEATON directed attention to slide 3, HB 90
Support Study-Spain, page 5 of 10 in the handout, which measured
mental and psychomotor development for children at age 14 months
from mothers measured in the second trimester of pregnancy. He
declared that the findings reflected more vitamin D naturally
occurred the closer the latitude to the equator.
4:07:27 PM
REPRESENTATIVE SEATON reported on slide 4, HB 90 Support Study-
Spain, page 6 of 10 in the handout, which graphed the higher
amount of vitamin D during the months with more light exposure.
4:08:10 PM
REPRESENTATIVE SEATON moved on to another mother-infant pair
study on slide 5, HB 90 Study-Pittsburgh, page 1 of 7 of the
handout. He said this study also compared black and white
pregnant women with the same levels of vitamin D in cord blood
at birth. He explained that this study was useful to Alaska, as
the skin pigment blocked ultra violet rays, which influenced the
amount of vitamin D absorbed. He pointed out that both pigment
and the long sleeves worn in Alaska blocked sunshine.
4:10:04 PM
REPRESENTATIVE SEATON referred to the article, "Vitamin D and
Suicide Risk Factors," and the article, "Is low Vitamin D linked
to military suicide?" [Included in the members' packets] He
said that low vitamin D doubled the risk for completing suicide.
4:11:07 PM
REPRESENTATIVE SEATON reported that a study of military basic
training in South Carolina surmised that the vitamin D levels
had dropped dramatically after eight weeks "because of the heavy
clothes" which blocked absorption and manufacture of vitamin D.
4:11:34 PM
REPRESENTATIVE SEATON referred to an intervention study in
Sweden in October, 2012, which divided a group of immune
compromised people for a year. Half of the group received
vitamin D supplements and the other half received a placebo,
with the vitamin D group having a 23 percent reduction in
infection rates. He suggested that Alaska study the impact of
vitamin D on infants.
4:13:04 PM
REPRESENTATIVE SEATON explained that the purpose of proposed HB
90 was to conduct a one year study of the vitamin D baseline
levels of new born children. He suggested that this could
reveal a causality problem of low vitamin D with the second
trimester development of the language center in the brain. He
pointed out the potential severity of the consequences of low
vitamin D. He suggested that the further from the equator, the
lower the amount of Vitamin D.
4:14:20 PM
REPRESENTATIVE SEATON explained that the proposed study to
establish the level for vitamin D in newborns in Alaska would
cost about $300,000. He clarified that the study was not
attempting to determine the proper level of Vitamin D. He
surmised that, if vitamin D deficiency in the second trimester
was found to be causally associated with language impairment,
then, given a similar regional distribution to other studies,
about 400 fewer kids would enter school each year with severe to
moderate language impairment. He said that language impairment
was the second largest disability category in Alaska. He stated
that the proposed bill was intended to establish a baseline for
vitamin D in children in order to promote the ongoing cause for
improvement of health and education in Alaska.
4:17:05 PM
REPRESENTATIVE SEATON directed attention to the letter from Eric
Gebhardt, Superintendent of the Nenana City School District
[Included in members' packets] which described a study of their
vitamin D supplement program. He relayed the statistics for
fewer days absent due to illness by students partaking in the
vitamin D supplement. He reported that returning students who
had continued participation from 2011 had lowered their absent
days by more than 50 percent over the previous year.
4:20:49 PM
REPRESENTATIVE SEATON clarified that the assessment of vitamin D
from new born children would use two drops of the umbilical cord
blood simultaneous to other testing.
4:21:24 PM
REPRESENTATIVE REINBOLD asked if there was already a test
offered for vitamin D.
REPRESENTATIVE SEATON, in response, said that, tests were
currently administered for heritable genetic disorders. He said
that there was not currently a test for vitamin D, as it was not
a heritable condition. He explained that the only condition was
that the mother did not have enough vitamin D.
4:22:52 PM
REPRESENTATIVE REINBOLD asked if there was an attached fiscal
note for proposed HB 90. She opined that a good way to lower
the overall budget for Department of Health and Social Services
(DHSS) would be for an emphasis on prevention. She stated that
she was interested in the "risk benefit cost analysis."
REPRESENTATIVE SEATON replied that the requested $300,000 was
far less than the $287 per test which DHSS would charge. As
this would be a temporary law, there had been a very inexpensive
offer for the tests and initial analysis. He suggested that the
proposed bill be amended to include private testing, and at the
least cost to the state. He added that DHSS had speculated that
further regulations would be necessary, which would necessitate
postponement of the proposed program.
4:24:45 PM
CHAIR HIGGINS asked who had paid for the studies in Australia
and Spain.
4:25:08 PM
REPRESENTATIVE SEATON, in response, said that he would find out.
4:25:32 PM
CHAIR HIGGINS offered his belief that the vitamin D industry
should pay for any studies done on its behalf. He stated that
studies were often for some businesses benefit. He opined that
people could not be forced to take vitamin D, even if the
studies revealed the necessity. He asked "what's the end
product here, what's the end result of what you're trying to
accomplish."
4:26:51 PM
REPRESENTATIVE SEATON replied that the goal was to make Alaskans
and the health system aware of ways to improve health in Alaska.
He stated that people needed to be aware of their personal need
for more vitamin D, pointing to the potential severe impacts for
its lack. He declared that there was not any attempt to
mandate.
4:27:58 PM
CHAIR HIGGINS opined that although many studies would show that
vitamin D was helpful, he questioned the necessity for another
study. He asked "is the state going to foot that bill too, that
campaign to get out there to tell people to get vitamin D." He
acknowledged that the state had a responsibility for good
health, and that it was incumbent to do what was necessary to
ensure that; however, he felt it was the responsibility for any
specific industry to pay for studies to which it benefited.
4:29:03 PM
REPRESENTATIVE SEATON replied that he agreed, but he explained
that, as vitamin D could not be patented, there was no money in
vitamin D studies. He pointed out that a year and a half supply
of vitamin D was $12. He clarified that it was technically a
hormone, not a vitamin. He offered to research the funders for
the vitamin D studies, and he opined that these longitudinal
studies were most often sponsored and funded by governments.
4:31:43 PM
REPRESENTATIVE TARR offered her support for the potential
positive affect to educational outcomes. She suggested a link
with the Department of Education and Early Development and
Department of Health and Social Services to encourage further
research.
4:32:47 PM
REPRESENTATIVE SEATON replied that he had spoken with the
president of the University of Alaska, who would discuss this
further with various departments.
4:33:16 PM
TANEEKA HANSEN, Staff, Representative Paul Seaton, Alaska State
Legislature, directed attention to the letter from Dr. Abel
Bult-Ito, University of Alaska Fairbanks. [Included in members'
packets]
4:34:00 PM
REPRESENTATIVE KELLER asked to clarify that this was not a
longitudinal study, but was only intended to identify the amount
of vitamin D in new born children. He asked if there was an
accompanying fiscal note.
4:34:52 PM
REPRESENTATIVE SEATON, in response, said that the cost to do the
survey and analyze the samples would be $300,000. He listed
other background information that would be beneficial to the
analysis. He repeated that this was not any attempt to
establish any levels, just to find a baseline. He declared that
people could opt out of the study, and that the study was Health
Insurance Portability and Accountability Act (HIPAA) compliant.
MS. HANSEN noted that the Western Institutional Review board
process would assure that this was all being conducted in
compliance.
REPRESENTATIVE SEATON stated that, as this study was for all
Alaskans, it would include an assessment of the sub populations
in relation to the aggregate.
4:37:39 PM
REPRESENTATIVE KELLER, directing attention to Version U, page 1,
line 11-12, read: "for testing the vitamin D levels of newborns
at birth or as soon after birth as possible." He asked if this
would include a survey of the mother and the family. He
questioned whether the specificity of the language of the
proposed bill would limit the expected breadth of the test.
REPRESENTATIVE SEATON, in response, explained that it was not a
longitudinal study, and would only test for vitamin D at birth.
He mentioned that the levels of vitamin D could vary
dramatically in different regions around Alaska, and how
important that knowledge would be for the communities.
4:39:52 PM
REPRESENTATIVE KELLER asked about the intent for the data after
it was collected.
REPRESENTATIVE SEATON emphasized that the proposed bill was for
one year only, and would provide Alaskans with health care
information in order to make determinations for themselves.
4:40:40 PM
REPRESENTATIVE PRUITT asked to clarify whether this proposed
bill was mandated, unless there was a religious concern.
REPRESENTATIVE SEATON replied that unless a mother opted out,
the attending health care professionals would take the cord
blood sample. He added that the heel stick method for testing
could also be used.
4:42:21 PM
REPRESENTATIVE PRUITT commented that, as there was a lot
happening during birth, it was necessary to ensure that there
was an understanding ahead of birth. He expressed his concern
for any costs associated with the program.
4:43:14 PM
REPRESENTATIVE SEATON explained that this information would be
collected by the health care providers, and he reiterated that
this cord blood test was the same as the other cord blood tests
being performed simultaneously.
4:44:09 PM
REPRESENTATIVE PRUITT asked why the State of Alaska was being
involved instead of the University of Alaska.
REPRESENTATIVE SEATON opined that the University of Alaska or
the Alaska State Hospital and Nursing Association could indeed
be the better "outfit" for this proposed program.
4:45:34 PM
REPRESENTATIVE PRUITT stated that the proposed legislation was
still necessary to mandate the testing, even if the University
of Alaska was conducting the program.
REPRESENTATIVE SEATON expressed his agreement.
4:46:00 PM
CHAIR HIGGINS expressed a desire to see how the study would be
performed. He offered his belief that the amount of vitamin D
would be different in each of the regions around the state. He
declared that a baseline was necessary, otherwise none of the
numbers had any value. He requested to know the methods of the
study in order to ensure the accuracy and reliability of the
results.
REPRESENTATIVE SEATON offered to share a survey draft. He
pointed to the survey information which ensured that there were
baselines, and would be filled out by the mother and the health
care provider. He expressed his agreement that many of the sub
populations could have very different baselines.
REPRESENTATIVE SEATON said that his staff had been working with
doctors and professionals to refine the survey to be applicable,
and to include the proper opt-out clause.
4:49:26 PM
WARD HURLBURT, M.D., Chief Medical Officer/Director, Division of
Public Health, Central Office, Department of Health and Social
Services, stated that the administration did not have a position
on proposed HB 90. He offered his concurrence with
Representative Seaton that the proposed study would provide data
on vitamin D levels in Alaska. He listed data from many
entities which expressed agreement that vitamin D was essential
and was a factor in bone health. He declared that, however,
there was disagreement for the vitamin D benefits to the other
issues mentioned earlier, which included cancer, diabetes, and
intellectual development. He declared that the data did not
support conclusions for the vitamin D benefit to these other
issues.
4:51:26 PM
CHAIR HIGGINS opened public testimony and announced that it
would be left open. He then announced that HB 90 would be held
over.