Legislature(2011 - 2012)BUTROVICH 205
04/13/2011 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB15 | |
| HCR5 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HCR 5 | TELECONFERENCED | |
| + | HB 15 | TELECONFERENCED | |
HCR 5-VITAMIN D SUPPLEMENTS
1:50:25 PM
CHAIR DAVIS announced the next order of business would be HCR 5,
Vitamin D supplements. [HCR 5(HSS) was before the committee.]
REPRESENTATIVE PAUL SEATON, sponsor of HCR 5 thanked the
committee for taking up the resolution. It asks the state to
move to a prevention of disease model for health care. The
governor's Choose Respect campaign is one example of trying to
move on to the prevention side. There are multitudes of ways the
state could be doing this.
1:52:18 PM
The resolution has numerous "Whereas" clauses. Each one refers
to an individual study that has been published in peer review
magazines; there is a large scientific body of evidence relating
to the health of the body. We in Alaska require more vitamin D
supplementation because of our geographic location in the
northern latitude.
1:53:26 PM
SENATOR ELLIS joined the meeting.
1:53:37 PM
REPRESENTATIVE SEATON noted Vitamin D is actually a pre-hormone.
We make it on our skin but it is converted in our blood. Alaska
has some of the lowest Vitamin D levels in the nation. If a
person is lacking in vitamin D, children get rickets. Older
people lose bone mass. Studies in Alaska show that many people
have Vitamin D levels between 6 and 16, which is right at the
level of rickets.
1:55:05 PM
Charts show the risk of colon cancer versus the person's vitamin
D status. The lowest one-fifth has a risk of one for getting
colon cancer; the highest one-fifth has a fifty percent less
chance. Colon cancer is rampant in Alaska. Breast cancer risk is
also lowered with vitamin D supplementation. He mentioned the
great reduction in many diseases with Vitamin D supplementation.
1:57:21 PM
Seasonal Affective Disorder is a precursor for depression.
Adequate vitamin D is better treatment than light therapy. This
is based on clinical trials. You do not have to take it every
day, because it is oil soluble. It can be given weekly or even
monthly. Alaska has trouble tracking this kind of thing, but in
Finland all of this is reported and all doctors follow the
recommendation of 3,000 IUs four times a year for the first year
of life. By tracking the children over time, they can see an
eighty percent reduction in the incidence of type 1 diabetes
after 30 years if people received adequate vitamin D in the
first year of life.
2:00:13 PM
The incidence of multiple sclerosis is five times higher for the
group with the lowest vitamin D levels compared to those with
the highest levels.
2:01:44 PM
None of the drug companies are promoting Vitamin D because they
don't make much money on it. He noted that our health care
system is no longer providing flu vaccine; Japanese school
children studied with 1200 IU per day of vitamin D and no flu
shot, had a 70 percent reduction in flu and upper respiratory
disease cases. There are ways to prevent the flu from spreading,
and this is most effective. Flu vaccines cost $30 per shot even
when subsidized.
2:03:19 PM
CRYSTAL ROGERS, staff to Representative Paul Seaton, said he had
covered all the information but she could answer any questions
from committee members.
CHAIR DAVIS said Ward Hurlburt was on-line to testify.
2:05:00 PM
WARD HURLBURT, Director, Division of Public Health (DHP), DHSS,
said they appreciated the commitment to prevention. There is a
large body of evidence and he recognizes that Vitamin D is an
essential component of the diet of every person. He did some
research regarding recommendations for vitamin D. The
administration does not have a position on the resolution. The
CS included some changes that Representative Seaton accepted,
but he does have ongoing concerns. There is a zero fiscal note
but if the recommendations were implemented there would be a
cost.
2:07:20 PM
The National Institute of Health (NIH) asked the Institute of
Medicine (NIM) to do a review of the claims. Their conclusions
were very different from the conclusions of those who believe it
will have many benefits. It is clear that Vitamin D is needed
and deficiencies can lead to problems such as osteoporosis. He
also has concerns if the legislature is the best place to make
clinical recommendations.
The example he used with House HSS was about using very high
doses of chemotherapy for women with metastatic breast cancer
such that bone marrow was essentially wiped out. Some
legislatures around the country did mandate this kind of
coverage. It was later determined that the information was not
interpreted correctly, and many deaths were significantly
hastened by this treatment that was believed in at the time.
There were times when Vitamin E was seen as an answer to many
health problems. Vitamin C was also given a lot of credit. Those
are all essential substances, but that high level of enthusiasm
did wane.
2:10:58 PM
There is no disagreement that low vitamin D levels can be
associated with certain conditions. Those taking cortisone type
drugs need more. Conclusions of NIM say there is not enough
evidence to conclude it lowers the risk of MS. They said
standard doses might help with MS, but it was ineffective for
breast cancer, hypertension, heart disease, high cholesterol,
and colorectal cancer. The NIM also felt there were some risks
with taking high levels with some other medications.
Evidence says that at high enough levels Vitamin D can be toxic.
NIM recommends no more than 2,000 units per day and prenatal
supplements in excess of that may be a risk to the fetus. He is
not saying it is not essential, but the recommended levels and
dose were increased to 800 IU a day for older people; less for
younger people. That applies to people all over North America,
not specifically Alaska. He applauds the efforts toward
prevention. NIM does come to a different conclusion. He is
particularly concerned about the use of Vitamin D to prevent
seasonal flu. Alaska did the best job in the whole US of
immunizing our senior population; that truly saves lives. Part
of the cost in the fiscal note would relate to the cost of a
comparison study. He is concerned if some did not receive
vaccine, for comparison purposes, we could be putting them at
jeopardy.
2:15:43 PM
JILL LEWIS, Deputy Director, Division of Public Health, DHSS,
said there is a zero fiscal note because this is a resolution
only. Since it urges the department to take certain steps, the
division has prepared a hypothetical fiscal note of the costs to
implement the recommendations, which is found on page 2 of the
fiscal note.
CHAIR DAVIS said she had missed that part.
WILDA LOUGHLIN, Legislative Liaison, DHSS, said the CS made
changes which lowered the hypothetical cost.
CHAIR DAVIS said Mr. Hurlburt had mentioned the changes. She
would like to know what they are.
2:19:18 PM
REPRESENTATIVE SEATON said this was an interactive process. They
made changes based on comments from DHSS. He said in the IMO
study, it was specifically for healthy individuals and was
related mainly to bone health. The NIM basically ignored
population based studies. Most of the studies he relied on were
population studies. The NIM likes to see clinical trials, which
only give information about a small group of people. In trying
to prevent disease, they would not want to deprive people of
Vitamin D.
2:22:59 PM
SENATOR MEYER joined the meeting.
2:23:07 PM
REPRESENTATIVE SEATON said with the Vitamin C awareness, it was
Linus Pauling. All of this evidence is independently reported in
the journals. The cost of Vitamin D supplements is roughly $8
for one year. If we look at Canada, it has been estimated they
could lower the death rate by 37,000 people a year if they had
adequate Vitamin D intake.
2:24:54 PM
He said there would be cost savings in the US health care system
if people had sufficient Vitamin D. They are asking the state to
do specific research looking at the data for Alaska, instead of
looking at a single dose. Also, the IMO did raise the limit and
said it could be toxic above 10,000 IUs a day. People should
monitor their blood levels, because people have different
responses and might need more or less. They should take the
supplements for six weeks and then have their level tested.
2:26:31 PM
SENATOR EGAN commented that he applauded the representative for
bringing the resolution forward. In 1976 he went blind in his
left eye. Doctors at the University of Washington hospital told
him he should start taking vitamin D. In 1982 he was diagnosed
with MS, sensory MS. The doctors upped his dose of vitamin D to
1,000 IUs. After triple bypass surgery his heart surgeon
recommended 3,000 IUs of vitamin D 3. So he now takes 3,000 a
day. Due to our lack of sunlight, vitamin D is more important in
Alaska.
2:28:46 PM
CHAIR DAVIS asked about the last further resolved; if that was
eliminated would it remove most of what he wanted.
2:29:34 PM
REPRESENTATIVE SEATON answered they were hoping to go to a
prevention model of health care. Data shows that many chronic
issues can be prevented in elderly people with Vitamin D
supplementation. They have data and individual studies that show
an increase in C sections from lack of Vitamin D; also studies
on Vitamin D supplementation during pregnancy. This lowered
incidence of Type 1 diabetes. He feels these are all very
important and is hoping that state will investigate or promote
Vitamin D supplementation. It would be good for the legislature
to request that our Division of Public Health (DPH) investigate.
The only one he heard a problem with was the influenza vaccine.
Since the state has taken a public policy of no longer
subsidizing influenza shots for the general population, he
really feels they need to look for alternatives that the state
will promote.
2:31:39 PM
It is not one or the other, flu shots or vitamin D; he does
both. If we don't give flu shots because of the cost, should we
not be looking at providing vitamin D as a way to prevent the
spread of influenza? DHSS should at least investigate.
2:32:25 PM
CHAIR DAVIS said she had no problem with investigation; her
concern was with the resolve "to promote." This could be taken
care of in resolve the above, which tells DHSS to increase
attention to blood testing and to promote awareness of potential
long-term health benefits.
2:33:12 PM
REPRESENTATIVE SEATON replied that previously they said provide,
and replaced it with promote.
CHAIR DAVIS so it doesn't necessarily mean you will actually
give it.
REPRESENTATIVE SEATON responded that is correct. This is more
educational. Senior health is important and costly. Data show
that increased vitamin D will prevent broken bones in the
elderly. Promote means to educate. If studies agree, they can
save the state a lot of money by making sure seniors have
adequate Vitamin D. This resolution does not require that.
2:34:48 PM
CHAIR DAVIS said this is a resolution; there is a possible
fiscal note, but that would depend if it passed. Then the
legislature would have to appropriate funds. Passing this
doesn't mean it has to be appropriated.
REPRESENTATIVE SEATON answered that is correct. The hypothetical
amount is if the state decides they should provide it, how much
it would cost. This would be especially important for low-income
seniors.
2:36:02 PM
SENATOR DYSON suggested it was appropriate to write the DHSS and
ask for a report on what the state is doing on prevention and
promoting prevention.
2:36:59 PM
CHAIR DAVIS said that was ongoing, but it had nothing to do with
the resolution. She asked if the members felt comfortable enough
to advance it. She noted there was not enough time to consider
the resolution at another meeting.
SENATOR EGAN moved to report CSHCR 5(HSS) from the Senate Health
and Social Services Standing Committee with individual
recommendations and attached fiscal note(s). Without objection,
it was so ordered.
| Document Name | Date/Time | Subjects |
|---|---|---|
| CS HCR5 Bill.pdf |
SHSS 4/13/2011 1:30:00 PM |
|
| HCR 5 Sponsor Statement.pdf |
SHSS 4/13/2011 1:30:00 PM |
|
| HCR5-DHSS-PHN-03-09-11Fiscal note (2).pdf |
SHSS 4/13/2011 1:30:00 PM |
|
| HCR5JBMR RPH_MFH 2011.pdf |
SHSS 4/13/2011 1:30:00 PM |
|
| HCR5AADA Response to Alaska.pdf |
SHSS 4/13/2011 1:30:00 PM |
|
| HCR5 disease_incidence_prev_chart_032310.pdf |
SHSS 4/13/2011 1:30:00 PM |
|
| HCR5 Backup Scientific Articles.pdf |
SHSS 4/13/2011 1:30:00 PM |
|
| HCR 5 Letter of Support 1.pdf |
SHSS 4/13/2011 1:30:00 PM |
|
| HCR 5Letter of Support 2.pdf |
SHSS 4/13/2011 1:30:00 PM |
|
| HCR5 Letter of Support 3.pdf |
SHSS 4/13/2011 1:30:00 PM |
|
| HCR5 Letter of Support 4.pdf |
SHSS 4/13/2011 1:30:00 PM |