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.