More about Health, Fitness, Science & Style
Article
Dermatologist Cynthia Bailey, Summer sun protection is much more than just picking the right sunscreen: As a California dermatologist, I spend most of my time treating people with skin cancer. I teach my patients to enjoy being outdoors and keep their skin safe. Today, sun protection information is complicated by vitamin D information such that even doctors are confused
Study
Differences in Control of Cardiovascular Disease and Diabetes by Race, Ethnicity, and Education: U.S. Trends From 1999 to 2006 and Effects of Medicare Coverage
The Commonwealth Fund supported this study published in the Annals of Internal Medicine. Here are a few paragraphs from the article:
"In time–trend analyses of nationally representative data, blood pressure, glycemic, and cholesterol level control improved significantly from 1999 to 2006 for adults with cardiovascular disease or diabetes. Overall trends were not explained by changes in population characteristics, suggesting that management of cardiovascular disease and diabetes has improved considerably over this period. These improvements probably have prevented adverse outcomes, increased life expectancy, and provided considerable value to society. However, improvements in disease control have not been associated with discernable reductions in racial, ethnic, or socioeconomic differences in blood pressure or glycemic control, and gaps in glycemic control between white and Hispanic adults with diabetes have widened. Therefore, to redress inequities in these health outcomes, quality improvement efforts focusing on disadvantaged groups and their health care providers or broader reforms to address social determinants of poor health are still needed. In particular, because black, Hispanic, and less educated adults are much more likely to be uninsured or underinsured, expanding insurance coverage may be especially beneficial for these groups. With near-universal Medicare coverage after age 65 years, differences in systolic blood pressure, hemoglobin A1c levels, or total cholesterol levels reduced substantially. These reductions may substantially decrease racial and socioeconomic differences in mortality as well. For example, 1 study estimated that eliminating racial differences in mean systolic blood pressure might reduce deaths from heart disease or stroke by more than 7500 annually among black adults."
"Our findings are consistent with previous studies that used experimental or quasi-experimental designs to assess effects of insurance coverage on health outcomes for adults with cardiovascular disease or diabetes. Thus, differences in insurance coverage before age 65 years may contribute substantially to sociodemographic differences in health. Sociodemographic comparisons of self-reported insurance coverage at the time of surveys suggested that diminished sociodemographic differences in disease control after age 65 years were due to narrowed gaps in coverage between groups. However, near-universal Medicare coverage after age 65 years probably improved disease control for greater numbers of elderly black, Hispanic, and less educated adults than these comparisons suggested because insurance status was only assessed at the time of surveys."
Article
John Malone, Sailing, Part One: It wasn’t until we began sailing in weekend races at the Pymatuning Yacht Club and won the handicap trophy that Papa stopped trying to be in control and let me handle the boat my way. We were notorious for having loud arguments out on the lake, so loud and prolonged that other boat owners used to joke, “Here come the Malone’s, sailing on hot air again!”
Ethics: A GAO Report on Human Subjects Research
Undercover Tests Show the Institutional Review Board System Is Vulnerable to Unethical Manipulation
Millions of Americans enroll in clinical studies of experimental drugs and medical devices each year. Many of these studies are meant to demonstrate that products are safe and effective. The Department of Health and Human Services’ (HHS) Office for Human Research Protections (OHRP) and the Food and Drug Administration (FDA) are responsible for overseeing aspects of a system of independent institutional review boards (IRB). IRBs review and monitor human subjects research, with the intended purpose of protecting the rights and welfare of the research subjects.
GAO investigated three key aspects of the IRB system: (1) the process for establishing an IRB, (2) the process through which researchers wishing to apply for federal funding assure HHS their human subjects research activities follow ethical principles and federal regulations, and (3) the process that medical research companies follow to get approval for conducting research on human subjects.
GAO investigated these three aspects of the IRB system by creating two fictitious companies (one IRB and one medical device company), phony company officials, counterfeit documents, and a fictitious medical device.
The IRB system is vulnerable to unethical manipulation, which elevates the risk that experimental products are approved for human subject tests without full and appropriate review. GAO investigators created fictitious companies, used counterfeit documents, and invented a fictitious medical device to investigate three key aspects of the IRB system. These are the results:
Establishing an IRB. GAO created a Web site for a bogus IRB and advertised the bogus IRB’s services in newspapers and online. A real medical research company contacted the bogus IRB to get approval to join ongoing human trials involving invasive surgery — even though GAO’s investigators had no medical expertise whatsoever. Since the transaction involved privately funded human subjects research and did not involve any FDA-regulated drugs or devices, GAO’s bogus IRB could have authorized this testing to begin without needing to register with any federal agency.
Obtaining an HHS-approved assurance. GAO also registered its bogus IRB with HHS, and used this registration to apply for an HHS-approved assurance for GAO’s fictitious medical device company. An assurance is a statement by researchers to HHS that their human subjects research will follow ethical principles and federal regulations, which is required before researchers can receive federal funding for the research. On its assurance application, GAO designated its bogus IRB as the IRB that would review the research covered by the assurance. Even though the entire process was done online or by fax — without any human interaction — HHS approved the assurance for GAO’s fictitious device company. With an HHS-approved assurance, GAO’s device company could have applied for federal funding for human subjects research.
Obtaining IRB approval for human testing. GAO succeeded in getting approval from an actual IRB to test a fictitious medical device on human subjects. GAO’s fictitious device had fake specifications and matched several examples of “significant risk” devices from FDA guidance. The IRB did not verify the information submitted by GAO, which included false information that FDA had already cleared GAO’s device for marketing. Although records from this IRB indicated that it believed GAO’s bogus device was “probably very safe,” two other IRBs that rejected GAO’s protocol cited safety concerns with GAO’s device. No human interaction with these IRBs was necessary as the entire process was done through e-mail or fax. GAO’s bogus IRB mentioned above also could have approved the fictitious protocol, which shows the potential for unethical manipulation in the IRB system.
GAO briefed HHS officials on the results of its investigation. The director of OHRP stated that, when reviewing assurance applications, HHS does not consider whether IRBs listed on the applications are adequate — even though HHS is required to do so by law. In addition, HHS officials stated that the department does not review assurance applications to determine whether the information submitted by applicants is factual.
Meet Me at MoMa: An Art Program for Those With Alzheimer's
Aside from The New York Times article* about this program, the New York Chapter of the Alzheimer's Association has posted this explanation of this resource:
"The MoMA Alzheimer’s Project: Making Art Accessible to People with Dementia is a nationwide initiative that builds on the success of MoMA's long history of serving people with disabilities and special needs. As the Museum is committed to enabling all visitors to experience its unparalleled collection of modern and contemporary art, MoMA offers a variety of Access Programs that annually serve over 10,000 individuals with physical, developmental, emotional or learning disabilities, and those who are blind, partially sighted, deaf or hard of hearing, as well as senior citizens. From 2003-2006, MoMA, along with staff from Artists for Alzheimer's, a project sponsored by the Hearthstone Alzheimer's Family Foundation, began focused interviews with people with Alzheimer's, and pilot programs with groups from Hearthstone.
"After this initial phase, MoMA independently expanded and deepened its research and program development. This included workshops for lecturers focusing on gallery teaching strategies and best practice, artwork selection, and audience appropriate activities. Educators also receive bi-annual training from professionals from the New York City Alzheimer's Association and Mount Sinai School of Medicine. In January 2006, MoMA launched Meet Me at MoMA programs for individuals with Alzheimer's and their family members or care partners as well as groups from support networks and assisted living facilities.
"MoMA educators have learned that the act of looking at art can be a rich and satisfying experience for people without full access to their memory, thus providing relaxation and pleasure for those who live with Alzheimer's and their caregivers. Studies show that Alzheimer's disease has a major impact on those who help care for an affected individual."
*Keeping Those With Alzheimer's Engaged
Balad, Iraq Trauma Bay Exhibit
The National Museum of Health and Medicine in Washington, DC has established an exhibit of an Air Force Hospital emergency facility in Balad, Iraq:
"In August 2007, a Congressional delegation visiting the US Air Force base in Balad, Iraq, was touring the installation’s tent hospital when they learned that it was to be demolished since a more permanent facility had recently opened."
"The delegation was moved by stories of the lives saved and heroic measures taken at the hospital’s emergency room, and upon their return, efforts were begun to coordinate with Museum staff and USAF leadership in Iraq to collect and preserve many of the objects on display in this exhibit."
" 'As we stood near Bay II, we realized that perhaps more lives have been saved, and lost, on this spot than perhaps any other during Operation Iraqi Freedom,” said a letter dated Aug. 7 authored by four congressmen, addressed to Army Maj. Gen. Galen Jackman, the Office of the Secretary of the Army legislative liaison chief. “The scuff marks and antiseptic stains on the floor tell a story of heroic efforts to give our wounded the best emergency medical care in the history of warfare. The lives saved, and lost, likely make the slab of concrete the most hallowed of ground in the entire country of Iraq.' — Major Jody Ocker, USAF-NC."
"Since the beginning of Operation IRAQI FREEDOM, this expeditionary hospital saw 700 to 800 patients every month. Thousands of American soldiers, marines, sailors and airmen; contractors and coalition forces; as well as Iraqi Army, Police and civilians were assured the best trauma care available anywhere in the world."
" 'Every American Warfighter knew he could count on us. We lived up to our motto, ‘Bustin’ Ours to Save Yours!’ The 98% survival rate of wounded Americans was unprecedented in the history of conflict … and we did it in tents!" — Major Jody Ocker, USAF-NC.' "Congressional Budget Office and Health Reform
There's a website for the CBO that presents health policy (and the need for its reform) and the projected financial impact on the US population.
Rising health care costs and their consequences for Medicare and Medicaid constitute the nation's central fiscal challenge. Without changes in federal law, the government’s spending on those two programs is on a path that cannot be sustained.
Over the past 30 years, total national spending on health care has more than doubled as a share of gross domestic product (GDP). According to CBO’s latest projections in its Long-Term Outlook for Health Care Spending, that share will double again by 2035, claiming more than 30 percent of GDP. Thereafter, health care costs continue to account for a steadily growing share of GDP, reaching more than 40 percent by 2060 and almost 50 percent by 2082. Federal spending on Medicare and Medicaid, which accounts for 4 percent of GDP today, is projected to rise to 9 percent by 2035 and 19 percent by 2082 under current law.
Although the aging of the population is frequently cited as the major factor contributing to the large projected increase in federal spending on Medicare and Medicaid, it accounts for only a modest fraction of the growth that CBO projects. The main factor is excess cost growth-or the extent to which the increase in health care spending exceeds the growth of the economy. The gains from higher spending are not clear, however: Substantial evidence exists that more expensive care does not always mean higher-quality care. Consequently, embedded in the country’s fiscal challenge are opportunities to reduce costs without impairing health outcomes overall.
Policymakers and the public need more analysis of the options for capturing those opportunities. CBO is therefore substantially augmenting its capabilities and work on health care issues--and this Web page collects many of the agency's activities in the area.
The New England Journal of Medicine presents an editorial on Health Care 2009: Budgeting for Change — Obama's Down Payment on Health Care Reform:
Obama's new nominee for secretary of health and human services — Kansas Governor Kathleen Sebelius — brings impressive credentials to the job, but in order to influence the administration's health policies she will have to contend with a phalanx of economists and analysts who are already entrenched in the White House. Seemingly to a person, they share Orszag's belief that, given the competitive environment created by globalization and the lack of evidence that spending more on health care necessarily results in higher-quality care, we must put a stop to the pattern of health care expenditures' growing far more rapidly than wages and the overall economy. A recent study by the McKinsey Global Institute4 estimated that the United States spends $643 billion more every year on health care than its peer industrialized countries, after adjustment for wealth (see graph and table). These findings have had a profound influence on the thinking of Orszag and his colleagues.
MedPage's blog, Musings of a Distractible Mind
Dr. Rob, Patient Rules, Rule 2: Be Honest
"Nobody likes to look silly. I think the main reason most people are untruthful is that they are embarrassed about the truth. But sometimes symptoms are strange, like the man having a heart attack who described it as 'a cold feeling when I take a deep breath.' Sometimes symptoms are embarrassing, like a testicular lump. Sometimes you just don't want to feel like a wimp, so you downplay your pain.
"While I can sympathize with this feeling, I don't see any good reason to be anything but truthful with your doctor. Yes, your symptom might sound strange. Yes, you may have flubbed up and not followed instructions properly. Yes, you may be afraid of what some of your symptoms may mean. But the goal is to fix (or prevent) problems, and trying to do that with bad information is an exercise in futility.
"We physicians hear it all. There are very few things a person can say to me in the exam room that will surprise me. My job is to help people, not judge them as 'weird,', 'crazy,' 'wimpy,', or 'panicky.' Don't worry about making a good impression on your doctor. Just give the facts. That will give the best chance to get the desired outcome."
Read all six of this doctor's rules at MedPage
Articles
Dermatologist Cynthia Bailey begins a quarterly column with Hydrate Skin to Soothe Winter Itch: If you give the skin a little extra attention in the winter and employ some simple tips, it will be as soft and hydrated as it is during the warmer and more humid weather of summer
Adrienne Cannon, Last in Line: I look around during rehearsals and classes and don’t see many of my age who are as persistent or energetic in trying to perfect their skill. I feel successful in many of the things I do, in spite of not being the best performer
Julia Sneden, Shrink Shrank Shrunken: My spine has begun to collapse, and most cruelly of all, this is happening as my granddaughter is starting her adolescent growth spurt. Soon she will be kissing me on the top of the head and, worse yet, noticing that my part isn’t straight as she does so
Multivitamin Use and Risk of Cancer and Cardiovascular Disease in the Women's Health Initiative Cohorts
"Neuhouser et al investigated multivitamin use and disease risk in the Women's Health Initiative (WHI), a large study of 161 808 postmenopausal women participating in either a set of clinical trials or an observational study. Of the WHI participants, 41.5% used multivitamins, but after a median of 8.0 years of follow-up in the clinical trials and a median 7.9 years in the observational study, there was no evidence that multivitamins confer meaningful benefit or harm in relation to cancer or cardiovascular disease. The risk for invasive cancers of the breast, colon/rectum, endometrium, lung, bladder, and ovary was no different among women who used multivitamin compared with those who did not use multivitamins. Similarly, risk of myocardial infarction, stroke, venous thrombosis, and death from any cause was no different for multivitamin users than for nonusers. Multivitamins do not appear to be effective for the prevention of cancer or cardiovascular disease.
Effects of Intentionally Enhanced Chocolate on Mood
by Dean Radin, PhD,1# Gail Hayssen,1 and James Walsh
Objective: A double-blind, randomized, placebo-controlled experiment investigated whether chocolate exposed to “good intentions” would enhance mood more than unexposed chocolate.
Design: Individuals were assigned to one of four groups and asked to record their mood each day for a week by using the Profile of Mood States. For days three, four and five, each person consumed a half ounce of dark chocolate twice a day at prescribed times. Three groups blindly received chocolate that had been intentionally treated by three different techniques. The intention in each case was that people who ate the chocolate would experience an enhanced sense of energy, vigor, and wellbeing. The fourth group blindly received untreated chocolate as a placebo control. The hypothesis was that mood reported during the three days of eating chocolate would improve more in the intentional groups than in the control group.
Subjects: Stratified random sampling was used to distribute 62 participants among the four groups, matched for age, gender, and amount of chocolate consumed on average per week. Most participants lived in the same geographic region to reduce mood variations due to changes in weather, and the experiment was conducted during one week to reduce effects of current events on mood fluctuations.
Results: On the third day of eating chocolate, mood had improved significantly more in the intention conditions than in the control condition. Analysis of a planned subset of individuals who habitually consumed less than the grand mean of 3.2 ounces of chocolate per week showed a stronger improvement in mood. Primary contributors to the mood changes were the factors of declining fatigue and increasing vigor. All three intentional techniques contributed to the observed results.
FDA's Consumer Alerts: Plavix
We continue to encourage our audience to subscribe to the FDA's MedWatch Alerts, a Safety Information and Adverse Event Reporting Program. This, for instance, is one example:
FDA notified healthcare professionals that the makers of Plavix have agreed to work with FDA to conduct studies to obtain additional information that will allow a better understanding and characterization of the effects of genetic factors and other drugs (especially the proton pump inhibitors (PPIs) on the effectiveness of clopidogrel. FDA is aware of published reports that clopidogrel is less effective in some patients than it is in others. Differences in effectiveness may be due to genetic differences in the way the body metabolizes clopidogrel or that using certain other drugs with clopidogrel can interfere with how the body metabolizes clopidogrel. These studies should lead to a better understanding about how to optimize the use of clopidogrel. The FDA recognizes the importance of obtaining these data promptly. The drug manufacturers have agreed to a timeline for completing the studies and FDA will review the new information expeditiously and will communicate its conclusions and any recommendations to the public at that time. It could take several months to complete the studies and analyze the results. Until further information is available FDA recommends the following:
http://www.fda.gov/medwatch/safety/2009/safety09.htm#plavix
Surgeon-General Interview
Before we discover who will be nominated for Surgeon-General, MedPage Today interviewed the outgoing holder of that post, Dr. Richard Carmona, 17th Surgeon General of the United States:
Dr. Val: What sort of experience is appropriate for a candidate of the office of Surgeon General?
Dr. Carmona: A successful candidate for the office of Surgeon General should have deep and broad public health experience, especially as a public health or uniformed military officer. The Surgeon General is given the rank of Admiral, and as such he or she will interface with other Admirals and Generals, and Army and Navy Surgeon Generals, most of whom are career officers with decades of experience in military matters. The Surgeon General must have the wisdom and experience to take on the position of an Admiral and represent our country internationally.
Dr. Val: What does the Surgeon General do on a daily basis?
Dr. Carmona: The Surgeon General is the commander of the US Public Health Service Commissioned Corps, which consists of thousands of officers in hundreds of locations around the world working anonymously to keep our nation and our world safe. The Surgeon General interfaces on a daily basis with the NIH, CDC, and all of the federally related health agencies as well as global health organizations like the World Health Organization, Pan American Health Association, and the American Public Health Association. The Surgeon General provides in-depth analysis of health policy for every cabinet minister, including the Interior, Commerce, and Homeland Security. It’s a very visible, credible, and iconic position.
Read the rest of the article at MedPage
Increasing Connectiveness for Women With Limitations; A Request for Participants
The Baylor College of Medicine hosts the Center for Research on Women with Disabilities (CROWD) has received a grant to to test an online self-help, interactive health promotion program designed to increase knowledge about exercise, nutrition, stress management, and the use of health care services; to improve health behaviors; and to reduce isolation and increase connectedness for women with functional impairments. The Principle Investigators are BCM researchers, Doctors Margaret A. Nosek and Susan Robinson-Whelen.
Eligibility consists of:
1. Being a woman at least 45 years of age, in the Houston area within one hour drive.
2. Having access to a computer with a high-speed Internet connection about 2-4 hours per week and who like learning using computers
3. Having a physical limitation, disability, chronic illness or health condition that limits activities (for at least one year).
Participants will be randomly assigned to two groups — an online intervention group for 8 weeks or a control group (that will have access to the online program about 6 months later).
All participants will be asked to complete some surveys and receive payment for participation in either group. They will come to the office once, the rest of the study is online. Participants in this study will help contribute valuable information about how providers can improve the health and well-being of women with physical disabilities.
Please contact Cathy Courtney, Sr. Project Coordinator
Center for Research on Women With Disabilities
Office phone and fax 713-523-0466
Email: Cathyc@bcm.edu
Article
Adrienne Cannon, One Beat Behind: 9:30 AM. Saturday morning. Jazzercise class. The beat revves up as does the complexity of the moves. Uh-oh ... that old feeling has come back. Was it really three years ago that I began to lament my position of “last in line?.
Women Cardiologists
The Journal of the American College of Cardiology has published an article reflecting the results of a survey conducted by the ACC Women in Cardiology Council. The survey cover a decade of change in cardiologists' professional life.
"Fewer women than men in cardiology are married or have children, representing a common trend across a broad spectrum of professional women . One possible reason for this trend is our concerning finding that the majority of women in cardiology continue to experience discrimination, largely because of gender in general, and particularly because of parenting responsibilities. In further defining the issues, we can better outline a plan and goals for reaching gender parity, embracing all members of the community, and meeting our workforce needs."
"At the same time, fewer women interrupted their training or their practice for pregnancy. Whether this reflects more liberal recommendations for continuing to work during pregnancy or, as other investigators have suggested, a greater degree of guilt or overt or subtle pressure not to burden one's colleagues is unknown. The trend for more men and women to choose to work less than full-time may have significant implications across the profession, including workforce supply, volunteerism, continuing medical education, and membership in professional societies, and requires further investigation and planning."
Global Library of Women's Medicine: A New Link
Special features of this site now in Beta testing are:The primary feature of the Global Library of Women's Medicine consists of 442 specialist chapters on women’s medicine, plus 53 supplementary chapters, authored by over 650 expert contributors citing more than 40,000 references (read more).
Short Michigan Alcoholism Screening Test, Geriatric Version
The Michigan Test has been used by professionals and can be self-administered as a way to determine if there could be an alcohol abuse problem.
An abstract from a recent publication, Alcohol Consumption by Aging Adults in the United States: Health Benefits and Detriments by Maria Pontes Ferreira and M. K. Suzy Weems, appearing in the past October issue of the Journal of the American Dietetic Association:
Abstract
The most rapidly growing segment of the US population is that of older adults (65 years). Trends of aging adults (those aged 50 years) show that fewer women than men consume alcohol, women consume less alcohol than men, and total alcohol intake decreases after retirement. A U- or J-shaped relationship between alcohol intake and mortality exists among middle-aged (age 45 to 65 years) and older adults. Thus, alcohol can be considered either a tonic or a toxin in dose-dependent fashion. Active areas of research regarding the possible benefits of moderate alcohol consumption among aging individuals include oxidative stress, dementia, psychosocial functioning, dietary contributions, and disease prevention. Yet, due to the rising absolute number of older adults, there may be a silent epidemic of alcohol abuse in this group. Dietary effects of moderate and excessive alcohol consumption are reviewed along with mechanisms by which alcohol or phytochemicals modify physiology, mortality, and disease burden. Alcohol pharmacokinetics is considered alongside age-related sensitivities to alcohol, drug interactions, and disease-related physiological changes. International guidelines for alcohol consumption are reviewed and reveal that many nations lack guidelines specific to older adults. A review of national guidelines for alcohol consumption specific to older adults (eg, those offered by the National Institute on Alcohol Abuse) suggests that they may be too restrictive, given the current literature. There is need for greater quantification and qualification of per capita consumption, consumption patterns (quantity, frequency, and stratified combinations), and types of alcohol consumed by older adults in the United States.
Distraction and the Senior Moment
We came across a WSJ article about neuroscientist Adam Gazzaley regarding his work with the aging brain. We tried to bring some of that article or bits from other research that has been published by Dr. Gazzaley. Nothing was quite in layman-enough language to allow it to be excerpted. However we did come across an article from the New York Academy of Sciences that seemed to be both interesting and non-technical enough to be understood:
Top-down Modulation and Normal Aging
Speaker: Adam Gazzaley, MD, PhD
University of California, San Francisco
- To make sense of the world, the brain filters sensory input according to goals.
- Older patients seem to have trouble ignoring irrelevant information.
- Perturbing activity in the prefrontal cortex mimics the effect of aging on memory performance.
"In young, normal patients, the activity of the scene-selective region spikes when patients are told to remember scenes and forget faces, and dips when they are told to forget scenes and remember faces. The converse is true in the face-selective region. Using these data, the researchers formulated enhancement and suppression indices, which quantify the degree to which a region is boosted above or squelched below its baseline activity.
"Comparing young brains and old brains, Gazzaley and his colleagues found that the baseline activities and enhancement indices are comparable, but older patients have lower suppression indices. The older patients seem to have a deficit not in remembering relevant information, but in ignoring irrelevant information. "Their ability to enhance information for relevant stimuli is preserved across aging, they perform like 20-year-olds in this case, but the suppression is severely compromised as a population."
Older patients have trouble ignoring irrelevant information.
"The suppression indices correlate with actual performance in the memory task. While the older patients' memory skills were on average worse than those of their younger counterparts, the average actually concealed a broad range of scores. When the researchers separated the data into high-performing and low-performing groups, only the older patients with poor memories showed deficits in their suppression indices.
"Interestingly, the poor-performing older patients actually had better memories in one respect: they were significantly better than their peers at recalling information they'd been told to ignore. Taken together, the data provide strong support for the longstanding but controversial "inhibitory deficit" hypothesis. In this theory, a defect in filtering information, not in storing it, underlies the memory declines that often occur during aging. Earlier behavioral studies were unable to distinguish the two processes clearly, but Gazzaley and his colleagues seem to have overcome that hurdle."
Read the entire article at the New York Academy of Sciences site
Medicare Advantage Plans At A Crossroads — Yet Again
The experience with private-plan contracting shows that assuring stable plan choices and extra benefits requires extra money by Robert A. Berenson and Bryan E. Dowd
ABSTRACT from the Health Affairs Journal:
Since risk-taking, private health insurance plans were introduced into Medicare twenty-five years ago, policymakers have disagreed on these plans' fundamental purposes. Articulated objectives, which include improving quality, reducing government spending, providing additional benefits (without expanding the entitlement), increasing choices for beneficiaries, and providing benchmark competition for traditional Medicare, are plausible but sometimes conflicting. The program's history demonstrates continuous shifts in emphasis on these objectives. We enumerate the differing advantages of public and private plans in Medicare and argue that policymakers should focus their efforts on leveling the public-private playing field, thereby dealing forthrightly with the reality of growing fiscal problems.
Read the entire article at the Health Affairs; The Policy Journal of the Health Sphere
Placebos
Results of national survey of US internists and rheumatologists
From the British Medical Journal
Objective To describe the attitudes and behaviours regarding placebo treatments, defined as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself.Participants 1200 practising internists and rheumatologists in the United States.
Main outcome measures Investigators measured physicians’ self reported behaviours and attitudes concerning the use of placebo treatments, including measures of whether they would use or had recommended a "placebo treatment," their ethical judgments about the practice, what they recommended as placebo treatments, and how they typically communicate with patients about the practice.
Results 679 physicians (57%) responded to the survey. About half of the surveyed internists and rheumatologists reported prescribing placebo treatments on a regular basis (46-58%, depending on how the question was phrased). Most physicians (399, 62%) believed the practice to be ethically permissible. Few reported using saline (18, 3%) or sugar pills (12, 2%) as placebo treatments, while large proportions reported using over the counter analgesics (267, 41%) and vitamins (243, 38%) as placebo treatments within the past year. A small but notable proportion of physicians reported using antibiotics (86, 13%) and sedatives (86, 13%) as placebo treatments during the same period. Furthermore, physicians who use placebo treatments most commonly describe them to patients as a potentially beneficial medicine or treatment not typically used for their condition (241, 68%); only rarely do they explicitly describe them as placebos (18, 5%).
Conclusions Prescribing placebo treatments seems to be common and is viewed as ethically permissible among the surveyed US internists and rheumatologists. Vitamins and over the counter analgesics are the most commonly used treatments. Physicians might not be fully transparent with their patients about the use of placebos and might have mixed motivations for recommending such treatments.
Read the entire study in the BMJ
Discoveries
The National Science Foundation has introduced a website that displays the objects of its funding: Discoveries. A more logical name could not be desired.
"With an annual budget of about $6.06 billion, we are the funding source for approximately 20 percent of all federally supported basic research conducted by America's colleges and universities. In many fields such as mathematics, computer science and the social sciences, NSF is the major source of federal backing."
A sampling of some of the most recent investments:
Using Your Computer to Grow More Nutritious Rice for a Hungry World: Computational biologists use a powerful distributed computing network to research rice genome for increased yields of more nourishing rice varieties Released October 14, 2008
Teaching Is in This Scientist's Genes: Doctoral student Susannah Gordon-Messer talks about her research and her science outreach using “bouncy, sticky, slimy chemistry” to educate and inspire young minds Released October 10, 2008
Klein Bottle is a Real Natural in the Zoo of Geometric Shapes: Discovery could advance understanding of human vision and lead to powerful data compression techniques Released October 7, 2008
The Bizarre Creatures of Madagascar: Paleontologist David Krause describes his search for the ancestors of mammals that live in Madagascar today Released September 24, 2008
Finding the Switches to Our Cells' 'Computer': Thousands of memory switches inside our cells help them remember and function. Released September 24, 2008
Glacier Movement Limits How Fast Sea Level Can Rise: Study finds 3 to 6 feet by 2100 possible. Released September 18, 2008
Get Discoveries Updates by Email
Consumer Reports Health
Dangerous drugs for older people
"People age 65 and older are more than twice as likely as younger ones to be treated in emergency rooms because of adverse drug reactions. One reason: Kidney function declines with age, making it harder for the body to eliminate drugs. Moreover, nearly half of them take at least five different medications, multiplying risks."
Read the article, cited drugs and possible alternatives at the Consumer Reports Health site.
NEJM & Candidates' on Health Care
From The New England Journal of Medicine: Election 2008: Health Care in the Next Administration |
View video of the symposium |
Election 2008: Campaign Contributions, Lobbying, and the U.S. Health Sector — An Update
R. Steinbrook
Free Full Text
J. McCain
Free Full Text
D. Blumenthal
Free Full Text
Undertriage of Elderly Trauma Patients to State-Designated Trauma Centers
Archives of Surgery 2008;143(8):776-781.
Objective To determine whether age bias is a factor in triage errors.Design Retrospective analysis of 10 years (1995-2004) of prospectively collected data in the statewide Maryland Ambulance Information System followed by surveys of emergency medical services (EMS) and trauma center personnel at regional EMS conferences and level I trauma centers, respectively.
Patients Trauma patients were defined as those who met American College of Surgeons physiology, injury, and/or mechanism criteria and were subjectively declared priority I status by EMS personnel.
Main Outcome Measure Undertriage, defined as when trauma patients were not transported to a state-designated trauma center.
Results The registry analysis identified 26 565 trauma patients. The undertriage rate was significantly higher in patients aged 65 years or older than in younger patients (49.9% vs 17.8%, P < .001). On multivariate analysis, this decrease in trauma center transports was found to start at age 50 years (odds ratio, 0.67; 95% confidence interval, 0.57-0.77), with another decrease at age 70 years (odds ratio, 0.45; 95% confidence interval, 0.39-0.53) compared with patients younger than 50 years. A total of 166 respondents participated in the follow-up surveys and ranked the top 3 causal factors for this undertriage as inadequate training, unfamiliarity with protocol, and possible age bias.
Conclusions Even when trauma is recognized and acknowledged by EMS, providers are consistently less likely to consider transporting elderly patients to a trauma center. Unconscious age bias, in both EMS in the field and receiving trauma center personnel, was identified as a possible cause.
The preceding is an abstract for an article in the Archives of Surgery.
The 8th Evacuation Hospital
The University of Virginia in World War II collection from the Claude Moore Health Sciences Library includes the story of the 8th Evac unit itself, personal recollections of their members and letters after the War.
What follows are excerpts from the collections:
Pietramala in Winter and the 1945 Spring Offensive
The 8th Evacuation Hospital was very busy in October and early November due to the Army’s attempt to advance in the mountains. During the winter months with less fighting the Hospital was only moderately busy, and the less hectic days permitted time for unit members to go to rest camps in Florence, Rome, or Montecatini.
The coming of spring meant another offensive attack by the Allies. In preparation the wards were cleared of those patients who could tolerate being moved further from the front. On April 15th the fighting started the area near the 8th Evacuation Hospital, and within hours the unit was deluged with casualties. At one point the Hospital had a backlog of eighty operative cases when it received another eighty-five wounded. The spring offensive was quickly successful. Within 19 days the Germans had been driven out of the mountains and across the Po Valley with all of their escape routes to the Alps blocked. More than a million Axis troops surrendered, and the war for Italy was finished.
Recollections of [Nurse] Alice M. Huffman:
A German submarine had sunk the ship carrying our equipment so we slept in pup tents for a week or more while waiting to be re-equipped. One day a friend and I decided to climb a small hill that had a church at the top. While we were resting, we found that one outfit was storing some of their belongings in the church. When they finished unloading, a general came out and asked if we would like a lift down the hill. We accepted his offer, and he introduced himself as General Sullivan, head of the quartermaster corps of the Fifth Army. He asked what outfit we were in, and we told him our story and that we were sleeping in pup tents. He asked what we needed most, and we told him we needed tents for the nurses. He sent them over that afternoon. He became a good friend and danced with me when we happened to be at the same party. He waltzed beautifully.
Correspondence with Nurse Ruth Beery with Next-of-Kin
Dear Capt. *Ruth Beery,
It gave me great pleasure to receive your letter, and added satisfaction knowing every thing possible was done for the
comfort of my son [ ], who made the supreme sacrifice.
It was very kind of you to write, and I appreciate it. Now that the war is over I am anxiously looking forward to the discharge of my two sons, one who has served Uncle Sam in the Marine
Corp since July 1940.
Thanking you for your kindness
*"Beery then trained at the University of Virginia Hospital where she remained as an instructor in science at the School of Nursing. While later a graduate student at the University of Minnesota, she was asked to be the principal chief nurse of the World War II hospital sponsored by the University of Virginia. Before she could accept the offer, the Army had to grant her an age waiver as she was 41, one year older than the Army age limit for entering service. Commissioned a 1st lieutenant in the Army Nurse Corps, she was instrumental in recruiting nurses to serve and dedicated herself whole-heartedly to the task, appealing for help by personal interviews, letters, speeches, and radio. According to Byrd Leavell’s book on the 8th Evacuation Hospital, Beery was a “capable nurse and competent administrator” who “was unselfish; her concern was for the comfort of the sick and wounded, the duties and welfare of the nurses, and the reputation of the 8th Evacuation Hospital.” She served as chief of nurses for the duration of the war, obtained the rank of captain, and was awarded the Legion of Merit."
Coming Clean Campaign
We tend to use Dr. Bronner's products for just about everything in our house as the older we get, the less we want toxic chemicals in our lives. We found the Organic Consumers Association in a Dr. Bronner's activism newsletter.
Their background:
"The Organic Consumers Association was formed in 1998 in the wake of the mass backlash by organic consumers against the US Department of Agriculture's controversial proposed national regulations for organic food. Through the OCA's SOS (Safeguard Organic Standards) Campaign, as well as the work of our allies in other organizations, the organic community over the last eight years has been able to mobilize hundreds of thousands of consumers to pressure the USDA and organic companies to preserve strict organic standards. In its public education, network building, and mobilization activities such as its Breaking the Chains campaign, OCA works with a broad range of public interest organizations to challenge industrial agriculture, corporate globalization, and the Wal-Martization of the economy, and inspire consumers to 'Buy Local, Organic, and Fair Made.' "
The Coming Clean Campaign is Campaigning for Organic Integrity in Bodycare Products:
"The word 'organic' is not properly regulated on personal care products (example: toothpaste, shampoo, lotion, etc.) as it is on food products, unless the product is certified by the USDA National Organic Program.
"Due to this lax regulation, many personal care products have the word 'organic' in their brand name or otherwise on their product label, but unless they are USDA certified, the main cleansing ingredients in particular are usually made with conventional not agricultural material, combined with petrochemical compounds."
Read more about the campaign at the Organic Consumers Association site.
Excerpt
From Hyping Health Risks; Environmental Hazards in Daily Life and the Science of Epidemiology
by Geoffrey C. Kabat, Columbia University Press:
Toward a Sociology of Health Hazards in Daily Life
We are all familiar with what has been referred to as the “hazard du jour” phenomenon. Typically, it starts with media reports of the findings of a new scientific study indicating that some lifestyle behavior, consumer product, or environmental factor is linked to some dire disease. Coffee drinking is linked to pancreatic cancer. Eating chocolate is claimed to dispose to benign breast disease in women. Environmental pollution, we are told, may cause breast cancer. Studies appear to show a connection between exposure to electromagnetic fields from power lines and electric appliances and a host of diseases, starting with childhood leukemia. Use of cellular telephones may lead to brain tumors. Exposure to secondhand tobacco smoke, or passive smoking, is linked first to lung cancer, then to heart disease, and most recently to breast cancer. Silicone breast implants are associated with connective tissue disorders. The list could be extended at great length. Following the initial report, a second report may appear soon after yielding further suggestive evidence of a hazard or, just as often, showing no effect. In this way, over time, a scientific literature develops on each topic marked by weak and inconsistent results, and the perception of a hazard takes on a reality.
Some scares, such as those surrounding coffee and cell phones, may subside fairly quickly, as better studies are published or as the hazard is put in perspective and deflated. In other cases, the hazard can take on a life of its own and persist over years or decades, becoming the focus of scientific research, regulatory action, lawsuits, and advocacy campaigns. In the case of electromagnetic fields from power lines, tens of billions of dollars have been spent to remediate a problem whose very existence is uncertain. But what characterizes all of these scares is that the public’s perception of a hazard was greatly exaggerated and was not counterbalanced by an awareness of the tenuousness of the scientific evidence or of the relatively modest magnitude of the potential risk. Thus, to a large extent, when one examines the public’s response to a high-profile health scare, one is dealing with the dissemination of poor information and appeals to fear. (It sometimes seems that the intensity of the fear is inversely proportional to the actual magnitude of the threat.)
Read the rest of the excerpt at the Columbia University Press site.
Articles
Doris O' Brien, The Girth of a Nation: Prohibition's failure proved that drinking didn't stop simply because the law, in effect, hid the bottle. The same can be said of any attempt to ban fast foods or the selective use of trans-fat. We learn good nutrition by example, not by condemnation
John Malone, Broca's Aphasia: Why was Rosie the dog scratching at the closed bedroom door? Or, rather, why was the white, furry thing with the licking tongue and anxious, pawing feet trying to get into our dark bedroom? Because I did not really think of the word “dog.”
Senate Approves Health Care Safety Net Act
From Womens' Policy, Inc.
On July 21, the Senate approved, by voice vote, the Health Care Safety Net Act (S. 901). Originally known as the Health Care Centers Renewal Act, the bill would reauthorize funding for community health care centers and programs for uninsured patients, including the Community Health Centers program, the National Health Service Corps, and the Rural Health Care programs. The Senate Health, Education, Labor, and Pensions Committee passed S. 901 on November 14 ; the House approved a similar version of the measure (H.R. 1343) on June 4.