A new study contends that echocardiograms, while safe, are often unnecessary. Only one-third of patients who receive the noninvasive ultrasound heart tests see a change in treatment, HealthDay News reports.
“The majority of echocardiograms are appropriate in terms of current guidelines,” said lead researcher Dr. Susan Matulevicius, an assistant professor at Texas Southwestern Medical Center. “But no one has looked at what an echo does to change a patient’s management.
“If we keep using echoes all the time just because we can and we are not going to be doing something with that information, you are just using health care dollars that could have been used for someone else,” Matulevicius said.
Echocardiograms cost between $100 and $1,000, and account for almost half of all cardiac-imaging services performed in the country, according to the study. In 2010, echocardiograms accounted for more than $1.1 billion, or 11%, of total Medicare imaging costs, the researchers said.
Millions of dollars could be saved each year if only patients who needed the test got it, Matulevicius said.
Yet another good reason to follow doctor’s orders: A new study found that patients who don’t take their blood pressure medication as prescribed increase their risk of stoke and death, HealthDay News reports.
By following patients with high blood pressure, aged 30 and up, from 1995 through 2007, researchers determined that those who didn’t stick to the schedule had nearly four times the risk of dying from a stroke in the second year after being prescribed their medicines and three times the risk in the 10th year, compared to patients that followed their schedule.
The study also found:
“These results emphasize the importance of hypertensive [high blood pressure] patients taking their antihypertensive medications correctly in order to minimize their risk of serious complications such as fatal and non-fatal strokes,” said study first author Dr. Kimmo Herttua, a senior fellow in the Population Research Unit at the University of Helsinki in Finland.
With the supply of primary care doctors already lagging behind demand – and about to get even more strained when millions of additional Americans get health insurance in January, under the health care reform law – many states are turning to nurses to address the shortage.
According to MedCity News, at least 17 states have relaxed “scope of practice” laws to allow nurses to work without a supervising physician, so long as they have advanced degrees in family medicine. Lawmakers in five big states are considering similar measures.
Advocates for patients, hospitals and insurers say that nurse practitioners (NPs) have the skill set necessary to provide basic health services by themselves. But physician groups disagree, arguing that nurses lack the training to safely diagnose, treat, refer to specialists, admit to hospitals and prescribe medications for patients, without a doctor’s oversight.
Based on a study reported this month in the journal Health Affairs, relaxing NP licensing laws appears to improve patient access to care. The authors found that between 1998 and 2010, as more states relaxed their laws, the number of patients receiving care from NPs increased by a factor of 15. Moreover, earlier research has shown that primary care provided by NPs has been as safe and effective as care provided by doctors.
Despite the best efforts of politicians and nutritionists, Americans continue to stubbornly favor taste over calorie count when it comes to selecting restaurant food. Today Health reports that even when given detailed information about healthy eating, a new study found that most individuals tend to go – literally – with their gut.
Researchers from Carnegie Mellon enlisted over 1,100 customers at two New York City McDonald’s to see how real people responded to the menu nutritional labels, which are required by municipal law (and will soon by nationwide under the Affordable Care Act). Prior to ordering, one group received a sheet of paper with the recommended calories for a single meal (650 calories for women; 800 calories for men); a second group received information about recommended calories for a day (2000 calories for women; 2400 for men), and a third group received no instructions.
So, armed with the additional information, surely members of the first two groups made more sensible dining decisions, right? Uh, not so much. Regardless of group, the majority of men and women ate more than the recommended intake for a meal – and whether a participant was overweight or healthy-weight made no difference in their selection.
In spite of the results, the researchers still say providing nutritional information of menus is a helpful tool, albeit mainly to those already inclined to choose healthier food options.
A new study suggests that long-term aspirin use may reduce a woman’s risk of colon cancer, even if not taken daily, Reuters Health reports.
Researchers found that women who took just 100 mg of aspirin every other day for at least 10 years ended up with about a 20% lower risk of colon cancer over the ensuing two decades, compared to women who took a placebo. The study did not show the same effect for other cancer types such as breast or lung.
The extended use of aspirin was not without risk, however. Study participants in the aspirin group had higher rates of stomach bleeding and ulcers.
“Aspirin use is recommended for most people who have had a heart attack, and has some benefits for colorectal cancer as well, but at this point the American Cancer Society does not recommend that people use aspirin specifically to prevent cancer,” noted Eric Jacobs, ACS’s strategic director of pharmacoepidemiology, who was not involved in the study
As we reported last week on this blog, any regular aspirin regimen should only be started under a family doctor’s care.
Average cholesterol levels in Americans have stopped falling since 2008 – a development that has pharmaceutical companies scrambling to come up with a new class of drugs, The New York Times reports.
A large analysis of patient records suggest that statins, the drugs that have contributed to reducing cholesterol levels throughout the population, may be reaching the limits of their effectiveness. Blood levels tested by the lab chain Quest Diagnostics found that LDL, or “bad” cholesterol, declined from 120 milligrams per deciliter of blood in 2001 to 104.7 in 2008 – a 13% drop. But in the next three years, average LDL levels flattened out.
While the study didn’t look at causes for the plateau, the researchers speculated that when the economy worsened in 2008, less people visited their doctors and, consequently, received statin prescriptions. The recession may also have affected stress levels, diet and evercise – factors that can contribute to higher LDL.
An LDL of 100 mg/dL is considered healthy, but experts say people at very high risk of heart disease should bring their levels down even further, to about 70 mg/dL or lower. However, a Times article from earlier this month notes that several drugmakers are working on pills that could drive LDL levels to new lows.
If you drink diet soda, chances are it’s for the low calorie count to help you lose weight, or keep it off. But a Purdue University study has found that the beverage may not be a healthier alternative to its sugary counterpart – and may actually contribute to weight gain.
According to USA Today, a review of recent studies found results that linked artificially sweetened sodas to a number of health problems. One large study found that people who drank diet soda were more likely to experience weight gain than those who drank non-diet soda. Others found those who drank diet soda had twice the risk of developing heart disease than those who abstained.
Some studies even suggested that diet soda, which contain such artificial sweeterers as aspartame, sucralose and saccharin, may be just as bad for our health as non-diet. Such findings may lead some to ask, are diet sodas worse for you that regular sodas?
“I think that’s the wrong question,” said Susie Swithers, Purdue University professor. “It’s, ‘What good are sodas for you in the first place?’”
In response to the study, the American Beverage Association said in an emailed statement, “This is an opinion piece not a scientific study. Low-calorie sweeteners are some of the most studied and reviewed ingredients in the food supply today. They are a safe and an effective tool in weight loss and weight management, according to decades of scientific research and regulatory agencies around the globe.”
Health care spending has slowed in recent years, but is still growing faster than the nation’s GDP, and amounts to nearly 1/5 of the total US economy. Carrington College (via MedCity News) identifies seven significant factors that contribute to health care spending growth – and if not kept in check, higher insurance costs:
At MedBen, we strive to find clients solutions to minimize the impact of rising health care spending. Our advanced surveillance system finds potential for large loss, inappropriate billing, and cost reduction opportunities. Our worksite wellness program promotes the use of your primary care doctor and personal coaching to members with chronic illness. And our fraud detection unit reviews questionable claims and other related information to help conserve plan assets.
Cutting back from a full pack to cigarettes a day to just half may help your pocketbook, but will do little to extend your lifespan, a new Scottish study suggests.
According to HealthDay News, the study, which tracked individuals’ smoking habits from the 1970 to 2010, concluded that only kicking by the habit altogether can a person hope to gain extra years. The researchers found no difference overall in death rates between those who smoked and those who only cut down.
“These inconclusive results support the view that reducing cigarette consumption should not be promoted as a means of reducing mortality, although it may have a valuable role as a step toward smoking cessation,” the researchers wrote.
Another tobacco-use researcher questioned the accuracy of the findings. “It is not possible to know the detailed smoking history of every subject, and there’s a myriad of subtle differences in consumption. There is little doubt that there is a difference in risk between one cigarette per day and 20, but it is not possible to measure all gradations in between,” said Brad Rodu, a professor of medicine at the University of Louisville. He added that participants who smoked fewer cigarettes may have underreported their habit, or compensated by “smoking more intensely.”
The Internet has become the go-to place for all manner of personal inquiries, including medical research: A recent survey found that 6 in 10 adults have gone online in the past year to diagnosis health issues. But how accurate is the information we find?
On KevinMD.com, family physician Kenneth Lin warns than many health websites contain “flawed, inaccurate, or biased” information. Sometimes, the group running the site may have a hidden agenda, such as a drug company that promotes awareness of a previously unrecognized to spur consumer demand for its new product – a practice known as “disease mongering". Or an organization may willfully disregard scientific evidence to promote certain health beliefs.
For his patients who need trustworthy health information, Lin recommends several websites that have received a high quality rating from independent medical associations, such as Healthfinder.gov and FamilyDoctor.org. The latter site offers a variety of handouts about preventive test basics or newly diagnosed health conditions, including one that advises patients to ask themselves three questions about every health-related website they visit:
While Lin warns patients not to use online information to self-diagnose or treat a medical problem, he does believe that visitng a high-quality health website can help them make better-informed choices – so long as its in conjunction with a doctor’s care.
The U.S. Food and Drug Administration has approved a new drug to treat advanced lung cancer, HealthDay News reports. Gilotrif (afatinib) will be available to patients with a specific subtype of non-small cell lung cancer (NSCLC).
The agency approved the drug to treat tumors that carry key deletions on the epidermal growth factor receptor (EGFR) gene, long a target for lung cancer therapeutics. Mutations in the EGFR gene – thought to occur in about 10% of NSCLCs – are targeted by Gilotrif.
“This drug represents a new important alternative to standard chemotherapy in the 10-15% of lung cancer patients who have EGFR mutations,” said Dr. Jorge Gomez, medical director of the thoracic oncology program at Mount Sinai Medical Center in New York City.
Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, added that new drugs such as Gilotrif “complement standard chemotherapy [and] give hope of increased survival even in late stage lung cancer.”
Along with common side effects such as itching, bladder inflammation, low blood potassium levels, fever, and eye inflammation, serious side effects associated with Gilotrif include diarrhea that can result in kidney failure and severe dehydration, severe rash, lung inflammation and liver toxicity, the FDA said.
An increase in the amount of time Americans spend exercising hasn’t slowed the rise in obesity, the Los Angeles Times reports.
Data published in the online journal Population Health Metrics revealed that while individuals in two-thirds of the nation’s counties have stepped up their physical activity in the past decade, national obesity rates have also climbed. On the positive side, some recent evidence suggests the rates may be leveling off.
“There has been a lot of progress on physical activity,” said Christopher Murray, lead author of the research. “But we probably also need to do more. There are still more calories coming in … than calories going out in physical activity.”
Indeed, bad diet choices are the single leading cause of America’s poor health compared to other countries, said Robert Lustig, a neuroendocrinologist and clinical professor at UCSF School of Medicine. While physical activity is a critical component of well-being, “[t]here is not one study anywhere in the world that shows that exercise [alone] causes weight loss.”
Lustig noted that poor diet also reduces the will to exercise, and advised that people reduce their insulin levels by drinking less alcohol and eating less sugar, trans fats and corn-fed beef and chicken.
Despite last year’s recommendation by the U.S. Preventive Services Task Force that older men shouldn’t get a prostate cancer screening, most still plan to do so, HealthDay News reports.
A survey of over 1,000 men aged 40 to 74 with no history of prostate cancer found that only 13% of respondents plan to follow the USPSTF recommendation and not get tested, compared to 54% who said they’d ignore it and 33% who were undecided. Blacks, wealthier men, those who’d had a recent PSA test, and those who were at least somewhat worried about prostate cancer were more likely to plan to get a test.
Overall, the survey shows that “we need to do a better job of presenting both the benefits and harms of screening to all patients,” said Linda Squiers, lead author of a report on the survey. “We also should explain the science behind the recommendation in plain language so everyone can understand it.”
The USPSTF website states that “current methods of PSA screening and treatment of screen-detected cancer are not the answer", and critics of the test believe it can lead to unnecessary and harmful treatment. Nevertheless, many physicians say the test serves a useful purpose.
MedBen follows American Cancer Society screening guidelines, which recommend that men at age 50 who are at average risk of the disease and are expected to live at least 10 more years consult with their primary care physician about getting tested.
While MedBen recommends that health plan members see their family doctor regularly, it’s also a good idea to rely on your pharmacist for guidance, as a new study of hypertension treatment demonstrates.
According to HealthDay News, researchers found that 72% of individuals who self-monitored their blood pressure with home kits for six months and partnered with a pharmacist for medication guidance kept their high blood pressure under control, compared to 45% whose care was limited to scheduled physician checkups. And six months following the study, 72% of the home monitoring group still controlled their high blood pressure compared to 57% of the usual care group.
“The reason that only about half of people with [high] blood pressure have it under control is that usual care isn’t working. We combined two interventions that we thought would be very powerful together – home monitoring and pharmacist managements – and this is one system that we’ve shown works very well for blood pressure control,” said senior investigator Dr. Karen Margolis, from the HealthPartners Institute for Education and Research in Minneapolis.
This is not to suggest, however, that the family doctor doesn’t play an important role in helping to control high blood pressure, in addition to managing a patient’s care in general. But it does show how taking on greater responsibility for one’s health, and taking advantage of every available resource, can make a positive difference.
An extensive new study of U.S. health trends from 1990 to 2010 revealed some positive developments, according to the Health Hub:
Still, not all the news was good. The study, conducted by the Cleveland Clinic, found that while the U.S. is spending more, our health is only gradually improving compared to other countries. Additionally, the gap between life expectancy and the expected number of healthy years that an American loses to disability increased from 9.4 to 10.1 years.
The study also determined that disease and long-term disability account for nearly half of the U.S. health burden. The researchers suggested that by stressing education and preventive medicine to limit chronic conditions, our country could reduce that number.
MedBen Worksite Wellness adheres to that philosophy. By promoting prevention of chronic diseases through physician office testing that uses the plan member’s primary care provider, we eliminate the logistical headaches and potential redundancy of on-site screenings. And our program uses customized education and counseling to help high-risk plan members reduce their odds of developing diseases in the first place.
For additional information about worksite wellness, contact MedBen Vice President of Sales and Marketing Brian Fargus at email@example.com.
So many studies have lauded the benefits of aspirin, it’s easy to conclude that a daily dose doesn’t hurt and may even help. But such thinking is unwise, the Cleveland Clinic’s Health Hub reports.
While it’s true many doctors prescribe aspirin therapy for patients with heart disease, self-prescribing to stay heart healthy carries serious risks, says Steven Nissen, MD, Chairman of the Department of Cardiovascular Medicine at Cleveland Clinic – and some, such as gastrointestinal bleeding or hemorrhagic stroke, can be potentially fatal.
“Only those individuals who are at high risk for a heart attack benefit from taking aspirin as a preventive measure,” says Dr. Nissen. “Before taking a daily dose, you need to have a dialog with your physician about the benefits and risks of aspirin therapy.”
Dr. Nissen acknowledges that for patients who have had a heart attack, bypass surgery or a history of coronary artery disease, the benefits of daily aspirin outweigh the risks. But for others, only people with a cluster of risk factors – say, having diabetes, being a smoker, having high cholesterol and high blood pressure – should consider a daily aspirin, and even then only under a doctor’s counsel.
Right on the heels of a recent study that found smoking and surgery don’t mix comes a analysis that suggests heavy drinking also hinders recovery.
Reuters Health reports that a review of 55 past studies concluded that people who have more that a couple of alcholic drinks every day tend to have more complications after surgery than teetotalers or light drinkers. Infections and slow wound healing were the most common complications associated with heavy drinking.
Patients who drank heavily leading up to surgery were also more than twice as likely to die in the month after their procedures than abstainers, according to lead author Marie Eliasen of the National Institute of Public Health at the University of Southern Denmark in Copenhagen.
While the analysis confirms that “alcohol and surgery are a bad combination,” it’s not clear what effect stopping drinking before surgery would have on complications, Bolette Pedersen of the Clinical Health Promotion Center of Bispebjerg told Reuters by email. Pedersen was not involved in the review.
A recent New York Times article highlights America’s growing use of narcotic painkillers in the past decade. Once prescribed primarily for short-term discomforts, OxyContin and other popular opiods now provide relief from such chronic conditions as back injuries, headaches and arthritis – though questions have arisen about the long-term effectiveness of such drugs.
The growing reliance on painkillers has led to an increase in usage beyond what is required for treatment. In addition to the risk of addiction, side effects can include psychological dependence, reduced drive, extreme lethargy and sleep apnea.
Deaths from opoid overdoses have also risen in the past decade, especially among females. According to the Centers for Disease Control and Prevention, prescription pain pills were involved in 6,631 overdose deaths, intentional and unintentional, among women in 2010, a 415% increase from the 1,287 such deaths in 1999.
In spite of the known risks, narcotic painkillers are now the most widely prescribed class of medications in the United States. But depending on a patient’s overall health, many ailments for which opoids provide temporary comfort may realize more lasting relief through physical therapy.
(Thanks to John Goodman’s Health Policy Blog for the link.)
Sometimes, the words “patient” and “consumer” are used interchangeably. And while it may seem unbecoming to describe a person getting a checkup with the same term used for buyers of Big Macs, there are times the word is entirely appropriate, writes Roys Laux:
“[A]s healthcare coverage changes in America, as patients become more responsible for paying out of pocket upfront, you can bet they’ll be looking at the decisions through a consumer lens.
“It’s time for all of us to change our thinking.
“Consumers need to think about what matters most to them so they can effectively value a provider or treatment when they embark on their next hiring decision. A convenient appointment time and waiting room with amenities may be valuable to one, while another places greater value on the volume of procedures the HCP performs each week and yet another values physician bedside manner and staff responsiveness most. With greater visibility into patient experience before one hires a provider, consumers can determine just what service they’re willing to pay for and how much.
“Caregivers need to be open to and encourage patient feedback. Many physicians don’t like to think of new patient acquisition as a ‘hiring experience.’ But that’s exactly what it is. Consumers are paying for a service – a very personal, very important service. Providers should provide great customer service, great clinical quality and visibility about price every step of the way.”
The Obama administration has released a final rule regarding female contraceptive coverage under health care plans offered by religious groups, MedPage Today reports. The rule – a provision of the Afforable Care Act – takes effect January 1.
The rule is similar to those proposed by Health and Human Services last year. While churches themsevles are exempt from covering birth control, hospitals, schools, and other organizations with religious affiliations are not.
What has changed is the definition of “religious employer", to better facilitate churches that may hire or serve individuals outside their denomination. The final rule eliminates requirements that a religious employer:
As for other faith-based groups, an insurance company must provide no-cost contraceptive coverage if notified by the group of its religious objection. In compensation, HHS will reduce the fees that insurers must pay to participate in the ACA’s federally-run health insurance exchanges.
Self-funded groups need to make arrangements to provide coverage through a separate health plan, and their third-party administrator must notify enrollees of coverage availability.