Two new studies reveal serious inconsistencies in how doctors interpret cancer guidelines:
The Wall Street Journal Health Blog reports that, in a study of over 1,000 primary care doctors, 28.5% surveyed said that they “sometimes” or “almost always” offered or ordered ovarian cancer screenings for low-risk women. Such actions go against the advice of professional groups, which do not recommend routine screening of women with no symptoms.
The United States Preventive Services Task Force and the American Congress of Obstetricians and Gynecologists have both concluded that the risks of ovarian cancer screenings (such as complications from unnecessary surgery) outweight the benefits, even for women with a high risk of the disease.
Guidelines for breast cancer surgeries also can vary widely by doctor, according to The New York Times. A study of women who received lumpectomies found that almost half had second operations that may not have been needed. Conversely, the data suggests that some women who might benefit from the surgey aren’t getting it.
Additional lumpectomies are performed when pathology reports suggest that the initial operation failed to locate all cancer cells. But doctors interpret these reports differently – evidence of uncertainty that study author Dr. Laurence E. McCahill called “a shame.”
As part of an ongoing effort to promote better health, Partners Community Health Plan is currently expanding its community health network. Local businesses, sharing a common dedication to consumer wellness, have generously agreed to provide discounts to Partners members.
Community health network merchants offer a variety of health-oriented products and services. Health clubs, nutritionists, masseuses, sporting goods stores, and even golf courses are among the area businesses that presently participate.
To receive the Partners discount from a participating business, members simply need to show their ID card at the time of purchase. In addition, the community health network is not exclusive to a particular area. Plan members are welcome to take advantage of discounts available in other areas that offer Partners.
MedBen, in conjunction with area hospitals, introduced Partners in 2010. The innovative plan design encourages members to visit local providers in order to receive the best benefits. In addition to the community health network, groups can realize further savings through such features as a worksite wellness program, free dental and vision screenings, and the best pharmacy discounts available.
Partners is currently offered in both fully-insured and self-funded versions, and is available in the following Ohio cities and surrounding areas: Cambridge, Coshocton, Marietta and Zanesville. The plan is also available in Murray, Kentucky and surrounding areas.
For additional information about Partners, contact a MedBen broker or call Vice President of Sales and Marketing Brian Fargus at (888) 627-8683. To see a list of participating community health network merchants in your area, visit the Partners website at www.partnerschp.com.
Last week, the House of Representatives voted 267-159 to repeal the Community Living Assistance Services and Support program, the Associated Press reports.
A provision of the Affordable Care Act, the program – known as the CLASS Act – was designed to provide affordable and voluntary long-term care insurance. However, in October, the Obama administration admitted that the program was financially unviable.
Individuals covered under CLASS would receive benefits of at least $50 a day should they require home health services or nursing home care. But government actuaries determined that the program would require a large number of healthy people to sign up in order to sustain it.
All 239 House Republicans present voted to remove the CLASS Act from the health care reform, in addition to 28 Democrats. The bill’s sponsor, Rep. Charles Boustany, R-La., said the administration finally has come to the conclusion “that we knew even before the bill passed, that this was unsustainable, it was unworkable, it was fatally flawed.”
But Rep. Henry Waxman, D-Calif., said the Republican goal was to “tear down and dismantle programs that provide health care in the United States.” He said “the solution is to amend the program to make it work, not just repeal it and leave nothing in its place.”
Many people have a serious aversion to getting a shot in the arm – or any other body part, for that matter. But a new report from the U.S. Centers for Disease Control and Prevention drives home the point (sorry) that other considerations should outweight the fear factor.
According to HealthDay News (via MedicineNet.com), the CDC found that about 45,000 Americans die from disease that could have been prevented by vaccine. And while the number of people getting some vaccines has risen slightly, overall numbers remain low.
In 2010, the usage rate of three vaccines – tetanus, diphtheria, and Tdap (to guard against whooping cough) – went up 1.6%, to 8.2%. Increases were also seen in the use of the shingles vaccine among whites aged 60 and older, and in the cervical cancer vaccine human papillomavirus (HPV) among women aged 19-26.
In contrast, among high-risk adults aged 19 to 64, just 18.5% received a vaccine that safeguards against pneumonia. And the adult vaccination rates for hepatitis A and B remained more or less unchanged from 2009.
Vaccine rates likely remain low because awareness is low as well, noted Dr. Carolyn B. Bridges, associate director of adult immunization at the CDC and co-author of the report: “There is not enough information about which vaccines are needed for adults and unlike children, who have regularly scheduled doctors’ visits for vaccines, this is not the case for adults.” She adds that vaccine schedules for adults are based on not just age, but on personal risk and occupation as well.
Does sugar need to come with a warning label, just like cigarettes? Well, maybe things aren’t that drastic, but a new commentary published in Nature calls for much greater regulation of sugar-sweetened foods.
According to The Wall Street Journal Health Blog, the authors of the piece – all scientists at the University of California – say that taxes, zoning ordinances and even age limits for buying sugary sodas should receive serious consideration by the federal government. Such measures, they stress, would not apply to fruit or other foods with naturally occurring fructose.
While sugar doesn’t receive the same level of disapproval as saturated fat or salt, the authors argue that it’s more than just empty calories, Overconsumption of fructose contributes to hypertension and diabetes, and is a leading factor in the rise in obesity over the past several decades.
Naturally, the Sugar Association begs to differ. In a response on its website, the industry group calls the authors arguments “flawed", noting that while people consume more calories per day than we did 40 years ago, caloric sweeters account for only a small fraction of those extra calories.
“We consider it irresponsible when health professionals use their platforms to instill fear by using words like ‘diabetes,’ ‘cancer,’ and even ‘death,’ without so much as one disclaimer about the fact that the incomplete science being referenced is inconclusive at best,” the association says.
Do you need professional help with your weight problem? Well, if your family doctor also happens to be battling the bulge, you may want to consider getting your counseling elsewhere. WebMD reports doctors of normal weight are more likely to offer advice on diet and exercise that one who is overweight or obese.
A survey of 500 primary care physicians found that doctors who have a normal body mass index were more likely to discuss weight loss issues, compared to overweight and obese physicians (30% to 18%, respectively). Additionally, doctors of normal weight were much more likely to diagnose someone as obese if they thought a person’s BMI equalled or exceeded their own, and were more confident that patients would follow their advice.
Exactly why heavier doctors may be reluctant to discuss weight issues is not fully understood. One possibility is that an overweight doctor won’t recommend eating less and exercise more when that same approach didn’t work for him or her. “They may not want to give advice that is not effective in their own minds,” says researcher Sara Bleich, PhD of the Johns Hopkins Bloomberg School. She adds that heavyset doctors are more likely to suggest weight loss pills.
Another possible explanation: “They are used to seeing overweight and obese patients who look like they do and doctors may think, ‘I am OK and so are they,’” Bleich says.
The Affordable Care Act no longer allows health insurers to set lifetime maximums on coverage. But the change doesn’t apply to people in high-risk insurance pools – sicker individuals who would benefit most from unlimited access to medical funds.
NPR reports that unlike commercial health plans, most state high-risk pools for people with pre-existing conditions aren’t licensed as insurance issuers, and therefore the provision eliminating lifetime limits doesn’t apply to them. About 45,000 people are currently enrolled in the pools, in addition to more than 200,000 who joined state pools that were in place prior to the enactment of the health care reform legislation in 2010.
The article notes that some state plans – specifically, the 23 run by the federal government – do not cap their high-risk plans, even though they’re under no obligation to offer unlimited coverage. And other states have kept the coverage limits, but bumped up the maximum amount.
Preexisting-condition insurance plans serve as a stopgap until 2014, when insurers must charge all consumers the same cost for coverage regardless of their condition. However, if the Supreme Court strikes the individual mandate from the ACA, the same-premium provision likely would also be dropped from the law.
Since the Food and Drug Adminstration approved direct-to-consumer pharmaceutical advertising in 1997, drug manufacturers have worked overtime to promote name recognition to potential customers. One proven strategy used in this pursuit: the checklist.
The New York Times recently examined the phenomenon of “disease mongering", in which a marketing team devises a list of symptoms that a specific medication can treat – symptoms defined broadly enough to make consumers think they may suffer from the condition. The checklists are then placed on websites, on downloadable apps and in pamphlets in doctors’ offices. And patients who diagnose their ailments in this manner associate the drug as an effective cure.
From the Well Blog:
“The makers of Yaz, a birth control pill, for example, used a checklist to help promote the use of their drug as a treatment for premenstrual dysphoric disorder, a controversial diagnosis said to affect up to 10 percent of women. Alongside links to articles on fashion, makeup, hair and celebrity news, Yaz’s Web site offered a ‘Body Diary’ checklist to help patients determine whether they suffer from the disorder.
“Taking its cues from the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., which mental health professionals use to diagnose disease, the checklist offered watered-down and potentially more inclusive descriptions. A symptom described in the D.S.M. as “persistent and marked anger or irritability or increased interpersonal conflicts” appeared in the Yaz questionnaire as “Felt angry, or irritable.” … The printable results that patients could then take to their doctors (the site has since been taken down) were on a form emblazoned with the birth control brand.”
A new Harris Interactive/HealthDay survey reveals that key provisions of the Affordable Care Act are increasingly finding favor with most Americans.
HealthDay News (via MedicineNet.com) reports that people remain sharply divided over the overall legislation, mainly along partisan lines – most Democrats support it, while most Republicans want it repealed. But major elements of the bill have gained in popularity, including:
One provision that has the masses have definitely not embraced is the individual mandate – only 19% of those polled support requiring most Americans to buy health insurance or pay a tax penalty.
The poll also found that 55% of respondents believe that health care reform should be addressed at the state level, rather than federally.
Dieting need not come down to how much fat, carbs or protein you consume – calories are what counts, says a new scientific study.
According to Reuters, researchers randomly assigned several hundred overweight or obese people to one of four diets: average protein, low fat and higher carbs; high protein, low fat, and higher carbs; average protein, high fat and lower carbs; or high protein, high fat and lower carbs. Each of the diets was designed to eliminate 750 calories a day from the people’s energy needs.
After six months, researchers found that participants had lost over nine pounds of fat and nearly five pounds of lean mass. A two-year follow-up revealed that, on average, people maintained a weight loss of eight pounds. But across-the-board losses were similar regardless of what diet was assigned.
“If you’re happier doing it low fat, or happier doing it low carb, this paper says it’s OK to do it either way. They were equally successful,” said Christopher Gardner, a Stanford University professor who was not involved in the study. Finding a diet you can stick with is more important, he added.
If you’ve put off a cancer screening, you’re not only doing yourself a disservice – you’re also disappointing your friends in the federal government.
According to WebMD, a new Centers for Disease Control and Prevention report says that screening rates for breast, cervical, and colorectal cancer remain below target levels set by federal officials in the Healthy People 2020 initiative:
The federal government doesn’t set target numbers for prostate cancer, so those sceening rates weren’t included.
At MedBen, we encourage all adults to get their age-appropriate cancer tests. A reminder for our Worksite Wellness members: you can monitor you compliance critical wellness examinations, including all four cancer screenings mentioned above, by visiting the MedBen Access website and clicking on the Wellness Plan link under “My Plan”.
Two health care reform news notes to begin the week:
Reuters reports that the Obama administration has presented a written brief to the Supreme Court, which argues that even if the individual mandate is found unconstitutional, almost all the rest of the Affordable Care Act can still function properly.
“Many provisions of the act, focused on controlling costs, improving public health and other objectives, have no connection to insurance coverage at all,” Solicitor General Donald Verrilli wrote in the brief. Only the provisions that bar insurers from rejecting an applicant because of pre-existing conditions, and from charging higher premiums based on a person’s medical history, would have to be removed from the law.
If the administration’s attorneys hadn’t already thought up a valid justification for the individual mandate, they got one this weekend from a surprising source: Republican presidential nominee Mitt Romney.
NPR reports that at a GOP debate in Jacksonville, Florida, Romney defended the introduction of a 2006 Massachusetts law which required most state residents to buy health insurance or pay a tax penality. Romney was governor at the time the law was passed.
“If you don’t want to buy insurance, then you have to help pay for the cost of the state picking up your bill, because under federal law if someone doesn’t have insurance, then we have to care for them in the hospitals, give them free care,” said Romney. “So we said, no more, no more free riders. We are insisting on personal responsibility. Either get the insurance or help pay for your care.”
The third time’s the charm for the diabetes drug Bydureon. MedPage Today reports that the Food and Drug Administation has approved the once-weekly injection for type 2 diabetes – the first such treatment to get the green light.
Drugmakers Amylin and Alkermes submitted Bydureon (exenatide extended-release) for FDA review in 2009, but approval was twice delayed due to questons about the manufacturing process and a possible cardiovascular side effect. The agency did make approval contingent upon the drugmakers putting together a strategy to address concerns over acute pancreatitis and potential risk of thyroid cancer.
Common side effects of Bydureon include nausea, diarrhea, upper respiratory tract infection, and injection site nodules. But earlier trials showed that the drug promotes weight loss rather than gain, and shows better glycemic control than with the once-daily version of exenatide (Byetta).
Specialists lately have experienced a boom in referral business. The New York Times reports that doctors decided to send their patients to specialists and other doctors 9.3% of the time, compared with 4.8% a decade earlier, according to a new Harvard Medical School study.
“This evolution in care patterns may be playing a role in the rising trajectory of health care spending in the U.S., as referrals to specialists may lead to increased use of higher-cost services,” the researchers said. They add that while sometimes the referrals lead to necessary treatments, in other cases the additional tests and procedures do little to benefit patients.
How to explain this trend? “Medicine is becoming increasingly technologically sophisticated,” as the number of specialists and subspecialists has risen, said study co-author Dr. Bruce E. Landon. But he also atrributes it to the “tyranny of the 15-minute visit,” as primary care physicians have less time and resources to delve into any potentially complicated medical condition.
MedBen recently introduced comprehensive care management through Accountable Care Solutions (ACS). These programs were designed by medical professionals to control expenses for three costly and pervasive chronic conditions: Cardiovascular, Kidney Care and Oncology, or cancer care.
In a recent e-newsletter, inVentiv Medical Management, MedBen’s ACS partner, highlighted three reasons why cancer care management is so important:
Comprehensive Oncology Care Management begins at the time of diagnosis and prior to therapy. ACS provides care resources during therapy to empower patients and caregivers, and provides claims surveillance to realize cost savings after therapy.
To learn more, contact MedBen Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.
The latest opinion poll by the Kaiser Family Foundation found that 54% of respondents feel that the Supreme Court should rule unconstitutional the individual mandate, The Wall Street Journal Health Blog reports.
Only 17% say that the provision requiring most Americans to buy health insurance should stand. The remaining 29% said they didn’t know or didn’t want to answer.
In other health care reform news:
During a Daily Show interview, Health and Human Services Secretary Kathleen Sebelius stated that if the Supreme Court does strike down the individual mandate, they are other ways to convince healthy people to carry coverage. “[T]he mandate’s the fastest way to do it, and it just says, basically, everybody’s got some responsibility. But there are other ways to encourage people to come in,” she said.
According to Healthwatch blog, Sebelius also thinks that businesses will continue to provide coverage to employees even after insurance exchanges become available.
Healthwatch also reports that former senator Norm Coleman, an adviser to Mitch Romney, predicted that should a Republican win the presidency this November, the Affordable Care Act would not be repealed. “You can’t whole-cloth throw it out. But you can substantially change what’s been done,” he told BioCentury This Week television.
Romney’s campaign feels differently. “With all due respect to Sen. Coleman, he’s wrong,” campaign spokeswoman Andrea Saul said via e-mail. “Gov. Romney can and will repeal Obamacare and is committed to doing so.”
The Food and Drug Administration needs to enact more stringent safeguards to protect the users of dietary supplements, according to a physician writing in the New England Journal of Medicine.
Pieter A. Cohen, MD, of Harvard Medical School writes that the more than 100 million Americans who annually buy vitamins, minerals, herbal ingredients, amino acids and other natural products presume that they are “both safe and effective". But weak FDA oversight of supplements provides no such reassurances.
In an article about Cohen’s essay, MedPage Today notes that ingredients used and sold in supplements prior to 1994 can be legally marketed without proof of safety or efficacy. A law called the Dietary Supplement Health and Education Act (DSHEA) requires manufacturers of any ingredient introduced after 1994 to provide the FDA with evidence supporting “a reasonable expectation of safety.” But Cohen says that part of the law “has thus far not been enforced.”
There are currently over 55,000 supplements on the market, 51,000 of which were introduced after DSHEA became law. But since 1994, the FDA has received notification for just 170 new supplement ingredients – “undoubtedly a small fraction of the ingredients for which safety data should have been submitted,” Cohen writes.
Last year, the FDA did issue draft guidance regarding information supplement manufacturers must submit to the agency. Cohen says the guidance “provides a thoughtful framework” and is a step in the right direction, but further measures are needed to protect consumers.
Putting in overtime at work may impress the boss but does no favors to your mental disposition, a new study suggests.
Health.com reports that researchers followed over 2,000 British employees for six years, and found that workers who stayed at the office an average of 11 hours per day were more than twice as likely to develop depression than their colleagues who stuck to an 8-hour schedule. The risk remained constant even when such factors as workplace support, alcohol use and smoking were taken into account.
An worker’s position on the job ladder also impacted how he or she responded to longer hours. Junior and mid-level employees were more prone to depression than executives who burned the midnight oil. That’s likely due to the amount of control higher-ups have over their own work, said Alan Gelenberg, M.D., chair of the psychiatry department of Pennsylvania State University.
“I do mostly what I want to do, and when I put in an extra hard week, it’s my choice,” said Gelenberg, who was not involved in the study.
The researchers theorize that for workers lower on the food chain, long hours could create family or relationship conflicts that contribute to depression. Job insecurity and sleep deprivation may also be factors.
One of the more controversial provisions of the Affordable Care Act is the requirement that health insurance plans cover contraceptive for women at no cost. Last week, the Obama administration rejected an exemption request by the Roman Catholic Church for employees of Catholic hospitals, colleges and charities.
The New York Times reports that federal officials did grant one minor concession: Church-affiliated organizations have until August 1, 2013 to comply with the requirement – one year longer that most other employers and insurers. Also, certain “religious employers", such as houses of worship, would be exempt, provided they exclusively employ or serve people of a single faith.
In deciding whether or not to grant an exemption, President Obama heard personal appeals by leaders of the Roman Catholic Church. He also considered the arguments of family planning advocates and experts on women’s health, who have long championed inexpensive access to birth control.
Kathleen Sebelius, the Secretary of Health and Human Services, said the ruling “strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services.” Archbishop Timothy M. Dolan of New York reponded that “the president is saying we have a year to figure out how to violate our consciences.”
Better treatment for diabetics are likely responsible for a dramatic decrease in foot and leg amputations, new government research finds. The Associated Press reports that the rate has fallen by more than half since the mid-1990s.
According to MayoClinic.com, diabetics can suffer from nerve damage and poor blood circulation that make the feet vulnerable to ulcers. If these ulcers go untreated, they can cause severe damage to tissues and bone – potentially necessitating surgical removal of a toe, foot or part of a leg.
The comprehensive study by the Centers for Disease Control and Prevention determined that for older diabetics – the population segment most suspectible to foot ulcers – amputations dropped from more that 11 to about 4 per 1,000 people. Officials noted that between 1988 and 2008, a greater proportion of diabetics got annual foot exams, and cited proper disease management as the main reason for the decline in amputations.
As the obesity rate has increased in the U.S., incidents of Type 2 diabetes have risen accordingly. But better treatment has led to declines in complications of the disease, including blindness and kidney failure in addition to amputations.