Apparently, fish oil advocates have hired a dynamic new publicist. After several recent studies challenged the virtues of Omega-3 fatty acids, earlier this month we learned that supplements may aid chemotherapy patients. And right on the heels of that comes news that Omega-3s may also help to prevent the onset of age-related macular degeneration.
NPR reports that a study of nearly 40,000 women found that women who ate fish at least once a week decreased their risk of getting the disease – a major contributor to vision loss – compared to those who ate fish just once a month. Earlier studies have shown that that Omega-3s slowed progression of the disease, but this is the first time researchers have concluded that fish may actually stop it before it develops.
The article notes that this was an observational study – and as we posted here just a couple days ago, findings from such research should hardly be taken as gospel. That said, there’s probably no harm in upping your fishy consumption if you’re all about better eyesight.
There hasn’t been much talk of health care reform on Capitol Hill these days as other issues have taken priority. But there’s still a couple of rather important matters bubbling under the surface, so just to keep you up to speed…
Last month, the House of Representatives passed an amendment that would eliminate funding for the Affordable Care Act from this year’s federal budget. The Senate has yet to vote on the budget, and party disagreements about various other cuts has put the issue on the back burner for the moment. In the interim, Congress has approved two stop-gap bills to keep the federal government running, neither of which have referenced the ACA or health care reform provisions. The latest three-week stop-gap measure proposed by the House continues the trend, to the chagrin of some of the more conservative Representatives.
Read more about the Congressional goings-on at Politico.
One aspect of the ACA that appears to be on its way out is the 1099 reporting requirement, which would have required businesses to report to the IRS each purchase of goods and services from vendors of more than $600. But even though both the Senate and the House have agreed to eliminate the provision, the question remains as to how Congress will make up for the estimated $22 billion shortfall that its removal will cause.
According to The Hill website, the House 1009 repeal measure would “requires taxpayers who receive federal health insurance subsidies to reimburse the IRS with substantial penalties if they earn more than expected, especially after qualifying for the subsidy.” House Democrats oppose the requirement, while Republicans argue that taxpayers should have to return the subsidy if they don’t need it. Surprisingly, Senate Majority Leader Harry Reid (D-Nev.) backs the House pay-for as well.
Coffee may reduce the risk of a stroke. And then again, it may not.
WebMD reports that new research in the journal Stroke – yes, there’s apparently a journal called Stroke – that women who drink at least one cup of coffee daily may lower their odds of a stroke by 22-25% compared to women who drank less coffee. The study’s authors aren’t sure why coffee apparently reduced risk, but speculate that coffee may reduce inflammation and help make the body more responsive to insulin.
So should women stock up on Maxwell House? Not so fast, says health care journalist Gary Schwitzer. On his HealthNewsReview blog, he criticizes media coverage of the findings, which were based purely on observational research. Even though the data was collected from over 34,000 women, Schwitzer stresses that the limited nature of the study makes its conclusions questionable at best. (And it’s worth mentioning that another recent study linked coffee to a higher stroke risk.)
“Observational studies have inherent limitations that should always be mentioned in stories,” Schwitzer writes. “They can show a strong statistical association, but they can’t prove cause and effect. So you can’t prove benefit or risk reduction.”
Schwitzer goes on to take the WebMD article to task, saying it was “just plain inaccurate” to claim that “1 or More Cups of Coffee a Day Reduces Stroke Risk in Women.” Conversely, he commends HealthDay’s story about the study, which emphasizes that the researchers simply asked subjects about their past coffee consumption in a questionnaire without determining if their behavior changed over time, or controlling for medication use or other health factors.
The lesson we can learn from this is that just because a news article uses language that sounds definitive, that may not necessarily be the case. An association between coffee and strokes, be it positive or negative, doesn’t prove causality. So if you’re not a java junkie, don’t feel like you have to pick up the habit now.
A Wall Street Journal article examines some of the less desirous effects of health care reform. The piece focuses on the fallout from the Affordable Care Act provision that excludes over-the-counter drugs as an approved flexible spending account purchase unless the buyer has a prescription, a provision that took effect on January 1. Not surprisingly, prescription requests from FSA participants have spiked since then, adding another task to doctors’ crowded “to-do” lists.
Dr. Sandy Chung, a pediatrician, says the new rule “drives up the cost of health care as opposed to reducing it.” In addition to the extra paperwork, there’s a legal consideration – a doctor who prescribes an OTC medication over the phone could be held responsible if the patient has a negative reaction to it. Further, the provision increases the workload of pharmacists and retailers, who have to apply personalized labels onto the products.
The ACA has experienced growing pains in other areas as well. High-risk insurance pools have been a particular disappointment, with enrollment running at only 6% of expectations. And the provision requiring coverage to children with pre-existing conditions has led some insurers to drop their child-only policies altogether.
Is there any single day of the year people hate more than the one where we move our clocks ahead one hour? Something about the loss of those 60 minutes really brings out our collective surly side.
Well, don’t look now, but Daylight Savings Time begins this Sunday. But rather than curse the darkness (or the light, as it were), make the best of it by laying some groundwork… specifically, by getting a little extra rest beforehand.
Speaking to HealthDay, sleep disorder specialist Dr. Aparajitha Verma recommends getting up and going to bed an hour earlier beginning several days before the time change. Alternately, take a nap on Sunday afternoon if you feel the need, but avoid doing so within a few hours of your regular bedtime.
Should parents encourage their kids to play video games? Absolutely – so long as the games offer a opportunity for better health, a new study finds.
WebMD reports that University of Massachusetts researchers monitored the metabolic rates of children playing “exergames", which require the users to move the upper or whole body to mimic dance moves or participate in a variety of virtual sports, for 10 minutes. They found the activity burned about the same number of calories as walking on a treadmill at three miles per hour – 400% to 800% over their resting metabolic rate.
Kids with higher body-mass indexes, who might be reluctant to participate in group physical activities, were found to enjoy exergames more than children of normal weight. Study researcher Kyle McInnis notes that the games offer “a kind of built-in positive reinforcement.”
But while exergames provide a decent workout, experts recommend that indoor activity be only one part of a health regimen. “These are not a substitute for being outside, riding a bike, being on the soccer field,” says Kevin R. Short, PhD, assistant professor in the department of pediatrics at the University of Oklahoma Health Sciences Center.
There’s a whole lotta waiverin’ going on in the federal government these days. Over 1,000 organizations have been granted waivers that temporarily exclude them from meeting mandated coverage limits since last September. And now a whole state is off the hook from a key provision of the Affordable Care Act.
The Boston Globe reports that Maine does not have to comply with the requirement that insurers spend ar least 80% of their premiums on medical care (85% for large groups). Rather, the Department of Health and Human Services will permit the state to continue its 65% standard for the next three years. Kentucky, Nevada and New Hampshire have made similar waiver requests.
Maine Insurance Superintendent Mila Kofman requested the waiver out of concern that a major insurer – one that covers over a third of the individual policyholders in the state – would withdraw from the market.
Maine premium costs are among the highest in the nation, as insurance companies that do business in the state must approve all applicants and cover their pre-existing conditions.
Last October on this blog, we noted a study that revealed patients who receive palliative care – which contentrates on relieving the pain and stress of chronic conditions – actually live longer on average than those who get care focused exclusively on extending life. Now another study has determined that palliative care can save money as well.
According to The Wall Street Journal Health Blog, researchers tracked palliative care teams at four New York State hospitals during the years 2004-07. By coordinating the care of seriously ill Medicaid patients, the teams reduced inpatient costs by an average of $6,900 per admission.
While patients suffered from a range of chronic conditions, not every one was at the end of their lives. Palliative care differs from hospice care, which provides physicial comfort and emotional support to the terminally ill. Study co-author R. Sean Morrison says that palliative care “focuses on improving the quality of life for patients living with serious or life-threatening illnesses and their families” while offering “all other disease-directed and life-prolonging treatments.”
The study followed 485 Medicaid patients receiving palliative care. Of those, 296 patients were discharged alive (some to hospice, others to home care) and 189 died in the hospital. Compared to patients who received standard care, the cost difference was $4,098 for the living discharges and $7,563 for those who passed away during their stay. Morrison says that savings came from heeding the wishes of the patients: “Some patients might want to pursue all treatment options, while others want to be comfortable and to minimize symptoms… In the setting of this very complex, very sick population, you’re eliminating misutilization.”
In an attempt to make the Affordable Care Act (ACA) comprehensible to those of us who don’t speak government-ese, some well-known organizations – AARP, the American Cancer Society, and the American Medical Association among them – have developed the Health Care and You website.
We’ve taken a look around the site and found it to be very user-friendly. In addition to explaining the purpose of the ACA, Health Care and You breaks down the health reform law by state and other factors (i.e., people under age 65, small business owners) so users can see how ACA provisions impact specific populations.
The site also contains a ACA timeline in which the user can select a specific year to learn about future changes, and how the law affects selected groups. All in all, it’s a well-designed resource for anyone looking for intelligble reform information.
The New York Times has a story on the site’s rollout – you can find it here.
MedPage Today recently reported on a study in which Pennsylvania orthopedic surgeons acknowledged that nearly 20% of the scans they performed were for purely defensive purposes – representing about 35% of their total imaging cost.
Robert A. Miller, MS, of Temple University in Philadelphia, ran a voluntary audit of members of Pennsylvania’s orthopedics society. The audits were prospective – doctors offered their reasons for the imaging prior to the procedure. A total of 72 orthopedic surgeons participated, and more than 2,000 imaging orders were analyzed.
Of the 19.1% of scans that were performed primarily to avoid potential malpractice suits, 70% were standard X-rays and 25% were MRIs. However, Miller estimated that the MRIs accounted for about 70% of the defensive costs.
The 1-in-5 ratio may not be reflective of defensive medicine in the country as a whole, as Pennsylvania has a high litigation rate compared to other states.
A paper published in Health Services Research spotlights the cost of chronic medical conditions – and the need for a wellness approach to help control those costs.
As noted on the Healthcare Economist website, health expenditure statistics are commonly broken down by payer (such as Medicare or private insurance) or setting (inpatient or outpatient). The paper’s co-authors instead apply a “patient-centered” grouping to organize health care costs, by focusing on life events of the individual. Using data from the 2007 Medical Expenditure Panel Survey, the co-authors arrange the costs into 7 patient-centered categories.
As the chart shows, chronic conditions account for nearly half of all patient-centered care. When acute illness – which often stems from a chronic condition – is added in, the amount reaches 72.6%.
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Not getting enough shut-eye these days? You’re hardly alone. Two studies by the Centers for Disease Control (CDC) found that over a third of U.S. adults may be getting less than seven hours of sleep per day – and risking bodily harm by doing so.
WedMD reports that of 74,000+ adults in a 2009 CDC study, 35.3% said that they typically got by on less than seven hours of sleep in a 24-hour period, under the 7-9 hours recommended by the National Sleep Foundation. Additionally, respondents who didn’t get enough sleep were more likely to report falling asleep while driving or nodding off unintentionally during the day at least one time per month.
Demographics factored into the results. People 65 and over tend to get more sleep than people 18 to 24, and married people are generally better rested than divorced, widowed, or separated people. One of the greater disparities can be found in race – 48.3% of African-Americans get less than seven hours of sleep, compared to 34.9% of whites and 33% of Hispanics.
The second CDC study examined the relationship between hours of sleep and its effect on concentration, working and other sleep-related issues. Not surprisingly, people who sleep less hours have a more difficult time paying attention – 29.3% of stayer-uppers said they had trouble concentrating, compared to 19.4% of their more alert counterparts.
ABC News reports that Judge Roger Vinson, the Florida federal judge who in January essentially voided the Affordable Care Act (ACA), has granted a stay until March 10 to allow the Obama administration to appeal his ruling.
In his 20-page response to the administration’s request for clarification of his original ruling – a motion filed nearly two weeks after it was handed down – Vinson bordered on the sarcastic: “While I believe that my order was as clear and unambiguous as it could be, it is possible that the defendants may have perhaps been confused or misunderstood its import.”
Elsewhere in the response, the judge expressed in writing his irration with the government lawyers for delaying their stay request: “It was not expected that they would effectively ignore the order and declaratory judgment for two and one-half weeks, continue to implement the Act, and only then file a belated motion to “clarify.” He had expected the request to follow immediately after the ruling.
The question of the health care law’s constitutionality is expected to ultimately be settled in the Supreme… and the sooner it is, “the better off the entire nation will be,” Vinson wrote.
On a related note, if you’re interested on following the various legal goings-on, Kaiser Health News is thoughtfully doing the heavy lifing for you. You can read the ACA Scorecard here.
You know those disinfectant wipe dispensers you see when you enter the grocery store? Snag a sheet before heading for the carts. USA Today reports a study of grocery carts found some rather unpleasant things lurking on the handles.
Checking the handles of 85 carts in four states for bacterial contamination, researchers discovered that 72% of the carts contained fecal bacteria – more than is usually found in a bathroom. The tests also turned up E. coli on half the handles sampled.
Scientists link the study results to prior investigations that found kids who touch the handles increase the risk of infection from salmonella and other bacteria.
In addition to wiping down the handles, the researchers recommend inspecting meats and vegetables before placing them in reusable shopping bags to ensure they’re properly wrapped.
On the heels of a major anti-fraud sweep last month, a new report issued by the Government Accountability Office finds that almost 10% of all Medicare payments are fraudulent or otherwise improper, according to Politico.
The Centers for Medicare & Medicaid Services (CMS) estimate that of the $509 billion in fiscal 2010 Medicare expenses, $48 billion went toward fraudulent claims. But the GAO report goes even further, pointing out the CMS failed to take into account improper payments in its Part D prescription drug benefit – so the final amount may be even higher. “CMS needs a plan with clear measures and benchmarks for reducing Medicare’s risk for improper payments, inefficient payment methods and issues in program management and patient care and safety,” the report says.
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If you’ve been wary about working out because you’re concerned about damage to your knees, a new study may offer some good news for you – or bad news, if you’ve been using a bum knee as an excuse to stick to the sofa.
According to WebMD, researchers in Australia say that exercise is beneficial for knee joint health. Noting that some earlier studies have focused on the overall impact to the knee, a member of the research team said that “none [has] looked at the effect of physical activity on individual parts of the knee.”
Reviewing 28 studies, all of which examined the relationship between physical activity and knee osteoarthritis, the researchers found exercise to have a positive effect on cartilage integrity, with no damage to joint space (where cartilage is housed). Their conclusions challenge long-held thinking that exercise promotes the development of osteophytes, bony spurs in the knee.
Team co-leader Donna Urquhart, PhD said in a statement, “These findings are significant, as they suggest that osteophytes, in the absence of cartilage damage, may just be a functional adaptation to mechanical stimuli.”
The Food and Drug Administration has ordered that more than 500 prescription cold, cough and allergy medicines be taken off the market, The New York Times reports. While none of the drugs on the list have been found to be unreliable or dangerous, they either predate 1962, the year that the FDA first required drugs to undergo agency review for safety and effectiveness, or contain the same ingredients as drugs marketed before 1962. As the drugs have never been approved, they will need to pass FDA testing before they can return to the market.
The drugs are generally not well known to modern consumers, and even in their absence, many approved prescription medications are still available – so doctors and their cold-suffering patients will still have plenty of remedies available. And the most popular over-the-counter medications are not affected by the FDA’s order.
A listing of the medicines pulled from the market can be found at the FDA website. Pharmaceutical companies have 90 days to stop making the drugs, and 180 to cease their distribution.
If you’re a regular visitor to this blog, you’re hopefully aware of the fact that the Affordable Care Act is alive and well (well, pretty well, anyway). But a pretty substantial number of Americans – nearly one-quarter, in fact – think that federal health reform is no more.
A Kaiser Family Foundation poll found that 26% were uncertain of the ACA’s current status, while 22% believe it had been repealed altogether. The balance of the 1,001 individuals surveyed correctly responded that the ACA is hanging tough.
Actually, it’s not hard to understand why there’s a bit of befuddlement about the current state of reform. The House bill calling for the law’s repeal did pass, and got a lot of press in the process. When the bill failed in the Senate, the news received comparatively little mention, possibly because it seemed such a foregone conclusion.
Other factors also come into play, as The Wall Street Journal Health Blog notes. The House voted several weeks ago to defund the ACA, and as the Senate hasn’t held a similar vote yet, the issue remains in limbo as the federal budget is hammered out. Also, two federal judges have ruled that the individual mandate provision is unconstitutional – one of whom has gone so far as to declare the entire law null and void. So there’s a good deal of confusion about where health care reform stands at the moment.
Perhaps in part to counter the public disorientation on the matter, the Obama administration has requested that the judge who struck down the ACA clarify his ruling.
In previous blog postings, we’ve been pretty rough on fish oil, noting separate studies that concluded that the supplements don’t enhance babies’ IQs, slow Alzheimer’s disease, or prevent heart rhythm problems. But finally there’s a bit a positive news: New research suggests that fish oil supplements may help patients undergoing chemotherapy to avoid the accompanying muscle loss and malnutrition.
According to HealthDay (via MedicineNet.com), a study of 16 lung cancer patients who took supplements containing omega-3 fatty acids throughout their chemotherapy showed greater muscle mass gains compared to 24 patients who didn’t take the supplements. Further, over the 10-week period, the fish oil group lost no weight, while the non-supplement group lost an average of 5 pounds.
Lona Sandon, a registered dietitian who reviewed the findings, was pleased that fish oil appears to aid against malnutrition while preserving lean muscle tissue – both vital to fighting the cancer. But she cautioned that the amount of supplements necessary to affect change is two to three times more than the weekly dietary allowance of fish.
“I would say this is certainly worthy of continuing research and exploration,” Sandon said. “But meanwhile, people should definitely not go out and start consuming huge amounts of fish oil.”
A few weeks, back, we highlighted a Consumer Reports study of physician attitudes toward their patients. One of the noteworthy findings was that doctors don’t care much for patient who do self-diagnoses online – nearly half felt that it served no useful purpose. But one doctor in the minority argues why Internet research can be a good thing, in an ABC News opinion piece.
Dr. Roni Zeiger shares a colleague’s personal story: When his infant daughter was acting strangely, the colleague and his wife sought a doctor’s diagnosis, only to be told to let the illness run its course. But when the odd behavior continued unabated, the parents took to the Internet to seek a potential cause for her lethargy and drooped head. And they found it – infant botulism, a sometimes fatal disease. ER doctors agreed with the diagnosis and brought in a specialist for treatment.
Dr. Zeiger notes that infant botulism is so rare – only about 100 cases are reported in the US every year – that most physicians will never encounter it. So in this case, the parents’ legwork had a critical impact and, moreover, the doctors were grateful for the diagnosis. He does admit that self-diagnoses can sometimes do more harm than good, as when an individual mistakes the symptoms of a common cold for something more serious. But Dr. Zeiger feels strongly that anything that forges a partnership between patient and doctor should be encouraged.