Dismantling the Affordable Care Act - Piece by Piece.

While Republican efforts in Congress failed to completely repeal the Affordable Care Act , the Trump administration continues to chip away at many of its protections, particularly repeal of the individual mandate, which required that all Americans have health insurance or pay a penalty on their tax return each year. Now, the administration is giving more power to states to oversee health insurance.  Kentucky last week received approval of a request to allow work requirements for Medicaid coverage.  Idaho officials said they will allow insurers to sell health plans that do not meet all the requirements of the Affordable Care Act. 
Meanwhile, the latest government funding bill managed to finally save the Children's Health Insurance Program, which covers more than 9 million children across the U.S.. -- after months of uncertainty and worry for parents.  It also delayed taxes on medical devices, high-priced employer-sponsored health plans (Cadillac Tax) and insurers..  Whether Congress will again turn its focus to health care is uncertain, but it is likely to be on the front-burner in 2018, as Congress continues to wrangle with stabilization and reinsurance bills and a possible additional stab at repealing the ACA.

The Power of Positive Pessimism Can Extend Our Lives

When we were in college, we adopted a mindset right before major tests or final exams that screamed to others: "Help, I'm going to fail...I'll never learn all this material."  When we landed our first big job, we secretly pondered whether we would ever be able to learn the the complexities of the business.  And in many of our personal encounters we wondered if people would really like us or love us or spend the rest of their lives with us.  Throughout these outwardly dramatic shows of  apparent pessimism, most of us were secretly thinking things would turn in our favor...most of us in our younger years were still generally optimistic about our overall futures even as we underestimated our abilities to perform. For these encounters, we practiced the power of positive pessimism, which is really cautious optimism in disguise.

A recent German study in the journal Psychology and Aging shows that genuine pessimism in older adults might have the added bonus of improving their life spans. Findings suggest that older adults are more likely to underestimate their satisfaction with their lives and that this underestimation was associated with positive health outcomes.  Pessimism was related to better subjective health and higher income.  The researchers speculate that, in older age, individuals are more likely to consider their time to be limited and this realization promotes a closer look at savoring the present rather than expecting things to improve in the future.

Data also indicated that younger people remained optimistic about their futures, the researchers found, perhaps because health was not as bi an issue,.   In midlife, they found that adults changed from a more optimistic view to a more realistic anticipation of their future satisfaction and that this group might experience a turning point with regard to their expectations for the future
So perhaps, in the older group, the pessimists worry more about their health and undertake more steps to ensure their well being.  The researchers suggest that their findings serve to underscore the critical role of realistic views on the future when having to cope with the challenges of aging.

Perhaps the power of positive pessimism provides a cautious approach for older Americans to embrace.

Baby Boomers are losing the health battle against diabetes high blood pressure and obesity, study says

The baby boom generation is known for pushing their bodies to exercise more and for striving for healthier diets.  They appear to be healthier than their parents in some important ways. Boomers smoke less, have fewer cases of emphysema and have fewer heart attacks,  according to a recent study appearing in JAMA Internal Medicine and featured on a segment of NPR's "All Things Considered."

However, the number of boomers with diabetes, high blood pressure and obesity is growing steadily.  And more people in their late 40s to mid 60s were found to be disabled and unable to work the researchers said.  This increase in disabilities, however, could be an indirect result of the physical and psychological stress resulting from years of a poor economy and  tough job market for people over 50.

The researchers examined data from the National Health and Nutrition Examination Survey to compare the two generations.

Part of the reason boomers appear sicker than their parents is that they are more likely to visit doctors and to be diagnosed and treated for diseases their parents didn't know they had, the researchers note.  While some bommers might live longer than their parents, the study sconcludes,  they are racking up more knee operations and taking more medications for high blood pressure, high cholesterol and diabetes.

When asked to describe their overall health, the study said, only 13 percent of boomers said they were in excellent health compared with 33 percent a generation ago, and twice as many said they were in poor health.

Comment:  Obesity, poor eating habits, longer work hours and greater family responsibilities (aging parents or chronically ill mates)  are contributing to health challenges that threaten to drastically increase health care spending in the baby boom generation.  Boomers know they need to better control their diets, increase their exercise and control their stress, but the medical community will have to continue to educate and perhaps take more drastic steps in the future to curb the increase in health risks among this generation.

World Health Organization targets chronic disease management as incidence rates rise for hypertension, diabetes and obesity

A new report from the World Health Organization (WHO) highlights the growing problem of the chronic disease burden. across the globe.  One in three adults worldwide has raised blood pressure – a condition that causes around half of all deaths from stroke and heart disease, the report says.  In addition, the incidences of diabetes and obesity are rising around the world.

“This report is further evidence of the dramatic increase in the conditions that trigger heart disease and other chronic illnesses, particularly in low- and middle-income countries,” says Dr Margaret Chan, Director-General of WHO. “In some African countries, as much as half the adult population has high blood pressure.”

Widespread diagnosis and treatment with low-cost drugs has significantly reduced mean blood pressure across populations in high income countries, WHO says.  In turn, this has contributed to a reduction in deaths from heart disease. In Africa, however, more than 40 percent of adults in many countries are estimated to have high blood pressure. Yet most of these people remain undiagnosed, even though many of these cases could be treated with low-cost medications, which would significantly reduce the risk of death and disabling illnesses.

For diabetes, the global average prevalence is around 10 percent but as much as one-third of populations in some Pacific Island countries have this condition.  The incidence of obesity doubled in every region of the world between 1980 and 2008, reports Dr. Ties Boerma, Director of the Department of Health Statistics and Information Systems at WHO. “Today, half a billion people (12 percent of the world’s population) are considered obese.”


Further action:  The World Health Assembly, being held in Geneva from May 21 to May 26, 2012, will review progress in these disease areas and will discuss ways to develop a global monitoring framework to set voluntary targets for prevention and control of these diseases, targeting risk factors.

Eating foods rich in omega-3 fatty acids may ward off Alzheimer's

People who eat foods rich in omega-3 fatty acids, such as fish, chicken, olive oil and nuts, may have lower blood levels of a protein related to Alzheimer’s disease and dementia, according to a new study published in the May 2, 2012, online issue of Neurology® and a press release issued by the American Academy of Neurology.

The study tracked 1,219 people older than age 65, free of dementia, and gather information about their diets for an average of 1.2 years before  targeting their blood as a test for the beta-amyloid.  The study reoports that the more omega-3 fatty acids a person took in, the lower their blood beta-amyloid levels. For example, eating one gram of omega-3 per day (equal to approximately half a fillet of salmon per week) more than the average omega-3 consumed by people in the study is associated with 20 to 30 percent lower blood beta-amyloid levels.


What you can do:  Try adding a handful of almonds, pecans or walnuts to your daily diet, eat a weekly portion of salmon, trout or tuna; and add a tablespoon of olive oil to your salad.  For more information about Alzheimer's disease and eating for a healthy brain, go to the following Alzheimer's Association site:  http://www.alz.org/we_can_help_adopt_a_brain_healthy_diet.asp.

U.S. Spends Too Little on Public Health Initiatives, Says New Institute for Medicine Report

The U.S. health system has failed to develop and deliver effective preventive strategies and this continues to take a growing toll on the economy and society, according to a new report from the Institute for Medicine (IOM).  The IOM report says America needs to improve its lackluster performance on health outcomes compared with its peer nations and to maintain its international competitiveness by investing more in its chronically underfunded public health system.  It also should spend public health dollars more efficiently. 

According to IOM, the United States spends more on health than other nations — almost $2.5 trillion in 2009 . Despite the big spend, the U.S. scores lower than other wealthy ations on life expectancy, infant mortality, and other indicators of population health.  The chronic diseases that contribute to the bulk of U.S. health spending are conditions that could be better controlled or prevented through public health initiatives, services, and expertise. Yet,, only 3.1 percent (2009 figures) of U.S. health dollars goes to government-administered public health, according to the Centers for Medicare and Medicaid's National Health Expenditure Accounts. This amounts to $251 per person in public health spending compared with $8,086 per person in medical care spending, IOM said in a press release.

The IOM committee that wrote the reportcalls on the U.S. Department of Health and Human Services to set new goals for U.S. life expectancy and per-person health spending as a critical first step in framing the nation's efforts to reach improved overall health outcomes. Setting these targets will engage public health professionals to maximize the value of the dollars invested in the nation's health system, the committee said. They also need to ensure that public health skills and knowledge are applied to medical care issues relevant to population health, such as the frequent overuse and misuse of medical procedures.

The IOM report concludes that federal spending on public health should at least be doubled from its current level of about $11.6 billion per year to approximately $24 billion as a starting point to meet the needs of public health departments and  the committee recommends ways to raise the extra funding.

Autism rates on the rise again, CDC reports

As the nation celebrated World Autism Awareness Day on April 2, we learned that new government estimates show autism on the rise among U.S. children.  About 1 in 88 children has been identified with an autism spectrum disorder (ASD), according to estimates from the Center for Disease Control's Autism and Developmental Disabilities Monitoring (ADDM) Network. This is a considerable increase over the 1 in 6 children identified with a developmental disability in 2006-2008, ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism.. Some experts have speculated that the increase in ASD cases is due to the improved diagnosis and expanded definition of autism and autism spectrum disorders.  Differences in record-keeping across different states also may account for the increasing numbers, the CDC notes, as the number of cases fluctuate from one state to another.  The CDC also found that ASDs are almost 5 times more common among boys (1 in 54) than among girls (1 in 252). ADDM Network investigators will continue to explore the factors surrounding ASDs, reports the CDC in a recent Morbidity and Mortality Weekly Report, with a focus on understanding disparities in the identification of ASDs among certain subgroups.  Researchers will also examine how these disparities have contributed to changes in the estimated prevalence of ASDs and will also take a look at risk factors that can contribute to these disorders.

Can an aspirin a day keep cancer away? New research suggests prevention benefits

Long been called "the wonder drug"  for its anti-inflammatory and cardiovascular benefits, inexpensive  aspirin could once again show us that the best things in life are almost free.  Studies by researchers at the University of Oxford report that taking an aspirin a day might help reduce the risk of cancer and ward off cancer metastasis, the spread of cancer from one body location or organ to another.  However, the researchers caution that this is not a call for everyone to begin taking aspirin.  Concerns over the gastrointestinal effects of aspirin remain for those at risk of bleeding and more research is needed to further examine the benefits regarding cancer prevention.

One of the studies reports that aspirin use reduced the risk of cancer by 20 percent.  In another review of several large randomized studies, the Oxford researchers reported that after more than an average of six years, a daily aspirin regimen reduced the risk of metastasis by 36 percent.  The study was published in the March 20 issue of The Lancet.

What you can do:  If you believe you have an increased risk of a particular type of cancer, check with your doctor to see if an aspirin a day regimen is warranted.

Better Heart Healthy Habits Could Reduce Cardiovascular Disease, but Few Americans Meet All Seven AHA Targets

The American Heart Association  recently recommended seven cardiovascular health targets that can encourage the general population to improve cardiovascular. They include: being physically active; not smoking; having normal blood pressure, blood glucose, total cholesterol levels, and weight; and eating a healthy diet. But a new study in the Journal of the American Medical Association reports that less  than 2% of Americans meet these seven recommended heart health targets, even though results indcated that eliminating these risks could dramatically reduce the risk of heart disease.  Unfortunately, the researchers from the Centers for Disease Control and Prevention found that the number of Americans meeting all seven heart health targets actually dropped from 2% in 1998-1994 to 1.2% in 2005-2010.  The prevalence of meeting six or more cardiovascular health targets was 10.3%  in 1988-1994 and declined to 8.8%  in 2005-2010.  Findings were also worse at the bottom end of the metrics.  The prevalence of those  meeting one or fewer cardiovascular health metrics increased from 7.2% in the earlier period  to 8.8% in 2005-2010. 

It's disappointing that even with greater access to medical care, generally improved health literacy and health information available via the Internet and social media, Americans' overall cardiovascular risk is increasing, rather than declining.

What you can do:  Take steps to improve your diet and exercise regimens and to read nutrition labels to avoid unnecessary refined sugars and cholesterol.  If you smoke, get help through various smoking cessation programs that are available online or through your doctor. 

Coaxing gut cells to make insulin: Could this be a viable treatment for Diabetes Type 1?

Diabetes type 1 can be a particularly brutal autoimmune disease that compromises the daily lives of millions of people, but researchers at Columbia University think they might have found a novel way to treat the disease. The researchers hypothesize that cells in the patient's intestine could be coaxed  into producing insulin, thereby avoiding the need for a stem cell transplant.  The research—conducted in mice—was published March 11 in the journal Nature Genetics.  The Columbia study has found that certain progenitor cells in the intestine of mice have the surprising ability to make insulin-producing cells.  They report that when they turned off a certain gene that plays a role in cell fate decisions—Foxo1—the progenitor cells also generated insulin-producing cells. More cells were generated when Foxo1 was turned off early in development, but insulin-producing cells were also generated when the gene was turned off after the mice had reached adulthood.  It's interesting that turning off Foxo1 in the pancreas did not have the same result, according to the report.  Insulin-producing cells in the intestine would be hazardous if they did not release insulin in response to blood glucose levels. However,  the researchers say that the new intestinal cells have glucose-sensing receptors and do exactly that.  They note that the insulin made by the gut cells also was released into the bloodstream, worked as well as normal insulin, and was made in sufficient quantity to nearly normalize blood glucose levels in otherwise diabetic mice.

What will further research do? The key to transforming these results into a viable therapy, says Dr. Domenico Accili, MD, professor of medicine at Columbia University Medical Center, will be to find a drug that has the same effect on the gastrointestinal progenitor cells in humans as "turning off" the Foxo1 gene does in mice. That should be possible, he says, because they also discovered that they could create insulin-producing cells from progenitor cells by inhibiting Foxo1 with a chemical.