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.

March is National Nutrition Month: 'Get Your Plate in Shape'

We all know we have to eat better and exercise more, but sometimes we need vivid reminders, especially after a series of holidays that encourage eating the wrong foods, along with calorie-rich desserts.  To underscore how to "get your plate in shape,"  the National  Academy of Nutrition and Dietetics has proclaimed March National Nutrition Month with a public information and education campaign that focuses attention on the importance of making informed food choices and developing good physical activity habits.  The theme of this year's campaign encourages consumers to eat the recommended amounts of fruits, vegetables, grains, protein foods and dairy each day.
"The Academy of Nutrition and Dietetics is committed to improving the nutritional health of consumers by translating sound, science- and evidence-based research into messages they can understand and apply to their everyday lives," said registered dietitian and Academy President Sylvia Escott-Stump. She said the campaign aims to help people make the simple changes to their daily eating plans that will benefit them
throughout their lives.

In 2011, the U.S. Department of Agriculture launched the program MyPlate, which  replaced MyPyramid as the government's primary food group symbol.  It is a visual cue to help consumers adopt healthy eating habits consistent with the 2010 Dietary Guidelines. It divides the plate into four sections: fruits, vegetables, grains and proteins, as well as a glass representing dairy products.

To further educate the public,  the Academy's National Nutrition Month website includes helpful tips, promotional tools, games and nutrition education resources designed to foster good nutrition around the "Get Your Plate in Shape" theme.

What You Can Do:  Get your own plates in shape by visiting the National Nutrition Month web site and by making a conscious effort to eat more fruits, vegetables, nuts and low-fat dairy products while adding moderate exercise to your daily routines.

Couch potatoes beware: Prolonged sitting can lead to health problems

A new study suggests that being a couch or computer potato for long periods is hazardous to your cardiovascular health.  Overweight people who sit for prolonged periods, whether in front of the TV or working at a computer, should stop and take short walking breaks every 20 minutes to avoid spikes in glucose and insulin levels, according to a new study in the March issue of Diabetes Care.  The 19 overweight or obese subjects in this trial were subjected to three different trial situations.  The first involved a long period (up to seven hours) of uninterrupted sitting; the second kept them seated with  2 minutes of of light-intensity walking every 20 minutes; and in the third, they were seated with 2-minutes of moderate-intensity walking every 20 minutes. Each subject received a high sugar, high fat test drink after an initial 2-hour period of uninterrupted sitting and then glucose and insulin levels were measured for each of the three treatments. In both the light intensity and moderate-intensity treatment sessions, the obese/overweight subjects had lower glucose and insulin levels than when they were in the uninterrupted sitting session.

The researchers, led by Dr. David Dunston of the Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia, conclude that when sitting for long hours, periodic breaks can help reduce cardiovascular risks and can potentially be an important public health intervention strategy.

What you can do:  If you sit for long hours at a computer desk or another "desk" job, or if you like to spend your entire evening in front of the TV, get up and take a walk (or exercise in place) every 20 minutes, for several minutes.  It will not only burn some calories, but could possibly lower your risk of cardiovascular disease.

Flavinoid in cocoa could help rebuild skeletal muslce in heart failure, diabetes patients

Maybe there is another good reason for most of us to love chocolate, especially the dark variety. A new study reports that treatment with epicatechin-enriched cocoa, a flavonoid in dark chocolate, showed improvement in the mitochondria of skeletal muscles after that mitochrondia had been damaged by the effects of Type 2 diabetes and heart failure.  Mitochondia are structures responsible for most of the energy produced in our cells.   In a small clinical trial at the University of California at San Diego, researchers found that patients with advanced heart failure and type 2 diabetes showed improved mitochondrial structure after three months of treatment with epicatechin-enriched cocoa. As a result of their diseases, these five patients had experienced significant damage to skeletal muscle mitochondria before treatment.  These "fuel cells"  had become dysfunctional as a result of both diseases, leading to abnormalities in skeletal muscle.  The patients suffered from shortness of breath, lack of energy and inability to walk longer distances.

The trial participants ate dark chocolate bars and a beverage with a total epicatechin content of about  100 mg per day for three months. After three months of treatment, the researchers looked at changes in mitochondria volume and the abundance of cristae, which are internal compartments of mitochondria that are necessary for efficient function of the mitochondria, and measurable by electron microscopy.  Before treament, these cristae had been severely damaged, the researchers said, but after threatment a recovery was seen and cristae numbers were returned to almost  normal levels.  The researchers also saw increases in several molecular indicators involved in new mitochondria production.

The study appears this week in the journal Clinical and Translational Science (Volume 5, Issue 1, February 2012, Pages: 43–47).  The researchers said they will conduct a larger study to see if the cocoa flavinoid can help improve exercise capacity in similar patients.

If you occasionally indulge in a square of dark chocolate, perhaps you don't have to feel guilty, after all. You may be feeding your skeletal muscles.

Food and Drug Administration relabels some cholesterol-lowering drugs on safety risks involving memory loss and diabetes

The U.S. Food and Drug Administration has changed the label on a group of statin drugs commonly used to lower bad cholesterol.  Added to the the labels of these drugs is information that some patients have experienced memory loss and confusion. The effects were not considered serious and the patients’ symptoms were reversed by stopping the statin, the new label says. However, patients should still alert their health care professional if these symptoms occur. 

The drugs involved in the label change include: Lipitor (atorvastatin), Lescol (fluvastatin), Mevacor (lovastatin), Altoprev (lovastatin extended-release), Livalo (pitavastatin), Pravachol (pravastatin), Crestor (rosuvastatin), and Zocor (simvastatin). Combination products include: Advicor (lovastatin/niacin extended-release), Simcor (simvastatin/niacin extended-release), and Vytorin (simvastatin/ezetimibe).
Another potential risk added to the label involves blood glucose levels.  Increases in blood sugar levels (hyperglycemia) have been reported with statin use, according to the FDA announcement. The agency notes that some studies have reported that patients being treated with statins "may have a small increased risk of increased blood sugar levels and of being diagnosed with type 2 diabetes mellitus". The new labels warn healthcare professionals and patients of this potential risk.

For those of you taking cholesterol drugs and receiving routine blood tests four times a year to monitor for liver function, you should be aware of a label change in that area as well, removing the need for periodic exams.  The FDA now recommends that liver enzyme tests should be performed before  a patient starts statin therapy, and then only as clinically indicated thereafter. FDA said  in its press release on the changes that serious liver injury with statins is rare and unpredictable in individual patients, and that routine periodic monitoring of liver enzymes does not appear to be effective in detecting or preventing this rare side effect.

If you are taking Mevachor (lovastatin), you should note that the label will now warn that Mevachor can interact with some drugs to increase the risk of muscle injury and recommends against taking the drug with drugs used to treat HIV (protease inhibitors) and those used to treat certain bacterial and fungal infections.

What you can do:
If you have symptoms of muscle weakness, memory loss, or suspected high blood sugar, contact your physician and report confirmed side effects to FDA's Medwatch system.  If you know you are pre-diabetic, you may want to ask your doctor to continue periodic exams to be sure your blood sugar is not pushed up into the diabetes range.

Medicare now covers yoga for heart health

One of the genuine improvements in Medicare as a result of the Affordable Care Act (ObamaCare) is the accent on programs that promote prevention, particularly in the areas of heart disease, such as cholesterol screening and blood glucose control tests. More than 25 million people participating in traditional Medicare during 2011 took advantage of at least one of the 21preventive testing programs available.  To fortify the commitment to prevention in the cardiovascular area, hospitals are now allowed to bill Medicare for their patient's yoga and group discussion sessions that are part of the Dean Ornish Program for Reversing Heart Disease.  The Ornish program is an approved intensive cardiac rehabilitation program.  Ornish  directed scientific research studies reporting that the progression of coronary heart disease can often be reversed by making significant lifestyle changes, including a very low-fat meat-free diet, moderate exercise, various stress management techniques including yoga-based stretching, breathing, meditation, and imagery; and enhanced love and social support, which may include support groups.

Sleepless in more cities than Seattle: New study tracks sleep disorders in 36 states

Where you live may affect how you sleep, according to researchers from the Perelman School of Medicine at the University of Pennsylvania.  People living in Southern states suffer from more sleep disturbances and daytime fatigue than other regions, while residents on the West Coast report the fewest number of problems, the research team reported in a study published online  in the Journal of Clinical Sleep Medicine. Looking at nationwide data collected in 36 states by the Centers for Disease Control and Prevention (CDC), the researchers developed a state-by-state sleep map. Among the states where data was collected, Oklahoma, Arkansas, Mississippi, Alabama and West Virginia ranked in the highest bracket for each category. Many of the states reporting the worst sleep and fatigue problems are the same states that tend to report higher prevalence of other conditions, such as obesity.  The pattern differed slightly between men and women.
Some of the factors that may play a role in sleep disturbances include demographics, obesity, health and even weather and sunlight patterns in different states.  They found that regional differences in mental health, race and ethnic origin and access to medical care were the streongest factors that explain these regional differences.  The Penn research team suggests that for regions with the worst sleep patterns, public health programs focused on healthy sleep patterns and increased screening programs for sleeplessness symptoms may guide those suffering from sleeplessness to receive the appropriate medical care.
 
What you can do:  If you think you have a sleep disorder, you can find more information at the Center for Sleep and Circadian Neurobiology and the WebMD's Sleep Disorders Health Center.

Healthier lifestyles and diet could prevent millions of cases of cancer; compliance with meds could save lives

The World Cancer Research Fund reports that healthier lifestyles and diet could prevent up to 2.8 million cases of cancer each year.  Inactivity is contributing to poor health and higher mortality for those who are obese, suffering from diabetes or on the brink of racking up those high glucose numbers. If more people walked just 20 to 30 minutes a day, or followed a routine exercise regimen, they can lose or maintain a healthy weight and avoid illnesses.  Stopping smoking can help to reduce cancers of the lung. 

On another front,  lack of health insurance leads to 45,000 deaths annually, according to the American Public Health Association.  Each year, thousands of people fail to go to a doctor when they are ill or fail to fill a prescription due to the high costs of healthcare.  In some cases,  faililng to get that prescription  could result in catastrophic infections or mortality from heart-releated or diabetes complications.

Prevention and wellness education is becoming more important, but the price of health insurance is still a deterrent to those who are just above the poverty line.  The working class poor without health insurance are often in worse shape healthwise than those on Medicaid.  While the U.S. has taken a stab at health care coverage for all, there are many that still won't be able to afford it, even when it becomes mandatory in 2014.  We should start thinking now about how to fix that problem, instead of watiting until it happens.

Obamacare: In critical condition but expected to survive

The Patient Protection and Affordable Care Act is moving through its first full year of implementation in 2011, faced with a court challenge to the constitutionality of mandatory health insurance and the everyday pitfalls of partisan politics. It appears to be following the path of other reform measures that were considered problematic - Social Security and Medicare, most notably. At the time they were passed, many critics predicted they wouldn't last a decade, and while our current economic crisis appears to threaten their solvency, these institutions have so far survived the test of time. Once again, as time and history will tell us, health reform could offer Americans positive opportunities in the areas of prevention and early intervention. The new law requires insurance companies to offer at no cost to the insured preventive screenings for certain conditions. This move is expected to save money over time and will also result in earlier treatment and hopefully, fewer adverse effects that can lead to costly hospitalizations. In Medicare, for example, enrollees are entitled to a wellness checkup once a year and personalized prevention plans. All new Medicare plans offer prevention services with no out-of-pocket costs. It's an evolving process that could save time and lives over time and one of the brightest spots in the somewhat confusing list of new measures Americans will face in the coming years. Still to be decided: the constitutionality of mandatory health insurance...Stay tuned.

U.S. House of Representatives passes health care reform legislation

In a historic vote and a major victory for President Obama and Speaker of the House Nancy Pelosi, the U.S. House of Representatives has passed health care reform legislation, giving final approval of the Senate bill by a vote of 219-212. The new legislation is likely to reshape the way Americans deal with medical conditions and prevention measures. It is expected to cost $940 billion and to be implemented over a 10-year period. The measure will provide health insurance for more than 30 million uninsured and will provide protections for millions more against losing their coverage. In a last-ditch effort to kill or stall the bill, there was a Republican motion to recommit the bill to change some language, particularly on abortion, but the move to recommit failed to pass by a vote of 232-199. A reconciliation bill (HR4872)that will allow amendments to the legislation also passed by a slim margin. Republicans have argued that the package is too expensive and promotes excess government powers. Democrats consider the legislation comparable historically to enactment of Social Security after the Great Depression of the 1930s and Medicare in the 1960s. One move that helped secure the victory was President Obama's executive order stating that the healthcare bill would not interfere with an existing ban on federal funding for abortions. That helped change the votes of at least seven pro-life Democrats, led by Rep. Bart Stupak of Michigan. The reconciliation bill now goes to the Senate, where it cannot be filibustered. Acknowledging that the vote was not an easy one for some House members, President Obama said "we proved that the government...still works for the people." He called it a victory of "common sense." One thing remains certain...the debate and disagreement over this legislation is likely to continue for years.

Let the patient participate in drug-safety reporting, NEJM commentary says

There's an interesting "Perspective" on drug-safety reporting in the March 11 issue of The New England Journal of Medicine. The article, by Dr. Evan Baugh of Mount Sinai Hospital in New York, notes that when a patient wants to know about symptoms related to a prescription drug he is taking, he might consult the information on the label or in the package insert. However, this information on side effects is based mostly on clinical trials and clinicians' impressions of their patients' symptoms, rather than on the firsthand reports of patients taking the drug. Yet,a substantial body of evidence contradicts the assumption that this information is truly representative of the patient experience. Instead, Baugh says, research indicates that clinicians systematically downgrade the severity of patients' symptoms, that patients' self-reports frequently report side effects that clinicians miss, and that clinicians' failure to note these symptoms results in the occurrence of preventable adverse effects. Patient self-reporting offers one solution that would enhance the capture of subjective elements of safety information. Baugh believes patient-reported adverse events provide both clinical and scientific value and arutes that patients are entitled to know the impressions of their peers. Scientist, regulators, and clinicians should have access to patient impressions when evaluating drugs, Baugh says. He also suggests that administrative efficiency might actually improve if patients reported adverse events before clinical interactions. Self-reports, Baugh concludes, are more sensitive to underlying changes in patients' functional status than are clinicians' reports. The patient is more likely to identify symptoms earlier during a course of treatment. It seems like a common sense approach to drug-safety reporting.