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.

Stents as effective as surgery for clearing neck arteries, study says

While surgical treatment (carotid endarterectomy) has been the gold standard for removing plaque from clogged neck arteries to prevent stokes, a new study shows that the less invasive method of using stents to open blocked neck arteries, can be just as effective, according to WebMd. This new finding could mean that cardiologists now can offer patients two options for treating these problems. The study, presented at the American Stroke Association's (ASA) International Stroke Conference, reported that in the weeks after the procedure, patients who received stents suffered slightly more strokes, and patients who underwent surgery had slightly more heart attacks. However, after an average of 2.5 years, "there was no significant difference in the number of events between the two groups," said researcher Dr.Wayne Clark of Oregon Health & Science University. The study also reported another interesting finding: patients under age 70 appeared to benefit slightly more from stents, while older patients benefited slightly more from surgery. A similar European study presented at the same conference found stenting somewhat inferior to surgery, but one doctor notes that patient selection could have accounted for the disparate results, along with differences in they types of stents used.

While FDA and Glaxo fiddle over Avandia, patients remain at risk

As a debate over the safety of Avandia has brewed for more than two years, patients still taking the drug have remained guinea pigs for science. This week the New York Times issued a report suggesting Glaxo, the maker of the billion dollar a year diabetes drug knew the drug had significant side effects, but maneuvered to keep the drug on the market. Dr. Steven Nissen, a cardiologist with the Cleveland Clinic, who raised the initial red flag concerning Avandia's cardiac risks, renewed his attack against the drug and its manufacturer, telling The Times that the medical community is still waiting for Glaxo to publish results of a safety study and suggesting the company is trying to whitewash reports of adverse events. HNe criticized the company for failing to publish a followup study, saying the results of Glaxo's Avandia study appear only on the company's web site. To fuel the debate, Nissen gave The Times a secret recording of a 2007 meeting with Glaxo executives. A 2007 study by Nissen found that the risk of cardiac death increased by 64% among patients on Avandia, a finding the company refuses to embrace. Nissen said in an interview that a taped recording of his meeting with Glaxo executives in 2007 showed the excecutives trying to persuade him not to publish his study, suggesting that they had contradictory information they would share with him in a joint study. Nissen said Glaxo did not have any contradictory data. Glaxo executives maintain they visited with Nissen to discuss a possible collaborative study. Meanwhile, the U.S. FDA has failed to take any action to truly protect patients, even after two officials from the FDA issued a report recommending the drug be removed from the market. Glaxo issued a press release refuting the charges in The Times article. When in doubt and when patients health is at stake, shouldn't the U.S. FDA err on the side of overprotection and pull this product, at least temporarily, before more innocent patients are harmed needlessly? If further studies definitively prove Avandia's cardiac safety, then the product can return to market. The FDA needs to adopt a common sense approach to safety in order to prevent any further adverse effects. One death is one too many.

Medical journal retracts research paper that linked autism to MMR vaccine -- 12 years later

The British medical journal, The Lancet, has issued a full retraction of a research paper it published 12 years ago, linking a cause of autism to the vaccine for measles, mumps and rubella (MMR). A BBC report says the journal has now accepted that the report was false. The move came after Britain's General Medical Council ruled last week that Dr Andrew Wakefield, the lead researcher in the 1998 paper, broke research rules. After the study appeared, a controversy erupted in the UK over vaccinations and many parents were afraid to vaccinate their children. As a result, the measles rate increased. The paper had been partially retracted years ago after the journal learned that Dr. Wakefield had accepted money from attorneys who represented parents who believed their children were harmed by the MMR vaccine. The full retraction goes further, saying saying the research was fundamentally flawed because of a lack of ethical approval and the way the children's illnesses were presented. Dr Wakefield, who now lives and works in the U.S. said the findings were "unjust and unfounded." As one doctor commented, the entire episode makes doctors and the media realize that they must be very certain of the strength of a study that affects public health before publishing it.

Low-carb diets may help to lower blood pressure

If you are looking to shed some pounds AND lower your blood pressure you might want to try a low-carbohydrate diet, according to a new study appearing in the current issue of the Archives of Internal Medicine. The study found that twice as many people on a low-carb diet lowered their blood pressure than those who were taking the diet drug orlistat (the active ingredient in over-the-counter Alli and the prescription drug Roche's Xenical.) Both approaches were equally effective at improving cholesterol and glucose levels, as well as reducing waist size and weight, the researchers from Duke University and the Veterans Administration reported. (See also: BBC News report)

Counterfeiting hits the OTC diet drug market with fake versions of Alli

Reports this week that there were counterfeit versions of the over-the-counter weight loss drug known as Alli were compounded by the news that the fake versions were contaminated with another weight loss drug known as subutramine. Subutramine is the active ingredient in Abbott's weight-loss prescription drug known as Meridia. The counterfeit Alli contained twice the normal amount of subutramine in Meridia and could have caused considerable adverse effects in some individuals, according to the U.S. Food and Drug Administration. The drug apparently can interact with other drugs to cause adverse effects and needs to be closely monitored. GlaxoSmithKline, the manufacturer of Alli, ran some preliminary tests on the counterfeit Alli and found it did not contain any of the GSK active ingredient, orlistat, but instead contained the dangerous levels of subutramine. It's amazing how sophisticated counterfeiting has become, because Alli comes in a distinctive larger package than most drugs and one would have thought it would be harder to reproduce the packaging, but in this modern age of electronic magic, everything is fair game. Fortunately, the counterfeiters failed to put a fake lot number and expiration date on the box and those are the clues that the packages are counterfeit. This is a case where a drug we would not expect to become life-threatening is counterfeited into a substance that threatens many unsuspecting individuals. So far it is believed that the counterfeit Alli has been sold only over the Internet and has not made its way to drug stores or other retail outlets.

A New Year, new health resolutions?

It's a new year, a new decade and that means it's time for many of us to take a look at our health and to make some lifestyle changes that could help add a few more years to our lives. After two weeks of "happy eating" that we all blame on the holidays, most of us want to change our bad habits. Some promise to exercise more often, to eat more of the healthful food groups in place of the empty calories of snacks and fast food. Others have made a vow to lower their blood pressure and their stress levels and to re-evaluate their time expenditures for work vs. family and fun. As we decide to change about our lifestyles in the new year, we should set aside time to achieve the goal, so that the resolutions don't fade into oblivion by the Ides of March! Health information on the Internet can help many of us change our evil ways. A new diet doesn't have to be drastic, nor does an exercise program. We all can start small by just picking one bad food habit to eliminate and by starting with excercise of 10 minutes a day, even if it is a few leg kicks after you get up in the morning or running in place in the bathroom as you brush your teeth. We can add some low fat dairy products, such as yogurt and fruits to our morning breakfast and skip the bagel or corn muffin. We can cut our stress by better time management. A bit of cinnamon and mustard instead of mayonnaise can help lower blood pressure and better regulate blood glucose, some studies show. Changing isn't easy, but the rewards are great when we see the pounds disappear or when we feel better because we've reduced our stress. Good luck with you resolutions in this year. You can change, you really can!

Top Health Stories of 2009: Alzheimer's test tops the Medscape list

A new test that may help detect Alzheimer's disease leads Medscape's list of top medical stories of 2009. The cognitive test examines 10 skills and can detect up to 93% of Alzheimer's cases, according to the Medscape report. The study was published June 10 in the British Medical Journal. Other stories making the list discuss a single screening question that may accurately identify unhealthy alcohol use, naproxen as the best Non-steroidal anti-inflammatory for heart-disease patients and the side effects of cholinesterase inhibitors in older aldults with dementia. Other stories concern a new ingrown toenail treatment, new sleep environment risk factors for sudden infant death syndrome, WHO guidelines for antiviral treatment of swine flu and other influenza and the American Academy of Pediatrics' revised guidelines for treatment of pediatric flu.

Cancer drug might help treat type 1 diabetes

There is hopeful news on the diabetes front this week. A new report in the November 25 issue of The New England Journal of Medicine says a drug used to treat cancer and rheumatoid arthritis helped type 1 diabetes patients keep producing some of their own insulin, even though the disease had destroyed some of their pancreatic beta cells. These are the cells that produce insulin. However, another researcher warned that the study does not show the drug Rituxan to be a "cure" for diabetes, but rather, a modest improvement in insulin levels. More research will be needed and it will take several years to test whether the treatment is feasible, but it's the beginning of another area of potential treatment and continued research might help lead to better control and ultimately to a cure.

Latest breast cancer screening recommendations leave women confused

Most of us had never heard of the US Preventive Services Task Force before last week, but now we expect to hear about its recommendations on breast cancer screening for many months to come. The task force recommends that women not begin getting annual mammographies until age 50 or older. Previous recommendations for screening targeted women 40 and older. Why the change and why now? Of course, it has turned into a political debate, as well as a medical one. Health and Human Services Secretary Kathleen Sebelius distanced the Obama Administration from the decision, saying the panelists joined the Task Force during the Bush Administration. Republicans point to the Democrats saying this is an example of how the new healthcare system would compromise public health. The waters are muddy in this debate, but one thing is clear to me. Women in their 30s and 40s get breast cancer. Most of the people I know who have had breast cancer contracted it during their 30s or 40s, so why would we want to make women guinea pigs (again) for a new approach that is bound to cost some people their lives? It appears that the breast cancer movement has another cause for which it needs pink ribbons...Don't change it, if it saves lives. If women in their 30s and 40s have to pay for mammograms, lives will be lost because in the current economy, many will delay spending the money. Let's be sensible and keep the old recommendations and let this band of questionable "experts" re-evaluate their decision. If one woman dies because of this new absurdity, it's one life too many.

Friends make a positive difference

After a wonderful mini-vacation and the start of a new consulting project, I am returning to blogging about health issues feeling renewed and refreshed. I definitely recommend a long weekend with old friends as a spiritual renewal therapy. We flew to Las Vegas and enjoyed the warm desert sun, the crazy action of the casinos, the wonderful stage shows of Bette Midler, Cirque du Soleil and Donnie and Marie Osmond and the zany company of six friends whom I have known since I was 17. This is good mental health in action! But don't take my word for the benefits of good friends. An Australian study reports that among 1,500 older people studied for 10 years, those who had a large network of friends outlived those with the fewest friends by 22%, according to WebMD. That's a great result! So, I feel blessed that I have good friends who are willing to share my joys and struggles. We are already talking about our next trip together, so I guess that will add another few months to our lives, according to the study!

Diet and exercise can help prevent diabetes

A new study supports the health community's view that diet and exercise can help ward off diabetes for those who are on the brink of developing the disease. Losing weight and controlling diet can help many people avoid diabetes for years, according to a Reuters report summarizing the study. (See also blog entry of October 1.) Researchers at the National Institute of Diabetes and Digestive and Kidney Disease said the 10-year study of overweight people with elevated blood sugar found that those who lost a modest amount of weight lowered their risk of developing type 2 diabetes by at least a third. People over 60 showed even betterresults, cutting their risk of diabetes during the study period by almost 50 percent. The key now is to better educate the public about the risks of obesity and diabetes and to encourage prevention measures early, particularly in those people who have a genetic predisposition to the disease.

Swine flu becomes "national emergency"

President Barack Obama has declared the outbreak of H1N1 flu a national emergency. The move will allow hospitals and local governments to establish alternate sites for triage and treatment if a big wave of patients materializes at one time. The New York Times reports that people are still waiting in long lines for the H1N1 vaccine but in some locations, people are being turned away. It has also led to the cancellation of a soccer game in France after a third player on one team was diagnosed with the swine flu. Health officials said the latest move by the President had nothing to do with a vaccine shortage, but more to do with planning ahead and logistics. This is a prudent move on the part of the Administration and will help hospitals and local officials prepare a "disaster plan" before the worst wave hits the American public.

Sen. Baucus calls for health care reform, introduces legislation that could foster reform

We all have heard the horror stories of people who suffered or died because they had no health insurance. Currently, more than 46 million Americans do not have coverage. The latest unfortunate media reports on the uninsured have involved overweight or underweight infants who have been refused coverage because of their weight, even though they are perfectly healthy in every other way. This is a national disgrace that needs to change. In an online article published Oct. 21 on the web site of The New England Journal of Medicine, Sen. Max Baucus (D-MT, chairman of the Senate Finance Committee,said doing nothing about health care policy is not an option. His committee introduced legislation on October 13, known as the America’s Healthy Future Act. An analysis from the Congressional Budget Office (CBO), said the bill would fulfill the promise to slow the growth of health care costs and to provide quality and affordable coverage. "Preserving the status quo would mean that Medicare would go broke in 2017," he said. In addition, he notes, more Americans would lose their insurance coverage and our country would have to sacrifice other priorities to spend more and more of our federal budget on health care. With his committee's legislation, there would be an increase in the percentage of Americans who have insurance to 94%, he said, adding that the legislation would reduce the federal deficit by $81 billion over the next 10 years. It might not be a perfect solution and the legislation might not attain its highest objectives, but it would be a starting point that could save more lives and begin to fix the problems that plague the health care system of the richest nation in the world. If we have money for guns and war and space missions, we should have money for healthcare and medicines for all who need it.

Autism and mercury in vaccines: new study says mercury levels in children with or without autism are similar

Autism and autism spectrum disorder is a challenging affliction affecting between 1 to 1.5 million Americans. For years, parents and health researchers have searched for a possible environmental cause of the problem that leaves many unable to communicate appropriately or make emotional connections in the same way as others. Some have suggested that the mercury used as a preservative in vaccines might be the cause of autism. So researchers wanted to examine whether kids with autism or other developmental disorders might bioaccumulate higher levels of mercury in their systems than normal kids. A University of California-Davis research team reports that, contrary to what some might have guessed, mercury blood levels were similar in children with autism and in those with normal development. The researchers looked at sources of mercury in the children's environments, such as fish consumption, use nasal sprays or earwax removal products, (which may contain mercury, and the types of vaccinations they received. They also examined dental fillings to determine whether any children had mercury-based amalgam fillings and whether they grind their teeth or chew gum. One interesting finding: children who chew gum and who have amalgam fillings had higher blood mercury levels. The researchers note that autism is a complex disease and will undoubtedly have complex causes. As of now, it doesn't appear that mercury is going to be the single reason for developmental problems. One thing is for sure. They mystery continues and more research is needed.