11 November 2010

Study: Obesity Rates to reach 42 Percent

Reuters


Americans will keep growing fatter until 42 percent of the nation is considered obese, and having fat friends is part of the problem, researchers said on Thursday.

The prediction by a team of researchers at Harvard University contradicts other experts who say the nation's obesity rate has peaked at 34 percent of the U.S. population.

The finding is from the same group, led by Nicholas Christakis, that reported in 2007 that if someone's friend becomes obese, that person's chances of becoming obese increase by more than half.

They now think this same phenomenon is driving the obesity epidemic, which will climb slowly but steadily for the next 40 years.

Alison Hill, a graduate student at Harvard and the Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, said the study is based on the idea that obesity can spread like an infectious disease and people can catch it from their friends.

For the study, she and colleagues applied a mathematical model to four decades of data from the long-running Framingham study -- a study of the health and habits of nearly an entire town in Massachusetts.

"We looked at the probability of becoming obese and what that was influenced by," Hill said in a telephone interview.

"We found there is some baseline risk of becoming obese based on the friends you have," Hill said.

Hill said that based on their calculations and looking at the influence of social interactions on obesity in the Framingham study, they think the U.S. obesity rates will top out at 42 percent of the population.

Over the long-running study, the rate of weight gain caused by social interaction -- a person's contact with friends who are obese -- has grown quite rapidly since 1971, Hill said.

"It looks like obesity is becoming more infectious," said Hill. The findings are reported in the Public Library of Science journal PLoS Computational Biology.

MULTIPLE SOCIAL CONTACTS

In the study, the team found that an American adult has a 2 percent chance of becoming obese in any given year, and each obese social contact increases the risk of becoming obese by 0.5 percent per year.

And while having fat friends increases the odds that you will become fat, befriending thin people does not appear to help you lose weight.

"We didn't find having more healthy-weight friends made it more likely to help people lose weight. It fits in with this idea of thinking about it as an infectious disease. You don't really catch healthiness," she said.

Hill said the findings are the best-case scenario based on current assumptions, but changes in public policy could make a difference.

U.S. government researchers in January said 68 percent of U.S. adults are considered overweight, having a body mass index or BMI of 25 or higher, and a third are obese, having a body mass index of 30 or higher.

BMI is equal to weight in kilograms divided by height in meters squared. A person 5 feet 5 inches tall is classified as overweight at 150 pounds (68 kg) and obese at 180 pounds (82 kg).

Being overweight or obese raises the risk of heart disease, diabetes, some cancers, arthritis and other conditions.

Obesity-related diseases account for nearly 10 percent of medical spending in the United States or an estimated $147 billion a year.

Cymbalta Approved for Chronic Joint and Muscle Pain

Bloomberg / BusinessWeek


Cymbalta (duloxetine hydrochloride) has received expanded approval from the U.S. Food and Drug Administration to treat chronic musculoskeletal pain, stemming from conditions including lower back pain and osteoarthritis.

Since its approval as an antidepressant in 2004, some 30 million people in the United States have used the drug, the agency said in a news release. The FDA also has sanctioned Cymbalta for the treatment of diabetic pain, generalized anxiety disorder and fibromyalgia.

The most common side effects from Cymbalta use include nausea, dry mouth, insomnia, drowsiness, constipation, fatigue, and dizziness. More serious adverse reactions have included liver damage, allergic reaction, pneumonia, depressed mood, and suicidal thoughts and behavior, the agency said.

The FDA has also warned that Cymbalta should never be used in patients who have recently taken a type of antidepressant called an MAOI, or Mellaril (thioridazine), or who have uncontrolled glaucoma.

Cymbalta is produced by Eli Lilly and Co., based in Indianapolis.

10 November 2010

AMA Chief says Medicare Cuts will be Catastrophic

Associated Press

The president of the nation's largest doctors' group says upcoming cuts in Medicare physician payments will be catastrophic for seniors.

Dr. Cecil Wilson of the American Medical Association says Medicare payments will drop by more than 20 percent by January unless Congress takes quick action.

Wilson says many seniors will lose access to needed care because some doctors will stop accepting Medicare patients. He adds it's a question of medical practices remaining financially viable.

Wilson spoke out against the cuts Monday at the AMA's interim meeting in San Diego. The AMA is running full-page newspaper ads and wants a 13-month reprieve so a permanent solution can be sought.

It's unknown if Congress will scrap the cuts, or even give doctors the full reprieve they're seeking.

09 November 2010

Wyoming, W. Virginia lead in Chewing Tobacco Use

Associated Press


Wyoming tops the nation in chewing tobacco use, with nearly 1 in 6 adult men in that state using the product.

Government researchers found men use chew, snus and other smokeless products at much higher rates than women. In Wyoming and West Virginia, about 9 percent of all adults - both men and women - use smokeless tobacco.

The report by the Centers for Disease Control and Prevention is one of the government's first attempts to gather state-level statistics on smokeless tobacco. Past research suggests the national usage rate is around 2 percent.

The study is based on a telephone survey last year of more than 430,000 people in all 50 states. The survey asked people whether they smoked cigarettes and/or used smokeless tobacco.

Often people said yes to both. Many of the states with the highest smoking rates also had the highest use of smokeless tobacco products.

In Wyoming, for example, nearly 14 percent of smokers also used smokeless tobacco; among men, it was 23 percent.

Wyoming's "rodeo culture" includes a tradition of chewing tobacco, one CDC official said.

California had the least smokeless tobacco use, with only a little more than 1 percent of adults in that state reporting that habit.

Health officials worry about smokeless tobacco, which they believe may be a reason U.S. smoking rates have stopped falling.

Their reasoning: As smokers face more workplace smoking bans, many of them - instead of quitting - are turning to chewing tobacco or snus to temporarily satisfy their nicotine addiction and get them through parts of the day.

Indeed, some unpublished CDC research suggests that some smokeless tobacco products were reformulated around 2007 and became more addictive. Researchers looked at two popular brands of smokeless tobacco and saw that the most addictive form of nicotine in them was dramatically higher.

Health officials have also noted that most chewing tobacco use starts at a young age, that it often precedes smoking, and that over half of young males who use smokeless tobacco also smoke.

"The bottom line here: Smokeless tobacco makes it more likely that kids will start smoking and make it harder to quit smoking," said the CDC's director, Dr. Tom Frieden.

Officials also have been unhappy to see that major cigarette companies have taken over the smokeless tobacco product market in the last few years, and have started selling smokeless versions of cigarette brands like Marlboro and Camel.

And they're no fan of spitless, nicotine-containing snus - Swedish for tobacco, it rhymes with "noose." These are tiny pouches of steam-pasteurized, smokeless tobacco. Snus were developed to be more socially acceptable than the dark drool of traditional chewing tobacco.

This year the U.S. Food and Drug Administration began requiring that smokeless tobacco products carry health warning labels.

Some health advocates note smokeless tobacco can cause oral and pancreatic cancer, and say it also increases risk of fatal heart attack and stroke.

"No tobacco product is safe to consume," said the American Heart Association's chief executive, Nancy Brown, in a prepared statement reacting to the CDC report.

Study: Brain Energy Crisis may spark Parkinson's

Associated Press

Parkinson's disease may stem from an energy crisis in the brain, years before symptoms appear.

If the research pans out, it points to a possible new approach for Parkinson's: Giving a boost to a key power switch inside brain cells in hopes of slowing the disease's inevitable march instead of just treating symptoms.

"This is an extremely important and interesting observation that opens up new therapeutic targets," says Dr. Flint Beal of New York's Weill Cornell Medical College, who wasn't involved with the new study.

Beal said scientists already are planning first-stage tests to see if a drug now used for diabetes might help Parkinson's, too, by targeting one of the implicated energy genes.

At issue are little power factories inside cells, called mitochondria. Increasingly, scientists suspect that malfunctioning mitochondria play some role in a list of degenerative brain diseases.

After all, brain cells are energy hogs, making up about 2 percent of body weight yet consuming about 20 percent of the body's energy. So a power drain could trigger some serious long-term consequences.

"It could be a root cause" of Parkinson's, says Dr. Clemens Scherzer of Boston's Brigham and Women's Hospital and Harvard University.

About 5 million people worldwide, and 1.5 million in the U.S., have Parkinson's, characterized by increasingly severe tremors and periodically stiff or frozen limbs. Patients gradually lose brain cells that produce dopamine, a chemical key to the circuitry that controls muscle movement. There is no cure, although dopamine-boosting medication and an implanted device called deep brain stimulation can help some symptoms.

No one knows what causes Parkinson's. To find genetic clues, Scherzer gathered an international team of researchers to comb studies of more than 300 samples of brain tissue - from diagnosed Parkinson's patients, from symptom-free people whose brains showed early Parkinson's damage was brewing, and from people whose brains appeared normal. They even used a laser beam to cut out individual dopamine-producing neurons in the most ravaged brain region, the substantia nigra, and examine gene activity.

The team found 10 sets of genes that work at abnormally low levels in Parkinson's patients, genes that turned out to play various roles in the mitochondria's energy production, Scherzer recently reported in the journal Science Translational Medicine. Especially compelling, the genes also were sluggish in people with presymptomatic, simmering Parkinson's.

And all the gene sets are controlled by what Scherzer calls a master regulator gene named PGC-1alpha - responsible for activating many other genes that maintain and repair those mitochondrial power factories.

So might revving up PGC-1alpha in turn boost underperforming mitochondrial genes and protect the brain? To see, the researchers tested dopamine-producing neurons from rats that were treated in ways known to cause Parkinson's-like damage. Sure enough, boosting the power switch prevented that damage.

This genetic evidence supports years of tantalizing hints that mitochondria are culprits in Parkinson's, says Dr. Timothy Greenamyre of the University of Pittsburgh Medical Center.

He ticks off the clues: A rare, inherited form of Parkinson's is caused by a mutated gene involved with mitochondrial function. A pesticide named rotenone that can kill dopamine cells and trigger Parkinson's symptoms in animals also is toxic to mitochondria. So is another Parkinson's-triggering chemical named MPTP.

Now with Scherzer's study, "it's going to be harder and harder for people to think that mitochondria are just a late player or an incidental player in Parkinson's disease," Greenamyre says.

The crux of all that complicated neurogenetics: A diabetes drug named Actos is among the compounds known to activate part of that PGC-1alpha pathway, and Weill Cornell's Beal says it's poised for an initial small trial in Parkinson's.

Separately, a nutrient named Coenzyme Q10 is believed important in mitochondrial energy production, and Beal is leading a study to see if high doses might help Parkinson's. Results are due in 2012.

But Scherzer issues a caution: The average Parkinson's patient has lost about 70 percent of his or her dopamine-producing neurons by the time of diagnosis. So if blocking a brain energy drain is going to do any good, scientists may have to find ways to spot brewing Parkinson's much earlier.

"I don't think you can turn back the clock," he says.

Study: CT Scans modestly cut Lung Cancer Deaths

Associated Press


A major study shows giving heavy smokers special CT scans can detect lung cancer early enough to modestly lower their risk of death - the first clear evidence that a screening test may help fight the nation's top cancer killer.

Now the hurdle is deciding who should get these spiral CT scans and how often, because the tests carry their own risks, including repeated radiation exposure and a lot of false alarms that trigger unnecessary repeat testing and even surgery.

"This finding has important implications for public health, with the potential to save many lives among those at greatest risk for lung cancer," said National Cancer Institute Director Dr. Harold Varmus, who released the study results Thursday. But, "we don't know the ideal way yet to do this screening."

Specialists with the American Cancer Society - which hadn't recommended the screening because of lack of evidence - planned to evaluate the findings when the full data is published in a few months.

Until then, "the best advice we can give is to encourage people to have conversations with their doctors about whether lung cancer screening is right for them," said chief medical officer Dr. Otis Brawley.

Standard chest X-ray screenings haven't proved powerful enough to reduce lung cancer deaths, so researchers turned to spiral CTs, where a rotating scanner views the lungs at various angles to spot growths when they're about half the size that regular X-ray can. But previous small studies have produced mixed results about whether the CTs work.

The massive National Lung Screening Trial enrolled 53,000 current or former heavy smokers with no initial symptoms of cancer to try to settle the debate. It found 20 percent fewer deaths from lung cancer among those screened with spiral CTs than among those given chest X-rays, the NCI said Thursday, a difference significant enough that it ended the study early.

The actual difference: Of those who got a spiral CT, 354 died over the eight-year study period compared with 442 deaths among those who got chest X-rays.

But with about 200,000 new lung cancers diagnosed in the U.S. each year and 159,000 deaths, even a modest reduction could translate into big benefits. Today, lung cancer usually is diagnosed at advanced stages, and the average five-year survival rate is just 15 percent.

Still, the best advice to avoid lung cancer, stressed NCI's Varmus: Stop smoking.

Smokers and former smokers have long sought scans in the hopes of earlier lung cancer detection, even though insurance seldom covers the $300 to $400 test in people who have no symptoms.

"Clearly it saves lives," said Dr. Stephen Swensen of the Mayo Clinic, among the 33 sites that conducted the massive study. But, because it carries the burden of unnecessary tests and treatment, "society has to figure out if we can afford this."

"We want to make sure what we recommend is appropriate rather than everybody going out and asking for it," added Dr. Edward F. Patz Jr. of Duke University, who was on the committee that helped design and oversee the study.

The new trial enrolled people ages 55 to 74 who are or had been very heavy smokers, puffing at least 30 "pack-years," the equivalent of a pack a day for 30 years or two packs a day for 15 years. They had one scan a year - either spiral CT or a standard chest X-ray - for three years, and then had their health tracked.

NCI's Varmus stressed that the study provided no data on whether screening helped lighter or younger smokers.

There were risks. The CTs frequently mistake scar tissue from an old infection or some other benign lump for cancer, giving about 25 percent of the spiral CT recipients a false alarm. In an earlier Mayo Clinic study of spiral CTs, more than 70 percent had a false alarm, because that study monitored even smaller lung nodules that the newer study ignored, Swensen said.

Then there's the radiation question. The new study used low-dose spiral CTs, equivalent to the radiation from a mammogram. That's far lower than the radiation emitted by regular CT scans used to diagnose various medical conditions, but several times more than is emitted by a standard X-ray.

The NCI will analyze whether the radiation exposures from the three scans in this study changed a smoker's lifetime risk of other radiation-related cancers. Doses can be vary widely at different hospitals using different scanners, but any CTs used for screening should be low-dose, Swensen said.

08 November 2010

Technology a Blessing, a Curse for remote Island

Associated Press


Muggs Bass doesn't own a computer. She's pretty much dead set against e-mail. Anyone who calls her home on Michigan's remote Beaver Island should be prepared for a busy signal, if she's on her land-line phone. She has no cell.

"When you don't have it, you don't miss it. That's what I say," says the spunky 70-year-old grandmother, who's as comfortable telling jokes at the local pub as she is attending Mass each morning.

Technology isn't really her thing. So, it's a small miracle when Bass drives, once a month, to her island's rural health center to sit down in front of a wide-screen television. There, she and a handful of other islanders connect by video conference with a similar group in Charlevoix, Mich., a two-hour ferry ride to the south and east.

They chat. They laugh. They cry together.

All of them have, or have had, cancer, Bass included. Hers started with a lump in her breast and has since metastasized to her bones, making her cancer treatable, but incurable, her doctors tell her.

Her own grandmother died of the same disease and went off the island for occasional treatments, as Bass does every few weeks. But that grandmother could hardly have imagined a day when islanders talked openly about their cancer, face-to-face with people in a support group miles away.

It's just one of many ways technology is making this rugged place less remote than it once was and, some would say, more livable for more people.

It also gives islanders hope for new jobs that could attract residents to this island in northern Lake Michigan where the year-round population is about 650 people, give or take a few dozen.

"In the last few years, technology has sprung," says Joe Moore, a retired teacher who's known as one of the geeks on the island who helps keep computers running.

Not that the change has come quickly, or that technology always works perfectly.

That's just how it is on an island where a popular bumper sticker reads "Slow Down! This Ain't The Mainland." It's aimed at anyone who's in too big a hurry, including lead-footed tourists who kick up dust on the many dirt roads or who panic when cell phone service drops.

That's life on wired - or at least, semi-wired - Beaver Island.

___

So, where is Beaver Island, anyway?

Some Michiganders would show you by holding up their right hands, palms up, and pointing just above the tip of their ring fingers - in other words, just off the far northwest tip of the state's lower peninsula. But that's if even THEY know where it is.

While Michigan's Mackinac Island is well known, Beaver Island - much of its 54 square miles covered in lush hardwood forests, sand dunes or pristine inland lakes - is not.

That's partly because it is more difficult to get to, especially in the off season. Ferry service runs from Charlevoix, from April through mid-December. Quick flights in small propeller planes are available year-round, weather permitting. In winter, it's not unusual for islanders to be physically cut off from the mainland, unless an emergency sends the U.S. Coast Guard to their rescue.

So when high-speed Internet service became available to most of the island last spring, this was more than just a convenience. For many, it was a godsend - even if having the service simply meant being able to shop online for just about anything, to play an online game or to watch a newly released movie. For others, it meant being able to stay on the island longer because they had a more reliable connection to do work.

Either way, the outside world was even more readily available, at least virtually.

Schoolchildren on the island were ahead of this curve: The main public school knew how valuable it would be for them to be technologically savvy, especially when students headed to college. In the last decade, those students have been encouraged to take language and advanced-placement classes online. Some in high school also take college courses. They learn how to download and evaluate statistics using palmtop computers.

Connie Boyle, a teacher at the school, helped implement the technology program. She had a vested interest in it, partly because she and her husband decided to raise their daughter on the island after moving here from Chicago 25 years ago.

"We were worried - 'How do you bring up a kid on very tiny Beaver Island?'" Boyle says. An answer came when their daughter, now a freshman at Michigan State University, called recently about her computer class.

"Mom, I don't get it," she said. "I'm helping everybody here. We did all this in high school."

___

Today's state-of-the-art Beaver Island school is quite different from the one Muggs Bass attended. For her, books were the only real window to the mainland, especially in elementary school.

Like many who settled on Beaver Island, her great-grandparents and a grandmother had come from Ireland, to farm, fish and find a better life. Her own father was a dairy farmer. Born Mary Margaret but called "Muggs" as long as she can remember, Bass went to a small school across the field from the family farmhouse.

Until her school combined with another in the island's main town, St. James, she didn't even know some of her own cousins on the island. Other than a trip to the doctor when she was a young child, she didn't go to the mainland of Michigan - "across," as the islanders like to say - until she visited an aunt in Detroit when she was 12 years old.

"It was big and noisy," she recalls.

She didn't mind that her family didn't have a television until she was a teenager. For a long time, the closest thing she had to a technological device was the family radio, which she sat beside with her father to listen to boxing matches.

Her world was small in those days. That's how she liked it.

But after she graduated from high school, she left the island to find work and she ended up living in other parts of Michigan and then Illinois, where she met her husband. They then moved to northern Indiana, where they raised their son and his children from a previous marriage. Always, she longed to return to the island one day.

___

It's not the kind of life that appeals to just anyone.

Donna Kubic, a registered nurse who heads the island's rural health center, gets that. She tells the story of a young woman who came to the island to apply for a job at the health center. The woman had planned to stay for a week, but left after staying just one night in a lakeside cottage.

It was too dark out there with no street lights, she told Kubic. Too solitary.

This is, indeed, a place where one doesn't take modern convenience for granted. There is one grocery store, a couple of gas stations, a handful of restaurants and bars but no movie theater. There is no full-time doctor on the island, though two visit from the mainland twice a month. Critical patients are airlifted off the island, by the Coast Guard if weather shuts down other options.

As recently as two years ago, if someone needed an X-ray, the films had to be flown to the Charlevoix hospital so a radiologist there could read them. Depending on weather, it could take days.

Kubic knew there was a better way. She persuaded the hospital to help her apply for a grant that recently helped her purchase digital X-ray equipment for the health center. Now images can be transmitted in a matter of minutes.

Next came video conferencing, connecting the island's nurse practitioner and physician's assistant to the mainland hospital's emergency room. It's the same technology that allows Bass and the other islanders to take part in the "Circle of Strength" cancer support group.

"Without it, we'd be out here, in the lake, without a lot of support," Kubic says. Eventually, she hopes that primary care doctors and specialists - even mental health care providers - will be more willing to offer their services to islanders (though so far, she says, they've been reluctant).

"I think it's just education, saying the technology is there, getting the docs used to it," she says.

___

When Muggs Bass moved back to the island 12 years ago, she had no idea that she'd soon be dealing with a serious health issue.

A year after she'd been there, she traveled to the mainland for her annual mammogram, which revealed cancerous tissue. She had surgery to remove a breast.

"Then I went along fine for 10 years," she says, until she got a cough she couldn't shake. One morning, she got up and said to her husband, "I need to go across, to the doctor."

Her lung was filling with fluid. The cancer had spread to her bones.

So for the past 18 months, she has traveled to the mainland every six weeks for an infusion of a drug that keeps her bones from fracturing, and also takes a daily pill to slow the cancer's growth. The goal is to extend her life as much as possible.

"I'm going to hold to this until I reach something else," Bass recently told her support group. "And then I'll have to make another decision."

The group in Charlevoix includes an 80-year-old woman with lung and colon cancer, as well as younger mothers who've survived breast cancer and those who are in the thick of the battle. They talk about infections and drainage tubes, mammograms and mastectomies. They somehow manage to find humor in topics such as constipation.

One of the moms, introduced to the Beaver Island group through video conference, thanked Bass for sending her a card and a prayer.

"I read it every day," the woman, who has 11- and 16-year-old children, told Bass. "I'm in it for the long term fight. I'm prayin' hard, too."

"That's what you do," Bass said, as she grabbed a tissue to dab her eyes.

Diane Gorkiewicz, who began the Charlevoix "Circle of Strength" six years ago, marvels at the intimacy that has developed so quickly between her group and the islanders.

"The only thing you're missing are all the hugs and stuff," Gorkiewicz told the islanders during a recent video conference.

"And the food," Bass said, teasing the Charlevoix group that they need to share the treats they bring to their meetings.

___

Joe and Phyllis Moore understand the dynamic.

Earlier this year, the longtime islanders were able to "attend" their youngest granddaughter's first birthday party via Skype. Guests at the party in Washington state sat at a computer to introduce themselves. The Moores saw the cake. They gave real-time wishes to the birthday girl.

"Just thinking about it, it almost brings tears to my eyes," Joe Moore says.

It's not ideal, but the best they can do - better than they could've hoped for, really. The hard reality is that the cost of getting off the island can be prohibitive.

Most islanders have to "wear many hats" just to get by, Moore says. In addition to his computer work, he's one of the island medics and also runs a local website that provides video footage of township meetings, as well as the school's soccer and volleyball games.

Phyllis Moore is now the assistant librarian, but when she moved back to the island after college, she and Joe ran a vacation lodge while he did his student teaching.

"Like most graduates, I was going to get off this rock and never look back," says Phyllis Moore, now 62. "And look where I am now."

Many young people who live here say technology - social networking and their cell phones included - make life on the island better for them, too. But in the end, they face the same dilemma as everyone else: How do you make a living here? And what if there's really no place for the kind of work you want to do?

Brontae Cole, a 17-year-old high school senior, will be heading to college next year and wants to become a homicide detective.

"There's one cop here, two in the summer if we get lucky," Cole says. She grins. "And not a lot of dead people."

Jewell Gillespie-Cushman, a 14-year-old freshman, also wonders where he'll land. His late grandfather, an island icon for whom he was named, was born on Beaver Island and lived here his entire life. Gillespie-Cushman isn't sure he could do the same, even with more contact with the outside world than his grandpa had.

"I'm still debating whether to stay here, or move over there," he says.

___

Like Muggs Bass, though, a growing number of people want to find a way ONTO Beaver Island - many of them among the thousands who visit each summer and would like to make it home. For many of them, technology is the key.

Jeff Stone and his wife, Sarah Rohner, were able to start spending more time on the island in 2006, when a satellite-based service began offering an Internet connection that was about two-thirds as fast as the newest service, and much faster than the sluggish dial-up service that had been the only option.

The satellite option enabled Stone to quit his real estate job in the Chicago area to start a website design business that he and his wife run from the island much of the year, though not without some initial glitches.

He recalls how snow from a huge storm covered their satellite dish, cutting off their Internet service just as they were about to launch their site.

"We ended up going out in the back yard and throwing snow balls at the dish," he says. That knocked off enough snow to get the Internet working, and they were back in business. But it's not always that easy, or quick.

Laurel Vietzen, a college professor, also from the Chicago area, who now spends several months a year on the island, remembers a violent summer thunderstorm two years ago that left much of the island without Internet and phones. "We had a daughter at the University of Iowa and we were hearing about terrible flooding in Iowa City," she says. "It was three days before we could reach her!"

Now that Internet service on the island is more reliable, many islanders say cell phone service is the big hurdle. One mobile provider's service works well here, though only on the upper third of the island - and outages happen more frequently than most would like.

Even those who reap the benefits of technology feel torn, though. They worry that it infringes on one of the very things they love about the island - its inherent, blissful peacefulness.

Technology is, at once, their blessing and their curse.

On a summer night, it's not unusual to see more than a dozen people sitting outside the library's memorial garden, on picnic tables and in their cars, tapping into the free wireless that's left on 24 hours a day.

At the same time, islanders and summer residents alike regularly complain about all the people who now walk around the main streets of St. James, staring at a smart phone screen or iPad instead of their beautiful surroundings.

"The technology is wonderful, but ... ," Phyllis Moore says. She raises her eyebrows, noting how, on a nice day, she isn't opposed to kicking kids out of the library after they reach their 30-minute time limit on the computers there.

Meanwhile, it used to be the joke that, by St. Patrick's Day, anyone who lived here year round couldn't stand the sight of anyone else. In many ways, communicating with the outside world helps with that, but not always.

"I don't think it's eliminated cabin fever or getting at each other's throats," Joe Moore says, chuckling. "Sometimes, I think it makes it worse because they can communicate more and get on each others' nerves even more."

___

Muggs Bass knows about the squabbles and the way a rumor can take on a life of its own, computer or no computer. She wasn't too happy, for instance, when she heard that some islanders were calling her cancer "inoperable." She didn't like the sound of it - wished they'd just ask her directly.

But that was nothing, she says, compared with the support she's gotten from her tiny island community.

"We joke. We kid. We take care of each other," she says. "I can't imagine living anyplace else."

When she got her latest diagnosis, islanders organized a "50/50 raffle" for her, where the winner is supposed to take half the donations. Instead, the winner gave his portion to Bass, a common outcome on Beaver Island. All up, she received nearly $9,000 to help with flights to the mainland and other expenses related to her illness.

"You talk about emotional," Bass says, tearing up again.

She recalls sitting down after that to pray and, as she might say, have a chat with God.

"I thanked Him, and thanked Him, and thanked Him. I was so grateful that I was able to come back and live here, and for holding me up at this time in my life," she says.

The support group and her new friends on the mainland are part of that.

For her, technology - at least her little slice of it - has allowed the best of both worlds.

Omega-3 pills fail to work in Alzheimer's Patients

Associated Press

 
Omega-3 pills promoted as boosting memory didn't slow mental and physical decline in older patients with Alzheimer's disease, a big disappointment in a multimillion-dollar government-funded study.

"We had high hopes that we'd see some efficacy but we did not," said Dr. Joseph Quinn, an author of the $10 million study and a researcher at Oregon Health and Science University.

The results with pills containing DHA, an omega-3 fatty acid, highlight "the continued frustration over lack of effective interventions" for the memory-robbing disease, an editorial said, published with the study in Wednesday's Journal of the American Medical Association.

DHA occurs naturally in the brain and is found in reduced amounts in people with Alzheimer's disease.

Some smaller, less rigorous studies suggested that mental decline could be slowed or prevented by eating fish, the main dietary source for omega-3 fatty acids, or supplements like fish oil pills that contain fatty acids including DHA. The study used capsules of DHA oil derived from algae.

Omega-3 fatty acids in fish or supplements have been shown to help protect against heart disease and are being studied for possible effects on a range of other illnesses including cancer and depression.

The new research involved nearly 300 men and women aged 76 on average with mild to moderate Alzheimer's disease. They were randomly assigned to take either DHA pills or dummy pills daily for 18 months.

Results were similar in both groups; DHA provided no benefits in slowing Alzheimer's symptoms. The pills also didn't work even in a subgroup of participants with the mildest Alzheimer's symptoms.

"There is no basis for recommending DHA supplementation for patients with Alzheimer disease," the authors concluded.

Given evidence that the underlying process that causes Alzheimer's begins years, if not decades, before diagnosis, starting treatment after symptoms appear may be too late, said editorial author Dr. Kristine Yaffe, a dementia researcher at University of California at San Francisco.

The National Institute on Aging paid for most of the research. The rest came from Martek Biosciences, maker of the DHA pills used in the study. Two co-authors are Martek employees and Quinn is an unpaid consultant to the company. Quinn and two other study authors are also inventors of a patent for using DHA pills to treat Alzheimer with a certain genetic variation.

Laurie Ryan, program director of Alzheimer's studies at the Institute on Aging, called the results discouraging. But she noted that the institute is spending millions of dollars on research into other possible treatments including lifestyle changes, drugs and biomarkers that might lead to more targeted drug treatment.

William Thies, scientific director of the Alzheimer's Association, said the results fit with new recommendations advocating starting treatment in the disease's earliest stages.

"It seems clear that either we have to have more powerful drugs or they have to be used earlier in the course of the disease," Thies said.

When the Doctor Has a Boss

The Wall Street Journal

More Physicians Are Going to Work for Hospitals Rather Than Hanging a Shingle

The traditional model of doctors hanging up their own shingles is fading fast, as more go to work directly for hospitals that are building themselves into consolidated health-care providers.

The latest sign of the continued shift comes from a large Medical Group Management Association survey, which found that the share of responding practices that were hospital-owned last year hit 55%, up from 50% in 2008 and around 30% five years earlier.

The biggest U.S. physician-recruiting firm, Merritt Hawkins, a unit of AMN Healthcare Inc., said the share of its doctor searches that were for positions with hospitals hit 51% for the 12 months ended in March, up from 45% a year earlier and 19% five years ago. The number of searches for physician groups and partnerships has dropped.

The trend is tied to the needs of both doctors and hospitals, as well as to emerging changes in how insurers and government programs pay for care. Many doctors have become frustrated with the duties involved in practice ownership, including wrangling with insurers, dunning patients for their out-of-pocket fees and acquiring new technology. Some young physicians are choosing to avoid such issues altogether and seeking the sometimes more regular hours of salaried positions.

Attila Barabas, a urologist who completed his residency in 2006 and then worked briefly in a group practice, is now working for a hospital in New Hampshire and next year will move to a hospital in Wyoming to be closer to family. As an employed physician, "I can really focus only on practicing medicine, which is nice," he said. "I don't have to worry about the business side of the operation."

Hospitals are also seeking to position themselves for new methods of payment, including an emerging model known as accountable-care organizations that is encouraged by the new federal health care law. These entities are supposed to save money and improve quality by better integrating patients'care, with the health-care provider sharing in the financial benefits of new efficiencies.

The consolidation wave is raising red flags among some regulators, researchers and health insurers, who warn that bigger health systems can use their leverage to push for higher rates. "We've always been concerned about combinations that are being done to increase prices," said Karen Ignagni, chief executive of America's Health Insurance Plans.

The American Hospital Association's chief executive, Richard Umbdenstock, said in a statement that "the goal of these new care arrangements is to produce real benefits and improve quality for patients" and that "there is plenty of federal and state oversight to ensure just that."

William F. Jessee, chief executive of the medical group association—which has 21,500 members, who are typically managers of medical groups—said he expected to see "more physicians selling out to hospitals." The survey included 2,348 practices both among the association's own members and outside and was conducted in January, February and March. The association warns that the survey wasn't focused on pinning down exact ownership numbers.

For their part, hospitals often aim to guarantee revenue. The surgeries and other care that employed doctors perform or order up will generate billing for that hospital, while independent physicians may be affiliated with multiple hospitals. "They want to essentially lock in volume, inpatient and outpatient," said Paul Mango, a director at consulting firm McKinsey & Co.

St. Luke's Hospital in Duluth, Minn., bought a local primary-care practice two years ago. It hired 20 doctors this year and is now planning to add more in the next two years, while searching for an additional 27 in specialties. "You need patients to support your facilities, and doctors bring patients," said John Strange, chief executive of the not-for-profit hospital, which has 267 beds and currently employs around 180 doctors.

Adding to the incentive, some procedures are paid more richly if done in a hospital than in a doctor-owned clinic. If doctors are employed by hospitals, this extra money can be figured indirectly into their compensation. Under anti-kickback laws, they still can't be rewarded directly for ordering services such as imaging tests that are lucrative for the hospital but may not be needed.

05 November 2010

Punch Drunk

Star-Tribune

A highly potent, caffeine-laced cocktail-in-a-can is on the radar at the U and other campuses.

 
 
What looks like an energy drink, tastes like fruit punch and packs the alcohol wallop of five shots?

A new crop of caffeinated booze beverages that is raising concerns coast to coast and sending some people, many of them college students, to emergency rooms with alcohol poisoning.

Four Loko, a caffeinated malt liquor that has been dubbed "blackout in a can," made headlines last month when nine freshmen at Central Washington University were hospitalized after drinking it at a party.

Several schools have since banned alcohol energy drinks on campus, and Harvard University last week issued an e-mail warning to students, urging them not to drink Four Loko or similar drinks. On Thursday, Michigan banned alcohol-infused energy drinks. And the Food and Drug Administration is reviewing their safety.

That some college students experiment with alcohol -- and sometimes overdo it -- is hardly a news flash.

But what troubles some about Four Loko and similar beverages is the potent combination of sugar, caffeine and alcohol in one dose. Four Loko contains 12 percent alcohol, about the same as wine, but while wine is typically served in a 5-ounce glass, Four Loko comes in a 23.5-ounce can.

"It's the equivalent of 4.7 standard drinks -- like five beers or five shots in a can," said Dana Farley, associate program director at the University of Minnesota's Boynton Health Service.

The malt liquor beverage comes in sweet, fruity flavors like watermelon and lemonade, and includes trendy ingredients like taurine and guarana, popular in energy drinks, in addition to caffeine.

"The sweetness masks the taste of the alcohol, and the caffeine masks the effects of the alcohol," Farley said. "My concern is that novice drinkers -- many first-year students -- may drink Four Loko thinking they're having a drink or two without realizing that, in fact, they're having five to 10 drinks."

04 November 2010

Many Higher-Income Parents Forgoing Kids' Vaccinations: Report

Bloomberg / BusinessWeek

Vaccination rates for children insured by commercial plans dropped almost four percentage points between 2008 and 2009, even though the rate of children on Medicaid getting vaccinated is rising.

"Rates had been gradually improving in the commercial plans. This was the first time we'd seen a drop -- and it was a pretty big drop," said Sarah Thomas, vice president of public policy and communication for the National Committee for Quality Assurance, which recently released its annual State of Health Care Quality report.

Although vaccination rates last year were still mostly higher among children in private health plans rather than Medicaid, researchers and other experts suspect that a counterintuitive trend in American demographics is at work: Parents in a relatively high socio-economic bracket -- with more education and relatively high incomes -- forgoing vaccines because of fears about their safety, with poor individuals taking good advantage of their access to free or extremely low-cost care to have their children immunized.

"We didn't really explore the reasons [for the trend], but one leading hypothesis is that parents have decided not to get their children vaccinated because of concerns about the potential for side effects and even autism," said Thomas.

"I would argue that parents are doing what they think is the best for their children; they're just misinformed," said Dr. Robert W. Frenck, Jr, professor of pediatrics at Cincinnati Children's Hospital Medical Center.

The view that vaccinations cause autism -- which is not supported by scientific research -- is also being publicly touted by a host of attractive celebrities.

Part of that misinformation may come from "very articulate, very good-looking movie stars or personalities that are giving information about how bad vaccines are," Frenck said. "Frumpy, middle-aged doctors" are extolling the value of immunization and may not be heard above the fray.

"Another idea is that people have bigger deductibles and that may have created some decreases in the use of these services as parents decide they don't want to spend money," Thomas said.

The report relied on voluntary reporting from 1,000 health plans covering 118 million Americans, in addition to data from Medicaid, which provides free or co-payment-only health coverage for some low-income people who could not otherwise afford it. (In certain cases, children may be eligible for coverage even if parents are not.)

The authors found a drop in several routine childhood vaccinations. Measles, mumps and rubella (MMR) vaccines decreased from 93.5 percent in 2008 to 90.6 percent in 2009; diphtheria, tetanus and whooping cough rates fell from 87.2 percent to 85.4 percent in that one-year period; and the proportion of kids getting vaccinated for chickenpox fell from 92 percent in 2008 to 90.6 percent in 2009.

Dr. Gabrielle Gold-von Simson, assistant professor of pediatrics at NYU School of Medicine, believes the success with the Medicaid rates "is due to the vaccines-for-children programs and other programs that are dedicated to supplying vaccines for children at low or no cost."

"I think that's a public health success in a way," she added.

But experts are worried that the downward trend in more middle-class families, if it continues, could jeopardize the public's health.

"People have to understand there's only one disease that we have eliminated from the earth so far and that's smallpox," Frenck said. That means that other diseases, including polio, are still lurking and could infect anyone who is not vaccinated.

Witness the recent pertussis or whooping cough in California, which has sickened more than 6,200 people -- the most cases reported in 60 years -- and killed 10 infants, according to the state health department.

There have also been outbreaks of mumps among college students, Frenck said.

Thompson is hopeful that recent efforts to promote vaccines as safe will eventually reverse this trend.

"Vaccines are among the safest and most effective therapies that medicine has available, period, for adults or children, particularly for children since the first vaccines against polio were developed coming on 60 years ago," stated Dr. Lee M. Sanders, associate professor of pediatrics at the University of Miami Miller School of Medicine.

03 November 2010

More Small Businesses to offer Health Insurance

The Wall Street Journal

The number of small businesses offering health insurance to workers is projected to increase sharply this year, recent data show, a shift that researchers attribute to a tax credit in the health law. Many small businesses, however, remain opposed to the law.

Some small businesses are benefiting from portions of the law, which includes a tax credit beginning this year that covers as much as 35% of a company's insurance premiums.

According to a report by Bernstein Research in New York, the percentage of employers with between three and nine workers and which are offering insurance has increased to 59% this year, up from 46% last year. The report relies on data from a September survey by the nonprofit Kaiser Family Foundation.

A full tax credit is available to employers with 10 or fewer full-time workers and average annual wages of less than $25,000. The credit phases out gradually and has a cap at employers with 25 workers and average annual wages of $50,000. The White House estimates that 4 million employers will qualify for the credit.

Small-business employers have been among the hardest-hit by double-digit premium increases, which health insurers blame in part on the cost of complying with new coverage mandates in the law, like allowing children to stay on a parent's plan until their 26th birthday.

They also are facing extra tax paperwork under the law, and the National Federation of Independent Business has joined 20 states that have sued to overturn the law.

The opposition by small businesses to the health law is a frustrating development for Democrats who had hoped to translate their signature legislative achievement into gains in this week's midterm elections.

Ken Weinstein, a Philadelphia owner of two eateries and a real-estate company, plans to begin offering health insurance to his five real-estate office workers—and possibly to his outside contractors—since he qualifies for the tax credit. Until now, Mr. Weinstein has subsidized individual insurance policies for his office workers but not the contractors.

While he said he was happy with that benefit, he was disappointed that his restaurant operation has too many employees to qualify for the credit, and said the health overhaul doesn't do enough to contain sharply rising insurance premiums.

"Costs keep going up and I don't think any parts of the legislation have yet addressed that," said Mr. Weinstein, owner of the city's Trolley Car Diner and Trolley Car Cafe.

Small business lobbyists say the Obama administration is overestimating the reach of the tax credit and failing to factor in a slate of new taxes in the health law that will fall on small business, such as a tax on insurers. NFIB, the small business lobby, estimates that fewer than two million employers will end up getting the credit.

"Most of them tell us they can't qualify for the credit, or it's just too low an incentive to be helpful," said Brad Close, vice president of public policy for NFIB.

John Stein, co-owner of Harbour Coffee in Williamsburg, Va., decided to drop the health insurance plan that covers his wife and their 7-year-old child after his carrier notified him in September that his $450 monthly premium for a high-deductible plan was going to increase more than 20%. He switched this week to a cheaper plan with comparable coverage.

Mr. Stein has no plans to try to tap the tax credit for his coffee-roasting business. "The government in general doesn't have the faintest idea what helps small businesses," Mr. Stein said. "It costs a fortune just to get the plan going, and I get nothing out of it."

Karen Mills, chief of the U.S. Small Business Administration, says insurers already were imposing premium increases before the law took effect. But factoring in the tax credit, she said "the cost of health-insurance to small businesses is going to be, overall, going down."

The Obama administration also is considering making it easier for employers to retain their grandfathered status for health plans, an administration official said. That would exclude them for the time being from some new coverage mandates, such as the requirement to cover certain preventive care.

The move could make it easier for small companies to skirt premium increases, the official said. The administration is weighing whether to allow employers that rely on an outside carrier to absorb their risk and pay insurance claims to shop between carriers without losing grandfathered status.

02 November 2010

Bristol-Myers, Gilead Seek AIDS-Like Win in Hepatitis

Bloomberg

 
Bristol-Myers Squibb Co. and Gilead Sciences Inc., makers of the top-selling combination pills for AIDS, are trying to duplicate their success to combat another evasive virus, hepatitis C.

The companies are among about a dozen that are developing drug cocktails more effective, less toxic and easier to take than current therapy. Hints of which blends may work will emerge next week, in research presented at a Boston meeting of the American Association for the Study of Liver Disease.

The pill combinations are designed to cure the liver- destroying hepatitis C virus without using interferon, a decades-old shot that causes a year of flu-like symptoms and works in only half of patients. While the virus outsmarted new mixtures in preliminary tests, study continues because the first blends to succeed will dominate a market that, according to Decision Resources Inc., may total $8 billion a year by 2014.

“We are trying to duplicate the paradigm that revolutionized HIV therapy well over a decade ago, and apply those lessons learned to hepatitis C,” said Ira Jacobson, medical director of the Center for the Study of Hepatitis C, a New York-based program of Rockefeller University, Weill Cornell Medical College, and New York-Presbyterian Hospital. “My belief is if we suppress it profoundly enough, the virus will eventually wither away and be eradicated in the liver.”

The shares of New York-based Bristol-Myers decreased 9 cents to $26.90 at 4 p.m. in New York Stock Exchange composite trading. Gilead, of Foster City, California, fell 19 cents to $39.67 in Nasdaq Stock Market composite trading.

200 Million People

About 200 million people worldwide have hepatitis C, an analysis at Dartmouth Medical School in Hanover, New Hampshire, found. The disease often persists as a chronic condition that causes nausea, weakness and exhaustion as it destroys the liver over the course of years or decades.

Interferon, the standard of care when paired with the generic drug ribavirin to increase potency, works by boosting the immune system. Roche Holding AG of Basel, Switzerland sells a version of interferon under the brand name Pegasys, while Merck & Co. of Whitehouse Station, New Jersey sells a form called PegIntron.

Two new hepatitis C options that may be introduced next year are telaprevir, from Cambridge, Massachusetts-based Vertex Pharmaceuticals Inc. and New Brunswick, New Jersey-based Johnson & Johnson, and boceprevir, from Whitehouse Station, New Jersey- based Merck & Co. The drugs are similar to the family of AIDS medicines called protease inhibitors that prevent viruses from replicating. Both are used with interferon and ribavirin.

$3 Billion

The combinations are expected to generate more than $3 billion in sales annually by 2013, with telaprevir accounting for $2.6 billion, said Howard Liang, an analyst at Leerink Swann & Co. in Boston, in a telephone interview.

The new antiviral combinations are oral drugs, not injections, and may have the potential to cure patients who haven’t benefitted from the older products, Liang said.

“Both clinicians and patients would prefer drugs that lack the side effects of interferon and ribavirin,” said Alexandra Makarova, an analyst at Decision Resources, a research company in Burlington, Massachusetts, in a telephone interview. “If the combination of direct antivirals will allow doctors to exclude interferon and ribavirin, it could spoil the party for those regimens.”

Optimal Combination

Research hasn’t identified the optimal oral combination for hepatitis C. Initial reports show treatment with just one pill or low-dose combinations aren’t enough to keep the virus in check, and investigators are building more, and more-powerful, combinations. The U.S. Food and Drug Administration, which initially rejected efforts to study treatments without interferon and ribavirin, has now let trials begin.

The ability to create liver cells from stem cells, breed mice that are better models for hepatitis C, and isolate cells from human livers infected with the virus are making it easier to identify and pull together the best cocktails before they are tested in humans, said Michael Charlton, director of the liver transplant program at the Mayo Clinic in Rochester, Minnesota.

“The door may be opening to more innovative combinations of oral therapies,” said Charlton, who sees a new patient every 30 minutes, on average, when working in Minneapolis. “There is still a tremendous second and third wave of drug combinations that are being explored,” he said in a telephone interview.

Second-Stage Tests


Bristol-Myers will present results at the Boston meeting from second-stage tests combining an experimental protease inhibitor, similar to those used for AIDS, with a pill from new family of virus-fighting medicines. The two ingredients, called BMS-790052 and BMS-650032 stopped working in as little as three weeks. Adding interferon and ribavirin to the two-drug cocktail suppressed the virus for as long as three months.

Gilead will report outcomes from a monthlong study of its experimental protease inhibitor, GS-9256, with a second new drug, GS-9190, which is in a different family of medicines.

Adding ribavirin alone delayed or reduced the breakthrough virus, the study found. Vertex stopped a low-dose combination of telaprevir and its experimental drug VX-222 after the virus broke through during the first month of treatment. A higher-dose combination is undergoing tests.

The combination approach is being pursued by biotechnology companies, among them Pharmasset Inc. of Princeton, New Jersey; Medivir AB of Huddinge, Sweden; Idenix Pharmaceuticals Inc. of Cambridge, Massachusetts; and Inhibitex Inc. of Alpharetta, Georgia.

Merck Developments

Merck is developing several oral hepatitis C drugs internally, while looking for outsiders to become partners on its compounds, said Lisa Pedicone, global director of scientific affairs for the company’s hepatitis C products.

A combination of two oral drugs from Roche and Pharmasset was able to keep the virus in check during an initial 13-day study. The combination includes a protease inhibitor and another medicine polymerase inhibitor.

“We need to be bringing the people who have all these agents together to sit down at the same table,” Charlton said. “It takes someone with deep resources to develop a multidrug cocktail.”

Preliminary data suggest that a new family of medicines known as nucleoside-based polymerase inhibitors, which block an enzyme the virus needs to thrive, may be a key player in the drug combinations, Leerink’s Liang said. Pharmasset and Idenix are among the few companies working with those drugs, making them desirable partners or potential takeover targets, he said.

‘Early Days’

“This is like the early days of HIV,” said Stuart Ray, director of the infectious-diseases fellowship training program at Johns Hopkins University School of Medicine in Baltimore. “We are trying to weigh the safety of getting these drugs when they are first available, against the risk of waiting when we know liver disease is likely to be progressing in all of our patients.”

01 November 2010

Sleep Deprived? Your Reaction could be Genetic

LA Times


You and your co-worker have been burning the midnight oil for a week to complete a project, and your abbreviated sleep schedule has you feeling like a zombie. Your co-worker, by contrast, bounces through the workday looking and acting none the worse for wear. There are drugs that can do this, you tell yourself, but your co-worker waves off the suggestion. “I’ve always been able to get by with less sleep,”  she says.

Is she just more disciplined than you are? Did she train herself to “need” less sleep? Is she just saying that to make you feel like a slug? While you may too tired to decide, a study published this week in the journal Neurology supplies the likely answer: It’s in her genes. And your exhaustion is in yours, as well.

The Neurology study, conducted at University of Pennsylvania School of Medicine, found evidence that “interindividual differences” in the way we fall asleep, stay asleep and cope with sleep shortage can be predicted reliably by whether or not we have inherited an allele called DBQ1*0602.
You may very well be one of the more than one-in-four people who are positive for the DBQ1*0602 allele, which happens to be a genetic marker for narcolepsy--a sleep disorder that causes sufferers to fall deeply asleep during the day with little warning. Most narcoleptics have this genetic peculiarity, although being DBQ1*0602-positive is no assurance you’ll be narcoleptic. Compared to those without this allele, someone who’s positive for this allele is likely to fall fitfully into sleep even when she’s exhausted; break free from sleep’s hold several times a night, and feel miserably sleepy when he hasn’t gotten enough shut-eye.

That resilient co-worker, by contrast, appears to be in the genetic majority: DBQ1*0602-negative. Faced with the prospect of less sleep, her body and brain settle into sleep more quickly, slide seamlessly into deep sleep, and stay under until she has to wake up.

After putting 129 healthy adults through a five-night ordeal of partial sleep deprivation (four hours per night), the authors of the Neurology study found no actual differences in cognitive performance between those who were positive and those who were negative for the allele: the differences were in how sleepy and fatigued individuals in the two groups felt after five nights of abbreviated sleep.

In a world where sleep is in chronically short supply, this kind of research is of considerable interest to employers. In lines of work where hours can be long, sleep is had in short bursts, and alertness is non-negotiable—e.g. fighting wars, tending to the sick, driving trucks and flying commercial aircraft—finding people who can function well on little sleep is essential. As research refines how our genes influence our sleeping patterns, some ethicists worry research like this will be used to weed out those who genes predispose them to tolerate sleep deprivation poorly. (The Genetic Information Nondiscrimination Act—GINA—made law in 2008 makes such actions illegal. But that legal protection can potentially be short-circuited by arguments about public safety or national security.)

Namni Goel, the author of the Neurology study published this week, says that using such research to weed out employees who feel miserable when sleep deprived “would be a negative outcome.” She’d rather people use such information to help themselves function optimally: if they know they’re genetically vulnerable to sleep deprivation, they should have a cup of coffee or take a nap when they’ve failed get enough nighttime sleep, said Goel.

Dogs alert Diabetes Patients when Blood Sugar is Off

USA Today


There was a time when Ashley Bogdan, 13, worried much more than a girl in middle school should have to.

She worried that her diabetes could cause her to collapse before she could inject the insulin that stabilizes her. She worried about the long-term effect on her parents, who awoke to check on her often each night to ensure she hadn't gone into diabetic coma while sleeping.

Now she has Bria, "and all that's crossed off my list of things to worry about," the spirited soccer player from Brentwood, Calif., says with a laugh. Bria, her constant-companion diabetes alert dog, was specially trained by Dogs4Diabetics, one of a handful of facilities that train such dogs. Bria signals Ashley several minutes before any symptoms — or the blood tests that she diligently conducts regularly — tell the girl she's entering the danger zone.

In the months they've been together, Bria has been alerting her "more than six times a day" when her blood sugar is starting to go off, Ashley says, helping her avoid the peaks and valleys that can, over time, cause organ damage.

Bria is one of 85 animals the non-profit D4D has placed, and several more will go to other people with diabetes this month as D4D holds its fall session this week and next.

Applicants go through a months-long application process to get a dog (valued at about $30,000, though recipients pay only a $150 application and materials fee). The process, which includes weeks of training for the person, too, is necessary because "having a service dog is not right for every person and every profession," says Breanne Harris, assistant program director.

Moreover, getting such a dog is "not a fix-all," she says. People who have diabetes must continue to carefully monitor blood sugar, and because diabetes is "an invisible disability, the person must be comfortable advocating for himself or herself."

D4D has placed dogs with people 12 to 75 years old, including an airline mechanic and college students, and the "life change can be profound," says Harris, who has diabetes.

"Diabetics can do everything right and still these highs and lows just happen sometimes," she says. With the 20-minute warning she gets from alert dog Destiny, she has eliminated the extremes, and "you aren't knocked out for an hour" as happens when there's a large drop in blood sugar levels.

D4D puts its dogs through months of special scent-detection training, and it gets most of them from Guide Dogs for the Blind and Canine Companions for Independence. They're already trained and well-mannered, but inappropriate for blind people — sometimes too tennis-ball-obsessed or dog-play crazy.

Diabetes can be a scary and isolating condition, experts say. And the alert dogs "bring not only the medical benefits," Harris says, "but also psychological benefits."

A New Set of Wheels Can Improve a Dog's Life, Too

TheWall Street Journal


Dogs and sheep and chickens are going around on wheels; cats not so much. Since people consider pets part of the family, they are ever more willing to spend money making life more pleasant for those laid up with injuries and illnesses.

Spin, a five-month-old pet lamb born with crippled hind legs, recently got her fourth progressively larger wheelchair. She is, after all, going through a growth spurt.

"Spin is very special," says Debra Jones Bachrach, her owner, gazing down as the animal pivots to brush her head up against Ms. Bachrach's knee. Ms. Bachrach has spent about $450 so far on rental fees and modifications for the chairs, which were designed for dogs. Once fully grown, Spin will get fitted with a custom chair of her own. Estimated price: $500.

Spin is in a select but growing cadre of animals that use wheelchairs to get around. Developed for dogs with joint diseases and other complaints, wheelchairs are used to help everything from ferrets to llamas and goats. A company in Washington recently shipped one to Hawaii for a chicken hit by a car.

The pet-wheelchair industry is one manufacturing niche the U.S. still dominates. It is populated by a handful of fiercely competitive small companies, two of them run—not so amicably—by a man and woman who used to be married to each other.

Most of the wheelchairs are designed for animals with difficulties using their hind legs. Generally speaking, the devices consist of a saddle in the rear with some sort of harness that goes over the animal's shoulders or midsection, connected to wheels that allow the creature to move by using its front legs.

Andrew Farabaugh, a veterinary neurologist at Angell Animal Medical Center in Boston, says some animals appear to forget they're even in a chair, once they adapt. "We had a Jack Russell terrier that went a little crazy" once he was mobile again, says Dr. Farabaugh. "He'd go down stairs, chase squirrels."

Most pet wheelchairs—also known as carts—are used for dogs. Chompy, a French bulldog living in New York, is one. He was diagnosed in 2008 with a spinal disease that required three operations and left him unable to walk. This type of injury is beyond the powers of dog glucosamine to fix.

"Six months after the second surgery, we decided to get the cart—because it was hard to take him out," says owner Karen Portnoy.

Ms. Portnoy bought her wheelchair from the same company that produced the ones used by Spin the lamb. Eddie's Wheels Inc., here in Shelburne Falls, sells between 2,000 and 2,500 chairs a year, 90% for dogs, the owners say. But they are branching out into other types of products. They recently made their first chair for a pot-bellied pig named Bacon, owned by a retired butcher in Peru, Mass. They have developed a cross-country ski bracket that attaches to a chair for the skier's best friend.

The average price for one of the company's chairs is $300 to $600, but special designs—such as four-wheeled carts for quadriplegic dogs—can run up to $1,200. The company is run by a husband-and-wife team who produce all the chairs in a 14-employee shop tucked behind their showroom. Some people bring their pets to be fitted at the factory. Most buy online.

"It's becoming less acceptable to offer euthanasia as the only alternative for a pet," says Leslie Grinnell, the company's president.

There are no hard numbers on the size of the industry. But Lincoln Parkes, a veterinary orthopedic surgeon who started building pet wheelchairs in the early 1960s and is widely viewed as the first to develop a business around pet carts, estimates that between 5,000 and 10,000 are sold each year world-wide. Dr. Parkes says the proliferation of mom-and-pop producers and Internet operations has made it a tough business in which to make money.

"Somewhat to my demise financially, I've tried to accommodate most animals that come down the pike," he says. Dr. Parkes says his company, K-9 Cart Company East, located in Oxford, Md., was selling more than 1,000 carts a year a decade ago—but that has fallen to 400.

One of his competitors is his ex-wife, Barbara, of K-9 Carts West, in Langley, Wash. Ms. Parkes says she was the one who ran the company to make the carts designed by her husband while the two were married and her website today opens with the line: "We are the original pet mobility company."

Ms. Parkes's company made the cart for the Hawaiian chicken. "The chicken was run over by a car—and it was picked up by a woman who rescues birds," she says, noting that this job required a special design: The cart is a small semicircular device the chicken rests in. She had one of her employees who keeps chickens at home bring one to the factory to test the design. Ms. Parkes hasn' t yet heard how the Hawaiian bird adapted.

Animals seldom refuse to use wheelchairs, but it does happen. Ms. Parkes notes that obese animals sometimes have trouble. "Sometimes a cat wants nothing to do with it," she adds. "Because it's a cat."

Spin the lamb was put in her first chair when she was 12 days old and seems to have loved it from the start. Ms. Bachrach, her owner, is a hobby farmer in Petersham, Mass., and realized there was something wrong as soon as Spin was born. She couldn't stand up, but would use her front legs to turn in circles.

"So we started calling her the spin lamb, and so it just stuck with her," says Ms. Jones. She recently signed Spin up to work with autistic children and with a group for children in wheelchairs.

She admits it takes a certain kind of person to put a lamb on wheels. It helps that her husband is a veterinary ophthalmologist. "Some of my husband's clients also use carts," she says. "People who seek out an ophthalmologist—they'll do anything."

Phillip Daniels calls NFL's Concussion Crackdown "Crazy"

The Washington Post


Here's a sneak peak of what you can expect from your national Wednesday NFL open locker room coverage: defensive players complaining loudly and eloquently about the league's sudden emphasis on preventing concussions. You will see stories like this from just about every NFL market, with players arguing that a certain level of violence is inevitable, and that legislating it out through fines and/or suspensions is both hypocritical and impossible.

For your sneak peak, I present Phillip Daniels's Tuesday appearance on the LaVar and Dukes show. Daniels actually began his critique of the NFL on Twitter; some of his comments are grouped together here:

    Have we become a cupcake league? We already have better helmets and gear. Wonder how the old school players feel about this. Not in the back of minds when talking about 18 game season so let's play football please....Even guys using shoulders to hit are getting flagged for helmet-to-helmet. Defense is getting sloppy because guys are avoiding fines and will get worse if suspending comes into play....

    There has been a warning sticker on the back of every helmet since pee wee league. When u put that helmet on you know you will hit or be hit. We still choose to play. Parents are asked to sign forms for their kids to play because of the dangers of the sport. Nothing is different.

On the radio, he was perhaps even more pointed when asked about the NFL's response to last week's carnage.

"To me, when I hear guys getting fined that much money for a game in which we're taught to be physical and hit people, I think it's ridiculous," Daniels said. "When this game started, from way back, your dream is to go out there and hit somebody and bring some excitement to the game. You're talking about taking that away. Guys are gonna get hurt. This is football. This ain't no cupcake league.You're gonna go out and play football, you're gonna get hit. Offensive players know they're gonna get hit, and defensive players go out to hit. Nothing's changed. You just go out there and play football and take all this other stuff out of it, this suspension stuff. It's kind of crazy. The fines are crazy too."

Daniels echoed a widespread opinion that the double knockout shot leveled by Dunta Robinson on DeSean Jackson was actually clean, and he said that players are virtually never trying to hurt each other.

"I don't think guys should just go be blatant and go after a head or leave their feet and spear somebody with a helmet, but we're taught to be physical, we're taught to go out and hit people," he said. "And now you get a couple of stars hurt in this league, now they want to talk about suspending guys? I just think this game is going downhill. Defenses right now are sloppy, there's more missed tackles, because guys are trying to avoid the helmet-to-helmet hit. Now you're talking about suspending guys? You definitely gonna get a lot of guys trying to go in the wrong way, missing tackles....You've just got to go out and play football."

Daniels said he uses an "old-school" helmet and is suspicious of the new helmet technology, saying that all three Redskins who have suffered concussions this season were using newer models. He said he's never been on a team that suffered as many concussions as these Redskins, who have already lost Chris Cooley, Rocky McIntosh and Anthony Bryant to head injuries. But he also said that when you go into his profession, you do so with the understanding that your body might be damaged.

"They've done a lot to make this league safer," he said. "It's changed a whole lot already. We protected the quarterback, you've got the horse collar [rule] that happened when T.O. went down. A superstar goes down, the rules change, that's just how it is. I don't get it. We get a couple big name guys go down this weekend, now we're talking about the helmet issue. I just think the NFL, they've done a lot to keep players safe.

"You're gonna get hurt, and if people ever wonder why we get paid so much, this is why. They're talking about this helmet-to-helmet stuff, but it's not coming into play when they're talking about 18 games....How can they argue the 18 game increase? It's crazy. This game is already tough enough with 16 games. To add two more, as physical as this game is, is kind of ridiculous."

28 October 2010

Patient, Heal Thyself

The Wall Street Journal

After Shorter Hospital Stays, Doctors Raise Demands and Time for Recovery

 
For Michael Noonan, knee surgery in April was practically a breeze—an outpatient procedure that had the 41-year-old investment banker hobbling home on crutches in a matter of hours after surgeon David Altchek replaced his anterior cruciate ligament using small incisions.

But recovery was another matter. He needed the crutches for three weeks, had 12 weeks of physical therapy three times a week, then six weeks of exercises at home. He rented a strap-on ice compression device to reduce swelling, and wore a brace for about five weeks. Though fully healed now, being responsible for so much of his own rehabilitation, he says, "was like taking a new baby home for the first time—you don't really feel like you're licensed to do it."

Surgery is easier and faster than ever before: Nearly 65% of all surgeries don't require an overnight hospital stay, compared to 16% in 1980. Hospitals that once kept patients for three weeks after some major operations now discharge them within a matter of days. But the body still heals at its own pace, and reduced time in hospital care means patients are assuming more responsibility for their own recovery—and more risks. Patients not only have to perform rehabilitation regimens at home, but they are more often caring for their own incision wounds and dressings and having to watch for signs of infections and blood clots. They also may be managing drains, implanted IV ports and pumps, all of which can be difficult and stressful.

The move to speedier surgeries is largely the result of new minimally invasive techniques, improvements in anesthesia and cost-cutting by insurance companies and hospitals. Surgical procedures now often use smaller incisions, cut less muscle, and result in less blood loss. Newer anesthetics allow patients to regain consciousness quickly or not go to sleep at all. Pain medications are more effective.

At the same time, concern about rising health care costs has led to changes in Medicare and insurance plans that have encouraged the development of outpatient surgical centers and created financial incentives for hospitals to shift less complex surgery to their own outpatient facilities. So, many types of surgeries previously performed in hospitals with overnight stays are now being done on an outpatient basis: The number of freestanding surgery centers grew from about 240 in 1983 to more than 5,000 now.

The mean charge for outpatient surgery was $6,100 versus $39,000 for inpatient surgery in 2007, according to the most recent report on surgical costs from the federal government. Insurance companies are also less likely to pay for stays at rehabilitation centers, places where surgical patients were often sent after hospital discharge to recuperate.

With patients going home so quickly, more are having to grapple with complications on their own. Of all the complications that occur in the 30 days after surgery, such as infection and blood clots, almost half will surface after a patient leaves the hospital, according to data from one million patients in a surgical quality improvement program sponsored by the American College of Surgeons.

"The onus is really on patients to recognize if something is a problem," says Clifford Ko, a colorectal surgeon at the University of California, Los Angeles, and director of research and optimal patient care for the American College of Surgeons. "The recovery period is often as important as the procedure itself, and patients who don't follow their discharge instructions could have longer recovery times, greater risk of a complication, and potentially more pain."

Knee surgery patients, for example, are counseled to maintain their weight after surgery. But a recent study shows that most patients gain weight, which can jeopardize the health of the other knee. Depression, another common after-surgery occurrence, also can inhibit healing, if patients don't seek treatment.

Efforts are underway to improve follow-up for patients, particularly those who have surgery in doctor's offices, which don't have the same regulation as outpatient surgery centers. The Institute for Safety in Office-Based Surgery has developed a checklist that includes assuring that discharge instructions are provided and a plan for follow-up care is clear. "Patients need to be asked things like if there is redness at the incision site, do you know what to do?" says Fred Shapiro, a Harvard anesthesiologist and president of the group. (Redness at an incision site can be a sign of infection.)

 
Infections that can occur after any surgery can lead to a severe bloodstream infection that can be fatal. A study published in July in the Journal of Hospital Infection of 84,000 patients who developed a surgical site infection found that more than half occurred after discharge, increasing the risks of an emergency room visit, readmission to the hospital, and another surgery.

For months after a procedure, surgical patients are also at high risk of developing blood clots which can travel to the lung and cause death from a pulmonary embolism. After joint replacement, for example, though the risk is greatest within two to five days, a second peak development period occurs about 10 days after surgery when most patients have been discharged from the hospital. In knee surgery patients, a clot can form in the calf if the patient fails to elevate the leg and perform specific movement exercises. Blood clots and subsequent pulmonary embolisms remain the most common cause for emergency readmission and death following joint replacement, according to the American Academy of Orthopaedic Surgeons.

The American Academy of Orthopaedic Surgeons sponsors workshops to teach its members better communications skills to help patients understand procedures and to stress the importance of follow-up care, such as providing clear written instructions and monitoring patients after surgery. "We can have a perfect total knee replacement but then have a poor outcome if we don't convince surgeons that explaining the post-operative care is in everyone's best interest," says John Tongue, a Portland, Ore.-area orthopedic surgeon and clinical associate professor at Oregon Health & Science University who teaches the workshops.

Insurers have become stricter about paying for inpatient rehabilitation programs where Detroit knee surgery patients were once transferred to recover. The move has been spurred partly by studies that show that cheaper at-home visits from therapists are effective.

But Nina Reznick, a 63-year old patient who had both hips replaced last July, says the home therapist her insurance paid for did not have the equipment or time to really help, so she did extra exercises on her own. She believes that effort enabled her to walk a week after surgery. "You are really on your own, and you have to be very motivated," she says.

Some doctors say that the changing demographics of their patients also can contribute to bumpy recoveries. Dr. Altchek, who performs knee and rotator cuff surgery at the Hospital for Special Surgery in New York, says that more younger patients are opting to replace troublesome knees and hips so they can resume athletic activities such as tennis and skiing; close to 42% of all knee replacements in 2008 were for patients aged 45 to 65, compared to less than 35% in 2002, and studies show that waiting too long once a joint starts to deteriorate before having surgery can make recovery more difficult.

But younger patients may also be impatient and assume they are healed, and then quit rehabilitation too early, Dr. Altchek says.

Andrew Minko, a 41-year-old patient of Dr. Altchek's who plays tennis and surfs, has had two surgeries to repair joints on his left shoulder and now needs surgery on his right shoulder. Though he healed well, he admits he was somewhat lax about doing his exercises at home and may have rushed into some activities too quickly after the previous procedures. For the upcoming surgery, he says, "I will be more diligent about the recovery."

25 October 2010

Mayo Clinic guide: Home Remedies can do the Trick

USA Today

 
In this age of rising medical costs and growing demands on our time, a trip to the doctor is something we hope to avoid.

But how do you keep yourself healthy enough to stay away? And how do you know what illnesses you can treat at home and which need professional attention?

Enter the Mayo Clinic's Book of Home Remedies, a 200-page guide for treating more than 100 common conditions. Savvy parents looking for quick advice and good bedside manner get both from author Philip Hagen, who discusses alternative and conventional approaches to healing, cautions about when to seek medical help and offers advice about how to stay healthy.

"This book reflects our experience in working with people who come to the doctor when there may be something that they can do at home," says Hagen, who specializes in internal and preventive medicine.

"We looked at conditions that had a broad impact on the population for which there seemed to be some reasonable home remedies. Then we asked the experts at Mayo to see if there might be reasonable scientific explanations for them and to determine that they're safe."

The need for families to stretch dollars wasn't overlooked by Hagen and his colleagues at Mayo. "The timeliness of this book is in no small part brought about by increasing medical costs," Hagen says.

The kinds of remedies addressed are as diverse as gentle stretching for back pain, swallowing a teaspoon of sugar for hiccups, trying ginger for morning sickness and using Tylenol for teething. And there are instructions for performing lifesaving moves such as CPR and the Heimlich maneuver.

Allergies


"The best way to approach managing allergies is to know and avoid your allergy triggers," Hagen says.

The most common allergens are inhaled — such as pollen, dust, mold and pet dander. At this time of year, when weed pollen is at its worst, people sensitive to pollen can be particularly miserable. He advises:

•Close windows and doors.

•Don't hang laundry outdoors.

•Use an allergy-grade filter on your heating system.

•Rinse out your sinuses with a nasal lavage.

Insomnia


Insomnia disturbs more than one-third of adults at some point, Hagen says. He suggests lifestyle changes — including getting exercise and taking a warm bath one to two hours before bedtime — before resolving to find other ways (antihistamines, sleeping pills) to improve sleep.

•Try gentle exercise like stretching to relax.

•Take a warm bath one to two hours before bedtime.

•Limit naps to 20 or 30 minutes.

Heartburn


Prevention is the key. If you can follow the drill, you won't need a remedy. Still get hit with heartburn? Over-the-counter remedies such as antacids and Pepcid will help.

•Maintain a healthy weight.

•Avoid food and drink that can trigger heartburn. These include fatty foods, alcohol, peppermint and tomato products.

•Don't eat two to three hours before bed.

Influenza


If you get the flu, rest, drink plenty of fluids, try chicken soup — which the authors say helps break up sinus congestion — and consider pain relievers, "but remember, they only make you feel better and can have side effects." Best to take preventive steps:

•Get a flu shot in October or November.

•Wash your hands.

•Eat right and sleep tight.