31 May 2010

What to do about Health Insurance if you are Jobless

Obama's health care reforms are making it easier for young adults to secure coverage.

If you've caught recent TV news about Washington's health care overhaul, you've probably heard talk about a mysterious thing called the COBRA. You may have even wondered, half-jokingly, "What does health care reform have to do with the terrorist group from G.I. Joe?"

The Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA, brought a variety of changes to federal law during the Reagan era, but the one for which it's become most famous was a requirement that large employers allow former employees to stay on the company's health plan temporarily (a year and a half is the norm) after they leave.

COBRA wound up helping unemployed college grads because the law also covered dependents of employees participating in a company health plan. Full-time college students have typically been allowed an exemption to remain on working parents' health insurance even though they're legally adults; if you're out of school and don't have a job, you're going to have to make another arrangement. The good news is, COBRA provides you with a temporary solution. And the Democratic majority in Congress keeps pushing legislation designed to strengthen the program.

The bad news is, your family has to cover the entire cost to get you COBRA coverage--you won't receive the financial contribution from a parent's employer that you may have received when you qualified for normal coverage. Luckily for you, the recently passed national health care overhaul, known as ObamaCare, addresses the high number of young adults struggling to find a long-term health coverage solution. And if you're a grad without a job, you may be able to take advantage of the new changes immediately.

One reform under ObamaCare allows children to remain on their parents' health insurance plans until age 26. The law will force a lot of plans to be more generous in offering coveage to young-adult children than they were previously. Technically, the new extension affects insurance plans that go through their annual renewal process after late-September, but many plans are already agreeing to put in place the new age limit before the change is officially mandated.

Government websites, like the U.S. Department of Labor, are posting lists of insurers that are implementing the age-limit increase ahead of schedule.

"Even if your insurer is included on the list, you have to call up and make sure it applies to you, because a lot of employer plans are self-funded, so different rules might apply,' cautions Cheryl Fish-Parham, deputy director of health policy at the nonprofit advocacy group Families USA.

If you don't have a parent's workplace health plan to rely on, you may be eligible for a government insurance program. A few states, including Connecticut and Massachusetts, have been expanding Medicaid (federally funded insurance historically reserved for the poor and disabled) so that the well-educated but out of work are more likely to be covered. In addition, each state has its own insurance program for low-income residents. Families USA's website has an interactive map where you can find state-by-state information on public health care options.

Whatever you do, try to avoid an interruption in health insurance coverage. If you experience a serious medical problem while uninsured, you'll be saddled with debt that could take you years to dig out from under. Also, when you apply for insurance after being uninsured, your new insurance company is bound to refuse to pay for medical bills related to a preexisting condition.

"If you have a gap in coverage, unfortunately you might find your pre-existing condition is excluded [by your new insurer] for a period of time," Fish-Parham warns. "Even if it's just a broken bone, they'll say, 'We won't cover it.'"

Federal Health Care Reform begins to Shape Consumer Options

Mercury News

SANTA CRUZ - Drew Miller, who works out of a small office on Pacific Avenue, has been helping local residents get health insurance for 30 years.

This year, he's had to advise people of some changes.

Though reforms in the much-hyped federal health care legislation won't unfold fully until the end of the decade, young adults, small businesses and Medicare recipients can benefit as soon as this summer, and already people are shopping for better care.

"Most clients are asking about this. It concerns them," said Miller of Drew Miller Insurance Services.

The changes arriving this year, which Miller and other brokers have begun telling clients about, allow people 26 years old and younger to get insurance on their parents' plans; owners of small businesses to qualify for a tax credit if they provide insurance to employees; and Medicare recipients to get a $250 rebate when they pay expenses in the so-called "doughnut hole," the range where federal coverage lapses.

"Most of the significant changes are still years off, but there are changes (now)," Miller said.

A county report released last week, the most detailed yet on how the federal legislation will play out locally, anticipates that 34,000 of the county's currently 44,000 uninsured will be covered by 2018. The gains will begin this year, the report confirms.

Most notable is the provision, effective in September, that permits children to remain on their parents' health insurance plan until age 26. The change provides new options for an unspecified number of young adults, including those attending UC Santa Cruz and Cabrillo College.

"As you know, kids launch a little later these days," said Rama Khalsa, director of the county Health Services Agency and chief author of the recent county report. "And yes, people get sick in their 20s."

Beyond extending family plans to older children, insurance companies this year will be prohibited from setting annual and lifetime limits on coverage as well as excluding coverage for children with pre-existing conditions.

Adults with pre-existing conditions who are denied coverage may qualify for a yet-to-be-established "high-risk" insurance pool offered by the state. Otherwise, they'll have to wait for the creation of the proposed health care exchanges in 2014, when people will be able to competitively shop on a public marketplace for insurance.

The county report suggests as many as 17,600 local residents, driven by the pending requirement that everyone be insured, will opt for coverage on the exchanges. Federal subsidies will assist poor residents who choose this option.

The other major boon for uninsured county residents, according to the report, will also come in 2014 with the expansion of Medi-Cal, the jointly-run state and federal insurance program. Thousands are expected to be newly enrolled in the program locally.

According to Alan McKay, executive director of the Central Coast Alliance for Health, county residents are already benefiting from a directive by the federal government that prohibits states from reducing eligibility for insurance programs until federal plans are in place.

As the most immediate reforms unravel, state Assemblyman Bill Monning, D-Carmel, who was recently appointed chair of the Assembly Health Committee, has begun working out details of how the coming initiatives will take shape.

Among them are making sure enough medical facilities are in place to accommodate the surge in health care. The committee is eyeing a number of work force development programs, from new training options to low-coast loans for medical students.

"If you boost the number of Californians who are going to be eligible for coverage and seeking California health insurance quotes, there's going to be necessary growth in providers," Monning said.

28 May 2010

'Sack Tapping' - Boys Punching Classmates in the Groin - Leads to Serious Injuries

NY Daily News

Punching the family jewels is no game, boys!

The act of hitting other students in the groin, a dangerous fad called "sack tapping," is sweeping through schools across the country. It can result not just in excruciating physical and emotional pain for the victim, but in emergency surgery with a lifelong impact.

"It's just gotten way out of control," urologist Dr. Scott Wheeler told KARE11.com, a Minneapolis TV station.

Wheeler now operates three or four times a year on boys who suffered complications such as a ruptured testicle after being groin-punched.

"All parents, you need to have this talk with your kids not to do it," he said. "It's lost its humor."

Homemade videos of students' "sack tapping" shenanigans can be found all over YouTube.

For victims like 14-year-old David Gibbons of Crosby, Minn., the pain after being punched in the groin by another student at his school was so intense he woke up his mother at 1 a.m. Christy Gibbons took her son to the hospital, where he had his right testicle surgically removed.

"This may be called a game, but it's not a game," the mom said. "It's dangerous and it needs to stop."

David's parents have since pulled him out of that high school and plan to move to a different school district. David's old school is investigating the incident. Meanwhile, doctors have reassured David that even though he now has just one testicle, he should still be able to father children one day.

Gibbons wants other parents to be educated about the dangerous practice.

"I've seen the pain he was in," she said. "I've seen what he went through every day, and it just breaks my heart and I don't want any other child to have to go through this."

Donor Cuts Hurt AIDS Fight in Africa

Boston Globe

JOHANNESBURG — Doctors are being forced to turn away people with HIV/AIDS in eight African countries as donors cut funding amid the global economic crisis, an aid group said yesterday.

Medecins Sans Frontieres, or Doctors Without Borders, said the patients being rejected will fall ill and almost certainly die without treatment.

The group called on rich countries to fulfill their obligations to poorer nations, saying the funding cuts threaten to unravel years of progress on the continent hardest hit by AIDS.

The MSF study looked at AIDS programs in Congo, Kenya, Lesotho, Malawi, Mozambique, South Africa, Uganda, and Zimbabwe, and found the effects of funding cuts widespread.

MSF said the Global Fund to Fight AIDS, Tuberculosis and Malaria — a major, independent supporter of AIDS programs around the world — was under pressure from the wealthy governments that pay for it to cut back.

The President’s Emergency Plan for AIDS Relief, a US program that is a major funder of AIDS programs around the world, has had its budget nearly frozen at a time of increasing need, MSF said.

27 May 2010

Food Industry Makes Strides in Ousting Trans Fats

U.S. News & World Report

In its move to oust trans fat from food products, the food industry is substituting the bad with better-for-you fats, a new report published in the New England Journal of Medicine suggests. That's good news, since some experts had worried the industry would just replace one unhealthy substance with another: saturated fat.

Researchers analyzed 83 reformulated products from grocery stores and restaurants and found that most had no more saturated fat than before—save for some baked goods they examined, HealthDay reports.

In April, U.S. News contributor Katherine Hobson wrote about the latest research on what types of fats are fine to eat. All fats are not alike in their effects on blood cholesterol levels, which can affect heart disease risk. Saturated fat, for example, generally increases levels of LDL, or "bad" cholesterol, Hobson wrote. Trading saturated fats for polyunsaturated fats—the omega-3 fatty acids found in certain fish and the omega-6 fatty acids in vegetable oils such as safflower and soybean oils—does seem to offer a heart benefit.

F.D.A. Weighs More Penalties In Drug Recall

NY Times

Dr. Joshua M. Sharfstein, the F.D.A.’s principal deputy commissioner, left, and Michael Chappell, the agency’s acting associate commissioner for regulatory affairs at a Congressional hearing Thursday morning.
The agency is considering further actions against McNeil Consumer Healthcare, the Johnson & Johnson unit, after a pattern of violations in manufacturing and quality control practices led to a number of recent recalls, Dr. Joshua M. Sharfstein, the F.D.A.’s principal deputy commissioner, said at a Congressional hearing on Thursday.

On April 30, McNeil voluntarily recalled more than 136 million bottles of liquid pediatric Tylenol, Motrin, Benadryl and Zyrtec because they may have contained metal debris, too much of the active ingredient of the drug or inactive ingredients that failed testing requirements, the agency said. But McNeil’s problems go beyond those related to last month’s recall, including other forms of contamination, dating back two years.

During a session in which some committee members questioned McNeil’s integrity, Dr. Sharfstein noted lengthy delays by the company in reporting problems to the agency. And in one case, in 2008, he said, McNeil hired a contractor to quietly remove packages of Motrin from retailers for suspected quality problems — which he suggested was essentially an unannounced recall that was not reported to the F.D.A.

“This is something troubling to the agency,” Dr. Sharfstein said. “We think it reflected poorly on the company.”

He said the F.D.A. was “considering additional enforcement actions against the company for its pattern of noncompliance, which may include seizures, injunction or criminal penalties.”

Another agency official, Deborah M. Autor, the director of the F.D.A. Office of Compliance at the Center for Drug Evaluation and Research, told the committee that officials had referred the McNeil case to the office of criminal investigation, the agency’s law enforcement arm. That office works with the Justice Department to prosecute companies accused of violating the laws governing drug manufacturing and marketing.

The House Committee on Oversight and Government Reform called Thursday’s hearing to examine the circumstances surrounding last month’s recall and whether the F.D.A. had responded adequately. But the evidence presented indicated long-running problems.

“I have become deeply concerned about your company,” Representative Edolphus Towns, the New York Democrat who is chairman of the committee, told the Johnson & Johnson executive who testified. “It paints a picture of a company that is deceptive, dishonest and that has risked the health of many of our citizens.”

That executive, Colleen A. Goggins, the worldwide chairwoman of Johnson & Johnson’s consumer group, acknowledged lapses by the McNeil unit. “The quality and process issues that we found at McNeil, those which led to the recall and others, are unacceptable,” she said.

But she also defended the company’s integrity. “There was never any intent to deceive or hide anything,” Ms. Goggins said.

The products in the latest recall were made at a company plant in Fort Washington, Pa.

Ms. Goggins said that the risk of serious medical problems from the recalled products was remote and that there were no reports that the products had caused serious medical harm.

Earlier this week, an F.D.A. spokeswoman said that the agency had received reports of health problems associated with the recalled products, including several deaths. But she said the agency had not found evidence that the products had caused the reported health issues.

Ms. Goggins said McNeil had identified and rejected the children’s medicines that contained metal particles or higher-than-normal doses before they reached the marketplace.

As part of an overhaul of its manufacturing and quality control processes, McNeil has replaced several senior executives and is making systemwide improvements, Ms. Goggins said.

McNeil posted a statement on a company Web site this week saying that it was making improvements in every part of its manufacturing and quality control operations, including organizational changes, employee training and new procedures for investigating product problems.

But Mr. Towns, the committee chairman, said McNeil’s corporate conduct surrounding the recalls dating back several years raised integrity questions.

For example, Dr. Sharfstein said, in 2008, McNeil notified the F.D.A. that it had hired an outside contractor to buy samples of Motrin from retailers to determine whether problems with the drug’s ability to dissolve warranted a recall.

In 2009, however, the agency received information that the contractor had been buying up inventories of the product in what seemed to be an unannounced recall, he said. McNeil later initiated a formal recall of the products after the agency questioned the company about the contractor’s conduct, he said.

In answer to questions from Mr. Towns, who referred to the incident as a “phantom recall,” Ms. Goggins said that McNeil had notified F.D.A. officials that it had hired a third-party contractor to determine how much of the product in question was on the market. But she said that she could not account for the contractor’s actions and that she would provide the committee with further information.

Committee members also questioned the executive about other incidents cited by the F.D.A.

In 2008, for example, McNeil received several consumer complaints about a moldy smell emanating from some over-the-counter products that had been made at a company plant in Puerto Rico. Some people also reported stomach problems. But the company did not notify the agency of the issue until 2009, Dr. Sharfstein said.

“It should not have taken a year,” he said. “It should have taken three days.”

After hearing Dr. Sharfstein’s testimony, Representative Eleanor Holmes Norton, a Democrat from the District of Columbia, asked Ms. Goggins whether the delay amounted to a “cover-up.”

Ms. Goggins said that McNeil had initially tested the products for microbiological contamination and that the tests had come back negative. When the consumer complaints subsided, the company thought the problem had resolved itself, she said.

The consumer complaints picked up again in 2009. McNeil recalled products in November, December and in January after it determined that the odor was caused by contamination from a chemical used to treat wooden transport pallets that had leached into some products.

In an F.D.A. inspection report last month about the Fort Washington plant, the agency cited McNeil for similar issues — failing to properly investigate 46 consumer complaints of foreign particles and unidentified black bits in some products. McNeil received that report on April 30 and announced the recall that evening. In her written testimony, Ms. Goggins said that McNeil took each complaint and report seriously and sought to investigate each one.

“Reports of possible serious adverse events, for example,” she wrote, “are reported to the F.D.A. quickly.”

Some committee members said that if Congress wanted to prevent delayed actions by drug makers on defective medicines, it should give the F.D.A. the authority to recall such products and levy civil penalties on companies. The agency cannot now require a recall, but pharmaceutical companies may voluntarily recall problem drugs.

Tanning Beds Triple Melanoma Risks

Minnesota Daily
Research by University professor Dr. DeAnn Lazovich showed that indoor tanning tripled one’s likelihood of developing melanoma.

Using any type of tanning bed for any period of time may increase the likelihood of developing melanoma — the most deadly form of skin cancer — by 74 percent, the study said.

The study showed that frequent patrons of indoor tanning salons were 2 1/2 to three times more likely to develop melanoma than those who have never used indoor tanning beds.

The study defined frequent users as those who spent at least 50 hours, 10 years, or more than 100 sessions using a tanning bed.

“What is remarkable about our results are that they are very consistent," said Dr. DeAnn Lazovich , an associate professor of epidemiology at the University and the principal investigator of the study.

These results fly in the face of past studies, which showed that using tanning beds increased the likelihood of developing melanoma by just 15 percent.

While previous studies suggested that the age of an individual is an important risk factor, Lazovich’s study indicated that frequency of use is the biggest determinant. Those who begin using tanning beds at a young age are likely to use them more frequently, she said.

“While the data has already been quite strong, there were parts of the question that were not answered to all of our satisfaction,” said Dr. Allan Halpern , a dermatologist at Memorial Sloan-Kettering Cancer Center in New York City.

“This study addresses them very well,” he said.

The study examined more than 2,200 Minnesotans — roughly half of whom were diagnosed with melanoma — and gathered information on their tanning habits and compared that data to the cancer-free control group.

“Doing it in Minnesota where we know we have a lot of indoor tanning use really makes a study like this possible,” Lazovich said.

26 May 2010

Study Finds Supplements Contain Contaminants

NY Times

Nearly all of the herbal dietary supplements tested in a Congressional investigation contained trace amounts of lead and other contaminants, and some supplement sellers made illegal claims that their products can cure cancer and other diseases, investigators found.

The levels of heavy metals — including mercury, cadmium and arsenic — did not exceed thresholds considered dangerous, the investigators found. However, 16 of the 40 supplements tested contained pesticide residues that appeared to exceed legal limits, the investigators found. In some cases, the government has not set allowable levels of these pesticides because of a paucity of scientific research.

Investigators found at least nine products that made apparently illegal health claims, including a product containing ginkgo biloba that was labeled as a treatment for Alzheimer’s disease and a product containing ginseng labeled as a treatment to prevent diabetes and cancer. They also described a salesperson at a supplement specialty store who claimed that a garlic supplement could be taken instead of blood pressure medication.

Any product that claims to treat, cure, prevent or mitigate a disease is considered a drug and must go through strict regulatory reviews.

The report, which was prepared by the Government Accountability Office, was provided to The New York Times and will be made public at a Senate hearing on Wednesday. Its release comes two weeks before the Senate is scheduled to begin debate on a landmark food safety bill that is expected to substantially increase the federal government’s authority over food manufacturers.

But it is uncertain how tough the bill will be on supplement manufacturers, and it has been the subject of fierce lobbying. Capitol Hill staff members familiar with the process said the bill was unlikely to include provisions opposed by supplement manufacturers.

Dr. Joshua M. Sharfstein, principal deputy commissioner of the Food and Drug Administration, said in an interview that he was not concerned about the safety of the supplements tested by the G.A.O. investigators. But Dr. Sharfstein noted that the agency had recently announced a recall of Vita Breath, a dietary supplement that it said might contain hazardous levels of lead.

Steve Mister, president of the Council for Responsible Nutrition, a trade association representing the dietary supplement industry, said it was not surprising that herbal supplements contained trace amounts of heavy metals, because these are routinely found in soil and plants. “I don’t think this should be of concern to consumers,” Mr. Mister said.

Senator Herb Kohl, a Wisconsin Democrat who will preside over Wednesday’s hearing of the Senate Special Committee on Aging, said that while improvements had been made in recent years in the oversight of supplements, “the F.D.A. needs the authority and tools to ensure that dietary supplements are as safe and effective as is widely perceived by the Americans who take them.”

Among the witnesses at the hearing will be Dr. Tod Cooperman, president of ConsumerLab.com, a company that has tested over 2,000 dietary supplements made by more than 300 manufacturers and has found that one in four have quality problems. According to Dr. Cooperman’s written testimony, the most common problems are supplements that lack adequate quantities of the indicated ingredients and those contaminated with heavy metals.

Travis T. Tygart, chief executive of the United States Anti-Doping Agency, wrote a letter to the committee saying that some athletes have been rendered ineligible for international competitions because they took supplements that contained steroids not listed on the products’ labels. There are thousands of supplements available for sale that contain steroids or other harmful ingredients, he wrote.

“The F.D.A. is operating in a regulatory environment that is simply too burdensome to allow for effective post-market regulation of these products,” Mr. Tygart wrote.

Half of the nation’s adult population takes vitamin supplements regularly, and about a quarter take herbal supplements at least occasionally. Annual sales are about $25 billion a year, and the growing popularity has led to an increasing number of imported supplements spiked with illegal drugs.

In 1994, Congress passed legislation that allowed supplement makers to sell products without first getting approval from the F.D.A. for their ingredients or for basic health claims. But scientific organizations have warned repeatedly since then that the F.D.A. should do more to ensure that the supplements are safe and that their health claims are substantiated.

In recent years, a vast majority of supplement suppliers have located overseas — principally in China. Nearly all of the vitamin C and many other supplements consumed in the United States are made from ingredients made in Chinese plants. Those plants are almost never inspected by the F.D.A. because the agency is not required to do so, has little money to do so and does not view the plants as particularly risky.

Mr. Mister said supplement sellers tested ingredients before using them, but he agreed that testing could not ensure quality. He called on Congress to provide the F.D.A. with more money to inspect foreign and domestic supplement plants. “I think you’ll see more and more inspections,” Mr. Mister said.

He said that a few companies made illegal health claims for their supplements, but that the industry was trying to police those. “I occasionally see these late-night commercials with health claims that make my blood boil,” he said.

Dr. Sharfstein said the F.D.A. had increased enforcement actions against supplements spiked with prescription drugs like Viagra. And he said the agency had taken action against supplement makers that made broad health claims. “We don’t want people to think they’re treating a disease with something that hasn’t been proven to do that,” he said.

The food safety bill expected to be introduced next month in the Senate is likely to mandate that supplement makers register annually with the F.D.A. and allow the agency to recall supplements suspected of being dangerous.

But a House provision that would require manufacturers to create plans to safely manufacture their products and a proposal made in February by Senators John McCain, Republican of Arizona, and Byron L. Dorgan, Democrat of North Dakota, to restrict supplements to ingredients approved by the F.D.A. will not be included, staff members said.

24 May 2010

Two Wars Producing Unique and Puzzling Brain Injuries

USA Today

Former Army Spec. Michael Cain, 29, pets his dog, Rocky, in his Washington, D.C., apartment. Cain was in a vehicle that hit land mines in Iraq in 2003. He lost his right leg below the knee, suffered a host of other issues and a brain injury.
WASHINGTON — What has been called the "signature wound" of the wars in Iraq and Afghanistan— the mild brain damage troops suffer from a roadside bomb — might be so unique in its destruction that it could be a newly discovered disease, scientists say.

"Most of us in this room would concur that this (blast-induced brain injury) disease ... perhaps does require a separate category," Army Col. Geoffrey Ling, a neurologist, told a roomful of colleagues at a brain-injury convention this year. "It may actually have some unique features to it, which makes it a very interesting new disease."

Among the new findings from neurodiagnostic services in Indianapolis: The blast wave causes a more dispersed pattern of brain-cell damage and keeps those cells inflamed for a longer period than occurs with a traditional blow-to-head concussion, according to research posted recently by the Defense and Veterans Brain Injury Center. The center's duties include coordinating traumatic brain injury (TBI) research and clinical care.

Army field studies have shown that more than 10% of troops in Iraq and Afghanistan have suffered at least one concussion or brain injury, the vast majority of those from exposure to a homemade bomb or improvised explosive device. Five percent to 15% of mild TBI patients develop lasting problems with concentration, short-term memory, fatigue and chronic headaches.

7 years ago, a life changed

One of those is former Army Spec. Michael Cain, who lost his right leg below the knee in a roadside explosion in Iraq in 2003. Today, he is still plagued with short-term memory loss, difficulty concentrating and irritability.

"If they tell me some important stuff, like appointments, if I don't write it down or put it in my BlackBerry right away, I'm not going to remember," Cain says.

Unemployed and living on a medical retirement income, Cain says he is uncertain about his future.

Blast-related brain injury is an issue of intense debate within the military medical community.

Detractors argue that any soldier close enough to an explosion to suffer brain damage from the blast wave would be killed by shrapnel. Others assert that long-term symptoms from mild TBI are more likely the result of post-traumatic stress disorder.

Explosions have been a part of war for centuries. But scientists say that because troops serving in Iraq and Afghanistan are wearing body armor, they are surviving bomb blasts that would have killed them in previous wars. As a result, they say, blast wave damage to the brain is more prevalent.

"Blast (in combat) has been around for a while," says Air Force Col. Michael Jaffee, director of the Brain Injury Center. "What is different now is our understanding of blast has never been greater."

The more that scientists learn about how the blast wave damages the brain, the more chance they will have to develop protective measures, such as a new helmet design, Jaffee says.

Different from sports injury

Questions remain about whether mild TBI caused by explosions is more serious than a sports-related blow to the head, detroit brain surgeons say. For now, the two appear to produce similar immediate symptoms such as loss of consciousness, dizziness and memory loss.

In most cases of mild TBI, regardless of the cause, victims appear to recover fully within hours or days, scientists say.

According to a summary of scientific research recently made public by the Pentagon, there are several ways in which exposure to an explosion differs from a blow to the head:

•Damage to wiring in the brain appears more widespread.

•Brain cell inflammation caused by blast waves lasts longer than inflammation caused by a blow to the head.

•In moderate or severe cases of blast-induced brain injury, blood vessels can inexplicably spasm and cut off oxygen flow to the brain for days after the injury. This can happen in a blow to the head but to a far lesser degree.

"Blast-induced neurotrauma is a unique clinical entity," says Ibolja Cernak, a scientist at the Johns Hopkins University Applied Physics Laboratory in Laurel, Md., who has studied the effect for a decade.

Many harmful factors

An explosion creates a shock wave traveling at the speed of sound. It also emits toxic fumes, heat and light. Scientists do not yet understand which of these elements, or what combination, causes this unique brain damage and exactly the type of St Louis neurosurgery is indicated.

Scientists at the Massachusetts Institute of Technology, using computer modeling to re-create the blast effect on the human skull, have found that a significant electromagnetic charge also occurs.

"When you compress bone with an incoming shock wave, you are going to generate an electrical field," says Raul Radovitzky, an MIT aeronautical engineer who is working on the project. "The electric fields are ... possibly well beyond accepted standards."

He says more research is necessary to determine whether the field generation is causing brain damage.

For Cain, after seven years of recovery, he wonders why his brain has not yet healed.

"I really wish that they'd go away," he says of symptoms such as short-term memory loss and his tendency to startle easily. "I didn't want them to tell me I had a brain problem, because I was a pretty smart person before. I had straight A's. ... It really frustrates me."

22 May 2010

Lyme Disease on the Rise in Wisconsin


PEWAUKEE - Wisconsin is among the worst states in the country for lyme disease, and the number of infections each year is growing. 

A mother from our area is spreading the message about how one bug bite can change a life.

"It's just sad to watch," said Ronda Arndorfer of the Midwest Lyme Foundation.

She nearly lost her son Chris, who is now 24 years old.  Even now, he always seems sick.

"Relentless pain, headaches, jaw, it's attacking his organs," Ronda said to TODAY'S TMJ4 HD's Tom Murray.

Finally, a specialist in New York diagnosed lyme disease.

"He's going to be OK someday, but it's going to be a long road."

Like most with the disease, Chris never saw the tick that likely gave him the infection. 

The month of May is prime season for ticks.   The tiny parasites tend to linger in the woods, bushes and especially high grass.

"It takes at least 24 hours for the ticks to transmit the bacteria," said Diep Hoang Johnson of the Wisconsin Department of Health Services. 

"If you check yourself over right away, you can remove the tick and avoid getting the infection."

"I look like I'm not sick," said Stacey Kremel, who is surviving with lyme disease.

"I have pain everywhere still, just get really tired."

As for Ronda, she is so passionate about spreading the message that she started the Midwest Lyme Foundation. 

This weekend will offer their first fund raiser, a bike ride around Pewaukee Lake.

"It's to educate the community, so no family has to suffer like we've had to suffer watching Chris be very sick."

FDA Urged to Make Public More Company Data


The U.S. Food and Drug Administration should make more information public, including its reasons for refusing to approve a drug or device, an agency task force recommended on Wednesday.

If adopted, the changes would shed considerable light on a review process that affects the entire drug and device industries. All of the proposals would offer the public more details on key agency decisions.

Wider disclosure could alter companies' ability to control news that could affect their stock prices, especially negative FDA actions such as denying a product or highlighting safety concerns.

"The FDA would make substantially more information about the regulatory process available to the public" if it accepts the proposals, FDA Deputy Commissioner Joshua Sharfstein and Afia Asamoah, director of the transparency effort, wrote in the New England Journal of Medicine.

Among the recommendations from the FDA Transparency Task Force, which included the FDA's top lawyer, chief scientist and the heads of the drug, device and other centers, was that the agency disclose letters to companies explaining why it declined to approve a product or refused to accept an application.

Such letters, known as "complete response" or "not approvable" and refuse-to-file letters, are currently only released if and when a company decides to make them public.

The agency should also publicly say when a company's proposed drug application has been placed on hold, terminated, or withdrawn, the task force said in a report released on the FDA's website. (Click on: link.reuters.com/dyk25k)

The FDA will take public comments until July 20 on the proposals before deciding whether to adopt them.

FDA Commissioner Margaret Hamburg will make the final decision on which proposals to adopt, Sharfstein told reporters, adding that some actions could come this summer.

Wall Street investors and shareholders have been particularly keen to understand why the FDA rejects products, saying company news releases often give sparse information on why they failed. Companies have said they are concerned about protecting proprietary details about their drugs and devices.

"Investors are frustrated because very often you have companies that like to spin what is in those complete response letters, and there's no way to know what's really in them," said Capitol Street analyst Ipsita Smolinski. Here "there's no question. Everybody has access to the same information."

Representatives for drug and device makers cautioned that the agency must protect their trade secrets.

Pharmaceutical Research and Manufacturers of America Senior Vice President Ken Johnson, in a statement, urged the FDA to "continue to protect proprietary information" and said it would submit more comments directly to the agency.

Disclosing information on products "that are still under review by the agency raises concerns," Advanced Medical Technology Association Vice President Janet Trunzo said.

FDA's Sharfstein and Asamoah said some proposals "would accelerate the development process for medical products by allowing companies to learn from the successes and failures of other products."

The task force also urged FDA to disclose safety and effectiveness summaries from pending applications if there is a public health interest, including when the agency believes it needs to correct misleading information.

Despite the call for more openness, it is unclear how the FDA would disclose the information or how quickly. It is also unclear how much detail could be "blacked out," or redacted, from public view.

"The Task Force believes that trade secrets should remain confidential," the report said.

Consumer advocate Sidney Wolfe said he was concerned that exemption could be too broadly interpreted and that key information could still be withheld.

"There obviously are legitimate trade secrets like manufacturing processes, but safety and efficacy data we don't think should be a trade secret," said Wolfe, head of Public Citizen Health Research Group.

Sharfstein told reporters the agency had not yet looked at whether it had the legal authority or resources to carry out any of the proposals and that it would analyze those issues.

"We didn't want to be sidetracked into a legal discussion," he said, acknowledging that some actions would require a change of law. "We really focused on what's the right thing to do."

21 May 2010

House Panel Probes Gene Tests

The Wall Street Journal

A House panel is investigating personal genetic test kits currently sold over the Internet after one company proposed selling its kits through stores operated by Walgreen Co. and CVS Caremark Corp.

Last week, Pathway Genomics, a closely held firm based in San Diego, announced plans to sell its Insight Saliva Collection Kit through 6,000 Walgreens stores for between $20 to $30 a test. Saliva collected from the test would be sent to the company and analyzed for an additional price of $79 to $249.

The test, which Pathway currently sells through its website, is designed to predict a person's risk for developing certain diseases or how they might respond to certain drugs. It can also predict the risk of 37 genetic diseases caused by recessive genes that might be passed to a child from parents.

But after the Food and Drug Administration raised concerns about the test, Walgreen and CVS Caremark both said they would hold off on selling the kits until all the regulatory issues are worked out with the agency.

The test isn't FDA-approved, but Pathway Genomics has said it didn't think the test needed agency approval. The company said it's currently working with the FDA to make sure it is compliant with agency rules.

Now, the House Energy and Commerce Committee is seeking information about Pathway's test along with tests from 23andMe Inc. and Navigenics, two other closely held firms based in California.

All three companies sell tests on the Internet that analyze a person's salvia to determine their risk of certain health conditions. The tests also allow people to obtain genetic ancestry data.

Rep. Henry Waxman, D-Calif., the chairman of the Energy and Commerce Committee, along with other lawmakers on the House panel, sent letters to the three companies Wednesday requesting information about how they analyze the test and how accurate the test results are. The panel is also seeking information about how the firms collect, process and store individual genetic samples collected from consumers.

It wasn't immediately clear if the panel planned to hold a hearing on the genetic tests.

Viagra Linked to Hearing Loss

Business Week

The erectile dysfunction drug Viagra, and possibly other similar medications, may prompt long-term hearing loss among users, a new study suggests.

In the May 18 issue of the Archives of Otolaryngology -- Head and Neck Surgery, researchers from the University of Alabama at Birmingham discuss evidence supporting an association between the onset of hearing problems and Viagra. The medication is one of the so-called class of phosphodiesterase type 5 inhibitors (PDE-5i), which also includes Cialis and Levitra.

The finding follows the 2007 decision by the U.S. Food and Drug Administration to adjust labeling for such medications to more prominently display warnings about hearing loss risks. The move stemmed from reports that year regarding sudden hearing loss among users of these drugs.

"It appears from these findings that the current government warning regarding hearing loss and the use of PDE-5i medications is warranted," study author Gerald McGwin, a professor of epidemiology in the University of Alabama at Birmingham School of Public Health, said in a news release. "Though there are limitations to this study, it is prudent that patients using these medications be warned about the signs and symptoms of hearing impairment and be encouraged to seek immediate medical attention to potentially forestall permanent damage."

The finding stems from an analysis of survey data concerning more than 11,500 men over the age of 40 that had been collected by the federal Agency for Healthcare Research and Quality between 2003 and 2006.

McGwin and his team found that men who said they used PDE-5i drugs had twice the risk for developing hearing loss as those who did not.

The authors stressed that more research is needed, while suggesting that one possible explanation could lie in the original purpose of these medications. They note that although now used mainly for erectile dysfunction, this class of drugs was initially prescribed for the treatment of pulmonary high blood pressure.

"PDE-5i medications work in erectile dysfunction patients by their ability to increase blood flow to certain tissues in the body," said McGwin. "It has been hypothesized that they may have a similar effect on similar tissues in the ear, where an increase of blood flow could potentially cause damage leading to hearing loss."

20 May 2010

UnitedHealth, Humana Seek Medicare’s 5-Star Bonus Pay


Insurers led by UnitedHealth Group Inc. and Humana Inc. may share in an estimated $2.5 billion in yearly bonuses if their U.S-backed Medicare plans rate four or five stars under a system created to improve quality of care.

The U.S. has ranked Medicare Advantage insurance plans that serve the elderly on a one- to five-star basis since 2007, weighing clinical outcomes, access to tests, preventive care and consumer satisfaction, among 33 criteria. Under the health law signed in March, those scores will be used to award bonuses that can boost U.S. subsidies for the plans by five percent.

The money may help offset an estimated $136 billion, 10- year scheduled cut in U.S. payments for the plans. UnitedHealth has begun an improvement push because most of their customers are in plans now ranked from three to three-and-a-half stars, said spokesman Matthew Burns. At the same time, America’s Health Insurance Plans, the industry’s lobbyist, is urging changes in the system that may allow more plans to get higher ratings.

It’s “health-care Darwinism,” said Nathan Goldstein, senior vice president of strategic development with Gorman Health Group, a Washington consulting firm that works with Medicare Advantage plans, in an interview.

The program begins with a 1.5 percent bonus in 2012, then 3 percent in 2013 and 5 percent in 2014.

Payments will be worth at least $700 million a year by 2014, said Brian Biles, a professor at George Washington University’s Department of Health Policy who wrote a study on the program. If all the three-star plans improved to four, the total bonus payments would be worth about $2.5 billion, according to a separate analysis by Biles.

‘Taking the Edge Off’

The bonuses “could be significant in taking the edge off cuts to Medicare Advantage,” said Ana Gupte, a Sanford C. Bernstein & Co. analyst in New York, in an e-mail.

UnitedHealth, based in Minnetonka, Minnesota, lost 26 cents to $30.18 at 4 p.m. in New York Stock Exchange trading. Humana, of Louisville, Kentucky, increased 31 cents to $46.20. The Standard & Poor’s 500 Managed-Care Index has fallen 12 percent since President Barack Obama signed the health-care law on March 30, compared with a 4.5 percent decline in the S&P 500.

Advantage plans compete with traditional Medicare plans by offering expanded benefits and different premiums. About 10.2 million of the 45 million Medicare recipients were Advantage members in 2009, according to the Kaiser Family Foundation, a Menlo Park, California, health-care research group.

UnitedHealth Coverage

UnitedHealth covered 2 million people in Advantage plans as of March 31 and Humana had 1.74 million, according to statements released last month. The Advantage program accounted for one- fifth of UnitedHealth’s $3.82 billion in earnings last year, said Matthew Borsch, a Goldman Sachs Group Inc. analyst in New York, in a May 3 note.

In 2009, he U.S. paid insurers an estimated $110 billion to run the plans, according to Kaiser. The payments were about 14 percent higher per-patient than the cost of traditional Medicare, the U.S. government’s basic health program for those 65 and older, the Medicare Payment Advisory Commission said.

In an effort to raise its ratings by 2014, UnitedHealth will encourage patients to use chronic and preventive care services more often, and the company plans to put resources into added call centers and customer support, said Rhonda Medows, the insurer’s chief medical officer for public and senior markets.

“We believe we’ll achieve four or better in time,” Medows said in a telephone interview.

Industry Lobbying

The insurance industry has been lobbying to influence many parts of the health-care overhaul that will affect how companies do business, including rules about the proportion of premium dollars to be used for administrative costs and profits. The rating system is also at issue, said Robert Zirkelbach, the group’s spokesman.

The star system grades insurers against one another on some of the 33 measures. America’s Health Insurance Plans is challenging the objectivity of having the criteria rated on a curve, Zirkelbach said in a telephone interview.

“We have raised concerns that some of the measures in the current star systems are not based on objective criteria, which could prevent some plans from moving up,” he said.

That means companies will find it harder to improve their ratings unless the metrics grading them against one another are changed to allow measurements against universal standards, said Biles, who wrote the study about the bonus program.

“For somebody as big as UnitedHealth, that all their plans could be four stars under the current system is impossible,” Biles said in a phone interview.

No Decision on Changes

Medicare hasn’t decided whether to change the criteria, said Peter Ashkenaz, a spokesman for the Centers for Medicare and Medicaid Services, in an e-mail.

Biles said ending the grading curve might make the star rating system less meaningful.

“They’ll set absolute values, but they’ll set them so low that everybody lives in the world of Lake Wobegon, where all the children and all the plans are above average,” he said, referring to radio show host Garrison Keillor’s fictional town in Minnesota.

Nonprofit Medicare Advantage plans tend to have higher ratings than for-profit companies. The average nonprofit plan has 3.87 stars, compared with 3.02 stars for the for-profit insurers, according to the Kaiser foundation.

Martin’s Point Health Care in Portland, Maine, a nonprofit insurer, is one of four plans in the U.S. with a five-star rating. The insurer had 2,652 Advantage patients that brought in $16.4 million in 2009. Martin’s Point competes locally against Humana among about 10 rivals, Chief Executive Officer David Howes said in a phone interview.

9 Percent Cut

All the local Maine plans are facing about a 9 percent cut to their government payment rates next year. “But they’re not all going to be getting the quality bonuses. I think the quality bonuses may be critical for success going forward,” Howes said.

Howes said Martin’s Point expects to double the number of Advantage customers in the next year. The plan relies on its existing relationships with doctors and hospitals to make sure they’re providing preventive care, one of Medicare’s metrics.

“We’ve spent a lot of time thinking about, ‘Who do we want to have in that network?’” Howes said. “Who gives nice access? Who gives us the ability to touch our members and patients in a way that is positive?”

Martin’s Point’s five-star ratings will help it win more customers from its competitors and perhaps eventually drive them from the market, said Goldstein, of Gorman Health Group, who has consulted with the Maine nonprofit.

“To the victor goes the members,” Goldstein said. “Mr. CEO, what I’m here to tell you is that your payment rate is getting cut down, and you have two levers you can pull to increase it -- your risk adjustment, and your star system.”

$35M for Dartmouth Health Care Delivery Center

Associated Press
Dartmouth College is getting $35 million to open a center it hopes will help the nation take the next big steps in health care reform: improving quality while lowering costs.

The historic health care overhaul legislation President Barack Obama signed in March will give millions of Americans access to health care, but "the real rocket science in health care right now is in the delivery," said Dartmouth President Jim Yong Kim, who has been promoting the idea of a national institute on health care delivery since arriving at Dartmouth last July.

Now, he has a $35 million commitment from an anonymous donor to establish the Dartmouth Center for Health Care Delivery Science, which will bring together experts in everything from medicine and management to sociology and systems engineering to figure out what is working in successful health care systems such as Minnesota's Mayo Clinic. They'll then teach practitioners, who can return home and make changes immediately, Kim said.

"We're not just doing the research and presenting it for people to either accept or not accept," he said.

The center also will be home to a new master's degree in health care delivery science, which will begin enrolling students in July 2011.

"The science of health care delivery is being practiced by many wonderful scholars throughout the country, but most colleges and universities have not made it a major focus," Kim said. "A lot of medical schools teach health policy, but they don't really teach the complexities of what it takes to actually build effective, functioning, health care systems, clinics or hospitals."

Kim, the first Asian-American to lead an Ivy League school, is a former director of the World Health Organization's HIV/AIDS department. He helped found Partners in Health to support health programs in poor communities worldwide. Kim came to Dartmouth from Harvard Medical School, where he was chairman of the Department of Global Health and Social Medicine.

He said he hopes Dartmouth's new center will be a clarion call to other colleges and universities.

"We're talking about an industry that's growing so quickly, and we're really worried that without improving quality, we're just going to have increased costs," he said. "So I think there's a tremendous urgency to tackling health care delivery, and I firmly believe that American institutions of higher education have a central role in tackling that problem."

Kim described the anonymous donor as a consumer who recognizes the health care system is in trouble. He expects the initial seed money will be enough to set the center up to attract government and private funding. And though he agrees with goals of Obama's health care legislation, Kim emphasized that the new center "is not about cheerleading" for the administration.

He pointed out that Sen. Judd Gregg, R-N.H., has long supported the research done by Dartmouth's Institute for Health Policy and has been involved in the planning for the new center, along with Sen. Jeanne Shaheen and Gov. John Lynch, both Democrats.

One idea they've discussed is using the center to make New Hampshire a model for innovative health care delivery.

"There's a lot of talk in Washington right now about setting up pilot programs," Kim said. "I think a really, really exciting possibility though would be to set up a pilot state to take on an entire state with multiple health care systems in it."

While a single health care system, such as a hospital, can perform well because of centralized control, "the challenge of performing well across an entire state is a different kind of challenge, and one we'd love to take on," he said.

19 May 2010

American Heart Association Teaming up with Nintendo Wii


Nintendo of America announced a strategic partnership with the American Heart Association this morning, effectively adding the AHA stamp of approval to all retail boxes of Wii Fit Plus, Wii Sports Resort, and the Nintendo Wii itself. "The brand serves as a chance to remind people about the benefits of a healthy approach to living and how active-play video games can be an integral part of a healthy lifestyle," the partnership's official website explains.

In addition to the marketing partnership, the AHA and Nintendo will host a "multidisciplinary summit of representatives from a variety of fields ... to take a closer look at the synergies and benefits of active-play video games," entitled the "Innovation Summit." No details have been provided on when and where said summit will occur. Finally, various "active-play Nintendo video games" will be available to play at select "Start! Heart Walk" events this fall.

Also, no, Nintendo hasn't explained the Vitality Sensor yet.

18 May 2010

Health Reform's Next Test

The Washington Post

Jim Yong Kim
Health insurance reform is now law, giving millions of Americans access to the full resources of our health-care system for the first time. The question becomes: How can we ensure that they -- and all of us -- receive value-based and high-quality care?

It is well known that U.S. health-care costs, as a share of our economy, are the highest in the world but that compared to other industrialized countries, our results are the worst. The Dartmouth Atlas has documented the enormous waste in our system and shown that spending more money and performing more medical procedures do not equal better outcomes for patients.

Americans deserve health care that is coordinated across physicians and health systems, and that is effective, appropriate and safe. As a nation, we have a moral and a fiscal responsibility to ensure that all patients receive value for health services. While the achievement of health insurance reform was historic, it is time to focus on the next step: improving quality while bending the unsustainable cost curve significantly.

We are physicians and researchers; one of us is now a college president, and the other head of a leading academic medical center. We share a history of work in medicine, science, policy reform and education. We also share the view that throughout history, our most difficult problems have found scientific solutions.

We propose the rapid expansion of a new field to tackle the twin problems of how to provide high-quality health care while lowering costs: health-care delivery science.

This new field will work with the recognition that truly reforming health care requires more than the efforts of one entity. We cannot blame government or insurers or physicians for the complex and multilayered problem. No single group or entity created the puzzle that is our health-care system; it is not reasonable to expect one group to solve it.

What will lead to improvements is a multidisciplinary approach that brings the best minds to focus on the problem. Experts in management, systems thinking and engineering, sociology, anthropology, environmental science, economics, medicine, health policy and other fields must join together to apply a laser focus to fixing the delivery system.

Why? Consider the moving pieces of a patient-health system encounter. A patient comes into the emergency room. Immediately, judgments are made about how sick she is and what treatments she needs. There is no universal medical record for that patient, so the provider has no idea about her medical history, medication use or preexisting conditions. Incomplete information is relayed through layers of nurses, physicians, specialists and the shifts of personnel who replace them. In the absence of real-time information, tests are ordered and treatment decisions made. Perhaps after an overnight stay, barring complications from drug interactions or perhaps an unrecognized underlying condition, she is discharged, with no further transfer of information to a provider and, more important, no follow-up to see whether the treatment was effective. The symptoms were treated; the patient was not.

The best insurance in the world will not fix this problem. We need a whole new cadre of people committed to applying their expertise to the challenge of health-care delivery.

We have begun building that cadre at Dartmouth with the establishment of a Center for Health Care Delivery Science. But it is our hope that many more institutions will work together to generate the needed evidence on health-care delivery solutions, to disseminate that knowledge and to train the current and future professionals who will put solutions into practice. We envision a network of centers across the country that will marry research and implementation from the start -- finding and testing delivery solutions with practitioners and patients on the front lines.

The recent health legislation establishes an implicit covenant with the American people. The spirit of this covenant goes far beyond insurance. In exchange for new public and private investment in the health system, Americans expect access to effective, high-quality care within a financially sustainable system. With a robust science of health-care delivery, this goal can be achieved.

Jim Yong Kim is president of Dartmouth College. James N. Weinstein is president of the Dartmouth-Hitchcock Clinic.

Cancer Treatment Uses Body's Immune System


A first-of-its kind prostate cancer treatment that uses the body's own immune system has received federal approval, offering a gentler alternative to chemotherapy and radiation.

Studies by the Dendreon Corp., of Seattle, found that its Provenge vaccine added four months to the lives of men with advanced prostate treatment. That's a month longer than the chemo drug Taxotere, and doctors hope it will provide even more benefit if given earlier in the course of the disease.

It works like this: From each patient, doctors collect special blood cells that allow the immune system to recognize cancer as a threat. The cells then are mixed with a protein found on most prostate cancer cells and another substance to rev up the immune system. The resulting "vaccine" is then given to the patient through three infusions over a two-week period.

"The big news here is that this is the first immunotherapy to win approval, and I suspect within five to ten years immunotherapies will be a big part of cancer therapy in general," said Dr. Phil Kantoff, an oncologist at the Dana-Farber Cancer Institute who helped run the Provenge research.

Side effects are relatively mild, including chills, fatigue, fever and headache. The one limiting factor will be the cost: nearly $100,000 per patient.

"There are going to be a lot of patients that want it and there will be limited resources as they are getting this up and running," said Dr. Deborah Bradle of Duke University.

Don't eat raw crawfish

Don't try to show friends what a cast-iron stomach you have by eating raw crawfish. You could wind up with a potentially fatal illness.

That's what at least six people recently discovered when they came down with lung-fluke infections after ingesting raw crawfish from Missouri rivers, according to the state's Department of Health and Human Services.

Usually seen in Asia, the lung fluke (paragonimiasis) is a food-borne infection caused by eating raw or undercooked freshwater crabs or crayfish. The parasitic trematode eventually breaks through the digestive tract to infest the rest of the body, including lungs, brain and nervous system. Symptoms can mimic tuberculosis -- fever, cough and spitting up blood.

People who develop such symptoms after eating raw crabs or crayfish are urged to seek immediate medical care. All six Missouri patients improved after they were hospitalized and give medicine to treat parasitic infections.

New cancer treatment study

A new study of women diagnosed with ductal carcinoma in situ may have uncovered important clues that will lead to personalized treatment.

DCIS is a common form of cancer in which malignant cells develop within the milk ducts of the breast. Currently, a woman who is diagnosed chooses either a lumpectomy with radiation treatment or has a mastectomy.

But a study of nearly 1,200 women at 63 San Francisco area hospitals uncovered three "biomarkers" that may help doctors determine how aggressively they should treat each patient. Of women with all three markers, 20 percent developed an invasive cancer within eight years. Of those with none of the markers, only 4 percent developed invasive cancer.

If the findings are confirmed, such differences may help women choose a more appropriate treatment, experts said.

"At this point in time we're probably overtreating people and undertreating people," said Dr. Karla Kerlikowske, a professor of medicine, epidemiology and biostatistics at the University of California San Francisco. "If we can define a woman's risk a little better, then we can personalize what they want to do."

Sun protection in vehicles

If you're in a car or truck for extended periods, you might want to add skin cancer to the list of traffic hazards you face.

A new study finds that skin cancer is found predominantly on the left side of the face -- and especially in men.

"Drivers need to be aware of the amount of sun exposure they receive behind the wheel," said Dr. Scott Fosko, the chair of dermatology at St. Louis University and co-author of the study, which appears in the Journal of the American Academy of Dermatology. "The cumulative effect of being exposed to the sun builds up over many years."

And, he says, professional drivers aren't the only ones that need to monitor exposure to the sun. Carpooling moms and daily commuters should be concerned as well.

His recommendations: Regularly apply sunscreen that blocks both UVA and UVB rays. Tinting glass and using UV filters on windows also can help. Wear protective clothing whenever possible.

The American Cancer Society estimates that most of the more than 1 million cases of non-melanoma skin cancer diagnosed annually in the United States are sun-related. Melanoma caused most of the 12,000 skin cancer deaths last year.

Noninvasive depression treatment

Psychiatrists at the Southern Illinois University School of Medicine in Springfield have become the first in downstate Illinois to use a new noninvasive treatment for depression.

Approved by the Food and Drug Administration in 2008, transcranial magnetic stimulation -- or TMS -- may help adults who have not had successful treatment results from anti-depressant medications.

TMS therapy uses magnetic pulses to stimulate targeted regions in the brain during the 45-minute outpatient procedure. The pulses induce a painless electric current, which, in turn, causes neurons to release mood-boosting natural substances such as serotonin and dopamine.

Patients are awake and alert during the treatment, which is usually administered daily for four to six weeks. National studies found it produced statistically significant improvement in such symptoms as sadness, loss of interest, insomnia, fatigue and low self-worth.

Kareem Abdul-Jabbar in area

Helping make cancer cures a slam-dunk will be Kareem Abdul-Jabbar's goal when he hosts "illumination10," the annual gala benefiting The Siteman Cancer Center in St. Louis.

This year's program on May 15 at the Chase Park Plaza will support the Barnes-Jewish Hospital's Foundation's Cancer Frontier Fund, a 10-year, $50-million initiative to boost research at Siteman.

Abdul-Jabbar, the National Basketball Association's all-time scoring leader and six-time MVP, has had a stake in the work long before he was diagnosed with chronic myeloid leukemia last year.

"My grandfather died from colorectal cancer, my uncle died from colorectal cancer and my father almost died from colorectal cancer," he told CNN last November. "I think it's possible for someone in my position to help save lives."

17 May 2010

Hip Joint Replacement Can Help Severe Arthritis Pain

SC Now

After years of work and play, and sometimes injuries or illnesses, some joints just wear out.  The years of wear and tear on joints can lead to arthritis and the pain and disability that go along with it.

The joints that bear the most weight are usually the ones to wear out first. The hips have a very great pressure across the joint because of the leverage action of the thigh muscles.

When a person’s doctor has determined that the joint damage is great enough and the symptoms severe enough, he may suggest a hip joint replacement in Dearborn. Usually, a person must have significant disability or uncontrollable pain before the operation is considered.

Hip joint surgery involves replacing the surfaces of the joint. A polyethylene socket is placed into the hip socket and the ball of the hip is replaced with a metal ball that is stabilized by a spike extending several inches down the thigh bone.

After surgery the person must be careful how he sits. He should not cross his legs for six weeks or there is a possibility of dislocating the joint.

Although the period of recovery and rehabilitation will take several months, the arthritis pain relief improves quickly with the surgery.

After Detroit hip replacement surgery a person can do almost anything he wishes, but in moderation because the prosthesis has the risk of loosening over 10 to 15 years if a person puts excessive stresses on the prosthesis.

15 May 2010

Walgreens to Begin Selling Genetic Testing Kits

The Chicago Tribune
Scientists, bio-ethicists and genetic counselors worry consumers will misuse or misunderstand test results

Coming soon to a drugstore near you, alongside the aspirin and greeting cards, will be the promise of answers to some of life's most personal mysteries: Am I at risk for Alzheimer's disease? Or breast cancer? Or obesity?

Starting Friday, Walgreens will begin selling Insight personal genetic testing kits, becoming the first major retail chain in the U.S. to offer home tests that say they assess the risk of developing one of dozens of different health conditions. CVS plans to have it in stores by August.

The product's introduction raises immediate concerns among scientists, bio-ethicists and genetic counselors. They worry that consumers will misuse or misunderstand the results of a test so open to interpretation it is potentially meaningless, or frightening, especially without a full medical assessment.

On Tuesday, the Food and Drug Administration told the Tribune it is investigating the medical claims the product's manufacturer, California-based Pathway Genomics, is making in marketing its genetic test, which hasn't been approved by U.S. regulators.

Pathway officials say the company's home genetic test meets federal regulations and doesn't require FDA approval.

"The tests conducted are not an in-vitro medical device and are not intended for use in diagnosis, treatment, mitigation or cure of disease. It does provide information that allows a person to learn about their health to make healthier lifestyle choices," said Ed MacBean, Pathway's vice president of product management. "If the FDA contacts us, we will discuss it and address any concerns they might have."

Drugstores already carry DNA paternity and gender prediction tests that can be done at home, and genetic test kits are sold online by several firms. But genetic testing typically requires a visit to the doctor's office, allowing for consultation with a health care professional.

Marketers think such kits could become as common as early pregnancy tests, helping consumers get initial information before going to the doctor.

"We recognize that for some people, genetic responses are becoming a more important component of managing their health care," said Jim Cohn, a spokesman for Deerfield-based Walgreens. "There are people who want to know more about their genetic makeup, and we pride ourselves on being convenient and accessible."

The Insight genetic test kit, priced at $20 to $30, comes with a vial and a shipping envelope. Buyers send a sample of their saliva to a Pathway Genomics laboratory and receive their results online. The report costs $79 to $179, depending on the type of test requested.

The kits will be appear on the shelves at about 6,000 of Walgreens' 7,500 stores nationwide.

Pathway Genomics Chief Executive Jim Plante said in a statement that his company is "revolutionizing" the way people access information about their genetics. "The value of knowing how genes play a role in our personal lives, and potentially the lives of our children, is critical for making well-informed health and wellness decisions," he said.

Pathway screens for genetic markers of more than 70 diseases, including diabetes, prostate cancer and cystic fibrosis. The company notes that "some markers have been researched more thoroughly than others, but scientific knowledge advances rapidly."

It recommends buyers discuss results with a doctor or one of Pathway's genetic counselors, particularly for complex health issues such as heart disease and cancer that have multiple causes, including lifestyle and environmental factors, MacBean said.

Scientists question the value of home genetic testing. For most diseases, no one knows exactly why one person gets it and another does not, said Peter Kraft, deputy director of the Program in Molecular and Genetic Epidemiology at Harvard School of Public Health.

"The company states, everyone has the right to know the secrets hidden within their DNA," he said. "Fair enough, but that is a lot of work. I don't think this is the way to go."

According to a paper published in The Lancet in May, a team of more than 30 researchers took a year to analyze the results from full-genome testing of a 40-year-old man with a family history of coronary artery disease who died suddenly. Although the amount of data they analyzed was far greater than that of Pathway's kit, the researchers used much of the same data on genetic health risks, disease risk and drug information.

Even then, the researchers acknowledged that the genetic information was incomplete, said Dr. Nilesh Samani, a professor of cardiology at the University of Leicester in England who wrote a commentary on the study.

Many of the risks have been calculated for the entire population, Samani said, but that doesn't mean it applies neatly to any one individual because of family history, lifestyle habits or, importantly, genetic variations.

Samani likened it to a card game in which you can only see a few cards. At first blush, you may be holding a bad hand, but what if the cards you can't see are all aces?

"You need to know the rest to know whether it is worthwhile," Samani said. "That is a limitation. It is a big limitation. [The companies] don't present it like this."

New Mutant Genes Linked to Rheumatoid Arthritis


A large study of European populations has uncovered seven new clusters of defective genes which may be responsible for rheumatoid arthritis, a painful and disabling disease that affects mainly the joints.

The paper was published in Nature Genetics on Monday together with findings of a separate study in Japan, which identified one of the seven genetic clusters as possibly causing the chronic inflammatory disease among Japanese.

"The findings leverage us to better understand the basic biology of rheumatoid arthritis (RA), with the goals of developing new targets for therapy and new biomarkers for diagnosis and prognosis," wrote research scientist Eli Ayumi Stahl at the Brigham and Women's Hospital in Boston in the United States, who led the study on European populations.

The study was also intended "to develop better genetic tests for RA risk, especially in people already at risk (such as arthritis patients or relatives of patients with autoimmune disorders)," Stahl told Reuters.

RA affects about 1 percent of the world's population. Apart from the joints, it may affect the skin, heart, lungs, kidneys and blood vessels. Many end up with deformed hands and feet, resulting in loss of functions and movement. There are few alternatives in the way of rheumatoid arthritis relief.

In the European study, Stahl and colleagues repeated six previous studies involving 5,539 patients, analyzing their genes using the latest technology. They shortlisted 34 genetic variants which they considered most suspect in causing RA.

They then checked if those genetic defects were found in another batch of 6,768 RA patients in Canada, North America, the Netherlands and Britain. Ten of the 34 variants figured most prominently in this replication phase.

"Ten of the 34 variants tested were validated in the replication phase of our study. Three were previously implicated in RA, leaving the 7 new ones mentioned above," Stahl wrote.

"This is more RA risk variants discovered in a single study than any other study to date, underscoring the importance of large-scale studies and the collaborations that enable them in order to make progress in unraveling common, complex diseases."

"Our results further suggest that many more RA risk variants remain to be definitively identified," Stahl added.

In the Japanese study, researchers led by Yuta Kochi at the RIKEN Center for Genomic Medicine in Yokohama, Japan, analyzed genes of 7,039 RA patients and identified a common genetic mutant near the CCR6 gene.

The CCR6 gene was also identified in the European study.

What you Should Know about Arthritis

Maitland Observer

More than 46 million adults in the U.S. report being diagnosed with some form of arthritis. Although often considered a disease affecting only the older population, close to 300,000 children under the age of 18 have some form of arthritis as well, which represents about one in every 250 kids.

In honor of May being designated as National Arthritis Month, we recently sat down with local fellowship trained joint specialist and orthopaedic surgeon, Dr. Samuel S. Blick, M.D., of the Orlando Orthopaedic Center in Winter Park to answer some of the more common questions he hears regarding the joint disorder.

Q: How do I know if I have arthritis and it's not just something that will go away in a day or two?

A: Arthritis is inflammation of one or more joints, which generally results in pain, swelling, stiff joints and, thus, limited movement. There are more than 100 different types of arthritis, one of the most common being osteoarthritis, or a type of arthritis that is caused by the breakdown and eventual loss of the cartilage joints. Usually, it's diagnosed with X-rays.

Q: Besides being an inflammation, what else should I know about the disease?

A: More than 70 percent of individuals in North America affected by arthritis are over the age of 65, however it can affect people of all ages. Arthritis is more common in women than men at all ages and affects all races, ethnic groups and cultures. Genetics, injury and weight also play a role.

Q: What are some risk factors or behaviors I can avoid to keep it from getting worse?

A: Neither rheumatoid arthritis nor osteoarthritis can be completely prevented; you can reduce the risks by becoming physically active while avoiding impact exercise. Instead, focus on low resistance muscle strengthening. Weight loss and a healthier diet may help as well.

Q: Sometimes my arthritis pain is too much to handle. What are some things I can do relieve pain at home quickly?

A: The best remedy for at home arthritis pain relief should be to ice the joint, take an over-the-counter pain reliever such as Tylenol and get plenty of rest. You may also want to try gently massaging the affected area as well.

Q: If I wanted to get rid of the pain for good, what are my options? Does joint replacement work?

A: There is no complete cure for arthritis other than joint replacement at this time. In fact, all other arthritis treatments are temporary whereas success rate for total knee and hip replacement is about 95 percent.

Spouses of Dementia Patients More Likely to Develop the Disease Too

The Detroit Free Press

Married adults who have a spouse with dementia are much more likely themselves to develop dementia, according to a study published last week in the Journal of the American Geriatrics Society.

The study suggested that either the stress of being a caregiver or something about the shared environment of the couple contributes to the second case of dementia.

Researchers from Utah examined 2,442 married people ages 65 and older, none of whom had dementia at the start of the study. They were monitored for 12 years.

During that time, 125 cases of dementia were diagnosed in husbands and 70 cases in wives and 30 cases in which both the husband and wife were diagnosed. The analysis showed that people with a spouse with dementia had a six times higher risk of developing dementia themselves. The risk, however, was much higher for men caring for their wives than for wives caring for their husbands.

"On the positive side, the majority of these individuals with spouses who develop dementia did not themselves develop dementia," said lead author of the study, Dr. Maria Norton of Utah State University.

09 May 2010

When Autism Begins may Dictate how Severe Illness will be

The Detroit Free Press

Among the most baffling observations about autism is that some children appear to have symptoms early in life while others develop normally and then regress before they reach their third birthday.

Still others have mild developmental delays and then experience a plateau in development.

Evidence suggests these are different types of autism. Researchers at Kennedy Krieger Institute in Baltimore found in a new study that children with early symptoms may actually be at lower risk for poorer outcomes than children who develop normally and then experience a loss of skills.

In data collected from 2,720 parents, researchers found that children with regression had a distinct increase in the severity of symptoms, such as not attaining conversational speech. The outlook was even worse for children whose parents also said the regression phase was severe.

"Children with developmental plateau are an especially under-researched group, and these findings have important implications for those designing and prioritizing clinical evaluations," a coauthor of the study, Dr. Paul Law, said in a news release.

More than one-third of the parents surveyed said they had concerns about their child's general development before they noticed the more obvious signs of regression.

The study is published online in the Journal of Autism and Developmental Disorders.

08 May 2010

An Alcoholic's Savior - Was it God, Belladonna, or Both

NY Times

In October 1909, Dr. Alexander Lambert boldly announced to a New York Times reporter that he had found a surefire cure for alcoholism and drug addiction. Even more astounding, he stated that the treatment required “less than five days.” The therapy consisted of an odd mixture of belladonna (deadly nightshade), along with the fluid extracts of xanthoxylum (prickly ash) and hyoscyamus (henbane). “The result is often so dramatic,” Lambert said, “that one hesitates to believe it possible.”

Dr. Lambert was hardly a quack looking for headlines. He was widely known as Theodore Roosevelt’s personal physician, a professor of medicine at Cornell Medical College and an expert on alcoholism. Dr. Lambert had years of experience taking care of thousands of alcoholics at Bellevue Hospital’s infamous “drunk ward.” In fact, it was on this storied hospital ward where he experimented with the belladonna cure.

He had obtained the recipe from a layman named Charles B. Towns, who, in turn, claimed to have learned about it from a country doctor. In 1901, Mr. Towns opened a substance abuse hospital in New York City at 293 Central Park West, between 89th and 90th Streets. He needed Dr. Lambert because he lacked a medical degree and, hence, professional credibility; Dr. Lambert needed Mr. Towns, because for all his medical knowledge, he had relatively little to offer his patients in terms of an effective treatment.

The Towns Hospital attracted only the wealthiest alcoholics and addicts, who gladly paid exorbitant fees for a treatment that “successfully and completely removes the poison from the system and obliterates all craving for drugs and alcohol.” Because of Prohibition and the paradoxical rise in alcoholism in 1920, the Towns Hospital restricted its practice to drying-out well-to-do alcoholics.

Perhaps the most famous patient was William Griffith Wilson, better known as Bill W., the co-founder of Alcoholics Anonymous. In the early 1930s, Mr. Wilson was consuming more than two quarts of rotgut whiskey daily, a definite health risk according to Alexander Lambert, who found in his copious research that consumers of cheap or bootlegged alcohol were far more prone to seizures, delirium tremens and brain damage than those who drank the expensive stuff. Between 1933 and 1934, at his wife’s urging and on his wealthy brother-in-law’s dime, Mr. Wilson was admitted to Towns four times. The cost upon admission was steep: up to $350 (roughly $5,610 today) for a four- to five-day stay.

Although Mr. Wilson made some progress in temporarily abstaining, he relapsed after each of the first three hospitalizations. It was around this time that he reunited with a drinking buddy named Ebby Thacher. Unlike previous times, when they went out on wild binges, Mr. Thacher told him that he quit booze and was a member of the Oxford Group, a church-based association devoted to living on a higher spiritual plane guided by Christianity. As a demonstration, on Dec. 7, 1934, Mr. Thacher took Mr. Wilson to the Calvary Mission on East 23rd Street and Second Avenue, where the most drunken of New York’s Depression-era down-and-outers went to be fed and, it was hoped, “saved.”

A few days later, a drunken Wilson staggered back into the Towns Hospital. There, his physician, William D. Silkworth, sedated him with chloral hydrate and paraldehyde, two agents guaranteed to help an agitated drunk to sleep, albeit lightly. This was especially important because the medical staff members had to wake patients every hour for at least two days to take the various pills, cathartics and tinctures of the belladonna regime.

On the second or third day of his treatment, Mr. Wilson had his now famous spiritual awakening. Earlier that evening, Mr. Thacher had visited and tried to persuade Mr. Wilson to turn himself over to the care of a Christian deity who would liberate him from the ravages of alcohol addiction. Hours later, depressed and delirious, Mr. Wilson cried out: “I’ll do anything! Anything at all! If there be a God, let him show himself!” He then witnessed a blinding light and felt an ecstatic sense of freedom and peace. When Mr. Wilson told Dr. Silkworth about the event, the physician responded: “Something has happened to you I don’t understand. But you had better hang on to it.”

Hang on to it he did. Indeed, this experience ultimately led Mr. Wilson to abstain from alcohol for the remaining 36 years of his life and to co-create the novel program whereby one alcoholic helps another through a commitment to absolute honesty and a belief that a higher power can help one achieve sobriety.

Long before Mr. Towns touted his cure for alcoholism, belladonna (as well as henbane) was known to cause hallucinations. The hallucinations brought on by alcoholic delirium tremens tend to be a transmogrification of things the alcoholic is actually seeing or experiencing into a realm of sheer terror. A stray coil of rope may appear to be a poisonous cobra; a pattern on the wallpaper seems to transform into a poisonous spider. But they can also be tactile, like the sensation of insects crawling on the skin. Other hallucinations associated with alcohol withdrawal, or alcoholic hallucinosis, tend to be brief and involve hearing accusatory or threatening voices.

Belladonna hallucinations, on the other hand, are typically based on recent discussions the person had but become far more fantastic. Many times, these visions appear to fulfill the wishes one might have had during the inspiring experience.

Several decades after his 1909 announcement, Alexander Lambert took great pains to distance himself from belladonna. Although Dr. Lambert found the detoxification process to be useful in the short run, he became discouraged by its toxicity, its propensity to induce hallucinations and the fact that many of those he treated at Bellevue relapsed and returned for subsequent treatment. Something more was needed, he declared, and that task fell to Bill Wilson and an alcoholic physician from Ohio named Bob Smith, who created Alcoholics Anonymous in 1935.

Were Bill Wilson’s spiritual awakening and influential sobriety the products of a belladonna hallucination shortly after his discussions with his friend Ebby Thacher? Could they have been incited by his alcohol withdrawal symptoms? Or did something else happen to him that science cannot explain? In the end, millions of people who have benefited from Alcoholics Anonymous and similar 12-step alcohol rehab programs  in New York and around the world would say that such pharmacological, physical or spiritual parsing hardly matters.