DMC Invests In Itself For The Community

Story first appeared in the Detroit News. 

With more than half a year in the books with its new for-profit owner, Detroit Medical Center President and CEO Mike Duggan said patients and doctors are returning to the eight-hospital system, spurred by Vanguard Health System Inc.'s planned construction improvements.

Vanguard, which bought the DMC on Dec. 31 and promised to spend $500 million on construction, expansions and renovations and $350 million in routine capital during the next five years, said Thursday its shareholders lost $9.9 million during its fourth quarter.

The loss, compared with earning a $2.8 million profit a year ago, was driven largely by charges related to its June initial public stock offering. But patient service revenue soared 75 percent to $1.28 billion, largely attributable to the acquisition of the DMC.

Keith Pitts, Vanguard's vice chairman, said Detroit's seeing good volume in the marketplace, so they have been very happy with some of the volume trends there, and they will continue to work to improve the operations there over the next few years.

While Duggan isn't talking volume or revenue specifics — and neither are his Vanguard bosses in Nashville, Tenn. — Duggan said Vanguard ownership has boosted employee morale and hospitals have been busy.

Duggan said he has talked to doctors and patients all the time that have chosen to come back to DMC because of the momentum from Vanguard.

The DMC, which last year generated nearly $2.1 billion in revenue, now represents more than a third of revenues for Vanguard, which operates 26 hospitals in five states. With such a large exposure in Detroit, some analysts expect much of Vanguard's stock earnings will be all about Detroit during the next few years.

One anyalst said with over $2 billion in revenue solely in the Detroit market, they believe investors should get used to almost all focus on this one particular market, as the stock will likely live and die by the success of the transaction.

While some have questioned Vanguard's wisdom in buying the DMC, several analysts predict the DMC will continue to increase revenue, improve its margins and help Vanguard's stock price grow over the next several years.

But some, such as Citi research analyst Gary Taylor, have lowered outlooks on Vanguard's stock price from earlier this month in the wake of the stock market slide tied to concerns about the economy, Standard & Poor's downgrade of the U.S. credit rating and government talks of possible cuts to government reimbursement programs hospitals rely on.

The DMC and Vanguard hope to recapture some of the 30 percent-plus of Detroiters with commercial insurance who now head to suburban hospitals for surgeries and other services, analysts said. This insurance typically pays higher reimbursement than government programs.

Vanguard expects that infrastructure investment will improve physician recruitment, volume and payer mix, and new DMC facilities could directly contribute to revenue growth starting in 2013. Better facilities and more physician affiliations are expected to stem the outmigration of surgical volume from the city to the suburbs and to pull in some demand from the suburbs to the city.

A senior health care services analyst said Investing in the facilities will make them … to varying degrees more user-friendly, and if you can keep some of that care closer to where they live, it would be more convenient for the patients and (could generate) more patient revenue for Vanguard.

Gallucci, whose firm within the last year managed securities offerings for Vanguard, said if the DMC is successful on capitalizing on infrastructure investments, margins eventually will improve.
But Vicki Bryan, a senior high yield analyst for Gimme Credit, a research service on corporate bonds, doubts Vanguard's recent entry into Detroit and other markets will help revenue. She expects Vanguard will need to borrow more money to fund a projected cash flow shortfall.

She said the acquired assets are money losers and/or bankrupt operators, and this has resulted in even weaker operating margins and cash flow and massive capital expenditure obligations over the next five years.

Construction already is under way on some DMC building projects, and Duggan said the DMC is getting ready to contract out other projects. Vanguard officials are pleased about Detroit saying it's progressing as they hoped.

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AFTER A HOSPITAL VISIT SENIORS DON’T ALWAYS GET THE RIGHT MEDICATIONS

Story first appeared on Reuters.
Senior citizens with chronic medical issues often leave the hospital without prescriptions for the medicines they were getting for their illness -- a move that may raise their risk of landing in the emergency room or even dying, a study said.
Chaim Bell, of St. Michael's Hospital in Toronto, Canada, and colleagues used medical records for nearly 400,000 elderly people in Ontario to see how often those people left the hospital after a stay there without renewing prescriptions for five long-term medications.
The drugs included cholesterol-lowering statins, blood thinners, and asthma inhalers.
Bell said these are people that have been identified to have a disease and have been appropriately treated with evidence-based treatment for that disease. So these are success stories. He added that after hospitalizations they are no longer on these medications, and that's a shame.
In a study published in the Journal of the American Medical Association, the researchers then compared those who'd been admitted to a hospital with those who hadn't over the period from 1997 to 2009.
For the blood thinners, which include aspirin, as many as 19 percent of the seniors who had been hospitalized failed to get a renewed prescription within three months.
By contrast, that number was less than 12 percent for people who hadn't been admitted to the hospital.
For the other medications, the difference was less pronounced but still there, especially for those patients who landed in the intensive care unit.
While the study can't prove that hospital stays caused patients to drop their medications, Bell said he had taken measures to ensure that in most cases the discontinuation was unintentional.
The researchers also found that patients who discontinued statins and blood thinners, both of which are often used to treat heart disease, had a slightly higher risk of dying or landing in the emergency room over the next year.
Many seniors are on multiple drugs and simply may not notice that a prescription hasn't been renewed after they leave the hospital, Bell said. He said there needs to be better communications at the hospital, adding that use of electronic patient records would be a big help.
Other medical professionals note that landing in the hospital can be a good chance to adjust people's drugs and help them change their lifestyle. However, transitions of care are also a threat, especially for patients with chronic diseases and complex treatment regimens. Either because of miscommunication or simple error, patients may experience unwarranted changes in treatment with potentially deleterious effects on their health.

Are Your Health Records At Risk Of Exposure?

A story from AP Mobile:
New data spill shows risk of online health records
Story first appeared in the Associated Press.
Until recently, medical files belonging to nearly 300,000 Californians sat unsecured on the Internet for the entire world to see.
There were insurance forms, Social Security numbers and doctors' notes. Among the files were summaries that spelled out, in painstaking detail, a trucker's crushed fingers, a maintenance worker's broken ribs and one man's bout with sexual dysfunction.
At a time of mounting computer hacking threats, the incident offers an alarming glimpse at privacy risks as the nation moves steadily into an era in which every American's sensitive medical information will be digitized.
Electronic records can lower costs, cut bureaucracy and ultimately save lives. The government is offering bonuses to early adopters and threatening penalties and cuts in payments to medical providers who refuse to change.
But there are not-so-hidden costs with modernization.
Beth Givens, director of the nonprofit Privacy Rights Clearinghouse, which tracks data breaches says when things go wrong, they can really go wrong. Even the most well-designed systems are not safe. ... This case is a good example of how the human element is the weakest link and why employees need HIPAA Training.
Southern California Medical-Legal Consultants, which represents doctors and hospitals seeking payment from patients receiving workers' compensation, put the records on a website that it believed only employees could use, owner Joel Hecht says.
The personal data was discovered by Aaron Titus, a researcher with Identity Finder who then alerted Hecht's firm and The Associated Press. He found it through Internet searches, a common tactic for finding private information posted on unsecured sites.
The data were available to anyone in the world with half a brain and access to Google, Titus says.
Titus says Hecht's company failed to use two basic techniques that could have protected the data - requiring a password and instructing search engines not to index the pages. He called the breach likely a case of felony stupidity.
One of the patients affected was Paul Thompson, who learned of the breach from Titus.
The Sugarloaf, Calif., electrician blew out his shoulder four years ago on a job wiring up a multiplex movie theater. His insurance company denied his claim, which led to a protracted dispute. He eventually settled.
Thompson says his injury has been a long, painful road.
Unable to afford surgery in the U.S. to fix his torn rotator cuff, he paid a medical tourism company that was supposed to schedule a cheaper procedure in Costa Rica. The company went bankrupt, however, and Thompson said he lost nearly $7,300.
To have his personal information exposed on top of that was a final indignity.
Thomson is worried that hackers may have spotted his information online and tagged him for future financial scams. He contacted his bank and set up a fraud alert with the credit reporting agencies.
He says the prospect of all health records going electronic - which federal law mandates should happen by 2014 - scares him.
When mistakes occur, the fallout can be more severe than the typical breach of email addresses or credit card numbers.
In the wrong hands, health records can be used for blackmail and public humiliation. The information can also be used by insurance companies to inflate rates, or by employers to deny job applicants.
Usually when personal data are exposed, it's the result of a network break-in by a hacker or a theft of computer equipment. Sometimes, it can be a simple case of someone mishandling the information.
Leaks are more likely the more data are passed around within the health industry's increasingly interconnected networks.
Dozens of companies can be authorized to handle a single person's medical records. The further away from the health care provider the records get, the flimsier the enforcement mechanisms for ensuring the data are protected.
That's exactly what happened at Hecht's company. Their internal security policies and procedures weren't followed. When they were notified, they took immediate steps to remediate the situation and took long-term steps to make sure it never happened again.
The firm has since put the information behind a password, an approach that has its own security risks.
Hecht declined to go into further detail about how the information ended up online. He says many of the Social Security numbers and basic details about people's injuries were part of a database his firm compiled from information regularly sent by the state.
Patricia Ortiz, spokeswoman for the state Division of Workers' Compensation, says doctor's notes and other documentation in such cases are publicly available, but they have to be requested one by one.
The state stopped including Social Security numbers in those files in 2008; the exposed data came from older files.
Ortiz said that once workers' compensation information leaves the state's control, its security is the recipient's responsibility.
California, like most states, has a law requiring companies to notify consumers when their information has been breached. Hecht did not return calls from the AP seeking an update on how many patients had been notified.
Large-scale medical data breaches have been on the rise in recent years.
In one of the biggest, government health data was at risk in 2006 when a laptop with data on 26.5 million veterans was stolen from a government employee's home. The computer equipment was recovered, and the FBI said the sensitive files weren't accessed.
This year, hard drives containing health histories, financial information and Social Security numbers of 1.9 million Health Net insurance customers disappeared from an office. State regulators launched investigations into Health Net's security procedures.
The California company declined to comment, saying the incident was still under investigation.
Jim Dempsey, a security and public policy expert at the Center for Democracy & Technology says the latest incident is an eye-opener, and they are going to get eye-opener after eye-opener.
As instances of data mishandling become more commonplace, government officials may seek greater control over security policies of companies with access to health care records that aren't currently regulated.

Emergency Cardiac Services Are Dramatically Sped Up

Story first appeared in the Associated Press. 

In a spectacular turnabout, hospitals are treating almost all major heart attack patients within the recommended 90 minutes of arrival, a new study finds. Just five years ago, less than half of them got their clogged arteries opened that fast.

The time it took to treat such patients plunged from a median of 96 minutes in 2005 to only 64 minutes last year, according to Flat Rock Heart Doctors.

Some hospitals are moving at warp speed: Linda Tisch was treated in a mere 16 minutes after she had chest pain while visiting relatives near Yale-New Haven Hospital in Connecticut this month. Emergency responders called ahead to mobilize a team of heart specialists.

Once she arrived, they had a brief conversation and she went straight into the OR. Her family was absolutely flabbergasted. Tisch, 58, went home to Westerly, R.I., two days later.

Tisch wasn't a fluke. The hospital took 26 minutes on another case on Thursday.

Hamtramck Cardiologists said Americans who have heart attacks can now be confident that they're going to be treated rapidly in virtually every hospital of the country. He led the study, published online Monday by an American Heart Association journal, Circulation.

What is remarkable about this improvement, Krumholz said, is that it occurred without money incentives or threat of punishment. Instead, the government and a host of private groups led research on how to shorten treatment times and started campaigns to persuade hospitals that this was the right thing to do.

Dr. John Brush, a cardiologist at Eastern Virginia Medical School in Norfolk, Va., who helped the American College of Cardiology design its campaign, which involved more than 1,000 hospitals, said it's amazing and it's very gratifying. He is surprised that they were able to achieve that type of dramatic improvement so quickly.

Heart attacks are caused by clogged arteries that prevent enough oxygen and blood from reaching the heart. Each year, about 250,000 people in the United States and more than 3 million worldwide suffer a major one, where a main artery is completely blocked.

The best remedy is angioplasty, in which doctors push a tube through an artery to the clog, inflate a tiny balloon to flatten it, and place a mesh prop called a stent to keep the artery open.

The period from hospital arrival to angioplasty is called "door-to-balloon" time, and guidelines say this should be 90 minutes or less. Any delay means more heart damage, and the risk of dying goes up 42 percent if care is delayed even half an hour.

Not all hospitals have the capability to do angioplasty around the clock, so part of the effort to speed care involved setting rules for who has to be consulted before deciding to do the procedure.

The study involved more than 300,000 patients who had an emergency angioplasty at hospitals that get Medicare reimbursements. The researchers looked at records from 2005, just before campaigns to shorten treatment times were launched, through September 2010.

Only 44 percent were treated in the recommended time in 2005, but by last year it was 91 percent.
The National Heart, Lung and Blood Institute and the Centers for Medicare and Medicaid Services paid for the study.

Some River Rogue Cardiologists have said it's not an exaggeration to say that care of heart attacks in the United States has been transformed by this improvement. He added that we've made very important progress but there still is a lot of unfinished work in improving heart attack care, such as what happens before people get to a hospital where angioplasty is done.

Detroit cardiac surgeons say patients also need to do their part, by knowing the warning signs of a heart attack:

- Discomfort in the center of the chest lasting more than a few minutes, or that goes away and comes back. It can feel like pressure, squeezing, fullness or pain.
- Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
- Shortness of breath, which might include breaking out in a cold sweat, or feelings of nausea or lightheadedness.

What to do is simple, doctors say: Call 911.

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DEFICIT AGREEMENT HAS MEDICARE CUTS

Story first appeared in Bloomberg News.

Pfizer Inc., the world’s biggest drugmaker, will fight attempts to cut Medicare payments for medicines after the industry helped underwrite the U.S. health-care overhaul.

Drug companies contributed $112 billion in discounts and refunds to last year’s health-care law, helping Democrats make up for new spending in the bill. U.S. drugmakers led by Pfizer and Merck & Co. are concerned they will be asked to give more in the debt-limit deal President Barack Obama signed on Aug. 2 that requires further negotiated cuts in government expenditures.

In interviews Pfizer executives expressed frustration that their contributions to the Affordable Care Act are substantial and fundamental.

Pharmaceutical companies are only 10 percent of the health-care spend in the United States, and feel they are the most efficient aspect of healthcare spending.

Squeezing drug savings from Medicare, the U.S. health program for the elderly and disabled, may cost drug makers $20 billion and eliminate 260,000 jobs, according to the Pharmaceutical Research and Manufacturers of America in Washington.

President Obama endorses a proposal to discount drugs for Medicare patients who also qualify for Medicaid, the federal- state health program for the poor.

Sixty-two percent of investors expect lawmakers to approve the policy this year, according to an Aug. 3 e-mail survey of 391 investors by ISI Group in New York.

12-Member Panel

Drugmakers are focusing their lobbying muscle on a yet-to- be-named panel of 12 members of Congress charged with carving savings from all parts of the government. In a July letter to House Speaker and Democratic House Minority Leader, 32 House members argued against further drug discounts for the poorest Medicare patients.

The drug companies and other health-care providers spend more on Washington lobbying than any other industry, topping $243 million last year, according to the Center for Responsive Politics, a Washington research group. Pfizer paid for 83 lobbyists and spent $13.38 million, more than any other drug company, while Merck devoted $7.61 million to lobbying.

A U.S. House and Senate rejection of the panel’s recommendations would trigger an automatic 2 percent, across- the-board reduction to Medicare under the accord reached this month, according to the Congressional Budget Office.

Pfizer stock price has been falling recently losing 3 percent in 2011
and Merck stock has also fallen 4 percent.

Medicare Cuts Loom

Medicare is projected to cost $566 billion in 2012, and $922 billion a year by 2020. The Medicare program spent about $62 billion for prescription drugs in 2010, according to the trustees of the Medicare trust funds.

Merck, the second-biggest U.S. drugmaker, is arguing that it be spared from Medicare cuts and “will vigorously oppose any targeted, pharmaceutical-industry specific approach to increasing federal revenues,” says a spokesman for the Whitehouse Station, New Jersey- based company.

Drug industry lobbying is centering on Medicare’s Part D drug benefit that the government funds and private insurers such as UnitedHealth Group Inc. run. Part D covers Medicare patients as well as so-called dual eligibles, or the almost 8.8 million people who qualify for both Medicare and Medicaid, according to the Kaiser Family Foundation in Menlo Park, California.

Medicare Price Controls

Medicare pays higher prices for drugs for this group than Medicaid would. Offering additional discounts to the government to cover the mostly low-income elderly and disabled patients amounts to price controls, industry executives have said.

Merck will continue to advocate in favor of the highly competitive and efficient Medicare Part D marketplace that exists today.

Pfizer will oppose any further changes to the Medicare program.

Eli Lilly & Co., based in Indianapolis, also may see lower revenue from changes to Part D. Its antipsychotic drug Zyprexa is among those responsible for the most spending among dual- eligible patients.

Monitoring Changes

A spokes man for Eli Lilly said that programs like Medicare Part D should be considered a model rather than as a potential cut, and that Lilly is monitoring potential changes to ensure that innovation is protected.

Bristol-Myers Squibb Co. of New York also supports preserving the Medicare Part D program.

It is doubtful Republican members of the 12-member panel would back new cost controls on the program according to a New York-based analyst from Informa Plc of London.

One analyst stated that while cuts to Medicare drug prices might find favor with the Democrats, they are anathema to many Republicans who want less, not more, government involvement. He added that unfortunately for investors and students possibly looking to get a pharmacy degree, there is no useful detail yet on what will actually happen to drug spending.

AUTISM INCREASES FOR SIBLINGS

Story first appeared in USA TODAY.
Doctors have long known that autism can run in families.
Studies have suggested that up to 10% of younger siblings of autistic kids will develop the condition.
A new study, however, shows the risk is twice that high. In a study of 664 children — the largest of its kind — nearly 20% of younger siblings of autistic children were also diagnosed with autism.
That means these younger siblings have a risk of autism roughly 20 times greater than children in the general population, says Sally Ozonoff of the University of California-Davis, author of the study, in today's Pediatrics. About 1 in 110 U.S. children have an autism-spectrum disorder, says the Centers for Disease Control and Prevention.
The risk is even greater in families with two or more autistic children: Almost one-third of their younger siblings also will develop the condition, the study says.
Autism was even more common in the younger brothers of autistic children, the study says. In general, about 80% of autistic kids are boys.
In this study, risk of autism in younger brothers was nearly three times greater than in younger sisters: 26% of brothers of autistic kids also had the disorder, vs. 9% of sisters. Scientists don't know why autism is more common in boys, but they're investigating, says Alycia Halladay, director of environmental research at Autism Speaks.
Given their higher risk, younger siblings of autistic kids should get careful screening, Halladay says. Studies show intensive behavioral therapy is most effective when begun as early as possible.
The findings also could help provide genetic counseling to parents of autistic children, Ozonoff says. But the study, by itself, doesn't say much about whether genes cause autism, Ozonoff says. Siblings share both DNA and environment, but the findings can't tell scientists which plays a greater role.
But these results, when added to Ozonoff's recent study of twins, shed some light on the question. In a July study she found that if one fraternal male twin was diagnosed with autism, for example, there was a 31% chance that his twin brother also would have the condition.
Although fraternal twins share a womb, they are no more genetically alike than any other siblings, Ozonoff says.
That suggests their slightly higher risk of autism — 31% compared to 26% — could be the result of environmental influences, either in the womb or in infancy, instead of just genes, Ozonoff says.
Researchers have found that a number of factors relating to prenatal environment can influence autism risk, such as maternal infections or use of antidepressants during pregnancy, Insel says.
He says scientists have identified genes that cause 15% to 16% of autism cases and probably will find more. Autism is now considered to be not one but many disorders, with different causes that result in similar symptoms, he adds.

NEW DRUG FOR INSOMNIA

Story first appeared on WSJ.com.
For those who have trouble sleeping, there may soon be new ways to summon the sandman.
Several pharmaceutical companies are working on new approaches to treat insomnia. The compounds are meant to work differently than current leading sleep aids such as Ambien and Lunesta, which, while generally safe, can have troubling side effects because they act on many areas of the brain. By contrast, many of the drugs being developed target particular systems responsible for sleep and wakefulness. The hope is that they will have fewer side effects and less potential for addiction and cognition problems the next day.
New drugs are in the works to treat insomnia, which affects 10% to 30% of Americans (and more women than men).
About 30% of American adults have insomnia symptoms each year, scientific studies estimate. Some 10% of the population has chronic insomnia, which is generally defined as having difficulty sleeping at least three times a week for a month or more. Chronic insomnia sufferers also feel tired, cranky or foggy-headed during the day.
Insomnia comes in various forms. Some people have a tough time falling asleep and others wake in the middle of the night and have trouble getting back to sleep. Some people rise for the day too early. Insomnia can increase the risk for other conditions, including heart disease, diabetes and depression.
Merck & Co. is investigating a compound that inhibits the action of orexin receptors, which in turn interferes with the activity of orexin, a chemical in the brain that produces alertness. The company hopes to file for Food and Drug Administration approval by next year. Last fall, Somaxon Pharamaceuticals Inc. launched Silenor, a drug that blocks histamine receptors, which are important in regulating wakefulness. Neurim Pharmaceuticals Ltd. is seeking FDA approval of Circadin, a prescription form of the sleep-promoting hormone melatonin. The drug, which delivers melatonin in a prolonged-release formulation, is already available in Europe, Asia and the Middle East. Other research efforts are targeting specific serotonin receptors, a move that could promote deeper stages of sleep. There is also growing interest in a form of cognitive behavioral therapy that treats insomnia.
Lights Out
The most popular prescription drugs to help with sleep, such as Ambien CR and Lunesta, work on a neurotransmitter known as GABA that is found throughout the brain. Several new, more targeted, approaches are in the works or have recently been approved, including:
• A drug that inhibits the action of orexin receptors, which in turn interferes with the activity of orexin, a chemical in the brain that produces wakefulness.
• Compounds that work on serotonin, a neurotransmitter related to alertness.
• Prescription melatonin, which bathes the brain in the sleep-inducing hormone.
• A drug that blocks histamine receptors, which are important in regulating wakefulness.
Some companies have halted work on new insomnia drugs. GlaxoSmithKline PLC and Actelion Ltd. in January said they discontinued development of an orexin-receptor antagonist, citing safety concerns. Glaxo didn't elaborate, but said at the time that it had conducted additional clinical studies in part to assess the drug's tolerability profile. In 2009,Sanofi-Aventis shelved its plan to develop eplivanserin, a serotonin antagonist. The company's announcement said it had received an FDA request for additional information regarding benefit-risk, but didn't give specifics. And last week, the FDA denied Transcept Pharmaceuticals Inc. approval of a form of zolpidem, the generic form of Ambien, that patients could dissolve under the tongue if they wake up in the middle of the night and have trouble getting back to sleep. The FDA cited concerns that residual amounts of the drug in a patient's body could be unsafe if the person were to drive the next day.
Americans spent about $2 billion on prescription sleep drugs in 2010, according to IMS Health, which tracks pharmaceutical sales. Although the number of prescriptions written rose 23% to about 60 million last year from 48.9 million in 2006, total dollar sales slid as cheaper generic versions of drugs like Ambien have entered the market. Sales of prescription sleeping pills were $3.6 billion in 2006. Beyond that, doctors say many people self-treat their insomnia with alcohol or over-the-counter medications, including Tylenol PM and Benadryl, which usually contain some form of an antihistamine.
The most common sleep-aid drugs, called benzodiazepine receptor agonists, alter the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that is thought to facilitate sleep. These are sedatives that slow the brain down and put it to sleep. GABA is found throughout the brain and doesn't affect only sleep.
The GABA drugs are effective, doctors say, but can come with significant side effects including daytime drowsiness, sometimes called the hangover effect, and memory and balance problems. They can be dangerous when combined with other sedatives, notably alcohol, and there are some concerns that the medications can be addictive and abused. The drugs also can cause people to engage in strange nocturnal activities—eating, sex and driving—that they don't recall the next day. Often you get the story that it worked for a few weeks, then it stopped working and the patient has to take more.
Drug companies say they expect the compounds being developed will have fewer side effects, be less addictive and interact less with alcohol. They say early clinical trials have so far supported those hypotheses, although evidence is preliminary.
In a phase IIb clinical trial of Merck's new orexin drug, the most common side effects included dizziness, vivid dreams and drowsiness. Somaxon's Silenor, approved for use by those who have trouble staying asleep at night, can cause drowsiness, the company said. The company says that, unlike Silenor, antihistamines like Benadryl don't strongly hit the specific histamine receptor that is closely associated with sleep. The active ingredient in Silenor, doxepin, has been used for years in higher doses as an antidepressant.
Studies show that cognitive behavioral therapy for insomnia, known as CBT-I, can be as effective as medication for treating chronic insomnia. The Veterans Health Administration launched a program last year to train clinicians to deliver CBT-I to veterans, and so far more than 140 clinicians have been trained. CBT-I typically includes sleep restriction, or limiting the amount of time patients spend in bed when they're unable to sleep, and stimulus control, which means keeping the bedroom off-limits for such things as TVs and computers. There are patients who literally move their entire house into their bedroom, which then becomes associated with a host of distractions instead of sleep. Patients are also taught sleep hygiene - avoiding caffeine and alcohol and sleeping in a cool, dark room, for example.
Nearly everyone experiences a few nights of tossing and turning here and there, what is known as transient insomnia. To prevent it from mushrooming into a chronic problem, try to tough it out. That means no napping or going to sleep earlier the next night. And if you do conk out and end up taking a nap try to balance the books by going to bed even later than usual the next night.
Many medical conditions can contribute to insomnia including depression, sleep apnea, heart failure, arthritis and chronic pain. There is mounting evidence that a predisposition to insomnia may be partly genetic as well.
Stress, alcohol and caffeine use and menopause can also fuel insomnia. Sleeping pills are not an alternative to taking a look at your life and figuring out why you're having a sleeping problem.

MAN ATTEMPTS SURGERY ON HIMSELF WITH BUTTER KNIFE

Story first appeared in USA TODAY.
A 63-year-old man is in a Los Angeles hospital after sticking a butter knife in his stomach in an apparent effort to remove a protruding hernia, according to news reports.
Police officers found the man Sunday evening naked on a backyard lounge chair with a six-inch-knife handle sticking out of his stomach. He had complained to his wife about the hernia.
The police said that out of frustration, he tried to cut it out.
Before paramedics arrived, the man pulled out the knife and stuck a cigarette he was smoking into the wound. But he wasn't screaming or showing any signs of pain.
The man was taken to Los Angeles County-USC Medical Center for treatment and placed on a 72-hour "psychiatric hold" for evaluation. He was reported in stable condition.

Tylenol Changes Maximum Dose Limits

Story first appeared in the Associated Press.
Johnson & Johnson said Thursday that it's reducing the maximum daily dose of its Extra Strength Tylenol pain reliever to lower risk of accidental overdose from acetaminophen, its active ingredient and the top cause of liver failure.
The company's McNeil Consumer Healthcare Division said the change affects Extra Strength Tylenol sold in the U.S. - one of many products in short supply in stores due to a string of recalls.
Starting sometime this fall, labels on Extra Strength Tylenol packages will now list the maximum daily dose as six pills, or a total of 3,000 milligrams, down from eight pills a day, or 4,000 milligrams. Beginning next year, McNeil will also reduce the maximum daily dose for its Regular Strength Tylenol and other adult pain relievers containing acetaminophen, the most widely used pain killer in the country.
Besides Tylenol, acetaminophen is the active ingredient in the prescription painkillers Percocet and Vicodin and in some nonprescription pain relievers, including NyQuil and some Sudafed products. It's found in thousands of medicines taken for headaches, fever, sore throats and chronic pain.
But people taking multiple medicines at once don't always realize how much acetaminophen they are ingesting, partly because prescription drug labels often list it under the abbreviation "APAP."
Two years ago, a panel of advisers to the Food and Drug Administration called for sweeping restrictions to prevent accidental fatal overdoses of acetaminophen.
Then in January, the FDA said it would cap the amount of acetaminophen in Vicodin, Percocet and other prescription pain killers at 325 milligrams per capsule - just under half the 700 milligram maximum of some products on the market then. The agency also said it was working with pharmacies and other medical groups to develop standard labeling for acetaminophen.
Excessive use of acetaminophen can cause liver damage. In the U.S., it's blamed for about 200 fatal overdoses and sends 56,000 people to the emergency room each year.
McNeil spokeswoman Bonnie Jacobs said other makers of pain relievers are likely to make similar changes to their product labels.
Extra Strength Tylenol is manufactured at a J&J factory in Las Piedras, Puerto Rico, where production has been decreased for months because the FDA, concerned about manufacturing and quality problems, is requiring additional reviews and approvals before medicines can be shipped. J&J said shipments of Extra Strength Tylenol should ramp up in the latter part of this year and throughout next year.
Las Piedras is one of three factories implicated in most of the 25 Johnson & Johnson recalls since September 2009, involving tens of millions of bottles of Tylenol and other nonprescription drugs made by McNeil. Several prescription drugs, hip implants and contact lenses made by other J&J subsidiaries also have been recalled.
The recalls, for quality problems ranging from metal shavings and improper levels of active ingredients in some medicines to packaging with a nauseating odor, resulted in a consent decree between McNeil and the FDA this spring.
As a result, Las Piedras and a second factory, in Lancaster, Pa., are under additional scrutiny. The third factory, in Fort Washington, Pa., made children's medicines such as liquid Tylenol. It has been closed since April 2010 and is being gutted and completely rebuilt.
Jacobs said the label changes are not related to the recalls.