Medicaid Fraud, Waste Prevention Efforts Begin in North Carolina

Business Week

Gov. Beverly Perdue said Wednesday that North Carolina can recover tens of millions dollars annually by shifting more Medicaid investigations from file cabinets to computer files that can be flagged for potential abuse and fraud in the state's $10 billion system.

Perdue rolled out the state's latest effort to target patients or physicians who are gaming the system.

The program will run Medicaid claims through a contractor's software program, crunching raw electronic billing and other data to identify suspicious trends among the nearly 2 million Medicaid patients and 60,000 Medicaid providers in the state. Medicaid investigations have historically relied on paper documents and workers had trouble analyzing such data, according to the Department of Health and Human Services.

Other anti-fraud efforts, some using another computer program, have shown some success.

The pressure to locate additional dollars in Medicaid insurance is growing as state revenues stagnate and the state's portion of the program is on track to cost $250 million more than budgeted this year. Medicaid is the federal-state government insurance program for low-income families and senior citizens, as well as people with disabilities.

"There are better ways to do it in 2010," Perdue said in a news conference held in a catherization lab at Rex Hospital in Raleigh real estate. "This system has the capacity to identify potential fraud, waste and abuse and we're doing it with the speed and efficiency that we never thought was possible before."

Perdue also wants to double the size of Attorney General Roy Cooper's anti-fraud unit, so it can prosecute more lawbreakers, and she wants tougher laws to discourage fraud among health care providers.

The initial effort won't require a large state investment. The state didn't pay IBM Corp. for the software program, Health and Human Services Secretary Lanier Cansler said. Instead, the company will get an amount equal to 10 percent of the money that the department determines should be recouped because services were fraudulent or unnecessary, with IBM's total capped at $5.4 million annually.

"It's like fishing," Cansler said. "You fish to find the people who break the rules. We've been fishing with a cane pole. The governor's pushed us to get depth finders, where we can not only locate the school of fish we can also locate the big fish."

The anti-fraud initiative, which should be fully running by early summer, already has found some unusual cases that required further inspection.

Perdue said a program demonstration using 2007 Medicaid documents uncovered one provider that billed the system $45,000 in "miscellaneous" prosthetic limbs. It's also not unusual for some Medicaid patients to go from doctor to doctor to receive services so they can get access to controlled substances, the governor said.

The most extreme cases of potential fraud will be sent to a newly created Medicaid "SWAT" team that will investigate providers or consumers. Cooper's office also could be called in to pursue criminal charges.

"Medicaid fraud hurts our state's most vulnerable residents and robs taxpayers," Cooper said in Perdue's news release. Cooper's Medicaid fraud unit, comprising 19 investigators and State Bureau of Investigations agents, helped recover $52 million last year.

Perdue said she also wants lawmakers to toughen rules to stop kickbacks to health care providers who refer patients to certain Medicaid services and to end the solicitation of patients to obtain unnecessary services. The governor also announced a publicity effort to blow the whistle on potential Medicaid fraud or waste.

Prescription for Trouble: Painkiller Abuse Plagues Florida

Daytona Beach News-Journal

DAYTONA BEACH -- The headlines scream more frequently now.

A mother addicted to prescription pain pills falls asleep while her son drowns in a bathtub. A group high on Xanax beat a man to death for money. An appliance repairman is arrested twice for stealing pain pills when he was supposed to be fixing appliances.

"This is the most serious problem facing law enforcement at this time," Volusia County Sheriff Ben Johnson said during a recent interview. "It's more serious than crack cocaine."

Fed by a society more medicated in general than ever before, and a system that doesn't keep track as it might on where powerful heroin-like drugs are going, the problem of prescription-drug abuse is growing.

The damage to families is clear.

According to state Health Department statistics, more than nine people die of prescription-drug overdoses each week statewide.

Florida has been at the forefront of the debate over prescription drug abuse because it has been one of only a few states that don't monitor how many prescription pills are sold.

A law passed last year could address the problem of "doctor shopping" by limiting the amount of pills that can be distributed to patients in a set time period.

Other pending legislation is aimed at preventing convicted felons from distributing pills and increasing access to patient records by the state Health Department.

Circuit Judge Joseph Will, who runs the local drug court and hears felony court cases in his Daytona Beach courtroom, said many adults start taking the drugs -- opioids like Valium, Xanax, Loritab and OxyContin -- for pain as prescribed.

"They think they still have the pain, but the pain stopped years ago," Will said. "Pretty soon, they're taking the pills just to stay normal, to be able to function."

Instead of the cocaine and heroin addiction treatment problems of years past, the vast majority of people who are enrolled in drug court these days are addicted to a prescription drug, Will said.

"Like everywhere, there are doctors in our community who over-prescribe these medications," Will said. "It doesn't take long to get hooked."

Part of the problem, he said, is that we live in a society of instant gratification. "We don't want to feel lousy."

"The thing that frustrates me is these are legal drugs being approved by the FDA and manufactured by drug companies," Will said. "The manufacturers and the FDA should be tracing where these pills are going. They ship them out in boxcars. Somebody should be accountable for how many they sell and which doctors are prescribing."

One of the most publicized local cases of prescription drug abuse was that of Crystal Giachetti, who put her 4-month-old baby son in the bath, injected a dose of Xanax between her toes, and fell asleep. Her son, Trenton, died April 6, 2009.

"When she wasn't high, she was the same old Crystal," Giachetti's cousin, Theresa Culver said. "But that was very seldom."

Giachetti, 31, who lived in a mobile home near Ormond Beach, pleaded guilty to aggravated manslaughter of a child last month in exchange for a 14-year sentence. Her abuse of Dilaudin, Xanax and Soma began a few years earlier, when she broke her back and started heavy use of prescription pills.

"She'd say, I need these drugs for my back," Culver said.

Authorities say that deaths, robberies and burglaries all highlight the intersection of powerful narcotics that are intended to be used under the supervision of a doctor and stupid things "stupefied" people do. That and the lengths addicted people will go to in order to get more drugs.

"It's off the chart," Daytona Beach Police Chief Mike Chitwood said Friday of the number of crimes that start with illegally obtained pills. "This is the new crack cocaine for this decade."

James Earl Mason was trying to be friendly when he offered prescription Xanax to a group of drifters he met at a beachside motel in Daytona Beach. Within hours of meeting Juanita Liebman, Jason Bowman and William McMinn, the three were stomping him to death on the floor.

"I can't fathom any rational explanation for why this occurred," Circuit Judge James Clayton said after he sentenced the second of two of the killers to life in prison earlier this month.

Bryan Langford, 38, was high on a mixture of alcohol, marijuana, morphine and oxycodone when he went on a rampage that ended the lives of his girlfriend, her son and himself. He was in serious need of drug detox and aloholics anonymous.

Langford also shot an Orange City police officer who was called to check on his well-being March 25, 2009. Officer Sherif El-Shami lost his eye in the shooting. As SWAT officers surrounded Langford, he put a .357-caliber revolver under his chin and pulled the trigger.

Experts say prescription drug problems have driven otherwise law-abiding people to commit criminal acts. Last year, Dr. Jerrold Ecklind, 38, was stopped by Daytona Beach police with his shoes on the wrong feet.

Ecklind, who had morphine in his car, and needed Xanax addiction treatment, was later accused of kidnapping. A jury acquitted him of that charge, but found he improperly displayed a weapon. Ecklind was ordered to enter a drug treatment center.

Judge Will said prescription drug problems can take longer to treat because for the abuser, the intended use gets in the way of understanding there is a problem.

"The cocaine addict says "I'm worthless, I'm scum," he said. "The opiate user says, "I'm better, I'm different, I just take pills because of pain."

To get help for these addicts, Will said, there must be an understanding that the substance abuse is not needed. "It's a matter of managing your life so you're comfortable without the stuff you put up your nose or up your arm."

With pill addiction, "it takes longer to get into that mind frame."

After the drug addiction grabbed hold of Crystal Giachetti, she didn't care about anything else, her cousin said.

When they told her she needed to stop taking pills and go for prescription drug treatment, Giachetti would say, "I know."

"One time we were at my mom's, the baby was just born, and Crystal went into the bathroom," Culver said. "She came out and she couldn't walk. She was instantly high. With the pills, it was like she didn't want the baby."

'The Man with the Golden Arm' has Saved Over 2 Million Babies

Mail Online

An Australian man who has been donating his extremely rare kind of blood for 56 years has saved the lives of more than two million babies.

James Harrison, 74, has an antibody in his plasma that stops babies dying from Rhesus disease, a form of severe anaemia.

He has enabled countless mothers to give birth to healthy babies, including his own daughter, Tracey, who had a healthy son thanks to her father's blood.

Mr Harrison has been giving blood every few weeks since he was 18 years old and has now racked up a total of 984 donations.

When he started donating, his blood was deemed so special his life was insured for one million Australian dollars.

He was also nicknamed the 'man with the golden arm' or the 'man in two million'.

His blood has since led to the development of a vaccine called Anti-D.

He said: 'I've never thought about stopping. Never.' He made a pledge to be a donor aged 14 after undergoing major chest surgery in which he needed 13 litres of blood.

'I was in hospital for three months,' he said. 'The blood I received saved my life so I made a pledge to give blood when I was 18.'

Just after he started donating he was found to have the rare and life-saving antibody in his blood.

At the time, thousands of babies in Australia were dying each year of Rhesus disease. Other newborns suffered permanent brain damage because of the condition.

The disease creates an incompatibility between the mother's blood and her unborn baby's blood. It stems from one having Rh-positive blood and the other Rh-negative.

After his blood type was discovered, Mr Harrison volunteered to undergo a series of tests to help develop the Anti-D vaccine.

'They insured me for a million dollars so I knew my wife Barbara would be taken care of,' he said.

'I wasn't scared. I was glad to help. I had to sign every form going and basically sign my life away.'

Mr Harrison is Rh-negative and was given injections of Rh-positive blood.

It was found his plasma could treat the condition and since then it has been given to hundreds of thousands of women.

It has also been given to babies after they are born to stop them developing the disease.

It is estimated he has helped save 2.2 million babies so far.

One of the mothers he has helped is Joy Barnes, who works at the Red Cross Blood Bank in Sydney.

 She has known Mr Harrison for 23 years but has only just told him she is one of the countless mothers he has helped.

Ms Barnes, who miscarried at four and five months before having treatment, said: 'Without him I would never have been able to have a healthy baby.'

Speaking to Mr Harrison on an Australian TV show, she said: 'I don't know how to thank you enough.'

His own daughter, Tracey, also had to have the Anti-D injection after the birth of her first son.

She said she was 'proud' of her dad for continuing to give blood, even after the death of her mother after 56 years of marriage.

Mr Harrison said: 'I was back in hospital giving blood a week after Barbara passed away.

'It was sad but life marches on and we have to continue doing what we do. She's up there looking down, so I carry on.'

Mr Harrison is expected to reach the 1,000 donation milestone in September this year.

Pregnancy May Protect Breast Cancer Survivors

Business Week

New research suggests that women who become pregnant after having had breast cancer may actually improve their survival odds, a notion contrary to what some medical experts had thought.

The finding is significant, given that the death rate from breast cancer is on the decline and more women are delaying pregnancy until later in life, the study authors said.

The new study joins two others looking at breast cancer and pregnancy, all of which are being presented this week at the European Breast Cancer Conference, in Barcelona.

Women in their childbearing years are more likely to develop breast cancer than any other malignancy.

The first study was a meta-analysis of 14 prior trials -- published between 1970 and 2009 -- involving approximately 20,000 women with a history of breast cancer, some pregnant and some not.

The researchers, from Belgium, Greece and Italy, found that women who became pregnant following a breast cancer diagnosis had a 42 percent lower risk of dying than women with breast cancer who didn't get pregnant.

Why would this be the case?

Possibly hormones, the study authors speculated. Although estrogen is known to fuel breast cancer tumors, above a certain level, they can actually protect against the disease. Also, a mother produces antibodies during pregnancy that may be protective.

"This is the largest meta-analysis to confirm this, but this has been known from previous, smaller studies from major institutions," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La.

Dr. Paul Tartter, senior attending physician at St. Luke's-Roosevelt Hospital's Comprehensive Breast Center in New York City, acknowledged that this was good news, but said "the average physician, including gynecologists, will still tell patients not to get pregnant after being treated for breast cancer. There's a tremendous mythology that we just can't shake."

"This has the strength of a meta-analysis. but it's controversial," said Dr. Massimo Cristofanilli, chairman of medical oncology at Fox Chase Cancer Center in Philadelphia. "Previous studies have shown that these women had no worse outcome. This may be too optimistic."

A second study of almost 3,000 Australian breast cancer patients found that women who were diagnosed with a tumor within a year of giving birth were almost 50 percent more likely to die compared with other women of the same age.

On the other hand, if the women were diagnosed during pregnancy, they had roughly the same odds of survival as other women.

This led the authors to surmise that breast cancer might be dependent on the timing of a woman's pregnancy or that breast changes during breast-feeding might conceal a tumor until it is more advanced.

In any event, patients in this situation might want to explore more aggressive treatment options with their doctors, the Australian researchers noted.

"I don't think anybody knows what the timeframe is from having been treated and when it's a good idea to have a child," said Leena Hilakivi-Clarke, a professor of oncology at Georgetown Lombardi Comprehensive Cancer Center in Washington, D.C. "But if the tumor has been satisfactorily treated and there is nothing growing in the breast, then the pregnancy should be protective."

A final study, from German researchers, found that chemotherapy given during a woman's pregnancy does not harm the developing fetus, meaning that women who are diagnosed with breast cancer while they are pregnant can go ahead and receive standard therapies to treat their tumors.

Gene Linked to Lung Cancer Risk in Non-Smokers

Business Week

Discovery could provide target for future treatments, researchers say

Researchers have identified gene variations linked with an increased risk for lung cancer in people who have never smoked.

The international research team analyzed DNA from more than 1,000 people with lung cancer and cancer-free people who had never smoked and found strong evidence that two variations in a gene called GPC5 were associated with lung cancer in people who had never smoked. The variations reduce expression of GPC5, the study authors explained.

Further investigation revealed that GPC5 expression levels were 50 percent lower in lung cancer tissue from people who had never smoked, compared with lung tissue from cancer-free non-smokers.

The findings suggest that GPC5 could be a new target for further research and drug development and could be used to identify non-smokers at high risk for St Louis lung cancer treatment.

The study findings are published online in The Lancet Oncology.

"Even though this study reports a two-fold reduction in GPC5 expression in [lung cancer] tissues compared to matched normal controls, it is far from clear how reduced GPC5 expression could predispose individuals to lung cancer," Dr. Ramaswamy Govindan, of Washington University School of Medicine in St. Louis cancer specialists, wrote in an editorial accompanying the study. "More studies are needed to confirm these preliminary observations in the tumor samples from those with no history of tobacco smoking."

Brain Network Scanning may Predict Injuries' Effects

cNet

A brain scanning technique known as resting-state functional connectivity (FC) could help clinicians identify and even predict the effects of brain injuries such as strokes, according to neurologists in St. Louis at the Washington University School of Medicine.

Originally developed to study how brain networks let various parts of the brain collaborate, FC also appears to enable scientists to link differences in harm done to brain networks to changes in patient impairment, according to results of a study in the Annals of Neurology March issue.

"Clinicians who treat brain injury need new markers of brain function that can predict the effects of injury, which helps us determine treatment and assess its effects," says Maurizio Corbetta, professor of radiology and neurobiology at Washington University. "This study shows that FC scans are a potentially useful way to get that kind of information."

FC relies on MRI scanners, which require patients to be still as the scanner tracks changes in blood flow to various brain regions. With mental inactivity, blood flow in networked regions tend to rise and fall in relative synchronicity.

Over the course of their Dearborn stroke center study of 23 patients who had recently survived strokes, the researchers came across a surprise finding.

Those with damage to networks that cross both sides of the brain were more impaired than those with damage to networks contained within one side of the brain. So while a stroke that occurs on, say, the left side of the brain might impair control of the right arm, that impairment would be far worse if the damage disrupted network connections over on the right side than if it was contained on the left side.

Neurosurgeons in St. Louis have long thought that one side of the brain controls the other, but this study suggests that our brains may house far more complicated connections between networks. This could render resting-state functional connectivity all the more important as it reveals detailed network health and/or damage.

"It's not wrong to say that one side of your brain controls the opposite side of your body, but we're starting to realize that it oversimplifies things," says Alex Carter, the study's lead author and an assistant professor of neurology. "It's starting to seem like proper function requires the two hemispheres to be competing for attention, pushing against each other and thereby achieving some kind of balance."

The group is already planning additional studies of brain injury patients, including long-term studies monitoring patient recuperation via FC.

Middle Class in New Jersey Becoming Uninsured Faster than all Other Groups

NorthJersey.com

Nearly 35,000 middle-class New Jersey residents lost their health insurance in the last eight years while the cost for coverage rose dramatically, according to a report released Wednesday by the Robert Wood Johnson Foundation.

The research was released as Congress is poised to vote on overhauling the health care system as early as Saturday. The measure would affect an estimated 30 million uninsured people, end insurance practices such as denying coverage to those with a preexisting condition and require almost all Americans to get coverage.

In New Jersey, the total number of uninsured in the middle class averaged 327,000 in 2008, up from 293,000 in 2000, according to the report "Barely Hanging On: Middle-Class and Uninsured."

"Maintaining the status quo is not sustainable," said Eve Weisman, health care coordinator for New Jersey Citizen Action. "We absolutely need some type of health care reform."

More than 1.3 million New Jersey residents are uninsured. Approximately 650 New Jersey residents lose health insurance every day.

Family costs rise 44%

Total cost for a family insurance policy in New Jersey increased 44 percent since 2000 — to $12,789 in 2008, according to the report. Even though employers pay most of the tab, the amount employees pay in premiums for a family plan increased 88 percent in the same time period.

And the cost of insurance is far outpacing income: Median earnings in the state increased just 0.7 percent from 2000 to 2008, according to the report.

Nationwide, the total number of uninsured middle-class people increased by more than 2 million since 2000 to 12.9 million in 2008. Just 66 percent of people in families earning $45,000 to $80,000 are now insured through their employer, a drop of 7 percent in the same time period. The nation's middle class became uninsured at a pace faster than those with less or more income, the report concluded.

"America's uninsured crisis means that hard-working people with average incomes are being squeezed," said Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation.

In 2008, 46.3 million people were known to be uninsured. Experts assume millions more have become uninsured since then because of job loss and rising costs of California health insurance quotes in the economic downturn.

About 23 percent of employees in New Jersey whose companies offered insurance were ineligible to participate — due to criteria established by the employer such as length of time with the company and number of hours worked.

Need for Elder Care Services Ready to Explode

Gaylord Herald Times

LANSING — At a press conference in Lansing on Tuesday, the Aging Services of Michigan will release its 2010 Annual Long Term Care report, “A Decade in Review,” focusing on long-term elder care issues.

The association is issuing a call for action on the state level to change public policies that are detrimental to the care of seniors, family caregivers and nonprofit care providers.

According to the Aging Services of Michigan, which represents nonprofit organizations providing community and home-based services for the elderly, there will be an explosion in the need for such services in the coming years.

Among the issues reported in the review is the estimation that Alzheimer’s disease will affect 180,000 Michigan elders in 2010, with an additional 200,000 people affected by from some form of dementia. The number of adults 65 and older will represent 20 percent of the population by 2030; the number of adults 85 and older, the fastest growing age group in the nation, will double by 2050. Michigan is not prepared for the increase in the aging population.

“Michigan’s long-term care system is under assault and has been for a long time,” said David Herbel, president and CEO of Aging Services of Michigan. “The need for Michigan senior care is increasing, while funding and state support is eroding.”

Women have traditionally been the caregivers of aging relatives, but economic factors over the last few decades have forced more and more women into the workforce as a necessity for family survival. The decreased funding and increasing need  for care providers as the aging population grows will put an additional burden on middle class families already struggling.

The report was initially released in the first of a series of regional meetings with Aging Services of Michigan’s nonprofit member organizations. It was held at the Otsego Memorial Hospital (OMH) in Gaylord March 4. OMH’s McReynolds Hall skilled nursing facility, which provides short and long-term care, is a member.

For a copy of the 2010 Annual Long Term Care Report, visit the Aging Services of Michigan’s Web site at www.AgingMI.org.

Managing the Effects of Parkinson's

PsychCentral

The American Academy of Neurology has published a new guideline to help people with Parkinson’s disease cope with common, albeit often unrecognized symptoms.

The guide recommends the most effective treatments to help people with Parkinson’s disease who experience sleep, constipation, and sexual problems.

The instruction is published in the current issue of Neurology, the medical journal of the American Academy of Neurology.

“While the main symptom of Parkinson’s disease is movement problems, there are many other symptoms to be aware of, including sleep disorders, constipation, and problems with urination and sexual function,” said lead guideline author Theresa A. Zesiewicz, MD, with the University of South Florida in Tampa and a Fellow of the American Academy of Neurology.

“Without treatment, these symptoms can cause as much pain and discomfort as movement problems and greatly affect daily routines and quality of life.”

Sexual problems often affect people with Parkinson’s disease. In men with Parkinson’s, erectile dysfunction is common. According to the guideline, the drug sildenafil citrate may improve erectile dysfunction.

The guideline also found the drug isosmotic macrogol may improve constipation in people with Parkinson’s disease.

For problems with excessive daytime sleepiness, the guideline recommends that doctors consider the drug modafinil to help people feel more awake.

However, it’s important to note that one study showed people taking modafinil had a false sense of alertness. This may pose a safety risk for activities such as driving.

The guideline also found the drug methylphenidate may help with fatigue.

The guideline mentions two tests to help identify nonmotor symptoms of Parkinson’s disease. One is the NMSQuest rating scale. The other is the Unified Parkinson’s Disease Rating Scale (UPDRS). The original UPDRS mainly tests for movement problems.

Doctors use the updated version of the UPDRS to test for all Parkinson’s symptoms, including those unrelated to movements. People with Parkinson’s disease should talk to their doctor about whether these tests may be helpful.

“More research is needed into these symptoms of Parkinson’s disease since there are still a lot of unknown answers as to what causes these symptoms and how they can best be treated to improve lives,” said Zesiewicz. All options need to be examined, including the dramatic step of neurosurgery.

Winning the War on Cancer? U.S. Death Rates Show Broad Decline.

Ars Technica

President Nixon declared war on cancer in 1971 and, since then, the National Cancer Institute (part of the NIH) has funded research on prevention, surveillance, and treatments. But, despite the effort, progress has been elusive, leading to press reports in Newsweek, Fortune, and The New York Times suggesting that, at best, cancer is fighting us to a draw. But a new analysis of death rates, performed by staff at the American Cancer Society, indicates that cancer death rates peaked around 1990, and have been declining broadly since. As a result, they're now below where they started in 1970.

The dynamics in many specific populations are quite distinct. Relative to women, men started out with a higher age-standardized death rate, saw a more rapid increase, peaked a year earlier, and then have seen a far more dramatic decline. Various ethnic groups also had different trajectories, but all have shown declines in recent years. The trends have been more dramatic in younger populations as well.

The changes also vary based on cancer types. "The 2006 death rates for Hodgkin lymphoma in men, cervical cancer in women, and stomach cancer in both men and women were less than one-third of the 1970 rates," the authors conclude. In contrast, liver cancer death rates are increasing, as are pancreatic cancers in women, and melanoma and esophageal cancer in women. But, for 15 of the 19 cancers studied, rates have dropped.

The biggest factor in the change, according to the authors, is prevention: people are smoking less, and we should see continued improvements in this regard due to the decreased rates of smoking in adolescents. Mammograms, the Pap smear, and increased colonoscopy rates all account for drops in their relevant cancers, indicating that detection is also playing a role, while new cancer treatments Indianapolis had impacts in lymphomas, leukemias, and testicular cancer.

There are a couple of take-home messages here. For one, we tend to expect success in the war on cancer to come in terms of treatments, but prevention and early detection are having a far more significant effect. But they take much longer; the oldest generations are missing out on the drop in smoking because the time-lags are so long. Finally, there's some indication that the rise in a few cancers may be tied to increased obesity, however, so there's no guarantee of continued success.

U.S. Health Survey: Too Few Exercising, Too Many Smoking

USA Today

This is not a nation of teetotalers or regular exercisers, new government data show.

The National Health Interview Survey, based on telephone interviews with 79,000 adults over three years, has found:

•61% of people in the USA drink alcohol. These are adults who have had at least 12 drinks in their lifetime and at least one drink in the past year.

•31% of people do enough regular leisure-time physical activity to get health benefits — that is, moderate exercise for 30 minutes five times a week or vigorous activity for 20 minutes three times a week.

•40% do no regular leisure-time physical activity.

•20% smoke.

•21% are former smokers.

•58.5% have never smoked cigarettes. That is, they have never smoked or smoked fewer than 100 cigarettes in their entire life.

"There has been no progress at all in increasing physical activity since we started doing this report in 1997," says Charlotte Schoenborn, a health statistician with the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. About 40% of respondents were doing nothing then, the same as now, Schoenborn says.

"We are a long way from where the health experts want us to be with smoking — one in five is way above national health goals," Schoenborn says.

Education makes a difference. The survey found that adults who had higher levels of education were less likely to be smoking, were more active in their leisure time, were less likely to be obese and were less likely to sleep as little as six hours or less in the past 24 hours.

Overall, "having higher levels of education or greater economic resources tends to increase the likelihood of having healthier behaviors," Schoenborn says.

In addition, Schoenborn says, "married adults tend to have healthier behaviors overall than people who are divorced, separated or widowed."

Prostate Cancer Radiation Side Effects May Subside With Time

Business Week

Ten years later, many men weren't bothered by treatment's effects, study finds

The balance between using enough radiation to shield patients from prostate cancer's return while keeping side effects at bay may not be as tricky as once thought, new research shows.

That's because radiation-linked side effects appear to lessen with time. In fact, 10 years after treatment, prostate cancer patients didnt' report suffering more severe side effects after doctors boosted their radiation to levels that made tumor recurrence 50 percent less likely, researchers say.

"A surprising number of men who reported symptoms that had bothered other patients surveyed before or soon after prostate cancer treatment described their current symptoms as normal," said Dr. James Talcott of the Massachusetts General Hospital Cancer, who led the study, in a statement.

The study examined two dose levels used for patients with early-stage prostate cancer treatment. The higher doses -- 79 Gy -- lowered the risk of recurring tumors by half. Of 398 participants, 280 returned surveys.

"Symptoms that seem to bother other patients early in the course of their prostate cancer were regarded as normal by these patients nearly a decade after treatment," Talcott says. "As clinicians, we know that patients adapt to their situation and accept physical changes as the 'new normal.' When talking with prostate cancer patients, I've been surprised when, for example, a patient in his late 60s who became impotent two or three years after treatment would comment, 'Well it would have happened anyway to a man my age.'

"While these results need to be confirmed, since this is just one study, it's looking like we should tell patients that Detroit cancer treatment side effects probably will bother them less than they originally fear because they are likely to adjust and experience less distress over time," he added. "We also may need to rethink our standard measures of treatment outcomes, which assume that the impact of symptoms on patients' quality of life does not change over time. While that may be true for pain, it doesn't seem to be true for these sorts of symptoms."

The study appears in the March 17 issue of the Journal of the American Medical Association.

As Patients Flock to Medicaid, Doctors Drop Them

NY Times

With Medicaid Cuts, Doctors and Patients Drop Out

 Rebecca and Jeoffrey Curtis searched for care for their son. In the process, they felt like “second-class citizens,” Ms. Curtis said.

FLINT, Mich. — Carol Y. Vliet’s cancer returned with a fury last summer, the tumors metastasizing to her brain, liver, kidneys and throat.

As she began a punishing regimen of chemotherapy and radiation, Mrs. Vliet found a measure of comfort in her monthly appointments with her primary care physician, Dr. Saed J. Sahouri, who had been monitoring her health for nearly two years.

She was devastated, therefore, when Dr. Sahouri informed her a few months later that he could no longer see her because, like a growing number of doctors, he had stopped taking patients with Medicaid.

Dr. Sahouri said that his reimbursements from Medicaid were so low — often no more than $25 per office visit — that he was losing money every time a patient walked in his exam room.

The final insult, he said, came when Michigan cut those payments by 8 percent last year to help close a gaping budget shortfall.

New doctors, with their mountains of medical school debt, are fleeing Michigan because of payment cuts and proposed taxes. Dr. Kiet A. Doan, a surgeon in Flint, said that of 72 residents he had trained at local hospitals only two had stayed in the area, and both are natives.

“My office manager was telling me to do this for a long time, and I resisted,” Dr. Sahouri said. “But after a while you realize that we’re really losing money on seeing those patients, not even breaking even. We were starting to lose more and more money, month after month.”

It has not taken long for communities like Flint to feel the downstream effects of a nationwide torrent of state cuts to Medicaid, the government insurance program for the poor and disabled. With states squeezing payments to providers even as the economy fuels explosive growth in enrollment, patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage. Inevitably, many defer care or wind up in hospital emergency rooms, which are required to take anyone in an urgent condition.

Mrs. Vliet, 53, who lives just outside Flint, has yet to find a replacement for Dr. Sahouri. “When you build a relationship, you want to stay with that doctor,” she said recently, her face gaunt from disease, and her head wrapped in a floral bandanna. “You don’t want to go from doctor to doctor to doctor and have strangers looking at you that don’t have a clue who you are.”

The inadequacy of Medicaid payments is severe enough that it has become a rare point of agreement in the health care debate between President Obama and Congressional Republicans. In a letter to Congress after their February health care meeting, Mr. Obama wrote that rates might need to rise if Democrats achieved their goal of extending Medicaid eligibility to 15 million uninsured Americans.

In 2008, Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare, which are themselves typically well below those of commercial insurers, according to the Urban Institute, a research group. At 63 percent, Michigan had the sixth-lowest rate in the country, even before the recent cuts.



In Flint, Dr. Nita M. Kulkarni, an obstetrician, receives $29.42 from Medicaid for a visit that would bill $69.63 from Blue Cross Blue Shield of Michigan. She receives $842.16 from Medicaid for a Caesarean delivery, compared with $1,393.31 from Blue Cross.

If she takes too many Medicaid patients, she said, she cannot afford overhead expenses like staff salaries, the office mortgage and malpractice insurance that will run $42,800 this year. She also said she feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies, because of underlying health problems.

As a result, she takes new Medicaid patients only if they are relatives or friends of existing patients. But her guilt is assuaged somewhat, she said, because her husband, who is also her office mate, Dr. Bobby B. Mukkamala, an ear, nose and throat specialist, is able to take Medicaid. She said he is able to do so because only a modest share of his patients have it.

The states and the federal government share the cost of Medicaid, which saw a record enrollment increase of 3.3 million people last year. The program now benefits 47 million people, primarily children, pregnant women, disabled adults and nursing home residents. It falls to the states to control spending by setting limits on eligibility, benefits and provider payments within broad federal guidelines.

Michigan, like many other states, did just that last year, packaging the 8 percent reimbursement cut with the elimination of dental, vision, podiatry, hearing and chiropractic services for adults.

When Randy C. Smith showed up recently at a Hamilton Community Health Network clinic near Flint, complaining of a throbbing molar, Dr. Miriam L. Parker had to inform him that Medicaid no longer covered the root canal and crown he needed.

A landscaper who has been without work and without a Michigan health insurance company for 15 months, Mr. Smith, 46, said he could not afford the $2,000 cost. “I guess I’ll just take Tylenol or Motrin,” he said before leaving.

This year, Gov. Jennifer M. Granholm, a Democrat, has revived a proposal to impose a 3 percent tax on physician revenues. Without the tax, she has warned, the state may have to reduce payments to health care providers by 11 percent.

In Flint, the birthplace of General Motors, the collapse of automobile manufacturing has melded with the recession to drive unemployment to a staggering 27 percent. About one in four non-elderly residents of Genesee County are uninsured, and one in five depends on Medicaid. The county’s Medicaid rolls have grown by 37 percent since 2001, and the program now pays for half of all childbirths.

But surveys show the share of doctors accepting new Medicaid patients is declining. Waits for an appointment at the city’s federally subsidized health clinic, where most patients have Medicaid, have lengthened to four months from six weeks in 2008. Parents like Rebecca and Jeoffrey Curtis, who had brought their 2-year-old son, Brian, to the clinic, say they have struggled to find a pediatrician.

“I called four or five doctors and asked if they accepted our Medicaid plan,” said Ms. Curtis, a 21-year-old waitress. “It would always be, ‘No, I’m sorry.’ It kind of makes us feel like second-class citizens.”

As physicians limit their Medicaid practices, emergency rooms are seeing more patients who do not need acute care.

At Genesys Regional Medical Center, one of three area hospitals, Medicaid volume is up 14 percent over last year. At Hurley Medical Center, the city’s safety net hospital, Dr. Michael Jaggi detects the difference when advising emergency room patients to seek follow-up treatment.

“We get met with the blank stare of ‘Where do I go from here?’ ” said Dr. Jaggi, the chief of emergency medicine.

New doctors, with their mountains of medical school debt, are fleeing the state because of payment cuts and proposed taxes. Dr. Kiet A. Doan, a surgeon in Flint, said that of 72 residents he had trained at local hospitals only two had stayed in the area, and both are natives.

Access to care can be even more challenging in remote parts of the state. The MidMichigan Medical Center in Clare, about 90 miles northwest of Flint, closed its obstetrics unit last year because Medicaid reimbursements covered only 65 percent of actual costs. Two other hospitals in the region might follow suit, potentially leaving 16 contiguous counties without obstetrics.

Michigan Medicare and Medicaid enrollees in the state's midsection have grown accustomed to long journeys for care. This month, Shannon M. Brown of Winn skipped work to drive her 8-year-old son more than two hours for a five-minute consultation with Dr. Mukkamala. Her pediatrician could not find a specialist any closer who would take Medicaid, she said.

Later this month, she will take the predawn drive again so Dr. Mukkamala can remove her son’s tonsils and adenoids. “He’s going to have to sit in the car for three hours after his surgery,” Mrs. Brown said. “I’m not looking forward to that one.”

Search for Better Diabetes Therapy Falls Short

The Wall Street Journal

Current Treatments, While Effective, Failed to Also Help Prevent Heart Attacks and Stroke

ATLANTA—New strategies to prevent and treat diabetes and heart disease failed to improve care in two major studies, frustrating researchers' efforts to find more-effective approaches to the world's burgeoning diabetes epidemic.

The studies are among the first large trials to test whether treatments recommended for diabetes patients also reduce the risk of heart attacks and strokes. Diabetics are between two and four times as likely to die of cardiovascular causes as nondiabetics. The lack of data on whether strategies to treat diabetes actually lower heart risk is of growing concern to physicians, researchers and regulators.

One new study, called Accord, found that treating blood pressure to lower levels than recommended in current practice doesn't further reduce risk of death, heart attack and stroke among people with diabetes. The same study also found that the drug Tricor, marketed by Abbott Laboratories, failed to prevent such events even though it lowered levels of blood fats called triglycerides that are associated with high diabetes risk.

In the other report, dubbed Navigator, a diabetes drug called Starlix failed to prevent people at high risk of diabetes from progressing to the disease. The blood-pressure medicine Diovan did modestly reduce risk of developing diabetes in the same study, but neither drug significantly cut the risk of heart-related deaths, heart attacks and strokes. Both pills in this study are sold by Novartis SA of Switzerland.

The results from both studies were unveiled Sunday at the annual scientific meeting of the American College of Cardiology and published online in four different papers by the New England Journal of Medicine.

"Physicians and patients are looking pretty desperately to decrease the toll that comes with diabetes," said David Nathan, director of the diabetes center at Massachusetts General Hospital, Boston, who wasn't involved in the reports. "These studies don't provide a new route or any new information about how to do that."

More than 23 million Americans suffer from diabetes. The International Diabetes Federation, Brussels, puts the global total at 285 million, with projections that it will rise to 438 million within 20 years. The vast majority have Type 2 diabetes, an impaired ability to process dietary sugars that is typically associated with obesity and lack of exercise.

In the U.S., combined annual costs to treat the disease and for additional factors such as lost productivity amount to $174 billion, according to the American Heart Association. Heart experts worry that without better ways to prevent and treat diabetes, the disease threatens to reverse nearly a half-century of advances against cardiovascular disease, which remains the world's leading killer.

Despite the disappointing findings, researchers said that overall, the data strengthen support for current treatment guidelines and that patients shouldn't abandon proven medications and strategies that may be keeping them out of trouble.

"What we're seeing is the effectiveness of our current therapies," said Darren McGuire, a cardiologist and diabetes researcher at UT Southwestern Medical Center, Dallas. "It's not that what we're presently doing isn't good; it's just that more isn't better."

Researchers said the findings also underscore the value of physical exercise, healthy diets and weight loss. Even a loss of 5% of body weight, for instance, significantly lowers the risk of developing diabetes.

Among current guidelines for diabetes patients, one calls for treating systolic blood pressure–the higher number in a blood-pressure test–to below 130, though limited evidence exists for that recommendation. For patients with triglyceride levels above 200, advice is to try a so-called fenofibrate drug such as Tricor if a statin alone doesn't help, especially if HDL, or good cholesterol, is low. Evidence for that strategy isn't strong either.

In one part of the Accord trial involving 4,733 patients followed for 4.7 years, the group assigned to intensive treatment achieved systolic blood pressure averaging 119 (target: below 120), compared with 134 in the group getting standard care (target: below 140). Researchers said while the more intensive approach slightly lowered the likelihood of heart attack, stroke or death from cardiovascular causes, the difference wasn't statistically meaningful. A second Accord paper found that adding Tricor to a generic statin successfully reduced triglyceride levels by about 25%, but that didn't lead to fewer heart attacks, strokes and heart related deaths. Researchers said the results suggested women might do worse adding Tricor while men might do better.

In addition, the combination appeared to benefit a subgroup of patients with triglycerides above 204 and an HDL of 34 or lower, lending some support to current guidelines. But that finding didn't quite achieve statistical significance and would need confirmation in new trial.

Abbott said it wasn't surprised by the results because the average triglyceride level of patients when the study began was 162; it says most patients treated with its drug have levels over 200. Researchers said the study suggested adding Tricor to a statin might help some patients with high triglyceride levels. Tricor and a sister drug Triplipix together accounted for $1.3 billion in revenue for Abbott in 2009. The study was sponsored by the National Institutes of Health.

The Navigator study, sponsored by Novartis, examined whether Starlix or Diovan, when added to an exercise and diet program, would prevent diabetes and major cardiovascular events among high risk patients.

"For people who don't have diabetes, neither drug will be recommended," said Robert Califf, vice chancellor for clinical research, Duke University, Durham, N.C., and a leader of the trial, because neither achieved success against both diabetes and heart disease.

Call for a New Children's Hospital

ABC News

The Southern Health network has revealed its plans for a new children's hospital in Melbourne, but it is waiting for State Government approval.

The network wants a 200 bed hospital with paedatric theatres, a cancer center and a bigger outpatient service to be built at the Monash Medical Centre site in Clayton.

It says the project would cost $220 million.

The State Government says the plans will be considered but no decision has been made.

The director of Monash Children's, Professor Nick Freezer says a new hospital is needed to keep up with demand in Melbourne's south-east.

"As the population grows in the south-east the demand for pediatric services increases," he said.

"We're increasing at about 10 percent per annum and at the moment we just can't continue to provide the services with the infrastructure we have in place."

The Health Minister Daniel Andrews says the Government provided planning money for it four years ago.

"Monash does need bigger buildings, they need new buildings and we're currently considering these matters as part of the budget," he said.

"No decision has been made, and again, I strongly support new and bigger buildings for Monash given the number of children they already treat."

The President of AMA Victoria, Dr Harry Hemley says a new hospital for children would help take the pressure off the Royal Children's Hospital.

"We're in the middle of a baby boom at the moment, so we really do need more paediatric and neonatal facilities, especially in the south-east where we've got a big population growth occurring down there now," he said.

"This is a very interesting proposal and should really be considered seriously by the Government."

The Opposition's Health Spokesman, Davis Davis says there is an undeniable need for extra health services in Melbourne's south-east.

"The Coalition supports a Monash Children's in principal," he said.

"There's no doubt that this Government should have been building and should have been focusing on the needs and services for children in the south-east."

Nursing Covering More Health Care

USA Today

FRANKFORT, Ky. — Each year, Wendy Fletcher says, she and two partners see more than 5,000 patients at their practice in Morehead, Ky.

They are not doctors, but rather registered nurse practitioners who say they are able to increase access to health care and make it more affordable.

"None of us are trying to play doctor," she said.

"If we'd wanted to be doctors, we would have gone to medical school," added nurse practitioner Melinda Staten of Louisville.

The Kentucky Medical Association claims otherwise and is fighting proposed legislation that would lift some limits on the ability of about 3,700 nurse practitioners in Kentucky to prescribe medication and perform other, mostly routine tasks such as signing a child's immunization certificate or certifying the need for employee sick leave.

Greg Cooper, a former Kentucky Medical Association president and family physician from Cynthiana, Ky., who testified against the Kentucky bill, said he objects to what he said "is this constant push by nurse practitioners to be physicians."

"It's a little bit frustrating, the way this has evolved," he said. "The family physician is the foundation of health care."

That argument has been echoed nationally by the American Medical Association, which issued a report last fall critical of the training that nurse practitioners receive.

Dealing with doctor shortage

As the debate over health care legislation continues in Washington, advocates for nurse practitioners say it is these primary care nurses who will make up for the shortage of primary care physicians and at the same time keep costs down.

According to the American Nurses Association, as of November, the median expected salary for a typical nurse practitioner in the United States was $83,293, while the median expected salary for a typical family practice physician was $160,586.

Rebecca Patton, president of the American Nurses Association, said that each year, state legislatures are seeing measures proposed that seek to increase the capabilities of nurse practitioners and in many cases eliminate a level of supervision from physicians.

Among recent examples she cited:

• In January, Ohio's Democratic Gov. Ted Strickland signed a bill that did away with the need for nurse practitioners moving to Ohio to repeat training with an Ohio physician as long as they have had prescribing privileges in another state at least one of the prior three years.

• In July 2009, Hawaii enacted a bill that gave nurse practitioners broader prescription authority that includes controlled substances.

In addition, the association cited several additional states that have bills pending that would either broaden or restrict prescription writing ability for nurse practitioners, including bills in Alabama, Colorado, Washington and West Virginia. And Alabama, Connecticut, Mississippi, Nebraska and New York have bills pending related to removing requirements for physician supervision or collaboration agreements.

'Don't see a big difference'

Nurse practitioners are "gaining traction because people are seeing how cost-effective they are," Patton said. "The primary care physician shortage is going to drive it."

Judi James, 56, who lives in Morehead, Ky., said she gets her basic medical care from a nurse practitioner and has no qualms about going to see a nurse rather than a doctor.

"I really just don't see a big difference," James said. "The nurses are the ones who take care of you anyway, not always the doctor. If I need a specialist, she'll send me there."

Each state sets up regulations for nurse practitioners. In Kentucky, for example, nurse practitioners are able to practice independently without being supervised by a physician. But in order to prescribe medicine they must obtain a signed agreement from a physician, even though that physician may not work directly with or consult with the nurse.

The Kentucky bill would allow nurses to forgo the agreement when it comes to certain medications, such as antibiotics and blood-pressure medication. Prescribing controlled drugs, such as narcotic painkillers and sedatives, would still require the physician agreement.

The Kentucky bill passed out of committee and could come to the full house for consideration as soon as Monday, said its sponsor, Rep. Mary Lou Marzian, a Louisville Democrat. Marzian said she's not sure the bill can make it through the Senate.

Twelve states, including Alaska, New Mexico, Montana, Wisconsin and Wyoming, and the District of Columbia allow nurse practitioners with a nursing degree to prescribe independently, including controlled substances, according to the American Nurses Association. In 29 states, laws require physician collaboration for prescribing controlled substances.

Some states have limits on which controlled substances can be prescribed by nurse practitioners. Laws in Florida and Alabama prohibit nurse practitioners from prescribing any controlled substances.

Health Care Ad Cyclorama to Clog Media Arteries

USA Today

WASHINGTON — It's not quite election season, but President Obama is on the stump, pushing his health care bill. Now, millions of dollars in political ads aimed at swaying Congress are hitting the airwaves.

Hundreds of business groups today launch a multimillion-dollar ad campaign in an effort to stop health care legislation and fire back at White House efforts to win support for a plan Obama says would expand insurance coverage to 31 million people.

The bill Obama is pushing Congress to pass by Easter "will cost jobs and stifle any creation of jobs," says Jade West of the National Association of Wholesaler-Distributors.

At the same time, the health insurance industry as soon as today will begin airing ads of its own on cable TV networks. Those ads, by America's Health Insurance Plans, aim to blunt White House criticism of insurance companies for raising rates.

"Doctors, hospitals, medicines and tests" drive up health care costs, not insurance companies, the ads say.

The group will not say how much it's spending on the ads beyond that it is at least $1 million.

The business ads by the U.S. Chamber of Commerce and nearly 250 other organizations will air on national cable networks.

In a few days, the ads will directly target members of Congress, airing in 17 states where House members either opposed health care legislation when a version passed the chamber in November or supported it but have suggested they are wavering now, according to Chamber Vice President of Government Affairs Bruce Josten.

The ads warn: "Billions in new taxes. More mandates on businesses. Health care costs will go even higher, making a tough economy worse. Washington's not getting the message. Tell Congress. Stop this health care bill we can't afford to pay."

The Chamber would not list the 17 states in the ad buy. Josten would not say specifically what the business groups are spending on the ads, only that it's between $4 million and $10 million.

"This is the endgame when it comes to the legislation," says Evan Tracey of the non-partisan Campaign Media Analysis Group, which tracks political advertising. The ads in the states are "a call to action to make the phone ring" in congressional offices.

The ads come as Obama has ramped up his own efforts to push health care through Congress in the next few weeks.

Today, he heads to the St. Louis suburbs for a reprise of his speech Monday outside of Philadelphia, where he urged Congress to pass his 10-year, $950 billion bill that also would tighten regulations on insurance companies.

In Pennsylvania, Obama appeared campaign-style in shirt sleeves as he blasted insurers for rate hikes that have left people without coverage or care and driven up the price of California health insurance quotes.

Robert Zirkelbach, spokesman for the health insurance industry group, says Obama's characterization is unfair and that insurers want to set the record straight that health care costs, not insurance rates, are what hurts the system most.

Speaking at an industry conference at The Ritz-Carlton hotel in Washington, while hundreds of union workers and other protesters who support the legislation chanted outside, Zirkelbach called Obama's depiction of the industry "politics as usual."

He said the industry supports health care changes — but not with the bill now before Congress. He says Obama's bill doesn't do enough to drive down health care costs. "It's a missed opportunity," he says.

Alzheimer's 'Epidemic' Hitting Minorities Hardest

U.S. News & World Report

Blacks, Hispanics at much higher risk for the illness, which carries huge price tag, report finds

Over 5 million Americans are living with Alzheimer's disease, and blacks and Hispanics are at highest risk of developing the disease, a new report finds.

The report, 2010 Alzheimer's Disease Facts and Figures, from the Alzheimer's Association, finds that black Americans are about two times more likely to develop Alzheimer's disease than whites, and Hispanics face about 1.5 times the risk.

"Alzheimer's is continuing to be on the rise," said Maria Carrillo, the association's senior director of medical and scientific relations. "So many people are affected by it across the country, but we are rallying to highlight the disparities that exist in populations," she said.

Much of the increase in Alzheimer's is because of increasing high blood pressure and diabetes, which increase the odds of developing Alzheimer's in all populations.

"African-Americans and Hispanics are particularly vulnerable, because the proportion of these two risk factors is higher even still," Carrillo said. "We can actually do something about this increased risk with better management of the conditions."

This year, 500,000 new cases of Alzheimer's will be diagnosed, with a greater number of new cases expected in the years to come, the report found. By 2050, the report estimates that almost a million new cases of Alzheimer's will be diagnosed annually.

In 2006, Alzheimer's was the seventh leading cause of death in the United States and the fifth leading cause of death among those 65 and older.

From 2000 to 2006, death rates declined for most major diseases, including heart disease, breast cancer, prostate cancer, stroke and HIV/AIDS. However, deaths from Alzheimer's rose more than 46 percent during that time period, according to the report.

Not only are there more cases of Alzheimer's, but more families are shouldering the burden of the disease, Carrillo said. This is particularly true for minority families who may have less access to outside care.

"There are 5.3 million Americans with Alzheimer's," noted Robert J. Egge, vice president of public policy and advocacy. "And for each of those people there are many others whose lives are consumed with caring for those Alzheimer's patients," he said.

That totals some 11 million Americans, Egge said.

In 2009, these unpaid caregivers provided 12.5 billion hours of care "valued at $144 billion, more than the federal government spends on Medicare and Medicaid combined for people with Alzheimer's and other dementias," according to the report.

Part of the problem is that Alzheimer's isn't recognized until it is in a late stage, Egge said. "So there isn't adequate care planning and other kind of support structures, especially in communities with socioeconomic disadvantages," he said.

Another reason behind Alzheimer's grim rise is that people are living longer -- escaping illnesses such as heart disease and cancer that might have killed them before Alzheimer's arose.

"We are managing many diseases that do allow us to live longer," Carrillo said. "With age being the greatest risk factor, we are just skewing our population towards the Alzheimer's arena."

Another expert agreed.

"We have some pretty effective solutions for a lifetime of cardiovascular disease risk, but your bypass and stent may just give you time to dement," said Greg M. Cole, a neuroscientist at the Greater Los Angeles VA Healthcare System and associate director of the Alzheimer's Disease Research Center at UCLA David Geffen School of Medicine.

Often, it all adds up to many years of needed care. And since it often takes a long time to die from Alzheimer's, "you may have lost touch with your loved ones for 10 years, sometimes even 20," Carrillo said.

Research dollars remain key to turning the numbers around, she said. "We really need to focus on Alzheimer's," she said. "We need more of an investment in Alzheimer's disease."

The report found that payments for health and long-term care services for people with Alzheimer's will total $172 billion this year.

In addition, Medicare costs for Alzheimer's patients are almost three times higher than for other older people, and Medicaid costs are almost nine times higher, the report found.

Many people with Alzheimer's also have one or more other medical conditions, such as diabetes or coronary heart disease, making their care even more expensive.

Yet far less is spent on Alzheimer's research than on other diseases.

In fact, "for every $25,000 the government spends on care for people with Alzheimer's and dementia, it spends only $100 for Alzheimer research," the report said.

According to Cole, "this new report details how the long predicted 'epidemic' rise in Alzheimer's disease and other dementia is already upon us."

The report also sounds the alarm that the situation may get worse before it gets better.

"We hope to have better treatments, but cures are unlikely," Cole said. "The only cost-effective answer we can realistically try to achieve is an effective prevention program in the field of michigan geriatrics," he said.

Survey Sheds Light on U.S. Bedtime Routines

CNN

Your racial and ethnic background can shape many aspects of your life: the type of food you eat, where you live, and your political views.

Now a new survey suggests that how you sleep and what you do before you hit the hay -- whether it's watch TV, pray, or have sex -- varies by ethnic group as well.

In the survey, the first of its kind, a representative sample of more than 1,000 whites, African Americans, Asians, and Hispanics ages 25 to 60 were asked about their sleep and bedtime routines. While their answers revealed plenty of differences between groups, they also showed that we have something in common: Most of us aren't sleeping well.

In each group, roughly six out of 10 people reported that they don't get a good night's sleep every night or almost every night, according to the survey, which was conducted by the National Sleep Foundation, a nonprofit organization based in Washington, D.C.

"A significant proportion of all ethnic groups are experiencing sleepiness that impacts their day to day living," says Thomas J.Balkin, Ph.D., chairman of the National Sleep Foundation. "Sleepiness impacts every aspect of our lives, so for those people who are not getting a good night's sleep, getting better sleep will make you sharper in the boardroom, give you a better quality of life, and [make] the sun seem a whole lot brighter."

Across the board, a lack of sleep appears to be affecting people's lives and relationships.

Roughly one in four people in each ethnic group said that they missed work or a family function because they were too sleepy, and a similar proportion said they were too exhausted to have sex on a regular basis.

The survey results offered a peek inside the bedrooms of Americans, and how we spend our time before drifting off.

For instance, 75 percent of African Americans reported watching television routinely in the hour before going to bed, compared with 64 percent of whites.

Only 52 percent of Asians said they watched TV before bed almost every night, but they were far more likely to use a computer or surf the Web before bed; more than half said they did so almost every night, compared with about 20 percent in the other groups.



Sexual activity also varied among the groups. Ten percent of African Americans and Hispanics reported having sex almost every night, compared with 4 percent of whites and 1 percent of Asians.

African Americans, meanwhile, were far more likely than other groups to pray before bedtime almost every night of the week.

Who -- or what -- Americans sleep with also appears to vary by ethnicity. Nine out of 10 whites who are married or "partnered" sleep with their significant others, a slightly higher rate than that among African Americans.

But three-quarters and two-thirds of Hispanics and Asians, respectively, said that they don't sleep with their partner. Those groups, however, were more likely to share a bedroom with their children.

"Asians tend to sleep with children in their beds and that could have an impact on sleep quality because anything that disrupts sleep like a dog or kid in the bed can negatively impact sleep and the restorative value of that sleep," Balkin says. Whites were more likely to sleep with their pets than other ethnic groups, the poll showed.

Although each group reported getting between six and seven hours of sleep on the average weekday (or other workday), the amount of sleep did vary significantly. African Americans got the least (about 6.25 hours), and whites got the most (just under seven hours).

With numbers like these, it's not surprising that relatively few of the survey respondents reported consistently getting a good night's sleep. "Most people require seven to nine hours of sleep to feel rested," says Balkin. "The first step is to become aware of the problem, and then make more time for sleep and engage in practices that promote good, healthy sleep."

According to Balkin, good sleep hygiene includes going to bed and waking up at the same time each day (ideally without an alarm clock); using the bedroom only for sleep and sex; abstaining from nicotine, caffeine, or alcohol after 2 p.m.; and avoiding stressful tasks right before bed.

"If you try all these tips and are still not getting enough sleep or are still sleepy, you may have a problem that requires a greater level of intervention, such as medication or light therapy, which can help re-train or reset your body's internal clock," he adds.

The rate of diagnosed sleep disorders differs among the groups, the survey found. Whites were more likely to have been diagnosed with insomnia, while African Americans were more likely to have sleep apnea, a breathing problem that causes people to wake up frequently.

What else is keeping us awake at night? Roughly 20 percent of whites, African Americans, and Hispanics said that financial problems were causing them to lose sleep at night, compared to just 9 percent of Asians. More so than other groups, Hispanics also worried about health-related concerns.

Priyanka Yadav, D.O., a sleep medicine specialist at Somerset Medical Center in Somerville, New Jersey, says that the survey's findings suggest that she and other experts in the field need to tailor their treatment to different ethnicities.

While Asians reported the fewest sleep problems and were among the least likely to use sleeping aids (such as medication), for instance, they were also least likely to bring up sleep problems with their doctors.

"Now that I know this, if I had an Asian patient, I would ask them about their sleep to get the dialogue started," says Yadav.

"It is really important to realize how ethnicities view sleep, so we can better target our treatment recommendations," she adds.

In the end, the racial and ethnic differences in the survey may be less important than the fact that so many people struggle to get a good night's, suggests Mark W. Mahowald, M.D., the director of the Minnesota Regional Sleep Disorders Center.

"There are ethnic and cultural differences and socioeconomic factors that play a role in how much sleep everyone gets, but a significant percent of the adult population is sleep deprived," he says. "The main consequence of this is impaired performance in the workplace, in the classroom, and behind the wheel, followed by irritability."

People with busy schedules often cut back on sleep to make time for other things, Mahowald adds. But, he says, "Sleep is non-negotiable and is as important as diet and exercise to our overall well-being."