Heart Related Deaths Drop for Diabetics

Story first appeared in The Daily Disruption.

Death rates for people with diabetes dropped substantially from 1997 to 2006, especially deaths related to heart disease and stroke, according to researchers at the Centers for Disease Control and Prevention and the National Institutes of Health.

Deaths from all causes declined by 23 percent, and deaths related to heart disease and stroke dropped by 40 percent, according to the study published today in the journal Diabetes Care. Scientists evaluated 1997-2004 National Health Interview Survey data from nearly 250,000 adults who were linked to the National Death Index. Although adults with diabetes still are more likely to die younger than those who do not have the disease, the gap is narrowing.

Improved medical treatment for cardiovascular disease, better management of diabetes, and some healthy lifestyle changes contributed to the decline, according to accredited Allen Park Heart Doctors. People with diabetes were less likely to smoke and more likely to be physically active than in the past. Better control of high blood pressure and high cholesterol also may have contributed to improved health.  However, obesity levels among people with diabetes continued to increase.

Taking care of your heart through healthy lifestyle choices is making a difference, but Americans continue to die from a disease that can be prevented. Although the cardiovascular disease death rate for people with diabetes has dropped, it is still twice as high as for adults without diabetes.

Experts specializing in Allen Park Stroke Care have shown that previous studies have found that rates of heart disease and stroke are declining for all U.S. adults. Those rates are dropping faster for people with diabetes compared to adults without diabetes.  Recent CDC studies also have found declining rates of kidney failure, amputation of feet and legs, and hospitalization for heart disease and stroke among people with diabetes.

Because people with diabetes are living longer and the rate of new cases being diagnosed is increasing, scientists expect the total number of people with the disease will continue to rise. The number of Americans diagnosed with diabetes has more than tripled since 1980, primarily due to type 2 diabetes, which is closely linked to a rise in obesity, inactivity and older age. CDC estimates that 25.8 million Americans have diabetes, and 7 million of them do not know they have the disease.

CDC and its partners are working on a variety of initiatives to prevent type 2 diabetes and to reduce its complications. CDC leads the National Diabetes Prevention Program, a public-private partnership designed to bring evidence-based programs for preventing type 2 diabetes to communities. The program supports establishing a network of lifestyle-change classes for overweight or obese people at high risk of developing type 2 diabetes.

Diabetes carries significant personal and financial costs for individuals, their families, and the health care systems that treat them. As the number of people with diabetes increases, it will be more important than ever to manage the disease to reduce complications and premature deaths.

Controlling levels of blood sugar (glucose), cholesterol and blood pressure helps people with diabetes reduce the chance of developing serious complications, including heart disease, stroke, blindness and kidney disease. Controlling these levels at home is simple with devices such as the Accu-Trend Plus Self-Testing Diabetes Monitor.

In 2001, the National Diabetes Education Program (NDEP), a joint effort of CDC and NIH with the support of more than 200 partners, developed a campaign to raise awareness of the link between diabetes and heart disease and reinforce the importance of a comprehensive diabetes care plan that focuses on the ABCs of diabetes – A1C (a measure of blood glucose control over a two- to three-month period), Blood pressure and Cholesterol. 

Last year CDC and the Centers for Medicare & Medicaid Services launched Million Hearts, an initiative to prevent 1 million heart attacks and strokes over the next five years.  The initiative focuses on two main goals: empowering Americans to make healthy choices and improving care for people, focusing on aspirin for people at risk, blood pressure control, cholesterol management and smoking cessation. More than 2 million heart attacks and strokes occur every year, and treatment for these conditions and other vascular diseases account for about 1 of every 6 health care dollars, say Allen Park Cardiologists.  Up to 20 percent of deaths from heart attack and 13 percent of deaths from stroke are attributable to diabetes or pre-diabetes.

Diabetes was the seventh leading cause of death in 2009 and is the leading cause of new cases of kidney failure, blindness among adults younger than 75, and amputation of feet and legs not related to injury. People with diagnosed diabetes have medical costs that are more than twice as high as for people without the disease. The total costs of diabetes are an estimated $174 billion annually, including $116 billion in direct medical costs.

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Why Do Healthcare Costs Fluctuate?

Surgery to remove your appendix in one California hospital could cost $180,000. Have the operation at a different facility in the same state and the bill might be as little as $1,500.

That kind of disparity, typical across the country, combined with escalating medical spending and the increasing amount of data available online, has prompted several startups to get into the business of helping companies and their employees save health-care dollars.

This is about changing the way people shop for health care, and as a consequence, changing the way care gets delivered.

Medical spending in the U.S. increased 88 percent to $2.59 trillion in the last decade while out-of-pocket expenses rose 49 percent to $299.7 billion, according to data from the Centers for Medicare and Medicaid Services.

Castlight works by showing how much doctors, labs and hospitals charge for their services, as well as providing quality ratings. On May 1, the company announced it raised $100 million from investors. Other sites such as HealthcareBlueBook.com, ClearCost Health and Change Healthcare Corp. help employers identify less costly doctors and providers for their workers.

Travelocity for Health Care

With their out-of pocket medical expenses on the rise, more and more employees are open to ways to save. Last year, 13 percent of U.S. employees were covered by so-called high- deductible plans that require them to pay for most health costs, an increase from 3 percent five years ago, according to Mercer, a New York-based industry consultant.

Castlight targets companies with self-insured health plans and charges them a monthly fee based on the number of employees and dependents covered. It compiles paid claims data from employers and insurers, then publishes that information on a website for companies and their employees. The closely held company, which bills itself as a Travelocity for health care, serves more than 250,000 employees and their dependents at dozens of companies.

By helping people compare the cost of medical providers, Castlight has saved the companies they work for from 3 percent to 5 percent of their baseline costs, Colella said.

Cheaper Care

CareOperative LLC, another closely held company, debuted HealthcareBlueBook.com in January 2009. CareOperative lets consumers use the service for free, while charging companies a fee for finding health areas where they and their employees can save. The service promises to reduce an employer’s health-care costs as much as 6 percent by finding cheaper alternatives for employees and giving them incentives to switch doctors or hospitals. The Nashville, Tennessee-based site has hundreds of thousands of visitors a year.

OutOfPocket.com was started in 2007 as a crowd-sourcing tool for patients. When few visitors posted the prices they paid for services, the founder supplemented it with Medicare data as well as links to paid claims data on other websites. About 300 to 500 people a day use the free service, which pays for itself with Internet advertising.

Everyone wants to search and look, but not many people want to contribute and share. It doesn’t have the same effect as some of these other social media tools, where people like to share where they’re eating and staying.

High Deductibles

One trouble with these services is that it’s not easy to make direct price comparisons with medical treatments and many consumers won’t take the time to do it even if such a service is available, said Paul Keckley, executive director of the Deloitte Center for Health Solutions in Washington.

Tthese services are expected to continue to expand, albeit at a slow pace, as more employees are shifted onto high-deductible insurance plans.

Wide Disparities

Arming patients with wide price disparities helps them negotiate. And those disparities can be wide. An assistant professor of emergency medicine at the University of California, San Francisco, highlighted the pricing variations in a research report that looked at how much California hospitals charge for routine appendicitis. Bills ranged from $1,529 to $182,955, with a median cost of $33,611, according to Hsia’s report, which didn’t name the facilities.

Health care is one of those things where there’s always going to be so much information asymmetry.

While consumer services such as Castlight can provide valuable data, patients need to understand that cost differences may depend on the individual decisions made by their doctors facing highly individualized situations.

Treatment Options

Understanding the differences among tests, medications and types of services is another hurdle.

You know the difference between filet mignon and chuck steak, but you don’t know the difference between generic amlodipine and brand-name Norvasc, which is Pfizer Inc.’s blood pressure medication.

Another customer, Life Technologies Inc., a Carlsbad, California-based maker of gene sequencing machines, hired Castlight in early 2011, and more than half of employees on the system made a different decision than they would have without the information, according to a survey.

While publishing prices may spur more-expensive providers to lower costs, it could also prompt some physicians to boost fees if they’re on the cheaper end of the scale, according to an editorial published in the New England Journal of Medicine last year.

Making the Effort

The chief medical officer for Quest Diagnostics Inc., said even with quality rankings available on doctors, most people don’t exert much effort finding the best providers. Patients spend twice as much time deciding which model TV to buy as they do deciding which physician to chose. Convenience is the biggest motivator for choosing a doctor.

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Sleep Apnea A Serious Illness

Story first appeared in The Detroit News.

The meaning of "apnea" is "no breathing." Sleep apnea is defined by 10-second or longer periods of no breathing during the night. To qualify as true sleep apnea, there must be five or more no-breathing episodes within an hour. Some people have as many as 30 such episodes every hour. The cause of the most common kind of sleep apnea is an obstruction of the flow of air by lax tissue in the back of the mouth and throat.

Loud snoring often is an indication of sleep apnea. The snoring grows louder and louder until there's a sudden quiet. The quiet comes about when apnea takes place. It's shattered by a gasp as the snorer partially wakens and begins breathing once again.

Sleep apnea patients wake in the morning feeling unrefreshed. They're tired during the day and fall asleep at inappropriate times and places, even when driving.

Sleep apnea has medical consequences. It causes a rise in blood pressure. It leads to heart disease. It's a serious illness.

Obesity makes a significant contribution to this problem. Weight reduction, therefore, is a natural way to put an end to it or to make it less of a threat to health. Abstaining from all alcohol in the evening is another natural treatment.

A dentist can recommend to patients an appliance that brings the jaw forward at night to prevent apnea. Many people use a device that delivers, via a mask, air under pressure.

The pressurized air makes it through the obstructing tissues in the throat. There are varying types of Sleep Medicine or Programs that can be administered to correct or lessen the symptoms of sleep apnea.

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Experts Warn Against PSA Testing

Story first appeared in USA Today.
Doctors should no longer offer the PSA prostate cancer screening test to healthy men because they're more likely to be harmed by the blood draw — and the chain of medical interventions that often follows — than be helped, according to government advisory panel's final report.

Even after studying more than 250,000 men for more than a decade, researchers have never found the PSA to save lives, according to the U.S. Preventive Services Task Force, a panel of doctors that advises the government on cancer screenings and other ways to avoid disease.

Yet the PSA can cause harm.

That's because the PSA, which measures a protein called prostate-specific antigen, often leads to unnecessary needle biopsies for men who don't actually have cancer. Even worse, those biopsies lead many men to be treated for slow-growing cancers that never needed to be found and that are basically harmless.

Because doctors today often can't tell a harmless tumor from an aggressive one, they end up treating most men with prostate cancer the same.

Treating harmless prostate tumors can't possibly help men, however. It only increases the odds of making them impotent or incontinent. Treatment can even be deadly: One in 200 men who have prostate surgery die shortly after the procedure.

The recommendation, first released as a draft in October, applies to healthy men of any age, although not for those who already have been diagnosed with prostate cancer.

The panel didn't consider cost in its deliberations. Federal legislation requires that Medicare must continue to pay for the PSA. Private insurers usually follow Medicare's example.

In the future, the hope is that doctors will simply stop mentioning the PSA when men come for office visits. If men ask for the test, or if doctors still want to offer the PSA, physicians should discuss both the risks and benefits of screening. Although the task force aims to help doctors by issuing recommendations, physicians aren't obligated to follow its recommendations. Men desperately need a better test. More than 28,000 men die of prostate cancer a year.

Unfortunately, there are no other better tests with which to replace the PSA, such as rectal exams, ultrasounds or variations on the PSA.

But the task force went too far in rejecting the PSA completely. Death rates from prostate cancer nationwide have dropped 30% to 50% since PSA testing became widespread in the early 1990s. In its recommendations, published in Monday's Annals of Internal Medicine, the task force said it's unlikely that screening alone could have reduced death rates so quickly. Some experts note that treatments also have improved.

Some experts don't want to go back to the "bad old days" before screening, when doctors found prostate cancer only after it had become incurable. And because many men are used to getting PSAs, some might not realize their doctors have stopped performing the tests.
A patient might presume they've had their PSA tested, then come back five or 10 years later with back pain, only to learn they have prostate cancer that's spread to their spine.

A 66 year old man had developed a life-threatening bloodstream infection called sepsis after his PSA results led to a needle biopsy, and he was hospitalized for three days. Though such infections are rare, the patient says one such experience was enough; he hasn't had a PSA since.

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New Screening Guidelines for Lung Cancer

Story first appeared in The Detroit News.

New lung cancer screening guidelines from three medical groups recommend annual scans but only for an older group of current or former heavy smokers.

The advice applies only to those age 55 to 74. The risks of screening younger or older smokers or nonsmokers outweigh any benefits, according to the guidelines.

About 8 million Americans would be eligible for screening under the new criteria, and if all of them got the scans, about 4,000 lung cancer deaths per year could be prevented.

The recommended screening involves low-dose CT scans, which are a special kind of X-ray that can detect lung cancer early, but also can have false-positive results.

Regular chest X-rays can also detect lung cancer, but they provide less detailed images than CT scans, can also have false-positive results and have not been recommended as a screening tool because they have not been shown to save lives. The guidelines were published online Sunday in the Journal of the American Medical Association.

An estimated 226,000 Americans will be diagnosed with lung cancer this year. It is the leading cause of cancer deaths for U.S. men and women. An estimated 160,000 lung cancer deaths nationwide will occur this year.

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Medical Malpractice Results in Flesh-Eating Bacteria

Story first appeared on WDBO.com.
A man suing after a major medical mistake left him disfigured gave testimony Thursday that revealed the intimate details of his misery.

Late Thursday afternoon, the patient testified at the Miami-Dade County Courthouse from his new home in Lima, Peru via Skype. He said he wanted a penile implant to improve his sex life in 2007. He stated that he was having problems with intimate relations between he and his wife for quite some time prior to the surgery.

A Miami Medical Malpractice Lawyer argues that an anesthesiologist overlooked his client's pre-existing medical conditions, which resulted in him having no more external male genitalia. According to the lawyer, the patient should have never been allowed to undergo elective penile implant surgery to treat erectile dysfunction back in August 2007.

The anesthesiologist involved in the surgery should have never allowed the surgery, the attorney said, because the patient had an extreme case of diabetes and high blood pressure, and his blood sugar levels were way too high on the day of his surgery. He had not seen a doctor in 15 years until that point.

The patient's problems began after a Gangrene infection spread through his genitals about nine days after the surgery. The infection turned into a flesh-eating bacteria that consumed his genitals centimeter by centimeter.

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