Arizona's Mayo Clinic Ceases Treatment Of Medicare Patients

Smart About Health

The Mayo Clinic in Arizona, as of tomorrow, will no longer accept patients who are on Medicare.

Medicare patients are no longer going to be accepted due to the fact that the compensation paid out by Medicare is apparently not adequate to make up for the cost of care taken on by the clinic.

For people who are 65 and older, Medicare acts as the most common health insurance program.

What this means is that many patients on Medicare are either going to have to begin to pay in cash, or be turned away to go elsewhere outside of the Mayo Clinic.

The Mayo Clinic has roughly 3,000 patients on Medicare who see their doctors in Arizona.

As of tomorrow though, they will either have to pay in cash for their doctor visits, or go somewhere else.

This is only for the Mayo Clinic in Arizona, as this does not impact their other locations in Florida and Minnesota.

A lot of this has to do with the fact that doctors make far less treating Medicare patients than they do treating patients on private health insurance plans.

The Future Of Brain-Controlled Devices

CNN

In the shimmering fantasy realm of the hit movie "Avatar," a paraplegic Marine leaves his wheelchair behind and finds his feet in a new virtual world thanks to "the link," a sophisticated chamber that connects his brain to a surrogate alien, via computer.

This type of interface is a classic tool in gee-whiz science fiction. But the hard science behind it is even more wow-inducing.

Researchers are already using brain-computer interfaces to aid the disabled, treat diseases like Parkinson's and Alzheimer's, and provide therapy for depression and post-traumatic stress disorder. Work is under way on devices that may eventually let you communicate with friends telepathically, give you superhuman hearing and vision or even let you download data directly into your brain, a la "The Matrix."

Researchers are practically giddy over the prospects. "We don't know what the limits are yet," says Melody Moore Jackson, director of Georgia Tech University's BrainLab.

Adds Emory University neuroscience professor Michael Crutcher, "Anything can happen."

At the root of all this technology is the 3-pound generator we all carry in our head. It produces electricity at the microvolt level. But the signals are strong enough to move robots, wheelchairs and prosthetic limbs -- with the help of an external processor.

Harnessing that power "opens up a whole new paradigm for us as human beings," says neuroscientist Rajesh Rao of the University of Washington.

Brain-computer interfaces (BCI) come in two varieties. Noninvasive techniques use electrodes placed on the scalp to measure electrical activity. Invasive procedures implant electrodes directly into the brain. In both cases, the devices interact with a computer to produce a wide variety of applications, ranging from medical breakthroughs and military-tech advances to futuristic video games and toys.

Much of the research focuses on neuroprosthetics, which offer a way for the brain to compensate for injuries and illness. Jackson helped develop an intelligent wheelchair called the Aware Chair, which can be guided by neural activity.

She is also working on communication programs for people who have been paralyzed by strokes or spinal-cord injuries. Implanted electrodes allow "locked in" patients to spell out messages by manipulating a computer cursor with their thoughts alone.

Rao is tapping into that same concept to help paralyzed people manipulate robots to fetch items or move things around the house. With cameras to provide visual feedback, the patients and robots don't even need to be in the same room, or the same city. Rao says the technology "frees the mind from the constraints of the body."

Cochlear implants are the most common neuroprosthetic. They help the brain interpret sounds and are sometimes called "bionic ears" for the deaf. Other researchers are looking for similar ways to help blind people see. Neurobiologist Ed Boyden of MIT says miniature optical devices can be implanted to convert photoreceptors into workable cameras for the brain.

None of this comes cheap. Most research is funded by deep pockets such as the National Institutes of Health, the defense department and NASA.

But every breakthrough brings the most advanced BCI technologies closer to the mass market. Jackson says she foresees a day when people with disabilities can spend a few hundred dollars instead of $20,000 on a workable system.

Mainstreaming the technology raises some troubling issues for Crutcher, who teaches a course at Emory in neuro-ethics. He fears that expensive eye and ear implants could produce a computer-enhanced elite.

"If only the rich can afford it, it puts everyone else at a disadvantage," says Crutcher, who believes many aspects of BCI are ripe for abuse. Just the idea of mucking about with a person's brain "raises questions about safety and efficacy," he says.

One of the more controversial uses under development is telepathy. It would require at least two people to be implanted with electrodes that send and receive signals back and forth.

DARPA, the Pentagon's technology research division, is currently working on an initiative called "Silent Talk," which would let soldiers on secret missions communicate with their thoughts alone. This stealth component is attractive, but naysayers fear that such soldiers could become manipulated for evil means.

Telepathy implants won't replace Facebook and Twitter anytime soon, but that possibility is problematic as well.

"You can imagine communicating with your friends through the devices, and that opens up a lot of ethical issues," Rao says. Would you want your friends and family to know everything you are thinking? Would little white lies become obsolete?

These questions of morality and liability are not a huge factor for the toy makers and video game developers who are already bringing the most basic BCI technology to consumers.

Games like Mindflex and the Star Wars Force Trainer use headsets with simple electrodes to monitor levels of concentration and relaxation. The signals trigger a fan that can move a ball up or down, depending on how hard you're thinking. Jackson calls it a "fascinating application of a very sophisticated technology in a very cheap package."

The headsets used in both games were designed by the California company Neurosky. Its corporate partners are working on games that help Alzheimer's patients improve memory techniques, teach concentration skills to kids with ADHD and let stressed- out CEOs work on relaxing.

Software entrepreneurs and executives are streaming into Boyden's neuro-ventures class at MIT, looking for ways to capitalize on the array of potential uses for brain-computer interfaces.

Some ventures are already up and running. NeuroVigil in California is working on iBrain, designed, in part, to help provide instant feedback to drivers who start falling asleep at the wheel. Eos Neuroscience is developing light-sensitive protein-based sensors that can treat blindness.

Numerous companies are developing video games based on direct brain-computer interfacing. Neurosky sells a wireless headset that connects to any computer for a series of brain-training games. NeuroBoy lets you set targets on fire just by concentrating on them. Relax, and your character levitates. Another application lets you see a colorful visualization of your brain-wave activity.

Boyden expects to see many more such products hitting shelves sooner rather than later. He says the possibilities are endless if just a "fraction of the business leaders" taking his class start "bringing the technology into the world."

Jackson, of Georgia Tech, agrees: "Nothing is out of the realm of possibility."

Senior Citizen Volunteers Fight Medicare Fraud

ABC News

The first box that arrived at Shirley Shupp's door was filled with braces to help with her arthritis. Then came a motorized scooter, just like the one the 69-year-old already owned. She hadn't asked for any of it — but Medicare was apparently footing the bill.

"There was just something that wasn't right about it," the Houston woman said.

So Shupp contacted her local Senior Medicare Patrol, which did its own research and then referred the matter to investigators. The equipment, worth thousands of dollars, was returned, the case was handed over to prosecutors and the perpetrators were charged with Medicare fraud.

The Senior Medicare Patrol is one of the least-known forces in the government's effort to eliminate such fraud, which drains billions of dollars a year. But it is seen as a valuable part of the Obama administration's bid to overhaul health care and bring down costs.

The 4,700 senior citizen volunteers who serve as the government's eyes and ears have been credited with saving taxpayers more than $100 million since 1997. The program relies on elderly people to apply a lifetime's worth of common sense and skepticism.

"They can tell when something just doesn't feel right to them," said Anne Gray, who works on the SMP program in Santa Ana, Calif.

The patrol, which evolved from another program founded in 1995, now has at least one unit in every state.

SMP sends its volunteers to senior centers, retirement communities and elsewhere to encourage Medicare beneficiaries to guard their personal information, beware of too-good-to-be-true offers on medical equipment and carefully review their benefit statements. The patrol also collects tips on potential scams and fields calls from senior citizens who believe their Medicare accounts have been fraudulently billed.

When all they have is a whiff of something fishy, SMP participants often keep probing until they have enough information to send on to the FBI and investigators with the Centers for Medicare and Medicaid Services.

"It really is detective work," said Barbara McGinity, director of the SMP in Houston.

Patrol volunteers have witnessed all kinds of schemes. There are fly-by-night clinics where patients endure multiple tests at the hands of staff members with dubious credentials. Patients may be followed home from the hospital by companies selling home health services, scooters, glucose monitors or treatments for rheumatoid arthritis.

Often, senior citizens are persuaded to give up their personal information with an offer of something they need, such as transportation to kidney dialysis appointments.

"They get their number and they pass it around," Gray said. "They have a ring where they're selling it."

Beneficiaries may have no idea their identities have been wrongly used unless their accounts are frozen for unusual activity or they try to obtain something the government already bought for them, such as a pricey hospital bed or wheelchair.

The Obama administration says eliminating Medicare fraud is key to overhauling the health care system. But agents and prosecutors tackling the issue are relatively sparse. The patrol helps fill in the gaps.

"There is no substitute for beneficiaries and on-the-ground resources to help us know where fraud is occurring and where problems are arising," said Kimberly Brandt, who oversees Michigan Medicare plans anti-fraud efforts at CMS.

All told, scam artists are believed to have stolen about $47 billion from Medicare in the 2009 fiscal year, nearly triple the toll a year earlier. Medicare spokesman Peter Ashkanaz said that since the Justice Department and Health and Human Services formed a task force after President Barack Obama took office, charges have been filed against 103 defendants in cases involving more than $100 million in Medicare fraud.

For every Medicare thief the senior citizen volunteers successfully pursue, McGinity said, it seems there are dozens more.

"Sometimes we feel like we're really beating our heads against the wall," she said.

Spectranetics Pays $5 Million To End Federal Investigation

USA Today

Spectranetics (SPNC) said Wednesday it will pay $5 million to end a government investigation into allegations it imported and marketed medical lasers that had not been cleared by regulators.

The U.S. Department of Justice said Spectranetics illegally imported the devices and marketed them for purposes that had not been approved by the Food and Drug Administration, which led to false claims being filed with Medicare between 2003 and 2008. It also said a Spectranetics clinical trial called CORAL did not meet federal standards.

The Colorado-based company agreed to pay $4.9 million to resolve the investigation, which began in 2008, and will forfeit another $100,000 in cash or property in the near future. The Justice Department said Spectranetics is cooperating with the investigation, but the agreement means the company will avoid prosecution. Spectranetics accepted responsibility for its conduct and instituted safeguards in response, the Justice Department said.

Spectranetics did not immediately return requests for comment.

The CORAL study evaluated lasers as a treatment for arterial plaque. The government said a second study also did not meet regulatory requirements. Products involved included the CVX-300 medical laser and the CliRpath turbo laser catheter, the TURBO elite laser ablation catheter, and the TURBO-Booster laser guide catheter.

In September 2008, the Food and Drug Administration and U.S. Immigration and Customs Enforcement served Spectranetics with a search warrant to get information related to the marketing, use and testing of a product, and payments to medical personnel. They also sought details of catheter guidewires and balloon catheters made by other companies, two post-market studies, and compensation packages for personnel.

Spectranetics shares jumped to an annual high on the news, rising 81 cents, or 13%, to $6.85. The stock peaked earlier at $7.77, its highest price since Sept. 4, 2008, the day the investigation was disclosed.

Tylenol Issues Voluntary Recall Of Arthritis Caplet

Business Week

Johnson & Johnson is expanding a voluntary recall of Tylenol Arthritis Caplets due to consumer reports of a moldy smell that can cause nausea and sickness.

According to a statement posted to the Food and Drug Administration Web site on Tuesday, the New Brunswick, N.J., company is now recalling all product lots of the Arthritis Pain Caplet 100 count bottles with the red EZ-Open Cap.

Johnson & Johnson had recalled five lots of the product last month after consumers complained of a musty, mildew-like odor that triggered nausea, stomach pain, vomiting and diarrhea.

The health care company said the odor results from trace amounts of a chemical called 2,4,6-tribromoanisole. That chemical is believed to result from the breakdown of another chemical used to treat wooden pallets that transport and store packaging materials.

To date, the side effects, which also include vomiting and diarrhea, have been "temporary and non-serious," although the health effects of the compound have not been studied.

The recall only affects the specific lots cited. All other Tylenol Arthritis pain products remain available.

The company will reintroduce Tylenol Arthritis Pain Caplets 100 count by January after moving production to a new facility.

Consumers seeking a refund or replacement of the arthritis medication can call J&J at 1-888-222-6036.

Company shares rose 45 cents to $65.39 in morning trading Tuesday.

Vivus Requests FDA Approval For Obesity Drug

LA Times

Drugmaker Vivus Inc. said Tuesday it asked regulators to approve its drug candidate Qnexa as a treatment for obesity.

Vivus said it has filed a new drug application with the Food and Drug Administration. A week ago, competitor Arena Pharmaceuticals Inc. said it filed for approval of its own experimental obesity drug, lorcaserin. Orexigen Therapeutics plans to request marketing approval for its product Contrave32 in the first half of 2010.

Vivus reported positive results from two late-stage clinical trials of Qnexa in September. Qnexa, lorcaserin and Contrave32 could all reach the market around the same time, and some analysts say they believe Qnexa could be the top seller of the group based on the weight loss observed in clinical testing.

In morning trading, Vivus shares rose 17 cents to $9.84.

Dogs Excel At Sniffing Out Cancer

NY Times

In the small world of people who train dogs to sniff cancer, a little-known Northern California clinic has made a big claim: that it has trained five dogs - three Labradors and two Portuguese water dogs - to detect lung cancer in the breath of cancer sufferers with 99 percent accuracy.

The study was based on well-established concepts. It has been known since the 80's that tumors exude tiny amounts of alkanes and benzene derivatives not found in healthy tissue.

Other researchers have shown that dogs, whose noses can pick up odors in the low parts-per-billion range, can be trained to detect skin cancers or react differently to dried urine from healthy people and those with bladder cancer, but never with such remarkable consistency.

The near-perfection in the clinic's study, as Dr. Donald Berry, the chairman of biostatistics at M. D. Anderson Cancer Center in Houston, put it, "is off the charts: there are no laboratory tests as good as this, not Pap tests, not diabetes tests, nothing."

As a result, he and other cancer experts say they are skeptical, but intrigued. Michael McCulloch, research director for the Pine Street Foundation in Marin County, Calif., and the lead researcher on the study, acknowledged that the results seemed too good to be true. (For breast cancer, with a smaller number of samples, the dogs were right about 88 percent of the time with almost no false positives, which compares favorably to mammograms.)

"Yes, we were astounded, as well," Mr. McCulloch said. "And that's why it needs to be replicated with other dogs, plus chemical analysis of what's in the breath."

He is applying for National Science Foundation grants to try just that, he said. The fact that the study was carried out by a clinic supported by the Pine Street Foundation that combines traditional chemotherapy with acupuncture and herbal medicine raised suspicions, as did the fact that it is to be published by a little-known journal, Integrative Cancer Therapies. (The journal published it online last year.)

But experts who read the study could not find any obvious fatal flaw in its methodology, and the idea that dogs can detect cancer is "not crazy at all," said Dr. Ted Gansler, director of medical content in health information for the American Cancer Society. "It's biologically plausible," he said, "but there has to be a lot more study and confirmation of effectiveness."

Dr. Berry, too, was interested but suspicious. "If true, it's huge," he said. "Which is one reason to be skeptical."

Dr. Berry noted, half-jokingly, that Gregor Mendel, the 19th-century discoverer of the laws of genetics, also reported data on his crossbreeding of green and yellow peas that was too good to be true: he repeatedly came up with the perfect 3-1 ratios he predicted. "But we've forgiven Mendel and his gardener," Dr. Berry added, "because his theory turned out to be right."

In Mr. McCulloch's study, the five dogs, borrowed from owners and Guide Dogs for the Blind, were trained as if detecting bombs. They repeatedly heard a clicker and got a treat when they found a desired odor in many identical smelling spots.

The clinic collected breath samples in plastic tubes filled with polypropylene wool from 55 people just after biopsies found lung cancer and from 31 patients with breast cancer, as well as from 83 healthy volunteers.

The tubes were numbered, and then placed in plastic boxes and presented to the dogs, five at a time. If the dog smelled cancer, it was supposed to sit.

For breath from lung cancer patients, Mr. McCulloch reported, the dogs correctly sat 564 times and incorrectly 10 times. (By adjusting for other factors, the researchers determined the accuracy rate at 99 percent.)

For the breath from healthy patients, they sat 4 times and did not sit 708 times.

Experts who read the study raised various objections: The smells of chemotherapy or smoking would be clues, they said. Or the healthy breath samples could have been collected in a different room on different days. Or the dogs could pick up subtle cues - like the tiny, unintentional movements of observers picked up by Clever Hans, the 19th-century "counting horse," as he neared a correct answer. But Mr. McCulloch said cancer patients who had begun chemotherapy were excluded, smokers were included in both groups and the breath samples were collected in the same rooms on the same days. The tubes were numbered elsewhere, he said, and the only assistant who knew which samples were cancerous was out of the room while the dogs were working.

"The fact that dogs did this is kind of beside the point," he said. "What this proved is that there are detectable differences in the breath of cancer patients. Now technology has to rise to that challenge."

The next step, he said, will be to analyze breath samples with a gas chromatograph to figure out exactly which mixes of chemicals the dogs are reacting to.

Even if the dogs are accurate in repeat experiments, Dr. Gansler of the American Cancer Society said, it will be useful only as a preliminary scan. "It's not like someone would start chemotherapy based on a dog test," he said. "They'd still get a biopsy."

Not All Generics May Be Equal To Brand Name Drugs

Vitals.com

The Generic Pharmaceutical Association’s slogan is “Same Medicine, Same Results.” Unfortunately this is not always the case, according to an article in the New York Times.

Patients, doctors and everyone else are all in agreement over the value of generic drugs. Not only do they save Americans 10 billion dollars a years, make medication accessible to those who need it, but also force down the price of brand name drugs.

“For many drugs, generics are just fine,” says Dr. Kimford Meador, a professor of neurology at Emory University.  “But when you are taking a seizure medication…If the absorption of the drug is slightly different between brand and generic then the patient could have a seizure and that seizure could lead to serious injury or perhaps death.”

although both products released the same amount of the active ingredient over 16 hours, the generic version released almost half of its medication after four hours and the brand name only one-quarter

According to Vitals.com, Dr. Meador completed his medical degree and residency at the Medical College of Georgia School of Medicine.

The FDA ensures the public that to be marketed in the United States these drugs must “bioequivilant” to their brand name equivalents, meaning the same doses of the same active ingredient is delivered in the same way according to the same standards of quality.

But some specialists worry that the allowable range is too wide, especially for patients taking medication to control problems like arrhythmias or seizures. Studies that were published in the journal Neurology, reported patients who switched to generics products had more seizures and higher hospitalization rates

Kathleen Jaeger, president of the Generic Pharmaceutical Association, sees this controversy as a propagandist plot masterminded by brand name drug companies. But doctors and psycho pharmacologists believe the FDA is ignoring the reality that in certain cases generic drugs can create serious problems for patients.

“If a patient with heart arrhythmia gets a blood thinner for which the levels are too low there is a risk for stroke and if the levels are too high it could result in bleeding,” says Dr. James A. Reiffel, a cardiologist and professor of clinical medicine at Columbia.

According to Vitals.com, Dr. Reiffel completed his medical degree and residency at Columbia University.

Wellbutrin XL, the fourth-most prescribed antidepressant in the United States with 20.184 million prescription sold in 2007, is an example of an effective brand name drug whose generic equivalent disappointed many.

Joe and Teresa Graedon publish a popular syndicated column, The People’s Pharmacy, and are founders of a respected multimedia clearinghouse. In the summer of 2007 they had received so many complaints about the generic version of Wellbutrin XL, they decided to do an independent study collaborating with ConsumerLab.com. The results were astounding.

Among their many findings they discovered that although both products released the same amount of the active ingredient over 16 hours, the generic version released almost half of its medication after four hours and the brand name only one-quarter. This accounted for the side effects so many patients were experiencing, including irritability, headaches, insomnia and a depressed mood toward the end of the cycle.

Nowadays generics constitute almost 70 percent of all prescriptions dispensed nationwide and work well for many people. But with health insurers pressuring patients to use these drugs, patients and doctors need to be vigilant. When switching from a brand name to a generic, keep tabs on how they are affecting you. Report all your concerns to your doctor or to the FDA’s adverse events monitoring system, called MedWatch (www.fda.gov/medwatch).

2 Doctors Unlocking Mysteries Of Dystonia

Washington Post

In 1970, a Japanese pediatric neurologist named Masaya Segawa examined two girls. The girls were cousins and they seemed to be suffering from the same puzzling ailment: a contraction of the muscles that caused their limbs to twist uncontrollably, a condition known as dystonia. Six years later, Segawa encountered a 51-year-old woman who had been experiencing the same symptoms since the age of 8.

Segawa discovered that in all three cases the symptoms could be controlled by small doses of L-dopa, which the body converts into the neurotransmitter dopamine. The disorder goes by the name dopa-responsive dystonia but it's also known as Segawa's disease, after that observant Japanese doctor, one of the grand old men of pediatric neurology. It affects girls three to four times more frequently than boys. In 1993, researchers were able to find the gene that causes the abnormality, mapping it to chromosome 14q.

In 2003, Morgan Campagna was an 8-year-old girl living in Guantanamo Bay, Cuba, with her mother, Christie, and sister, Ashlyn. From the age of 4, Morgan had been experiencing strange symptoms, including a limp that worsened as the day progressed. Odder still, Morgan would draw her arms up to her chest, her hands twisting in on themselves.

"Doctors would tell me she was going to grow out of it, but nobody would tell me what 'it' was," her mother said.

A Navy doctor visiting the base decided this was not something Morgan was going to grow out of. The doctor arranged for Morgan to be seen by Mark Batshaw at Children's National Medical Center in Washington and his colleague Bennett Lavenstein.

"Dr. Batshaw invited me to see her and asked what I thought of her gait," said Lavenstein, a pediatric neurologist. "We put our heads together and, quite frankly, I thought L-dopa."

Dopamine has a lot of roles in the nervous system. With Segawa's disease, Lavenstein said, "we're focusing on predominantly dopamine in the basal ganglia of the brain, which is inherently responsible for controlling smooth, graded motions, as opposed to concentrations elsewhere, which may relate to attention deficit disorder, schizophrenia or the pleasure centers."

Because of an enzymatic deficiency, Segawa's patients are unable to synthesize dopamine properly, unable to control some of their muscles. The disease is similar to Parkinson's disease, without that ailment's inevitable downward spiral.

Morgan underwent a battery of tests -- liver function, amino acids, copper metabolism -- but her doctors at Children's were pretty sure they knew the answer. The correct diagnosis would be confirmed by the treatment. They started Morgan on a twice-a-day regimen of Sinemet, a pill used to treat Parkinson's. Within a week, her symptoms were almost gone.

Morgan is 16 now. Her family lives in Manassas. She likes science, likes to read, likes to draw her own comic books. She goes on walks without tiring easily, as she once did. She marvels at the fact she was once unable to control her body, remembering how strange it was to look down and find her hands up near her chin when she'd never intended to move them there.

"When I was little, I just thought I was normal," Morgan told me recently. "I didn't really know what normal was."

When Joints Take A Turn For The Worse

The Times Of India

Joint pain is often associated with old age. However, now, the young are also suffering from this as inactive lifestyles take hold. If the pains are resulting from arthritis, winter can prove to be a testing time for the sufferer, because low temperature causes the condition to worsen, said doctors.

They added that earlier, the season caused an increase in the number of old people complaining of joint pains, but now, the young were also being affected by the condition as they did not exercise much and tended to avoid other physical activity.

They stated that the young adult category had seen an increase in patient numbers by 20%.

“Generally, more women are prone to joint pains especially emerging from osteo-arthritis. The second major cause for this in women’s case tends to be rheumatoid arthritis. As the age of people contacting this condition is falling, it is leading to a lot of concern. Cold weather also causes more people to be affected. It also slows down the healing process for surgical stitches,” said Dr Harpreet Singh Gill, senior consultant and head of orthopaedics department, Apollo hospital.

He added that earlier, the average age of patients receiving rheumatoid arthritis treatments tended to be 50 and now many of them were in their 30s, with women being the worst-affected group. He stated that the way prevent the condition was having a good diet and exercising properly. Dr Gill added that on an average, 20 young women came to the OPD daily with these problems, while the number used to be just two or three a few years back. “Squatting too much, having an inactive lifestyle or being deficient in vitamin D are the main causes and the major modes of treatment are physiotherapy, lifestyle modification and medication,” he added.

Associate professor at Dayanand Medical College and Hospital, Dr Sanjeev Mahajan, said that the young could easily avoid the condition with more physical activity, which they were quite capable of. “Early diagnosis and change in lifestyle are effective in arthritis pain management,” he added. He mentioned that arthritis-related swelling tended to get worse as weather got cold. Dr Jagdip Madan, orthopaedician at Guru Teg Bahadur Hospital, said that young women were getting arthritis and the reason for that could be genetic or having a generally negligent attitude towards joints. Dr Madan said that in his hospital, about 15 to 20 young women came for treatment daily, which was quite a lot as arthritis was a problem encountered mostly in sexagenarians.