Glucosamine, Chondroitin Don't Help Arthritis Pain

USA Today

 

A Wall Street Journal investigation into online privacy has found that popular children's websites install more tracking technologies on personal computers than do the top websites aimed at adults.

The Journal examined 50 sites popular with U.S. teens and children to see what tracking tools they installed on a test computer. As a group, the sites placed 4,123 "cookies," "beacons" and other pieces of tracking technology. That is 30% more than were found in an analysis of the 50 most popular U.S. sites overall, which are generally aimed at adults.

The most prolific site: Snazzyspace.com, which helps teens customize their social-networking pages, installed 248 tracking tools. Its operator described the site as a "hobby" and said the tracking tools come from advertisers.

Starfall.com, an education site for young children, installed the fewest, five.

The research is part of a Journal investigation into the expanding business of tracking people's activities online and selling details about their behavior and personal interests.

The tiny tracking tools are used by data-collection companies to follow people as they surf the Internet and to build profiles detailing their online activities, which advertisers and others buy. The profiles don't include names, but can include age, tastes, hobbies, shopping habits, race, likelihood to post comments and general location, such as city.

Selling the data is legal, but controversial, especially when it involves young people. Two companies identified by the Journal as selling teen data initially denied doing so. Only when shown evidence that they were offering data for sale—in one case, it was labeled "teeny boppers"—did they confirm it.

The Journal found that many popular children's sites are run by small companies or mom-and-pops, and privacy practices vary widely. Among the sites studied, the Journal identified one, y8.com—featuring kids' games with names like "Crush the Castle 2" and "Dreamy Nails Makeover"—that has had ties to a pornography site, xnxx.com, according to Internet registration records. Y8 installed 69 tracking files on the Journal's test computer. It also asks users to provide an email address to register.

"Children are safe on y8," a site employee named Olivier G. said in response to emailed questions. "We are *strongly against* the exposure of children to any adult content." Asked twice about y8.com's apparent ties to a pornography site, he didn't respond.

The Journal's study focused on sites popular with young people according to comScore Media Metrix.

Companies placing the tracking tools say the information they collect is anonymous and mainly used to deliver targeted ads or to gauge ads' effectiveness. They also say they don't collect "personally identifiable information" like names or email addresses and generally don't specifically target children.

Collecting data on minors is regulated, albeit lightly. The only federal restrictions require parental consent to collect names and other personal information of children under 13 in most circumstances. Currently, the Federal Trade Commission is considering whether changes to the law are warranted. No changes are expected before next year.

Many kids' sites are heavily dependent on advertising, which likely explains the presence of so many tracking tools. Research has shown children influence hundreds of billions of dollars in annual family purchases.

Google Inc. placed the most tracking files overall on the 50 sites examined. A Google spokesman said "a small proportion" of the files may be used to determine computer users' interests. He also said Google doesn't include "topics solely of interest to children" in its profiles.

Still, Google's "Ads Preferences" page (google.com/ads/preferences) displays what Google has determined about web users' interests. There, Google accurately identified a dozen pastimes of 10-year-old Jenna Maas—including pets, photography, "virtual worlds" and "online goodies" such as little animated graphics to decorate a website.

"It is a real eye opener," said Jenna's mother, Kate Maas, a schoolteacher in Charleston, S.C., viewing that data.

Jenna, now in fifth grade, said: "I don't like everyone knowing what I'm doing and stuff."

A Google spokesman said its preference lists are "based on anonymous browser activity. We don't know if it's one user or four using a particular browser, or who those users are." He said users can adjust the privacy settings on their browser or use the Ads Preferences page to limit data collection.

As part of the project, the Journal calculated an "exposure index" for each site, taking into account the number of trackers on the site and data-handling practices of those trackers. Snazzyspace.com ranked highest in exposing users to potentially aggressive tracking. A site owned by Viacom Inc., neopets.com, where kids can create make-believe "pets," had the highest exposure index of sites popular with children under 12.

Viacom's Nickelodeon TV network accounted for eight of the 50 sites in the survey. On average, the eight installed 81 tracking tools, close to the 82 average for all 50 sites. One, a games site called Shockwave.com, installed 146; another game-and-video site, nick.com, installed 92.

The vast majority of tracking files on Nickelodeon sites were installed by other firms, such as ad networks. A Nickelodeon official said those services "are collecting data on what users like to see and do based on their web behaviors and activities."

Many tools raise no privacy concerns. They might merely remember, say, where users pause in a game, so they aren't forced to start every time they visit.

But other tools are used to develop profiles of web-surfing behavior. Those can be used to deliver targeted ads that home in on children's concerns—say, dieting ads aimed at youngsters worried about their weight.

The number of tracking files installed by any specific site can vary from visit to visit. In the Journal's examination, the math-games site coolmath4kids.com installed 60 on a test computer.

However, when Angela La Fon, a teacher in Big Island, Va., checked her own computer with a tracker-detection tool called Abine, she found the site had installed 89 "cookies" on her machine. (Cookies are little text files that can give a computer a unique identity, which data-collection companies can use to track people's activities).

"That's creepy," says Ms. La Fon, who encouraged her six-year-old son, Lee, to use the site. "I wouldn't have thought I would have had 89 cookies, period. Much less than from one site."

Karen Davis, chief executive of coolmath4kids.com, declined to be interviewed, citing concern for her own privacy. In an email she wrote, "We are assured by our service providers that all data gathered is anonymous and compliant with all laws and privacy policies."

Several sites, including coolmath4kids.com, modified their privacy policies after being contacted by the Journal with its findings. For example, the math-games site no longer states that using cookies to collect anonymous data is "no big deal." Ms. Davis said she made the changes "to provide as much transparency as possible for our users."

A spokeswoman for weeworld.com, where kids can create a WeeMee avatar and chat with friends, said that as a result of a Journal analysis, it changed its privacy policy to provide a clearer explanation of how to disable cookies. Weeworld.com installed 144 tracking tools in the Journal's test.

Of the 50 sites examined by the Journal, only one had no posted privacy policy, the gaming site y8.com. Records at archive.org, a library of previous versions of websites, indicate that y8.com launched in the late 1990s as a sex site for adults at least 21 years old.

Y8.com became a game site aimed at a younger audience in 2006. ComScore reports that 12.2% of its users are 2 to 11 years old, and 22.8% are 12 to 17.

Internet registration records from December 2006 show that y8.com and a hard-core sex site, xnxx.com, shared the same mailing address in France, plus the same email address. Later, the sites changed their contact information and no longer share the same addresses. On the website games.xnxx.com, which bills itself as offering "fun sex games," there is a prominent link at the top and bottom of the page to "non-adult" games on y8.com.

The y8.com employee, Olivier G., didn't respond to questions about who owns the site or its apparent relationship with xnxx.com. He wrote in an email that y8.com is "strongly against the collection and use of personal information." He also said "we don't do anything" with email addresses provided by users.

Parents hoping to let their kids use the Internet, while protecting them from snooping, are in a bind. That's because many sites put the onus on visitors to figure out how data companies use the information they collect.

Gaiaonline.com—where teens hang out together in a virtual world—says in its privacy policy that it "cannot control the activities" of other companies that install tracking files on its users' computers. It suggests that users consult the privacy policies of 11 different companies.

In a statement, gaiaonline.com said, "It is standard industry practice that advertisers and ad networks are bound by their own privacy policy, which is why we recommend that our users review those." The Journal's examination found that gaiaonline.com installed 131 tracking files from third parties, such as ad networks.

An executive at a company that installed several of those 131 files, eXelate Media Ltd., said in an email that his firm wasn't collecting or selling teen-related data. "We currently are not specifically capturing or promoting any 'teen' oriented segments for marketing purposes," wrote Mark S. Zagorski, eXelate's chief revenue officer.

But the Journal found that eXelate was offering data for sale on 5.9 million people it described as "Age: 13-17." In a later interview, Mr. Zagorski confirmed eXelate was selling teen data. He said it was a small part of its business and didn't include personal details such as names.

BlueKai Inc., which auctions data on Internet users, also said it wasn't offering for sale data on minors. "We are not selling data on kids," chief executive Omar Tawakol wrote in an email. "Let there be no doubt on what we do."

However, another data-collecting company, Lotame Solutions Inc., told the Journal that it was selling what it labeled "teeny bopper" data on kids age 13 to 19 via BlueKai's auctions. "If you log into BlueKai, you'll see 'teeny boppers' available for sale," said Eric L. Porres, Lotame's chief marketing officer.

Mr. Tawakol of BlueKai later confirmed the "teeny bopper" data had been for sale on BlueKai's exchange but no one had ever bought it. He said as a result of the Journal's inquiries, BlueKai had removed it.

The FTC is reviewing the only federal law that limits data collection about kids, the Children's Online Privacy Protection Act, or Coppa. That law requires sites aimed at children under 13 to obtain parental permission before collecting, using or disclosing a child's "personal information" such as name, home or email address, and phone and Social Security number. The law also applies to general-audience sites that knowingly collect personal information from kids.

The FTC is considering, among other things, whether to broaden "personal information" to include data "collected in connection with online behavioral advertising."

To try to avoid having to comply with Coppa, some sites state they prohibit kids under 13 from visiting. But that's easy for children to circumvent. Jenna Maas, the Charleston 10-year-old, opened an account on weeworld.com (which prohibits kids under 13 from registering) simply by fibbing about her age.

In Jenna's case, she got her mother's permission first. Ms. Maas says she lets Jenna visit sites for older kids "as long as I can monitor it."

Claire Quinn, weeworld.com's chief of safety, says the site has "tools in place" to prevent underage kids from joining, but "there is obviously no great age verification system out there."

FTC officials said website operators can't be held responsible if children lie about their age unless they glean from other information that a child is under 13.Two popular supplements used to treat joint pain don't work and health authorities should stop paying for them, a new study says.

European researchers analyzed the results of 10 past trials in 3,803 patients who took glucosamine, chondroitin or a placebo to treat arthritis in their hips or knees. They found neither supplement, taken either separately or together, did any better than a placebo.

The study was led by Peter Juni, head of the Institute of Social and Preventive Medicine at the University of Bern in Switzerland. It was paid for by the Swiss National Science Foundation and was published Friday in the journal BMJ.

For the past decade, glucosamine and chondroitin have been recommended by doctors to treat arthritis in the hip or knee. The supplements are components of human connective tissues found in cartilage and bone. Globally, sales of glucosamine supplements hit nearly $2 billion in 2008.

Chronic arthritis in the hip or knee can be treated with drugs that reduce inflammation, but those can cause serious stomach and heart side effects if they are used in the long term.

In the BMJ analysis, the researchers didn't find any proof glucosamine or chondroitin were dangerous. "We see no harm in having patients continue (taking these supplements) as long as they perceive a benefit and cover the cost of treatment themselves," wrote Juni and colleagues.

Still, the researchers said because the supplements didn't reduce joint pain, insurers and governments should stop buying them. "New prescriptions to patients who have not received treatment should be discouraged," they wrote.

In Britain, the government does not pay for the supplements, citing a lack of evidence.

Jane Tadman, a spokeswoman for the charity Arthritis Research U.K., said results from previous trials testing the supplements had been mixed. She was not connected to the research and said it was up to patients to decide whether to keep taking the supplements.

"Some people may want to consider an over-the-counter trial as part of a wider self-management plan which includes exercise and keeping to an ideal weight," she suggested.

Some experts believe the federal law also should apply to collecting data on teens, though not necessarily by requiring parental consent.

"We need clearer explanations of what's happening to their data online, that they can understand—not the kind of legalese in a privacy policy that basically obscures what's really going on," says Kathryn C. Montgomery, a professor of communication at American University.

Gunman kills himself, mother at Johns Hopkins

Associated Press

 

Paul Warren Pardus listened as a Johns Hopkins Hospital surgeon updated him on the condition of his elderly mother who likely would never walk again. Overwhelmed, he pulled a gun from his waistband, wounded the doctor, then barricaded himself in his 84-year-old mother's hospital room before killing her and himself, authorities said.

"I guess he just couldn't bear to see her the way she was," said Pardus' brother 59-year-old Alvin Gibson.

The doctor, identified by colleagues as orthopedic surgeon David B. Cohen, was shot in the abdomen and collapsed Thursday afternoon outside the eighth-floor room where Pardus' mother was being treated. He was expected to survive.

Jean Davis was being crippled by arthritis and rheumatism and had surgery last week at the world-renowned cancer hospital, but it didn't go well, said Gibson of Remington, Va. It was unclear what sort of operation was performed.

"I guess because he thought my mom was suffering because the surgery wasn't successful and she probably wouldn't be able to walk again," Gibson said about a possible reason for his 50-year-old brother's actions. "She was a dear, sweet lady. She just wanted to walk around like she did when she was younger."

Pardus holed up in the room in a more than two-hour standoff that led authorities to lock down a small section of the Nelson Building while allowing the rest of the sprawling red-brick medical complex - a cluster of hospital, research and education buildings - to remain open.

When officers made their way into the room, they found Pardus and his mother shot to death, he on the floor, she in her bed.

Police Commissioner Frederick H. Bealefeld III said Pardus had been listening to the surgeon around midday when he "became emotionally distraught and reacted ... and was overwhelmed by the news of his mother's condition."

Gibson said he learned of their deaths while watching coverage of the shooting at a friend's house and "was really torn up inside."

Pardus was from Arlington, Va., and had a handgun permit in that state, police said. He was initially identified as Warren Davis, but police later changed that. Gibson said his brother had legally changed his name from Davis to Pardus, but he did not know why.

Pardus had worked as a driver for MetroAccess, which provides rides for disabled passengers in the Washington, D.C., region, but the subcontractor that employed him, Diamond Transportation, said he had been on leave since June.

Next-door neighbor Teresa Green said Davis had been hospitalized for months and that Pardus had been a fixture at her bedside. He appeared to be his mother's sole caretaker, she said.

"He loved his mother. That really showed," Green said.

The wounded doctor, an assistant professor at the medical school, underwent surgery.

"The doctor will be OK," police spokesman Anthony Guglielmi said. "He's in the best place in the world - at Johns Hopkins Hospital."

Hopkins, a world-class institution, is widely known for its cancer research and treatment. It is part of Johns Hopkins University, which has one of the foremost medical schools in the world.

Cohen's neighbor in Cockeysville, Md., couldn't believe it when she heard about what happened.

"It was very scary," Jennifer Wickwire said. "It's very upsetting to think it's somebody from this area."

The hospital uses handheld metal detectors to screen patients and visitors known to be high-risk, said Harry Koffenberger, vice president of security. However, with 80 entrances and 80,000 visitors a week, it is not realistic to place metal detectors and guards everywhere.

"Not in a health-care setting," Koffenberger said. The hospital will review procedures and look again at the use of metal detectors, he said.

Gibson said his brother had never been in trouble and didn't mess around with guns, though when they were young, he liked to hunt and fish.

Thomas Robinson, 67, had known Jean Davis since he was a child.

"She used to be quite a horsewoman when she was young," he said. But she was not able to get around too well on her own in recent years. "She was in good spirits, but she was getting weaker all the time."

Robinson, who is Gibson's neighbor, was perplexed by Pardus' actions.

"Why would he blame the doctor?" he asked. "That's what I don't understand."

New Drug-Resistant 'Superbug' Reaches U.S. Shores

Bloomberg / BusinessWeek

But the nation already has its own version of this antibiotic-resistant bacteria, CDC says

 

 

 

 

A new antibiotic-resistant germ that apparently has it origins in India has sickened a handful of people in North America, with three of the cases reported in the United States, health officials said Tuesday.

But the bacterium -- designated New Delhi metallo-beta-lactamase NDM-1 -- is a close genetic cousin of another bacterium that's been present in the United States for many years. Both germs produce an enzyme that makes them resistant to a group of antibiotics called carbapenems, which include drugs such as penicillin and ampicillin.

"NDM-1 is a newly recognized mechanism of resistance that allows certain bacteria to become resistant to certain antibiotics," said Dr. Alexander J. Kallen, a medical epidemiologist and outbreak response coordinator with the U.S. Centers for Disease Control and Prevention's Division of Healthcare Quality Promotion.

"Unfortunately, carbapenem resistance is not uncommon even in the United States," Kallen added. "We have our own homegrown version of NDM-1 that has been recognized for quite a few years."

In the United States, carbapenem-resistant bacteria -- designated carbapenem-resistant carbapenemase (KPC) -- are usually transmitted in health-care facilities such as hospitals and nursing homes, and are typically spread from patient to patient from contaminated surfaces and hands, he said.

While none of the patients in the United States died from their infections with the NDM-1 germ from India, people should be very concerned about this new breed of germs that are showing resistance to carbapenem antibiotics, Kallen said.

"What is new in NDM-1 is a new mechanism that produces a strain [of bacterium] that looks the same as KPC," Kallen said.

NDM-1 appears to have started in India and is now found in countries such as Canada, Pakistan and some nations in Europe. Some people have died from their infections, but Kallen couldn't say how many.

In the United States, three cases have been reported. They were in Massachusetts, Illinois and California, Kallen said. None of the U.S. patients died from their infections, he said.

While NDM-1 is new, carbapenem resistance has been increasing, Kallen said.

How dangerous NDM-1 will become isn't known, Kallen said. But some studies have found the death rate from KPC [the North American bacterium] to be as high as 40 percent, he said.

Most of the transmission of the NDM-1 (Indian) and the KPC (North American) bacteria happen as infected people travel around the world, Kallen added. "These people carry with them all their antibiotic-resistant bacteria and that mechanism [travel] has been recognized lots of times, including with NDM-1 and KPC," he said.

Kallen said routine testing can reveal bacteria resistance. "As far as treating the patient or infection control, it doesn't matter what the mechanism is -- they're all bad and they all need to be controlled in the same way," he said.

Hospitals that identify cases of NDM-1 or KPC infection should isolate the patient before treatment. Hospitals should also check to see if other patients have had contact with infected patients.

One of the most common ways that bacteria become resistant to antibiotics is through the overuse of the drugs, Kallen noted.

Infectious diseases expert Dr. Marc Siegel, an associate professor of medicine at New York University in New York City, said that "the number of [NDM-1] cases is small, but what is concerning about this is this is a new bacteria that is emerging because of a genetic change that is causing a garden-variety bacteria to become resistant to most antibiotics."

Antibiotic-resistant bacteria are emerging because of lack of cleanliness and sterility in hospitals, too many antibiotics being prescribed, and drug companies not developing new antibiotics because they aren't profitable, Siegel said.

Dr. Pascal James Imperato, dean and distinguished service professor at the School of Public Health at SUNY Downstate Medical Center in New York City, explained: "Bacteria with this resistance capability are most likely to pose a problem first in hospitals. Some antibiotics are still effective against NDM-1. The first three cases in the U.S. were successfully treated. It is difficult to predict the future role of NDM-1 bacteria since they were only first detected in December, 2009."

Headed to ER? Some Post Waits by Text, Billboard

Associated Press

 

Need an X-ray or stitches? Online, via text message or flashing on a billboard, some emergency rooms are advertising how long the dreaded wait for care will be, with estimates updated every few minutes.

It's a marketing move aimed at less urgent patients, not the true emergencies that automatically go to the front of the line anyway — and shouldn't waste precious minutes checking the wait.

"If you're in a car accident, you're not going to flip open your iPhone and see what the wait times are," cautions Dr. Sandra Schneider, president-elect of the American College of Emergency Physicians.

Despite that fledgling trend, ERs are getting busier, forcing them to try innovative tactics to cut delays — such as stationing doctors at the front door to get a jump-start on certain patients.

And in 2012, hospitals are supposed to begin reporting to Medicare how fast their ERs move certain patients through, a first step at increasing quality of care across the board.

"The longer people stay in the emergency department, the more likely they're going to have complications, deaths. If they're elderly, they're more likely to end up in a nursing home," says Dr. Nick Jouriles, emergency medicine chief at Akron General Hospital in Ohio, among the hospitals that post estimated wait times.

ER visits hit a new high of more than 123 million in 2008, up from 117 million a year earlier, says preliminary data released this month by the Centers for Disease Control and Prevention. A disturbing report last year from Congress' investigative arm found too often, patients who should have been seen immediately waited nearly a half hour. Add in tests and treatment, and a trip to the ER can easily last three or four hours.

So why post wait times that might encourage people who otherwise could have tried an urgent-care center?

There are no statistics on how many hospitals advertise wait times, although they tend to have multiple ERs in a region, usually the suburbs. The idea: People with less urgent conditions — maybe they need stitches for a cut — might drive a bit farther for a shorter wait, possibly helping a hospital chain spread the load without losing easier cases to competitors.

Akron General, for instance, has four medical centers about a half-hour apart. One afternoon last week, the posted wait from check-in to seeing a physician at the main downtown campus was 53 minutes, while suburban locations were less than 20. Jouriles is beginning a study to see if the postings make a difference in patient volume, the total time spent in the ER and satisfaction.

"They're on their Blackberries in the waiting room," matching the posted wait to the clock, he says. "Not a single patient today, I bet, is going to be 53 minutes" exactly — because that's an average of some who got in in 5 minutes and others who cooled their heels over an hour.

Perhaps more common than posting wait times are other attempts at easing the traffic jams:
 

In Nashville, Vanderbilt University Medical Center does "team triage," with a doctor, nurse and paramedics manning the ER's front door. They work the waiting room, ordering blood work or X-rays so that less urgent cases — like a sprained ankle — may be diagnosed without ever tying up an ER bed and more complicated ones get a head start on diagnosis that can save 40 minutes a person.

Emergency medicine chief Dr. Corey Slovis says the ER averages a 20 minute wait to see the doctor that he hopes to cut to 10 minutes. Team triage allows discharging about 15 patients a day directly from the waiting room.

The main cause of ER crowding isn't an influx of sprained ankles but a lack of hospital beds for patients so sick they need to be admitted, leaving them "boarding" in the ER so there's no room to bring in new patients, says Dr. Peter Viccellio of the State University of New York at Stony Brook. Mondays, when most hospitals fill inpatient beds with elective surgeries, are especially bad.

Viccellio pioneered "hallway medicine" to ease boarding, where patients are divided on gurneys among the hospital's wings to await available beds. Distributing the load shortened total hospital stays by a day, possibly as patients benefited from more nursing attention, he says.

That jam is where Medicare is focusing first, as hospitals are to begin reporting in 2012 how quickly they move patients from the ER to inpatient beds. Still to come is a final decision on reporting additional wait times, such as how long it takes to see a doctor.

Paradoxically, in the last year some ERs have deliberately started keeping certain patients longer: About 10 or 15 patients a day at Stony Brook have chest pain but a normal EKG, and need to be observed to separate out the 10 percent who really need heart care. Rather than admitting them all to the hospital, some ERs now keep them for up to 16 hours to do repeat testing that shows who can safely go home, Viccellio says — making it all the more important to avoid other logjams.

New Ratings for Heart Surgeons from Consumer Reports

KMOX - St. Louis

The Consumer Reports Health Ratings Center has published a list of fifty top-rated heart-bypass surgical groups in the United States — but no St. Louis-area cardiologists appear in it.

That’s because of the 221 surgical groups that voluntarily submitted data to Consumer Reports, not one was from St. Louis.

“We can’t figure out how St. Louis heart surgeons did unless they consent to release this data,” said Dr. John Santa, director of the Consumer Reports Health Ratings Center.

“I hope they see the beneficial effects of this ratings system and agree to release their data in the future because we think this is the best information out there for sorting out these important decisions,” Santa tells KMOX.

So what should you do if your heart surgeon doesn’t participate?

“If the heart surgery group you are considering has not volunteered to release their information, you should ask that heart surgeon for the information.   And if they won’t give it to you, you should look at your options.”

The surgeon ratings plus advice on getting the right care to treat heart disease are available in the October issue of Consumer Reports.

Walters, Letterman Compare Notes on Heart Surgery

Associated Press

Barbara Walters is feeling wonderful after heart surgery in May — and has practically no scar, she added proudly Tuesday as she returned to active duty on "The View" after taking the summer off for recovery.

"I would like to say, once and for all, to all the people who say, 'How are you?': I'm FINE!" she told viewers as the audience gave her a rousing welcome.

Joining the welcome party was David Letterman in his first visit. The "Late Show" host had open-heart surgery a decade ago, and he and Walters spent much of his appearance gratefully comparing notes.

"It's plumbing, really. You're talking about pipes, valves and pumps," said Letterman, who underwent an emergency quintuple bypass in January 2000. When the Indianapolis heart surgeons go to work, he marveled, "amazing things are accomplished."

"It's more than a miracle," he said.

Letterman recalled when he got the post-surgery good news from the doctor.

"He puts his hand on my shoulder and he said, 'Everything went great.' And that was the best part of the whole thing — that and, later, the sponge bath," he cracked.

In mock oneupmanship in his exchange with Walters, Letterman declared: "I had coronary artery disease. You just blew out a valve."

To which Walters retorted: "I have a pig valve. YOU don't have a pig valve!"

"I have other pig parts on me, though," Letterman joked ruefully, in an apparent reference to a scandal a year ago involving revelations about his affairs with co-workers.

Then, when talk turned to his flop as host of the Oscars in 1995, Letterman pretended to have chest pains. Asked whether he would ever host the Oscarcast again, he said no.

"I had my shot, I screwed it up — and almost put an end to the Academy Awards," he joked. "They were nice enough to ask me to do it again, and I said, 'What, are you drinking?!'"

Letterman redeclared support for Conan O'Brien, the short-lived "Tonight Show" host who was unseated by Jay Leno, his predecessor, when Leno reclaimed the job during last season's late-night turmoil at NBC.

"It was fun to see Jay squirm," said Letterman, hinting that Leno's nice-guy image doesn't tell the whole story. "We got to see a little bit of the real Jay Leno in action here."

Airing weekdays at 11 a.m. Eastern, "The View" is starting its 14th season. Other hosts are Joy Behar, Whoopi Goldberg, Elisabeth Hasselbeck and Sherri Shepherd.

For more Health News, visit the Healthcare and Medical News blog.

For more national and worldwide Business News, visit the Peak News Room blog.

For more local and state of Michigan Business News, visit the Michigan Business News blog.

For more Electronics News, visit the Electronics America blog.

For more Real Estate News, visit the Commercial and Residential Real Estate blog.

For more Law News, visit the Nation of Law blog.

For more Advertising News, visit the Advertising, Marketing and Media blog.

For more Environmental News, visit the Environmental Responsibility News blog.

For information on website optimization or for the latest SEO News, visit the SEO Done Right blog.

Health Insurers Plan Hikes

The Wall Street Journal

Rate Increases Are Blamed on Health-Care Overhaul; White House Questions Logic





Health insurers say they plan to raise premiums for some Americans as a direct result of the health overhaul in coming weeks, complicating Democrats' efforts to trumpet their signature achievement before the midterm elections.

Aetna Inc., some BlueCross BlueShield plans and other smaller carriers have asked for premium increases of between 1% and 9% to pay for extra benefits required under the law, according to filings with state regulators.

These and other insurers say Congress's landmark refashioning of U.S. health coverage, which passed in March after a brutal fight, is causing them to pass on more costs to consumers than Democrats predicted.

The rate increases largely apply to policies for individuals and small businesses and don't include people covered by a big employer or Medicare.

About 9% of Americans buy coverage through the individual market, according to the Census Bureau, and roughly one-fifth of people who get coverage through their employer work at companies with 50 or fewer employees, according to the Kaiser Family Foundation. People in both groups are likely to feel the effects of the proposed increases, even as they see new benefits under the law, such as the elimination of lifetime and certain annual coverage caps.

Many carriers also are seeking additional rate increases that they say they need to cover rising medical costs. As a result, some consumers could face total premium increases of more than 20%.

While the increases apply mostly to the new policies insurers write after Oct. 1, consumers could be subject to the higher rates if they modify their existing plans and cause them to lose grandfathered status.

The rate increases are a dose of troubling news for Democrats just weeks before an election in which they are at risk of losing their majority in the House and possibly the Senate.

In addition to pledging that the law would restrain increases in Americans' insurance premiums, Democrats front-loaded the legislation with early provisions they hoped would boost public support. Those include letting children stay on their parents' insurance policies until age 26, eliminating co-payments for preventive care and barring insurers from denying policies to children with pre-existing conditions, plus the elimination of the coverage caps.

Weeks before the election, insurance companies began telling state regulators it is those very provisions that are forcing them to increase their rates.

Aetna, one of the nation's largest health insurers, said the extra benefits forced it to seek rate increases for new individual plans of 5.4% to 7.4% in California and 5.5% to 6.8% in Nevada after Sept. 23. Similar steps are planned across the country, according to Aetna.

Regence BlueCross BlueShield of Oregon said the cost of providing additional benefits under the health law will account on average for 3.4 percentage points of a 17.1% premium rise for a small-employer health plan. It asked regulators last month to approve the increase.

In Wisconsin and North Carolina, Celtic Insurance Co. says half of the 18% increase it is seeking comes from complying with health-law mandates.

The White House says insurers are using the law as an excuse to raise rates and predicts that state regulators will block some of the large increases.

"I would have real deep concerns that the kinds of rate increases that you're quoting... are justified," said Nancy-Ann DeParle, the White House's top health official. She said that for insurers, raising rates was "already their modus operandi before the bill" passed. "We believe consumers will see through this," she said.

Previously the administration had calculated that the batch of changes taking effect this fall would raise premiums no more than 1% to 2%, on average.

After Regence mailed a letter notifying plan administrators of its intention to raise group insurance rates in Washington state, the White House contacted company officials and accused them of inaccurately justifying the increase. Kerry Barnett, executive vice president for Regence BlueShield, said the insurer is changing the letter to more precisely explain the causes of the increase.

The industry contends its increases are justified. "Anytime you add a benefit, there are increased costs," said Karen Ignagni, president of America's Health Insurance Plans, the industry's lobbying group.

Massachusetts, which enacted universal insurance coverage several years ago, also has seen steadily rising insurance premiums since then. Proponents of that plan attribute the hikes there to an overall increase in medical costs, while insurers cite it as a cautionary example of what can happen when new mandates to improve benefits aren't coupled with a strong enough provision to force healthy people to buy coverage.

Republicans, who have sought voter support by opposing the health law, say premium increases could help in November's congressional races. "People are finding out what's in [the law], they don't like it, and I think it's going to play a big factor in this election," said Iowa Sen. Charles Grassley, the top Republican on the Senate Finance Committee.

About half of all states have the power to deny rate increases. Ms. DeParle pointed out that the law awards states $250 million to bolster their scrutiny of insurance-rate proposals, saying that will eventually curb premiums for people.

"In Kansas, I don't have a lot of authority to deny a rate increase, if it is justified," said Kansas Insurance Commissioner Sandy Praeger. She recently approved a 4% increase by Mennonite Mutual Aid Association to pay for the new provisions in the health law.

The process of reviewing rate increases varies by state. For instance, Ms. Praeger said she can deny only rate increases that are unreasonable or discriminatory.

Some regulators say not all insurers have adequately justified their increases. "A lot of it is guesswork for companies," said Tom Abel, supervisor at the Colorado Division of Insurance. "I was anticipating the carriers to be more uniform."

Regence BlueCross BlueShield of Oregon, which estimates its increase covers 57,000 members, said its goal is to "anticipate the financial needs of our members as accurately as possible and to collect just enough premiums to cover costs," said a spokeswoman. Other insurers offered similar explanations or declined to discuss their increases.

A small number of insurers have submitted plans to lower rates and cite the new mandates in the legislation as the reason. HMO Colorado, a Blue Cross Blue Shield plan owned by WellPoint Inc., submitted a letter to state regulators saying small group rates would fall 1.8% starting Oct. 1 because of changes from the law.

Democrats had hoped to sell the bill in the fall elections. But in recent weeks, some Democrats who voted for the bill have shied away from advertising that fact, while the handful of House Democrats who cast "no" votes see it as a potential boost to their re-election bids.

"I think it's a question of short term versus long term," said North Carolina Insurance Commissioner Wayne Goodwin, a Democrat up for re-election in 2012. "Thankfully we're seeing people get more coverage and protections than they've ever had before. But until we see the medical-cost inflation affected, you're likely to see rate increases as long as they are not excessive and in violation of the law."

Stenting Riskier for Older Patients With Blocked Carotid Artery

Bloomberg / BusinessWeek

But for folks under 70, stents and surgery have similar outcomes, study finds.

For patients aged 70 and older who have a blocked neck artery, inserting a stent to reopen the artery is riskier than surgically widening the artery, a new study finds.

But for younger patients, stenting may be a viable option, the researchers say.

The carotid arteries, located on each side of the neck, are the major supplier of blood to the brain. Wyandotte Stroke Care center experts say that when they become blocked or narrowed -- a condition known as carotid stenosis -- strokes can result.

Earlier research found that treating carotid stenosis with stenting raised the risk of stroke more than surgery to widen the artery (endarterectomy). But in this new study, British researchers determined that the risk of stenting is age-related.

"For patients with recent relevant symptoms who need treatment for carotid stenosis, surgery should be the first choice in older patients," said researcher Dr. Martin M. Brown, professor of stroke medicine at the National Hospital for Neurology and Neurosurgery and Institute of Neurology at the University College London in the United Kingdom.

In patients 70 and older, "stenting was on average about twice as likely to cause a stroke or kill the patient as carotid endarterectomy," Brown said.

"In contrast, in patients younger than 70, the risk of stroke or death associated with stenting was half that of older patients and was very similar to the risk of surgical carotid endarterectomy," Brown added. "In younger patients, stenting might be a suitable alternative to carotid surgery," he concluded.

"Interestingly, the risk of stroke or death with surgical carotid endarterectomy did not alter substantially with age," Brown noted.

For the study, published in the Sept. 10 online edition of The Lancet, Brown and colleagues studied three trials that included 3,433 patients who had symptoms of carotid stenosis. In each trial, the researchers looked for causes of stroke or death.

Those who received stents had a 53 percent higher risk of having a stroke or dying in the four months after the procedure compared with patients who underwent a carotid endarterectomy, the Southgate Stroke Care researchers found.

But among those younger than 70, the risk for stroke or death was similar in both procedures. For patients 70 and older, the risk for stroke or death was two times higher in the stent group than for those who underwent endarterectomy (12 percent versus 5.9 percent).

Moreover, in the 30 days following treatment, the risk for stroke or death among the under-70 patients was similar, while 10.5 percent of the 70-and-older group who received stents had a stroke or died, compared with 4.4 percent of the carotid endarterectomy patients, the researchers found.

Dr. Larry B. Goldstein, professor of neurology and director of the Duke Stroke Center at Duke University Medical Center, said another new trial -- CREST -- supports the study results. CREST is the largest trial to date comparing endarterectomy with stenting in patients with a narrowing of the carotid artery, Goldstein said.

"CREST found no difference in the trial's primary outcomes of stroke, death or myocardial infarction [heart attack], but a higher risk of stroke in those having stenting that was balanced by a higher risk of heart attack in those having endarterectomy," he said. The new British study only looked at the rate of stroke and death; findings for heart attack were not part of the methodology.

"Similar to this study, CREST found increased risk of stenting versus endarterectomy in older [patients] as compared to younger patients in whom outcomes seemed better with stenting," Goldstein said.

Many experts had thought that stenting, which is less invasive than endarterectomy, would be safer for older patients, but taken together, this study and CREST suggest that may not be true, say Trenton Stroke Care experts.

For more Health News, visit the Healthcare and Medical News blog.

For more national and worldwide Business News, visit the Peak News Room blog.

For more local and state of Michigan Business News, visit the Michigan Business News blog.

For more Electronics News, visit the Electronics America blog.

For more Real Estate News, visit the Commercial and Residential Real Estate blog.

For more Law News, visit the Nation of Law blog.

For more Advertising News, visit the Advertising, Marketing and Media blog.

For more Environmental News, visit the Environmental Responsibility News blog.

For information on website optimization or for the latest SEO News, visit the SEO Done Right blog.

Brain Scans Could Spot Developmental Problems in Kids

Bloomberg / BusinessWeek

 

A new study suggests that a quick MRI scan could tell doctors if a child's brain is maturing properly, potentially providing an early warning sign that mental problems are developing.

Researchers say the strategy could turn an ordinary brain scan into a tool similar to the age-old growth charts that tell pediatricians if kids are growing at an appropriate rate.

"It's a way to understand individual differences and make predictions about an individual's neurologic and psychological health," said study co-author Dr. Bradley L. Schlaggar. "The earlier you can intervene, the more likely it is that you'll benefit a patient."

Currently, brain scans don't play a major role in the treatment of mental illness, said Schlaggar, an associate professor of developmental neurology at Washington University School of Medicine and St. Louis Children's Hospital.

It's possible to find a tumor or diagnose a stroke with the help of a brain scan, he said, but the technology almost always fails to reveal any problems in the brain of a person who has a disorder like autism, schizophrenia or epilepsy. "That's vexing," he said, "because you know that something is wrong with the brain, but the report is normal."

In the new study, Schlaggar and colleagues report that they've found a way around this challenge. Using MRI technology that detects which areas of the brain are most active based on their usage of oxygen, they scanned 238 volunteers aged 7 to 30. They compiled the results and developed a baseline of what the brains of people should look like as they grow older.

The findings, which are published in the Sept. 10 issue of Science, could allow doctors to measure whether a patient's brain has matured to the level it should have reached based on his or her age, Schlaggar said.

But if a child's brain isn't as developed as it should be, can doctors do anything about it? Possibly, said Dr. Paul R. Carney, chief of pediatric neurology at the University of Florida.

If a 7-year-old child has a frontal lobe that looks like that of a 5-year-old, for example, doctors could turn to learning therapies designed to boost that part of the brain, said Carney, who's familiar with the findings.

"Right now, most learning techniques don't speak to a specific brain network," Carney said. "But here, you'd be able to design a therapy and measure the response."

In other words, the brain scans from a St. Louis neurologist could both diagnose a problem in the brain and help gauge whether a treatment is working.

Study: Impaired Mental Performance More Common in Elderly Men than Women

LA Times

In storyteller Garrison Keillor's corner of Minnesota, all the children may be "above average." But a study of older Minnesotans in the county surrounding the famed Mayo Clinic suggests that the ones who stay "above average" mentally are more likely to be female, to have completed more education, and to have been married at some point.

The study, published Tuesday in Neurology, aims to refine what we know about age-related cognitive decline. Starting in 2004, it tracked 4,398 Minnesotans aged 70 to 89 to see how that population's mental state weathered advancing age and to determine who was most likely to develop a condition called mild cognitive impairment -- a greater-than-average decline in mental performance that often progresses to dementia, including the dementia of Alzheimer's Disease.

All told, 16% of the population studied was diagnosed by standard neurocognitive tests as having mild cognitive impairment. Roughly two-thirds of those with MCI primarily had memory problems, while the remaining third had broader problems of thinking and reasoning. As a group, women were less likely at every age to be diagnosed with mild cognitive impairment from an Indianapolis neurologist than were men of the same age. Men and women who had been married at some point in their lives and those who had completed more schooling also had a lower likelihood of MCI at every age.

Alzheimer's disease is thought to affect men and women roughly equally or to be slightly higher in women, suggesting that at some point, women catch up with men. But the authors of the study suggested gender may play a role in how the disease starts and progresses. They suggested, for instance, that men who will go on to develop Alzheimer's may begin their mental decline earlier and experience a gradual decline in memory, while women who will go on to develop Alzheimer's may experience a more dramatic transition from normal cognition to dementia, all at a later age than men typically do.

The study follows one appearing in the same journal last week that found that for those whose engagement in mentally challenging activities was intensive, the transition from normal cognition to dementia, when it came, was very rapid.