Study: Obesity Rates to reach 42 Percent

Reuters

Americans will keep growing fatter until 42 percent of the nation is considered obese, and having fat friends is part of the problem, researchers said on Thursday.

The prediction by a team of researchers at Harvard University contradicts other experts who say the nation's obesity rate has peaked at 34 percent of the U.S. population.

The finding is from the same group, led by Nicholas Christakis, that reported in 2007 that if someone's friend becomes obese, that person's chances of becoming obese increase by more than half.

They now think this same phenomenon is driving the obesity epidemic, which will climb slowly but steadily for the next 40 years.

Alison Hill, a graduate student at Harvard and the Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, said the study is based on the idea that obesity can spread like an infectious disease and people can catch it from their friends.

For the study, she and colleagues applied a mathematical model to four decades of data from the long-running Framingham study -- a study of the health and habits of nearly an entire town in Massachusetts.

"We looked at the probability of becoming obese and what that was influenced by," Hill said in a telephone interview.

"We found there is some baseline risk of becoming obese based on the friends you have," Hill said.

Hill said that based on their calculations and looking at the influence of social interactions on obesity in the Framingham study, they think the U.S. obesity rates will top out at 42 percent of the population.

Over the long-running study, the rate of weight gain caused by social interaction -- a person's contact with friends who are obese -- has grown quite rapidly since 1971, Hill said.

"It looks like obesity is becoming more infectious," said Hill. The findings are reported in the Public Library of Science journal PLoS Computational Biology.

MULTIPLE SOCIAL CONTACTS

In the study, the team found that an American adult has a 2 percent chance of becoming obese in any given year, and each obese social contact increases the risk of becoming obese by 0.5 percent per year.

And while having fat friends increases the odds that you will become fat, befriending thin people does not appear to help you lose weight.

"We didn't find having more healthy-weight friends made it more likely to help people lose weight. It fits in with this idea of thinking about it as an infectious disease. You don't really catch healthiness," she said.

Hill said the findings are the best-case scenario based on current assumptions, but changes in public policy could make a difference.

U.S. government researchers in January said 68 percent of U.S. adults are considered overweight, having a body mass index or BMI of 25 or higher, and a third are obese, having a body mass index of 30 or higher.

BMI is equal to weight in kilograms divided by height in meters squared. A person 5 feet 5 inches tall is classified as overweight at 150 pounds (68 kg) and obese at 180 pounds (82 kg).

Being overweight or obese raises the risk of heart disease, diabetes, some cancers, arthritis and other conditions.

Obesity-related diseases account for nearly 10 percent of medical spending in the United States or an estimated $147 billion a year.

Cymbalta Approved for Chronic Joint and Muscle Pain

Bloomberg / BusinessWeek

Cymbalta (duloxetine hydrochloride) has received expanded approval from the U.S. Food and Drug Administration to treat chronic musculoskeletal pain, stemming from conditions including lower back pain and osteoarthritis.

Since its approval as an antidepressant in 2004, some 30 million people in the United States have used the drug, the agency said in a news release. The FDA also has sanctioned Cymbalta for the treatment of diabetic pain, generalized anxiety disorder and fibromyalgia.

The most common side effects from Cymbalta use include nausea, dry mouth, insomnia, drowsiness, constipation, fatigue, and dizziness. More serious adverse reactions have included liver damage, allergic reaction, pneumonia, depressed mood, and suicidal thoughts and behavior, the agency said.

The FDA has also warned that Cymbalta should never be used in patients who have recently taken a type of antidepressant called an MAOI, or Mellaril (thioridazine), or who have uncontrolled glaucoma.

Cymbalta is produced by Eli Lilly and Co., based in Indianapolis.

AMA Chief says Medicare Cuts will be Catastrophic

Associated Press

The president of the nation's largest doctors' group says upcoming cuts in Medicare physician payments will be catastrophic for seniors.

Dr. Cecil Wilson of the American Medical Association says Medicare payments will drop by more than 20 percent by January unless Congress takes quick action.

Wilson says many seniors will lose access to needed care because some doctors will stop accepting Medicare patients. He adds it's a question of medical practices remaining financially viable.

Wilson spoke out against the cuts Monday at the AMA's interim meeting in San Diego. The AMA is running full-page newspaper ads and wants a 13-month reprieve so a permanent solution can be sought.

It's unknown if Congress will scrap the cuts, or even give doctors the full reprieve they're seeking.

Wyoming, W. Virginia lead in Chewing Tobacco Use

Associated Press

Wyoming tops the nation in chewing tobacco use, with nearly 1 in 6 adult men in that state using the product.

Government researchers found men use chew, snus and other smokeless products at much higher rates than women. In Wyoming and West Virginia, about 9 percent of all adults - both men and women - use smokeless tobacco.

The report by the Centers for Disease Control and Prevention is one of the government's first attempts to gather state-level statistics on smokeless tobacco. Past research suggests the national usage rate is around 2 percent.

The study is based on a telephone survey last year of more than 430,000 people in all 50 states. The survey asked people whether they smoked cigarettes and/or used smokeless tobacco.

Often people said yes to both. Many of the states with the highest smoking rates also had the highest use of smokeless tobacco products.

In Wyoming, for example, nearly 14 percent of smokers also used smokeless tobacco; among men, it was 23 percent.

Wyoming's "rodeo culture" includes a tradition of chewing tobacco, one CDC official said.

California had the least smokeless tobacco use, with only a little more than 1 percent of adults in that state reporting that habit.

Health officials worry about smokeless tobacco, which they believe may be a reason U.S. smoking rates have stopped falling.

Their reasoning: As smokers face more workplace smoking bans, many of them - instead of quitting - are turning to chewing tobacco or snus to temporarily satisfy their nicotine addiction and get them through parts of the day.

Indeed, some unpublished CDC research suggests that some smokeless tobacco products were reformulated around 2007 and became more addictive. Researchers looked at two popular brands of smokeless tobacco and saw that the most addictive form of nicotine in them was dramatically higher.

Health officials have also noted that most chewing tobacco use starts at a young age, that it often precedes smoking, and that over half of young males who use smokeless tobacco also smoke.

"The bottom line here: Smokeless tobacco makes it more likely that kids will start smoking and make it harder to quit smoking," said the CDC's director, Dr. Tom Frieden.

Officials also have been unhappy to see that major cigarette companies have taken over the smokeless tobacco product market in the last few years, and have started selling smokeless versions of cigarette brands like Marlboro and Camel.

And they're no fan of spitless, nicotine-containing snus - Swedish for tobacco, it rhymes with "noose." These are tiny pouches of steam-pasteurized, smokeless tobacco. Snus were developed to be more socially acceptable than the dark drool of traditional chewing tobacco.

This year the U.S. Food and Drug Administration began requiring that smokeless tobacco products carry health warning labels.

Some health advocates note smokeless tobacco can cause oral and pancreatic cancer, and say it also increases risk of fatal heart attack and stroke.

"No tobacco product is safe to consume," said the American Heart Association's chief executive, Nancy Brown, in a prepared statement reacting to the CDC report.

Study: Brain Energy Crisis may spark Parkinson's

Associated Press

Parkinson's disease may stem from an energy crisis in the brain, years before symptoms appear.

If the research pans out, it points to a possible new approach for Parkinson's: Giving a boost to a key power switch inside brain cells in hopes of slowing the disease's inevitable march instead of just treating symptoms.

"This is an extremely important and interesting observation that opens up new therapeutic targets," says Dr. Flint Beal of New York's Weill Cornell Medical College, who wasn't involved with the new study.

Beal said scientists already are planning first-stage tests to see if a drug now used for diabetes might help Parkinson's, too, by targeting one of the implicated energy genes.

At issue are little power factories inside cells, called mitochondria. Increasingly, scientists suspect that malfunctioning mitochondria play some role in a list of degenerative brain diseases.

After all, brain cells are energy hogs, making up about 2 percent of body weight yet consuming about 20 percent of the body's energy. So a power drain could trigger some serious long-term consequences.

"It could be a root cause" of Parkinson's, says Dr. Clemens Scherzer of Boston's Brigham and Women's Hospital and Harvard University.

About 5 million people worldwide, and 1.5 million in the U.S., have Parkinson's, characterized by increasingly severe tremors and periodically stiff or frozen limbs. Patients gradually lose brain cells that produce dopamine, a chemical key to the circuitry that controls muscle movement. There is no cure, although dopamine-boosting medication and an implanted device called deep brain stimulation can help some symptoms.

No one knows what causes Parkinson's. To find genetic clues, Scherzer gathered an international team of researchers to comb studies of more than 300 samples of brain tissue - from diagnosed Parkinson's patients, from symptom-free people whose brains showed early Parkinson's damage was brewing, and from people whose brains appeared normal. They even used a laser beam to cut out individual dopamine-producing neurons in the most ravaged brain region, the substantia nigra, and examine gene activity.

The team found 10 sets of genes that work at abnormally low levels in Parkinson's patients, genes that turned out to play various roles in the mitochondria's energy production, Scherzer recently reported in the journal Science Translational Medicine. Especially compelling, the genes also were sluggish in people with presymptomatic, simmering Parkinson's.

And all the gene sets are controlled by what Scherzer calls a master regulator gene named PGC-1alpha - responsible for activating many other genes that maintain and repair those mitochondrial power factories.

So might revving up PGC-1alpha in turn boost underperforming mitochondrial genes and protect the brain? To see, the researchers tested dopamine-producing neurons from rats that were treated in ways known to cause Parkinson's-like damage. Sure enough, boosting the power switch prevented that damage.

This genetic evidence supports years of tantalizing hints that mitochondria are culprits in Parkinson's, says Dr. Timothy Greenamyre of the University of Pittsburgh Medical Center.

He ticks off the clues: A rare, inherited form of Parkinson's is caused by a mutated gene involved with mitochondrial function. A pesticide named rotenone that can kill dopamine cells and trigger Parkinson's symptoms in animals also is toxic to mitochondria. So is another Parkinson's-triggering chemical named MPTP.

Now with Scherzer's study, "it's going to be harder and harder for people to think that mitochondria are just a late player or an incidental player in Parkinson's disease," Greenamyre says.

The crux of all that complicated neurogenetics: A diabetes drug named Actos is among the compounds known to activate part of that PGC-1alpha pathway, and Weill Cornell's Beal says it's poised for an initial small trial in Parkinson's.

Separately, a nutrient named Coenzyme Q10 is believed important in mitochondrial energy production, and Beal is leading a study to see if high doses might help Parkinson's. Results are due in 2012.

But Scherzer issues a caution: The average Parkinson's patient has lost about 70 percent of his or her dopamine-producing neurons by the time of diagnosis. So if blocking a brain energy drain is going to do any good, scientists may have to find ways to spot brewing Parkinson's much earlier.

"I don't think you can turn back the clock," he says.

Study: CT Scans modestly cut Lung Cancer Deaths

Associated Press

A major study shows giving heavy smokers special CT scans can detect lung cancer early enough to modestly lower their risk of death - the first clear evidence that a screening test may help fight the nation's top cancer killer.

Now the hurdle is deciding who should get these spiral CT scans and how often, because the tests carry their own risks, including repeated radiation exposure and a lot of false alarms that trigger unnecessary repeat testing and even surgery.

"This finding has important implications for public health, with the potential to save many lives among those at greatest risk for lung cancer," said National Cancer Institute Director Dr. Harold Varmus, who released the study results Thursday. But, "we don't know the ideal way yet to do this screening."

Specialists with the American Cancer Society - which hadn't recommended the screening because of lack of evidence - planned to evaluate the findings when the full data is published in a few months.

Until then, "the best advice we can give is to encourage people to have conversations with their doctors about whether lung cancer screening is right for them," said chief medical officer Dr. Otis Brawley.

Standard chest X-ray screenings haven't proved powerful enough to reduce lung cancer deaths, so researchers turned to spiral CTs, where a rotating scanner views the lungs at various angles to spot growths when they're about half the size that regular X-ray can. But previous small studies have produced mixed results about whether the CTs work.

The massive National Lung Screening Trial enrolled 53,000 current or former heavy smokers with no initial symptoms of cancer to try to settle the debate. It found 20 percent fewer deaths from lung cancer among those screened with spiral CTs than among those given chest X-rays, the NCI said Thursday, a difference significant enough that it ended the study early.

The actual difference: Of those who got a spiral CT, 354 died over the eight-year study period compared with 442 deaths among those who got chest X-rays.

But with about 200,000 new lung cancers diagnosed in the U.S. each year and 159,000 deaths, even a modest reduction could translate into big benefits. Today, lung cancer usually is diagnosed at advanced stages, and the average five-year survival rate is just 15 percent.

Still, the best advice to avoid lung cancer, stressed NCI's Varmus: Stop smoking.

Smokers and former smokers have long sought scans in the hopes of earlier lung cancer detection, even though insurance seldom covers the $300 to $400 test in people who have no symptoms.

"Clearly it saves lives," said Dr. Stephen Swensen of the Mayo Clinic, among the 33 sites that conducted the massive study. But, because it carries the burden of unnecessary tests and treatment, "society has to figure out if we can afford this."

"We want to make sure what we recommend is appropriate rather than everybody going out and asking for it," added Dr. Edward F. Patz Jr. of Duke University, who was on the committee that helped design and oversee the study.

The new trial enrolled people ages 55 to 74 who are or had been very heavy smokers, puffing at least 30 "pack-years," the equivalent of a pack a day for 30 years or two packs a day for 15 years. They had one scan a year - either spiral CT or a standard chest X-ray - for three years, and then had their health tracked.

NCI's Varmus stressed that the study provided no data on whether screening helped lighter or younger smokers.

There were risks. The CTs frequently mistake scar tissue from an old infection or some other benign lump for cancer, giving about 25 percent of the spiral CT recipients a false alarm. In an earlier Mayo Clinic study of spiral CTs, more than 70 percent had a false alarm, because that study monitored even smaller lung nodules that the newer study ignored, Swensen said.

Then there's the radiation question. The new study used low-dose spiral CTs, equivalent to the radiation from a mammogram. That's far lower than the radiation emitted by regular CT scans used to diagnose various medical conditions, but several times more than is emitted by a standard X-ray.

The NCI will analyze whether the radiation exposures from the three scans in this study changed a smoker's lifetime risk of other radiation-related cancers. Doses can be vary widely at different hospitals using different scanners, but any CTs used for screening should be low-dose, Swensen said.

Technology a Blessing, a Curse for remote Island

Associated Press

Muggs Bass doesn't own a computer. She's pretty much dead set against e-mail. Anyone who calls her home on Michigan's remote Beaver Island should be prepared for a busy signal, if she's on her land-line phone. She has no cell.

"When you don't have it, you don't miss it. That's what I say," says the spunky 70-year-old grandmother, who's as comfortable telling jokes at the local pub as she is attending Mass each morning.

Technology isn't really her thing. So, it's a small miracle when Bass drives, once a month, to her island's rural health center to sit down in front of a wide-screen television. There, she and a handful of other islanders connect by video conference with a similar group in Charlevoix, Mich., a two-hour ferry ride to the south and east.

They chat. They laugh. They cry together.

All of them have, or have had, cancer, Bass included. Hers started with a lump in her breast and has since metastasized to her bones, making her cancer treatable, but incurable, her doctors tell her.

Her own grandmother died of the same disease and went off the island for occasional treatments, as Bass does every few weeks. But that grandmother could hardly have imagined a day when islanders talked openly about their cancer, face-to-face with people in a support group miles away.

It's just one of many ways technology is making this rugged place less remote than it once was and, some would say, more livable for more people.

It also gives islanders hope for new jobs that could attract residents to this island in northern Lake Michigan where the year-round population is about 650 people, give or take a few dozen.

"In the last few years, technology has sprung," says Joe Moore, a retired teacher who's known as one of the geeks on the island who helps keep computers running.

Not that the change has come quickly, or that technology always works perfectly.

That's just how it is on an island where a popular bumper sticker reads "Slow Down! This Ain't The Mainland." It's aimed at anyone who's in too big a hurry, including lead-footed tourists who kick up dust on the many dirt roads or who panic when cell phone service drops.

That's life on wired - or at least, semi-wired - Beaver Island.

___

So, where is Beaver Island, anyway?

Some Michiganders would show you by holding up their right hands, palms up, and pointing just above the tip of their ring fingers - in other words, just off the far northwest tip of the state's lower peninsula. But that's if even THEY know where it is.

While Michigan's Mackinac Island is well known, Beaver Island - much of its 54 square miles covered in lush hardwood forests, sand dunes or pristine inland lakes - is not.

That's partly because it is more difficult to get to, especially in the off season. Ferry service runs from Charlevoix, from April through mid-December. Quick flights in small propeller planes are available year-round, weather permitting. In winter, it's not unusual for islanders to be physically cut off from the mainland, unless an emergency sends the U.S. Coast Guard to their rescue.

So when high-speed Internet service became available to most of the island last spring, this was more than just a convenience. For many, it was a godsend - even if having the service simply meant being able to shop online for just about anything, to play an online game or to watch a newly released movie. For others, it meant being able to stay on the island longer because they had a more reliable connection to do work.

Either way, the outside world was even more readily available, at least virtually.

Schoolchildren on the island were ahead of this curve: The main public school knew how valuable it would be for them to be technologically savvy, especially when students headed to college. In the last decade, those students have been encouraged to take language and advanced-placement classes online. Some in high school also take college courses. They learn how to download and evaluate statistics using palmtop computers.

Connie Boyle, a teacher at the school, helped implement the technology program. She had a vested interest in it, partly because she and her husband decided to raise their daughter on the island after moving here from Chicago 25 years ago.

"We were worried - 'How do you bring up a kid on very tiny Beaver Island?'" Boyle says. An answer came when their daughter, now a freshman at Michigan State University, called recently about her computer class.

"Mom, I don't get it," she said. "I'm helping everybody here. We did all this in high school."

___

Today's state-of-the-art Beaver Island school is quite different from the one Muggs Bass attended. For her, books were the only real window to the mainland, especially in elementary school.

Like many who settled on Beaver Island, her great-grandparents and a grandmother had come from Ireland, to farm, fish and find a better life. Her own father was a dairy farmer. Born Mary Margaret but called "Muggs" as long as she can remember, Bass went to a small school across the field from the family farmhouse.

Until her school combined with another in the island's main town, St. James, she didn't even know some of her own cousins on the island. Other than a trip to the doctor when she was a young child, she didn't go to the mainland of Michigan - "across," as the islanders like to say - until she visited an aunt in Detroit when she was 12 years old.

"It was big and noisy," she recalls.

She didn't mind that her family didn't have a television until she was a teenager. For a long time, the closest thing she had to a technological device was the family radio, which she sat beside with her father to listen to boxing matches.

Her world was small in those days. That's how she liked it.

But after she graduated from high school, she left the island to find work and she ended up living in other parts of Michigan and then Illinois, where she met her husband. They then moved to northern Indiana, where they raised their son and his children from a previous marriage. Always, she longed to return to the island one day.

___

It's not the kind of life that appeals to just anyone.

Donna Kubic, a registered nurse who heads the island's rural health center, gets that. She tells the story of a young woman who came to the island to apply for a job at the health center. The woman had planned to stay for a week, but left after staying just one night in a lakeside cottage.

It was too dark out there with no street lights, she told Kubic. Too solitary.

This is, indeed, a place where one doesn't take modern convenience for granted. There is one grocery store, a couple of gas stations, a handful of restaurants and bars but no movie theater. There is no full-time doctor on the island, though two visit from the mainland twice a month. Critical patients are airlifted off the island, by the Coast Guard if weather shuts down other options.

As recently as two years ago, if someone needed an X-ray, the films had to be flown to the Charlevoix hospital so a radiologist there could read them. Depending on weather, it could take days.

Kubic knew there was a better way. She persuaded the hospital to help her apply for a grant that recently helped her purchase digital X-ray equipment for the health center. Now images can be transmitted in a matter of minutes.

Next came video conferencing, connecting the island's nurse practitioner and physician's assistant to the mainland hospital's emergency room. It's the same technology that allows Bass and the other islanders to take part in the "Circle of Strength" cancer support group.

"Without it, we'd be out here, in the lake, without a lot of support," Kubic says. Eventually, she hopes that primary care doctors and specialists - even mental health care providers - will be more willing to offer their services to islanders (though so far, she says, they've been reluctant).

"I think it's just education, saying the technology is there, getting the docs used to it," she says.

___

When Muggs Bass moved back to the island 12 years ago, she had no idea that she'd soon be dealing with a serious health issue.

A year after she'd been there, she traveled to the mainland for her annual mammogram, which revealed cancerous tissue. She had surgery to remove a breast.

"Then I went along fine for 10 years," she says, until she got a cough she couldn't shake. One morning, she got up and said to her husband, "I need to go across, to the doctor."

Her lung was filling with fluid. The cancer had spread to her bones.

So for the past 18 months, she has traveled to the mainland every six weeks for an infusion of a drug that keeps her bones from fracturing, and also takes a daily pill to slow the cancer's growth. The goal is to extend her life as much as possible.

"I'm going to hold to this until I reach something else," Bass recently told her support group. "And then I'll have to make another decision."

The group in Charlevoix includes an 80-year-old woman with lung and colon cancer, as well as younger mothers who've survived breast cancer and those who are in the thick of the battle. They talk about infections and drainage tubes, mammograms and mastectomies. They somehow manage to find humor in topics such as constipation.

One of the moms, introduced to the Beaver Island group through video conference, thanked Bass for sending her a card and a prayer.

"I read it every day," the woman, who has 11- and 16-year-old children, told Bass. "I'm in it for the long term fight. I'm prayin' hard, too."

"That's what you do," Bass said, as she grabbed a tissue to dab her eyes.

Diane Gorkiewicz, who began the Charlevoix "Circle of Strength" six years ago, marvels at the intimacy that has developed so quickly between her group and the islanders.

"The only thing you're missing are all the hugs and stuff," Gorkiewicz told the islanders during a recent video conference.

"And the food," Bass said, teasing the Charlevoix group that they need to share the treats they bring to their meetings.

___

Joe and Phyllis Moore understand the dynamic.

Earlier this year, the longtime islanders were able to "attend" their youngest granddaughter's first birthday party via Skype. Guests at the party in Washington state sat at a computer to introduce themselves. The Moores saw the cake. They gave real-time wishes to the birthday girl.

"Just thinking about it, it almost brings tears to my eyes," Joe Moore says.

It's not ideal, but the best they can do - better than they could've hoped for, really. The hard reality is that the cost of getting off the island can be prohibitive.

Most islanders have to "wear many hats" just to get by, Moore says. In addition to his computer work, he's one of the island medics and also runs a local website that provides video footage of township meetings, as well as the school's soccer and volleyball games.

Phyllis Moore is now the assistant librarian, but when she moved back to the island after college, she and Joe ran a vacation lodge while he did his student teaching.

"Like most graduates, I was going to get off this rock and never look back," says Phyllis Moore, now 62. "And look where I am now."

Many young people who live here say technology - social networking and their cell phones included - make life on the island better for them, too. But in the end, they face the same dilemma as everyone else: How do you make a living here? And what if there's really no place for the kind of work you want to do?

Brontae Cole, a 17-year-old high school senior, will be heading to college next year and wants to become a homicide detective.

"There's one cop here, two in the summer if we get lucky," Cole says. She grins. "And not a lot of dead people."

Jewell Gillespie-Cushman, a 14-year-old freshman, also wonders where he'll land. His late grandfather, an island icon for whom he was named, was born on Beaver Island and lived here his entire life. Gillespie-Cushman isn't sure he could do the same, even with more contact with the outside world than his grandpa had.

"I'm still debating whether to stay here, or move over there," he says.

___

Like Muggs Bass, though, a growing number of people want to find a way ONTO Beaver Island - many of them among the thousands who visit each summer and would like to make it home. For many of them, technology is the key.

Jeff Stone and his wife, Sarah Rohner, were able to start spending more time on the island in 2006, when a satellite-based service began offering an Internet connection that was about two-thirds as fast as the newest service, and much faster than the sluggish dial-up service that had been the only option.

The satellite option enabled Stone to quit his real estate job in the Chicago area to start a website design business that he and his wife run from the island much of the year, though not without some initial glitches.

He recalls how snow from a huge storm covered their satellite dish, cutting off their Internet service just as they were about to launch their site.

"We ended up going out in the back yard and throwing snow balls at the dish," he says. That knocked off enough snow to get the Internet working, and they were back in business. But it's not always that easy, or quick.

Laurel Vietzen, a college professor, also from the Chicago area, who now spends several months a year on the island, remembers a violent summer thunderstorm two years ago that left much of the island without Internet and phones. "We had a daughter at the University of Iowa and we were hearing about terrible flooding in Iowa City," she says. "It was three days before we could reach her!"

Now that Internet service on the island is more reliable, many islanders say cell phone service is the big hurdle. One mobile provider's service works well here, though only on the upper third of the island - and outages happen more frequently than most would like.

Even those who reap the benefits of technology feel torn, though. They worry that it infringes on one of the very things they love about the island - its inherent, blissful peacefulness.

Technology is, at once, their blessing and their curse.

On a summer night, it's not unusual to see more than a dozen people sitting outside the library's memorial garden, on picnic tables and in their cars, tapping into the free wireless that's left on 24 hours a day.

At the same time, islanders and summer residents alike regularly complain about all the people who now walk around the main streets of St. James, staring at a smart phone screen or iPad instead of their beautiful surroundings.

"The technology is wonderful, but ... ," Phyllis Moore says. She raises her eyebrows, noting how, on a nice day, she isn't opposed to kicking kids out of the library after they reach their 30-minute time limit on the computers there.

Meanwhile, it used to be the joke that, by St. Patrick's Day, anyone who lived here year round couldn't stand the sight of anyone else. In many ways, communicating with the outside world helps with that, but not always.

"I don't think it's eliminated cabin fever or getting at each other's throats," Joe Moore says, chuckling. "Sometimes, I think it makes it worse because they can communicate more and get on each others' nerves even more."

___

Muggs Bass knows about the squabbles and the way a rumor can take on a life of its own, computer or no computer. She wasn't too happy, for instance, when she heard that some islanders were calling her cancer "inoperable." She didn't like the sound of it - wished they'd just ask her directly.

But that was nothing, she says, compared with the support she's gotten from her tiny island community.

"We joke. We kid. We take care of each other," she says. "I can't imagine living anyplace else."

When she got her latest diagnosis, islanders organized a "50/50 raffle" for her, where the winner is supposed to take half the donations. Instead, the winner gave his portion to Bass, a common outcome on Beaver Island. All up, she received nearly $9,000 to help with flights to the mainland and other expenses related to her illness.

"You talk about emotional," Bass says, tearing up again.

She recalls sitting down after that to pray and, as she might say, have a chat with God.

"I thanked Him, and thanked Him, and thanked Him. I was so grateful that I was able to come back and live here, and for holding me up at this time in my life," she says.

The support group and her new friends on the mainland are part of that.

For her, technology - at least her little slice of it - has allowed the best of both worlds.

Omega-3 pills fail to work in Alzheimer's Patients

Associated Press

 

Omega-3 pills promoted as boosting memory didn't slow mental and physical decline in older patients with Alzheimer's disease, a big disappointment in a multimillion-dollar government-funded study.

"We had high hopes that we'd see some efficacy but we did not," said Dr. Joseph Quinn, an author of the $10 million study and a researcher at Oregon Health and Science University.

The results with pills containing DHA, an omega-3 fatty acid, highlight "the continued frustration over lack of effective interventions" for the memory-robbing disease, an editorial said, published with the study in Wednesday's Journal of the American Medical Association.

DHA occurs naturally in the brain and is found in reduced amounts in people with Alzheimer's disease.

Some smaller, less rigorous studies suggested that mental decline could be slowed or prevented by eating fish, the main dietary source for omega-3 fatty acids, or supplements like fish oil pills that contain fatty acids including DHA. The study used capsules of DHA oil derived from algae.

Omega-3 fatty acids in fish or supplements have been shown to help protect against heart disease and are being studied for possible effects on a range of other illnesses including cancer and depression.

The new research involved nearly 300 men and women aged 76 on average with mild to moderate Alzheimer's disease. They were randomly assigned to take either DHA pills or dummy pills daily for 18 months.

Results were similar in both groups; DHA provided no benefits in slowing Alzheimer's symptoms. The pills also didn't work even in a subgroup of participants with the mildest Alzheimer's symptoms.

"There is no basis for recommending DHA supplementation for patients with Alzheimer disease," the authors concluded.

Given evidence that the underlying process that causes Alzheimer's begins years, if not decades, before diagnosis, starting treatment after symptoms appear may be too late, said editorial author Dr. Kristine Yaffe, a dementia researcher at University of California at San Francisco.

The National Institute on Aging paid for most of the research. The rest came from Martek Biosciences, maker of the DHA pills used in the study. Two co-authors are Martek employees and Quinn is an unpaid consultant to the company. Quinn and two other study authors are also inventors of a patent for using DHA pills to treat Alzheimer with a certain genetic variation.

Laurie Ryan, program director of Alzheimer's studies at the Institute on Aging, called the results discouraging. But she noted that the institute is spending millions of dollars on research into other possible treatments including lifestyle changes, drugs and biomarkers that might lead to more targeted drug treatment.

William Thies, scientific director of the Alzheimer's Association, said the results fit with new recommendations advocating starting treatment in the disease's earliest stages.

"It seems clear that either we have to have more powerful drugs or they have to be used earlier in the course of the disease," Thies said.

When the Doctor Has a Boss

The Wall Street Journal

More Physicians Are Going to Work for Hospitals Rather Than Hanging a Shingle

The traditional model of doctors hanging up their own shingles is fading fast, as more go to work directly for hospitals that are building themselves into consolidated health-care providers.

The latest sign of the continued shift comes from a large Medical Group Management Association survey, which found that the share of responding practices that were hospital-owned last year hit 55%, up from 50% in 2008 and around 30% five years earlier.

The biggest U.S. physician-recruiting firm, Merritt Hawkins, a unit of AMN Healthcare Inc., said the share of its doctor searches that were for positions with hospitals hit 51% for the 12 months ended in March, up from 45% a year earlier and 19% five years ago. The number of searches for physician groups and partnerships has dropped.

The trend is tied to the needs of both doctors and hospitals, as well as to emerging changes in how insurers and government programs pay for care. Many doctors have become frustrated with the duties involved in practice ownership, including wrangling with insurers, dunning patients for their out-of-pocket fees and acquiring new technology. Some young physicians are choosing to avoid such issues altogether and seeking the sometimes more regular hours of salaried positions.

Attila Barabas, a urologist who completed his residency in 2006 and then worked briefly in a group practice, is now working for a hospital in New Hampshire and next year will move to a hospital in Wyoming to be closer to family. As an employed physician, "I can really focus only on practicing medicine, which is nice," he said. "I don't have to worry about the business side of the operation."

Hospitals are also seeking to position themselves for new methods of payment, including an emerging model known as accountable-care organizations that is encouraged by the new federal health care law. These entities are supposed to save money and improve quality by better integrating patients'care, with the health-care provider sharing in the financial benefits of new efficiencies.

The consolidation wave is raising red flags among some regulators, researchers and health insurers, who warn that bigger health systems can use their leverage to push for higher rates. "We've always been concerned about combinations that are being done to increase prices," said Karen Ignagni, chief executive of America's Health Insurance Plans.

The American Hospital Association's chief executive, Richard Umbdenstock, said in a statement that "the goal of these new care arrangements is to produce real benefits and improve quality for patients" and that "there is plenty of federal and state oversight to ensure just that."

William F. Jessee, chief executive of the medical group association—which has 21,500 members, who are typically managers of medical groups—said he expected to see "more physicians selling out to hospitals." The survey included 2,348 practices both among the association's own members and outside and was conducted in January, February and March. The association warns that the survey wasn't focused on pinning down exact ownership numbers.

For their part, hospitals often aim to guarantee revenue. The surgeries and other care that employed doctors perform or order up will generate billing for that hospital, while independent physicians may be affiliated with multiple hospitals. "They want to essentially lock in volume, inpatient and outpatient," said Paul Mango, a director at consulting firm McKinsey & Co.

St. Luke's Hospital in Duluth, Minn., bought a local primary-care practice two years ago. It hired 20 doctors this year and is now planning to add more in the next two years, while searching for an additional 27 in specialties. "You need patients to support your facilities, and doctors bring patients," said John Strange, chief executive of the not-for-profit hospital, which has 267 beds and currently employs around 180 doctors.

Adding to the incentive, some procedures are paid more richly if done in a hospital than in a doctor-owned clinic. If doctors are employed by hospitals, this extra money can be figured indirectly into their compensation. Under anti-kickback laws, they still can't be rewarded directly for ordering services such as imaging tests that are lucrative for the hospital but may not be needed.

Punch Drunk

Star-Tribune

A highly potent, caffeine-laced cocktail-in-a-can is on the radar at the U and other campuses.

 

 

What looks like an energy drink, tastes like fruit punch and packs the alcohol wallop of five shots?

A new crop of caffeinated booze beverages that is raising concerns coast to coast and sending some people, many of them college students, to emergency rooms with alcohol poisoning.

Four Loko, a caffeinated malt liquor that has been dubbed "blackout in a can," made headlines last month when nine freshmen at Central Washington University were hospitalized after drinking it at a party.

Several schools have since banned alcohol energy drinks on campus, and Harvard University last week issued an e-mail warning to students, urging them not to drink Four Loko or similar drinks. On Thursday, Michigan banned alcohol-infused energy drinks. And the Food and Drug Administration is reviewing their safety.

That some college students experiment with alcohol -- and sometimes overdo it -- is hardly a news flash.

But what troubles some about Four Loko and similar beverages is the potent combination of sugar, caffeine and alcohol in one dose. Four Loko contains 12 percent alcohol, about the same as wine, but while wine is typically served in a 5-ounce glass, Four Loko comes in a 23.5-ounce can.

"It's the equivalent of 4.7 standard drinks -- like five beers or five shots in a can," said Dana Farley, associate program director at the University of Minnesota's Boynton Health Service.

The malt liquor beverage comes in sweet, fruity flavors like watermelon and lemonade, and includes trendy ingredients like taurine and guarana, popular in energy drinks, in addition to caffeine.

"The sweetness masks the taste of the alcohol, and the caffeine masks the effects of the alcohol," Farley said. "My concern is that novice drinkers -- many first-year students -- may drink Four Loko thinking they're having a drink or two without realizing that, in fact, they're having five to 10 drinks."