With consumer premiums continuing to rise and doctors' reimbursement continuing to decrease, perhaps its not healthcare reform we need. Perhaps what we really need is insurance reform as the industry continues to report windfall profits at the expense of patients and their doctors.

One in Five Struggles to Pay Medical Bills

By Emily P. Walker, Washington Correspondent, MedPage Today Published: December 29, 2011

WASHINGTON -- One American in five reported having trouble paying medical bills in 2010, according to a study by the Center for Studying Health System Change. That proportion didn't change much from 2007 to 2010 -- a somewhat surprising finding, according to the study authors, given that the period was the peak of the economic recession. "Given the recession, the sluggish recovery, and healthcare costs continuing to increase faster than incomes, it's a bit surprising that the rate of medical bill problems didn't increase," Anna Sommers, PhD, co-author of the study, said in a press release. One reason may be that people cut back on medical services -- such as visiting a doctor -- during the recession, something that other studies have confirmed. On the other hand, compared with 2003, the percentage of families with problems paying medical bills in 2010 was significantly higher (15% versus 21%). That increase reflects the rise in the cost of healthcare, which grew faster than salaries and the U.S. economy as a whole, wrote Sommers and co-author Peter Cunningham, PhD. The findings came from the center's 2010 Health Tracking Household telephone survey of a nationally representative sample of 17,000 people. Respondents were asked, "During the past 12 months, have you or your family had any problems paying medical bills?" Among the 21% of people who reported having trouble, the average medical debt for the family was $6,500. More than half of respondents in that group expected it to take more than a year to pay off the bills; 17% said paying down their medical debt would take longer than five years. There were no statistically significant changes in the amount of per-family debt reported from 2007 to 2010. The study found that people without insurance were more likely to have bill-paying problems than people with insurance (31.5% vs. 20.2%). The study also found that among insured people, 9.2% of those who had problems paying medical bills reported not meeting their medical needs because of cost concerns. The study showed that the proportion of people 65 and older with medical bill problems rose from 6.9% in 2003 to 10.3% in 2010, even though people in that age group were eligible for Medicare. Almost all people who reported having problems paying their medical bills reported having "serious financial consequences" as a result. In all, 66% of respondents said medical bills caused them to be unable to buy other necessities; 52% said they had to postpone a major purchase; half borrowed money; nearly two-thirds took money out of savings; and nearly two-thirds were contacted by a collection agency. The study authors said that the Affordable Care Act (ACA) is likely to reduce, but not eliminate, financial pressures of paying for medical bills, especially for families with incomes below 400% of the poverty level. As a result of the ACA, starting in 2014, people who earn less than 133% of the federal poverty level will be able to enroll in Medicaid, and those who are between 133% and 400% of the poverty level will be eligible for tax credits from the federal government to help them buy health insurance. Whether Americans will continue to struggle to pay medical bills likely will depend on growth in healthcare spending, the authors concluded. "If wages continue to stagnate and health care costs continue to grow faster than real income, the financial burden of health care likely will grow more acute," Sommers and Cunningham concluded. The study performed by the Center for Health System Change, which is affiliated with Mathematica Policy Research and based in Washington DC. It was funded by the Robert Wood Johnson Foundation.

From the category of "News You Should Know" comes this report of two deaths occurring from using tap water to sinus cleanse. But maybe its just that Bayou water.

'Brain-Eating' Amoeba Kills Second Neti Pot User

By Cole Petrochko, Associate Staff Writer, MedPage Today Published: December 17, 2011 Louisiana state health officials are warning patients about potential dangers of using tap water in the sinus-irrigating neti pot after two patients died of Naegleria fowleri infection. N. fowleri is known as a "brain-eating" amoeba because it can enter a patient's nose, infect the brain, and cause primary amebic meningoencephalitis (PAM), a brain-tissue destroying condition. The first Louisiana patient died of neti pot-induced infection in June. An additional two patients died of N. fowleri infection in August after swimming in warm, fresh water. The amoeba usually infects patients that submerge their heads in freshwater lakes and rivers, though it can be transmitted through inadequately chlorinated pool water or underheated (less than 116°F) tap water that enters a patient's nose, a statement from the Louisiana Department of Health and Hospitals said. Patients that irrigate their noses with a neti pot should use distilled, sterile, or previously boiled water, Raoult Ratard, MD, a Louisiana state epidemiologist, said in the statement. He noted that tap water was safe to drink, but may not be safe for nasal cleansing. Symptoms of PAM include headache, fever, nausea, vomiting, and stiff neck, and may take one to seven days to start. Later symptoms include confusion, lack of attention to environment, loss of balance, seizures, hallucinations, and, in one to 12 days after infection, death. The disease progresses rapidly and symptoms may resemble bacterial meningitis, the statement warned. N. fowleri infection is rare in the U.S. -- only 32 cases have been documented from 2001 to 2010, according to the CDC website. The agency also noted that patients should rinse devices like the neti pot after use and to allow it to air dry. The CDC is actively working with Louisiana state health officials on the investigation, an agency representative told MedPage Today.

According to this researcher (with ties to the biopharma industry), individual vitamins play little role in helping to prevent strokes, while improved nutritional intake is of benefit.

Vitamin, Diet Link to Stroke Risk Assessed

By Kristina Fiore, Staff Writer, MedPage Today Published: December 12, 2011 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco. There's little that individual vitamins and nutrients can do to prevent stroke, but overall healthier diets may lower the risk, an Australian researcher found. In a review, neither antioxidant vitamins nor B-vitamins were associated with stroke prevention, but a healthy diet, such as the Mediterranean diet, did appear to diminish risk, Graeme Hankey, MD, of Royal Perth Hospital in Australia, reported in The Lancet. "The overall quality of an individual's diet and balance between energy intake and expenditure seem to be more important determinants of stroke risk than individual nutrients and foods," he wrote. Hankey reviewed the literature on individual vitamins, nutrients, foods, and overall diets and their effects on stroke risk.     Vitamins & Minerals Randomized trials have shown that beta-carotene, the biologically active metabolite of vitamin A, won't prevent stroke; in fact, it appears to up the risk of all-cause and cardiovascular death. Similarly, large randomized controlled trials have shown that vitamins C and E won't prevent stroke, either, Hankey reported, adding that vitamin E may even increase the risk of death. Calcium could also increase the risk of stroke, and trials have shown that it may increase the risk of heart attack by 31%. While B-vitamins reduce stroke risk, he found, in places with low folate intake, treating deficiency may lower stroke risk. Similarly, vitamin D deficiency is also associated with a higher stroke risk, as well as other related factors such as hypertension and cardiovascular disease. The relationship between stroke risk and sodium and potassium intake is a bit clearer; high salt intake -- about 5 g per day -- has been associated with a 23% increased risk of stroke in observational studies, and also carries clear heart disease risk, Hankey said. At the same time, upping potassium intake could diminish risk, he reported. Studies have shown a 21% lower risk of stroke with a higher intake of the mineral, and the benefits may come through its ability to help lower blood pressure. Macronutrients Patients who eat a lot of fat overall don't appear to be at a heightened risk of stroke, Hankey reported. In fact, a high intake of the vilified trans- or saturated fats doesn't appear to up the risk. But polyunsaturated omega-3 fatty acids from marine life have been shown to reduce the risk of heart events and death, and those found in plants have been shown to diminish stroke risk. Eating lots of carbohydrates has been associated with other poor outcomes that could be related to stroke risk, such as higher blood sugar levels and increased body weight, but high fiber intake appears to lower risk factors such as blood pressure and cholesterol. Hankey added that there are no ties between protein and stroke. Foods When it comes to specific foods, a few have been repeatedly linked with a lower risk of stroke, such as chocolate, coffee, and tea. Cocoa, for instance, may be protective via its antihypertensive or anti-inflammatory properties, Hankey wrote. One major stroke risk trial, INTERSTROKE, found that greater intakes of fish and fruit were each associated with a lower risk of stroke, while a handful of observational studies have shown that eating too much meat may up the risk of ischemic stroke. It's not clear, however, whether the type of meat, be it red or processed, for instance, has a specific effect on stroke risk, he added. Finally, while not directly related to stroke risk, sugary drinks have been linked with several other risk factors, including adiposity, metabolic syndrome, diabetes, and heart disease. But whole grains, on the other hand, can protect against heart events. Diets There have been some conflicting results as to whether a "healthy" diet can diminish stroke risk -- depending on how that diet is defined, Hankey wrote. The Women's Health Study, which defined a healthy diet as one with high fiber, folate, and omega-3 intake paired with low consumption of bad fats, was associated with a higher risk of stroke over 10 years, but the Nurses' Health Study and the Health Professionals' Follow-Up found that a diet high in fruits, vegetables, and fiber and low in fat and red meat was associated with a lower risk of stroke. Yet other studies have shown that unhealthy "Western" diets are clearly associated with an increased risk of stroke, Hankey reported. Two popular healthy diets -- the DASH diet (which focuses on reducing hypertension) and the Mediterranean diet -- have been shown to reduce stroke risk, and the latter has also been shown to diminish heart disease and death. Malnutrition Though overnutrition has clearly been associated with an increased risk of stroke -- likely through its effects on obesity, hypertension, hyperlipidemia, and diabetes -- poor nutrition can also play a role in risk, Hankey wrote. Observational studies have suggested that malnutrition in the first year of a woman's life may ultimately be associated with a greater risk of stroke in her offspring, and malnutrition in childhood can up the risk of stroke later in life as well. Hankey noted that findings of the many studies on stroke risk are diverse because the majority of them are epidemiological and subject to limitations. Thus, he called for further research to improve the quality of evidence relating to the association of nutrients, foods, and dietary patterns with stroke risk. Hankey was the principal investigator of the VITAmins TO Prevent Stroke (VITATOPS) trial. He reported relationships with sanofi-aventis, Johnson & Johnson, Bristol-Myers Squibb, Boehringer Ingelheim, Bayer, and Pfizer.

As difficult as it may be at times, the public needs to discern between facts of health claims and marketing spin, particularly when it comes to weight loss products.

FDA Yanks HCG Weight-Loss Agents from Market

By John Gever, Senior Editor, MedPage Today Published: December 06, 2011

The FDA and the Federal Trade Commission said over-the-counter weight-loss products containing human chorionic gonadotropin (HCG) are fraudulent and illegal, and the agencies have told seven manufacturers to stop selling them. Noting that the product labels call for the pellets, liquids, and sprays to be taken in conjunction with a very low-calorie diet, an FDA official said it did not appear that oral HCG offers any extra benefit. "There is no substantial evidence HCG increases weight loss beyond that resulting from the recommended caloric restriction," said Elizabeth Miller, acting director of the FDA's fraud unit for OTC products, during a conference call with reporters. The recommended diets call for daily calorie intake as low as 500 calories, low enough to create a risk of malnutrition, electrolyte imbalance, cardiac arrhythmias, and gallstone formation, Miller said. The warning letters sent to manufacturers of the products note that HCG has not received FDA approval for any weight-loss indication. The substance is approved as an injectable drug for certain forms of female infertility and is therefore clearly subject to FDA regulation. HCG weight-loss products are typically sold over the Internet, often promoted with unsolicited "spam" emails, with such claims as "Lose 26 pounds in 26 days" and "Resets your metabolism." According to one of the letters, sent to HCG Diet Direct of Tucson, Ariz., "The claims made on your product labeling and website ... clearly demonstrate that this product is a drug as defined" by federal law. The companies have 15 days to inform the FDA of the steps they have taken to correct the violations. Theoretically, the firms could seek FDA approval for the weight-loss claims, but the agencies expect that they will simply stop selling the products. If the companies do not do so voluntarily, the FDA and FTC threatened to forcibly halt their operations. Many of these products are labeled as homeopathic remedies, but they are illegal whether the word "homeopathic" is used or not, said Richard Cleland, assistant director of the FTC's advertising practices division. If the product is marketed or meets federal standards to qualify as a drug, but is not FDA approved, it cannot be sold legally, Cleland said. Officials from both agencies were unable to estimate how many people have bought HCG weight-loss products, but Cleland said they were the current hot item in the lose-weight-fast category. "Four years ago, the miracle weight-loss ingredient was Hoodia gordonii, and then it was acai berry, and now it's homeopathic HCG," he said. "Almost more than any other, the weight-loss industry is fad-driven," he added. "Unfortunately, all too often, it is also fraud-driven." The seven companies receiving the warning letters, in addition to HCG Diet Direct, included Nutri Fusion Systems, Natural Medical Supply (doing business as HCG Complete Diet), HCG Platinum, Theoriginalhcgdrops.com, and HCG-miracleweightloss.com. The FDA and FTC emphasized that the letters were a "first step in halting sale" of HCG weight-loss remedies. Other companies that market such products "should also read these letters carefully and take appropriate action," Cleland said.

Your son or daughter may not want to hear this, but they spend too much time sitting in front of the computer or playing video games....and not enough time in physical activities.

Study Finds Benefit for Mandatory Gym Classes

By Michael Smith, North American Correspondent, MedPage Today Published: December 05, 2011 Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Schoolchildren are not getting enough physical activity during the school day, largely because few states require it, researchers reported. In a cross-sectional analysis of nearly 1,800 schools in 47 states, only 6% of states required a daily recess period, according to Sandy Slater, PhD, and colleagues at the University of Illinois at Chicago. And only 13% of states required that students get the recommended 150 minutes a week of physical education, Slater and colleagues reported online in Archives of Pediatrics & Adolescent Medicine. Despite the lack of strong state policies, Slater and colleagues reported, 69.9% of the 1,761 schools in the sample reported daily 20-minute recess periods.  But just 17.9% reported offering at least 150 minutes a week of physical education, as recommended by the National Association for Sport and Physical Education and the American Heart Association. And the two forms of activity – recess and physical education – appear to be inversely associated, Slater and colleagues found: schools that offered one were only half as likely to offer the other. The findings come from a nationally representative survey of public schools that, in order to account for different grade compositions, all included a third grade. Principals were asked about the school's physical education and recess policies, including what barriers prevented them from meeting recommendations. The researchers used legal databases to pin down state policies. In a multivariate analysis, the odds of schools having 150 minutes a week of physical education rose if they were in states whose policies required it. The odds ratio was 2.8 with a 95% confidence interval from 1.3 to 5.7. As well, the researchers reported, schools in states with laws encouraging daily recess were significantly more likely to offer 20 minutes of recess a day. The odds ratio was 1.8, with a 95% confidence interval from 1.2 to 2.8. Interestingly, state laws requiring daily recess were not associated with what happened in the schools, perhaps because only three states had such a law, Slater and colleagues reported. The researchers also found evidence that schools are trading off the two types of physical activity: If a school offered daily recess, the odds ratio for also offering physical education was 0.5, with a 95% confidence interval from 0.4 to 0.6. And if a school offered at least 150 minutes a week of physical education, the odds ratio for daily recess was also 0.5, but with a slightly wider 95% confidence interval from 0.4 to 0.7. Slater and colleagues cautioned that the analysis was a snapshot and doesn't address cause and effect. As well, they noted, there is a possibility of response bias because of the self-reported data from school principals. The study also has no data on what sorts of physical activity actually take place during recess or physical education or on outcomes such as body mass index, they noted. It's to be expected that strong state and local policies in favor of physical education and recess will be associated with schools actually offering both forms of activity, according to Kristine Madsen, MD, of the University of California San Francisco. But an open question, she noted in an accompanying editorial, is why so few states have such policies, especially since there is growing evidence that "lack of physical activity may be a far greater public health problem than obesity." She added that it is "concerning" that recess and physical education appear to compete with each other. "While schools appear to use (physical education) and recess somewhat interchangeably," she argued that they "make unique and separate contributions." The study was supported by the Robert Wood Johnson Foundation and the National Institute on Child Health and Human Development. The journal said the authors made no disclosures. The journal said Madsen made no disclosures. Primary source: Archives of Pediatrics & Adolescent Medicine Source reference: Slater SJ, et al "The impact of state laws and district policies on physical education and recess practices in a nationally representative sample of US public elementary schools" Arch Pediatr Adolesc Med 2011; DOI: 10.1001/archpediatrics.2011.1133. Additional source: Archives of Pediatrics & Adolescent Medicine Source reference: Madsen K "Promoting the health of our youth: Why physical activity policies are critical" Arch Pediatr Adolesc Med 2011; DOI: 10.1001/archpediatrics.2011.1245.

Eating healthy should be a goal for all people as its benefits are enormous in helping to ward off disease while aiding one to remain productive throughout a lifespan.

RSNA: A Fish a Week Keeps the Brain at Its Peak

By Kristina Fiore, Staff Writer, MedPage Today Published: November 30, 2011 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

CHICAGO -- Eating fish at least once a week could help lower older patients' risk of developing dementia, researchers said here. Those who ate baked or broiled -- but not fried -- fish on a weekly basis had a greater volume of gray matter in areas of the brain associated with Alzheimer's disease than people who didn't eat fish as often, Cyrus Raji, MD, PhD, of the University of Pittsburgh, and colleagues reported at the Radiological Society of North America meeting here. Preserving brain volume was also associated with lower rates of developing cognitive impairment, he said. "Fish consumption benefits gray matter volume, potentially reducing the risk of [Alzheimer's disease and dementia] long-term," Raji said during a press briefing. Although a National Institutes of Health panel decided last year that nothing conclusively prevents Alzheimer's disease, researchers continue to investigate whether a healthy diet, or specific components thereof, can have any beneficial effects. For their study, Raji and colleagues assessed 260 people, mean age 71, when they enrolled in the Cardiovascular Health Study between 1989 and 1990. At that time, they filled out questionnaires on dietary intake; 163 reported eating fish at least weekly, and some did so as often as four times a week. All patients had an MRI 10 years later to assess brain volume, and then had follow-up cognitive testing between 2002 and 2003. The researchers found that patients who ate fish at least once a week had greater volume in the frontal lobes and the temporal lobes, including the hippocampus and the posterior cingulate gyrus – "areas responsible for memory and learning, which are severely affected in Alzheimer's disease," Raji said. Five years after the MRI, they found that 30.8% of patients who had low fish intake had developed mild cognitive impairment or dementia, compared with just 3.2% of those who had the highest fish intake and the greatest preservation of brain volume. They also saw that 47% of patients with brain atrophy who didn't eat fish had abnormal cognition five years later compared with 28% of those who ate more fish and had more gray matter volume, Raji reported. "That's an impressive reduction in the risk of developing mild cognitive impairment of Alzheimer's," Raji said. In further analyses, the researchers found that mean scores for working memory -- a function severely impaired in Alzheimer's disease -- were significantly higher among those who ate fish weekly (P=0.02), and those findings persisted even after accounting for potential confounders (P=0.03). This "simple lifestyle choice" of eating more fish increases the brain's "resistance" to Alzheimer's disease, Raji said, potentially via a few mechanisms: Fish are rich in omega-3 fatty acids, which can help increase blood flow to the brain and can also act as an antioxidant, thereby reducing inflammation, he said. Omega-3s may also prevent the accumulation of amyloid plaques in the brain, he added. He noted that fatty fish like salmon have more omega-3s, while smaller fish, such as cod, have less. Although dietary intake of fish was measured only twice -- once at baseline and again in 1995 -- Raji said patients tended to maintain their levels of consumption, and he suspects that the observed benefits "are more likely to be observed if eating fish is a long-term habit as opposed to a short-term approach." Mary Mahoney, MD, of the University of Cincinnati, who was not involved in the study, told MedPage Today that future studies should investigate whether omega-3s specifically are leading to benefits in brain volume. "We're making the assumption" that fish is a marker for healthy lifestyle, she said. "If we could just cut to the chase and look at the protective mechanism, that would be better." Zaven Khachaturian, PhD, an Alzheimer's expert from Potomac, Md., told MedPage Today that the findings are preliminary and should be replicated in a larger sample. "It would be safe to say that this study provides another hypothesis about the possible beneficial effect of a diet rich in fish ingredients and a delay of cognitive decline," Khachaturian said. The study was supported by grants from the NHLBI, NIA, AHA, and RSNA. The researchers reported no conflicts of interest.

Primary source: Radiological Society of North America Source reference: Raji C, et al "Fish consumption, brain structure, and risk of Alzheimer's disease" RSNA 2011.