Healthcare - always an issue during an election year - has even the New England Journal of Medicine presenting comments by presidential candidates Obama and Romney

Obama vs. Romney on Healthcare in NEJM

By Peggy Peck, Editor-in-Chief, MedPage Today

Published: September 26, 2012

 

Less than a week after they co-starred on TV's "60 Minutes," President Barack Obama and Governor Mitt Romney delivered another "showdown" with dueling commentaries on the Affordable Care Act, published online Wednesday by the New England Journal of Medicine.

The statements came in response to a request from NEJM editors asking the candidates to "describe their healthcare platforms and their visions for the future of American healthcare."

Not surprisingly, the statements were long on sound bites and light on details.

The president made a case for "Obamacare" -- and he, too, used that term in his statement, saying he doesn't mind the term because "I do care."

Romney pledged to repeal Obamacare and replace it with "common-sense, patient-centered reforms suited to the challenges we face."

If re-elected, Obama said his priorities will include:

• A permanent fix for "Medicare's flawed payment formula that threatens physicians' reimbursement"
• Medical malpractice reform that doesn't include "placing arbitrary caps that do nothing to lower the cost of care"
• Support of clinical research.

Moreover, he wrote, "I will keep Medicare and Medicaid strong, working to make the programs more efficient without undermining the fundamental guarantees."

Romney said he will control and reduce healthcare costs by offering incentives to do so to everyone, "providers, insurers, and patients." He did not, however, offer many specifics about those incentives, but he did call for changes in the tax code as well as strengthening and expanding "health savings accounts" and establishing "strong consumer protections."

A Romney-Ryan administration would not propose any changes to Medicare for current beneficiaries or for those who would be enrolling in the next 10 years, Romney wrote, but future beneficiaries would be covered through a means-tested premium support program.

Romney also pledged support of "those who cannot afford the care they need."

"We will provide support for low-income Americans and those uninsured persons whose preexisting conditions push the cost of coverage too high for them to pay themselves. But my experience as a governor and the lessons from the president's attempt at a one-size-fits-all national solution convince me that it is states -- not Washington -- that should lead this effort. I will convert Medicaid into a block grant that properly aligns each state's incentives around using resources efficiently. Each state will have the flexibility to craft programs that most effectively address its challenges -- as I did in Massachusetts, where we got 98% of our residents insured without raising taxes."

The health reform plan in Massachusetts, "Romneycare," has often been cited as a model for the Affordable Care Act, particularly in its implementation of an individual mandate.

Primary source: New England Journal of Medicine

Source reference:
Obama, B "Securing the future of American health care" This article was published on Sept. 26, 2012, at NEJM.org.

Additional source: New Enland Journal of Medicine
Source reference:
Romney, M "Replacing Obamacare with real health care reform" This article was published on Sept. 26, 2012, at NEJM.org.

Perhaps not so surprising, in a study funded by the makers of yogurt and cranberry juice, it was found that yogurt, cranberry juice and rice/bran oil all help to lower blood pressure.

Medscape Medical News from the:

• High Blood Pressure Research (AHABP) 2012 Scientific Sessions
  

This coverage is not sanctioned by, nor a part of, the American Heart Association.

From Heartwire > Conference News

Food Fighters: Yogurt, Cranberries, Rice/Bran Oil Lower BP

Lisa Nainggolan

September 20, 2012 (Washington, DC) — Including foods such as low-fat yogurt, sesame/rice-bran oils, and low-calorie cranberry juice in the diet can help keep blood pressure under control, according to three new studies presented as posters at the American Heart Association High Blood Pressure Research 2012 Scientific Sessions , this week [1,2,3]. And the rice/bran oil also helped lower LDL cholesterol and triglycerides and increased levels of HDL cholesterol, the meeting heard.

Asked to comment on the findings for heartwire , chair of the AHA's nutrition committee Dr Rachel Johnson (University of Vermont, Burlington) said: "These results, the three abstracts together, very much reinforce the DASH diet--which the AHA supports--as an effective dietary intervention to lower blood pressure and a heart-healthy way to eat."

DASH recommends two to three servings of fat-free or low-fat milk and milk products per day, four to five servings of fruit a day, and two to three servings of "healthy" fats and oils, "and certainly sesame/rice-bran oil, which contains polyunsaturated fatty acids and is rich in antioxidants, would be classified as a healthy fat," she observes.

Yogurt: Keep It Low in Fat and Sugar 
 
The yogurt research was presented by Dr Huifen Wang (Tufts University, Boston, MA), who together with colleagues examined the effects of consuming low-fat yogurt in just over 2000 adults participating in the Framingham Heart Study Offspring Cohort. Participants, who did not have hypertension at baseline, were said to be "consumers" if they ate one or more servings of yogurt per month, as noted by a food frequency questionnaire. Of those in the study, 44% were yogurt consumers at the beginning, and this increased over the 14 years of follow-up. There were 913 people who developed incident hypertension over the course of the study.

Yogurt can be an effective way to add milk or dairy products to your diet.

 

Those who ate >2% of total calories from yogurt (the high-intake group, representing one six-ounce cup of low-fat yogurt every three days) had about a 30% lower risk of incident hypertension than nonconsumers (OR 0.69, after adjustment for demographic and lifestyle factors and cholesterol medication use). The high-intake group also had 0.19-mm-Hg smaller annualized elevation of systolic BP than nonconsumers (p=0.04).

Johnson says: "Yogurt can be an effective way to add milk or dairy products to your diet, because many people do not come close to meeting those recommendations for two to three servings per day. The yogurt study reinforces what we already know about the role of dairy products." However, she cautions that care must be taken regarding the amount of sugar in yogurt: "We know that added sugars have the opposite effect on BP, so you need to watch the amount of sugar, and some yogurts are high in sugar."

Cranberry Juice an Option for a Fruit or Vegetable Portion 
 
In a second study, researchers from the US Department of Agriculture, led by Dr Janet A Novotny, gave low-calorie cranberry juice or a color/flavor/calorie-matched placebo beverage to 56 adult volunteers, incorporated into a controlled diet for eight weeks. At the end of the study, when BP values were compared with baseline, cranberry juice was associated with a significant decrease in diastolic BP (p=0.049) and a trend toward decreased systolic BP, while the placebo was associated with no change from baseline.

You can use cranberry juice or cranberries, which are rich in potassium and antioxidants, to meet that recommendation to eat plenty of fruits and vegetables.

 

Johnson observes that this was "a small study" and some key details are missing, such as the amount of cranberry juice consumed. Nevertheless, "It does show that you can use cranberry juice or cranberries, which are rich in potassium and antioxidants, to meet that recommendation to eat plenty of fruits and vegetables," she says. She notes also that low-calorie cranberry juice was employed in this study, "which I would certainly recommend. Cranberries are quite sour tasting, so they really do need to be sweetened to make them palatable, and full-calorie cranberry juice can be quite high in added sugars."

Blend of Sesame/Rice-Bran Oil Drops BP and Improve Lipids
 
Finally, Dr Devarajan Sankar (Fukuoka University Hospital, Fukuoka, Japan) and colleagues conducted a prospective, randomized open-label dietary-intervention study in 300 hypertensive patients in New Delhi, India, randomizing them to one of three groups: the calcium-channel blocker (CCB) nifedipine 30 mg/day; 35 g/day of a blend of sesame and rice-bran oil (trademark Vivo); or nifedipine plus sesame-oil blend for 60 days.

The CCB, sesame oil, and combination of the two induced significant falls in systolic BP (-16.2 mm Hg, -14 mm Hg, and -36 mm Hg, respectively) and in diastolic BP (-12 mm Hg, -10.8 mm Hg, and -23.8 mm Hg), respectively, over the course of the study. The combination resulted in such a remarkable drop in BP that the dose of nifedipine had to be reduced. And those using the oil saw a 26% fall in LDL and a 9.5% increase in HDL cholesterol.

"We have demonstrated, for the first time, that dietary interventions with blends of sesame and rice-bran oils lower BP and lipids in hypertensive individuals," say Sankar et al. However, they note that further studies of the oil--which was made specifically for this study and is not marketed commercially--are needed.

The yogurt study was funded by a research grant from Dannon and the cranberry study by Ocean Spray Cranberries. Sankar et al report no conflicts of interest.

Though its difficult learning how to get your baby to fall asleep on its own, a new study demonstrates that there is little harm in your child crying him/herself to sleep.

'Crying' to Sleep Safe for Babies

By Crystal Phend, Senior Staff Writer, MedPage Today

Published: September 10, 2012

 

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

 

Behavioral techniques for getting babies to sleep by themselves, such as camping out in the child's room initially, can be effective without any long-term downside for parents or children, clinical trial follow-up showed.

 

Sleep problems at age 6 weren't significantly more common among kids trained to go to bed with such methods as infants (9% versus 7% among controls, P=0.2), reported Anna M.H. Price, PhD, of the Royal Children's Hospital in Parkville, Australia, and colleagues.

The training didn't leave kids more distant from their parents or emotionally damaged, the group stated in the October issue of Pediatrics.

"Parents and health professionals can confidently use these techniques," they suggested.

The trial originally showed that "camping out" to get kids to fall asleep and "controlled comforting" to teach them to settle down on their own by gradually lengthening intervals at which parents respond to crying did improve infants' sleep and cut maternal depression by 60%.

Because of worries about long-term harm if parents don't consistently respond to their child -- as noted by the distress caused by an older technique that called for parents to let children "cry it out" without responding at all -- the researchers followed children into the school years.

Of the 328 families randomized to behavioral training or usual care for infant sleep problems reported at well-child visits by parents when the child was 7-months-old, 225 participated in the study for assessment around the child's sixth birthday.

For the primary outcomes, the intervention group didn't show poorer scores on children's emotional or conduct behavior (P=0.8 and P=0.6, respectively).

Likewise, the population-based study showed no differences between groups at age 6 for the following outcomes:

• Sleep habits (P=0.4)
• Parent-reported psychosocial functioning (P=0.7)
• Child-reported psychosocial functioning (P=0.8)
• Chronic stress as measured by saliva cortisol levels on a non-school day (29% versus 22%, P=0.4)
• Child-parent closeness (P=0.1)
• Conflict between parent and child (P=0.4)
• Overall quality of the relationship between parent and child (P=0.9)
• Disinhibited attachment (P=0.3)
• Depression, anxiety, and stress scores in the mother (P=0.9)
• Authoritative parenting, viewed as the optimal parenting style with warmth and control (63% versus 59%, P=0.5)

Although there weren't lasting benefits, the lack of harm suggested the techniques are safe, the researchers concluded.

They cautioned that loss to follow-up of about a third of families meant the study couldn't rule out small harms or benefits long term.

"Nonetheless, the precision of the confidence intervals make clinically meaningful group differences unlikely," they wrote.

The inclusion of only English speakers in largely more advantaged families might limit generalizability to other settings, they noted.

"Along with trials like ours demonstrating that sleep problems can be effectively treated in older infants, recent efficacy trials for children younger than 6 months suggest that parent education programs that teach parents about normal infant sleep and the use of positive bedtime routines could effectively prevent later sleep problems," they wrote.

The Infant Sleep Study was funded by the Australian National Health & Medical Research Council Project and the Pratt Foundation. The follow-up Kids Sleep Study was funded by the Foundation for Children and the Victorian Government's Operational Infrastructure Support Program.
The researchers all reported financial support from the Foundation for Children.

Primary source: Pediatrics
Source reference:
Price AMH, et al "Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial" Pediatrics 2012; 130: DOI: 10.1542/peds.2011-3467.

Once again another clinical trial demonstrates that the supplement ginkgo biloba is ineffective in preventing Alzheimer's Disease.

Forget About Ginkgo to Ward Off Alzheimer's

By Kristina Fiore, Staff Writer, MedPage Today

Published: September 05, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

 

 

Yet another large trial has failed to find long-term ginkgo biloba supplements effective at preventing Alzheimer's disease.

 

In a randomized, controlled trial of elderly patients who had complaints about their memory -- but no overt dementia -- there were no significant differences in the number of patients who progressed to dementia over 5 years whether they were taking ginkgo or placebo, Bruno Vellas, MD, of Hopital Casselardit in Toulouse, France, and colleagues reported in The Lancet Neurology.

Ginkgo has been used in some countries by patients with cognitive disorders, and its plausible mechanisms of action for brain benefits include antioxidant effects and potential inhibition of caspase-3 activation and amyloid-beta aggregation, the researchers wrote.

Yet several studies -- including the Ginkgo Evaluation of Memory trial reported in 2008 -- haven't been able to demonstrate that the plant extract can prevent dementia. Indeed, the entire field of prevention of Alzheimer's disease is lacking, with little effects seen for various therapies including hormone replacement therapy, NSAIDs, vitamins, and cholinesterase inhibitors, the researchers noted.

To further assess ginkgo's effects, Vellas and colleagues conducted the GuidAge trial of adults, ages 70 and up, who were free of dementia but reported memory complaints to their primary care doctors in France.

A total of 2,854 patients were enrolled between March 2002 and November 2004 and randomized to placebo or to 120 mg of ginkgo biloba extract twice a day.

Patients were followed for a median of 5 years, with 2,487 completing the trial.

Overall, the researchers found no significant difference in the proportion of patients who developed dementia over those 5 years: 61 in the ginkgo arm and 73 in the placebo group (HR 0.84, 95% CI 0.60 to 1.18, P=0.306).

That translated to a similar incidence of probable Alzheimer's disease: 1.2 per 100 person-years in the ginkgo group compared with 1.4 per 100 person-years in the placebo group.

Nor were there significant differences in diagnoses of pure Alzheimer's or mixed dementia: 70 among those on ginkgo and 84 among those on placebo, for a rate of 1.4 per 100 person-years and 1.6 per 100, respectively (P=0.267).

Also, the incidence of adverse events was similar between groups:

• Death: 76 for ginkgo, 82 in placebo (HR 0.94, 95% CI 0.69 to 1.28, P=0.68)
• Stroke: 65 for ginkgo, 60 in placebo (RR 1.12, 95% CI 0.77 to 1.63, P=0.57)

There were no differences in the incidence of other hemorrhagic or cardiovascular events, either, they added.

The study was limited because the number of dementia events was much lower than expected, leading to a lack of statistical power to detect effects, the researchers noted. There was also some evidence of selection bias, as those who chose to participate had a higher level of education than the general elderly population.

In an accompanying editorial, Lon Schneider, MD, of the University of Southern California in Los Angeles, wrote that more than 10,000 patients have now been involved in clinical trials of ginkgo biloba with no reported benefits.

"The GuidAge trial adds to the substantial evidence from the Ginkgo Evaluation of Memory trial ... that ginkgo biloba does not prevent dementia in elderly individuals with or without memory complaints or cognitive impairment and is not effective for prevention of Alzheimer's disease," Schneider wrote.

"It would be unfortunate if users of ginkgo biloba, nevertheless, are led to believe that the extract prevents the dementia. Some users will rationalize that, in the absence of effective treatments, ginkgo biloba could still possibly help, and appearing safe, will not harm them," he added.

But other users, he wrote, "might now consider letting it go."

Nikos Scarmeas, MD, from Columbia University Medical Center in New York City, said in an email to MedPage Today that the trial was "very well designed and executed" with a "long enough follow-up to see conversion."

When asked about the dearth of preventive strategies for Alzheimer's, Scarmeas acknowledged that there's little advice for Alzheimer's prevention. But "with an increasing number of scientists and researchers in the field and commitment and investment from society, we can be hopeful it will change in the future," he said.

The study was supported by Ipsen, producer of ginkgo biloba extract.
Two researchers are employees of Ipsen.
Scheider reported relationships with Ipsen and Schwabe, both makers of ginkgo extract. He also reported relationships with Baxter, Genentech, Johnson & Johnson, Eli Lilly, Novartis, Pfizer, Abbott Laboratories, AC Immune, Allon, AstraZeneca, Bristol-Myers Squibb, Elan, Exonhit, GlaxoSmithKline, Lundbeck, MedAvante, Merck, Roche, Sanofi, Servier, Takeda, Toyama, and Zinfandel.

Primary source: The Lancet Neurology
Source reference:
Vellas B, et al "Long-term use of standardized ginkgo biloba extract for the prevention of Alzheimer's disease (GuidAge): A randomized placebo-controlled trial" Lancet Neurol 2012; DOI: 10.1016/S1474-4422(12)70206-5.

Additional source: The Lancet Neurology
Source reference:
Schneider LS "Ginkgo and AD: Key negatives and lessons from GuidAge" Lancet Neurol 2012; DOI: 10.1016/S1474-4422(12)70212-0.

According to an article published in the Kaiser Health News, male healthcare does not fare as well as healthcare for women under the new ACA. So while political debates pop up regarding the ACA and who's more or less in support of womens healthcare, it seems important for men to inquire about getting all necessary healthcare for themselves.

Health Law Has Gaps in Services for Men

By Kaiser Health News

Published: September 02, 2012

 

 

The federal healthcare overhaul greatly expanded women's access to free preventive services, particularly for sexual and reproductive health. Men didn't fare nearly as well.

The Affordable Care Act guidelines' promise of free contraception may have generated the most controversy, but the law also provides many other services for women, including free screening for HIV, chlamydia and gonorrhea, and pregnancy-related benefits such as screening for gestational diabetes, and breastfeeding support, supplies, and counseling.

"Groups that were really focused on the health of women were identifying specific gaps that they wanted to make sure were covered," says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a research and advocacy organization.

Gaps in men's preventive health didn't receive the same focused attention by men's health groups, he says.

Under the law, new health plans or those whose benefits have changed substantially are required to provide four types of preventive care without any copayments or other forms of cost-sharing: services recommended by the U.S. Preventive Services Task Force (USPSTF), immunizations recommended by the CDC's Advisory Committee on Immunization Practices, and preventive services and screenings for women and for children that are recommended by the Health Resources and Services Administration (HRSA).

Sen. Barbara Mikulski (D-Md.) championed adding women's preventive services recommended by HRSA following an outcry over a USPSTF recommendation that regular mammography screening for most women begin at age 50 rather than age 40. In a separate amendment, she successfully pushed to reinstate the earlier recommendations that called for mammography screening starting at age 40. The new requirements substantially broadened the free preventive services available to women.

The new law requires most health plans to begin providing free contraceptives to women when their new plan year begins this fall or next year. It covers all FDA-approved methods, including permanent ones such as tubal ligation. But since its scope is limited to women's services, it does not offer free coverage for vasectomies.

Men's health specialists say both men and women could have benefited from such a requirement. Even though they're generally simpler and less expensive than female sterilization, cost can be a factor that deters men from getting vasectomies.

"Particularly for older men who are interested in playing a role in pregnancy prevention through sterilization, there are not many low-cost services available, even in a large city," says David Bell, MD, MPH, medical director of the Young Men's Clinic at New York-Presbyterian Hospital's Family Planning Clinic.

The health law also requires free coverage for screening for a number of sexually transmitted diseases in women but not men. For example, HIV screening is covered annually for all sexually active women. In men, free screening is recommended for those who are at higher risk, such as men who have sex with men or with multiple partners.

Similarly, the USPSTF, a federal panel of experts, recommends screening all sexually active women younger than 25 for chlamydia and screening at-risk women for gonorrhea. But the task force says there's not enough evidence to make such recommendations for men.

Some of the new preventive coverage requirements do address men's sexual health. For example, under CDC recommendations that become effective in December, new health plans must cover the three-shot human papillomavirus (HPV) vaccine for young men at no charge. Previously recommended for young women primarily to prevent cervical cancer, the vaccine is also associated with some cancers that affect men. It is recommended routinely for young men ages 11 or 12, and for those ages 13 to 21 who haven't been vaccinated.

It's no accident that most of the new preventive benefits are aimed at women, say experts. "Women bear a disproportionate burden when it comes to sexually transmitted diseases and preventing pregnancy," says Deborah Arrindell, vice president for health policy at the American Social Health Association, an advocacy group.

As women enter their reproductive years, they typically begin to see a primary-care practitioner, often a gynecologist, for regular checkups and to receive contraceptives. In 2009, 66% of women ages 18 to 44 visited a primary-care provider, compared with 52% of men in that age group, according to the CDC's National Center for Health Statistics.

Although men may visit the doctor to get a physical for work, sports, or school, it's not routine, say experts. "Many of the men who visit the family planning clinic are sent by their partners," says Bell. "Fifty percent came because of a female in their life."

Part of the problem in improving coverage of sexual and reproductive health for men is that research is scarce and comprehensive clinical guidelines have never been established, say experts. The USPSTF, in declining to recommend screening for chlamydia in men, for example, said there was a "critical gap" in research on the benefits of screening men for the disease.

Some women's health advocates note wryly that although there may be a relative dearth of data related to men's sexual and reproductive health, much of the broad medical research conducted to date has focused on men. Clinical trials for many drugs, for example, for many years excluded women.

Regardless, advocates agree that leveling the playing field for the sexes for sexual and reproductive health services only makes sense.

"It seems foolish to do it differently for women than for men," says Sonfield.

This article, which first appeared August 27, 2012, was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.