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My editorial on the Affordable Care Act’s section that prohibits insurance companies from discriminating against classes of health care provider is now posted at Health Insights Today.

When fully implemented, this federal nondiscrimination policy will for the first time forbid any American health insurance company from refusing to cover services legally provided by a class of licensed health care practitioners (e.g., chiropractors, acupuncturists or clinical social workers) acting within the scope of their state licenses, if it covers those services when provided by a different class of practitioners (e.g., medical or osteopathic physicians). While the Affordable Care Act does not mandate equal payment for equal work (i.e., paying a chiropractor providing a service the same rate as an MD providing the same service), friend and foe alike understand that Section 2706 would make it illegal for insurers to cover any health service for one class of providers licensed to perform it while rejecting coverage for another also licensed to do so. (This nondiscrimination policy does not apply to the two largest government insurance plans—Medicare, which offers partial chiropractic coverage nationwide, and Medicaid, where coverage varies from state to state.)

This part of the law goes into effect on January 1, 2014. Because it applies to all services that a practitioner is licensed to provide under state law, the implications are quite broad. I’ll be writing more about this in the near future, and presenting on the prevention and health promotion part of this equation at the March ACC-RAC conference in Washington, DC. (ACC-RAC is the annual Association of Chiropractic Colleges Research Agenda Conference).

The only exception is sub-Saharan Africa. A world in which people have struggled for milliennia against having too little has now become one in which most now face a different problem — having too much, or at least too much of the wrong things.

From a CNN report on a new study published in The Lancet:

The report revealed that every country, with the exception of those in sub-Saharan Africa, faces alarming obesity rates — an increase of 82% globally in the past two decades. Middle Eastern countries are more obese than ever, seeing a 100% increase since 1990.

“The so-called ‘Western lifestyle’ is being adapted all around the world, and the impacts are all the same,” Mokdad said.

The health burden from high body mass indexes now exceeds that due to hunger, according to the report.

And for the first time, noncommunicable diseases like diabetes, stroke and heart disease top the list of leading causes of years spent sick or injured.

“All these problems are tied to obesity,” Mokdad said. “We’re even seeing a large percentage of people suffering back pain now. If we could lower the obesity rates, we’d see the numbers of noncommunicable diseases and pain decrease as well.”

People are living longer than projected in 1990 — on average, 10.7 more years for men, and 12.6 more years for women. But for many of them, the quality of life during those years is not good. On average, people are plagued by illness or pain during the last 14 years of life, according to the study.

Researchers credit advances in medical technology for longer lives.

“We’ve figured out how to keep the person who suffered a stroke alive, but then they’re living disabled for years afterward. That’s not the quality of life that person expected, ” Mokdad said.

In Western countries, deaths from heart disease are down 70%. However, the number of people diagnosed with heart disease is increasing at alarming rates.

Noncommunicable diseases are a global challenge of “epidemic proportions,” according to Dr. Margaret Chan, director-general of the World Health Organization.

In a speech to the U.N. General Assembly last year, she said NCDs are a “slow-motion disaster” that eventually could break the bank.

The military is pragmatic — if something works, they will use it whether it’s conventional or alternative. Over time, the evidence-based alternatives become the norm.

While preparing for overseas deployment with the U.S. Marines late last year, Staff Sgt. Nathan Hampton participated in a series of training exercises held at Camp Pendleton, Calif., designed to make him a more effective serviceman.

There were weapons qualifications. Grueling physical workouts. High-stress squad counterinsurgency drills, held in an elaborate ersatz village designed to mirror the sights, sounds and smells of a remote mountain settlement in Afghanistan.

There also were weekly meditation classes — including one in which Sgt. Hampton and his squad mates were asked to sit motionless in a chair and focus on the point of contact between their feet and the floor.

“A lot of people thought it would be a waste of time,” he said. “Why are we sitting around a classroom doing their weird meditative stuff?

“But over time, I felt more relaxed. I slept better. Physically, I noticed that I wasn’t tense all the time. It helps you think more clearly and decisively in stressful situations. There was a benefit.”

That benefit is the impetus behind Mindfulness-based Mind Fitness Training (“M-Fit”), a fledgling military initiative that teaches service members the secular meditative practice of mindfulness in order to bolster their emotional health and improve their mental performance under the stress and strain of war.

Designed by former U.S. Army captain and current Georgetown University professor Elizabeth Stanley, M-Fit draws on a growing body of scientific research indicating that regular meditation alleviates depression, boosts memory and the immune system, shrinks the part of the brain that controls fear and grows the areas of the brain responsible for memory and emotional regulation.

h/t The Schwartz Report

 

 

Considering the side effects and costs of taking the medication, exercise is by far the better choice.

From a Reuters story on an article published August 1, 2012 in the Journal of the American College of Cardiology:

People with heart disease who are also depressed may get as much relief from their depression symptoms with regular exercise as with medication, according to a U.S. study.

Researchers writing in the Journal of the American College of Cardiology found that of 101 heart patients with signs of depression, those who exercised for 90 minutes per week and those who started taking Zoloft both improved significantly compared to participants assigned to drug-free placebo pills.

 

The Harvard Nurses health study has found an association between milk, particularly skim milk, and acne.  The most likely explanation is the hormone content in the milk, which is present in both organic and conventional milk.

From the accompanying editorial in the Journal of the American Academy of Dermatology:

“The papers…from the Harvard School of Public Health establish an association between milk consumption and acne. But how could milk cause acne? Because, drinking milk and consuming dairy products from pregnant cows exposes us to the hormones produced by the cows’ pregnancy, hormones that we were not designed to consume during our teenage and adult years. It is no secret that teenagers’ acne closely parallels hormonal activity…So what happens if exogenous hormones are added to the normal endogenous load? And what exactly is the source of these hormones? Consider that, in nature, milk is consumed from a mother, whether human or bovine, until weaning occurs. Normally, the mother then ceases lactation before the next pregnancy occurs—so that consuming milk from a mother pregnant with her next offspring is not a common occurrence. We’ve all seen nature films of animals chasing their offspring away to encourage weaning at the appropriate time. Further, in nature the offspring consumes only the milk of its own species—but both of these natural rules are broken by humans. Viewed objectively, human consumption of large volumes of another species’ milk, especially when that milk comes mainly from pregnant cows during the human’s normally post-weaned years, is essentially unnatural.”

The upside is that there is a clear recognition of the scale of the problem of over-prescription and inappropriate use of addictive painkillers. As noted in this Medpage article, “the prescription painkiller epidemic … was responsible for about 15,600 deaths in 2009, the latest year for which there are data.”

But industry sponsorship is a major red flag, leading some to opine that these educational programs fall far short of constituting an adequate response to the problem.

“The FDA’s goal is to ensure that healthcare professionals have the education they need to prescribe opioids and that patients have the know-how to safely use these drugs,” FDA Commissioner Margaret Hamburg said during a press call.

But critics cite a number of problems with the guidance, including its reliance on industry sponsorship of education, even with middle-man medical education companies. Also, extended-release and long-acting opioid analgesics training will not be mandatory for prescribers.

Finally, the program will not cover powerful short-acting opioids such as hydrocodone (Vicodin) that have an equally high potential for abuse.

“These educational programs are likely going to do more harm than good,” said Andrew Kolodny, MD, chair of psychiatry at Maimonides Medical Center in New York City. “Nowhere does it say that prescribers should tell patients these drugs are addictive. And these programs give the implied message that there’s evidence for using opioids in long-term, noncancer chronic pain.”

My editorial on the health reform law has been posted as part of the new issue of Health Insights Today, here. There’s a focus on the potential effects of the law for chiropractic and CAM, along with broader societal effects that will come with implementation (or repeal).

I hope you all click through to the full editorial. Here’s an excerpt.

First, the landmark provider nondiscrimination rule, Section 2706:

Since most readers of Health Insights Today have a strong interest in chiropractic and complementary and alternative medicine (CAM), let’s begin with the provisions directly related to those fields. First and foremost, the Affordable Care Act’s Section 2706 enacts for the first time a nationwide provider nondiscrimination policy, prohibiting insurance companies from denying coverage based on provider type for services provided by licensed health care practitioners. For example, this policy appears to indicate that if spinal manipulation or acupuncture (or any other service within a practitioner’s scope of practice) is covered when performed by a medical or osteopathic physician, insurers cannot have a policy denying such coverage when the service is performed by a chiropractor or acupuncturist. In the past, such discriminatory policies have had the effect of routing patients away from DCs, LAcs and other non-MD/DO practitioners.

The nondiscrimination rule is a landmark step forward and marks the first time that legislation applies such a policy across the entire nation. However, it does not bar all forms of discrimination. Importantly, insurers are not barred from paying some types of practitioners more than others for the same services. Chiropractors and a variety of other non-MD/DO practitioners sought such a ban but did not achieve it in this legislation. Success on that front will have to wait until later.

The full ramifications of Section 2706 will become clearer over time, as uncertainties are resolved through state and/or federal regulatory actions or litigation. For now, it is seen by chiropractic and CAM leaders and attorneys as the most significant piece of federal legislation in many years. The American Medical Association House of Delegates approved a resolution at its June 2012 national meeting that calls for the repeal of the nondiscrimination policy. While vigilance on the part of chiropractic and CAM organizations remains necessary, this AMA repeal effort faces a steep uphill climb unless the November 2012 election brings a president, House, and Senate that repeals the entire Affordable Care Act. Senate Republican Leader Mitch McConnell and House Speaker John Boehner have pledged to seek full repeal in early 2013. 

I ask each of our readers … please familiarize yourself with what is in the law, so that you will be able to evaluate all claims — pro or con — based on facts rather than distortions.  

 

 

 

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