The Daily HIT

There is no such thing as going bankrupt due to health expenses in any advanced nation other than the United States. Whatever imperfections the current Senate and House health reform bills may have, the fact that they address this issue directly (by making lifetime maximums illegal and capping out-of-pocket expenses at $10,000 a year) is among their greatest strengths.

Today’s New York Times has a heartwrenching story about people in Tennessee declaring bankruptcy for no reason other than having had the misfortune of being sick or injured.

Jodie and Charlie Mullins of Dickson, Tenn., were making ends meet on his patrolman’s salary until she developed debilitating back pain that required spinal surgery and forced her to quit nursing school. As with many medical bankruptcies, they had health insurance but their policy had a $3,000 deductible and, to their surprise, covered only 80 percent of their costs.

“I always promised myself that if I ever got in trouble, I’d work two jobs to get out of it,” said Mr. Mullins, a 16-year veteran of the Dickson police force. “But it gets to the point where two or three or four jobs wouldn’t take care of it. The bills just were out of sight.”

Advances in technology sometimes outpace rules designed for an earlier, simpler era.

This bill banning employment discrimination based on genetic testing is an important step in the right direction.

Reporting from Washington – The most sweeping federal anti-discrimination law in nearly 20 years takes effect today, prohibiting employers from hiring, firing or determining promotions based on genetic makeup.

Additionally, health insurers will not be allowed to consider a person’s genetics — such as predisposition for Parkinson’s disease — to set insurance rates or deny coverage.

Not since the Americans With Disabilities Act of 1990 has the federal government implemented such far-reaching workplace protections. Stuart J. Ishimaru, acting chairman of the Equal Employment Opportunity Commission, said in a statement that the law reaffirms the idea that people have a right to be judged solely on merit.

“No one should be denied a job or the right to be treated fairly in the workplace based on fears that he or she may develop some condition in the future,” he said.

The Senate Democrats’ blended bill contains the nondiscrimination language championed by Senators Tom Harkin (D-IA) and Christopher Dodd (D-CT), along with a couple of other steps forward.

Here’s today’s report from the American Chiropractic Association:

Reid’s Reform Bill Includes ACA Supported Provider Non-Discrimination Provision

Of specific interest to the chiropractic profession, is the fact that Reid’s bill includes an important federal provider non-discrimination provision the inclusion of which was strongly advocated by the ACA.  The provision, found in Section 2076 of the measure, would apply to ERISA and other health insurance plans, and is intended to serve as an important protection aimed at preventing insurance plans from discriminating against entire classes of non-MD health care providers, including DCs, based solely on their state license or certification.  The inclusion of the provision in the Reid bill was primarily championed by Senator Tom Harkin (D-Iowa), current Chairman of the Senate HELP Committee and Senator Chris Dodd (D-Conn).  The inclusion of the provision in Reid’s bill means the chiropractic profession will not have to launch what would likely be an uphill battle to insert the provision via the amendment process on the floor of the Senate.  With respect to provision, ACA’s main mission now, is to work to ensure that the provision remains included in the final floor amended bill, assuming one is successfully voted out of the Senate.  It is important to note that the recently House passed version of the heath reform bill (HR 3962) does not contain an identical provision, but does contain an important non-discrimination provision that seeks to maintain the applicability of state-enacted provider non-discrimination laws.  The ACA will lobby for inclusion in any final bill to be enacted by Congress of both the House and Senate provider non-discrimination provisions.

Chiropractic Included in Other Provisions:

• Community Health Teams: Doctors of chiropractic are specifically included as potential members of interdisciplinary Community Health Teams.  These teams support the development of medical homes by increasing access to comprehensive, community based, coordinated care.  Community health teams are integrated teams of providers including specialists, other clinicians and licensed integrative health professionals as well as community resources to enhance patient care, wellness and lifestyle improvements.  The language in the bill ensures that doctors of chiropractic can be included in these patient-centered and holistic teams.

• National Health Care Workforce Commission: The bill establishes a National Health Care Workforce Commission to examine the current and projected needs in the health care workforce.  The Commission specifically includes doctors of chiropractic by defining them as part of the health care workforce, and including them in the definition of health professionals.  Schools of chiropractic are also included in the health professional training schools to be studied.  The National Health Care Workforce Commission is tasked providing comprehensive, unbiased information to Congress and the Administration about how to align federal health care workforce resources with national needs. Congress will use this information when providing appropriations to discretionary programs or in restructuring other federal funding.  The language in the bill guarantees that the need for doctors of chiropractic will be addressed when considering federal health care workforce programs.

This is an important step forward in what promises to be a long journey.

Apparently it’s a very old story, not solely a modern phenonemon.

CT scans of Egyptian mummies, some as much as 3,500 years old, show evidence of atherosclerosis, or hardening of the arteries, which is normally thought of as a disease caused by modern lifestyles, researchers said Tuesday.

However, the diet of these upper-crust Egyptians sounds remarkably familiar, laden with high-fat meats and salt.

The study’s results may mean scientists need to look beyond modern risk factors to fully understand what causes the condition, the researchers said.

Both groups, however, share some risk factors. The high-status Egyptians ate a diet high in meat from cattle, ducks and geese, all fatty.

And because mechanical refrigeration was not available, salt — another contributing factor in heart disease — was widely used for food preservation.

This is the kind of profiteering behavior for which the drug manufacturers have become famous. It flies in the face of all reasonable norms of civilized behavior, yet here it is for all to see.

Even as drug makers promise to support Washington’s health care overhaul by shaving $8 billion a year off the nation’s drug costs after the legislation takes effect, the industry has been raising its prices at the fastest rate in years.

In the last year, the industry has raised the wholesale prices of brand-name prescription drugs by about 9 percent, according to industry analysts. That will add more than $10 billion to the nation’s drug bill, which is on track to exceed $300 billion this year. By at least one analysis, it is the highest annual rate of inflation for drug prices since 1992.

The drug trend is distinctly at odds with the direction of the Consumer Price Index, which has fallen by 1.3 percent in the last year.

Exercise brings many health benefits but its stand-alone effects on weight loss are less than some have claimed.

From today’s New York Times:

“The message of our work is really simple,” although not agreeable to hear, Melanson said. “It all comes down to energy balance,” or, as you might have guessed, calories in and calories out. People “are only burning 200 or 300 calories” in a typical 30-minute exercise session, Melanson points out. “You replace that with one bottle of Gatorade.”

This does not mean that exercise has no impact on body weight, or that you can’t calibrate your workouts to maximize the amount of body fat that you burn, if that’s your goal.

“If you work out at an easy intensity, you will burn a higher percentage of fat calories” than if you work out a higher intensity, Carey says, so you should draw down some of the padding you’ve accumulated on the hips or elsewhere — if you don’t replace all of the calories afterward. To help those hoping to reduce their body fat, he published formulas in The Journal of Strength and Conditioning Research last month that detailed the heart rates at which a person could maximize fat burning. “Heart rates of between 105 and 134” beats per minute, Carey said, represent the fat-burning zone. “It’s probably best to work out near the top of that zone,” he says, “so that you burn more calories over all” than at the extremely leisurely lower end.

Perhaps just as important, bear in mind that exercise has benefits beyond weight reduction. In the study of obese people who took up exercise, most became notably healthier, increasing their aerobic capacity, decreasing their blood pressure and resting heart rates, and, the authors write, achieving “an acute exercise-induced increase in positive mood,” leading the authors to conclude that, “significant and meaningful health benefits can be achieved even in the presence of lower than expected exercise-induced weight loss.”

Plenty of room for improvement here, obviously. Pre-term births figure prominently, for reasons not yet well understood.

Most of the deaths are among pre-term infants and the United States has a very high rate of pre-term births, according to the report from the National Center for Health Statistics.

“In 2005, the latest year that the international ranking is available for, the United States ranked 30th in the world in infant mortality, behind most European countries, Canada, Australia, New Zealand, Hong Kong, Singapore, Japan, and Israel,” the NCHS, part of the Centers for Disease Control and Prevention, said in the report.

“One in 8 births in the United States were born preterm, compared with 1 in 18 births in Ireland and Finland,” added the report, available at http://www.cdc.gov/nchs/data/databriefs/db23.htm.

“If the United States had Sweden’s distribution of births by gestational age, nearly 8,000 infant deaths would be averted each year and the U.S. infant mortality rate would be one-third lower.”

A new study from Singapore shows a protective effect of soy for hip fractures. The effect is noted in women but not men.

Postmenopausal women may lessen their chances of fracturing a hip by adding soy-based foods to their diet, a study from Singapore hints.Women in the study were 21 to 36 percent less likely to fracture a hip when they reported eating a moderate amount of soy, Dr. Woon-Puay Koh, at the National University of Singapore, and colleagues found.

In their study, daily moderate soy intake was at least 2.7 grams of soy protein, 5.8 milligrams of soy isoflavones per 1000 calories, or the equivalent of 49.4 grams of tofu.

This level of soy is consistently “higher than the low levels of consumption in the West,” Koh told Reuters Health in an email.

A varied whole foods diet has numerous preventive effects. One of them relates to the likelihood of developing depression. The data is from Great Britain but the dietary issues certainly apply in the U.S., as well.

From the BBC:

The team said the study was the first to look at the UK diet and depression.

The UK population is consuming less nutritious, fresh produce and more saturated fats and sugars Dr Andrew McCulloch, Mental Health Foundation

They split the participants into two types of diet – those who ate a diet largely based on whole foods, which includes lots of fruit, vegetables and fish, and those who ate a mainly processed food diet, such as sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products.

After accounting for factors such as gender, age, education, physical activity, smoking habits and chronic diseases, they found a significant difference in future depression risk with the different diets.

Those who ate the most whole foods had a 26% lower risk of future depression than those who at the least whole foods.

By contrast people with a diet high in processed food had a 58% higher risk of depression than those who ate very few processed foods.

Hopefully this is just the beginning of the blowback against the deal between the American Academy of Family Physicians and the Coca-Cola Corporation.

Yesterday, 20 family physicians in Contra Costa County, California,  ripped up their membership cards in the American Academy of Family Physicians in protest over the AAFP’s partnership with Coca-Cola.

The director of the Contra Costa Department of Health Services, Dr. William Walker, announced that he was resigning his 25-year membership in AAFP.

Dr. Walker said:

…I am appalled and ashamed of this partnership between Coca-Cola and the American Academy of Family Physicians. How can any organization that claims to promote public health join forces with a company that promotes products that put our children at risk for obesity, heart disease and early death.

…The AAFP is supposed to be an organization that works to protect the health of children not put them at risk. Their decision to take soda money is all the more unconscionable because, unlike doctors in the 40s, they well know the negative health impact of soda. There is no shortage of documentation that soda is a major contributor to our nation’s obesity epidemic.

…Let me be clear about something: as disappointed as I am with the American Academy of Family Physicians for being duped into thinking that Coca Cola wants to help promote health, the real problem here is our children are being put at risk.

Companies like Coca Cola are polluting our communities with deceptive advertising promoting products that put our children’s health at risk.

…as a family practice doctor and the Health Officer for Contra Costa, I do have a prescription for every parent, teacher, community leader and student:

Look beyond the glitzy advertising that makes you think pouring liquid containing sugar into your body is healthy. Read the label. Look at the ingredients. I’m not suggesting that you boycott sugared drinks, but please make an informed decision about what you are consuming.

I’m calling on every city and neighborhood in our County to fight back against the industry that pushes these harmful products. I ask the American Academy of Family Physicians to end this unhealthy partnership and to join us in leading this important campaign to take back the health of our residents and end the obesity epidemic.