The Daily HIT

The Good Times in Health Care?

Daniel Redwood, DC — Mon, 15 Mar 2010 15:53:01 +0000

Today’s Wall Street Journal health blog cites projections from credible sources on how, in the absence of health reform, millions more will be uninsured in the near future.

Not a happy scenario.

The number of Americans without health insurance could rise to almost 60 million by 2015 from 49 million today if nothing is done to overhaul the health-care system, a new forecast says.

The uninsured could reach more than 67 million in 10 years, according to the Robert Wood Johnson Foundation, which paid for the study conducted by the Urban Institute. Read the study and related data here.

Marion Nestle: The Fate of Vitamins in Stored, Cooked and Raw Foods

Daniel Redwood, DC — Sun, 14 Mar 2010 18:20:53 +0000

I highly recommend Marion Nestle’s Food Politics blog as an excellent source of accurate news and information.

This post on the loss or retention of vitamins after foods have been steamed, stored, boiled, microwaved, or just eaten raw is refreshingly clarifying.

Bottom line: it’s a bit more complicated than you thought:

Cooking also destroys vitamin C. While I was looking for that article I came across this one, which describes experiments looking at the effects of common cooking practices (boiling, microwaving, and steaming) on beneficial antioxidants and phytochemicals in Brussels sprouts.

Steaming increased phytochemicals in fresh and frozen sprouts. Boiling did too, but only in the fresh vegetables. Cooking reduced phytochemical content in frozen samples. Microwaving was the best cooking method for retaining color and vitamin activity. As expected, all cooking methods destroyed vitamin C.

So what to make of this? Eat a mixture of cooked and uncooked vegetables and the vitamins will take care of themselves. If you do cook, steaming is great and microwaving is better for preserving vitamin activity. For vitamin C, raw wins every time.

The Longrunning Controversy on Autism and Vaccines Continues

Daniel Redwood, DC — Sun, 14 Mar 2010 17:43:31 +0000

I do not hold a firm opinion on this topic. This controversy has swirled for an extended time and allegations of falsifying data by both sides have muddied the waters to the point where uncertainty seems a reasonable response.

If one is to believe the preponderance of evidence in the peer-reviewed literature, a causal link is hard to find.

But in this article by Robert F. Kennedy, Jr, a man whose intelligence and integrity I trust, a series of very serious questions are raised about the quality of that evidence and the honesty of the central figure behind the research used to attack claims of a vaccine-autism link.

A central figure behind the Center for Disease Control’s (CDC) claims disputing the link between vaccines and autism and other neurological disorders has disappeared after officials discovered massive fraud involving the theft of millions in taxpayer dollars. Danish police are investigating Dr. Poul Thorsen, who has vanished along with almost $2 million that he had supposedly spent on research.Thorsen was a leading member of a Danish research group that wrote several key studies supporting CDC’s claims that the MMR vaccine and mercury-laden vaccines were safe for children. Thorsen’s 2003 Danish study reported a 20-fold increase in autism in Denmark after that country banned mercury based preservatives in its vaccines. His study concluded that mercury could therefore not be the culprit behind the autism epidemic.

His study has long been criticized as fraudulent since it failed to disclose that the increase was an artifact of new mandates requiring, for the first time, that autism cases be reported on the national registry. This new law and the opening of a clinic dedicated to autism treatment in Copenhagen accounted for the sudden rise in reported cases rather than, as Thorsen seemed to suggest, the removal of mercury from vaccines. Despite this obvious chicanery, CDC has long touted the study as the principal proof that mercury-laced vaccines are safe for infants and young children. Mainstream media, particularly the New York Times, has relied on this study as the basis for its public assurances that it is safe to inject young children with mercury — a potent neurotoxin — at concentrations hundreds of times over the U.S. safety limits.

I encourage you to read the whole article. I hope it is not true that researchers (and possibly the CDC itself) have engaged in fraudulent activity. This article leads me to keep an open mind on the topic and await further developments.

Two Physicians’ Views on Why Healthcare Costs Are Out of Control

Daniel Redwood, DC — Mon, 08 Mar 2010 14:07:43 +0000

This Medscape article may not address every reason for skyrocketing costs, but it certainly gets the conversation started. Some of the experiences they report are quite stunning.

Aside from malpractice reform, which has been extensively discussed in the public debate on reform, most of the other points will come as news to many readers.

1. The Building of Shrines for Hospital Administrators. We have both witnessed the building of expensive and unneeded new healthcare facilities to satisfy the desire of an institution to provide a monument to a hospital executive who is nearing the end of his or her career. In one case, architecturally spectacular new hospital buildings costing billions of dollars were erected within a few hundred yards of similar facilities belonging to a competing institution. In another case, a specialty hospital was constructed despite the fact that 2 other similar specialty facilities existed within a few miles. In both instances, as large as the costs of the new buildings may have been, they were dwarfed by the costs of the duplicative staffs required for the new facilities. Moreover, to keep both new facilities acceptably occupied, substantial additional monies continue to be spent on advertising and public relations campaigns.

2. Unnecessary Duplication of Services. One large city had 3 excellent transplant programs, each associated with a different university hospital. Administrators at a fourth university hospital decided they also wanted a transplant program to enhance their institutional image and prestige. When the relevant state agency determined that there was no need for a fourth transplant program in the city, there was a rumor that a top officer at the medical center interceded personally with a high-ranking elected state official. Whatever the truth of the rumor, the unneeded fourth program was quickly approved. The costs for the complex and extensive additional staffing and equipment for the extra program were borne by our healthcare system. Because the number of organ transplants in the area is totally dependent on the number of donor organs and not on the number of programs, no increase in quality or number of patients treated could accrue — only an increase in the overall cost. The sole purpose served by the additional program was gratification of the egos who served the institution.

Chiropractor Helps Fellow Soldiers in Iraq

Daniel Redwood, DC — Sun, 07 Mar 2010 21:35:55 +0000

Dedication above and beyond the call:

“During that time I had a chiropractic table shipped to me,” Smith said. “While there, the word got out that there was a chiropractor in the neighborhood and soldiers from other units would show up to seek care. I saw many people from all branches of the U.S. military as well as British and other coalition forces.”

…

“Toward the mid- to late part of our deployment, I would take a portable adjusting table with me on the airplane and would adjust people at different bases while we were waiting on cargo or fuel,” Smith said. “It was great to take care of people in such a capacity. I learned that there are many chiropractors serving in the Army National Guard and other branches of the Guard and Reserve forces in non-healthcare rolls, taking their passion for chiropractic, and their caring for others, to war with them.”

While Smith was able to help others, he had to rely on his fellow chiropractors to maintain his own health. He was able to locate a fellow chiropractor to bring him relief, which allowed him to continue his service to his fellow troops. Although he was there to help the cause in Iraq, he also eased the suffering of his colleagues. As a fellow soldier, he knew from experience just how much his treatment meant to those in uniform.

“No one knows more than the soldier on the ground about the benefits of chiropractic care for quality of life and mission success,” Smith said.

Navajo Nation Hospital in Arizona Shows How to Lower Caesarean Delivery Rates

Daniel Redwood, DC — Sun, 07 Mar 2010 05:07:13 +0000

Elsewhere, the rates keep climbing, driven not by medical need but a toxic combination of laziness and greed.

Good reporting here on how an Indian hospital is bucking the trend.

Washington debates health care, this small hospital in a dusty desert town on an Indian reservation, showing its age and struggling to make ends meet, somehow manages to outperform richer, more prestigious institutions when it comes to keeping Caesarean rates down, which saves money and is better for many mothers and infants.This week, the National Institutes of Health will hold a conference in Bethesda, Md., about the country’s dismal rates of vaginal birth after Caesarean, or VBAC (pronounced VEE-back), which have plummeted since 1996. “I think it’s the purpose of this conference to see if we can turn the clock back,” said Dr. Kimberly D. Gregory, vice chairwoman of women’s health care quality and performance improvement at Cedars-Sinai Medical Center in Los Angeles.

Tuba City will not be on the agenda, but its hospital, with about 500 births a year, could probably teach the rest of the country a few things about obstetrical care. But matching its success would require sweeping, fundamental changes in medical practice, like allowing midwives to handle more deliveries and removing the profit motive for performing surgery.

Insurance Companies: Rates Up, Competition Down

Daniel Redwood, DC — Sun, 07 Mar 2010 04:59:44 +0000

Just in from a Goldman Sachs analysis telling their clients to buy health insurance stocks.

The Goldman Sachs analysis shows that while insurers can be aggressive in raising prices, they also walk away from clients because competition in the industry is so weak, the White House said. And officials will point to a finding that rate increases ran as high as 50 percent, with most in “the low- to mid-teens” — far higher than overall inflation.

The analysis could be a powerful weapon for the White House because it offers evidence that an overhaul of the health care system is needed not only to help cover the millions of uninsured but to prevent soaring health care expenses from undermining the coverage that the majority of Americans already have through employers.

The Cost of Doing Nothing on Health Care

Daniel Redwood, DC — Sun, 28 Feb 2010 18:14:47 +0000

Perhaps the major impediment to passing health care reform is the assumption on the part of the majority who currently are insured, that they will face no adverse consequences if no legislation is passed.

This article in today’s New York Times makes a compelling case that such an opinion is profoundly mistaken.

“People think if we do nothing, we will have what we have now,” said Karen Davis, the president of the Commonwealth Fund, a nonprofit health care research group in New York. “In fact, what we will have is a substantial deterioration in what we have.”

Nearly every mainstream analysis calls for medical costs to continue to climb over the next decade, outpacing the growth in the overall economy and certainly increasing faster than the average paycheck. Those higher costs will translate into higher premiums, which will mean fewer individuals and businesses will be able to afford insurance coverage. More of everyone’s dollar will go to health care, and government programs like Medicare and Medicaid will struggle to find the money to operate.

Policy makers, in the end, may be forced to address the issue.

“It will break all of our banks if we do nothing,” said Peter V. Lee, who oversees national health policy for the Pacific Business Group on Health, which represents employers that offer coverage to workers. “It is a course that is literally bankrupting the federal government and businesses and individuals across the country.”

Diabetes Drug’s Adverse Heart Effects

Daniel Redwood, DC — Thu, 25 Feb 2010 14:20:23 +0000

I have a personal interest here, since a very close relative of mine (who has Type II diabetes) was prescribed this drug, Avandia, a fewyears ago. Her doctor told her it was an excellent new medication.

She responded that she didn’t trust new medications as much as she trusted older ones, whose side effects were better known. It turns out she may have saved herself from a heart attack as a result.

This New York Times article lays out the unfortunate details.

Hundreds of people taking Avandia, a controversial diabetes medicine, needlessly suffer heart attacks and heart failure each month, according to confidential government reports that recommend the drug be removed from the market.

The reports, obtained by The New York Times, say that if every diabetic now taking Avandia were instead given a similar pill named Actos, about 500 heart attacks and 300 cases of heart failure would be averted every month because Avandia can hurt the heart. Avandia, intended to treat Type 2 diabetes, is known as rosiglitazone and was linked to 304 deaths during the third quarter of 2009.

“Rosiglitazone should be removed from the market,” one report, by Dr. David Graham and Dr. Kate Gelperin of the Food and Drug Administration, concludes. Both authors recommended that Avandia be withdrawn.

It also turns out that the research results on which Avandia’s approval depended were skewed based on the funding source . No major surprise here, but studies funded by the drug companies were more positive than independent studies.

Excellent Summary of Soy Research

Daniel Redwood, DC — Thu, 25 Feb 2010 13:57:56 +0000

Dr. Neal Barnard has a high-quality, evidence-based summary of soy research on Huffington Post. It’s readable, referenced and answers all the questions you might have.

Here’s the breast cancer section:

Women who include soy products in their routines are less likely to develop breast cancer, compared with other women. In January 2008, researchers at the University of Southern California found that women averaging one cup of soymilk or about one-half cup of tofu daily have about a 30 percent less risk of developing breast cancer, compared with women who have little or no soy products in their diets (1). However, to be effective, the soy consumption may have to occur early in life, as breast tissue is forming during adolescence (2-3).

What about women who have already been diagnosed with breast cancer? A study published in the Journal of the American Medical Association in 2009 shows that soy products may reduce the risk of recurrence (4). In a group of 5,042 women previously diagnosed with breast cancer who were participating in the Shanghai Breast Cancer Survival Study over a four-year period, those who regularly consumed soy products, such as soymilk, tofu, or edamame, had a 32 percent lower risk of recurrence and a 29 percent decreased risk of death, compared with women who consumed little or no soy. An accompanying editorial suggested that inconsistencies in prior research may be attributable to the comparatively low soy consumption in the United States, making beneficial effects harder to identify (5).