How Profit is made in Healthcare

The Affordable Care Act mandates that health insurance companies cannot discriminate based on past medical history, as they had frequently in the past. They have therefore begun to use different techniques to avoid signing up "sick" patients.

In a recent review it was found that over 40% of insurance carriers categorized all HIV drugs as "third tier". This creates an extremely high financial burden on these patients and will make them much less likely to choose that company. This type of behavior exists in many other diseases.

The fact that we do not have a public not-for-profit option and the greed of the health insurance industry will continue to allow such loopholes in the ACA to be exploited. It seems that we will need to wait at least until the next presidential election before we see any changes or improvements.

Do We Need More Proof to Stay Healthy?

Two recent long term studies once again show convincing proof that healthy habits prevent cardiovascular disease.

In the first, researchers followed over 80,000 women for over 20 years. They discovered that assessed six healthy lifestyle habits (i.e., not smoking, ≥2.5 hours weekly physical activity, healthy diet, normal body-mass index, average ≤1 alcoholic drinks daily, and ≤7 hours weekly television watching) resulted in an astounding 92% reduction in heart disease over the 20 year period!

In another study, the relatively low socioeconomic Franklin County, Maine, began a comprehensive effort to lower cardiovascular risk in 1970. The community-led program, which resulted in over 150,000 patient encounters, sought to help residents lower elevated blood pressure and cholesterol, quit smoking, improve their diets, and increase their physical activity.

When compared with other Maine counties, Franklin County had a lower-than-expected, income-adjusted total mortality rate after the program started. There was a similar drop in hospitalization rates, resulting in a reduction of $5.4 million in hospital charges annually.

These costs alone would justify such a program nationally; although there would probably be wide resistance from the for-profit hospital lobby!

Take Your Lipitor at Night!

When you take that drug can affect how it works!

You may have noticed that you can feel different, both physically and emotionally, at different times of the day or night. A recent study has shown that sleep/wake cycles can affect physical performance, especially in elite athletes. Athletes coming from the East coast may find that their athletic ability is decreased in a late event, as their body may peak in the afternoon hours.

Many medications affect enzymes or other bodily functions which also can have different activities during the day. This circadian rhythm may result in different rates of effectiveness. Researchers have shown that 43% of genes exhibit a circadian rhythm. For example the cholesterol making gene works more at night; so it would seem that you should take your statin (like Lipitor, etc) before bed. The gene that causes the muscle pain from statins peaks in mid-day; so if you do get these symptoms a short acting statin at night may be the answer!

As more genes are studied we may rethink the timing of many drugs. In the meantime take those statins at night!

A Measles story from the author of Charlie and the Chocolate Factory

A take on measles vaccination from Roal Dahl - worth reading!

http://m.dailykos.com/story/2015/01/30/1361224/-Roald-Dahl-s-Heartbreaking-Take-on-Vaccines?detail=facebook

Roald Dahl's Sad Tale

Get off your Butt!!

We have been advised to exercise at least 20 minutes a day to decrease our risks of heart disease. But it seems that what we do the rest of the day also is important!

Comparing many studies, researchers found that Increased sedentary time was associated with significant, independent increases in risk for all-cause, cardiovascular, and cancer mortality, as well as cardiovascular disease, cancer, and type 2 diabetes incidence. Increased exercise blunted — but did not completely eliminate — the excess risks associated with sedentary behavior.

So get off your butt!

Do Birth Control Pills cause Brain Tumors?

A recent press release suggested that exposure to hormonal contraceptives (birth control pills or BCP) was associated with an increase in brain tumors.

In the actual study, in Denmark, researchers looked at 300 women with gliomas, a kind of brain tumor, and matched them with 2000 similar women without the tumor. They found that 59% of women with tumors had used BCP, while only 50% of controls had.

While this is suggestive of a cause and effect, the risk was so low it is not cause for major alarm. As well, use of BCP is associated with lower risk for certain other tumors so the overall risk is probably insignificant.

However, they did discover that progesterone only BCPs had a much higher association. Curiously, it is also the progesterone in post-menopausal hormone treatment that seems associated with breast cancer.

It would be appropriate not to use progesterone only BCPs as a result of this study.

Keep Those TV Screens Away from our Children!

There has been much written about screen time for children and its effect on their learning and behavior. Currently recommendations are for 2 hours or less a day, and none for children under about three.

What about TVs, ipads, or phones in children's rooms? In a recent study it was found that having any sort of such device was associated with about 20 minutes less sleep per night in 4th through 7th graders. When you link this with several studies that showed a decrease in sleep results in impaired learning, a strong argument is made for no screen time in children's bedrooms.

Keep the TV and small screens out of your kid's bedrooms!

Measles at Disneyland

Recently there was publicity concerning an outbreak of measles which began at Disneyland. So far 26 people in 4 states (22 in California) have been documented with measles; 4 patients were hospitalized.

This once again is a result of our complacence and misplaced concerns about vaccination. Of the 16 cases in California whose vaccination status was known, 12 were unvaccinated. Measles is a highly contagious and potentially fatal disease. 

The vaccine is safe and highly effective.

New Weight Loss pacemaker?

Scientists have developed a new method of stopping people from eating! 

When we are full, our stomach signals the Vagus nerve to tell our brain that we should stop. So they decided to create an implantable pacemaker device which stimulates the nerve and makes you feel full.

In the studies, the device did not reach its goal of more than a 10% loss of weight versus control patients. This is not very good, considering it does involve surgery. However the FDA approved it because of the possibility of long term weight loss.

Side effects included nausea and vomiting. Long term studies are underway.

I am not optimistic about this new device.

Influenza Deaths Declared Epidemic

The CDC has reported that influenza and pneumonia deaths have reached epidemic proportions in December. Almost 10% of deaths, including 15 children, were reported due to these diseases.

The current flu vaccine is not as effectively matched to the current viruses as we had hoped, and we can expect a bad season.

The good news is that the virus is still sensitive to Tamiflu, so do not hesitate to see your doctor early in a flu like illness. As well, pregnant women should be vaccinated; the CDC reports the vaccine is safe and effective.

An Advance in Antibiotics!

At a time where there has been a decrease in new antibiotic discoveries, scientists developed a successful method to search for new compounds.

Over 99% of the bacteria, or germs, growing in the soil have never been cultured or evaluated, since they are not biologically important in humans, animals, or plants. Using a novel extraction method, researchers have begun to look at these bacteria to see if they can produce new antibiotics.

They discovered a compound they called Teixobactin which is highly effective against many bacteria (but not all) and seems to work in a different way than current antibiotics. Even more impressive, it works against two very difficult bugs, Tuberculosis and MRSA.

No resistance has been reported (yet) and it seems that this may not occur quickly. And it is so far safe in mice.

The technique is very promising as is the new drug.

Fish Oils and Rheumatoid Arthritis

There have been many reports of the anti-inflammatory and medical protective effects of fish oils. 

In a recent study, patients with Rheumatoid Arthritis who took high dose fish oil supplements (greater than 2.7gms EPA plus DHA daily) had significantly less pain and swollen joints.

In the study this was added to current treatments.

I believe this safe and effective treatment is worth trying in inflammatory arthritis!