How often is it that we encounter views such as “cultural differences” or “culture-related health beliefs” as the reasons why immigrants encounter disparities when approaching healthcare institutions? Is culture really to blame for the inequalities that migrants face when accessing healthcare systems? Why is this even an important question to ask?

There is no doubt that migrants face a hearth of vulnerabilities when settling in a new country, such as lack of language knowledge, unfamiliarity with institutions and access to labor market opportunities. But how do migrants access healthcare systems when they first arrive? How do they communicate their illnesses and what are their expectations in how doctors may diagnose them or communicate their methods of treatment?

If you do your homework in the suffocating amount of immigrant health literature that looks at how immigrants access healthcare facilities (as well as the quality of those services provided in terms of accommodating migrants’ specific needs), you begin to notice the creeping re-appearance of culture as an explanatory ground on the inequalities that migrants face.

How different could the culture of the host country and the country of departure be when comparing people’s health attitudes? This question of course relies on which ethnic group of people you observe as well as the countries of settlement: Turks in Germany, Africans in Italy, Chinese in Australia, Albanians in Macedonia. The migratory pathways and patterns are enormous, complex and almost impossible to summarize.

The point is not to undermine culture as an aspect to analyze when looking at the ways in which migrants integrate into their host country, in particular approach healthcare services. In fact, analyzing different understandings of culture regarding health has lead to an array of interesting ethnographic accounts of how different ethnic groups of people communicate health differently.

The point is, on the contrary, to look beyond the cultural explanations when looking at how migrants perceive or interact with healthcare institutions. The culture of a particular group of “ethnic” immigrants is not homogeneous, static or stationary. Migrants are a diverse group of people, and differ in mountainous ways in terms of their age, gender, socio-economic status, class, recency of arrival, education, city of settlement and departure.

For example, imagine two Italians, a man from Naples and a woman from Milan moving to America. Would the pathways through which these two people incorporate into America be the same? Would the “culture” of these two people be the same? Here, gender would play an imperative role, as would ‘city of departure’, as the cultural traditions, behaviors and customs between Naples and Milan are vastly different. Migrants are therefore diverse; they come from different places, have different life trajectories and come from various cities. It is important to acknowledge this because scholars attend to migrants as if they share strong cultural bonds, identity and unity. What about the people that don’t identify with their cultural groups and do not rely on their ethnic background to access institutional services?

So why do scholars, scientists and academics continue to use the “cultural” model when exploring not only how migrants access health systems, but incorporate into the society in general? Perhaps looking at this through a political dimension could help answer the question. It is simply in the interest of nations and policymaking strategies to homogenize ethnic groups of migrants. If you endorse the pluralism and diversity of people, then you must also adopt and embrace multicultural policies. However, multicultural policies are not always in the interest of all countries.

Politics aside, the point is to give more attention to diversity and difference, rather than lumping people into a particular cultural or ethnic category. This clearly impacts the way we view each other, the stereotypes that are created and perpetuated. Stereotypes are useful for one thing only: funny films. But looking at the ways in which they impact institutions and policies is important, and affects a lot of people.

Step outside the cultural model, look at culture through a meticulous lens and try not to base assumptions on cultural unity.

Image credit: Doctors of the World UK via Flickr.com

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Beijing, with a population of over 20 million, has suffered from hazardous air pollution since last January, which has threatened the people greatly since the pollutants can cause fatal health problems.

On January 12, the air quality monitor run by the U.S. embassy in Beijing reported an air pollution level of 886, which directly indicated PM2.5 – a fine particulate less than 2.5 micrometers in diameter – is off its maximum level of 500. This warns that everyone should refrain from all physical activities outdoors. According to the World Health Organization (WHO), the average concentrations of PM2.5 per cubic meter should not be more than 25 micrograms, yet the readings on some days in January exceeded 40 times of the standard.

The effect of the PM 2.5 is even more disastrous: The U.S. embassy Beijing air quality monitor website stated “PM 2.5 particulates are of concern since they are small enough to directly enter the lungs and even the blood stream,” and warned that ‘hazardous’ level of air quality can result in “Serious aggravation of heart or lung disease and premature mortality in persons with cardiopulmonary disease and the elderly; serious risk of respiratory effects in general population.”

Nonetheless, you did not need to check the Air Quality Index (AQI) to see how dreadful the air quality was. The darkness from the extreme dustiness lasted the whole afternoon on that day, and the thick dusty layers hindered sight within approximately 300 meters, where even the huge skyscrapers were hardly visible. “The smog was so thick that more than 50 flights were cancelled at Beijing Capital International Airport, causing chaos ahead of Chinese New Year, when city-dwellers travel to see relatives” reported the Independent on January 29. The effect of the ‘hazardous’ level of the air quality was immediate. Dr. Huang of the Beijing Shijitan hospital said in an interview with CBS News that the number of patients hospitalized because of chronic bronchitis or other respiratory illnesses had increased by 20% after the hazardous air quality days.

Yet, this catastrophic phenomenon did not just happen for an occasional day. Beijing has been besieged by the hazy and dusty skies for the last several months at a consistent level, and there have been only a few days of blue skies; the AQI reads under the degree of ‘Unhealthy’. Even China’s national newspaper, China Digital Times, published an article titled “Beijing Air Quality: Worse than SARS.”

As a response to the people’s outcry, the city government took urgent action. According to Bloomberg on the last January 29, Beijing decided to temporarily shut down the 103 factories around the city, and the government agencies and state-owned companies were commended to reduce vehicle use by 30% until the end of January.

The scenery of Beijing in the past months has been changed visibly. People started wearing PM 2.5-blocking masks outside, and frequently check AQI via the application on their mobile phones. The term ‘PM 2.5’ is often being discussed everywhere – in newspapers, television and people’s daily dialogue. Some companies distribute free 3M dust masks for college students on campus instead of their traditional marketing strategies of giving a small gift such as stationary.

It is estimated to affect the job market in Beijing as well. On April 1, Financial Times reported that the ‘Airpocalypse’ has made it difficult for companies to find international work talent, and many expatriates are planning to leave Beijing due to the concern for health. There are nearly 200,000 foreign residents in Beijing and many of the expats are professionals with high-earning jobs, which contribute greatly to the socio-economic development of the city, the news report said.

“Air pollution is a major problem in China because of the country’s rapid pace of industrialization, reliance on coal power, explosive growth in car ownership and the sometimes disregard for environmental laws,” said CNN news on January 19. China has been the world’s largest greenhouse gas emitter since 2007, and approximately 70 percent of its total energy still comes from coal.

The 2012 Cancer Registry Annual Report showed that cancer-related mortality in China has increased by 465 percent in the past three decades and the lung cancer was the top cause among all the cancers.

According to the World Bank (WB) report, 20 cities in China listed on the 30 most polluted cities in the world. In the recent study by Greenpeace and Peking University’s School of Public Health, it is estimated that the exposure to PM2.5 caused more than 8,500 premature deaths in Beijing, Shanghai, Guangzhou, and Xi’an in 2012.

Image credit: People in Beijing via Flickr.com

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CrossFit, a workout and training program designed by Greg Glassman in 2001, is rapidly becoming the new way to get moving and into shape. Unlike fad diets, slim-quick schemes, and dusty gym memberships, CrossFit is a trainer-led program that focuses on strength, cardiovascular conditioning, and “…simply to ensure the broadest and most general fitness possible” as stated by Glassman in The CrossFit Journal Classics.

The program is so general that military training and police academies use it, yet the average man or woman is still able to pick up the routines.

CrossFit is a brand name, and the program works out of 5,500 affiliated gyms and through over 35,000 certified CrossFit trainers, according to the official website.

So how and why does CrossFit work? The first thing those looking into it should know is, that the method is intense. Each day the official website puts up a Workout of the Day, or WOD, and an explanation. Though it is possible to do at home, CrossFit trainers at affiliated gyms run most CrossFit programs, which means no more incorrect or ineffective workouts stemming from lack of know-how. The trainer leads and everyone does the same workout all together, like a group class, just at different speeds or with augmented actions to compensate for individual levels of fitness. The idea is to push your workout and yourself to do more than you could before.

The exercises, which require short periods of speed, lifting, gymnastics, and endurance, are designed to build power and energy seemingly through exhausting them. Workouts are in circuit form, one following immediately after the other, so calories are burned quickly. Unlike cardio-focused workouts, muscle is also built, but without the single-minded bulk of pure weight training. Workouts change daily, and are never quite the same twice consecutively, resulting in a continued interest to members. No muscle group is overlooked, no jump or kick left out, and every moment is a challenge for both the body and the mind.

One of the main differences between traditional gym time and CrossFit, is the community that has developed internationally and within individual gyms. Followers of the program actively aid one another through encouragement, offering support both on the mats and online through the company’s website. Sometimes, this atmosphere of encouragement and the never-quit mentality found in the program, can be more than a little intimidating to new-comers; but the program stresses that everyone can do the exercises with a little bit of prep work. After signing up with an affiliate, there is a one-month initiation course which serves to bring everyone to the necessary baseline fitness needed to successfully complete the circuits without serious risk of injury. This is a smart way to ease the body into the intensity and teach participants important workout basics they would not be taught in the traditional gym setting. Once complete, people join the general class and set the work building their bodies and some new friendships.

As with all workout programs, there are risks along with the rewards. Instead of the normal risk of losing interest or not seeing results due to lack of trying, CrossFit has the odd problem of people pushing themselves too much. Exhaustion and dehydration are the top problems seen in workouts, which by medical standards are easily preventable through drinking plenty of water and by not letting the ‘never-quit’ mantra be taken too literally.

CrossFit affiliates and locations can be found here, on the search page.

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Barack Obama won re-election, and America lost its future. Many would call that statement a sign of sour grapes the words of a poor loser. Yet, it is neither. It is the simple conclusion for anyone who has a calculator and has done the math. The national debt for the United States is 16 trillion dollars. That’s 101% of the Gross National Product. It would be like someone making $50,000 a year owing $5,000,000 dollars. Now that Obama has been reelected, the country is projected to reach 20 trillion in debt by the time he is out of office. The only thing that could change that path is if the President were willing to cut the spending spree, something he has shown he does not want to do.

Our debt is unsustainable at its current level. Now that we are guaranteed to have Obamacare written in stone and the two to three trillion dollars it will cost, by 2016 the country will be on a path that cannot be altered: insolvency. It is simple math. It has nothing to do with being a Republican or Democrat. Issues of racism or classicism makes no difference. It is zero’s and one’s. The income either adds up or it does not.

Greece is learning this lesson now. They spent too much on social programs, guaranteed state and country wide union wages, infrastructure built to provide “jobs” and higher taxes. The net result is a country that went running, hat in hand to the European countries for money to keep their country alive. The loans came with strings attached, as most loans do, and the string was a total restructuring of Greece’s spending. The result has been civil unrest, labor strikes, and riots. If you ask the rioters why they are doing these things, they will tell you because of the cuts to wages, and social programs. The very things that made them have to go begging for loans to stay afloat. It is like a person who buys the exotic sports car, and then gets mad at the person who comes to repossess the car, because they cannot make the car payment.

America is on that path, and has been for quite some time. Like the minor tremors that portent a large earthquake, little signs have been appearing: polls that show most people wanting those that make more than they to pay more in taxes, backlashes against any plan to slow down the spending and cost of medicare, men and women alike defending the idea that others have an obligation to pay for the birth control of women, support for fiscally dubious high speed rail projects across the country. Little by little, inch by inch, the mindset of the government spending the viewpoint of entitled thinking has been creeping into the psyche of the American populace.

Tonight’s election was the seismic event that was building. It signals that America has turned toward a social democracy like Europe. This has occurred not because of Barack Obama, but because people chose him. America’s populace chose tonight. They did not choose Romney because he was a bad candidate or ran a bad campaign. They chose Barack Obama, because they want the freebies, and they want someone else to pay for it. There are more people that embrace class warfare, than shun it. The days when President Kennedy said, “ask not what your country can do for you, but what you can do for your country,” is dead and gone.

We want the healthcare, we want the free birth control; we want the government to take care of us. The only problem is we cannot afford to do it. We cannot do it at 16 trillion in debt, and moving to 20 trillion in debt will not make things better. More debt never does.

American lost tonight, make no mistake about it. America died tonight. What the country that now occupies its space on this planet ends as is pretty clear. We become Greece on steroids, and the collapse will be televised.

Image Courtesy : WCHI News

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Now everyone knows that you should eat healthy in order to be a healthy person however, but here is another reason; to improve your video gaming abilities. There being various different types of games which would mean that you require different types of food. This can apply to puzzle-based games, strategy games, first-person shooters, and more.

One of these types of food is fish, which greatly enhances your brainpower. Fish is a good source of protein that is filled with omega-3 fatty acids. Omega-3 fatty acids assist in brain functioning and can also lower the risk of having dementia or a stroke. Thus fish plays a large role in slowing mental decline and enhancing memory however; you will need to eat three servings per week to receive these benefits. If you ever find yourself playing a game with memory based puzzles or an RPG where you need to remember all your quests, then you might want to eat something that’s pretty fishy.

Another type of food which will increase your brainpower is bananas, which have been shown to enhance memory. Furthermore, they contain vitamin B6, which helps in the body’s production of serotonin, norepinephrine, and dopamine. All of these improve your concentration. If you play fast-paced first-person shooters or stealth games then you should definitely go bananas.

Spinach is also sure to improve your mind, since the minerals in it have been proven to improve concentration. A regular consumption of spinach has also been linked to a reduced risk for brain deterioration and memory diseases such as Alzheimer’s. It is full of vitamins such as magnesium and vitamin B12, which both play an important role in the creation of red blood cells, which carry oxygen to the brain. This will keep your brain thinking quickly in games which might be timed such as racing games or battle games when you are competing against friends. In either case, this is a vegetable that is sure to make you stronger.

However, if you want to get a bit of a workout from your videos games and decide to play the Wii or Kinect then you’re going to need the right meal to help keep you from getting tired too fast. Unlike the other video games where you are stationary, it is important in cardio based games to watch what you eat.

For example, if you plan on playing these stimulating games and eat two or three hours before you play, then you should eat a meal in the 300-400 calorie range. The best kind of meal would be a lean protein with veggies or a fruit and nut bar with a small serving of yogurt. If you plan on working out one or two hours before you play an active game you should eat a snack under 200 calories. A bowl of cereal or trail mix would be ideal.

If you would rather not have to wait too long to play your entertaining games and plan to eat 15 or 30 minutes before you play, then it is recommended that you eat about 25 grams of carbs. Snacks that would fit into this category would be some raisins, saltine crackers, or applesauce.

However, if you don’t have any time to wait and have to play the game immediately, then you should have a snack that is about 15 grams of carbs: seven to nine jellybeans or one slice of white bread.

If you are interested in researching this for yourself, all this information can be found here.

Even though people do not generally eat healthy to help their gaming capabilities perhaps this will give people just another good reason to eat healthy. In fact, a majority of the time people expect video games to be a detriment to a fit human being. However, maybe video games will give people a good reason to continue trying to become healthier.

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Ann Arbor, U.S.A. – The Center for Healthcare Research & Transformation (CHRT) released a policy paper that shows how the Patient Protection and Affordable Care Act (ACA) in 2014 will streamline eligibility categories and may also help between 400,000 and 500,000 citizens to become newly eligible for Medicaid coverage. Currently, there are at least 40 different ways — each with varying eligibility requirements—to qualify for Medicaid in Michigan.

Whether or not Michigan decides to expand coverage for Medicaid, the paper shows that enrolling in Medicaid and maintaining that coverage should become easier for Michigan residents starting in 2014, when the ACA requires states to eliminate asset tests — a review of an individual’s assets to ensure they do not exceed certain limits—and consolidate existing eligibility categories.

“Many changes were included in the ACA that go beyond the Medicaid expansion. These changes were designed to make enrollment policies and processes simpler for those who have existing Medicaid coverage, and enable those newly eligible to go through an easier enrollment process than exists today. These enrollment changes alone should help ensure that more people have access to the affordable care when they need it,” says Marianne Udow-Phillips, CHRT’s director.

Under current federal rules, the Medicaid program provides coverage to those at or below a certain income level who also fit within certain categories, and states can opt to expand Medicaid eligibility.

In 2014, all existing eligibility categories—mandated or optional—will be simplified and consolidated into three categories:

• Parents and caretaker relatives of dependent children under 19.
• Pregnant women.
• Infants and children under age 19.

Additionally, those who receive Supplemental Security Income (SSI) or qualify as “medically needy” will remain Medicaid eligible to avoid gaps in coverage.

For states that opt to expand Medicaid, all non-elderly citizens and eligible resident immigrants with incomes at or below 138 percent of the federal poverty level will become Medicaid eligible, even if they are not categorically eligible.

While the Medicaid expansion is optional for states, streamlining eligibility criteria and simplifying enrollment processes is still required.

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Philadelphia, U.S.A. – Premature babies are more likely to survive when they are born in high-level neonatal intensive care units (NICUs) than in hospitals without such facilities, and this benefit is considerably larger than previously reported.

The likelihood that an extremely premature baby will survive if born in a high-technology, high-volume hospital unit was already known, but the current study, the largest to date, revealed a stronger effect. Pediatric researchers who analyzed more than 1.3 million premature births over a 10-year span found that the survival benefits applied not only to extremely preterm babies, but also to moderately preterm newborns.

The research team performed a retrospective study of all hospital-based deliveries of infants with a gestational age between 23 and 37 weeks in Pennsylvania, California and Missouri—a total of over 1,328,000 births. The study focused on preterm deliveries in high-level NICUs, compared to preterm deliveries at all other hospitals.

“Prior studies from the early 1990s found increased survival rates of 30 to 50 percent among preterm infants delivered at high-level NICUs, compared to preterm infants delivered elsewhere,” said study leaderScott A. Lorch, M.D., a neonatologist at The Children’s Hospital of Philadelphia. “However, our research found rates as high as 300 percent improvement, when our study design controlled for the effect of sicker patients who typically deliver at high-level NICUs.” Complication rates were similar for both types of hospitals.

The retrospective study, which appeared online July 9 in the journal Pediatrics, analyzed records for all births occurring between 1995 and 2005 in Pennsylvania and California, and all births between 1995 and 2003 in Missouri. Lorch added that the results varied slightly among the states, possibly reflecting state-level differences in health policies, such as whether or not the state government designated hospitals within a regional perinatal system.

Premature babies are those born before 37 weeks gestational age (full term is 40 weeks). In this study, the researchers defined extremely preterm infants as those born before 32 weeks and moderately preterm infants as those born between 32 and 37 weeks. They defined a high-level NICU as a level III facility that delivered at least 50 very low birth weight infants annually. “We found survival benefits in high-level NICUs for both extremely premature and moderately premature infants,” said Lorch. “This suggests that the choice of a delivery hospital may influence the outcomes for the full range of preterm infants.”

Unlike many previous analyses of birth outcomes, said Lorch, the current study covered more than a single state system. Using hospital data from states in three regions of the country suggests that the results may be more generalizable throughout the United States than in more limited studies, he added.

However, concluded Lorch, “this research does not imply that every hospital should aspire to build a high-tech NICU—there just aren’t enough babies born prematurely for every birth hospital in the U.S. to have a high-level, high-volume NICU. Instead, the results may assist health care policy makers in organizing regional and statewide care systems to more efficiently provide the best care for premature infants within a geographical area.”

Financial support for this study came from the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. Lorch’s co-authors were Michael Baiocchi, Ph.D., andDylan S. Small, Ph.D., of the University of Pennsylvania, and Corinne E. Ahlberg, M.S., of The Children’s Hospital of Philadelphia. In addition to his position as an attending neonatologist at Children’s Hospital, Lorch is also on the staff of the Hospital’s Center for Outcomes Research and is a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania.

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New York, U.S.A. – A recent clinical trial conducted by The Institute for Music and Brain Science at Harvard University on the positive effects of music on Parkinson’s disease has received substantial support from science activist, Jeffrey Epstein and his foundation, The Jeffrey Epstein VI Foundation. The study was conducted with the Department of Neurology at Massachusetts General Hospital and Harvard Medical School.

The trial evaluated the effects of ambient music on a group of Parkinson’s patients with severe to mild symptoms. Specifically, the study looked at visuomotor integration, rapid alternating movements (RAM’s) and gait. Twenty trials per category were conducted and measured in milliseconds. The music had a strong metrical rhythm and medium tempos confined to a range of 128 to 192 beats per minute.

Control test conditions of patients were either silence or asymmetrical instrumental music. The results were encouraging: in the visuomotor tests, 40% of those with mild Parkinson’s were significantly faster with ambient music. In the RAM tests, 83% of those with moderate Parkinson’s showed faster results. In the gait tests, 25% of those with moderate Parkinson’s showed faster and larger strides.

“The results are remarkable,” Jeffrey Epstein asserted. “More studies need to be done to show that music improves motor coordination. However, these studies highlight how areas in the auditory cortex are affected, providing a road map for how to duplicate the stimulus and enhance it.”

The Jeffrey Epstein VI Foundation is a long-standing supporter of science research at Harvard University. In 2003, it gave a $30 million grant to Harvard to establish the Program for Evolutionary Dynamics, which studies evolutionary biology from a mathematical point of view.

Founded by Dr. Mark Tramo, the Institute for Music and Brain Science seeks to advance knowledge about the neurological impact of music and to combat neurological and other diseases using music as a lens into the brain and as a rehabilitator.

Dr. Tramo is an Associate Professor of Neurology at Harvard Medical School and Attending Neurologist at Massachusetts General Hospital. He is the recipient of numerous awards for original research on the effects of music on the brain.

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So far in our series about the Affordable Care Act (ACA), we have provided an overview in Part 1 and reviewed the benefits of Pre-existing conditions and continuing coverage for kids under their parent’s plans. This law is a complicated one, with over 2,700 pages. It is the goal of this series to explain the more common provisions in a simple and logical way, so you do not have to read the entire law. In Part three, we will look at the following provisions: no cap on lifetime benefits, and preventative care benefits.

No Lifetime Limit on Coverage

Most health insurance plans, either private or through employment, have a limit on the amount of coverage for each person. Often, that limit is between one million to two million dollars. This is an average, and can be more or less depending on the health insurance plan. When you reach that limit, you no longer have coverage. If you or your kids have a rare illness like hemophilia, or rare form of cancer, you can reach the limit fast. Once you do, you have to pay for your care out of your own pocket.

Congress set out to end this within the ACA law. Now there will be no limits on coverage. If you have a rare disease or other health care problem that costs five million dollars, then the insurance company must pay it. While there are no official statistics on people that reach and exceed lifetime limits, it takes only a few people with news stories of their plight to make this a popular provision of the law. It is hard to argue against.

Implications

The primary result of this policy is higher premiums. On one hand are the very real costs of paying the additional medical bills of people who would have reached and passed a limit. Not many people do, but that is not the issue. The insurance company must factor in the costs of additional expenses for everyone. That is how they figure out risk and determine appropriate rates: by using actuaries and high level math to determine risks, average costs, etc. When their expenses for payouts go up, their rates must go up as well. It is simple to say, “They should just eat the expense for the good of people over profits,” but without profits there is no company to pay any premiums.

On the patient side, you will no longer have to worry about being wiped out by an illness. If you can afford the premiums for coverage, then you will not have to stress over possible high health care costs.

A more subtle implication is the continuing argument over how much are and should people be responsible for their decisions. As we will discuss in detail in the section on preventative care, no limits are another barrier to people understanding health care costs, and being responsible. Often, insurance plans have riders that allow individuals to purchase a higher limit amount, and people decline to do so.

They see two million dollars, and think “Hey I’ll never have that many doctor visits.” Then, the illness hits and it is too late. Sometimes people are innocent victims of fate, other times they are the victim of their own choices. As laws take more and more responsibility away from individuals in different areas, there is the real effect of people being more irresponsible.

Preventative Care

If you have caught even a slight amount of news about the ACA law, then you have probably heard supporters of the bill tout this benefit. Beginning in section 4,000 of the law, a host of preventative services are now covered under the law at no co-payment.

The number of services covered are too numerous to fully list here, but include things like disease screenings, mental illness screenings, immunizations, and most controversial presently, birth control and sterilization procedures. Many of these services were covered under current plans offered for sale or through employers, but now they must be covered at no co-payment to the insured.

Implications

The primary idea behind covering preventive care in a comprehensive manner is the fact that the best way to keep costs down for serious illnesses is to not get sick. If individuals take better care of themselves, get regular checks-ups, and prevents illness, then over time health care costs will go down, and then premiums will go down. The problem, however, is that you cannot make people go to the doctor. Many insurance plans already cover items of preventative care at no cost, or very low co-pays.

Many offer lower premiums for things like joining a gym, or joining wellness programs. Yet, people still do not take better care of themselves. You cannot make people go to the doctor, get checks-ups, or engage in wellness programs. By making them free, you have just taken any incentive or responsibility out of their hands.

When you divorce people from real costs, they do not worry about costs. When you make something free that they were not planning to do anyway, then all you have done is raise the costs of premiums, because these services must be covered. By making all sorts of preventative services covered, both the practical like immunizations and the esoteric like fully funded wellness centers, you increase costs.

The other implication is that the Obama administration has set up a coming legal war over the issue of birth control. By mandating that religious organizations must cover birth control, they have impended, many feel, on the rights of the religious. Birth control is a personal choice, but the ACA has made it everyone’s business because it requires everyone to pay for it.

The crux of the situation is simple, should you have to pay for your neighbor’s choices? If you are an employer, religious or otherwise, should you have to pay for the choices of your employees? The ACA says yes, and many organizations will be fighting this provision.

The next part of our series will explain provisions requiring equal premiums for women, and mandates dictating how much insurance companies must pay in health care expenses. These are two of the more controversial provisions with wild and inaccurate statements flying in the media. Tune back in to get the real facts on these two provisions of ACA.

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In Part One of Toonari’s Affordable Care Act series, we gave an overview of the law’s structure. In Part Two, we will begin to review the benefits as stated in the law, and their possible implications. The provisions we will review first are two that will be at the forefront of the President’s campaign stump speeches. These are benefits related to children and preexisting conditions.
Children Can Stay On

Before the 2008 recession, this is a benefit that would not have been a big deal for most parents. In the wake of the recession and Millennials moving back home in droves, it has become a more frequent problem. Before the ACA, children could remain on their parent’s health insurance plans until some time between age 21 and 24; it varied from state to state.

Now under the ACA, children can remain on their parents plan until age 26. This is something that many parents like, and sounds good on the campaign trail. For parents with kids with serious, ongoing chronic illnesses this also relieves, in theory, some of the stress of approaching health care costs. This is a catch gap designed to be a bridge between now, and when the preexisting condition benefits kick-in, in 2014.

Implications

The consequences of this change are minute. It is true that some people have a philosophical problem with what could be seen as further coddling of young adults, the reality is the difference between 24 and 26 is small. Keeping kids on the parent’s plans for a couple of extra years does increase the risk of higher and more medical payouts for the insurance companies, but most people at age 26 do not go to the doctor that often. In addition, the parents still have to pay the extra premium they were paying for their kids remaining on their plan for a few more years.

That is added income to the insurance company. Basically this is a wash. The one caveat to this is that one of the benefits mandated by the ACA (more in this later in the series) is the coverage of birth control costs with no co-pay. Young adults are typically more sexually active so there will be an increase in costs to the insurance company for that benefit, which will force an increase in premiums from the insurance company.

Premium increases are a subject we will return to again and again in this series about the ACA law. It is important to remember; health insurance companies do not have the power to tax the public. They pay their claims out of the earnings they make. When their expenses go up, they must charge more. This is not a matter of evil intentions. It is basic business 101. You must charge enough to cover your expenses. If expenses go up, then so must your prices.

Pre-existing Conditions

This is the big one. The issue that pulls the most heart strings, and the one that most people agree upon. Starting in 2014 there will be no preexisting conditions limitations for anyone. Before the law, if you had a preexisting condition and were not on an employee health care plan, you would be denied coverage. The reason for this is simple. If you have diabetes, then you are a guaranteed expense for the insurance company.

Insurance is all about minimizing risk to cover as many people as possible, for as little as possible. That basic tenant of insurance planning is now off the table. Cancer, AIDS, asthma, congenital conditions, previous surgeries; it is unimportant what the condition is, you can now get coverage.

Implications

The possible and real implications for this are huge. On the consumer side, you do not have to worry about being denied coverage. The days of worrying about choosing bankruptcy over health care are now ostensibly over. On the insurance side, the costs will skyrocket. It is easy for many to say, “Life before profits, or money” but that is because they are not the ones writing the check to cover the costs. One of the main selling points politically was that the ACA would reduce costs of health insurance and health care expenses.

This is one component of the law that makes that claim hard to reach. Millions of people who are very sick will now have coverage. This is a good thing. However, this will prove to be a bad thing fiscally. As the law settles in (assuming an Obama victory in November), costs for premiums and actual care will move up under the law. At some point cost containment measures will have to be looked at, which could mean rationing of care.

The other implication is that many Americans will opt not to buy insurance and just pay the penalty, because it is less money then annual premiums for the insurance. If they do get sick, or need an expensive surgery, they can just sign up for the coverage after they find out what they need. The scenario painted by conservatives is the picture of a person signing up for the plan in an ambulance on the patient’s way to a hospital.

The image is extreme, but it is also true. A person can do that. The law has no provisions in it to keep people from waiting till they know they need to sign up, and then dropping coverage once the medical situation is treated.

This will also have an effect of increasing costs, but also limiting the funds necessary to run the plan, as those missing premiums will affect the balance sheets of the insurance companies and cause higher premiums.

In our next installment, we will review the health care cost limitations, and preventative care provisions.

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Halifax, U.S.A. — Under a US Army contract valued at USD$4.2 million, MedMira will develop and commercialize this multiple rapid test which detects HIV, Hepatitis B and C simultaneously in 3 minutes from a single drop of blood.

MedMira Inc., a developer of rapid diagnostic technology and solutions, announced today that it has been awarded a U.S. Army Medical Research Acquisition Activity (USAMRAA) contract to develop and commercialize a rapid test capable of simultaneous detection of HIV and Hepatitis B and C.

The contract, awarded through a competitive bid process, involves a two-year base period and a 10-month option with a value of USD$4,266,144, if all options are exercised. MedMira presented its technology and multiple rapid tests, which met the U.S. Army’s advanced technology readiness level requirements. The Multiplo Rapid HBV/HIV/HCV Antibody Test resulting from this contract award will be deployed on the frontlines of military healthcare for use in emergency screening for transfusion transmitted diseases where no FDA approved donor screening tests are available. The military could also put the test to use during pre and post deployment screenings and civilian disaster relief efforts.

“We are thrilled to receive this new contract from USAMRAA for the development and commercialization of our Multiplo test. This contract award demonstrates the excellent fit between MedMira’s technology and products and military requirements. We have built a lasting relationship with the U.S. Army, delivering advanced diagnostic solutions that reduce the need for militaries to undertake ground-up development work,” said Hermes Chan, CEO, MedMira Inc. “MedMira’s technology and products are elegantly simple, portable, fast, and high quality. All of these attributes are mission critical in deploying diagnostic healthcare solutions on the frontlines of military healthcare.”

Chan continued, “Our team recently attended a conference focused on military pre-hospital trauma management where we heard first hand of the need for a multiple rapid HBV/HIV/HCV test from many of the leading experts, military personnel, and medical professionals in this field.”

Under contract number W81XWH-12-C-0151 the U.S. Army will fund all development costs and associated fees in obtaining a U.S. Food and Drug Administration (FDA) premarket approval (PMA) for this multiple rapid test. The scope of work under this contract will see MedMira advance and fully commercialize a multiple rapid test that will simultaneously detect three of the most serious infectious diseases, namely HIV-1/2, Hepatitis B, and C antibodies within three minutes using just a small drop of blood. Once approved, the product will be supplied by MedMira directly to the U.S. Army and to other customers throughout the world, both military and civilian, via the Company’s distribution network.

“A multiplexed test for transfusion transmitted diseases provides an enabling technology that will be used to mitigate risk in austere environments where emergency blood collections are necessary to save lives of severely wounded war fighters,” said Colonel Richard Gonzales, Product Manager, U.S. Army Medical Materiel Development Activity.

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The Affordable Care Act (ACA), commonly known as Obamacare, has been ruled constitutional. Not because the government has a right under the Commerce Clause to tell citizens what they must buy, but because the Supreme Court ruled in a 5-4 vote that the penalties involved for not buying health care insurance represent a tax. Congress has the right to impose taxes, and so they can create a law that imposes a tax on people who do not purchase health insurance.

Whether the government has any business forcing money out of citizen’s wallets for not doing something, and the implication of such a precedent is a question for another day. What will be most important for Americans, and others viewing the continuing electoral fight over the law, is what does it really mean? What is in the law, how does it affect me, what are the facts?

This is the first in a series of articles about the ACA Toonari will conducing to answer that exact question. This series will breakdown the 2,700 page law into bite-sized components explaining the benefits, structure, and implications of each part of the law. Arguments about whether it is good or bad will not be a function of this series. The reality is that most people do not have the time, nor the inclination to read, study, and research information about a 2,700 page law written in legalese. That is the province of political junkies and geeks. We will start with a general overview.

The ACA law is one that changes the way health insurance is run in the United States. It is not a government run health insurance plan in sense of Britain or Canada. In those countries, the government is the insurance company. With ACA insurance companies will still exist. However, the ACA mandates what must be covered. These are:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorders
• Prescription drugs
• Rehabilitative services
• Laboratory services
• Prevention and wellness services
• Chronic disease management
• Pediatric services
• Limit total out-of-pocket spending

Anyone not meeting this coverage will pay a penalty, or tax, for not having it. The penalty starts off low at $95 per adult, 47.50 per child, or 1% of your income whichever is higher. This is a key point. You will hear on television people saying its just $95. That is not true. If you make $50,000 per year, your fine will be 500 dollars. After 2014, that amount will rise until it gets to 2.5 of your income. This is stated in Section 1501, page 146 of the ACA law.

The insurance policies will be sold via an exchange. All the plans will be the same; meaning they have the same benefits. You will be able to buy different levels, with each level paying a higher percentage of total costs, but the benefits will remain the same from company to company.

Employers with 50 or more employees will have to provide insurance coverage to their employees, and it will have to meet the essential requirements of the ACA law. If they do not provide coverage they will face a fine of $2,000 per employee. Some companies and unions have been given waivers stating they do not have to comply with the law.

According to the ACA states have to expand their Medicaid rolls. This is the provision that the Supreme Court found unconstitutional. Originally, this is how more people were going to get health care insurance. Individuals and family’s that make too much for current Medicaid benefits, but make too little to afford the premiums for the plans under ACA, will go on the Medicaid plan in theirs states. States would have to pay 10% of the Medicaid costs. IF the state did not participate in the plan then they would lose federal funding for their whole Medicaid program. 

The Supreme Court has ruled that states can now opt out of this provision. It is unclear how many states will not participate, or what the result will be if they do not. A total of 26 states sued the federal government over the mandate and medicaid provisions, so presumably it is possible half the nation’s states will refuse to comply with the Medicaid expansion. The state of Florida and Texas have already declared their intentions to not comply.

This is a very general overview of the law. In the next installment we will describe two of the more popular features of the plan: children 26 and under, and preexisting conditions.

Image Courtesy of  Christopher Halloran / Shutterstock.com

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Washington, U.S.A. – According to a survey by StrategyOne, U.S. adults disagree with the Supreme Court’s recent ruling on the Affordable Care Act. While opinion of the decision is generally polarized by party – 66% of Republicans disagree with the ruling; 71% of Democrats agree – Independents are more aligned with Republicans. Fully 46% of Independents disagree with the ruling, while only 35% agree. Intensity among Independents is also strongly against the ruling, with 35% saying they strongly disagree and just 12% strongly agreeing.

Steve Lombardo, global CEO of StrategyOne, believes negative reaction among Independents could assist Republican presidential candidate Mitt Romney come Election Day. According to Lombardo, Independent opposition to the Supreme Court decision “suggests that the Roberts ruling has the potential to move swing voters and the GOP base toward Romney.”

Additionally, a majority (52%) of adults say they are more likely to vote in the presidential election as a result of the decision. The Supreme Court’s actions appear to have a greater impact on Romney supporters. Among those voting for Romney, 49% say they are much more likely to vote because of the SCOTUS ruling, compared to 38% of President Obama’s supporters. Those who disagree with the ruling are also more inclined to say the decision makes them much more likely to vote (43%) compared to those who agree with the ruling (35%).

Lombardo sees this enthusiasm gap between those opposing the ruling and those supporting it also benefiting the GOP in the election. “If the electorate looks more like 2010 than 2008, it will be a big boost for Romney,” added Lombardo.

According to the StrategyOne survey, U.S. adults overall are slightly more likely to agree with the Supreme Court’s ruling on the Affordable Care Act than disagree. Fully 48% of respondents agree with the decision, while 41% disagree.

Survey Methodology

StrategyOne conducted a nationwide telephone survey of 1,022 adults, 510 men and 512 women 18 years of age and older, living in the continental United States. All interviews were undertaken using computer assisted telephone interviewing (CATI) technology. A total of 772 interviews were conducted among landline respondents, and 250 interviews were conducted among cell phone respondents. Results are weighted to represent the U.S. population using data from the Current Population Survey on age, gender, race, region, and education from the National Health Interview Survey (NHIS). The overall margin of sampling error for the total N of 1,022 is +/- 3.5.

Image Courtesy of  Walter G Arce / Shutterstock.com

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There is the no two ways about it, President Obama received a huge victory today, and got it from an unexpected source. Chief Justice John Roberts was the deciding vote that upheld the individual mandate for the Affordable Care Act.

Here is the walk-through. The United States Supreme Court was deciding four major things in today’s ruling.

• Did the Federal government under the Commerce Clause of the Constitution have the authority to mandate individuals’ purchase of health insurance?
• Was the mandate necessary for the entire law to be upheld? The idea of Severability. If you got rid of the mandate, would it invalidate the whole law?
• Did the Federal government have the ability to withhold a state’s Medicaid funding, IF they did not enact the Affordable Care Act, and not place more people under their Medicaid health care plans?
• Is the penalty a tax?

The Individual Mandate

From the start, the primary fight against the ACA or Obamacare law was the idea that the law forced people to buy health insurance. That was the primary issue that people have been discussing for the last two years. Does the Commerce Clause give the federal government that power? In a 5 to 4 vote the court said that no, the federal government does not have that power. And when that was announced on the news, a million plus sighs and cries of “YES!” could be felt from conservatives around the United States. It was short lived.

Although the court said it was unconstitutional under the Commerce Clause it was upheld as constitutional as a tax. Not only that, but the deciding vote for the law was Conservative judge John Roberts. To call this a crushing blow is an understatement, and underscores how Presidents can never know how their appointees will decide. President Bush appointed John Roberts, and he has been a frequent attack subject by the political left. Yet, he voted their way today. And the man who was supposed to be the deciding vote Justice Kennedy had this to say in his dissent, “In our view, the entire Act before us is invalid in its entirety.”

The total opinion is 200 hundred pages long and will take time to digest, but in the law itself, there is not a single mention of the word “tax.” This could be because President Obama and the Democrats knew they could not sell it, if it were called a tax. That, however, did not stop the lawyers of the government from calling it that in the briefs and oral arguments. It was persuasive, as the Court upheld the idea that under Congress’s power to tax, the mandate, and the penalty charged for not getting health insurance falls under that umbrella, even if it were not called that in the law itself. Lastly, because the mandate was upheld as a tax there was no reason to even discuss severability.

The Issue of Medicaid

This is one issue that was central to the 26 states that brought suit against the Obamacare law, but not necessarily followed by most U.S. Citizens. In this area the Supreme Court, also in a 5-4 vote, held that is was unconstitutional for the federal government to withhold a state’s federal Medicaid funding, if the state did not create the exchanges and add the millions of new people onto their Medicaid rolls. The states position was that it was too expensive, and that the federal government could not force them to expand their Medicaid rolls.

While this question did not receive much attention before it will now. The segment of the population that Obamacare was created to give insurance coverage to was the poor, and the working middle-class. However, the way in which they would be getting this coverage was through an expansion of the Medicaid rolls in each state. Now, the states can refuse to do it. This means one primary purpose of the act has been nullified. This will have huge implications for the practical working of the law and goes back to the issue nonpartisan evaluations of Obamacare have always maintained. That the law tried to do too much, too fast, and was not crafted well.

Twenty-six states sued over both the mandate and the Medicaid requirements. Presumably all 26 will refuse to set up the exchanges. That means the millions who were supposed to be getting the new benefits will not, and that also means that one of the funding apparatus’s; namely, premiums for the policies, will not be forthcoming. That adds another financial burden to a law that was financially fraught from conception. In today’s news, and from now to election day, this aspect may be out shined by the huge win for President Obama. However, the practical measures of getting the law started in terms of the health care policies, could rear its ugly head soon after the election.

What now?

What happens next is anyone’s guess. One possible consequence is the independent and conservative bases that fueled the 2010 midterm elections could rise again. If that happens, Obama loses in a landslide, and the Republicans take the Senate and the House. Spending, the threat of taxes, and Obamacare fueled the 2010 election outcomes. This ruling has put all those items squarely back in play.

But, President Obama can campaign on making sure he is reelected so that he can preserve his law, a law that has been ruled constitutional. Republicans would be making a mistake to think Democrats cannot be rallied to the polls to keep that from happening. Presidential election cycles always have a higher turn out than midterm elections. Thinking that the conservative and independent base will overwhelm the Democratic base would be a mistake.

Still, one problem with the law has always been that did it not address health care costs, just access. So how to pay for it still remains a big question. The mandate leaves one funding avenue open, but the state not having to make the exchanges closes down another. The Congressional Budget Office and the Medicaid Department have both released studies showing that the law does not reduce health care costs or the costs of insurance. The bottom line from these two nonpartisan agencies was even if everyone followed the mandate and bought health insurance, it still was too expensive. Now, you add in some states not even creating the exchange, and you have a bigger mess. Further complicating this is that you can bet the Court will shortly have another case related to this from religious organizations that do not want to pay for a woman’s choice to use birth control pills.

Today is a historic, and for me, ironic day. According to the Supreme Court, conservatives were correct in their assertion that it is unconstitutional under the commerce clause, but lost because of the government’s ability to tax is broader than the commerce clause. Ironic that they won, but lost. Ironic that President Obama wins via a tax, yet he has never called it a tax. Ironic indeed.

Image Courtesy of spirit of america / Shutterstock.com

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Facebook has launched its latest tool where users can share that they are an organ donor, in the hope that it will help save more lives on a daily basis. Facebook users have to go to their timelines, where under ‘Life Event’ they will see a health and wellness section and then you can click to become an organ donor and share your story about when, where or why you decided to become a donor.

More than 114,000 people in the United States are awaiting organ donations, 79 people daily receive a transplant while 18 die, according to Organdonor.gov. In the UK, National Service Health Service (NHS) pointed out that there are over 10,000 people on the waiting list for an organ, while an average of three people a day die waiting for a transplant.

The new Facebook feature is working in the United States, UK, and Australia but it is expected to expand in other parts of the world. The US previously averaged about 506 new registrations per day, but since Facebook introduced the tool on April 30 more than 24,000 people have registered to donate their organs, according to Donate Life America.

Facebook added the organ donation feature to raise awareness to the issue after CEO, Mark Zuckerberg, took a personal interest in it, partly because of his friendship with Apple co-founder Steve Jobs. Jobs’s liver transplant extended his life several years.

The move will raise awareness about the critical shortage of organs for people in need of life-saving transplants. It may also create social pressure to inspire Facebook friends to consider registration.

This solidary initiative is seen by many skeptics like another way to obtain personal information concerning our health. Once we become an organ donor our privacy is stripped away, no matter how good Facebook´s intentions, sharing our data with the social network entails releasing information to an unknown companies without our consent. In an indirect way behind our altruistic behavior many big firms will make a killing exchanging information.

This donor program might bring about many successful and happy stories about saving lives, but in the end you are also an information donor, giving away your personal information to a company that can make profit off of it. Medical insurance companies will use our personal medical information to determine our eligibility for insurance coverage for their own protection, allowing health businesses to capitalize on insurance payments for the healthy, whereas others with bad medical history will be overcharged.

Another concern about organ donation is that medical information on Facebook is not protected by U.S. laws. According to the state´s Uniform Anatomical Gift Law, being an organ donor on Facebook is just as good being on the state´s organ donation registry.

Organ donation has never been “private” as it is openly displayed upon a public identification card. The choice of being an organ donor is personal and has to be respected. With the new Facebook feature, this choice becomes a public identity marker, something to be socially shared, commented upon, and potentially, conspicuously absent.

The advocacy group Donate Life American found that many people decline to became an organ donor for diverse reasons: citizens fear that they are not healthy enough or they are too old to donate their organs; others are concerned that doctors will not try their best to save them if they are known to be an organ donor; some people believe there is a black market where organs or tissues are sold; and some citizens question whether or not a person can recover from brain death.

Organ donation, as displayed through Facebook, is at once a deeply personal decision about death and the body, and a public display of generosity, fear, and/or general health. Whether you think that Facebook has made a strong move in a positive direction, or has once again taken sharing too far, the organ donation feature on Facebook embodies the categorical fusion that represents a connected era.

Image Courtesy of  withGod / Shutterstock.com

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Registered nurses at a Manhattan Veterans Affairs hospital failed to notice a patient had become disconnected from a cardiac monitor until after his heart had stopped and he could not be revived, according to a report Monday from the VA inspector general.

The incident from last June was the second such death at the hospital involving a patient connected to a monitor in a six-month period. The first, along with two earlier deaths at a Denver VA hospital, raised questions about nursing competency in the VA system, ProPublica reported last month.

The deaths also prompted a broader review of skills and training of VA nurses. Only half of 29 VA facilities surveyed by the inspector general in a recent report had adequately documented that their nurses had skills to perform their duties. Even though some nurses “did not demonstrate competency in one or more required skills,” the government report stated, there was no evidence of retraining.

Monday’s report documents the June 2011 death of patient in his 80s at the Manhattan campus of the VA’s New York Harbor Healthcare System. The man had undergone several heart procedures and needed to have his vital signs continuously monitored, the report said.

On his fifth day at the hospital, monitor records show that an alarm indicated a problem with the device or the patient. But there is no evidence nurses were aware of the alarm until the man was discovered unresponsive an hour and a half later. He was declared dead shortly afterward, the report said.

“The patient’s telemetry status was not effectively monitored at the time of his death due to a lack of awareness of the disconnected lead,” inspectors concluded.

Registered nurses assigned to telemetry units typically place cardiac leads, set parameters for the monitors tracking each patient, verify heart rhythms and take appropriate actions if there is an irregularity. They also enter progress notes and inform doctors of any changes.

Ironically, federal inspectors were in the hospital the same month to investigate the first death, which occurred in a different monitoring unit in January 2011.

During that investigation, the inspectors discovered nurses at the hospital didn’t understand how the monitors even worked. None of those interviewed could accurately explain what would happen if a patient became disconnected from a cardiac monitor.

Inspectors also found no evidence that the nurses’ competence had been checked. Records showed that one of the patient’s nurses had last received training on the monitors 13 years earlier, according the October 2011. The report recommended sweeping changes and retraining, which the hospital agreed to implement.

IG inspectors were not notified of the second death at the Manhattan facility until someone complained in November 2011, five months after the alarm was missed and the patient died.

The latest report does not recommend any additional changes or training at the hospital because “managers have made significant progress” after the first report.

In a response to the inspector general, the hospital acknowledged receipt of the report and said it concurred with the document. A spokeswoman for the VA in Washington didn’t immediately respond to our requests for comment.

by Charles Ornstein and Tracy Weber, ProPublica, May 15, 2012, 3:06 p.m.

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Philadelphia, U.S.A. – Researchers studying the molecular signals that drive a specific type of lymphoma have discovered a key biological pathway leading to this type of cancer. Cancerous cells have been described as being “addicted” to certain oncogenes (cancer-causing genes), and the new research may lay the groundwork for breaking that addiction and effectively treating aggressive types of B cell lymphoma.

B cell lymphomas, which occur both in children and adults, are cancers that attack B cells in the immune system.

“Our research suggests ways to devise more specific therapies to selectively kill tumor cells in a subset of lymphomas,” said study leader Andrei Thomas-Tikhonenko, Ph.D., an oncology researcher at The Children’s Hospital of Philadelphia.

The study, conducted in animal cells and human cell cultures, appeared May 1 in The Journal of Clinical Investigation.

An oncogene is a type of gene that normally produces a protein active in cell growth or regulation. However, when the gene is mutated or otherwise overproduced, it can cause cancer. One family of oncogenes is called MYC, and the current study focused on how the MYC oncogene drives B cell lymphoma. MYC codes for Myc, a type of protein called a transcription factor. At high levels, MYC causes the uncontrolled cell growth that is a hallmark of cancer.

The researchers focused on the crucial role of the cell surface receptor CD19, a protein residing on the surface of all B cells that normally recognizes foreign invaders. “We found that CD19 is absolutely required to stabilize the Myc protein,” said Thomas-Tikhonenko. “When Myc is stable and present in high levels, it fuels cancer.” Patients with high levels of the Myc protein are more likely to die of lymphoma.

Patients with high levels of Myc also had high levels of CD19, and the current study describes a previously unknown molecular pathway that depends on CD19. It also implicates CD19 as a molecular on-off switch on that pathway. Usually, said Thomas-Tikhonenko, when you inhibit one pathway, another pathway compensates to produce the same end result. But in this case, there is no such redundant pathway: “Without CD19, there is no Myc,” he added, “so controlling that on-off switch could represent a powerful tool against lymphoma.”

The findings are particularly relevant, said Thomas-Tikhonenko, to current oncology clinical trials that are testing antibodies that act broadly against the CD19 receptor. Such antibodies kill all B cells, and thus weaken the immune system. His study suggests that understanding the CD19 pathway could enable researchers to design a more specific therapy that selectively kills tumor cells while sparing healthy B cells.

Further studies in his lab, he added, will further investigate these molecular pathways and how to translate this knowledge into future anti-cancer treatments.

The National Institutes of Health, the V Foundation and the W.W. Smith Charitable Trust supported this study. In addition, a co-author, Elaine Y. Chung, Ph.D., was a fellow of the Leukemia and Lymphoma Society. Other co-authors, all from Children’s Hospital, were James N. Psathas, Ph.D., Duonan Yu, M.D., Ph.D., Yimei Li, Ph.D., and Mitchell J. Weiss, M.D., Ph.D.

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Pasadena, U.S.A. – Experts estimate nearly 30 million Americans, approximately 10% of the population, take some form of cholesterol-lowering drug, also known as statins, under brands such as Lipitor, Zocor, Pravachol, and Crestor.

Statins are among the most widely prescribed drugs in the United States and cardiologists agree that they remain the most effective long-term treatment for cholesterol patients in the high-risk category. However, many patients are not aware that through regular statin therapy they may be depleting their bodies of valuable vitamins and nutrients essential for healthy living. The depletion may be associated with an increasing number of side effects exhibited by statin patients – and relief from these side effects is not commonly known.

In the past, statins have generally been considered to be safe, however, as the population of statin users continues to rapidly increase, statin studies continue to emerge showing that there is also a significant increase in the number of side effects, such as chronic fatigue and muscle pain.

In fact, studies show that 10 to 20% of patients treated with statins complain of muscle symptoms and in rare instances use may result in serious muscle damage with myositis, inflammation and rhabdomyolysis. Even in the absence of clinically relevant muscle damage a significant number of patients experience an array of symptoms including muscle pain (myalgia), weakness, cramps and fatigue.

“Statins reduce cholesterol production effectively but not selectively – they also block the synthesis of Ubiquinol, a powerful lipid-soluble antioxidant found in every cell in the body that helps to protect the cardiovascular system from oxidative damage and an essential coenzyme required for cellular energy production,” explains Dr. Robert Barry, Executive Director of Scientific Affairs at Kaneka Nutrients, the leading manufacturer of Ubiquinol supplements in the United States.

The company reports that depletion of Ubiquinol can induce mitochondrial dysfunction by impairing oxidative phosphorylation, energy production and aerobic capacity. Ubiquinol depletion resulting from statin treatment may therefore impair muscle energy metabolism and contribute to the development of myopathy and muscle symptoms.

Many statin patients are not informed of this sometimes severe side-effect. Statin-related symptoms can affect the quality of life and often result in multiple dose alterations, switching brands of statins and ultimately, non-compliance. Statin patients who take Ubiquinol as a supplement therapy will be replacing the loss of Ubiquinol in the body and giving back what the muscles need to perform.

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Red Bank, U.S.A. – With more than 60 percent of women in the United States classified as overweight and one-third of those women being obese,[1] a new survey from HealthyWomen (HW) sheds light on women’s understanding of obesity and the options available to regain their health. The survey found that while women are knowledgeable about the heart health impact of obesity, they don’t understand other serious health consequences, namely cancer. When asked about the secondary health conditions associated with obesity, only 49 percent recognized the link between obesity and breast cancer, and 29 percent knew about the link between obesity and uterine cancer.

This lack of knowledge extended to weight-loss strategies as well. When women were asked about obesity-prevention actions available to them, more than half of the respondents (52%) did not know if their health insurance offered support. Only 10 percent believed their plans covered bariatric surgery, and only 6 percent thought their plans included prescription drug reimbursement. While plans vary, many do provide support for a range of weight-loss interventions.

“We were reassured to find that women understand some of the health consequences associated with obesity,” said Beth Battaglino Cahill, RN, executive director of HealthyWomen. “However, the survey does show several gaps in knowledge, which tells us more needs to be done to offer support and access to tools that will help them lead a healthier lifestyle.”

The online survey of nearly 1,500 women was designed to assess their understanding and knowledge of obesity and related health consequences. It also included a self-assessment of their current weight status and their strategies for losing weight. More than three-quarters of respondents identified themselves as either overweight (47%) or obese (25%). Overweight is defined by medical experts as a body mass index (BMI) greater than 25, while obesity is associated with a BMI greater than 30.[1]

Asked how much weight they would need to lose to significantly reduce health risks associated with being overweight or obese, 30 percent of respondents said a 10 percent reduction was needed, followed by 28 percent who said a 5 percent reduction was needed. This is evidence that respondents understand that a modest amount of weight loss—5 to 10 percent of body weight—can produce health benefits, such as improvements in blood pressure, blood cholesterol and blood sugars.[2]

When it came to employing a weight-loss strategy, the largest group — 41 percent of women – stated that starting or increasing exercise was the one weight-loss strategy that was most effective for them, with 51 percent of respondents engaging in three to seven hours of physical activity a week. Managing caloric intake ranked second in popularity, favored by 25 percent of respondents. Additionally, when asked if a prescription weight-loss option were available as part of a long-term weight-loss plan, more than half of the women said they would be somewhat or very likely to try it (31% and 29%, respectively).

To support women with their weight-loss goals, HealthyWomen provides an array of resources that can help women tackle their toughest weight-loss issues at www.HealthyWomen.org/obesity. This month HealthyWomen will launch its new Online Community, providing women a venue to connect with medical experts on a variety of health topics, including weight loss, fitness and nutrition, as well as to share success stories and get support from other women just like them.

[1] U.S. Department of Health and Human Services. “Overweight, obesity and weight loss” Fact Sheet. Available at: http://womenshealth.gov/publications/our-publications/fact-sheet/overweight-weight-loss.cfm#a. Accessed: April 23, 2012.

[2] NIH Heart, Lung and Blood Institute. “Fact About Healthy Weight” Fact Sheet. Available at:http://www.nhlbi.nih.gov/health/prof/heart/obesity/aim_kit/healthy_wt_facts.htm. Accessed: April 27, 2012

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A version of this story was published in The Washington Post.

As the U.S. Senate Finance Committee launched an investigation Tuesday into makers of narcotic painkillers and groups that champion them, a leading pain advocacy organization said it was dissolving “due to irreparable economic circumstances.”

The American Pain Foundation, which described itself as the nation’s largest organization for pain patients, was the focus of a December investigation by ProPublica in The Washington Post that detailed its close ties to drugmakers.

The group received 90 percent of its $5 million in funding in 2010 from the drug and medical-device industry, ProPublica found, and its guides for patients, journalists and policymakers had played down the risks associated with opioid painkillers while exaggerating the benefits.

It is unclear whether the group’s announcement Tuesday evening — that it would “cease to exist, effective immediately” — was related to letters sent earlier in the day from Sens. Max Baucus, D-Mont., the finance panel chairman, and Charles Grassley, R-Iowa, to the foundation, drug companies and others.

In the letters, the senators cited an “an epidemic of accidental deaths and addiction resulting from the increased sale and use of powerful narcotic painkillers,” including popular brand names like Oxycontin, Vicodin and Opana.

Growing evidence, they wrote, suggests that drug companies “may be responsible, at least in part, for this epidemic by promoting misleading information about the drugs’ safety and effectiveness.”

The American Pain Foundation’s website carried a statement Tuesday night saying its board had voted May 3 to dissolve the organization because it couldn’t stay “operational.” The foundation did not respond to requests for comment Tuesday.

The senators are targeting a who’s who of the pain industry, seeking extensive records and correspondence documenting the links, financial and otherwise, between them and the makers of the top-prescribed narcotic painkillers.

Letters went to three pharmaceutical companies, Purdue Pharma, Endo Pharmaceuticals and Johnson & Johnson, as well as five groups that support pain patients, physicians or research: the American Pain Foundation, American Academy of Pain Medicine, American Pain Society, Wisconsin Pain & Policy Studies Group, and the Center for Practical Bioethics.

The Federation of State Medical Boards, the trade group for agencies that license doctors, received a letter, as did The Joint Commission, an independent nonprofit that accredits hospitals nationwide and made pain management a national priority in 2001.

A report by the U.S. Government Accountability Office in 2003 noted that the commission partnered with Purdue Pharma, the maker of Oxycontin, to distribute pain educational materials nationwide. The committee’s letter to Purdue noted that the company pleaded guilty in 2007 to federal criminal charges that it misled regulators, physicians and consumers about Oxycontin’s risk of addiction.

The senators requested payment information since 1997 to 10 groups and eight people, including two doctors featured in ProPublica’s December report. They asked about any influence the companies had on a 2004 pain guide for physicians that was distributed by the Federation of State Medical Boards; on the American Pain Society’s guidelines; and on the American Pain Foundation’s Military/Veterans Pain Initiative.

In addition to citing ProPublica’s work, the letters also mention the reporting of the Milwaukee Journal Sentinel and MedPage Today.

Patients in serious pain need access to opioids, the senators wrote, but drugmakers and health-care groups “must distribute accurate information about these drugs in order to prevent improper use and diversion to drug abusers.”

“The problem of opioid abuse is bad and getting worse,” Sen. Grassley said in a statement. “Something has to change.”

“When it comes to these highly addictive painkillers, improper relationships between pharmaceutical companies and the organizations that promote their drugs can put lives at risk,” Baucus said in a prepared statement.

Dr. Andrew Kolodny, chairman of psychiatry at Maimonides Medical Center in Brooklyn, N.Y., and president of Physicians for Responsible Opioid Prescribing, applauded the investigation.

“These groups, these pain organizations … helped usher in an epidemic that’s killed 100,000 people by promoting aggressive use of opioids,” Kolodny said. “What makes this especially disturbing is that despite overwhelming evidence that their effort created a public health crisis, they’re continuing to minimize the risk of addiction.”

Concerns about the overuse and abuse of painkillers have intensified in recent years. As sales of the powerful drugs have boomed — rising 300 percent since 1999 — so, too, have overdose deaths. Opioids were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined, according to the U.S. Centers for Disease Control and Prevention.

In 2009, the use and misuse of the drugs were cited in more than 475,000 emergency department visits, nearly doubling the 2004 number, the CDC said.

Pain doctors and patient groups say that while drug overdoses are a legitimate concern, only a small percentage of deaths involves patients who receive them from their doctors. Most deaths involve illicitly obtained drugs, statistics show.

The groups also say that patients’ risk is low if they do not have addictive personalities, and that any restrictions should not punish patients who suffer from serious pain.

In recent weeks, two articles in medical journals have documented different aspects of abuse.

According to a paper published online this week by the Archives of Pediatrics & Adolescent Medicine, one of every eight high school seniors surveyed said they had used prescription opioids for nonmedical reasons.

A paper released last month by The Journal of the American Medical Association found that the rate of newborns diagnosed with drug withdrawal jumped threefold from 2000 to 2009. And the rate of mothers using opioids at the time of delivery was five times higher in 2009. (Not all babies born to mothers using the drugs exhibit signs of withdrawal.)

Janssen Pharmaceuticals, a Johnson & Johnson subsidiary that makes the painkiller Nucynta, said in a statement that it “is committed to the responsible prescribing and appropriate use of opioid pain medications” and has supported educational websites about safe use.

The company is reviewing the senators’ letter and “will work with them to fulfill their request for information,” spokesman Mark Wolfe said via email.

Purdue Pharma acknowledged in a statement that it had received the letter, was reviewing it and looked forward to “cooperating with the committee on this matter.”

Endo did not return a request for comment. A spokeswoman for The Joint Commission said the group had just received the senators’ letter and had no comment yet. The Federation of State Medical Boards responded but did not offer immediate comment.

by Charles Ornstein and Tracy Weber, ProPublica, May 8, 2012, 9:57 p.m.

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Wisconsin, US -Kohl’s Department Stores announced that in celebration of life, survival, and a “Wish for a World with Less Breast Cancer and More Birthdays,” Kohl’s threw a “One Wish” Birthday Bash at the 2012 American Cancer Society Making Strides against Breast Cancer walk, May 5, 2012, on Milwaukee’s lakefront. Decorated with nearly 8,000 pink cake pops, balloons and giant birthday candles, the celebration represents the company’s greater commitment to the fight against breast cancer. More than 3,000 Kohl’s associates, friends and family took part in the walk.

“Kohl’s is proud of our partnership with the American Cancer Society in providing valuable information and resource tools to local women battling breast cancer. It is important that Wisconsin women – our mothers, daughters, friends and co-workers – have easy access to breast health care information for prevention, diagnosis and treatment.”

“In the three years since we began our partnership, our program has provided nearly 17,000 women in southeast Wisconsin with life-saving breast health information and more than 1,850 breast cancer patients have received services and information,” said Julie Gardner, executive vice president and chief marketing officer of Kohl’s Department Stores.”

“This year our Kohl’s team included more than 3,000 associates, friends and family members – making it the largest corporate team in the history of the Making Strides against Breast Cancer Milwaukee walk. We know breast cancer has impacted thousands of families across the state and as a company, we are passionate about making a true difference in the fight against breast cancer and providing support to those when they need it most.”

“In 2012, more than 4,000 Wisconsin women will be diagnosed with breast cancer. Our partnership with Kohl’s Department Stores provides Wisconsin women access to life-saving breast health information and the steps necessary to prevent breast cancer or find it early.

It’s a gift that is truly life changing,” said Jari Johnston-Allen, chief executive officer, American Cancer Society, Midwest Division. “The American Cancer Society is honored to partner with Kohl’s in the fight against breast cancer and together, are working towards creating a world with less breast cancer and more birthdays.”

In 2010, Kohl’s philanthropic program, Kohl’s Cares, announced a nearly $5 million donation to the American Cancer Society’s Midwest Division over three years. In addition to this contribution, Kohl’s offers its Kohl’s Cares women’s cause merchandise, a series of exclusively-designed products to support the fight against breast cancer.

This women’s health philanthropic initiative builds upon Kohl’s long history of charitable involvement in the communities it serves. Since 2000, Kohl’s and the Kohl’s Cares program have combined to give approximately $47 million to support charitable initiatives in the metro-Milwaukee area. Also, during the past 12 years, the company’s Kohl’s Cares kids cause merchandise program, which sells plush toys and books, has raised more than $208 million to benefit children’s health and education initiatives nationwide.

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The recent brouhaha over pink slime (and other lovely mass meat production processes) is only the beginning. Here’s our roundup of some standout reporting about the food on your plate.

This is a multifaceted, perennial topic. If you think Propublica missed any, we’re happy to hear suggestions. Please email a link to MuckReads@propublica.org or tweet it with the hashtag #muckreads.

Safety of Beef Processing Method Is Questioned, The New York Times, December 2009
A look at the development of Beef Product Inc.’s “novel” method of meat production that later became known as the infamous “pink slime.” Reporter Michael Moss won a Pulitzer Prize for his investigations into contaminated beef.

Our Dwindling Food Variety, National Geographic, July 2011
Our dwindling food variety, in a stride-stopping infographic.
Contributed by @kleinmatic

What the USDA Doesn’t Want You to Know About Antibiotics and Factory Farms, Mother Jones, July 2011
The U.S. Department of Agriculture appears to have repeatedly removed a report by a USDA-contracted researcher that summarized recent academic work, from “reputed, scientific, peer-reviewed, and scholarly journals,” on possible links between antibiotic-resistant infections and factory farm animals. Mother Jones got a permanent PDF of the researcher’s report, dubbing it the “document the USDA doesn’t want you to see.”
Contributed by @foodinteg

Asian Honey, Banned in Europe, Is Flooding U.S. Grocery Shelves, Food Safety News, August 2011

Some of the biggest U.S. honey packers knowingly bought honey of questionable quality so they could sell it on the cheap. Much of it was likely smuggled from China (honey the European Union has banned) and may have been laced with lead and illegal animal antibiotics — if it was really honey at all.

America’s Dangerous Food-Safety System, The Daily Beast/ Newsweek, September 2011
A shortage of inspectors in the U.S. food-safety system exposes Americans to the risk of illness and death.
Contributed by @StepShep

Nation’s Food Anti-terror Plans Costly, Unwieldy, Associated Press, September 2011 
An AP investigation into the United States’ $3.4 billion food counter-terrorism program found that progress had been slowed by a complex web of bureaucracy.
Contributed by @joannalin

On The Menu, But Not On Your Plate, Boston Globe, October 2011
A Globe-organized DNA test revealed scores of mislabeled fish in Massachusetts restaurants, grocery stores and seafood markets. Often, “local” fish was actually hauled from thousands of miles away, and while some chefs and store owners seemed to have no clue, others admitted to knowingly selling mislabeled food to boost profits. Experts said it reflects a nationwide trend that causes diners to unwittingly overpay, may make people sick and results in overfishing.

Contributed by @JoeYerardi

Dispute Over Drug in Feed Limiting U.S. Meat Exports, MSNBC, January 2012
The controversial drug ractopamine has sickened or killed more pigs than any other livestock drug on the market, leading the EU and China, which together produce and consume about 70 percent of the world’s pork, to refuse meat imports raised on the additive. The U.S. pork industry wants to change their minds.
Contributed by @NaomiStarkman

How Washington Went Soft on Child Obesity, Reuters, April 2012
The food and beverage industries have more than doubled their spending on lobbying in Washington in the last three years. And now Congress has declared pizza a vegetable.
Contributed by @mariancw

A History of FDA Inaction on Animal Antibiotics, ProPublica, April 2012
Everything you ever wanted to know about the Food and Drug Administration’s actions, or lack thereof, to keep antibiotics out of your food.

As Beef Cattle Become Behemoths, Who Are Animal Scientists Serving? The Chronicle of Higher Education, April 2012
A growing number of animal scientists employed by public universities are accepting payouts from pharmaceutical companies. They’re often hired to persuade farmers to use antibiotics that fatten up cattle but haven’t necessarily been proven safe. Some have been banned in the E.U. and China.
Contributed by @MelodyPetersen

Bonus points: In 1968, Nathan Kotz of the Des Moines Register and Minneapolis Tribune won a Pulitzer Prize for reporting on unsanitary conditions in meat packing plants, which, according to the Pulitzer site, helped ensure passage of the Federal Wholesome Meat Act of 1967. Anybody have an online copy?

by Blair Hickman, ProPublica, May 7, 2012, 12:21 p.m.

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SAN FRANCISCO, U.S.A.- A Chicago Tribune investigation reveals that corporations making halogenated flame retardant chemicals spent tens of millions of dollars on public relations firms, lobbyists, and front groups to deceive the American people and legislators into believing their toxic chemicals are both necessary and safe.

“We have flame retardant chemicals similar to banned pesticides like DDT in our furniture that end up in our bodies, our pets, and wildlife,” said Arlene Blum, PhD,  UC Berkeley chemist, and Green Science Policy Institute founder. “This investigation should help stop new flammability standards  that are designed to sell chemicals rather than to increase fire safety.”

“Studies on halogenated flame retardants find they can cause lowered IQ, learning disabilities, infertility, other reproductive problems, and endocrine system irregularities,” says Sharyle Patton from Commonweal Biomonitoring Resource Center.

“Scientific evidence is exhaustive, yet the flame retardant industry continues to deceive the public and policymakers,” says Martha Dina Arguello of Physicians for Social Responsibility-LA. ”It’s time we stop exposing ourselves to unnecessary toxics that can impede children’s ability to learn, can cause cancer, and are linked to many health problems low-income and communities of color face.”

“Firefighters have elevated rates of multiple myeloma, non-Hodgkin’s lymphoma, prostate, testicular cancer, malignant melanoma, brain cancer; many linked to halogenated flame retardants,” says Tony Stefani, cancer survivor, founder, San Francisco Firefighters Cancer Prevention Foundation, and retired SF Fire Department Captain. “Lawmakers should stop listening to chemical industry representatives who misrepresent the facts.”

Judy Levin  with Center for Environmental Health comments, ”It is time that devious tactics used by the chemical industry are exposed to the public. Their drive for corporate profit trumps ethics, honesty, or concern for human health or the environment.”

“California leaders should be moved to stop the use of these dangerous chemicals,” says Janette Robinson Flint of Black Women for Wellness. ”Our community already has staggering health inequalities, and is overburdened with chemical exposure in our personal care and cleaning products, food, and now even furniture in our homes…enough is enough.”

“An obsolete CA. regulation (Technical Bulletin 117) de facto forces companies to use toxic chemicals in their products. Both business owners and consumers lose with this industry influenced scenario,” comments Richard Holober of Consumer Federation of California.

Info: http://toxicfreefiresafety.net/CaliforniansForToxicFreeFireSafety.php

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Indianapolis, U.S.A. – Eli Lilly and Company applauded law enforcement officials for their successful investigation and the recovery of more than $70 million in pharmaceuticals stolen from its United States distribution center located in Enfield, Connecticut, on Sunday, March 14, 2010.

“For more than two years, Lilly has cooperated with this criminal investigation – providing important information to federal and local authorities to help piece together the details of the theft,” said Maria Crowe, President, Manufacturing Operations, Eli Lilly and Company.

“We applaud the dedication of the Enfield Police Department, the Federal Bureau of Investigation, Department of Justice prosecutors in New
Haven, Newark, and Miami, and the Miami Organized Crime Drug Enforcement Task Force,  who have worked tirelessly to identify and apprehend those suspected of being involved in the March 2010 burglary,” said Crowe.

The pharmaceuticals taken from Lilly’s warehouse have been successfully recovered, preventing them from entering pharmaceutical distribution channels. Lilly plans to destroy the products when they are no longer needed as evidence.

Crowe added that Lilly is committed to partnering with the Food and Drug Administration, law enforcement, and other officials and organizations to help ensure patient safety and the secure distribution of Lilly medicines.

To that end, in addition to strengthening security for its facilities and pharmaceutical transportation, Lilly is one of seven pharmaceutical companies that formed the Coalition for Patient Safety and Medicine Integrity in 2011. Two primary goals of the coalition are to protect patients from risks posed by stolen and inappropriately handled medical products that enter legitimate distribution channels and increase the associated federal criminal penalties for crimes involving stolen medical products.

Image Courtesy of    http://www.lilly.com

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Bronx, N.Y. – Researchers at Albert Einstein College of Medicine of Yeshiva University in collaboration with Nurses’ Health Study investigators have shown that levels of certain related proteins found in blood are associated with a greatly reduced risk for developing type 2 diabetes up to a decade or more later. The findings, published Thursday, May 3, in the online edition of Diabetes, could open a new front in the war against diabetes.

These proteins are part of what is called the IGF axis. This axis was named for insulin-like growth factor-1, (IGF-1), so called because it has biological effects similar to those of insulin (the hormone that regulates blood glucose levels) but has a greater effect on cell growth than insulin. The researchers also looked at levels of several proteins known as IGF binding proteins, or IGFBPs, that may have strong effects independent of IGF-1.

Researchers have hypothesized that the IGF axis may influence risk for developing diabetes – an idea supported by laboratory and mouse studies, and a few initial studies in humans. However, the current study  is the first large, prospective investigation of several components of the IGF-axis and the risk for developing diabetes, according to co-senior author Howard Strickler, M.D., M.P.H., professor of epidemiology & population health at Einstein.

In the current study, the researchers analyzed levels of IGF-1, IGFBP-1, IGFBP-2, and IGFBP-3 in blood taken from 742 women in the Nurses’ Health Study who years later developed type 2 diabetes as well as a similar number of women in the study who did not develop diabetes. None of the women had any signs or symptoms of the disease at the time their blood samples were taken. The median time between the taking of blood samples and diabetes onset was nine years.

Each component of the IGF axis (IGF-1 and IGFBP-1, -2, and -3) had a significant independent association with diabetes risk – most notably IGFBP-1 and -2. Compared with women in the bottom 20 percent with respect to their levels of IGFBP-1, having high levels of IGFBP-1 (top 20 percent) was associated with a three-fold reduction in risk for diabetes, while high levels of IGFBP-2 were associated with a more than five-fold reduction in diabetes risk.

“Our data provide important new evidence that circulating IGF-axis proteins may have a role in the development of type 2 diabetes,” said Dr. Strickler.

The findings have potential clinical implications. First of all, IGF-axis proteins could help in stratifying people at risk for diabetes. “For example,” said Dr. Strickler, “we know that obesity is a major risk factor for diabetes. But some overweight individuals don’t develop diabetes, while some thin people do. If our findings are confirmed, they could help doctors more precisely determine who is actually at risk for the disease.”

The proteins may also prove useful as targets for novel therapies to prevent or treat diabetes. But Dr. Strickler cautions that it’s too early to apply these findings to clinical practice. “IGF-axis proteins have other effects, some beneficial and some not,” he notes. “We need to learn more about the connection between the IGF-axis and diabetes before we recommend that people get tested for these substances, and before deciding how we can exploit the IGF-1 axis to help address diabetes.”

The Diabetes paper is titled, “The Insulin-Like Growth Factor Axis and Risk of Type 2 Diabetes in Women.” The first author was Swapnil Rajpathak (who was at Einstein at the time this work was conducted). The other senior author is Frank B. Hu, M.D., Ph.D, of Harvard School of Public Health,Boston, MA.

Additional contributors include Meian He, M.D., Ph.D., (Harvard and Huazhong University of Science and Technology, Wuhan, Hubei, China); Qi Sun M.D., Sc.D., (Harvard); Jeannette Beasley, Ph.D., R.D., M.P.H., (Fred Hutchinson Cancer Research Center, Seattle, WA);  Michael Pollak, M.D., (McGill University, Montreal, Quebec, Canada); and Robert Kaplan, Ph.D., Radhika Muzumdar M.D., M.B.B.S., Thomas Rohan, M.D., Ph.D., Mimi Kim, Sci.D.,  Jeffrey Pessin, Ph.D., and Judith Wylie-Rosett, Ed.D., all of Einstein. Co-author Marc Gunter, Ph.D., contributed to the paper while at Einstein.

The study was supported by grants from the National Institutes of Health. Laboratory testing and data analysis were supported in part by NIDDK 5-R01-DK-080792.

The NHS is supported by grants CA-87969, DK-58845, and DK-58785 from the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Child Health and Human Development. Q.S. was supported by a career development award (K99HL098459) from the National Heart, Lung, and Blood Institute. The authors report no conflicts of interest.

For more information, please visit www.einstein.yu.edu  and follow on Twitter @EinsteinMed.

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Cincinnati, OH, U.S.A.- Researchers have rejuvenated aged hematopoietic stem cells to be functionally younger, offering intriguing clues into how medicine might one day fend off some of the ailments of old age.

Scientists at Cincinnati Children‘s Hospital Medical Center and the Ulm University Medicine in Germany report their findings online May 3 in the journal Cell Stem Cell. The paper brings new perspective to what has been a life science controversy – countering what used to be broad consensus that the aging of hematopoietic stem cells (HSCs) was locked in by nature and not reversible by therapeutic intervention.

HSCs are stem cells that originate in the bone marrow and generate all of the body’s red and white blood cells and platelets. They are an essential support mechanism of blood cells and the immune system. As humans and other species age, HSCs become more numerous but less effective at regenerating blood cells and immune cells. This makes older people more susceptible to infections and disease, including leukemia.

Researchers in the current study determined a protein that regulates cell signaling – Cdc42 – also controls a molecular process that causes HSCs from mice to age. Pharmacologic inhibition of Cdc42 reversed HSC aging and restored function similar to that of younger stem cells, explained Hartmut Geiger, PhD, the study’s principal investigator and a researcher in the Division of Experimental Hematology/Cancer Biology at Cincinnati Children’s, and the Department of Dermatology and Allergic Diseases, Ulm University Medicine.

“Aging is interesting, in part because we still don’t understand how we age,” Geiger said. “Our findings suggest a novel and important role for Cdc42 and identify its activity as a target for ameliorating natural HSC aging. We know the aging of HSCs reduces in part the response of the immune system response in older people, which contributes to diseases such as anemia, and may be the cause of tissue attrition in certain systems of the body.”

The findings are early and involve laboratory manipulation of mouse cells, so it remains to be seen what direct application they may have for humans. Still, the study expands what is known about the basic molecular and cellular mechanisms of aging – a necessary step to one day designing rational approaches to aiding a healthy aging process.

One reason the research team focused on Cdc42 is that previous studies have reported elevated activity of the protein in various tissue types of older mice – which have a natural life span of around two years. Also, elevated expression of Cdc42 has been found in immune system white blood cells in older humans.

In the current study, researchers found elevated activity of Cdc42 in the HSCs of older mice. They also were able to induce premature aging of HSCs in mice by genetically increasing Cdc42 activity in the cells. The aged cells lost structural organization and polarity, resulting in improper placement and spacing of components inside the cells. This disorganization contributed to the cells’ decreased functional efficiency.

The researchers then analyzed HSCs from older mice to see if inhibition of Cdc42 would reverse the aging process. They used a specific dose (5uM) of a pharmacologic inhibitor of Cdc42, CASIN, to reduce the protein’s activity in the cells – processing them for 16 hours ex vivo in laboratory cultures. This improved structural organization, increased polarity and restored functionality in the older cells to levels found in young cells.

To test the rejuvenated cells, the researchers used a process known as serial competitive transplantation. This included extracting HSCs from young (2-4 months) and aged (20-26 months) mice and processing them in laboratory cultures. Young and rejuvenated cells were then engrafted into recipient mice. This allowed scientists to compare how well young and rejuvenated aged HSCs started to repopulate and transform into different types of blood cells. It also confirmed that HSCs rejuvenated by targeting Cdc42 do function similarly to young stem cells.

Researchers next plan to test the Cdc42 inhibitor, CASIN, in mice to see how HSCs and various tissues in the laboratory models respond. In particular, they are testing red blood cell production, endurance and immune response in the mice. The research team is also acquiring samples of human HSCs to see how those cells respond in laboratory tests to Cdc42 expression.

The first author on the study was Maria Carolina Florian, PhD, from the University of Ulm. Also collaborating were Karin Doerr, Anja Niebel, Deidre Daria, Hubert Schrezenmeier, MD, PhD, Markus Rojewski and Karin Sharffetter-Kochanek, all from the University of Ulm, and Yi Zheng, PhD, and Marie-Dominique Filippi, PhD, of Cincinnati Children’s.

Funding support for the research came from the Deutsche Forschungsgemeinschaft and the National Institutes of Health.

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Each prescription drug you take has a unique code that the government can use to track problems. But artificial hips and pacemakers? They are implanted without identification, along with many other medical devices. In fact, the FDA doesn’t know how many devices are implanted into patients each year – it simply doesn’t track that data.

The past decade has seen numerous high profile cases of malfunctioning medical devices, which have led to injury or even death. Critics say the FDA’s minimal monitoring of devices contributes to these problems.

“If you’re lucky, you might find a sticker on the operating room note that was left over from the product,” said Richard Platt, who runs the Harvard Pilgrim Health Care Institute. Otherwise, there is little way of knowing what device was used.

Right now, the FDA depends mostly on voluntary reports from doctors, patients, manufacturers and hospitals to notify them of problems with devices already on the market. The agency does have some power to require manufacturers to conduct further studies or track a particular device once it is sold. But many devices don’t get that level of surveillance.

“It’s much like a patchwork of streams of information getting to the FDA,” said cardiologist Frederic Resnic of Brigham and Women’s Hospital, who has worked with the FDA on medical device safety monitoring. “The FDA is relying on anecdotal and very variable information about the safety of medical devices.”

If manufacturers get word from a doctor or hospital about a death or injury that occurred as a result of their product, they are legally obligated to investigate the event and report it to the FDA. But the process isn’t straightforward, as has become clear in the recent controversy over the malfunctioning St. Jude’s Riata defibrillator leads (wires that connect a defibrillator to the heart). The FDA said an individual doctor’s report helped alert them to the problem, but it was months before the device was recalled.

According to attorney William Vodra, a regulatory law expert and member of the Institute of Medicine panel that published a report on medical device safety last year, the number of doctors who actually contact manufacturers is small.

And after being notified of patient harm, manufacturers can minimize their own responsibility if they point the blame elsewhere, said health policy expert Diana Zuckerman, president of the National Research Center for Women & Families.

For example, if someone dies from complications in a surgery to remove an implant, the manufacturer may argue that it was the surgery – not the implant – that killed the patient.

“You have a system that is not rigorous, the standards are not always understood, and they are interpreted differently by different people,” Zuckerman said.

The FDA responds to the criticism by pointing out that while every medical device carries a potential risk, the vast majority of devices perform well and improve patient health. An FDA spokeswoman emphasized that the agency must evaluate thousands of medical devices each year, and is constantly looking for ways to better and more quickly identify problems.

While the FDA makes the adverse event reports publically available in a searchable database, it doesn’t have a standardized system for reviewing reports once they are sent in, said Vodra, the attorney. A disclaimer on the site specifically states that the data is “not intended to be used either to evaluate rates of adverse events or to compare adverse event occurrence rates across devices.”

“What you would normally consider the simplest kind of data analysis is not done,” said Zuckerman. Often, doctors catch a malfunctioning device before the FDA ever notices.

In one case, a group of Pennsylvania doctors noticed that several patients were showing severe complications a few years after getting an IVC filter – a device designed to capture blood clots. Bits of the filter were breaking off, causing chest pain and a dangerous build-up of fluid and pressure around the heart. In 2010 the doctors conducted their own studyand found that the filter broke in a quarter of all patients who used it.

On the day that study was published, the FDA issued a warning saying it had received over 900 reports of problems with IVC filters since 2006, and that the device was meant to be removed after a few months, not left in permanently.

There have been numerous attempts at reform. Five years ago Congress ordered the FDA to set up a post-market surveillance system to track the safety of all medical projects, but a system hasn’t yet been set up for medical devices.

A year later the FDA announced the Sentinel Initiative, which would combine existing data from electronic health records and medical claims to track drugs, vaccines, and devices. Some groups of hospitals or other organizations have voluntarily set up registries to collect information about the make and model of devices.

While the FDA has made significant progress on tracking drugs, it’s not yet in a position to do the same thing for devices, according to Harvard’s Platt, who is the principal investigator of Mini-Sentinel, the FDA’s pilot program for the national system. The data isn’t there.

The FDA has long acknowledged the need for a unique device identifier system, and got permission from Congress to set one up five years ago. No such system of ID-tags exists yet, but after several recent high profile medical device failures, the issue getting some attention from Congress. A proposed Senate bill, which cleared the Health, Education, Labor and Pensions Committee last week, sets a timeframe for implementing a unique identification system, among other reforms.

“If UDI’s were used in a consistent way, we could use the same kinds of techniques we’ve developed for drugs for devices,” said Platt. “It would be a huge breakthrough.”

by Lena Groeger, ProPublica, May 3, 2012, 1:07 p.m.

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New York, U.S.A. – New, nationally projectable survey results released by The Partnership at Drugfree.org and MetLife Foundation found that past-month marijuana use – particularly heavy use – has increased significantly among U.S. high school students since 2008.

The Partnership Attitude Tracking Study, sponsored by MetLife Foundation, found that 9% of teens (nearly 1.5 million) smoked marijuana heavily at least 20 times. Overall, past-month heavy marijuana use is up 80% among U.S. teens since 2008.

Past-month use is up 42% (up from 19% in 2008 to 27% in 2011, which translates to about 4 million teens), while past-year use is up 26% (up from 31% in 2008 to 39% in 2011, which translates to about 6 million teens). Lifetime use is up 21% (up from 39% in 2008 to 47% in 2011, which translates to nearly 8 million teens).

This marks an upward trend in teen marijuana use over the past three years. The last time marijuana use was this widespread among teens was in 1998 when past month use of marijuana was at 27%.

“These findings are deeply disturbing as the increases we’re seeing in heavy, regular marijuana use among high school students can spell real trouble for these teens later on,” said Steve Pasierb, President and CEO of The Partnership at Drugfree.org.

“Heavy use of marijuana – particularly beginning in adolescence – brings the risk of serious problems and our data show it is linked to involvement with alcohol and other drugs as well. Kids who begin using drugs or alcohol as teenagers are more likely to struggle with substance use disorders when compared to those who start using after the teenage years.”

Teen Marijuana Use Has Become a Normalized Behaviour

Teens now report seeing more of their peers smoking marijuana and only 26% agree with the statement, “in my school, most teens don’t smoke marijuana” (down from 37% in 2008). Also, 71% of teens say they have friends who use marijuana regularly (up from 64 percent in 2008).

Social disapproval of marijuana among teens remained the same, with 61% of teens saying they disapprove of their peers using marijuana. (About 41% say they ‘strongly disapprove’). The PATS data also found an erosion of anti-marijuana attitudes among teens, with only about half of teens (51%) saying they see “great risk” in using marijuana, down significantly from 61% in 2005.

“We have also seen a considerable decline over the past five years in the proportion of teens seeing great risk associated with marijuana use,” says Professor Lloyd Johnston, the principal investigator of the nationwide Monitoring the Future study conducted at the University of Michigan. “We believe that this decline in perceived risk has played an important role in the increases in teen use of marijuana, as it has done in the past. The fact that perceived risk is still falling portends a further increase in use.”

As teen drug use takes a turn for the worse, a heavier burden is placed on the shoulders of parents to play a more active role in protecting their kids from the health risks posed by drug and alcohol abuse.

The removal of critical pieces of our national prevention infrastructure across the country – The National Youth Anti-Drug Media Campaign, which was highly focused on educating youth about the dangers of teen marijuana use, and the elimination of the Safe and Drug-Free Schools Program – left a gaping hole where drug and alcohol education resources should be.

“The latest findings showing an increase in marijuana use among teens is unsettling and should serve as a wake-up call to everyone in a position to prevent unhealthy behavior,” said Dennis White, President and CEO of MetLife Foundation. “While it may be difficult to clearly understand just how dangerous marijuana use can be for teens, it is imperative that we all pay attention to the warning signs and intervene anyway we can. Early intervention is critical to helping prevent teens from drug abuse and addiction.”

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London, UK – Action on Bladder Cancer (ABC) releases findings from a new National survey^[1] exposing how little the general public knows about bladder cancer. Awareness around the main warning sign for bladder cancer – blood in the urine – is gradually increasing (50% in 2010 rising to 55% in 2012), but still only 5% of the public recognise that smoking is a main cause of bladder cancer.

Over 10,000 people are diagnosed every year in the UK^[2] and ABC, the only UK charity dedicated to bladder cancer, wants to encourage more people to understand how to recognise the warning signs and consult their doctor if they are concerned. Up to date information on the disease and advice on how people can help raise awareness is available through the ABC website (http://www.actiononbladdercancer.org).

The work of ABC supports the Be Clear on Cancer Campaign run by the Department of Health as well as Bladder Cancer Awareness Day which is organised out of the US (this year on May 5th).

Bladder cancer is the 4th most common cancer in men and the 11th most common in women^[2]. Across different areas of health, women are traditionally better informed. Yet, in the case of bladder cancer, one quarter (25%) of both men and women wouldn’t know what a sign of possible bladder cancer might be.

Over half of survey respondents have no idea what causes it. One in five people think it is caused by drinking too much alcohol rather than citing the most common cause of smoking. The main area where public awareness has increased over the last two years is around treatment options. More people recognise chemotherapy (32% in 2010 versus 38% in 2012) and radiotherapy (12% in 2010 versus 24% in 2012) as possible treatment approaches for bladder cancer.

Mr Colin Bunce, Chair of ABC and Consultant Urologist in Barnet says: “We don’t expect everyone to be an expert, but such a huge lack of understanding can lead to people being mis-diagnosed and/or diagnosed at a later stage in the disease which can narrow down the best treatment choices. Over the last 15-20 years bladder cancer has been in the shadows. Greater public attention is urgently needed to improve understanding about the disease so that people know when and where to go for help. We also need to help people take steps to reduce their risk of getting the cancer in the first place, such as giving up smoking.”

Dr Mary Archer, who has been affected by bladder cancer, supports the work of Action on Bladder Cancer: “If you notice blood in your urine, you should consult your GP as soon as possible. It may not be bladder cancer, but if it is, the earlier it is caught the better the chances of successful treatment”, comments Dr Archer. ”Blood in the urine is a sign that you need to be seen by a GP and a specialist urgently.”

ABC is working with healthcare professionals, patients, their carers and the general public, to help improve the treatment and prevention rates of bladder cancer through raising awareness, education and research.

Mr Tony Kirkbank, Trustee of ABC and a Service User, says: “The profile of bladder cancer and, as a result, the care of patients can be significantly improved by asking the public and healthcare professionals and providers to become involved in our dedicated advocacy group, ABC (http://www.actiononbladdercancer.org) – we want to work together”.

References:

http://info.cancerresearchuk.org/prod_consump/groups/cr_common/@nre/@sta/documents/generalcontent/crukmig_1000ast-2778.pdf

Survey Technical Details:

GfK NOP conducted a nationally representative face-to-face omnibus survey amongst 2055 adults aged 16+ in 2010.  In 2012 Gfk NOP commissioned TNS Research to conduct a face-to-face omnibus survey amongst 1015 adults aged 16+ in Great Britain.

Weighting was applied to the data in both surveys to ensure it matched known population profiles.

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After a patient died last year at a Veterans Affairs hospital in Manhattan, federal inspectors discovered nurses in his unit had a startling gap in their skills: They didn’t understand how the monitors tracking vital signs worked.

None of the nurses interviewed could accurately explain what would happen if a patient became disconnected from a cardiac monitor — which allegedly occurred to the patient who died, according to an October 2011 report from the U.S. Department of Veterans Affairs’ inspector general.

The incident followed two deaths in the cardiac monitoring unit at a VA hospital in Denver that raised similar questions about nurse competency.

Earlier this month, a broader review by the VA inspector general of 29 VA facilities found only half had adequately documented that their nurses had the needed skills. Some nurses “did not demonstrate competency in one or more required skills,” but there was no evidence of retraining, the report said.

An outside nursing expert who reviewed the reports at ProPublica’s request called them “troubling” and said the fact that the lapses weren’t caught and corrected “signified much broader problems.”

The inspector general’s findings reveal “a lack of oversight and adherence to accepted clinical and regulatory standards,” said Jane Hirsch, a clinical professor emeritus at the University of California, San Francisco School of Nursing, who previously oversaw nursing at U.C. San Francisco Medical Center.

The April 20 IG report also noted that previous inspections had found nurse competency issues in “dialysis, mental health, long-term care, spinal cord injury, endoscopy procedure areas, the operating room and the cardiac catheterization laboratory and with reusable medical equipment.”

In a response to the inspector general, the VA pledged to create uniform competency standards for its 152 hospitals and to ensure that evaluations of every nurse’s skills are up-to-date. Nurses will not be able to work in areas in which they have not demonstrated competency.

A VA spokeswoman declined further comment.

Nurse competency has increasingly become an issue in medicine. Hospitals and clinics create their own procedures and tests for assessing the skills of nurses, but their adherence to these policies is spotty.

Outside regulators don’t test individual nurses, but simply check if a sampling of the nurses’ files have the appropriate paperwork certifying competency.

That’s what VA’s inspector general did for the April review. As such, officials acknowledged that they could not verify whether nurses at those hospitals, or others, are providing competent care.

“We did not look at actual care or actual competence,” Julie Watrous, director of the inspector general’s combined assessment program, which inspects each VA hospital every three years, told ProPublica.

Only half the 29 facilities included in the new report had complete nurse skill assessment records that met the hospitals’ standards, inspectors found. Of the 349 nurses whose files were examined, paperwork showed that 58 lacked skills in at least one area. And for 24 in that group, there was no evidence that anything was done in response.

In an interview, however, the IG official who coordinated the report said she was generally pleased with the findings. Although both the VA and its hospitals had room to improve, she said, all of the hospitals had policies in place and at least some proof of skills in each nurse’s file.

“We never found one single site or even person that didn’t have at least components of competency assessment and validation,” said Carol Torczon, associate director of the St. Petersburg, Fla., office of the inspector general. “Where we found the holes was in the paper process.”

Torczon said she believed that the problems identified in Denver and New York were not reflective on the care generally provided by VA nurses in cardiac monitoring units.

Inspectors in the New York and Colorado cases said they could not definitely tie the deaths of the patients to their nurses’ care. But they noted that their lack of training put patients at risk.

Registered nurses assigned to telemetry units typically place cardiac leads, set parameters for the monitors tracking each patient, verify heart rhythms and take appropriate actions if there is an irregularity. They also enter progress notes and inform doctors of any changes.

After the patient in New York died, inspectors quizzed nurses and a biomedical engineer about what would happen if a patient got disconnected. “According to some staff, a ‘red alarm’ would be triggered since a disconnected lead was considered critical,” the report said, “whereas other staff told us that a disconnected lead would trigger a yellow alarm or that it would not trigger any alarm at all.”

Inspectors also found no evidence that the nurses’ competence had been checked. Records showed that one of the patient’s nurses had last received training on the monitors 13 years earlier.

Two years earlier at a VA hospital in Denver, inspectors looked into the deaths of two patients on cardiac monitors. After the first death, the hospital gave nurses a basic test of their ability to interpret monitor readings: only one of 28 passed, according to a January 2010 report. The nurse in charge when both patients died had never received specialized training in cardiac monitors.

Even after the second patient died in 2009, inspectors found “it was unclear who was responsible for telemetry training, and staff were not aware that policies had been updated.”

Both facilities vowed extensive reforms in responses that were included in the IG reports.

Experts say up-to-date competency evaluations are important because they ensure that nurses, who provide the bulk of the frontline care in hospitals, have the skills for their position.

“It would appear that the old adage ‘inspect what you expect’ has most certainly not been taken very seriously in these environments,” said Hirsch, who was chief nursing officer at UCSF Medical Center for nine years.

After reading the New York and Denver reports, Hirsch said her concern wasn’t the incidents themselves as much as that the competency of the nurses hadn’t been documented or evaluated in a long time.

Had she been in charge, the findings would have caused her “to be really nervous and want to jump on it immediately,” she said.

by Tracy Weber and Charles Ornstein, ProPublica, April 30, 2012, 1:19 p.m.

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