News News News
HEALTH CARE REFORM NOW REQUIRES A PRESCRIPTION FOR OTC SUPPLEMENTS, DRUGS
In 2011, the new “Affordable Care Act” requires a prescription should you wish to use your health care savings account to buy over the counter medications, vitamins, herbal and dietary supplements.
It is certain that this “reform” increases costs by creating more work for the both physicians and pharmacists. Look also for the prices of “prescription” over the counter drugs to increase. As is usual, the presence of the word “affordable” in any legislation indicates costs will soon be rising sharply.
For those formulas and supplements which I recommend, you can still use your health savings account to reimburse yourself with no penalty. Ask us for a prescription for over the counter medications should you want to fulfill the requirements of the new law.
YOGA HELPFUL FOR SLEEP, REDUCES FATIGUE IN CANCER PATIENTS
Both the disease process and treatment contribute to fatigue and sleep disturbances in cancer patients.
410 patients with sleep problems were randomized to test the use of Yoga for Cancer Survivors program, which included components of hatha and restorative yoga, including postures, breathing exercises, and meditation and visualization exercises in two 75 minute classes twice a week for four weeks.
At the end of the study, sleep quality improved by 22% in the yoga group and 12% in the control group. Moreover, 31% of those in the yoga group that improved had normal sleep at the end of the four week trial, as compared with 16% in the control group.
Compared with their counterparts in the control group, patients in the yoga group had significantly greater reductions in fatigue 42% vs. 12%, daytime sleepiness 29% vs. 5%, and quality of life 6% vs. 0%.
The use of sleep medication decreased by 21% in the yoga group but increased by 5% in the control group. (Family Practice News Jun 15, 2010 p 45).
DANGEROUS TREATMENT FOR DELIRIUM
Doubts have been raised about the use of rivastigmine (Exelon®) to treat delirium in intensive care patients after a national trial in the Netherlands was halted because of safety concerns.
Delirium has become a top hospital-acquired condition. By some estimates, up to 80 percent of all ICU patients suffer from it as a result of pain, sleep disruption, and disorientation.
The double blind trial intended to study 440 patients in six hospitals, but was stopped prematurely after its data safety monitoring board found higher mortality among patients receiving rivastigmine than those taking placebo.
A total of 104 patients completed the trial, with 12 deaths among the 54 patients taking the drug compared with four deaths among the 50 patients receiving placebo. Further, the researchers found that median duration of delirium was longer in the treatment group (five versus three days; P = 0.06). (BMJ 2010; 340:c2895 doi: 10.1136/bmj.c2895).
TRAMADOL WARNING ISSUED
A warning about increased risks of suicide associated with the use of the opioid analgesic tramadol, (Ultram) has been announced by the FDA and added to the drug’s prescribing information.
The revised label advises “caution” when prescribing to patients who are taking tranquilizers, antidepressant drugs, abuse alcohol and those who have emotional disturbances or depression. (Family Practice News June 15, 2010 p 5).
INSTITUTE OF MEDICINE DENIES VALUE FOR VITAMIN D SUPPLEMENTATION
The Institute of Medicine has just come out with its new recommendations. It says that “all North Americans are receiving enough vitamin D” from their diets and exposure to the sun.
It also says there is “inconsistent and conflicting results” on whether or not vitamin D protects you from cancer and other diseases.
Nonetheless, we are still suggesting patients maintain their blood levels at therapeutic levels by taking supplements:
• A four-year study conducted by researchers at Creighton University found that vitamin D and calcium supplementation can help prevent 17 types of cancer and lower your overall cancer risk by 77 percent.1
• Another extensive study conducted on more than 27,000 patients at the Intermountain Medical Center in Salt Lake City found that those with the lowest vitamin D levels were 43 percent more likely to develop coronary artery disease than those with normal levels.2
• In addition, vitamin D is known to help lower the risk of Type-1 and Type-2 diabetes, and helps prevent auto-immune disorders like multiple sclerosis and rheumatoid arthritis.
• Best of all, it does all this naturally and with no side effects. But vitamin D doesn’t do all of this at the 400-600 IU level that they just recommended. It only does this at much higher levels. I recommend from 2,000-5,000 IUs.
• As for the IOM’s other claims, that people already get enough vitamin D, what about the study from earlier this year, published in the Archives of Internal Medicine, which found that 75 percent of Americans don’t get enough vitamin D3
• It’s also irresponsible to recommend eating fortified foods to bolster your vitamin D intake. Real dietary sources of vitamin D come from animal fats. Fortified milk gives you the synthetic, chemical form of vitamin D2, not the vitamin D3 you need to boost your energy level and maintain a strong immune system.4
• The same is true of other fortified foods like breakfast cereals, yogurt, margarine, and soy beverages. These often contain additives such as inulin, maltodextrose, and polydextrose that don’t provide the same health benefits as foods with natural fibers.5
• The benefits of vitamin D and magnesium for building strong bones and avoiding skeletal diseases such as rickets, osteomalacia and osteoporosis are already well known.
1. Lappe, J.M., et al, “Vitamin D and calcium supplementation reduces cancer risk,” Am. J. Clin. Nutr. June 2007; 85(6):1586-91 2. “Vitamin D Shows Heart Benefits in Study,” NYTimes.com, 11/16/2009 3. Ginde, A. “Demographic Differences and Trends of Vitamin D Insufficiency in the US Population, 1988-2004,”Archives of Internal Medicine, March 23, 2009; vol 169: 626-63 4. “Vitamin D2 vs. vitamin D3,” The Heart Scan Blog (http://heartscanblog.blogsport.com), April 26, 2007 5. “The Pros and Cons of Fiber-Fortified Foods,” Healthy Living (www.shine.yahoo.com), Dec. 2, 2010
ANOTHER EXAMPLE OF POLICIAL COWARDICE
In the latest example of unfunded mandates for physicians, payment for advance care counseling has been eliminated by the Centers for Medicare and Medicaid Services.
In November of 2010, the payment for this service was announced, as many hospice and geriatric physicians have for years asked for reimbursement for these time-consuming advance planning consultations. The White House announced on January 5th that the policy would be reversed, and physicians would not be paid, even though these services were still necessary and would probably still be required of physicians under ever increasing physician “performance” guidelines.
The AMA news staff speculates that the reason for the reversal is to avoid criticism that payment will create incentives for “euthanasia” by paying for advance directive counseling.
By reversing the policy, Medicare avoids paying for a needed medical service, and politicians avoid honestly addressing these concerns. In contrast, the American College of Physicians disagrees with the reversal, suggesting that higher payments should be available for physicians who undertake these difficult and complex discussions with patients. (American Medical News January 17, 2011 p. 1).
MARIJUANA SMOKING APPEARS PROTECTIVE AGAINST DIABETES
At the annual meeting of the American Public Health Association, Dr. Magda Shaheen reported that cannabis use may be associated with a markedly decreased risk of diabetes.
Analysis from the Third National Health and Nutrition Examination Survey indicates marijuana users had 66% lower odds of having diabetes after adjustment for numerous potential confounding factors.
The mechanism suggested at the meeting was that marijuana contains anti inflammatory cannabinoids that interfere with systemic inflammation, one of the purported factors associated with damage to the pancreas.
Dr Shaheen suggested that prospective studies need to be performed in rodents and humans to determine a causal relationship between cannabinoids receptor activation and diabetes. (Family Practice News January, 2011 p 16).
AIRPORT SCREENING SCANNERS SHOULD BE AVOIDED
As unpleasant as it is to be searched in the same fashion as arrested suspects, there is no indication or assurance of safety during the use of airport imaging technology.
The FDA is not involved in any aspect of their certification, as they are not medical devices. TSA officials will not provide any safety information or radiation dose on these scanners because any operational information is considered “secret”.
The operators are clearly not trained to know anything about safety, and have no responsibility or tradition for ethical behavior. It is also extremely unlikely that they would be able to recognize malfunctions that may cause unintentional overdoses. All-in-all, this latest manifestation of Security Theater immeasurably raises the bar of absurdity and risk.
THYROID-HEART CONNECTION AFFIRMED
A relationship between high homocysteine levels and heart disease has been well documented. Attempts to decrease these levels by administering B vitamins have not had a corresponding effect on heart disease, however.
Researchers at the Cleveland Clinic have found that correcting underactive thyroid function normalizes elevated homocysteine levels. (Ann Intern Med 99;131:348-351) Whether this will result in decreased levels of heart disease is yet to be determined, but these results suggest a rationale for ensuring that iodine levels in the diet are sufficient by taking an iodine supplement.
METFORMIN ASSOCIATED WITH B-12 DEFICIENCY
The widely prescribed medication for diabetes, metformin, has been found to increase vitamin B-12 deficiency, an effect that increases the longer it is taken, according to a study in the Netherlands.
In addition a decrease in folate levels was seen. Regular testing and supplementation is suggested. (Family Practice News June 15, 2010 p 3)
CHEMICAL FOUND IN SHAMPOO AND TOYS COULD LEAD TO LOW BIRTH WEIGHT
Exposure to phthalate, a toxic chemical used as a plasticiser in a wide variety of personal care products and children’s toys might contribute to low birth weight in babies.
Low birth weight is the leading cause of death in children under five and is a risk factor for cardiovascular and metabolic disease in adulthood.
Phthalate exposure can begin while the foetus is in the womb and has been associated with disruption of endocrine function. A Chinese team examined 201 pairs of newborns, 88 of whom were born with low birth weight, and their mothers.
The researchers analysed samples of the infants’ meconium (the first bowel movement that occurs after birth) and cord blood to determine phthalate levels.
Low birth weight babies were consistently found to have higher levels of phthalates in their systems, suggesting that phthalate exposure might be an environmental risk factor for the condition. (Phthalate levels and low birth weight: a nested case-control study of Chinese newborns. J Pediatr. 2009 Oct;155(4):500-40).
CHILDREN, IN MODERATION, GOOD FOR HEALTH
Childless women have a greater risk of dying earlier and suffering poor health in later life than women who have two to four children.
However, women who have five or more children, teenage mothers and women whose children are spaced less than eighteen months apart also show greater risk of dying and suffering poor health in later life.
Late motherhood (over 40) is also associated with better health in later life, perhaps because only healthy women are likely to conceive and contemplate motherhood at that age.
The findings were derived from analysis of three population-wide studies of around 100,000 UK women born between 1911 and 1940. (Partnership and parenthood history and health in mid and later life study, funded by the UK’s Economic and Social Research Council).
"Is Anyone Thinking?" Department
PROMISE THEM ANYTHING
Our plan will lower annual health care costs by $2500.00 for a typical family. For Americans satisfied with their current health insurance, nothing will change except their costs will go down.
Americans will also be able to choose from a range of private health insurance options though a new National Health Exchange, which will establish rules and standards for participating plans. The Exchange will also include a new public plan that will provide coverage similar to the kind members of Congress give themselves.
Senator Barack Obama, "Affordable Health Care for All Americans", Journal of the American Medical Association, October 22/29, 2008 p. 1927
AMA Agitated Over Absence of Payoff
One of the ways organized medicine tried to sell "reform" to doctors and the public was to assure their membership that the little people would benefit just like themselves, the intermediate-level fat cats.
In order to buy support from physicians and their handlers, six provisions were added to the bill to provide increases in Medicare payments to doctors, and these were to be retroactive to the beginning of 2010.
But, Lo! Here it is 2011 and there never was a payment of the estimated 200 million dollars that should have been paid to doctors last year. The American Medical Association sent an inquiry about the payments in a letter to Health and Human Services Secretary Kathleen Sebelius on December 10th, but to no one's surprise, there has been no response.(American Medical News Dec 27,2010 p 2)
The 2008 promises that of reducing the costs of the program by "eliminating waste and inefficiency" has been revealed as impossible, as no where in the thousands of pages of the bill is "efficient" medical care defined.
Nor is there any insight or mechanism into determining what constitutes waste and inefficiency.
Indeed, as has been pointed out before, the continuing theater of health reform has been solely about controlling cash flow, and who will define where it will go. The present law essentially removes all of the decisions as to what is important, and, what it is worth, from both the doctor and the patient, and has placed it firmly and irrevocably in the hands of regulators, politicians and lobbyists.
Unfortunately, the interests of regulators, politicians, and lobbyists are often diametrically opposed to those of the patient and the physician.
Kathleen Sebelius is not going to respond to the AMA because she doesn't even know which bureaucratic operation will control the payments promised in the "Affordable Care Act" of 2010. she probably doesn't even know if the regulators and committees that will administer the law are in place.
In the June 2009 newsletter I reported the May 2009 promise by the President and various favored health care organizations that they would save 2 trillion dollars over the next decade.
That would be about 317 billion dollars in reduced health care costs by now.
I predict that doctors are as likely to see the promised 200 million dollars as the American people are to see that promised 2 trillion dollars.
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