Would you like a side of Dioxin with your Burger?

The Environmental Protection Agency is holding public hearings beginning today to review a proposed safe exposure limit for dioxin, a known carcinogen and endocrine disruptor produced as a common industrial byproduct. It's all but impossible to avoid exposure to dioxin. Women exposed to it pass it on to fetuses in the womb, and both breast milk and formula have been shown to contain the stuff. Research done by the Environmental Working Group has shown that a nursing infant ingests an amount 77 times higher than what the EPA has proposed as safe exposure. Adults are exposed to 1,200 times more dioxin than the EPA suggests is safe, mostly through eating meat, dairy, and shellfish.

What's a diabetic to do?

A growing number of health plans are trying a number of programs to encourage diabetics to take better care of themselves. One such program offers to reduce a or eliminate a plan member's diabetes drug co-pays as an incentive to take their medications regularly. Sounds like a good idea, unless that medication is Avandia. A recent story by Gardner Harris in the New York Times (read it here) tells the sad tale about how its manufacturer, SmithKline Beecham, waged a decade long campaign to cover up study results that clearly showed Avandia to not only be no better than a competing pill, but also showed clear signs that it was riskier to the heart.

The company knew about the heart risks associated with the drug as early as 1999. But it wasn't until 2007 when a cardiologist at the Cleveland Clinic filed a lawsuit to force the company (now known as GSK) to publish the test results on its website. Even then, the company would only admit to knowing about the heart risks back to 2005.

How can we expect people who suffer from chronic ailments like diabetes to embrace plans that encourage healthy behavior, when a drug they are being encouraged to take puts their health at greater risk?

Email helps improve health of patients with diabetes and hypertension

A recent study by Kaiser Permanente researchers found that patients suffering from diabetes and hypertension who emailed their doctors had higher quality of care scores than those who do not use such technology.

The study specifically focused on 35,423 patients with diabetes or hypertension in Kaiser's Southern California region. Those that used Kaiser's electronic health records system--dubbed My Health Manager--had better cholesterol and blood pressure levels after two months than those who did not.

The study provides new evidence that making secure email available to patients can improve their clinical outcomes. Unfortunately, a Harris Interactive/HealthDay poll determined that less than 10 percent of American adults even use electronic health records or exchange emails with their doctors,

Are we being treated, and overtreated, to death?

Hope springs eternal. But that American tendency to fight death to the bitter end might not be the best way to depart this mortal coil.

Doctors can't tell you how long a patient will live, but they usually know when an illness is incurable, according to the Associated Press.

Yet doctors persist in practicing "exhaustion medicine"--treating until there are no more options left to try--Dr. Martha Twaddle, chief medical officer of Midwest Palliative & Hospice Care Center in suburban Chicago, told the AP.

More than 80 percent of patients with progressive chronic illnesses such as cancer, heart failure or Alzheimer's disease, say they want to avoid hospitalization and intensive care when they are dying, according to the Dartmouth Atlas Project, which monitors healthcare trends.

Yet hospitalizations during the last six months of life have risen for Medicare recipients between 1996 and 2005. Nearly one in three Medicare dollars goes toward treating chronic illness in the last two years of life.

Meanwhile, the average amount of time spend in hospice and palliative care, which stresses comfort and quality of life after an illness becomes incurable, is dropping because people start too late. In 2008, one-third of people had it for a week or less, according to the National Hospice and Palliative Care Organization.

"People are actually now sicker as they die," Dr. Ira Byock, director of palliative care at Dartmouth-Hitchcock Medical Center told the AP. Often families push for treatment, choosing needless medicine that prolongs suffering over comfort care. But "there are worse things than having someone you love die," he said.

See Marilynn Marchione's Associated Press article on the subject for a closer look.

F is for Fat (or should I say Fatter)

The Trust for America's Health has just released its seventh annual report on obesity and the results are depressing. Here are the highlights of the report:

Adult obesity rates rose in 28 states over the past year. Only the District of Columbia experienced a decline in adult obesity rates.

More than two-thirds of states (38) now have adult obesity rates above 25 percent.

Eight states have rates above 30 percent: Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee and West Virginia.

In 1991, no state had an obesity rate above 20 percent.

Adult obesity rates rose for a second consecutive year in 15 states and rose for a third consecutive year in 11 states.

Mississippi had the highest rate of obese adults at 33.8 percent. Colorado had the lowest rate at 19.1 percent and is the only state with a rate below 20 percent.


The news about childhood obesity is equally depressing.

Highlights from the report:

State-specific obesity rates ranged from a low of 9.6 percent in Oregon to a high of 21.9 percent in Mississippi.

Eight states, plus the District of Columbia, have childhood obesity rates greater than 20 percent: Arkansas, Georgia, Illinois, Kentucky, Louisiana, Mississippi, Tennessee and Texas.

Nine of the 10 states with the highest rates of obese children are in the South, as are nine out of the 10 states with the highest rates of poverty.

Go here to read the full report.

It's Healthrageous!

A Boston-based start up may have a powerful tool to help individuals overcome their unhealthy behavior. The company, Healthrageous, a is a spinout of Partners Center for Connected Health. The startup’s software is designed to automatically give people personalized advice to help them reach health goals such as losing weight, lowering blood pressure, or controlling their diabetes. However, unlike a lot of personal health record products which depend on a user to conscientiously update the information about their health status, Healthrageous says they will automate the gathering of essential biometric data. They will do this by linking wireless monitoring devices such as glucose meters directly to a users online personal health record. The company's software will then be able to provide feedback to the user,offering advise and motivation to help the user achieve desired health goals. The feedback can be delivered to an internet-connected computer, mobile phone, or even via snail mail. For a closer look at this company's new offering check out this article by Ryan McBride at XConomy Boston

One Way to Lower Health Costs: Pay People to be Healthy

Good news: Health costs as little as $3 a day. At least, that's all it took in one recent study for several patients to forgo bad behaviors that put their health at risk.

Each year, more than 40% of premature deaths in the United States result from unhealthy behaviors such as smoking, over-eating or failing to take medications as prescribed. Physicians routinely struggle to get patients to give up their bad habits for the sake of their long-term health, yet 20% of Americans still smoke, and 71% are either overweight or obese.

"We know that people in the short term have a lot of trouble changing
their behavior in ways that is in their long-term best interest," says Kevin Volpp, Wharton professor of medicine and health care management, and a professor at the University of Pennsylvania School of Medicine. "People aren't very good at making these tradeoffs between immediate gratification and delayed and often intangible benefits, such as good health 10 years from now."

As director of Penn's Center for Health Incentives, part of the Leonard Davis Institute of Health Economics, Volpp is in perpetual pursuit of carrots that will lure patients away from lethal behaviors. In a series of ongoing studies, Volpp has found evidence that money can motivate some patients to stop smoking, lose weight or keep up with their daily medication. Read more on the results of these studies here

Poor David

David In Italy


David After A Trip To America

Another Incentive To Lose Weigth...Swine Flu

An unexpected characteristic has emerged among many swine flu victims who become severely ill: They are fat.
Doctors tracking the pandemic say they see a pattern in hospital reports from Glasgow to Melbourne and from Santiago to New York. People infected with the bug who have a body mass index greater than 40, deemed morbidly obese, suffer respiratory complications that are harder to treat and can be fatal.
With the new virus on a collision course with the obesity epidemic, the World Health Organization says it’s gathering statistics to confirm and understand this development. Drugmaker Roche Holding AG is combing through studies to determine whether heavier people should get bigger doses of its Tamiflu antiviral.
“Morbid obesity is one of the most common findings turning up in severely ill patients,” said Nikki Shindo, who is leading the investigation of swine flu patients at the WHO in Geneva. “It’s a huge problem.”

Mississippi's still fattest but Alabama closing in | Comcast.net

It's that time of year again when the Trust for America's Health and the Robert Wood Johnson Foundation publish their annual obesity rates. And for the fifth year in a row, MS leads the way with a 32.5% rate of adult obesity. Not far behind at 31.2% is Alabama. W. VA and TN are in hot pursuit at 31.1% and 30.2%.

At the other end of the spectrum are states that somehow don't surprise you with their relative lack of flab. Colorado is the leanest with an obesity rate or 18.9%, followed by MA, 21.2% and CT, 221.3%

The study shows that in every state, obesity rates among 55-64 year olds are higher than those 65+. This means a major hit on an already strained Medicare system. It is estimated that Medicare spends up to $6,000 more annually on health care for an obese senior than for the non-obese.

Study Says Prevention Efforts Won't Cut Health Costs

A popular idea for fixing the healthcare system that just about everyone seems to agree on is increasing government's role in disease prevention. Sounds good, but Louise Russell a researcher professor at Rutgers University says it is not going to cut costs, and it is not going to make us healthier. She points out that we already do a lot more prevention than other countries, but we are not healthier. Her research findings don't question the benefits of a healthy lifestyle and the effectiveness of many preventive measures. The problem as she sees it is that when preventive testing becomes too widespread, or heavy investments are made in monitoring people with chromic conditions, the rewards often fail to match the costs.

The Congressional Budget Office in a recent report concluded that greater use of preventive care would at best generate modest reductions in cost over 10 years, and might eventually result in increases. One reason cost savings are hard to acheive, according to Russell, is that much of the money spent on disease prevention goes for people who aren't going to get sick anyway.

Medicare has conducted seven pilot programs over the past ten years to test whether preventive measures save money. The largest of these included about 200,000 patients with chronic conditions, mostly diabetes and congestive heart failure. Nurses contacted patients to make sure they were following doctor's instructions and taking their meds. They sent out literature packets about caring for patient's diseases and guided them toward communit health classes. Overall these efforts didn't reduce these patients rate of acute care hospitalizations, hospital readmissions, emergency room visits, or deaths. In short, these preventive actions were not able to lower patient's Medicare payments by an amount equal to cost of the prevention services. In spite of results like this, private health insurers are placing bets that prevention can lower their costs. United Health Group estimates that Medicare could save almost $25 billion over 10 years on patients with congestive heart failure if it identifed high risk patients early and counseled them to stay healthier.

Many will argue that focusing on savings is the wrong way to think about prevention. Healthcare is a good, and we don't purchase goods to save money. When a new antibiotic comes out, we don't react by first asking if it saves money.

So You Think Owning a Home Will Make You Happy? Don't Be Too Sure - Knowledge@Wharton

So You Think Owning a Home Will Make You Happy? Don't Be Too Sure - Knowledge@Wharton

Shared via AddThis

Are You Sure You Want That Doughnut?

Krispy Kreme doughnuts appear to have much the same effect on a sewer line as they do on a human artery.

Citing goop-clogged pipes, Fairfax County is looking to recoup millions of dollars from the confectionery giant, claiming yeast and grease dumped at the company's Lorton plant destroyed the surrounding sewer system.

The civil lawsuit, filed this month in Fairfax County Circuit Court, comes after Fairfax sent Krispy Kreme a $1.9 million bill for the cost of repairing the system — the result of years of discharging "excessive quantities of highly corrosive wastes, doughnut grease and other pollutants" into the sewer, according to the suit.

Toothless In Kentucky

I was shocked to hear about the impact of poverty, drug abuse, and traditional eating habits on oral health in KY. Would you believe that 1 in 10 residents are missing not just a few but all their teeth? Would you believe that people addicted to pain killers routinely crack healthy teeth one by one so they can get prescriptions for more drugs. And how about teenagers who have lost virtually all their teeth due to chronic malnutrition? Sadly the problem doesn't stop at the state line. Residents in neighboring states suffer similar problems. For instance,  W. Virginia has the highest percentage of people over 65 without teeth and the lowest number of people who see a dentist at least once a year.

Kentucky is among the worst states nationally in the proportion of low-income residents served by free or subsidized dental clinics.  According to federal data less than 25% of the state's dentists accept Medicaid. And even if they did, it wouldn't be of much help. For  seriously infected teeth, the only thing Medicaid will pay for is for them to be pulled.  No root canals. No dentures. Although it will help pay for a liquid diet for those with no teeth!

The situation would be even worse if it weren't for the dedication of dentists such as Dr. Edwin E. Smith who has created a mobile free clinic in a converted 18-wheeler to attend to the dental needs of children in impoverished rural areas. 

Do You Live In An Asthma Capital?

Each year the Asthma and Allergy Foundation of America creates a top 10 list as a subset of their analysis of the 100 most difficult places to live for Asthma sufferers.  While the list may be good for grabbing headlines I found it difficult to discern from the data they provide how one city can truly be defined as worse (or better) than others on the list.  I was surprised that smog-bound Los Angeles was not on the list, or any city in the Northeast where pollen falls as thick as snow this time of year. I was also a bit sceptical about the study when I noted that the study was made possible by a "charitable" contribution from Astra Zenica, maker of Symbicort for treatment of Asthma.

Here are the top 10 Asthma Capitals for 2009:

1.   St. Louis, MO
2.   Milwaukee, WI
3.   Birmingham, AL
4.   Chattanooga, TN
5.   Charlotte, NC
6.   Memphis, TN
7.   Knoxville, TN
8.   McAllen, TX
9.   Atlanta, GA
10. Little Rock, AR

For a closer look at how these rankings were developed go here.

St. Louis moved from ranking  in ninth place last year to top of the list this year. According to the study this just was caused by  a number of factors including a higher than average pollen score, continued poor air quality, a lack of “100% smoke-free” laws and others. 

It's Not What You Eat, It's What You Drink

When it comes to calorie intake, researchers at Johns Hopkins Bloomberg School of Public Health found that liquid calorie intake has a stronger impact on weight gain (or loss) than solid calorie intake. As you might suspect sugar sweetened beverages are the leading source of liquid calories.

Consumption of liquid calories from beverages has increased in parallel with the obesity epidemic. Earlier studies by Bloomberg School researchers project that 75 percent of U.S. adults could be overweight or obese by 2015 and have linked the consumption of sugar-sweetened beverages to the obesity epidemic, which affects two-thirds of adults and increases the risk for adverse health conditions such as type 2 diabetes.

“Among beverages, sugar-sweetened beverages was the only beverage type significantly associated with weight change at both the 6- and 18-month follow up periods,” said Liwei Chen, MD, PhD, MHS, lead author of the study and a Bloomberg School graduate.

Thought You'd Be Interested

In a recent post I pointed out that current economic conditions are forcing a growing number of Americans to engage in unhealthy behavior, like skipping renewing prescriptions in order to save money. However, the leaders of the companies who produce the drugs many people can no longer afford won't have a similar problem. Here are the compensation numbers for the 10 best paid big pharma execs as compiled by fiercepharma.com:

1. Miles White - Abbott - $33.4M

2. Fred Hassan - Schering-Plough - $30.1M

3. Bill Weldon - Johnson & Johnson - $25.1M

4. Bob Essner - Wyeth - $24.1M

5. Robert Parkinson - Baxter - $17.6M

6. Daniel Vasella - Novartis - $15.5M

7. Richard Clark - Merck - $14.5M

8. Frank Baldino - Cephalon - $13.5M

9. Sidney Taurel - Eli Lilly - $13M

10. Jeff Kindler - Pfizer - $12.6M

Unhealthy Behavior With iPods Among Teens

A new study by Univ. of Colorado and Boston Children's Hospital highlights surprising behavior among teens when using their iPods. When teens are asked to turn down the volume of their iPods they instead increase the volume (which significantly increases their risk for hearing loss). The study also found that boys listen at higher volume than girls, and that teens listen at higher volume than young adults. The most surprising result of the study was that teens who were most concerned about the risk and severity of hearing loss from iPods actually play their music at higher levels than their peers. The researchers could not come up with an explanation for such behavior.

It Costs Too Much To Stay Healthy

This chart comes from a white paper, Integrated Healthcare Management, published by The Trizetto Group, Inc. The combination of premiums and out-of-pocket expenses per insured worker is approaching an unsustainable $1,600 a month! Note the sharp rise in heathcare premiums and out of pocket expenses paid by individuals, and the slope of the curves tracking these expenses. No wonder, as reported yesterday, individuals are engaging in unhealthy behavior because of the cost of their healthcare.

High Helath Costs Drive Unhealhty Behavior

The Kaiser Family Foundation Health Tracking Poll published past month found that 53% of Americans cut corners on their health during the past year care because of the cost involved. The chart above summarizes their actions.