Category: Health

Tropical virus goes from Zero to 1.24 mIllion cases in the Americas – in 1 year!

In slightly more than a year, the Americas have seen more than 1.24 million cases of chikungunya virus, a mosquito-borne disease that causes high fever and debilitating joint pain.

The tropical virus was rare in North, Central, and South America until December 2013, when investigation of suspected dengue virus in the Caribbean island of St. Martin turned up 26 cases of chikungunya, without any sign they had been imported from elsewhere.

As of the end of February 2015, that handful of cases had exploded to 1,247,400 suspected and confirmed cases, affecting almost every country in the hemisphere, according to the Pan-American Health Organization.

Until the end of 2013, chikungunya in the Americas was almost entirely imported from countries in Africa or Asia where the tropical virus was endemic.

In the U.S., most cases are still imported — a cumulative total of some 2,542 since 2013, according to the PAHO, with an additional 11 cases, all in Florida, blamed on local transmission. But most of that transmission now comes from the epidemics raging elsewhere in the region.

The U.S. numbers might be an underestimate…until this year, the virus was not a nationally notifiable disease, so some cases might have been missed.

The virus — the name is pronounced chik-un-GUHN-ya — is carried by mosquitoes, mainly Aedes aegypti and Aedes albopictus, which are widespread in the U.S.

The CDC notes that both species primarily bite in the daytime and urges that travelers take precautions against mosquito bites, including wearing long-sleeved shirts and long pants, if weather permits, and using insect repellents.

There is no specific treatment for the virus and no vaccine, but its dramatic spread has re-focused the attention of vaccine researchers…

By summertime, some enterprising news-as-entertainment-network will pick up on the fear-factor potential of another disease originating in Africa and take a shot at American Ebola panic to get traffic up on their crappy channel. There have been a few false starts; but, the Philistines haven’t succeeded. Yet.

Meanwhile, support for vaccine studies proceeds at a deliberate pace. Something else for both New Age and Old Testament Luddites to use to up their anti-science game.

The CDC will have – and does have – reasonable safety suggestions. Not unlike the usual sensible practices everywhere insect-borne disease may flourish.

Restaurant honors birthday rule — 101-year-old gets 101% refund!


Looks pretty good for 101

A restaurant’s policy to give customers a percentage off their bill on their birthday actually became a 7-cent refund for man who turned 101.

Joseph Nelson, who celebrated a birthday breakfast at the Belmont Hall and Restaurant in Manchester on Monday, told WMUR-TV he never thought he’d live this long.

The restaurant’s policy is that customers get a percentage taken off the bill on their birthday based on their age. At 101 years old, the restaurant owed Nelson money.

Nelson ate scrambled eggs and ham, topped off with a piece of chocolate cake.

You can’t buy publicity like this – this cheap.

Medicare drug costs continue to shrink under ObamaCare

ObamaCare has led to substantial savings in prescription drug costs and a strong increase in the use of preventive services…

“Our parents and grandparents on Medicare saved more than $15 billion on prescription drugs since President Obama signed the Affordable Care Act in 2010,” Health and Human Services Secretary Sylvia Mathews Burwell said.

Those savings amount to nearly $1,600 per person enrolled in Medicare — an increase from about $1,400 in average savings last year…

Under ObamaCare, recipients in the “doughnut hole” receive a rebate or discount from the government to help them save on prescription drug costs until the gap can ultimately be closed.

Burwell also highlighted the growing use of preventive healthcare coverage under ObamaCare — another top issue for the administration. Many provider groups only signed onto healthcare reform with the promise that preventive care would be a central tenet.

Nearly 40 million people have used at least one of Medicare’s free preventive services in the last year alone, the secretary said. Nearly 5 million enrollees received the annual wellness exam…

Doctors groups, such as the American Medical Association, have been key administration partners in the implementation of ObamaCare. But the two sides have not entirely agreed on the creation and rollout of ObamaCare, Burwell acknowledged Tuesday.

She specifically pointed to the unpopular rules on electronic health records, which doctors have lamented as costly and bureaucratic. She also pointed to the president’s support of for a permanent Sustainable Growth Rate formula, which decides the reimbursement rate for Medicare doctors.

As a geek and a fiscal conservative, I’m happy to see the electronic health records have proved to be a boon in catching fraud. Individual doctors, group practices, hospitals and clinics are beginning to learn that appropriate data mining brings sleazy practices to light easier than anything before Obamacare.

There’s more to criticize and more to come. I’d still like to have a classic single payer mode and access to national-negotiated prices for meds – just like that provided for our military. At the passage of the ACA, there were enough Republican conservatives and Blue Dog Democrats around to block that savings. Big Pharma got their money’s worth out of Congress that time.

Are diabetics dumb enough to share pen devices and [sometimes] needles

The FDA is adding a warning label on diabetes pen devices, making clear that the pens are intended for single patient use only and shouldn’t be shared, even if the needle is changed.

In an announcement on their website last week, the agency said they are trying to reduce the risk of serious infections from the sharing of multidose pens. They will require that pens and packaging with multiple doses of insulin or other injectable diabetes medicines carry a warning label stating “For single patient use only.”

The FDA will also add warnings in the prescribing information and to the patient Medication Guides, Patient Package Inserts, and Instructions for Use. There are several different brands of the pens on the market, including exenatide (Byetta), liraglutide (Victoza), pramlintide acetate (Symlin), insulin detemir (Levemir), and insulin glargine (Lantus).

Pen cartridges usually contain enough insulin for several doses. After a patient uses the pen, blood might be on the pen even when the needle is changed, said the FDA.

The FDA saw signs as early as 2008, when the Institute of Safe Medication Practices brought up the issue, that bloodborne pathogens could be shared with pens designed for one patient only. In 2009, a U.S. Army facility announced that more than 2,000 patients were infected with a pathogen when pens were shared, leading to the FDA issuing an alert.

And in 2013, the Veterans Health Administration notified 716 patients that they might have been exposed because the devices were shared…

C’mon, folks. A little sensible hygiene goes a long way. Injectable medication has always carried the risk of bloodborne infection when devices are shared. Not rocket science.

Nevada Republican says cancer is a fungus – just wash it away

Nevada Assemblywoman Michele Fiore (R) wants to reform the rules of end-of-life medical care so that more cancer patients can simply flush out their disease using baking soda.

Fiore, who is also CEO of a healthcare company, told listeners to her weekly radio show on Saturday, that she will soon introduce a “terminally ill bill,” to allow more non-FDA-approved treatments for those diagnosed as having terminal illnesses.

As first reported by Jon Ralston, Fiore told listeners: “If you have cancer, which I believe is a fungus, and we can put a pic line into your body and we’re flushing, let’s say, salt water, sodium cardonate [sic], through that line, and flushing out the fungus…These are some procedures that are not FDA-approved in America that are very inexpensive, cost-effective.”

The American Cancer Society warns that while cancer patients whose immune systems are weakened by high doses of chemotherapy can sometimes contract fungal infections, “there is no evidence that antifungal treatment causes the patients’ tumors to shrink.” Cancer Research UK dismisses the claim that sodium bicarbonate (baking soda) can cure cancer as a debunked “persistent cancer myth.”

Although Fiore’s views on cancer are particularly fringe, the bill she is backing is gaining traction in a number of states. At least five states have now passed similar legislation that allows patients to use drugs not cleared by the FDA, dubbed so-called “right to try” bills.

What passes for American conservatism, nowadays, seems more and more to be populated by lemmings who never studied any science in their whole lives. That is in addition to those who fear science, hate science, dare not study science because they might be struck by lightning from an angry old white guy on a cloud.

Leading state legislatures to pass legislation not only foolish and stupid; but, dangerous to human life is becoming an Republican specialty.

First genetic test submitted by 23andMe approved by the FDA

A test for Bloom syndrome carrier status, a rare condition seen mainly in Ashkenazi Jews (and uncommon among them as well), was approved by the FDA — remarkable primarily because it’s the first time a direct-to-consumer test for a specific genetic condition has won the agency’s OK.

The decision was also notable because the test will be sold by 23andMe, the company that initially began selling a panoramic health-risk test directly to consumers and was slapped down by the FDA. The agency told the firm that it had to seek formal approval for each and every specific component of the test, with proof that the tests were accurate, that consumers could provide proper samples, and that they could understand the results and their health implications.

Although the FDA was widely criticized for discouraging innovation and preventing people from getting access to their own genomic data, 23andMe promised that it would comply with the agency’s demands.

First out of the box for 23andMe was the carrier status test for Bloom syndrome, which is marked by short stature, extreme sun sensitivity, and increased cancer risk. About one in 107 people of Ashkenazi Jewish ancestry carry the gene, two copies of which are needed to cause the clinical syndrome, according to 23andMe…

Additionally, 23andMe conducted a “user comprehension” study with its results report to confirm that individuals understood them and the implications for family planning decisions.

Good news for everyone interested in easy access to knowledge about their genetic factors particularly as they relate to inherited conditions. Easy – in that you needn’t cave to the medical-industrial complex. Good news especially because it looked from the start that the FDA was out for a classic bureaucratic shutdown of an entreprenuerial challenge to the status quo.

Good science seems to have prevailed. Maybe reason and understanding are next. I hope.

Popular soda ingredient poses cancer risk

Public health researchers have analyzed soda consumption data in order to characterize people’s exposure to a potentially carcinogenic byproduct of some types of caramel color. Caramel color is a common ingredient in colas and other dark soft drinks. The results show that between 44 and 58 percent of people over the age of six typically have at least one can of soda per day, possibly more, potentially exposing them to 4-methylimidazole (4-MEI), a possible human carcinogen formed during the manufacture of some kinds of caramel color.

Building on an analysis of 4-MEI concentrations in 11 different soft drinks first published by Consumer Reports in 2014, researchers led by a team at the Johns Hopkins Center for a Livable Future (CLF) estimated exposure to 4-MEI from caramel-colored soft drinks and modeled the potential cancer burden related to routine soft drink consumption levels in the United States.

“Soft drink consumers are being exposed to an avoidable and unnecessary cancer risk from an ingredient that is being added to these beverages simply for aesthetic purposes,” says Keeve Nachman, PhD, senior author of the study…”This unnecessary exposure poses a threat to public health and raises questions about the continued use of caramel coloring in soda…”

While there’s currently no federal limit for 4-MEI in food or beverages, Consumer Reports petitioned the Food and Drug Administration to set limits for the potential carcinogen last year. It also shared the findings with the California Attorney General’s office, which enforces the state’s Proposition 65 law aimed at reducing consumers’ exposure to toxic chemicals. Under this state law, any food or beverage sold in the state that exposes consumers to more than a specific amount of 4-MEI per day requires a health-warning label.

Another one I don’t have to worry about. I actually keep most New Year’s Resolutions as long as I limit myself to one at a time. Make it simple. Make it achievable.

A number of years ago I stopped consuming any carbonated beverages.

Hospitals buy up doctors’ practices — we get screwed with higher charges

Imagine you’re a Medicare patient, and you go to your doctor for an ultrasound of your heart one month. Medicare pays your doctor’s office $189, and you pay about 20 percent of that bill as a co-payment.

Then, the next month, your doctor’s practice has been bought by the local hospital. You go to the same building and get the same test from the same doctor, but suddenly the price has shot up to $453, as has your share of the bill.

Patients around the country are getting that unpleasant surprise, as more and more doctors’ offices are being bought by hospitals. Medicare, the government health insurance program for those 65 and over or the disabled, pays one price to independent doctors and another to doctors who work for large health systems — even if they are performing the exact same service in the exact same place.

This week, the Obama administration recommended a change to eliminate much of that gap. Despite expected protests from hospitals and doctors, the idea has a chance of being adopted because it would yield huge savings for Medicare and patients.

In the dry language of the annual budget, the White House asks Congress to “encourage efficient care by improving incentives to provide care in the most appropriate ambulatory setting.” In normal English, that means reducing financial incentives that are causing many doctors to sell their practices to hospitals just to take advantage of extra revenue.

The heart doctors are a great example. In 2009, the federal government cut back on what it paid to cardiologists in private practice who offered certain tests to their patients. Medicare determined that the tests, which made up about 30 percent of a typical cardiologist’s revenue, cost more than was justified, and there was evidence that some doctors were overusing them. Suddenly, Medicare paid about a third less than it had before.

But the government didn’t cut what it paid cardiologists who worked for a hospital and provided the same test. It actually paid those doctors more, because the payment systems were completely separate. In general, Medicare assumes that hospital care is by definition more expensive to provide than office-based care.

You can imagine the result: Over the past five years, the number of cardiologists in private practice has plummeted as more and more doctors sold their practices to nearby hospitals that weren’t subject to the new cuts. Between 2007 and 2012, the number of cardiologists working for hospitals more than tripled, according to a survey from the American College of Cardiology, while the percentage working in private practice fell to 36 percent from 59 percent. At the time of the survey, an additional 31 percent of practices were either in the midst of merger talks or considering it. The group’s former chief operating officer once described the shift to me as “like a migration of wildebeests.”

Cardiologists are not the only doctors who have been migrating toward hospital practice. In the last few years, there have been increases in the number of doctors working for hospitals across the specialties. And spreads between fees for office services exist in an array of medical services, down to the basic office visit.

RTFA for more disheartening details. The crux remains, Obama and Congress in those first couple of years managed to get changes through to lower costs for some healthcare. The lawyers, lobbyists and other professional creeps working for the medical-industrial complex figured out a way around the changes – and increased profits to boot. Doctors around the country lined up to join the money parade. Not all of them. There remains a principled class in the corner here and there.

But, who noticed the changes? Who did anything about it? Certainly not Congress. They may be elected to represent the people of America, every state; but, they only listen to the Sound of Money riffling into their bank accounts.

It’s taken Obama till the last half of his second term to stand up and notice the change, propose new legislation to sort the problem. How much of a chance do you think we have of getting regulations through a Congress controlled by greenback conservatives, both Republican and Democrat – and restore a human focus to healthcare and family practice?

First IVF births using new screening tool for genetic disease

The first three babies screened at the embryonic stage with karyomapping, a novel screening tool for genetic disease, have been born…

For couples who are at risk of passing on genetic disease to their offspring, the technology helps determine which embryos are disease-free and viable for implantation following in vitro fertilization (IVF), according to the firm, New Jersey-based Reprogenetics.

Although preimplantation genetic diagnosis (PGD) has been available for decades, karyomapping takes advantage of advances in genetic sequencing that have reduced the price, time, and complexity of the process. Thus, the main benefit of karyomapping is the diminished amount of time it takes for couples to get results and get pregnant, company officials said…

“This is considered the ‘inevitable evolution’ of genetic studies for our field,” Robert Greene, MD, a reproductive endocrinologist in Syracuse, N.Y., told MedPage Today. “The race … has been in making the technique practical. It will only be adopted clinically if it meets those practical considerations. Otherwise, most centers will stick with the current technique until the price comes down…”

As with other forms of PGD, karyomapping can test for genetic diseases such as Down syndrome, cystic fibrosis, and fragile X syndrome. Konstantinidis said the tool can detect 60 genetic disorders and has been performed on more than 1,000 embryos to date.

Another simple scientific tool enabling easier, broader choices to folks getting ready to have children. Hopefully, a decision involving some forethought.

Hopefully, a process liable to lass and less interference from politicians governed by pandering to superstition and ignorance.

Smoking is bigger cause of mortality than previously accepted

Deaths due to smoking increased by 17% with the inclusion of multiple diseases that do not have established relationships with cigarette smoking, data from five large cohort studies showed.

The analysis of almost 1 million adults showed that smoking increased the risk of dying of one of the diseases by 30% (breast cancer) to 500% (intestinal ischemia) as compared with nonsmokers. Researchers found that 17% of excess deaths attributable to smoking resulted from the additional smoking-associated diseases…

The newly associated diseases included cancers, infections, pulmonary diseases, and cardiovascular diseases…”These associations should be investigated further and, when appropriate, taken into account when the mortality burden of smoking is investigated,” Brian Carter’s group concluded.

What’s unique about this study is the data,” the American Lung Association’s Norman Edelman told MedPage Today. “They have large populations and very large numbers, which provide the statistical power to identify small, but statistically significant effects that couldn’t be seen in smaller studies. Most of these [diseases] have been suspected, and now we know that there are many other things related to smoking other than the dozen or so that have already been proven.”

“When you run the numbers and add up all the deaths attributable to smoking, you come up with an astonishing increase,” he added.

RTFA for methodology, analysis and a caution or two.

Boy, am I glad I quit smoking 57 years ago. :)