Category: Health

Expensive placebos work better than cheap placebos — Gotcha!

For the most part, there is no difference — chemical or otherwise — between generic drugs and their more expensive, brand-name counterparts. But that doesn’t mean they can’t have varying effects, especially if their users are under the assumption that expensive drugs are more effective.

In a recent study, researchers found a patient’s perception or expectations of a drug (based on how much it costs) significantly affected the drug’s efficacy.

“Patients’ expectations play an important role in the effectiveness of their treatments, and the placebo effect has been well documented, especially in people with Parkinson’s disease,” explained lead study author Alberto J. Espay, a researcher at the University of Cincinnati who is currently serving as a fellow with the American Academy of Neurology.

“We wanted to see if the people’s perceptions of the cost of the drug they received would affect the placebo response,” Espay added.

To find out, Espay and his colleagues gave a group of study volunteers two shots of a placebo drug for Parkinson’s disease. Of course, the participants weren’t told it was a simple saline solution. Doctors told them that they were receiving two drugs, one shot and then the second after the first “wore off.”

Prior to the shots, doctors told the participants each drug had proven equally effective, but that one was significantly more expensive than the other — one costing $100 per dose and the other costing $1,500 per dose.

Despite being the exact same saline solution, the “expensive” placebo minimized hand shaking and improved motor skills among the Parkinson’s disease patients more effectively than did the “cheap” placebo.

After eventually revealing the ruse, researchers found the difference in efficacy was most pronounced among patients who admitted to expecting an improved result from the expensive version of the drug.

The brain is powerful drug — one that researchers hope to use to improve treatments.

If you casually note the number of miraculous cures popular through history – you shouldn’t be surprised at any of this. Both the placebo effect and the belief in “getting what you pay for” are demonstrably strong. Combined in a society rife with ignorance, the sophistry is destined to have some effect.

Homeless adults – mental illness and cognitive deficits

Nearly three-quarters of homeless adults with mental illness in Canada show evidence of cognitive deficits, such as difficulties with problem solving, learning and memory, new research has found…

“This points to an often unrecognized problem for the segment of Canada’s homeless population that suffers from mental illness,” said Dr. Vicky Stergiopoulos, chief of psychiatry at St. Michael’s Hospital and a scientist in its Centre for Research on Inner City Health.

These are the skills that people need to follow treatment or support recommendations, maintain housing stability or successfully complete day-to-day tasks.”

Each year up to 200,000 Canadians are homeless. The prevalence of mental illness among homeless individuals is much higher than the rest of the population, with more than 12 per cent suffering from severe mental illness, 11 per cent having mood disorders and close to 40 per cent reporting alcohol and drug addictions.

All of the participants in Dr. Stergiopoulos’ study experienced mental illness. About half met criteria for psychosis, major depressive disorder and alcohol or substance abuse, and nearly half had experienced traumatic brain injury…

“The data doesn’t help us to predict whether someone will have cognitive challenges, but it does show that if they experience homelessness and mental illness, it’s very likely,” said Dr. Stergiopoulos. “It adds to our understanding about why people may have difficulty accessing or keeping housing.”

Dr. Stergiopoulos noted the study is important for those who work directly with disadvantaged populations because it highlights that adaptations and improvements need to be made to treatment and support options. Lack of engagement is not necessarily because someone doesn’t want help, but may be because they don’t understand how to access or make use of it.

At least it sounds like our Northern Neighbors are trying. Perhaps Harper isn’t as callous as his role model Ronald Reagan.

Every Republican’s favorite Tin Jesus just about single-handed created the tidal wave of homeless, especially those with mental illness. His efforts to crush the US Public Health Service and hospital system put thousands of the mentally ill on our streets.

Pic of the Day


Ebola handshake going strong as Ebola cases decrease

U.S. Ambassador to the United Nations Samantha Power and Dr. Peter Graaff, the World Health Organization’s representative in Liberia, are among the first to publicly use the Ebola handshake. It’s a trend that’s catching on.

When this new form of salutation was introduced in disease-torn west Africa in October, it was considered yet another way to temper the Ebola epidemic. Today, bumping elbows, hitting arms and knocking shoes — each considered an Ebola handshake — is the new normal, especially among young men.

It’s not a trend that’s going away anytime soon. As the three hardest hit nations — Liberia, Sierra Leone and Guinea — cope with the aftermath of Ebola, some are considering new ways to institute safer health practices. In parts of hard-hit Sierra Leone, where some 3,000 have died from Ebola, the handshake is law…

The Ebola handshake has even spread beyond the borders of Africa. Earlier this month, United Nations Secretary General Ban Ki-moon was seen using the Ebola handshake.

Maybe this will help us all out with the flu, as well.

Melinda Gates’ response to anti-vaccine fools is education, history

On the heels of the measles outbreak at Disneyland, Melinda Gates of the Bill and Melinda Gates Foundation took aim at the vaccine naysayers who make these types of disease outbreaks more likely.

“We take vaccines so for granted in the United States,” Gates told the Huffington Post in a prerecorded interview published on Thursday. “Women in the developing world know the power of [vaccines]. They will walk 10 kilometers in the heat with their child and line up to get a vaccine, because they have seen death. [Americans have] forgotten what measles deaths look like.”

She added, “I’d say to the people of the United States: we’re incredibly lucky to have that technology and we ought to take full advantage of it.”

In response to the Disneyland outbreak, pediatric infectious disease specialist James Cherry told the New York Times the outbreak was “100 percent connected” to the anti-vaccine movement. “It wouldn’t have happened otherwise — it wouldn’t have gone anywhere,” he said.

The key is what the scientific community calls herd or community immunity. If every American of age was vaccinated, measles wouldn’t spread much further even if foreign travelers came into the country with the disease — as appears to be the case with measles.

Vaccinated people essentially act as barriers to measles outbreaks, since the disease can’t pass through them and infect other people. The awful truth of the anti-vaccine movement is that it puts the most vulnerable populations at risk: infants under 12 months of age, who can’t get vaccinated and are more susceptible to infection, and the elderly, who have a higher risk of death if they contract these illnesses.

Between religious nutballs whose anti-science hangups are reinforced by some dude behind a pulpit talking about an invisible dude sitting on a cloud in the sky — and conservative nutballs who indulge hangups that lead to unconcern about someone else dying from a condition we all can prevent – anti-science spookiness runs riot. They haven’t a clue.

Like that woman Melinda Gates talks about in the developing world, I grew up in a time and place where vaccines for many childhood diseases didn’t exist. Every spring we looked around at school to see who died over winter. Measles, scarlet fever, mumps, diptheria – all took their toll. Then we had the summer and polio to look forward to.

No – it wasn’t Africa or Asia. It was a factory town in southern New England. A town like every other in the United States at the time. No one was spared.

So, Melinda Gates’ response to anti-vaccine fools is education, history. My response to that is similar to Dr. King’s response when he was asked if civil rights laws would help bigots to love him. I don’t care if idjits love me. I just want to stop them from killing me and my family.

The hygiene hypothesis and allergies revisited

We all love carrots

Food allergies and other allergic and atopic disorders are largely diseases of the modern age. They were rarely diagnosed before the 20th century and are far less prevalent in underdeveloped parts of the world where bacterial and parasitic contamination of water and food supplies is common and access to vaccination and health care is poor.

The epidemic rise in allergic disease and asthma in the United States and throughout the Western world has coincided with a decline in infectious disease, due to improved public health, vaccination programs and better hygiene.

Is there a link between the risk in allergic disease and asthma and decline in infectious disease? According to the hygiene hypothesis, the decrease in exposure to microorganisms in the US and other prosperous nations is directly responsible for the dramatic increase in disorders that involve exaggerated immune responses to foreign antigens.

The theory that exposure to certain infections and allergens early in life or in utero protects against allergies and asthma has been bolstered by numerous epidemiologic and animal studies and even some clinical trials since it was first proposed by epidemiologist David P. Strachan of St. George’s University London.

Strachan showed that having more siblings was associated with a lower incidence of hay fever, and he postulated that exposure to infections from contact with older siblings protected against allergic disease.

But 25 years later, the hygiene hypothesis remains just that, experts say.

While there is strong evidence supporting the idea that increasingly clean environments have led to the rise in allergic and atopic disorders, other evidence suggests the hygiene hypothesis may only be part of the story, said Jonathan I. Silverberg, who is an assistant professor of dermatology at the Northwestern University Feinberg School of Medicine in Chicago…

Silverberg’s own recent research showed a lower prevalence of asthma, eczema, hay fever and food allergies in US-dwelling children born in other countries compared to children born in the United States. Foreign-born American children were significantly less likely to have developed one or more of these diseases than US-born children…

However, the protection associated with foreign birth was not evident in children who had lived in the United States for 10 years or more…

Silverberg and colleagues noted that the findings were consistent with the hygiene hypothesis, but they also suggested that protection may not be life-long and that subsequent exposure to allergens and other environmental factors may trigger atopic disease later in life…

He added that dietary changes, increased obesity, and environmental pollutants could all play a part in the increased risk associated with living in the US…

One consistent finding in the hygiene hypothesis research is that growing up on a farm is protective against allergic disease and asthma.

“This has been shown all over the world,” epidemiologist Neil Pearce said.

The more you hang out with animals the healthier you are likely to be.

I have no idea if that’s provable or not. Just seems to be another possibility. RTFA for all the details, considerations in the whole article.

Bridger’s Poplar pipeline spills into the Yellowstone River

Screen Shot 2015-01-19 at 9.33.56 PM
Bridger LLC – “We are committed to environmetal stewardship”

Bridger Pipeline LLC said on Monday it has shut the 42,000 barrel per day Poplar pipeline system after a weekend breach that sent as much as 1,200 barrels of crude oil into the Yellowstone River near Glendive, Montana.

The company said crews are now cleaning up the site after the leak on Saturday morning. Bridger estimates between 300 and 1,200 barrels spilled but could not say how much of the light crude flowed into the river.

The pipeline system runs from the Canadian border to Baker, Montana, where it meets the Butte pipeline. The Poplar system gathers crude from Bakken producers in eastern Montana and North Dakota. The company cannot yet say when the line will reopen or what caused the leak…

The spill is the second in the river in recent years. In 2011, Exxon Mobil Corp’s 40,000 bpd Silvertip pipeline in Montana ruptured underneath the river, releasing more than 1,000 barrels of crude and costing the company about $135 million to clean up…

Yup. The Yellowatone is a lovely river to fish. When you’re not concerned if the oil coating the fish is something other than olive oil.

When Reuters rolled out this article at 4:13 EST, they said no municipalities reported any problems with their water supplies. Well – the EPA has now shut down the water supply system for the town of Glendive, There is oil pollution in that system,, Federal, state and local agencies are working to secure a separate clean water supply for residents until the system can be flushed – and clean water from the river is available.

The screen shot at the top is from Bridger’s website. No mention of any oil spill in the Yellowstone River,

First in the US – New Orleans is housing all their homeless vets

Most people celebrate the New Year by making resolutions. The city of New Orleans rang in 2015 by keeping one.

At 6 p.m. on Jan. 2, social workers in New Orleans moved the city’s last known homeless veteran into his new apartment – becoming the first US city to effectively eliminate veteran homelessness.

Homelessness advocates around the country are hailing New Orleans as a model for cities around the country looking to end homelessness, not just for veterans, but for all people needing a permanent home…

This time last year, nearly 50,000 US veterans had no home to call their own, according to an annual count. On Independence Day, first lady Michelle Obama launched the Mayor’s Challenge to End Veteran Homelessness. Since that time, more than 300 mayors, six governors, and 71 other local officials have joined the pledge to house every veteran by the end of 2015.

New Orleans Mayor Mitch Landrieu took that pledge one step further, promising to meet the goal by the end of 2014.

Mayor Landrieu said in a statement Wednesday…that New Orleans had housed all known veterans in the Crescent City…In total, the city has placed 227 veterans in housing since the start of 2014.

RTFA for the progress made around the country. Overdue? You betcha.

Most working class families care. After all, we provide the cannon fodder for all our nation’s useless, unproductive wars. A fair number of politicians care – maybe half – although they all know how to beat the military drum.

It took a city with its own history of grief and disaster to show the way.

Health care is getting more affordable — see that on the local news, yet?

Every two years, the Commonwealth Fund surveys Americans on how difficult it is to afford medical care. The 2014 survey showed something new: for the first time in a decade, the number of Americans who say they can afford the health care they need went up.

The Commonwealth Fund fielded the survey during the second half of 2014, meaning they captured the people who signed up for Obamacare during the open enrollment period earlier in the year. And it showed, for the first time in the survey’s 10-year history, a decline in the number of Americans who reported having difficulty paying medical bills or who carried medical debt.

The Commonwealth Fund also looked at Americans who said they put off care because it was too expensive. And there, too, they saw a decline: 36 percent of Americans reported delaying care because of the price, an all-time low in the survey’s history.

This also coincided with an increase in the number of Americans who reported having health insurance, a finding that lines up with other national surveys on coverage.

In a way, it seems obvious that more people with health insurance would mean more Americans able to afford care. But that notion hasn’t always been taken for granted with Obamacare. Some of the plans sold on the new marketplaces have had especially narrow networks that limit coverage to a smaller set of doctors. These plans have also had particularly high deductibles, often over $2,000.

So it hasn’t been totally clear whether these plans would make it easier for Americans to afford coverage: would enrollees with a $2,000 deductible, for example, still find it too expensive to go to the doctor?

The Commonwealth Fund survey suggests that the answer is no: that the plans sold on the marketplace are making it easier for the people who buy them to see the doctor — which is one of the main points of having health insurance to begin with.

Makes sense to me. My Medicare Advantage has gone up a very small percentage; but, I’m entering the second year with a new provider – and all the insurance companies seem to play the same game of lowballing the first year.

The few other folks and family members I chatted with on the topic – admittedly a short sample – all agree with the article.

Inactivity kills more than obesity

A lack of exercise could be killing twice as many people as obesity in Europe, a 12-year study of more than 300,000 people suggests.

University of Cambridge researchers said about 676,000 deaths each year were down to inactivity, compared with 337,000 from carrying too much weight.

They concluded that getting everyone to do at least 20 minutes of brisk walking a day would have substantial benefits.

Experts said exercise was beneficial for people of any weight.

Obesity and inactivity often go hand in hand…However, it is known that thin people have a higher risk of health problems if they are inactive. And obese people who exercise are in better health than those that do not…

“The greatest risk [of an early death] was in those classed inactive, and that was consistent in normal weight, overweight and obese people,” said one of the researchers, Prof Ulf Ekelund…

He said eliminating inactivity in Europe would cut mortality rates by nearly 7.5%, or 676,000 deaths, but eliminating obesity would cut rates by just 3.6%.

Prof Ekelund added: “But I don’t think it’s a case of one or the other. We should also strive to reduce obesity, but I do think physical activity needs to be recognised as a very important public health strategy…”

Professor Ekelund…says all it would need to transform health, is brisk walking…”I think people need to consider their 24-hour day.

“Twenty minutes of physical activity, equivalent to a brisk walk, should be possible for most people to include on their way to or from work, or on lunch breaks, or in the evening instead of watching TV.”

Seems to make a difference for me. I put on a bunch of weight the last few years before retiring. Two things took care of that: My wife really pushed me into healthier nutrition and portion control – and finally qualifying for Medicare I was able afford the studies confirming my guess that I have sleep apnea. Now, I’m the poster child for CPAP therapy.

I’ve lost 6-8 pounds each of the last eight years.

While I’m going through a bit of a plateau now that I’m back down to average weight I need extra discipline to further modify food behavior to get down to where I’d like to be.

I walk every day. About 40 minutes/day – a few laps along our fence line. But, regardless of weather, I get the laps in every day.

Head Start Program really does help obese kids

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Head Start preschool programs had a positive effect on the body mass index (BMI) for obese and overweight children over the course of an academic year. Both obese and overweight children who participated in Head Start saw a greater decline in BMI z score during their first academic year than their counterparts in comparison groups, according to a new study to be published in the February issue of Pediatrics…

Julie Lumeng said that Head Start is a valuable intervention for clinicians concerned about the health and well-being of their low-income patients. “Practically speaking, if you’re a pediatrician or family medicine doctor who’s working with children and you’re concerned about their weight, if those children are low-income, meaning they would be eligible for the Head Start preschool program, just suggesting to the parent that they sign them up for Head Start might actually help them achieve a healthier weight,” she concluded…

The study may also have implications for the overall population health of children. “By looking at adopting not just developmental and educational policies, but also implementing strategies or evidence around food or playtime, it proves there’s a benefit to this when you compare it to fairly similar populations,” said Stephen Cook, MD, MPH…at the University of Rochester Medical Center in New York…

One of the most important limitations of the study may be the study design, which Lumeng calls “second best” compared with a randomized, controlled trial. However, she says a randomized controlled trial would be extremely unethical for this particular population. “You couldn’t enroll a family in a study and say ‘Well, I’m going to flip a coin basically and decide if your child’s going to get preschool or not’ when they’re living in poverty,” said Lumeng…

Cook sees this study as a jumping off point for further data collection, possibly involving Head Start providers, as well as the siblings and parents of the children involved. He hypothesized there might be a “halo effect” with kids’ healthier eating habits and greater physical activity having a positive impact on the adults in their lives.

Head Start is a federally funded preschool program that is free to 3- to 5-year-old US children living in poverty. Head Start program regulations mandate nutritional and health services, adequate time and space for active play, and parental involvement.

Republicans hate it.