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Shiver Yourself Thin?

Picture by Ryan DuBosarBritish researchers are trying to causally link raising the thermostat to obesity prevalence.

“Domestic winter indoor temperatures” appear to be rising, the researchers wrote, as is obesity. They focused on a causal link, focusing on acute and long-term effects of being comfortable in the winter.

They write: “Reduced exposure to seasonal cold may have a dual effect on energy expenditure, both minimizing the need for physiological thermogenesis and reducing thermogenic capacity. Experimental studies show a graded association between acute mild cold and human energy expenditure over the range of temperatures relevant to indoor heating trends.”

They also look at brown adipose tissue (BAT), aka “brown fat,” the type of fat that actually consumes energy instead of stores it. We all have this fat as infants, to help us regulate our body temperatures until our bodies learn to do it on their own. The researchers suggest that “increased time spent in conditions of thermal comfort can lead to a loss of BAT and reduced thermogenic capacity.”

Determining a link “may raise possibilities for novel public health strategies to address obesity,” although I shiver to think what those strategies might entail.

*This blog post was originally published at ACP Internist*

State Of Healthcare In The Union

Short and sweet. That’s how President Obama addressed healthcare reform in his State of the Union address [Tuesday] night. In less than 700 words, he outlined how he’d improve but not retreat on what’s been enacted into law.

He’s willing to work on changes, he said, naming malpractice reform and reducing onerous paperwork burdens for small businesses. But, he cautioned, “What I’m not willing to do is go back to the days when insurance companies could deny someone coverage because of a pre-existing condition.”

President Obama had invited two real people to his address to highlight the law’s successes. One is a brain cancer survivor who can access health insurance through high-risk pools created by the law. The other is a small business owner who lowered health insurance costs by $10,000 for his nine employees, a probable jab at the “job-killing” title of an attempted yet futile repeal vote last week.

The President’s remarks come at a time when the public is of two minds on healthcare reform. While many state they don’t like the entire package, they also love individual aspects of it. The individual mandate remains widely unpopular, but allowing those with pre-existing conditions to access insurance is widely popular, as does Medicare and Social Security.

The Republican response by Rep. Paul Ryan, R-Wis., Chairman of the House Budget Committee, responded that, “The President mentioned the need for regulatory reform to ease the burden on American businesses. We agree — and we think his healthcare law would be a great place to start.” The House has voted for a repeal and Senate Republicans are preparing legislation and promising to ask for a vote. (Los Angeles Times, Politico, Kaiser Health News, Greenville [South Carolina] Online)

*This blog post was originally published at ACP Internist*

Effect Of Autism-Vaccine Fraud Not Easily Undone

Eighteen percent of American believe that vaccines can cause autism, 30 percent remain unsure, and 52 percent of Americans don’t think vaccines can cause autism, according to public opinion polling done after research linking vaccines to the condition was reported as fraudulent.

While 69 percent of respondents said they had heard about an association between vaccination and autism, 47 percent knew that the original Lancet study had been retracted, and that recently the research is reported as being fraudulent.

The poll also found that 86 percent of parents who have doubts about the vaccine said that their children were fully vaccinated, compared to 98 percent of parents who believe vaccines are safe, and that 92 percent of children are fully vaccinated.

The poll was conducted after news reports were published that said Andrew Wakefield, the lead researcher of the research linking autism to the MMR vaccine, had used faked data.

More than 20 studies since Wakefield’s have disputed the association between vaccination and autism.

The online survey of 2,026 adults from Jan. 11 to 13 was done by Harris Interactive and HealthDay. (AP/Fox News, CNN, BMJ, WebMD)

*This blog post was originally published at ACP Internist*

Baby Boomers 2011: A “New Frontier” With Few Guideposts

This is a guest post by Dr. John Schumann.

**********

In 2011, the first wave of baby boomers will turn 65 years old. Sixty-five still has currency because that’s the age at which non-disabled Americans are eligible to be covered under the Medicare program (now itself having reached middle age).

As our economy continues to recover (hopefully) from the Great Recession, the entrance of millions of Americans to the Medicare rolls over the next decade and a half will be a formidable planning challenge. Look at this chart to see how the baby boomers population has surged:

So is the promise of healthcare reform (the “PPACA“), which will enlarge Medicaid by an additional 16 million Americans — about half of the projected growth in coverage for those currently uninsured.

A couple of recent patient encounters got me thinking about these phenomena, and how we are very much in historically uncharted territory. Never have we had so many living so well for so long. We have an entire generation of people reaching “seniority” who will continue to want the most out of life, without many guideposts on how to achieve it. Read more »

*This blog post was originally published at ACP Internist*

Who’s More Pessimistic About Healthcare Reform, Physicians Or Patients?

While public opposition to healthcare reform has diminished since its passage, physician opinions are still negative, especially among specialists who see their value to the healthcare system decreasing as reform emphasizes primary care.

A survey reports that 65 percent of nearly 3,000 physicians in all specialties said the quality of healthcare in the country will deteriorate in the next five years. Seventeen percent of respondents believe the quality of healthcare will stay the same and 18 percent believe it will improve. Meanwhile, 30 percent of healthcare consumers believe that the quality of healthcare will improve.

Physicians cited as reasons for their pessimism personal political beliefs, anger at insurance companies and a lack of accurate planning in the reform act. Other reasons include that primary care physicians won’t have the time to keep up with the extra workload, forcing more patients to depend upon nurse practitioners for primary care. When asked who will likely handle the 32 million Americans expected to receive healthcare following passage of the reform, 44 percent said primary care physicians will handle the load and 44 percent said that nurse practitioners will see them. (Physicians could vote for more than one category; options include physicians assistants and specialists, for example.) Read more »

*This blog post was originally published at ACP Internist*

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