February 2nd, 2011 by Mary Knudson in Health Tips, Opinion
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I confess to loving Campbell’s tomato bisque soup. I mix it with 1 percent-fat milk and it’s hot and delicious and comforting, but one of the worst food choices I could make because one cup contains more sodium than I should have in a day. Knowing this, I have already relegated it to an occasional treat. But by the end of this blog post I will do more.
We are overdosing on sodium and it is killing us. We need to cut the sodium we eat daily by more than half. The guidelines keep coming. The U.S. government has handed out dietary guidelines telling Americans who are over 50, all African Americans, people with high blood pressure, diabetes, or chronic kidney disease to have no more than 1,500 milligrams (mg) — or two thirds of a teaspoon — of sodium daily. That’s the majority of us — 69 percent. Five years ago the government said that this group would benefit from the lower sodium and now it made this its recommendation. The other 31 percent of the country can have up to 2,300 mg a day, say the guidelines from the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS).
Or should they? The American Heart Association (AHA) recommends that all Americans lower sodium to less than 1,500 mg a day. Excessive sodium, mostly found in salt, is bad for us because it causes high blood pressure which often leads to heart disease, stroke, and kidney disease and can also cause gastric problems. People with heart failure are taught to restrict salt because water follows salt into the blood and causes swelling of the ankles, legs, and abdomen and lung congestion that makes it difficult to breathe.
I saw one recommendation by an individual on the Internet to just drink a lot of water to flush the sodium out of your body rather than worry about eating foods that have less sodium. BAD idea, especially for people with heart problems who need to restrict fluids to help prevent fluid accumulation in their bodies. The salt will draw the water to it.
But cutting our salt consumption by half is quite a tall order for an individual consumer because Americans have been conditioned from childhood to love salt and we on average consume 3,436 mg — nearly one and a half teaspoons — a day. Sodium is pervasive in our food supply. We get most of our sodium from processed foods and restaurant and takeout food, sometime in unexpected places. Read more »
*This blog post was originally published at HeartSense*
November 30th, 2010 by PeterWehrwein in Better Health Network, Health Tips, News, Research
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Vitamin D has been talked about as the vitamin — the one that might help fend off everything from cancer to heart disease to autoimmune disorders, if only we were to get enough of it.
“Whoa!” is the message from a committee of experts assembled by the Institute of Medicine (IOM) to update recommendations for vitamin D (and for calcium).
The IOM committee’s report, released this morning, says evidence for many of the health claims for vitamin D is “inconsistent and/or conflicting or did not demonstrate causality.” The exception is the vitamin’s well-documented (and noncontroversial) benefits on bone growth and maintenance.
The IOM panel’s report also says most North Americans (Canadians as well as Americans) have more than enough vitamin D in their blood to achieve the desired effect on bone. The committee said a blood level of 20 nanograms per milliliter (ng/mL) is sufficient for most people.
The panel set 600 International Units (IU) as the recommended daily intake for children and for adults ages 19 to 70. People ages 71 and older are supposed to get an additional 200 IU, or 800 IU a day.
That’s a fairly sizable increase over the previous recommendations of 200 IU per day through age 50, 400 IU for people ages 51 to 70, and 600 IU for people ages 71 and older. Read more »
*This blog post was originally published at Harvard Health Blog*
March 24th, 2010 by DavidHarlow in Better Health Network, Primary Care Wednesdays, Research
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Ten years after the release of the IOM report To Err is Human, which documented the toll taken by medical errors in this country, the question remains: What can be done to reverse the trend of ever-increasing morbidity and mortality due to medical errors? Last December, a look back over the decade since the release of To Err is Human — and a steady medical error death rate of about 100,000 per year included a series of suggestions for tweaks to the health care delivery system that may help ameliorate the situation. Earlier this week, a gadget that enforces good handwashing technique by sniffing caregiver and clinician hands for soap before a hospital patient may be touched has been touted as potentially saving significant costs related to HAIs.
Today, the Lucian Leape Institute released a report titled Unmet Needs: Teaching Physicians to Provide Safe Patient Care which focuses on moving back the point in time where an intervention is needed to reverse the trend documented in To Err is Human and since. Leape and his colleagues at the National Patient Safety Foundation are now focused on reinventing the medical school curriculum, so that patient safety will be taught more effectively in medical schools. Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
November 11th, 2009 by Richard Cooper, M.D. in Better Health Network, Health Policy, Opinion
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The Institute of Medicine (IOM) has addressed seven key health care reform questions and offered answers that capture today’s consensus. No surprises, but good clear analyses. But what if the underlying conceptual framework is not an excessive use of services by wrongly incentivized providers but the tragic over-use of services by the poor? Here are seven “what ifs” plus an eighth question.
1. Is health care too expensive?
What if health care is the economy, the major source of jobs and the basis for America’s worker productivity? And what if the problem is an unfair insurance system and inequitable distribution of fiscal responsibility?
2. How much too expensive is it?
What if regional variation is not a manifestation of excessive spending but of income inequality and the intersection of wealth and poverty? And what if differences in price and economic development, rather than waste and inefficiency, differentiate costs among countries? Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
March 20th, 2009 by Dr. Val Jones in Health Policy
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What would it be like to have most of healthcare’s key stakeholders in one room, and allow each of them to take turns at a podium in 3 minute intervals? It would be like the meeting I attended today at the Institute of Medicine.
The goal of this public forum was to allow all interested Americans to weigh in on prioritization rankings for comparative clinical effectiveness research (CCER). CCER, as you may recall from my recent blog post on the subject, is the government’s new initiative to try to establish “what works and what doesn’t” in medicine. Instead of answering the usual FDA question of “is this treatment safe and effective?” We will now be asking, “is this treatment more safe or more effective than the one(s) we already have?”
There are many different treatments we could study – but let’s face it, 1.1 billion isn’t a whole lot when you consider that some CCER studies (like the ALLHAT trial) cost upwards of 100 million a piece. So we have to think long and hard about where to channel our limited resources, and which treatments or practices we want to compare first.
The public forum attracted most of the usual suspects: professional societies, research organizations, industry stakeholders, health plans, and advocacy groups. But the imposed time limit forced them to really crystallize their views and agendas in a way I’d never seen before.
I “live-blogged” the event on Twitter today and if you’d like to see the detailed quotes from all the presenters, feel free to wade through the couple of hundred comments here.
For those of you more interested in the “big picture” I’ll summarize my take home points for you:
Almost everyone agreed that…
- The process for establishing research priorities should be transparent and inclusive of all opinions.
- More information is good, and that CCER is a valuable enterprise insofar as it provides greater insight into best practices for disease management.
Most agreed that…
- Preventive health research should be a priority – so that we can find out how to head off chronic disease earlier in life.
- CCER should be considered separately from cost effectiveness decisions.
- One size doesn’t fit all when it comes to patient needs and best disease treatments.
- Physicians should be included in the CCER research and clinical application of the findings.
- Research must include women and minorities.
- CCER should not just be about head-to-head drug studies, but about comparing care delivery models and studying approaches to patient behavior modification.
- CCER should build upon currently available data – and that all those who are collecting data should share it as much as possible.
Some agreed that…
- There is a lack of consistent methodology in conducting CCER.
- We need to be very careful in concluding cause and effects from CCER alone.
The best organized 3 minute presentations:
In my opinion, the industry folks had the best presentations, followed by a powerful and witty 3 minutes from the American Association for Dental Research. Who knew the dentists had such a great sense of humor? Here are the top 4 presentations:
#1. Teresa Lee, AdvaMed – best all around pitch. In three short minutes, Teresa persuasively argued for transparency in CCER priority-setting, presented her top disease research picks (including hospital acquired infections and chronic diseases like asthma, diabetes, and clinical depression), the importance of physicians and patients making shared decisions about care (rather than the government imposing it), and the need to distinguish CCER from cost effectiveness.
#2. Randy Burkholder, PhRMA – “Without physician input, the questions we pose via CCER will not be clinically relevant.”
#3. Ted Buckley, BIO – “What’s best for the average patient is not necessarily best for every specific patient.”
#4. Christopher Fox, American Association for Dental Research – he said that “his good oral hygiene made it possible for him to deliver his presentation today.”
Most innovative idea
Dr. Erick Turner of Oregon Health and Science University suggested that FDA trial data be used as the primary source of CCER-related data analysis rather than the published, peer-reviewed literature since journals engage in publication bias – they tend to publish positive studies only.
Most shocking moment
Merrill Goozner, from the Center for Science In The Public Interest, essentially told the public forum hosts that the event was a terrible idea. He suggested that industry stakeholders were inherently biased by profit motives and should therefore not be allowed to influence the IOM’s CCER priority list. The crowd squirmed in its seats. For me, Merrill’s suggestion was like saying that a plan to reform the auto industry should exclude car manufacturers because they have a profit motive. Sure profit is a part of it, but reform is just not going to happen without buy in and collaboration. As I’ve argued before – there’s no such thing as complete lack of bias on anyone’s part (patients, doctors, nurses, dentists, health plans, advocates, or industry). The best we can do is be transparent about our biases and include checks and balances along the way – such as inviting all of us biased folks to the table at once.
I’m glad that happened.
