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Top 10 Health Stories Of 2010

1. Health care reform

How could the health care reform legislation that President Barack Obama signed into law on March 23, 2010, not be the #1 story of the year?  Whether you are for or against it, the Patient Protection and Affordable Care Act is nothing if not ambitious, and if implemented, it will fundamentally alter how American health care is financed and perhaps delivered.  The law is designed to patch holes in the health insurance system and extend coverage to 32 million Americans by 2019 while also reining in health care spending, which now accounts for more than 17% of the country’s gross domestic product. The biggest changes aren’t scheduled to occur until 2014, when most people will be required to have health insurance or pay a penalty (the so-called individual mandate) and when state-level health insurance exchanges should be in place. The Medicaid program is also scheduled to be expanded that year so that it covers more people, and subsidized insurance will be available through the exchanges for people in lower- and middle-income brackets. But plenty is happening before 2014. The 1,000-page law contains hundreds of provisions, and they’re being rolled out in phases. This year, for example, the  law created  high-risk pools for people with pre-existing conditions,  required health plans to extend coverage to adult children up to age 26, and imposed a 10% tax on indoor tanning salons. Next year, about 20 different provisions are scheduled to take effect, including the elimination of copayments for many preventive services for Medicare enrollees, the imposition of limits on non-medical spending  by health plans, and the creation of a voluntary insurance that will help pay for home health care and other long-term care services received outside a nursing home. Getting a handle on the complicated law is difficult. If you’re looking for a short course, the Kaiser Family Foundation has created an excellent timeline of the law’s implementation (we depended on it for this post) and a short (nine minutes) animated video that’s one of the best (and most amusing) overviews available. The big question now is whether the sweeping health care law can survive various legal and political challenges. In December, a federal judge in Virginia ruled that the individual mandate was unconstitutional. Meanwhile, congressional Republicans have vowed to thwart the legislation, and if the party were to win the White House and control of the Senate in the 2012 election, Republicans would be in a position to follow through on their threats to repeal it.   

2. Smartphones, medical apps, and remote monitoring 

Smartphones and tablet computers are making it easier to get  health care information, advice, and reminders on an anywhere-and-anytime basis. Hundreds of health and medical apps for smartphones like the iPhone  became available this year. Some are just for fun. Others provide useful information (calorie counters, first aid and CPR instructions) or perform calculations. Even the federal government is getting into the act: the app store it opened this summer has several free health-related apps, including one called My Dietary Supplements for keeping track of vitamins and supplements and another one from the Environmental Protection Agency that allows you to check the UV index and air quality wherever you are. Smartphones are also being used with at-home monitoring devices; for example, glucose meters have been developed that send blood sugar readings wirelessly to an app on a smartphone. The number of doctors using apps and mobile devices is increasing, a trend that is likely to accelerate as electronic health records become more common. Check out  iMedicalapps if you want to see the apps your doctor might be using or talking about. It has  become a popular Web site for commentary and critiques of medical apps for doctors and medical students. Meanwhile, the FDA is wrestling with the issue of how tightly it should regulate medical apps. Some adverse events resulting from programming errors have been reported to the agency.  Medical apps are part of  a larger “e-health” trend toward delivering health care reminders and advice remotely with the help of computers and phones of all types. These phone services are being used in combination with increasingly sophisticated at-home monitoring devices. Research results have been mixed. Simple, low-cost text messages have been shown to be effective in getting people wear sunscreen. But one study published this year found that regular telephone contact and at-home monitoring of heart failure patients had no effect on hospitalizations of death from any cause over a six-month period. Another study found that remote monitoring did lower hospital readmission rates among heart failure patients, although the difference between remote monitoring and regular care didn’t reach statistical significance. Read more »

*This blog post was originally published at Harvard Health Blog*

Echinacea For Colds: Does It Really Work?

Does echinacea, the popular natural cold remedy, really work?

It depends on what you mean by “work.” Results [recently] reported in the Annals of Internal Medicine found that echinacea may reduce the length of a week-long cold by 7 to 10 hours and make symptoms a little less onerous. That can’t be characterized as a major effect, so many people may figure that the trouble and expense of echinacea just isn’t worth it (fortunately, side effects from echinacea don’t seem to be much of an issue.)

But others may decide that some benefit is better than none, and these results do fit with others that have left the door slightly ajar for echinacea having some effect as a cold remedy — a modest effect, but an effect, nonetheless.

A summary for patients published by the Annals summed up the situation nicely:

People who take echinacea to treat colds may experience a decrease in the length and severity of their cold symptoms but to such a small degree that they may not care about the difference. Although many studies of echinacea have been performed, researchers still disagree about its benefits in treating the common cold. This study is unlikely to change minds about whether to take this remedy.

Have you tried echinacea as a cold remedy? Has it worked? How do research findings, pro and con, affect your opinion of so-called alternative medicines?

Many of the echinacea studies, especially early on, were sponsored by companies making or selling the product. This study was supported by a grant from the National Center for Complementary and Alternative Medicine, which is part of the National Institutes of Health.

– Peter Wehrwein, Editor, Harvard Health Letter

*This blog post was originally published at Harvard Health Blog*

Painkiller Safety

Perhaps as many as one in every five American adults will get a prescription for a painkiller this year, and many more will buy over-the-counter medicines without a prescription. These drugs can do wonders — getting rid of pain can seem like a miracle — but sometimes there’s a high price to be paid.

Remember the heavily marketed COX-2 inhibitors? Rofecoxib, sold as Vioxx, and valdecoxib, sold as Bextra, were taken off the market in 2004 and 2005, respectively, after studies linked them to an increased risk of heart attack and stroke.

The nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen (sold as Advil and Motrin), and naproxen (sold as Aleve) seem like safe bets. But taken over long periods, they have potentially dangerous gastrointestinal side effects, including ulcers and bleeding. Kidney and liver damage are possible, too. More recently, some of the NSAIDs have been linked to an increased risk of cardiovascular disease. Low doses of aspirin (usually defined as 81 mg) is an exception and is often prescribed to lower the risk of heart and stroke.

Even acetaminophen, which is often viewed as the safest pain drug and a low-risk alternative to the NSAIDs because it doesn’t have their gastrointestinal side effects, comes with a caution about high doses possibly causing liver failure. Read more »

*This blog post was originally published at Harvard Health Blog*

New Recommendations For Vitamin D

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*

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