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Contaminated Beachwater May Be Hazardous To Your Health

June 15th, 2009 by Paul Auerbach, M.D. in Better Health Network, Health Tips, News

Tags: Beaches, Beachwater, E. Coli, Infectious Disease

Summer has arrived and so many of us are headed for the beaches that line the coasts of the United States as well as those of our inland waters, such as lakes and rivers. There are plentiful healthcare concerns for beachgoers. These include sunburn, drowning, jellyfish stings, sprains, strains, and cuts and bruises. What perhaps doesn’t receive as much attention as it deserves is ocean water quality – specifically, whether or not the water is contaminated by environmental toxins and/or harmful bacteria.

Nearly a year ago, reports circulated in the press that indicated that at least 7% of beach water samples in the U.S. exceeded acceptable (from a health perspective) levels of bacteria. A writer for the New York Times reported, “The number of beach closings and health warnings issued to swimmers as a result of pollution fell in 2007 from a record level in 2006,” according to the Natural Resources Defense Council (NRDC). But the writer continued that the NRDC noted “that American beaches ‘continue to suffer from serious water pollution that puts swimmers at risk.'” He cited that the NRDC analyzed “data obtained from the Environmental Protection Agency on more than 3,500 beaches,” revealing “that beaches across the country closed because of pollution or issued pollution-related health advisories for a total of more than 22,000 days in 2007, down from more than 25,000 days in 2006.”

A reporter for the Los Angeles Times wrote that the NRDC found that “Los Angeles County is home to the dirtiest beaches in the state (California), with repeat offenders Avalon on Santa Catalina Island and Santa Monica among those with the highest levels of fecal bacteria in ocean water.” Overall, the NRDC found that, “Illinois has the most coastal beaches in the country with water samples exceeding acceptable levels of (potentially harmful) bacteria, such as E. coli.”

The NRDC posts an informative page on beach pollution. The major takeaway is that the beachgoer should be well aware of the current situation with regard to pollution or contamination of any body of water for which human entry is contemplated.

Here is the status of the federal Beach Protection Act of 2008, as reported by OpenCongress:

Read more »

This post, Contaminated Beachwater May Be Hazardous To Your Health, was originally published on Healthine.com by Paul Auerbach, M.D..

Hot Topics In Healthcare Reform: A Primer

June 15th, 2009 by Gwen Mayes, J.D. in Health Policy, News

Tags: Accountable Care Organizations, Avalere, Co-op, Comparative Effectiveness, EMR, Gwen Mayes, Healthcare reform, Patient-Centered Care, Primer, Public Plan

For those of who believe there is a pill for every ill, the recent flurry of legislation and ensuing debates on health care reform may be just too big a pill to swallow.

You’ll need a very large glass of water for sure.

“There’s a lot to consider and not everyone is going to like everything about this legislation,” Rep. Lois Capps (D-CA) told participants at Avalere Health’s conference on Raising the Bar:  Payment Reform and CV Disease on Friday, June 12 in Washington.  Capps, a 20 year veteran school nurse, co-chair of the Democratic Heart and Stroke Caucus and member of the House Energy & Commerce Health Subcommittee describes the pending legislation in terms of “choice” and “a balance” but readily admits that finding a way to pay for it will be difficult.

For those who might not feel up to speed on the latest buzz on health care reform, here’s a quick primer:

Public Option. To cover the 47 million uninsured or underinsured Americans, the President is asking for a public plan that would compete within the insurance market place either directly on cost, or indirectly with clout.  Supposedly, this plan (yet to be included in the Senate HELP health reform legislation introduced last week but rumored to be coming in the markup) will be subject to the same rules and regulations of the private health insurance market.  It could be an extension of Medicare, Medicaid or a hybrid of approaches involving capitation and integrated systems for physicians and hospitals.

The debate about whether or not to introduce a new public option to the current health insurance system involves more than a sense of fairness or simply closing the gap.  The private insurance business is strongly tied to state regulations and competitive forces that will remain as long as 15% of Americans purchase their insurance out of pocket and another 40% have insurance through employment .  Designing the right form of public assistance that can compete with private insurance but not control the market place is surely to reflect the strong differences between political parties.

Centralists in Congress, namely Sen. Kent Conrad (D-ND), have proposed co-ops as a third approach between a public option and the status quo.  Co-ops are membership-owned and operated non-profit organizations that adhere to state laws for health care coverage and provide health insurance for individuals and small businesses.  Reaction has been mixed but some believe co-ops will hit the right balance of competition and public assistance needed for passage in the Senate.

Comparative Effectiveness. Comparative effectiveness research seeks to compare the clinical effectiveness of two alternative therapies for the same condition.  It’s rooted in the idea that our system of paying for the volume (e.g., “fee-for-service”) should be replaced with payment for effectiveness and value that is based on the best science possible.  Recent examples of comparative effectiveness research include trials comparing bare metal coronary stents to drug-eluting stents and comparing older versus newer drugs for treatment of schizophrenia.   All this can be extremely valuable to clinicians and patients trying to decide between alternative courses of treatment.  And to the extent that comparative effectiveness research improves the quality of care, it can also reduce costs.

But clinical data alone cannot reflect patient preferences or whether a treatment course for the overall population is the best one for an individual.   The hot button here is how to encourage clinical research that can help physicians and patients make the best treatment choices yet safeguard it from being used by insurance companies and the government to deny coverage or set payment.  What, exactly, will be compared needs close scrutiny.

Accountable Care Organizations (ACOs). An ACO is a combination of one or more hospitals, primary care physicians and possibly specialists, who are accountable for the total Medicare spending and quality of care for a group of Medicare patients.   Various carrots and sticks are being discussed, but the idea is to control Medicare spending and improved quality of care.  While most physicians recognize the need to move away from Medicare’s fee-for-service approach, the incentives and infrastructure needed to coordinate among providers isn’t apparent.  What about rural areas where coordination of care is a misnomer?  This may be a hot topic for systems change, but practitioners are skeptical.

Patient-Centered Care. It’s hard to imagine that the American College of Cardiology felt the need to launch a new initiative, the “Year of the Patient” or the British Medical Journal depicted tango dancers on its cover story, “Partnering with the Patient” but re-infusing the health care debate from the patient’s perspective is long overdue.   Look for it in every piece of legislation, new commission and advisory group.  Raising the voice of a few on a plum commission or panel discussion  is a laudable start, but we’re all, at one time or another, patients.  We’re all consumers of health care and drawing upon our own experiences to improve our professional stance will be necessary.

Gateways. The Senate HELP Committee’s legislation introduces the concept of “gateways” or “exchanges”, a clearinghouse of sorts on a state level to help consumers parse through insurance plans and public services.  The program would be optional for states for the first six years then federal compliance would prevail.  Organizations such as Kaiser Family Foundation have already established online “gateways” (www.healthreform.kff.org) to inform consumers wanting to know more.

Health reform is coming fast and furious.  On Monday, June, 15, the Congressional Budget Office is expected to release their projections on what it will take to pay for such massive reforms.  Hospitals and physician groups are deeply concerned about cuts in Medicare payments – estimated by the President on his weekend radio chat as an additional $313M on top of the $309M included in the Administration’s FY2010 budget.

Further legislation will be released this week; keep an eye on the Senate HELP Committee, Senate Finance Committee, House Energy & Commerce, House Ways & Means, and House Education and Labor.

There’s much more to health reform than covered here.  I encourage you to find a passion point of entry and share your insights.

And get ready to swallow a very big pill.

Here’s a quick list of what’s hot in health care reform:

• Public Option
• Electronic Medical Records
• Elimination of pre-existing exclusion
• Patient-Centered Care
• Accountable Care Organizations
• Payment based on value not volume
• Integrated health delivery systems
• Federal Health Board
• Transparency in data, costs and outcomes
• Personalized health care/personalized information
• Chronic care models/Transitional Care Models
• Prevention and wellness programs
• Comparative Effectiveness
• Payment reform/Medicare cuts
• Shared decision making

Recent NPR Stories on Plastic Surgery

June 9th, 2009 by RamonaBatesMD in Better Health Network, News

Tags: Fat Sculpting, NPR, Plastic Surgery, Silicone

I want to say these two stories were well done (both aired on June 1, 2009).  I was actually interviewed, but not quoted, for the story on fat-grafting.  I pointed Allison Aubry to Dr Scott Spear as her expert.  He is involved in one of the U.S. studies on breast augmentation using fat grafting.

Sculpting the Body with Recycled Fat by Allison Aubry.

Doctors Still Unsure Of Long-Term Risks

Surgeons like Dr. Scott Spear of Georgetown University Hospital want to know more about the techniques used to transfer fat for breast augmentation.

“We’re at the beginning of the learning curve,” he says. He has initiated a clinical trial to answer some questions about the best way to perform the procedure and whether there are any measurable risks. To date, there are no published studies in the United States, so doctors are relying on their own clinical experience.

Silicone Injections May Harm Some Patients by Patti Neighmond

When people get injected with silicone at pumping parties, Gorton says “there is no way to verify if they’re using medical-grade silicone. You can go to hardware stores and buy a big tub of it,” he says. “The element is the same, but it’s just not the same safety or purity or quality.”

*This blog post was originally published at Suture for a Living*

Cheerios: A Drug?

May 12th, 2009 by admin in Better Health Network, News

Tags: Cheerios, Cholesterol, Drug, FDA, Food and Nutrition, Hypercholesterolemia, Lipid, Lipid Lowering

I really don’t think the cholesterol lowering effects of Cheerios are comparable to how a drug may help lower cholesterol, but the Food and Drug Administration (FDA) is saying that the claims Cheerios is making on it’s boxes are similar to those made by drug companies. And, by the way, it is against the law. The FDA sent General Mills a letter (read the whole letter here) saying that the phrases they are using on their packages and website are misleading consumers.

Here is snapshot of what FDA said in their letter:

Unapproved New Drug
Based on claims made on your product’s label, we have determined that your Cheerios® Toasted Whole Grain Oat Cereal is promoted for conditions that cause it to be a drug because the product is intended for use in the prevention, mitigation, and treatment of disease. Specifically, your Cheerios® product bears the following claims on its label:
• “you can Lower Your Cholesterol 4% in 6 weeks”
• “Did you know that in just 6 weeks Cheerios can reduce bad cholesterol by an average of 4 percent? Cheerios is … clinically proven to lower cholesterol. A clinical study showed that eating two 1 1/2 cup servings daily of Cheerios cereal reduced bad cholesterol when eaten as part of a diet low in saturated fat and cholesterol.”

These claims indicate that Cheerios® is intended for use in lowering cholesterol, and therefore in preventing, mitigating, and treating the disease hypercholesterolemia. Additionally, the claims indicate that Cheerios® is intended for use in the treatment, mitigation, and prevention of coronary heart disease through, lowering total and “bad” (LDL) cholesterol.

You may or may not think this is a big deal, but I can tell you that the FDA takes health claims seriously. There are only certain FDA approved claims that food companies are allowed to make on a product label. In this letter they also included the website as part of the label since the web address www.wholegrainnation.com is listed there. So that means that everything on the website also needs to comply with the official FDA health claims.

Cheerios is a great cereal that is low in sugar and has soluble fiber. I am sure they will correct their language to comply with the FDA’s request and this will blow over. Keep eating your Cheerios with low fat milk and a handful of blueberries. Yum!

This post, Cheerios: A Drug?, was originally published on Healthine.com by Brian Westphal.

Blog Workshop At The Canyon Ranch Institute In Tucson

April 19th, 2009 by Dr. Val Jones in Health Policy, News

Tags: Arizona, Blog Workshop, Canyon Ranch, Canyon Ranch Institute, Desert, Diet, Dr. Richard Carmona, Dr. Val Jones, Exercise, Healthy Living, Javelina, Kerri Morrone, Tucson

I just got back from a blog workshop at the Canyon Ranch Institute in Tucson, co-led by yours truly and the lovely and charming Kerri Morrone Sparling of SixUntilMe. We had a wonderful time with the locals, acquainting them with social media terminology, and teaching them how to blog and Tweet. We were also immersed in their culture, which largely meant that I lectured (for the first time in my physician career) in yoga pants, and enjoyed small portions of food rich in fruits and vegetables.

A Javelina

Despite the arid, inhospitable environment, the Arizona desert is teeming with life. Quail, rabbits, lizards, javelinas, humming birds and woodpeckers, bob cats and coyotes – all roam around freely near adobe homes nestled between flowering cacti. The extraordinary liveliness of the desert takes the casual visitor by surprise, and the variety of scrubby plants, aloes, and cacti of every imaginable shape, size, and pricklyness is a horticulturalist’s dream.

Since I was on east coast time, I was willing to participate in the 6:30am speed walks in the desert each morning. The lovely landscape inspired reflectiveness in the walkers, though I was somewhat distracted by the roaming hoard of javelinas (very large peccaries who resemble wild boars, smell like skunks, are virtually blind, and live to eat flowering plants). The javelinas had new babies with them – described by one Canyon Rancher as “footballs with legs.”

In between workshop lectures, Kerri and I were treated to some spa services – (regular readers know that I’m a huge fan of massages) which were welcome respites from our very busy work lives.  But best of all, we got to spend some time with Dr. Richard Carmona (who attended our workshop), and we discussed how social media could be the key to inspiring behavior modification in Americans who need to eat more healthily and get more exercise.

As beautiful as the Canyon Ranch is, the healthy lifestyle it promotes won’t reach beyond its own walls if they don’t engage people in ways that fit their budgets and time constraints. Now that 70% of Internet users are engaged in social media, and Facebook, Twitter, blogs, and online support groups are growing exponentially, there’s never been a better time to find ways to reach people with disease prevention messages and strategies. As Washington gears up to support preventive health initiatives as part of healthcare reform, innovative non-profits like the Canyon Ranch Institute can play an important role in helping us get America back on track in terms of weight management and fitness. Online communities like SparkPeople or the Canyon Ranch Institute could be one avenue for change.

Of course, if you can afford to vacation in Arizona, the place itself has a calming, therapeutic effect. If that’s not in the cards for you, you can still emulate the lifestyle in your own javelina-free environment. As I take my regular walks back in DC, I’ll be sure to remember those cute little footballs with legs, and wear yoga pants as often as possible during future lectures (if the NIH looks at me quizzically next month during my NLM presentation, I’ll just blame Rich Carmona).