Jim Johnson's List: Health

• The real Medicare villain is not Barack Obama, and it's not "evil" Paul Ryan. The real villain is America's medical-industrial complex -- and once you grasp this, everything changes.
• The United States spends twice per person on health care what most other advanced nations spend without better outcomes to show for it.

• All this shows why the entire Medicare and broader health care debate needs to be recast. Rightly understood, health-care entitlement reform is not, as conservatives suggest, a matter of lessening the dependency of big chunks of the population on government largess. It's about weaning the members of our medical-industrial complex from their entitlement to far higher payments, despite shabby results, than their counterparts abroad get. This license for inefficiency, issued by both parties to doctors, hospitals, health plans, drugmakers and device firms, is diverting precious resources in an aging United States from urgent non-health care, non-elderly needs.

  This is what's really going on. It's also what's slated to continue, regardless of what you'll hear in the campaign about big "cuts" a-coming.

  The politics of reform are awful because every dollar of health care "waste" is somebody's dollar of income. And no one has a sure fix. As with any alcoholic, however, the path to renewal begins with admitting that you have a problem.

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• Teens who routinely smoke marijuana risk a long-term drop in their IQ, a new study suggests.

  The researchers didn't find the same IQ dip for people who became frequent users of pot after 18. Although experts said the new findings are not definitive, they do fit in with earlier signs that the drug is especially harmful to the developing brain.

• "I think this is the cleanest study I've ever read" that looks for long-term harm from marijuana use, said Dr. Nora Volkow, director of the National Institute on Drug Abuse, which helped fund the research.

  Ken Winters, a psychiatry professor at the University of Minnesota and senior scientist at the Treatment Research Institute in Philadelphia, said the new findings aren't definitive, but they underscore the importance of studying how marijuana may harm young people. He had no role in the work.
• The study drew on survey data from more than 1,000 people in New Zealand, everybody born in the town of Dunedin during a year-long span ending in 1973. In addition to IQ tests, they were interviewed five times between ages 18 and 38, including questions related to their marijuana use.

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• Quoting Dr. Alan Yeasted, reporter Bill Toland wrote, "There is somewhat of a shortage of PCPs (primary care physicians) and a bigger one looming in the future." This will especially be true in Pennsylvania if the governor expands Medicaid coverage under the provisions of the Affordable Care Act.

  I couldn't help but remember similar concerns expressed in the 1960s when primary care physicians also were in short supply, a shortage sure to be exacerbated with the passage of Medicare and Medicaid.

  What's different, though, is the changing face of primary-care delivery, which now includes the extensive use of nurse practitioners and physician assistants. Indeed, it was the legislation that created Medicare and Medicaid in 1965 that spurred the development of these professions.
• These nurses hold degrees at the master's level. In the near future, nurse practitioners will be prepared at the doctoral level, earning Doctor of Nursing Practice degrees
• Furthermore, nurse practitioners are more likely to work in rural and remote areas than are other primary-care providers.
• Almost 50 years after the first nurse practitioners graduated from the University of Colorado, their importance to the provision of primary care was recognized by the Institute of Medicine in its 2010 publication "The Future of Nursing: Leading Change, Advancing Health." Nurse practitioners have been studied since their field was created, and their ability to deliver high-quality, cost-effective health care has been demonstrated repeatedly. They, and their physician assistant colleagues, stand ready to again help alleviate a looming shortage in primary care.

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• A new study published in the Annals of Internal Medicine finds that inadequate shut-eye has a harmful response on fat cells, reducing their ability to respond to insulin by about 30 percent. Over the long-term, this decreased response could set the stage for Type 2 diabetes, fatty liver disease and weight gain.

• The link between childhood trauma and adult outcomes was striking.
• In Paul Tough's essential book, "How Children Succeed," he describes what's going on. Childhood stress can have long-lasting neural effects, making it harder to exercise self-control, focus attention, delay gratification and do many of the other things that contribute to a happy life.
• In the past several decades, policy makers have focused on the material and bureaucratic things that correlate to school failure
• But, more recently, attention has shifted to the psychological reactions that impede learning -- the ones that flow from insecure relationships, constant movement and economic anxiety.
• Attention has shifted toward the psychological for several reasons. First, it's become increasingly clear that social and emotional deficits can trump material or even intellectual progress.
• Second, over the past few years, an array of psychological researchers have taught us that motivation, self-control and resilience are together as important as raw IQ and are probably more malleable.
• Finally, pop culture has been far out front of policy makers in showing how social dysfunction can ruin lives.

• Schools are now casting about, trying to find psychological programs that will help students work on resilience, equanimity and self-control. Some schools give two sets of grades -- one for academic work and one for deportment.

  And it's not just schools that are veering deeper into the psychological realms. Health care systems are going the same way, tracing obesity and self-destructive habits back to social breakdown and stress.
• But, in their disjointed ways, they are all dealing with the same problem
• Maybe it's time for people in all these different fields to get together in a room and make a concerted push against the psychological barriers to success.

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• A new study, however, shows that a simple education program for pediatricians can cut in half the number of inappropriate antibiotic prescriptions.
• A total of 174 clinicians from 18 different practices were randomly assigned to either a control group (that was informed that a study was being conducted) or an intervention group that received a short educational session on current pediatric antibiotic prescription guidelines as well as a quarterly report on their individual prescribing stats. The education program focused on pneumonia, sinus infections and strep throat—respiratory infections that often do not require broad-spectrum antibiotics yet are often cited as the reason for prescribing them. The study lasted for a year and covered more than 1.4 million office visits. Prescriptions were tracked via electronic health records
• “The impact of the intervention group was much better than we thought it would be,”
• “It shows that getting people up to speed and providing simple reminders are helpful. It also shows that you can leverage electronic health records to put together a relatively low-maintenance system to improve prescribing.”
• “The intervention isn’t complicated or high-tech, so it should be scalable to large populations, where it could make a big difference in slowing resistance and preventing the complications of inappropriate antibiotic use,”

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• In January 2012, Michael Osterholm, an epidemiologist at the University of Minnesota’s Center for Infectious Disease Research and Policy, and his colleagues published a meta-analysis in The Lancet Infectious Diseases that analyzed the results of all randomized controlled clinical trials conducted between 1967 and 2011 on the effects of flu shots. It found that there have been no clinical trials evaluating the effects of the traditional flu vaccine in the elderly. The only vaccine shown to protect against infection or death in older adults, it said, is the live-attenuated vaccine—an inhalable vaccine that contains a live, modified version of the virus—which is not approved in the U.S. for adults over age 50.
• The traditional vaccine may not work so well in older people because of an idea known as immune senescence, which posits that as people age, their immune systems weaken, resulting in poor vaccine response, especially to inactivated strains.

• A new study finds that a certain frequency of ultraviolet (UV) light can kill almost all of these nasty bugs from at least the surfaces of a hospital room—even when not directly exposed to the light.

   

  A team of researchers sampled five high-contact areas in hospital bedrooms and bathrooms (such as bed rails, toilets and remote controls) where patients with C. difficile, Acinetobacter or VRE infections had been staying. They then brought in a machine outfitted with eight bulbs to emit short-wave UV radiation (UV-C) for 25 to 45 minutes. Afterward, the researchers sampled the same locations for any persisting bacteria or spores.

   

  “We were able to demonstrate that we could achieve well over 90 percent reduction in each of those three bad bugs after using the UV light,”
• “We would never propose that the UV light be the only form of room cleaning,”
• “But in an era of increasing antibiotic resistance, it could become an important addition to hospitals’ arsenal.”

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• A new study from Johns Hopkins University updates 2006 research that found excess levels of arsenic in U.S. chicken. In 2009 the Center for Food Safety petitioned the FDA to stop the use of arsenic in chicken feed. The Center’s lawyer Paige Tomaselli tells host Steve Curwood that the FDA has not responded to the petition, so now the Center has filed a lawsuit.
• It’s administered to chickens, turkeys and swine as an antimicrobial,
• It started in the 1940s
• it’s used to treat parasites in food animals, but it's also used to increase the weight of animals so that they have more feed efficiency, and to change the color of the chicken flesh to make it more appealing for human beings
• In 2010, the industry estimated that 88 percent of the roughly nine billion chickens in the United States raised for meat were administered arsenic-based feed additives.
• The proportion of turkey and pork is much smaller than chicken. It’s mostly fed to chickens
• Inorganic arsenic can cause cancer, heart disease, decreased intellectual function and many other problems. Now the amount of arsenic residue in the chickens is not going to directly cause cancer - what it does is it increases the overall arsenic burden that humans suffer from drinking water, eating rice and all the other exposure so we have to arsenic
• At one time, they thought that organic arsenic was not as dangerous as inorganic arsenic. But recent studies that shown that organic arsenic, the kind that feed additives are made out of, converts to inorganic arsenic both in the gut of a chicken and in the gut of a human, and so now we're finding that these arsenic-based feed additives are actually exposing humans to inorganic arsenic, which is a known carcinogen.
• I think that there's a lot of industry pressure from the pharmaceutical companies on FDA not to completely ban certain feed additives. Part of the problem is that FDA not only has to deal with the pharmaceutical companies, but they’re also dealing with the factory farming industry
• If you purchase organic chicken, you're not going to be exposed to additional arsenics. So my advice is to choose organic or to choose arsenic-free or antibiotic-free chicken at this point.

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• why Obamacare looks the way it does.

  Start with the goal that almost everyone at least pretends to support: giving Americans with pre-existing medical conditions access to health insurance. Governments can, if they choose, require that insurance companies issue policies without regard to an individual's medical history, a.k.a. "community rating," and some states, including New York, have done just that. But we know what happens next: Many healthy people don't buy insurance, leaving a relatively bad risk pool, leading to high premiums that drive out even more healthy people.

  To avoid this downward spiral, you need to induce healthy Americans to buy in; hence, the individual mandate, with a penalty for those who don't purchase insurance. Finally, because buying insurance could be a hardship for lower-income Americans, you need subsidies to make insurance affordable for all.

  So there you have it: Health reform is a three-legged stool resting on community rating, individual mandates and subsidies. It requires all three legs.
• the individual mandate is an essential piece of the reform, which can't and won't be bargained away, while the employer mandate is a fairly minor add-on that arguably shouldn't have been in the law to begin with.

• There's growing evidence that epigenetics is critical in determining a child's risk of developing problems ranging from autism to diabetes, says Dani Fallin, who studies the genetics of mental disorders at Johns Hopkins Bloomberg School of Public Health.

  Epigenetic control of genes is part of what allows a tiny cluster of identical cells in the womb to grow into a fully formed baby. By switching certain genes on and off, some cells become heart cells while others become brain cells.
• And the first week or so after conception appears to be "a particularly vulnerable time where environmental influences can directly affect an epigenetic outcome," she says.
• the results of epigenetic changes don't necessarily appear at birth or even during childhood. That's because things that affect development very early in life can show up decades later,

• "If you think of development as a ball rolling down a creviced hill, there are many different paths that ball can take," Fallin says. "And epigenetic mechanisms may help shape that path."

  So what happens in the womb may cause epigenetic changes that contribute to schizophrenia or diabetes decades later, she says.

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• Mississippi researchers
• The nuggets came from two national fast food chains in Jackson. The three researchers selected one nugget from each box, preserved, dissected and stained the nuggets, then looked at them under a microscope.

• The first nugget was about half muscle, with the rest a mix of fat, blood vessels and nerves. Close inspection revealed cells that line the skin and internal organs of the bird, the authors write in the American Journal of Medicine.

  The second nugget was only 40 percent muscle, and the remainder was fat, cartilage and pieces of bone.
• "What has happened is that some companies have chosen to use an artificial mixture of chicken parts rather than low-fat chicken white meat, batter it up and fry it and still call it chicken,"
• The nuggets he examined would be okay to eat occasionally, but he worries that since they are cheap, convenient and taste good, kids eat them often.

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• While the brain sleeps, it clears out harmful toxins, a process that may reduce the risk of Alzheimer's, researchers say.

  During sleep, the flow of cerebrospinal fluid in the brain increases dramatically, washing away harmful waste proteins that build up between brain cells during waking hours, a study of mice found.
• The results appear to offer the best explanation yet of why animals and people need sleep.
• The scientists noticed that during sleep, the system that circulates cerebrospinal fluid through the brain and nervous system was "pumping fluid into the brain and removing fluid from the brain in a very rapid pace,"
• this increased flow was possible in part because when mice went to sleep, their brain cells actually shrank, making it easier for fluid to circulate. When an animal woke up, the brain cells enlarged again and the flow between cells slowed to a trickle.
• The process is important because what's getting washed away during sleep are waste proteins that are toxic to brain cells,
• So why doesn't the brain do this sort of housekeeping all the time? Nedergaard thinks it's because cleaning takes a lot of energy. "It's probably not possible for the brain to both clean itself and at the same time [be] aware of the surroundings and talk and move and so on,
• It does raise the possibility that one might be able to actually control sleep in a way to improve the clearance of beta amyloid and help prevent amyloidosis that we think can lead to Alzheimer's disease."

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• recent research that suggests that the "obsession" with lowering a patients' total cholesterol with statins, and a public health message that has made all sources of saturated fat verboten to the health-conscious, have failed to reduce heart disease.
• After the Framingham Heart Study showed a correlation between total cholesterol and risk for coronary artery disease in the early 1970s, patients at risk for heart disease were urged to swear off red meat, school lunchrooms shifted to fat-free and low-fat milk, and a food industry eager to please consumers cutting their fat intake rushed to boost the flavor of their new fat-free offerings with added sugar (and, of course, with trans-fats)
• The result is a rate of obesity that has "rocketed" upward
• a 2009 UCLA study showing that three-quarters of patients admitted to the hospital with acute myocardial infarction do not have high total cholesterol; what they do have, at a rate of 66%, is metabolic syndrome -- a cluster of worrying signs including hypertension, high fasting blood sugar, abdominal obesity, high triglycerides and low HDL ("good" cholesterol).
• Recent research has also shown that Mediterranean diets -- admittedly skimpy on red meat but hardly light on saturated fats -- have outpaced both statins and low-fat diets as a means of preventing repeat heart attacks. Other research suggests that the saturated fat in dairy foods may protect against hypertension, inflammation and a host of other dysfunctions increasingly linked to heart attacks.
• When saturated fat got mixed up with the high sugar added to processed food in the second half of the 20th century, it got a bad name,"
• Real food includes saturated fat, Lustig said, and real food lives up to the principle that food should confer wellness, not illness. "Instead of lowering serum cholesterol with statins, which is dubious at best, how about serving up some real food?"

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• nsisted heart disease resulted from the simple fact of elevated blood cholesterol.
• we opinion makers i
• only accepted therapy was prescribing medications to lower cholesterol and a diet that severely restricted fat intake
• The discovery a few years ago that inflammation in the artery wall is the real cause of heart disease is slowly leading to a paradigm shift in how heart disease and other chronic ailments will be treated.
• Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped.
• f we chronically expose the body to injury by toxins or foods the human body was never designed to process,a condition occurs called chronic inflammation.
• he recommended mainstream diet that is low in fat and high in polyunsaturated fats and carbohydrates, not knowing we were causing repeated injury to our blood vessels.
• This repeated injury creates chronic inflammation leading to heart disease, stroke, diabetes and obesity.
• What does all this have to do with inflammation? Blood sugar is controlled in a very narrow range. Extra sugar molecules attach to a variety of proteins that in turn injure the blood vessel wall. This repeated injury to the blood vessel wall sets off inflammation. When you spike your blood sugar level several times a day, every day, it is exactly like taking sandpaper to the inside of your delicate blood vessels.

• oday’s mainstream American diet has produced an extreme imbalance of these two fats. The ratio of imbalance ranges from 15:1 to as high as 30:1 in favor of omega-6. That’s a tremendous amount of cytokines causing inflammation. In today’s food environment, a 3:1 ratio would be optimal and healthy.

   

  To make matters worse, the excess weight you are carrying from eating these foods creates overloaded fat cells that pour out large quantities of pro-inflammatory chemicals that add to the injury caused by having high blood sugar
• There is but one answer to quieting inflammation, and that is returning to foods closer to their natural state. To build muscle, eat more protein. Choose carbohydrates that are very complex such as colorful fruits and vegetables. Cut down on or eliminate inflammation- causing omega-6 fats like corn and soybean oil and the processed foods that are made from them.
• Animal fats contain less than 20% omega-6 and are much less likely to cause inflammation than the supposedly healthy oils labelled polyunsaturated.

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• A small study of casual marijuana smokers has turned up evidence of changes in the brain, a possible sign of trouble ahead, researchers say.

  The young adults who volunteered for the study were not dependent on pot, nor did they show any marijuana-related problems.
• "What we think we are seeing here is a very early indication of what becomes a problem later on with prolonged use," things like lack of focus and impaired judgment
• 20 pot users in the study, ages 18 to 25, said they smoked marijuana an average of about four days a week, for an average total of about 11 joints. Half of them smoked fewer than six joints a week. Researchers scanned their brains and compared the results to those of 20 non-users who were matched for age, sex and other traits.
• The results showed differences in two brain areas associated with emotion and motivation — the amygdala and the nucleus accumbens.
• larger studies are needed to explore whether casual to moderate marijuana use really does cause anatomical brain changes, and if so, whether that leads to any impairment.
• the new results suggest "the effects of marijuana can occur much earlier than previously thought."

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• The United States' health system once again comes in last when compared to 10 other rich nations, according to the latest Commonwealth Fund report on the issue.

   

  The nonprofit group said that while Americans spend much more per person on medical care, they are less healthy than people in the other nations. In addition, the U.S. health care system is less fair and efficient than those in the other 10 countries, NBC News reported.

   

  "Among the 11 nations studied in this report -- Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States -- the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions,"

• The American Academy of Pediatrics announced today that it is recommending that middle and high schools start at 8:30 a.m. or later, drawing on research that points to teenagers’ need for 8½ to 9½ hours of sleep and evidence that delaying school start times is an effective way to mitigate the detrimental effects of chronic sleep loss.
• The pediatricians’ policy statement, four years in the making, builds on a growing body of evidence that has reached a tipping point
• lack of sleep hurts student health, safety and performance.
• Hormonal changes that shift teenagers’ circadian rhythms, making it difficult for them to fall asleep before 11 p.m., combine with environmental factors such as a desire to socialize and early morning classes to form a “school sleep squeeze
• insufficient sleep is deleterious, hurting academic performance and increasing teenagers’ risk of depression as well as rates of absenteeism, tardiness, substance use and car accidents.
• cost is not the only thing driving early start times.
• interscholastic athletics are a very big part of the culture

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• The drought is so dire that experts are considering adding a fifth level to the four-tiered drought scale. That's right: D5. But each almond requires 1.1 gallons of water to produce,
• thousands of endangered king salmon in northern California’s Klamath River are threatened by low water levels because water is being diverted to almond farms.
• demand is driving prices ever higher.
• there had been a spate of thefts and missing almond trucks.
• Over-pumping of aquifers threatens infrastructure like roads, which stand to collapse into sunken ground. Farmers can fallow vegetable fields during droughts, but almond trees need steady supplies of water.
• California's almond industry is also completely reliant on honeybees to pollinate its almond trees.
• Because of colony collapse disorder, honeybees are a commodity
•  The almond farmers' requirements represent approximately 60 percent of the country's managed colonies.
• many of the mercenary pollinating bees brought to California died due to exposure to pesticides.
• when I buy almonds, I don't think about having a hand in killing bees or salmon, or getting someone's truck stolen or collapsing a road. It's just a jumble of what's "good for me," what I feel like eating, and how much things cost. Michael Specter’s feature on GMOs in last week's New Yorker gets into how seven billion people on the planet will be 10 billion by the end of the century, and feeding that population might well be the greatest challenge to humanity ever.
• the point isn’t really nutrition, it's environmental consciousness and sustainability

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• dentists who examined 278 athletes at the 2012 Summer Olympics in London reported that a majority displayed ‘poor oral health,’ including high levels of tooth decay, often in conjunction with gum disease and erosion of the tooth enamel.
• researchers from the dental school at University Hospital in Heidelberg, Germany recruited 35 competitive triathletes and 35 healthy non-triathletes of matching age and gender.
• This allowed researchers to compare the groups’ teeth and the condition of their mouths after exercise. The results were surprising. “The athletes showed significantly greater erosion of their tooth enamel. They also tended to have more cavities, with the risk increasing as an athlete’s training time grew. Over all, the more hours that an athlete spent working out, the more likely he or she was to have cavities.”
• There was no link between sports drinks or diet
• “During their experimental runs, the amount of saliva that they produced progressively lessened, meaning that their mouths became drier, regardless of whether they consumed water or other beverages during the workout. The saliva’s chemical composition also shifted, growing more alkaline as the workout continued. Excess alkalinity in saliva is thought to contribute to the development of tartar plaques on teeth and other problems.”
• Researchers commented that since saliva has a protective function for teeth, the reduction of it (due to a dryer mouth during exercise) is causing the problem for athletes. However because the study was on a small group of hardcore triathletes the results are not conclusive or general for all of us that exercise

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