Later On

A blog written for those whose interests more or less match mine.

Archive for the ‘Medical’ Category

Obama quails (again)

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Obama is taking steps against excessive use of antibiotics by signing an executive order. Because of evolution, which actually does work, natural selection favors pathogens that can resist the antibiotics used, so such pathogens proliferate. In this case, however, the selection is not really “natural”: since humans are administering the antibiotics (in large numbers), we are in effect artificially selecting pathogens for antibiotic resistance—that is, we are engaged in a stupendously large program to breed pathogens that we cannot kill with our current medications.

Why one earth would we do such an insane thing? Money! You can make a lot of money by breeding superstrong pathogens that we cannot kill. Of course, eventually such pathogens will become a real problem, with people once again dying from small infections, but the beauty part is by then the money will have been made!

That is actually the “thinking” (if one can call it that) behind the great pressure to continue the super-pathogen breeding program.

Of course, Obama all to frequently seems incapable of committing himself to effective action. He may indeed have good intentions, but they are frittered away in compromises, half-measures, and backing down. Kerry Grens writes in The Scientist:

President Obama yesterday (September 18) signed an executive order and announced a National Strategy to fight antibiotic resistance. His administration also offered up a $20 million reward for developing a fast diagnostic test that could identify highly resistant bugs.

The National Strategy is a five-year plan including goals such as slowing the spread of drug-resistant bacteria; accelerating the development of new antibiotics, vaccines, and drugs; and enhancing the surveillance of antibiotic resistance. The President’s Council of Advisers on Science and Technology (PCAST) also released its report outlining similar strategies.

“What’s new here is there is a highly federal focus that’s highly coordinated,” Eric Lander, the cochair of PCAST and founding director of the Broad Institute of MIT and Harvard, told CNN. “We are endorsing a variety of specific goals in order to get our arms around this problem. If we’re producing antibiotics at a greater rate than we’re losing them, then we win in the long run.”

Those in the infectious disease community appeared pleased by the attention on antibiotic resistance.“The President’s engagement and actions in fighting antimicrobial resistance are a great step forward, but follow-up with resources and leadership in implementation will be critical,” Jesse Goodman, the director of the Center on Medical Product Access, Safety and Stewardship at Georgetown University Medical Center, said in a statement e-mailed to The Scientist.

The Natural Resources Defense Council (NRDC), however, expressed disappointment in the lack of focus on antibiotic use on farms. “Just as the administration is taking steps to deal with abuse of antibiotics in humans, it must take steps to curb the overuse of antibiotics in animals, which consume about 80 percent of the antibiotics sold in the United States. Shying away from taking these needed steps will not yield the ‘substantial changes’ that PCAST says are necessary,” Mae Wu, health attorney at the NRDC, said in a statement. The FDA has spearheaded efforts to get drugmakers to change their labeling to help curb the use of antibiotics for beefing up livestock.

Emphasis added. And Obama? He went home. He will do nothing about the core of the problem, just kind of tap around the edges.

I am so disappointed in this Administration. Plenty of fire in the belly for going after whistleblowers, protecting torturers, making more and more of government secret, letting the NSA and CIA do whatever they want, and so on—but actual constructive change? I think he used it all up in the Affordable Care Act.

Written by LeisureGuy

19 September 2014 at 3:30 pm

How to help your kids under 6 have a stronger memory

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It’s too late for you, unfortunately. Via Kevin Drum, this article by Melissa Dahl at New York magazine explains how to do it. From the article:

. . . To understand this apparent gender divide in recalling memories, it helps to start with early childhood — specifically, ages 2 to 6. Whether you knew it or not, during these years, you learned how to form memories, and researchers believe this happens mostly through conversations with others, primarily our parents. These conversations teach us how to tell our own stories, essentially; when a mother asks her child for more details about something that happened that day in school, for example, she is implicitly communicating that these extra details are essential parts to the story.

And these early experiments in storytelling assist in memory-making, research shows. One recent studytracked preschool-age kids whose mothers often asked them to elaborate when telling stories; later in their lives, these kids were able to recall earlier memories than their peers whose mothers hadn’t asked for those extra details.

But the way parents tend to talk to their sons is different from the way they talk to their daughters. Mothers tend to introduce more snippets of new information in conversations with their young daughters than they do with their young sons, research has shown. And moms tend to ask more questions about girls’ emotions; with boys, on the other hand, they spend more time talking about what they should dowith those feelings.

This is at least partially a product of parents acting on gender expectations they may not even realize they have, and the results are potentially long-lasting, explained Azriel Grysman, a psychologist at Hamilton College who studies gender differences and memory. “The message that girls are getting is that talking about your feelings is part of describing an event,” Grysman said. “And for boys, emotions are something to be concerned with when they are part of a larger issue, but otherwise not. And it’s quite possible, over time, that those tendencies will help women establish more connections in their brains of different pieces of an event, which will lead to better memory long-term.”

Because a memory doesn’t exist the way we tend to imagine it; it’s not a singular, fully formed thing buried in some small corner of the mind. Instead, it’s “a pattern of mental activity, and the more entry points we have to what that pattern might be, the more chances we have to retrieve it,” Grysman said. Researchers call those entry points “retrieval cues,” and they can be as seemingly mundane as what you were feeling, what you were eating, or what you were wearing.

The more entry points you’ve got about an event, the more likely you are to remember it. It’s how Grysman advises his students to study for tests. “I tell them to try to make links between the material they’re studying and other parts of their lives, and those other parts of their lives serve as entry points,” he said.

So Grysman’s theory, which he explored in an extensive review of the literature published last year, is that those early conversations with your parents implicitly told you which details are important to remember about the things that happen to you, and which are not. And because parents’ conversations with girls include references to both more information and more emotion, they’re setting their daughters up to have stronger memories over their lives. . .

UPDATE: The more I thought about this—and I did think about it, given that I have 3 grandsons 2 and under—the more it seemed that it would be easy to provide an environment for young children that will strengthen their memory. For example, in asking “What happened to you today?”, you can ask follow-up questions to provide more points of access while also helping the children know what details to notice. For example:

Who was involved? What did they say? What were their emotions/feelings? (E.g., happy, sad, laughing, crying) What did you hear? (Was there any music?) What colors?  and so on.

By asking about smells, tastes, sounds, sights, and so on, children get to pay attention to their senses. By asking about emotions and feelings, they learn to pay attention not only to their own feelings (something that must be learned), but also learn to think about (analyze, to some degree) the feelings of others and what causes those feelings. And so on.

Now I want a do-over: to have my children very young once more and to listen better to their stories and ask them more about what they notice.

Written by LeisureGuy

19 September 2014 at 11:35 am

Once they’ve collected your insurance premiums, health insurance companies are loathe to spend that money

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Basically, insurance companies love having the money come in as premiums, but they hate paying out settlements and in general do everything in their power to stall and reduce payments. Now they have adopted a new tactic, reported by Charles Ornstein at ProPublica:

Health insurance companies are no longer allowed to turn away patients because of their pre-existing conditions or charge them more because of those conditions. But some health policy experts say insurers may be doing so in a more subtle way: by forcing people with a variety of illnesses — including Parkinson’s disease, diabetes and epilepsy — to pay more for their drugs.

Insurers have long tried to steer their members away from more expensive brand name drugs, labeling them as “non-preferred” and charging higher co-payments. But according to an editorial to be published Thursday in the American Journal of Managed Care, several prominent health plans have taken it a step further, applying that same concept even to generic drugs.

The Affordable Care Act bans insurance companies from discriminating against patients with health problems, but that hasn’t stopped them from seeking new and creative ways to shift costs to consumers. In the process, the plans effectively may be rendering a variety of ailments “non-preferred,” according to the editorial.

“It is sometimes argued that patients should have ‘skin in the game’ to motivate them to become more prudent consumers,” the editorial says. “One must ask, however, what sort of consumer behavior is encouraged when all generic medicines for particular diseases are ‘non-preferred’ and subject to higher co-pays.”

I recently wrote about the confusion I faced with my infant son’s generic asthma and allergy medication, which switched cost tiers from one month to the next. Until then, I hadn’t known that my plan charged two different prices for generic drugs. If your health insurer does not use such a structure, odds are that it will before long.

The editorial comes several months after two advocacy groups filed a complaint with the Office of Civil Rights of the United States Department of Health and Human Servicesclaiming that several Florida health plans sold in the Affordable Care Act marketplace discriminated against H.I.V. patients by charging them more for drugs.

Specifically, the complaint contended that the plans placed all of their H.I.V. medications, including generics, in their highest of five cost tiers, meaning that patients had to pay 40 percent of the cost after paying a deductible. The complaint is pending.

“It seems that the plans are trying to find this wiggle room to design their benefits to prevent people who have high health needs from enrolling,” said Wayne Turner, a staff lawyer at the National Health Law Program, which filed the complaint alongside the AIDS Institute of Tampa, Fla.

Turner said he feared a “race to the bottom,” in which plans don’t want to be seen as the most attractive for sick patients. “Plans do not want that reputation.”

In July, more than 300 patient groups, covering a range of diseases, wrote to Sylvia Mathews Burwell, the secretary of health and human services, saying they were worried that health plans were trying to skirt the spirit of the law, including how they handled co-pays for drugs.

Generics, which come to the market after a name-brand drug loses its patent protection, used to have one low price in many insurance plans, typically $5 or $10. But as their prices have increased, sometimes sharply, many insurers have split the drugs into two cost groupings, as they have long done with name-brand drugs. “Non-preferred” generic drugs have higher co-pays, though they are still cheaper than brand-name drugs.

With brand names, there’s usually at least one preferred option in each disease category. Not so for generics, the authors of the editorial found.

One of the authors, Gerry Oster, a vice president at the consulting firm Policy Analysis, said he stumbled upon the issue much as I did. He went to his pharmacy to pick up a medication he had been taking for a couple of years. The prior month it cost him $5, but this time it was $20.

As he looked into it, he came to the conclusion that this phenomenon was unknown even to health policy experts. “It’s completely stealth,” he said. . .

Continue reading.

Obviously some laws and regulations will be needed to prevent this sort of discriminatory price.

Written by LeisureGuy

17 September 2014 at 8:40 am

Introducing impulse control into our culture

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UPDATE: Good complementary reading: Descartes’ Error: Emotion, Reason, and the Human Brain, by Antonio Damasio.

A massive amount of money is spent promoting (uncontrolled) impulsive actions—specifically, the action of buying something. Advertisers everywhere encourage you to act on the impulse to buy this or that, and money is spent in studies to learn how to augment the impulse—for example, those menus that show appealing photographs of the food (and I’m sure scratch-and-sniff menus are just around the corner). And yet we now know that impulse control contributes to a happy, prosperous, and productive life. David Desteno discusses in Pacific Standard on efforts to instill impulse control and suggests an alternative strategy that enlists rather than combats our emotions:

The children’s television show Sesame Street has always had a way of reflecting the zeitgeist in shades of Muppet fur. Consider, for instance, the evolution of Cookie Monster. For his first few decades on air, he was a simple character: blue, ravenous, cookie-fixated; a lovably unleashed id. A 1990 White House report dubbed him “the quintessential consumer.” But in the mid-2000s, as concern mounted over childhood obesity, Cookie Monster’s tastes became a problem. So he went from devouring cookies to guzzling bowls of fruit. Then, last year, he changed yet again, as the show’s curriculum designers saw in his voracious appetite a different kind of teaching opportunity.

For the show’s 44th season on the air, Cookie Monster was essentially repurposed into a full-time, walking, talking, googly-eyed vehicle for a set of intensely fashionable ideas about psychology and success. The blue Muppet was now, as an official Sesame Street website put it, a “poster child for someone needing to master self-regulation skills.”

Read the rest of this entry »

Written by LeisureGuy

15 September 2014 at 9:40 am

Should we add lithium to our drinking water where it’s now lacking?

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Very interesting article pointed out by The Younger Daughter. Anna Fels points out that the drinking water for some communities contains trace amounts of naturally occurring lithium, and it seems to do a power of good. From the article:

. . . Lithium is a naturally occurring element, not a molecule like most medications, and it is present in the United States, depending on the geographic area, at concentrations that can range widely, from undetectable to around .170 milligrams per liter. This amount is less than a thousandth of the minimum daily dose given for bipolar disorders and for depression that doesn’t respond to antidepressants. Although it seems strange that the microscopic amounts of lithium found in groundwater could have any substantial medical impact, the more scientists look for such effects, the more they seem to discover. Evidence is slowly accumulating that relatively tiny doses of lithium can have beneficial effects. They appear to decrease suicide rates significantly and may even promote brain health and improve mood.

Yet despite the studies demonstrating the benefits of relatively high natural lithium levels present in the drinking water of certain communities, few seem to be aware of its potential. Intermittently, stories appear in the scientific journals and media, but they seem to have little traction in the medical community or with the general public.

When I recently attended a psychopharmacology course in which these lithium studies were reviewed, virtually none of the psychiatrists present had been aware of them.

The scientific story of lithium’s role in normal development and health began unfolding in the 1970s. Studies at that time found that animals that consumed diets with minimal lithium had higher mortality rates, as well as abnormalities of reproduction and behavior.

Researchers began to ask whether low levels of lithium might correlate with poor behavioral outcomes in humans. In 1990, a study was published looking at 27 Texas counties with a variety of lithium levels in their water. The authors discovered that people whose water had the least amount of lithium had significantly greater levels of suicide, homicide and rape than the people whose water had the higher levels of lithium. The group whose water had the highest lithium level had nearly 40 percent fewer suicides than that with the lowest lithium level.

Almost 20 years later, a Japanese study that looked at 18 municipalities with more than a million inhabitants over a five-year period confirmed the earlier study’s finding: Suicide rates were inversely correlated with the lithium content in the local water supply.

More recently, there have been corroborating studies in Greece and Austria.

Not all the research has come to the same conclusion. . .

The article’s conclusion:

Some scientists have, in fact, proposed that lithium be recognized as an essential trace element nutrient. Who knows what the impact on our society would be if micro-dose lithium were again part of our standard nutritional fare? What if it were added back to soft drinks or popular vitamin brands or even put into the water supply? The research to date strongly suggests that suicide levels would be reduced, and even perhaps other violent acts. And maybe the dementia rate would decline. We don’t know because the research hasn’t been done.

For the public health issue of suicide prevention alone, it seems imperative that such studies be conducted. In 2011, suicide was the 10th leading cause of death in the United States. Research on a simple element like lithium that has been around as a medication for over half a century and as a drink for millenniums may not seem like a high priority, but it should be.

Written by LeisureGuy

14 September 2014 at 6:01 am

Find lower prices for prescription drugs

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Cool Tools has a good post that tells about GoodRx.com.

Written by LeisureGuy

12 September 2014 at 10:57 am

Best medical system in the world? I wonder…

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Greg Gordon reports for McClatchy:

During a meeting that was secretly recorded, a salesman for Reliance Medical Systems promised that within a month or two of joining its illicit kickback scheme, spinal surgeons could collect enough money to pay for their kids’ college educations, Justice Department lawyers charge.

Taxpayers were the multimillion-dollar sugar daddies in this plot, initially uncovered by two doctors-turned-whistle blowers who could collect a sizable reward under a law compensating those whose tips lead to federal financial recoveries.

In May 2010, a Michigan spinal surgeon bought into one of the schemes that aimed to circumvent a federal law barring device manufacturers from making payments to induce physicians to use their products, the government alleges in two suits filed under the federal False Claims Act.

One suit charges that Dr. Aria Sabit, who now lives in Birmingham, Mich., and Sean Xie, who was studying under Sabit, each paid $5,000 to become an investor in Apex Medical Technologies, a distributorship for Southern California-based Reliance. That month, the government alleges, each got back $20,117 from Apex – a return of more than 400 percent in 30 days’ time.

That was just the beginning.

Over the next nine months, Apex paid Sabit $264,957 while he repeatedly used Reliance products for spinal fusion surgeries, some of them unnecessary – and $483,570 before he stopped using Reliance equipment, the suit said. Sabit also presumably collected handsome physician fees for his services.

Meanwhile, Community Memorial Hospital in Ventura, Calif. paid Apex $1.4 million for the cost of the implants that Sabit used in his surgeries.

The hospital, in turn, billed Medicare – and federal taxpayers – for nearly all of those devices.

A second California-based Reliance distributorship, known as Kronos Spinal Technologies, made improper payments to two other physicians, Drs. Ali Mesiwala and Gowriharan Thaiyananthan, the suit said. Kronos was based at the same Jacksonville, Fla., address as Apex, it said. One of the distributorships’ owners allegedly was recorded as saying that the scheme was formed as part of a plan to “get around” the federal Anti-Kickback Statute, it said.

In July 2011, Mesiwala was recorded as stating that there was an “expectation” that doctors who bought into the distributorships would be using Reliance equipment, the suit said. He also was quoted as saying: “If you truly are in this to make money and you have a finite time limit to do it, I don’t know a better way to do it.”

Kronos paid its investor physicians $4.9 million from August 2007 through September 2012, the government said. . .

Continue reading.

Written by LeisureGuy

8 September 2014 at 6:11 pm

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