Why We Must Reduce Health Care Costs

Health care costs continue to rise, with no end in sight. But many people aren't aware of what accounts for those costs and where the money goes. However, such awareness is key to finding ways to bring costs down.

Where does the money go?

Here are the major categories of health care costs in the U.S. as reported in 2007:
* Hospitals: 32%
* Health insurance administration and profits: 13%
* Medications: 10%
* Physician income: 9%
* Physician expenses: 7%
* Clinical laboratory services: 5%


Private health insurance

The overhead costs and profits of private health insurance is just one of the reasons for my disappointment that a health reform bill, now being considered in Congress, will likely have no type of public insurance option. In contrast to these large costs for private insurance, administrative overhead for Medicare is only about three percent. Of course, anyone who has tried to deal with private insurance companies can express plenty of other objections about them. It is evident that their total attention is to bottom line profit rather than to any real interest in providing for the health of their policy holders.

New medications and increasing longevity

Scientific advances have led to the availability of many new medications that may prolong life or at least reduce suffering. Medications are likely to become an even larger fraction of the health care budget because of their high development costs, the extraordinary effectiveness of some, and the increasing longevity of individuals. Although many patients take these largely insurance-covered costs in stride, they still contribute significantly to the overall cost of health care.

Nonetheless, some savings are possible. If physicians were more aware of the costs of drugs, they might be able to prescribe equally effective, less costly alternatives. Physicians tend to prescribe the newest drug for high blood pressure, for example, even though it is more expensive and no more effective than earlier medications. Not infrequently a physician may acquiesce to a patient's request to get a drug they have heard about in a television ad-for example, the highly touted Plavix which is far more expensive and not necessarily any better than aspirin in many situations.

Physician income reasonable

It seems reasonable to me that we physicians share about nine percent of the pie. Although physician incomes have not fallen, studies show that on average they need to spend more working time to maintain such incomes. However, what is not evident from the nine percent figure is the unfair discrepancy in reimbursements, which pay big bucks to specialists for procedures and far less to the internist or general practitioner who carries out the evaluation and long term management of patients. Interventive cardiologists may deny it, but it's easy to understand how their income from an angioplasty procedure may lead them to recommend it even though angioplasty prolongs life no more than non-invasive medical treatment in people with stable coronary heart disease.

Physician expenses and insurance claims

Physician expenses include obvious things such as rent and salaries for a receptionist and nurse, but physicians also spent 10 to 15 percent of their gross income for billing and collection, preparing a variety of insurance forms (often requiring hiring an additional person), and an average of three hours a week on the phone or corresponding with insurance claims adjusters. The cumulative cost of the time physicians spend in these interactions with insurers is estimated at $23 to $31 billion annually. The costly and time consuming tasks of paperwork and completing multiple insurance forms weigh heavily in physician dissatisfaction and early retirements.

Laboratory tests... more to come

The rising number of laboratory tests ordered by physicians continue to be of concern to both the medical community and the public.

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The Power of Positive Reinforcement

When you're faced with a challenge, a little positive self-talk goes a long way. Learn how to find your own success mantra.

Studies back up the benefits of positive self-talk: Research suggests that consistently replacing negative thoughts with optimistic ones may improve your outlook, reduce stress and lift your self-esteem. Here's how to come up with a motivating personal mantra you can rely on again and again:

1. First, envision your ideal life, then come up with an encouraging phrase that makes it sound as if what you desire is already a reality. Instead of "I hope tomorrow is better," try "I believe that tomorrow will be a better day."

2. Repeat your mantra whenever you start to badmouth yourself ("I'm such a loser!"). You'll retrain your brain to focus on the positive, not the negative. Share your successful mantras on our Happiness forum.

3. Can't think of a mantra that doesn't make you feel silly? Try one of these:

"I choose to love and appreciate myself and others."
"I am grateful for the good and wonder in my life."
"I can make healthy choices and be the architect of my future."
"I forgive my flaws and celebrate my strengths."

Source: http://health.yahoo.com/

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Lessons in Home Cooking

The most healthful meal is the one you cook at home. But for those of us skilled at the art of takeout, the idea of cooking in our kitchens is daunting. Who has time after a busy day to shop, chop, prepare and cook?

The Times’s food writer Mark Bittman always makes cooking look easy as author of the weekly Minimalist column and his new blog Bitten. He’s also the author of several cookbooks, including “How to Cook Everything: Simple Recipes for Great Food.'’ I recently spoke with Mark about the how-to’s of home cooking, his favorite ingredients and a lot about beans.

Why do you think so many people find it tough to cook regularly at home?

I think there are a couple of lost generations. In the years after the war it became less and less popular to cook and more and more common to do things conveniently. Especially people born after 1960 or after, when reentering the workforce and using canned and frozen microwave stuff — they just didn’t see their mothers cooking.

For those of us who want to cook more, what’s your advice for getting started?

I would say start with a decent cookbook. Pick something you really like, and make the effort to be successful; you want positive reinforcement. Read the recipe carefully, set aside the time and make sure you’ve got the ingredients and the equipment and really walk yourself through it. What takes you two hours the first time may only take 15 minutes the third time.

What supplies should I always have in my kitchen? Are there any special pots or pans I need?

In “How To Cook Everything,” there are lists of what you need for your pantry and a list of the equipment. You can start with three or four pans, a couple different utensils. And you can start with 10 or 15 ingredients. The list includes pasta and rice, canned beans and tomatoes, spices, olive oil, eggs and butter, long-keeping vegetables like onions, potatoes and garlic and canned stock. You have to start with the right ingredients, and you have to invest a little money and a fair amount of time.

But that is usually the problem for most people. They say they don’t have time to cook. I know I often don’t.

Well, whatever it takes to get food on the table, you have to do something. I’m not saying calling the Chinese takeout guy is harder than cooking. But all things considered, it’s not that much different. Yesterday morning I woke up and cooked beans while getting ready to come to work. I got home really late, like at 7:45 p.m. I reheated the beans, washed some lettuce and broiled a piece of fish. I had stuff on the table in 15 minutes. People say, “I have no time.” It’s like exercise: you have to want to do it.

For me the worst part of cooking is shopping for groceries and figuring what ingredients I need for a meal.

These days I cook a lot of things that are already in the house. I eat a lot of eggs, vegetables, beans and pasta. A lot of people think cooking is complicated. But this is the thing. Once you learn what you’re doing you realize it’s not. As I said, I woke up yesterday and made beans. Even if you take a can of beans and throw it in a pot with cherry tomatoes (you don’t even have to cut them up), some garlic and olive oil — there’s nothing wrong with that. Broil a piece of fish, wash some lettuce, and you have a fine meal. If your kids don’t like fish, then use shrimp or a piece of meat. I’ve gotten so used to cooking simply I almost never do anything else. Even when people come over for dinner — they get the same things I cook for myself. If I made what I just described to you and you were coming over for dinner, you’d probably think, “He cooked. How nice.'’ People worry about this too much.

How many different types of meals should we know how to make? Is variety important?

Whatever makes you happy. If you know how to broil a piece of fish or meat, if you know how to make a stir-fry and a couple pasta dishes and maybe a rice dish, and if you know how to deal with beans and make a salad, at that point you are well on your way.

When you are cooking, do you ask yourself whether it’s healthy, or do you just want it to taste good?

I always thought if you were aware of what you were putting in your mouth you’re not going to eat badly. Nobody can cook what they cook in fast-food joints and restaurants, in general, because you just don’t have the same ingredients. But if you looked at what it means to put a half a cup of butter in a dish, you would just look and say, “I’m going to use less.'’ When you cook yourself, you just don’t put the same kind of crappy things in there that people put in food that is prepared for you.

Do you have a favorite ingredient?

I go through an awful lot of olive oil, a stunning amount. I’m eating a lot of legumes.

You’ve talked a lot about beans. How do you cook them? Don’t you have to soak them?

You don’t have to soak them, but it makes it faster if you do. If you soak small dried beans overnight, I wager you could get them most of the way cooked by the time you and your daughter got out of the house in the morning. There’s a lot of stuff you can start and stop in the morning, especially beans and grains.

I have to confess, I’m not much of a bean eater. Maybe I need to start. Why are you such a fan?

It’s the flavor, the satisfaction, the non-meatness, the high-fiberness. When you get into cooking you start to see the subtle differences among things. At first I didn’t know anything about fish, then I learned 50 species, and then it mattered if it was bay scallops or sea scallops or pink scallops. That’s where I’m at these days with vegetables and legumes. I didn’t pay much attention to cooking them for most of my adult life, and now I’m starting to understand the subtle differences.

Okay, so what beans should we all be trying?

Chickpeas are the best. Now I’m into these huge beans called gigantes. You eat three of them and it’s like you had a small potato. But you can take a pound of chickpeas, cook them on a Saturday and stick them in the refrigerator tossed with olive oil, and you can eat them all week long.

Do you have a particular food indulgence?

I have a lot of friends in the food business, so I get my share of treats. At home it’s almost like I’m happy with pretty much everything I cook. It’s not that it’s so great. It’s the knowledge that I put something together, it’s simple and I put something on the table and there we are, sitting and eating it. It’s something I’ve loved doing for a long time, and I’m still into it.

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What's a Normal Blood Pressure?

A wealth of information is available about blood pressure, and sometimes the most important points get lost or confused. Although we often hear announcements in the press about new or revised blood-pressure guidelines, the basic facts haven't really changed much over the past several decades.

Blood pressure is measured by two numbers. The systolic pressure (the "top" number) is the highest pressure inside your arteries, measured at the moment when your heart is contracting.

It's the active part of a heartbeat. In contrast, the diastolic pressure (the "bottom" number) is the lowest pressure in your arteries, measured while your heart is relaxing between beats.

Experts have long debated whether the systolic or diastolic pressure is more important for health. The current evidence suggests that the systolic is a little more important, but the simple answer is that both numbers matter.

Let's review some of the basic facts about blood pressure.

Normal blood pressure is 120/80 or below. I'm often asked, "What is a normal blood pressure for my age?" The answer is much simpler than most people realize: Less than 120/80. While it's true that blood pressure tends to rise with age, that's no reason to feel complacent: Such a rise will always carry with it an increased risk of heart attack, stroke, kidney failure, and other complications of high blood pressure (hypertension).

Blood pressure normally varies throughout the day, often by 40 points or more. Exercise and stress are especially likely to increase it, while relaxation and sleep will usually lower it. Standing up or talking, for example, can increase blood pressure by 10 or more points. Even simply worrying about blood pressure will increase it. If your blood pressure is only high when you're exercising or when you're at the doctor's office, that's okay. But if it's high even part of the time in routine situations, that is abnormal and deserves treatment.

High blood pressure is anything above 120/80. However, mild elevations beyond those numbers only slightly increase the risk of significant health problems. We generally don't prescribe medication to bring down blood pressure until the systolic reaches 140 or the diastolic reaches 90. The exception is for people with diabetes or impaired kidney function, in whom we use medication for anything above 130/80. That's because people with diabetes and kidney disease are already at higher risk for heart attack and stroke.

Treating high blood pressure takes more than just medication. If your blood pressure is ever above 120/80, you can improve your overall health by lowering it, even if you don't need medication. Losing weight, exercising regularly, and limiting your sodium (salt) and alcohol intakes are proven ways of reducing blood pressure. Such treatments don't cost any money and the only side effect is likely to be improved health!

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© 2007 Johns Hopkins University. All Rights Reserved. This article from Johns Hopkins University is provided as a service by Yahoo. All materials are produced independently by Johns Hopkins University, which is solely responsible for its content.

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Pet Allergies: Making It Work

With a few changes you can keep your companion animal -- and manage your pet allergies, too.

Do pet allergies have you wheezing and sneezing -- again? Well, there are over 132 million good reasons for that.

That's the number of cats and dogs living in U.S. homes as of 2002, says the American Veterinary Medical Association. And while these four-legged friends are by far the most common companion animals in America, they aren't the only creatures behind the exasperating symptoms of pet allergies.

The Cause of Pet Allergies: Protein

You'll find pet dander on just about every warm and fuzzy critter we bring in to our homes: from cats and dogs, to birds, hamsters, and ferrets. And just about anything with dander has the potential to bring susceptible people down with a suite of allergy symptoms, says allergist Asriani Chiu, MD.

But it's not a pet's hair, or even the flaky, dandruff-like dander itself, that causes allergies. Instead "it's a specific protein in the dander that people are allergic to," says Chiu, associate professor of pediatrics and medicine (allergy/immunology) at the Medical College of Wisconsin. "With any allergy, from hay fever to peanut allergies, it's always a protein in the substance that you're reacting to."

Pet allergy-producing proteins -- called allergens -- are also found in your pet's urine and saliva. Add to this the fact that these proteins are tiny, easily airborne, and ubiquitous, and it explains why some people can develop pet allergy symptoms simply by walking into an empty room.

What are the most common symptoms of pet allergies? "I get a stuffy nose and runny eyes, very much like seasonal allergies," says Anthony Herrig, an Oregon web developer with cat allergies. Other symptoms can range from mild -- itchy throat, nasal congestion, and sneezing -- to a more severe, asthma-like response, including coughing, wheezing, and shortness of breath.
Why Pet Allergies Hit You

Usually, not everyone in a family or household is allergic to pets. Just as you have your mom's smile or dad's laugh, you may have inherited your family's genetic predisposition to allergies. Add to this a higher risk of developing allergies to pets if you have other allergies or asthma, and it's clear why you may be alone in your congestion. What's not clear just yet, says Chiu, is why one person can have mild symptoms, while another is laid low with an acute, asthma-like response.

Fortunately, there's a lot you can do to manage pet allergies -- no matter how they affect you. But before you try the following tips, it's a good idea to make sure you really are allergic to dander. If you're not positive you are allergic to dogs, cats, or other pets, visit an allergist, who can help identify which specific allergen is triggering your symptoms.
Tips to Help You Cope With Allergies and Pets

Though the best way to find relief from allergies is to avoid exposure to what you're allergic to, you can have your precious pets and live well, too. Allergists and pet allergy sufferers offer these tips:


Pet Allergies Tip 1: Change Your Environment

* Keep Your Bedroom Pet-Free. Something as simple as making your bedroom a pet-free sanctuary "can significantly decrease levels of allergens" in that space, says Alan Goldsobel, MD, a spokesman for the American Academy of Allergy, Asthma & Immunology. Goldsobel also suggest switching to special bedding designed to be less permeable to allergens.
* Consider a HEPA Filter . HEPA filters remove tiny airborne pollutants, like dust mites, pollen, and pet dander, from the air you breathe. "Dander is so airy and light that HEPA filters can filter it out of the air," reducing your exposure, Chiu tells WebMD. Within a given area stand-alone filters are typically more effective than a whole-house HEPA system, Chiu adds. As for those air de-ionizers/purifiers often hawked on late-night infomercials, they may make allergies worse by releasing harmful ozone gas.
* Learn to Love Housework. "I try to vacuum the bedroom frequently and change furnace filters to reduce the dander in the air," says Herrig. Other allergy sufferers tackle pet allergies by shampooing rugs regularly, changing people and pet bedding frequently, wiping down walls where pets rub, and dusting often. And to reduce the number of places where allergens can build up, Goldsobel suggests converting to hard-surface floor and minimizing the amount of upholstered furniture in your home

Pet Allergies Tip 2: Change Yourself

* Wash Your Hands . Some people bathe their companion animals in an effort to reduce pet dander, but this approach is "very transient" Goldsobel tells WebMD. While washing does decrease the amount of shed allergens, the effect lasts mere days -- while the cat's bad mood may last far longer! More effective is giving yourself a scrub by washing hands and face frequently.
* Mediate With Medication. Over-the-counter allergy medications, such as antihistamines, can relieve mild allergy symptoms like nasal congestion and itchy eyes, but they won't help asthma-type symptoms, such as wheezing and chest tightness. Talk to your primary care physician or an allergist if you think you'll benefit from prescription allergy medication.
* Consider Allergy Shots. If you know you'll be around pets long-term -- for example, your young kids have a new puppy -- you might want to consider allergy shots. These shots are also called allergy vaccines. Allergy shots help you develop protective antibodies so that you won't have an allergic reaction when exposed to an allergen. Allergy shots require patience, however. It can take almost a year of weekly injections before you convert to monthly maintenance doses, then another 3-5 years of monthly shots before you no longer have allergy symptoms -- and need no more medication.
* Understand Your Environment. No matter how religiously you clean, you'll still be exposed to dander. Pet allergens are "sticky," making it easy for people to carry them on their clothes. This explains why you'll find them in places that have no pets, such as schools, workplaces, and pet-free homes.
* Expand Your Definition of "Pet." If, after Fido or Fifi have passed on, you still crave a pet's companionship, think creatures without feathers or fur. Allergy experts recommend turtles, geckos, lizards, snakes, fish -- even tarantulas.

Finally, "don't give up hope," says Anthony Herrig. With a few lifestyle changes and a little help, you can enjoy pets all your life!

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By Wendy C. Fries
WebMD Feature

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How to Recognize an Asthma Attack

An asthma attack is a sudden worsening of asthma symptoms caused by the tightening of muscles around your airways (bronchospasm). During the attack, the lining of the airways becomes swollen or inflamed and more and thicker mucus than normal is produced. All of these factors -- bronchospasm, inflammation, and mucus production -- cause symptoms such as difficulty breathing, wheezing, coughing, shortness of breath and difficulty performing normal daily activities. Other symptoms of an asthma attack include:

* Severe wheezing when breathing both in and out
* Coughing that won't stop
* Very rapid breathing
* Chest pain or pressure
* Tightened neck and chest muscles, called retractions
* Difficulty talking
* Feelings of anxiety or panic
* Pale, sweaty face
* Blue lips or fingernails
* Or worsening symptoms despite use of your medications

Some people with asthma may go for extended periods without having any symptoms, interrupted by periodic worsening of their symptoms, due to exposure to asthma triggers or perhaps from over doing it during exercise.

Mild asthma attacks are generally more common. Usually, the airways open up within a few minutes to a few hours after treatment. Severe attacks are less common but last longer and require immediate medical help. It is important to recognize and treat even mild symptoms to help you prevent severe episodes and keep asthma under control.

What Happens If an Asthma Attack Goes Untreated?

Without immediate treatment, your breathing will become more labored, and wheezing may get louder. If you use a peak flow meter at this time, your personal best reading will probably be reduced.

As your lungs continue to tighten, you will be unable to use the peak flow meter at all. Gradually, your lungs will tighten so much that there is not enough air movement to produce wheezing. This is sometimes called the "silent chest," and it is a dangerous sign. You need to be transported to a hospital immediately. Unfortunately, some people interpret the disappearance of wheezing as a sign of improvement and fail to get prompt emergency care.

If you do not receive adequate treatment, you will eventually be unable to speak and will develop a bluish coloring around your lips. This color change, known as "cyanosis," means you have less and less oxygen in your blood. Without immediate aggressive treatment in an intensive care unit, you will lose consciousness and eventually die.

How Do I Recognize the Early Signs of An Attack?

Early warning signs are changes that happen just before or at the very beginning of an asthma attack. These changes start before the well-known symptoms of asthma and are the earliest signs that your asthma is worsening.

In general, these signs are not severe enough to stop you from going about your daily activities. But by recognizing these signs, you can stop an asthma attack or prevent one from getting worse.

Early warning signs include:

* Frequent cough, especially at night
* Reduced peak flow meter readings
* Losing your breath easily or shortness of breath
* Feeling very tired or weak when exercising
* Wheezing or coughing after exercise
* Feeling tired, easily upset, grouchy or moody
* Decreases or changes in lung function as measured on a peak flow meter
* Signs of a cold, or allergies (sneezing, runny nose, cough, nasal congestion, sore throat and headache)
* Trouble sleeping

The severity of an asthma attack can escalate rapidly, so it's important to treat these symptoms immediately once you recognize them.

What Do I Do If I Have An Asthma Attack?

If you are experiencing an asthma attack and your symptoms do not improve after following your asthma action plan contact your doctor and follow the "Red Zone" or emergency instructions immediately. You need medical attention right away.

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Reviewed by the doctors at The Cleveland Clinic Department of Pulmonary, Allergy and Critical Care Medicine.

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Sex Infections Found in Quarter of Teenage Girls

The first national study of four common sexually transmitted diseases among girls and young women has found that one in four are infected with at least one of the diseases, federal health officials reported Tuesday.

Nearly half the African-Americans in the study of teenagers ages 14 to 19 were infected with at least one of the diseases monitored in the study — human papillomavirus (HPV), chlamydia, genital herpes and trichomoniasis, a common parasite.

The 50 percent figure compared with 20 percent of white teenagers, health officials and researchers said at a news conference at a scientific meeting in Chicago.

The two most common sexually transmitted diseases, or S.T.D.’s, among all the participants tested were HPV, at 18 percent, and chlamydia, at 4 percent, according to the analysis, part of the National Health and Nutrition Examination Survey.

Each disease can be serious in its own way. HPV, for example, can cause cancer and genital warts.

Among the infected women, 15 percent had more than one of the diseases.

Women may be unaware they are infected. But the diseases, which are infections caused by bacteria, viruses and parasites, can produce acute symptoms like irritating vaginal discharge, painful pelvic inflammatory disease and potentially fatal ectopic pregnancy. The infections can also lead to longterm ailments like infertility and cervical cancer.

The survey tested for specific HPV strains linked to genital warts and cervical cancer.

Officials of the Centers for Disease Control and Prevention said the findings underscored the need to strengthen screening, vaccination and other prevention measures for the diseases, which are among the highest public health priorities.

About 19 million new sexually transmitted infections occur each year among all age groups in the United States.

“High S.T.D. infection rates among young women, particularly young African-American women, are clear signs that we must continue developing ways to reach those most at risk,” said Dr. John M. Douglas Jr., who directs the centers’ division of S.T.D. prevention.

The president of the Planned Parenthood Federation of America, Cecile Richards, said the new findings “emphasize the need for real comprehensive sex education.”

“The national policy of promoting abstinence-only programs is a $1.5 billion failure,” Ms. Richards said, “and teenage girls are paying the real price.”

Although earlier annual surveys have tested for a single sexually transmitted disease in a specified population, this is the first time the national study has collected data on all the most common sexual diseases in adolescent women at the same time. It is also the first time the study measured human papillomavirus.

Dr. Douglas said that because the new survey was based on direct testing, it was more reliable than analyses derived from data that doctors and clinics sent to the diseases center through state and local health departments.

“What we found is alarming,” said Dr. Sara Forhan, a researcher at the centers and the lead author of the study.

Dr. Forhan added that the study showed “how fast the S.T.D. prevalence appears.”

“Far too many young women are at risk for the serious health effects of untreated S.T.D.’s, ” she said.

The centers conducts the annual study, which asks a representative sample of the household population a wide range of health questions. The analysis was based on information collected in the 2003-4 survey.

Extrapolating from the findings, Dr. Forhan said 3.2 million teenage women were infected with at least one of the four diseases.

The 838 participants in the study were chosen at random with standard statistical techniques. Of the women asked, 96 percent agreed to submit vaginal swabs for testing.

The findings and specific treatment recommendations were available to the participants calling a password-protected telephone line. Three reminders were sent to participants who did not call.

Health officials recommend treatment for all sex partners of individuals diagnosed with curable sexually transmitted diseases. One promising approach to reach that goal is for doctors who treat infected women to provide or prescribe the same treatment for their partners, Dr. Douglas said. The goal is to encourage men who may not have a physician or who have no symptoms and may be reluctant to seek care to be treated without a doctor’s visit.

He also urged infected women to be retested three months after treatment to detect possible reinfection and to treat it.

Dr. Forhan said she did not know how many participants received their test results.

Federal health officials recommend annual screening tests to detect chlamydia for sexually active women younger than 25. The disease agency also recommends that women ages 11 to 26 be fully vaccinated against HPV.

The Food and Drug Administration has said in a report that latex condoms are “highly effective” at preventing infection by chlamydia, trichomoniasis, H.I.V., gonorrhea and hepatitis B.

The agency noted that condoms seemed less effective against genital herpes and syphilis. Protection against human papillomavirus “is partial at best,” the report said. [nytimes.com]

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A Heart Device Is Found Vulnerable to Hacker Attacks

To the long list of objects vulnerable to attack by computer hackers, add the human heart.

The threat seems largely theoretical. But a team of computer security researchers plans to report Wednesday that it had been able to gain wireless access to a combination heart defibrillator and pacemaker.

They were able to reprogram it to shut down and to deliver jolts of electricity that would potentially be fatal — if the device had been in a person. In this case, the researcher were hacking into a device in a laboratory.

The researchers said they had also been able to glean personal patient data by eavesdropping on signals from the tiny wireless radio that Medtronic, the device’s maker, had embedded in the implant as a way to let doctors monitor and adjust it without surgery.

The report, to published at www.secure-medicine.org, makes clear that the hundreds of thousands of people in this country with implanted defibrillators or pacemakers to regulate their damaged hearts — they include Vice President Dick Cheney — have no need yet to fear hackers. The experiment required more than $30,000 worth of lab equipment and a sustained effort by a team of specialists from the University of Washington and the University of Massachusetts to interpret the data gathered from the implant’s signals. And the device the researchers tested, a combination defibrillator and pacemaker called the Maximo, was placed within two inches of the test gear.

Defibrillators shock hearts that are beating chaotically and dangerously back into normal rhythms. Pacemakers use gentle stimulation to slow or speed up the heart. Federal regulators said no security breaches of such medical implants had ever been reported to them.

The researchers said they chose Medtronic’s Maximo because they considered the device typical of many implants with wireless communications features. Radios have been used in implants for decades to enable doctors to test them during office visits. But device makers have begun designing them to connect to the Internet, which allows doctors to monitor patients from remote locations.

The researchers said the test results suggested that too little attention was being paid to security in the growing number of medical implants being equipped with communications capabilities.

“The risks to patients now are very low, but I worry that they could increase in the future,” said Tadayoshi Kohno, a lead researcher on the project at the University of Washington, who has studied vulnerability to hacking of networked computers and voting machines.

The paper summarizing the research is called “Pacemakers and Implantable Cardiac Defibrillators: Software Radio Attacks and Zero-Power Defenses.” The last part refers to defensive possibilities the researchers outlined that they say would enhance security without draining an implant’s battery. They include methods for warning a patient of tampering or requiring that an incoming signal be authenticated, using energy harvested from the incoming signals.

But Mr. Kohno and Kevin Fu, who led the University of Massachusetts arm of the project, said they had not tried to test the defenses in an actual implant or to learn if anyone trying to use them might run afoul of existing patent claims.

Another participant in the project, Dr. William H. Maisel, a cardiologist who is director of the Medical Device Safety Institute at the Beth Israel Deaconess Medical Center in Boston, said that the results had been shared last month with the F.D.A., but not with Medtronic.

“We feel this is an industry-wide issue best handled by the F.D.A.,” Dr. Maisel said.

The F.D.A. had already begun stepping up scrutiny of radio devices in implants. But the agency’s focus has been primarily on whether unintentional interference from other equipment might compromise the safety or reliability of the radio-equipped medical implants. In a document published in January, the agency included security in a list of concerns about wireless technology that device makers needed to address.

Medtronic, the industry leader in cardiac regulating implants, said Tuesday that it welcomed the chance to look at security issues with doctors, regulators and researchers, adding that it had never encountered illegal or unauthorized hacking of its devices that have telemetry, or wireless control, capabilities.

“To our knowledge there has not been a single reported incident of such an event in more than 30 years of device telemetry use, which includes millions of implants worldwide,” a Medtronic spokesman, Robert Clark, said. Mr. Clark added that newer implants with longer transmission ranges than Maximo also had enhanced security.

Boston Scientific, whose Guidant division ranks second behind Medtronic, said its implants “incorporate encryption and security technologies designed to mitigate these risks.”

St. Jude Medical, the third major defibrillator company, said it used “proprietary techniques” to protect the security of its implants and had not heard of any unauthorized or illegal manipulation of them.

Dr. Maisel urged that patients not be alarmed by the discussion of security flaws. “Patients who have the devices are far better off having these devices than not having them,” he said. “If I needed a defibrillator, I’d ask for one with wireless technology.” [nytimes.com]

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The Language of Autism

Are people with autism trapped in their own world? Or are the rest of us just trapped in ours?

After seeing 27-year-old Amanda Baggs, featured in this month’s Wired magazine, you may rethink your views of the so-called “normal” world. Ms. Baggs, who lives in Burlington, Vt., is autistic and doesn’t speak. But she has become an Internet sensation as a result of an unusual video she created called “In My Language.'’

For the first three minutes of the video, she rocks, flaps her hands, waves a piece of paper, buries her face in a book and runs her fingers repeatedly across a computer keyboard, all while humming a haunting two-note tune.

Then, the words “A Translation” appear on the screen.

Although Ms. Baggs doesn’t speak, she types 120 words a minute. Using a synthesized voice generated by a software application, Ms. Baggs types out what is going on inside her head. The movement, the noise, the repetitive behaviors are all part of Ms. Baggs’ own “native” language, she says via her computerized voice. It’s a language that allows her to have a “constant conversation” with her surroundings.

My language is not about designing words or even visual symbols for people to interpret. It is about being in a constant conversation with every aspect of my environment, reacting physically to all parts of my surroundings.

Far from being purposeless, the way that I move is an ongoing response to what is around me….The way I naturally think and respond to things looks and feels so different from standard concepts or even visualization that some people do not consider it thought at all. But it is a way of thinking in its own right.

Ms. Baggs does far more than give us a vivid glimpse into her mind. Her video is a clarion call on behalf of people with cognitive disabilities whose way of communicating isn’t understood by the rest of the world. As the story in Wired points out, Ms. Baggs is at the forefront of a nascent civil rights movement on behalf of people with autism.

“I remember in ‘99, seeing a number of gay pride Web sites,'’ she tells the magazine. “I envied how many there were and wished there was something like that for autism. Now there is.”

Watching Ms. Baggs rock and flap is to see a person most of us would define as disabled. And that’s why the impact of the computerized voice and her cogent argument on behalf of people with autism is so powerful.

In the end I want you to know that this has not been intended as a voyeuristic freak show where you get to look at the bizarre workings of the autistic mind. It is meant as a strong statement on the existence and value of many different kinds of thinking and interaction in the world….Only when the many shapes of personhood are recognized will justice and human rights be possible.


Update: To read more about the autism activism movement, see “How About Not ‘Curing’ Us, Some Autistics Are Pleading,” which appeared in the Times in 2004. To read the story, click here.

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Study Finds Death Risk From Anemia Drugs

Widely used anemia drugs sold by Amgen and Johnson & Johnson raise the risk of death among cancer patients by about 10 percent, according to a new analysis of previous clinical trials that is to be published Wednesday.

The study is the first compilation of clinical trial data — called a meta-analysis — to show a statistically significant increase in the risk of death from the drugs, said Dr. Charles L. Bennett, a professor at Northwestern University and its lead author.

The Food and Drug Administration is planning to convene an advisory committee on March 13 to discuss whether to impose further restrictions on the use of the drugs, Aranesp from Amgen and Procrit from Johnson & Johnson, with cancer patients.

The Amgen drug Epogen, which is the same as Procrit but is aimed at kidney dialysis patients, will not be directly affected by the discussions.

Amgen said the study, being published in The Journal of the American Medical Association, provided little new information. “What he observes is the risks that we’ve already talked about that are in the label,” said Roger Perlmutter, Amgen’s executive vice president for research and development.

The F.D.A. ordered stronger warnings on the drugs’ labels last year, after a flurry of studies suggested that the products, if used too aggressively, could worsen cancer conditions or hasten death. And Medicare sharply restricted reimbursement for the drugs when used to treat anemia caused by cancer chemotherapy.

Sales of Aranesp, Amgen’s best-selling product, declined to $3.6 billion last year from $4.1 billion in 2006.

One option that analysts expect to be discussed at the meeting in March would be to bar the use of the drugs for specific types of cancer, like breast cancer and head and neck cancer. Another would be to delay treatment with the drugs until patients became more anemic than the current threshold, a change that would more closely match the Medicare reimbursement policy.

A third option, which many analysts say is unlikely, would be for the F.D.A. to no longer authorize the drugs’ use in treating anemia caused by chemotherapy. The drugs would still be allowed to treat anemia caused by kidney disease.

Jim Birchenough, an analyst with Lehman Brothers, estimated in a report on Monday that rescinding approval for chemotherapy-induced anemia would reduce Amgen’s sales of Aranesp by $1 billion a year. A change in the label to match the Medicare policy would cut them by $300 million.

The new analysis on death risk, which could play into the discussions on March 13, combines data from 51 clinical trials involving 13,611 patients. The study also found a 57 percent increase in the risk of blood clots in veins, a known side effect of the drugs.

Dr. Bennett, an oncologist and hematologist, said he did not think that the higher risk of death came from those blood clots. Rather, he said, there is evidence that the drugs, which are synthetic forms of a natural hormone called erythropoietin, directly stimulate the growth and spread of tumors. Amgen scientists dispute that explanation.

Procrit, which Johnson & Johnson sells under license from Amgen, was approved for treatment of cancer patients in 1993, and Aranesp in 2002, based on their ability to reduce the need for blood transfusions. But the studies on which the approvals were based were not large and long enough to measure the effect on patients’ longevity.

As a result, efforts have been made to pool the results of many smaller trials to look for safety problems.

A meta-analysis published in 2004 by the Cochrane Collaboration, an international research group, found that patients who were given the drugs tended to live longer.

But in recent years, some new clinical trials, aimed at showing that using the drugs at higher doses than indicated on the label would improve survival, found the opposite. As those studies were added to the compilations, the safety balance appeared to shift.

A meta-analysis published in 2006 by the Cochrane Collaboration found an 8 percent higher risk of death among users of the drugs, but the result just missed being statistically significant. The analysis being published Wednesday adds some more recent studies and reaches statistical significance.

That still leaves unclear whether the drugs are dangerous if used at the levels indicated on the label, a question that bedeviled an F.D.A. advisory committee last year and is likely to do so again in March.

“We didn’t ask the right questions for 15 years,” Dr. Bennett said.

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By ANDREW POLLACK, published at Newyorktimes.com

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Conflict on the Menu

New York City’s new rules for menu labels at chain restaurants have set off a food fight among the nation’s obesity experts.

French fries at a McDonald’s. A new rule would force many New York restaurants to post calorie information in noticeable places.

Most support the theory of the city’s health commissioner that forcing chain restaurants to list the calories alongside menu items — flagging that a Double Whopper With Cheese has 990 calories, for example — will make patrons think twice about ordering one. The rules are set to take effect at the end of March.

There is a countertheory, however, set forth by Dr. David B. Allison, the incoming president of the Obesity Society, a leading organization of obesity doctors and scientists. An affidavit he recently submitted to the United States District Court for the Southern District of New York has ignited a controversy within his organization.

In the filing, Dr. Allison argues that the new rules could backfire — whether by adding to the forbidden-fruit allure of high-calorie foods or by sending patrons away hungry enough that they will later gorge themselves even more.

“What harms (if any) might result” from the new rules? Dr. Allison wrote in the court filing. “That is difficult to predict.”

It might be only a scientific debate among nutrition experts, except for the fact that Dr. Allison was paid to write the document on behalf of the New York State Restaurant Association, which is suing to block the new rules.

Dr. Allison’s role in the debate has angered some members of the Obesity Society, setting off an e-mail fury since word of his court filing began to circulate. Some have pointed to Dr. Allison’s other industry ties, which have included advisory roles for Coca-Cola, Kraft Foods and Frito-Lay.

Many of the group’s 1,800 members are “completely mad that a president-elect of the Obesity Society, an organization that cares about obesity and cares about healthy eating, wants to hold back information from people that helps them make healthy choices,” said Dr. Barry M. Popkin, a member of the organization, who is director of the Interdisciplinary Obesity Center at the University of North Carolina, Chapel Hill.

Dr. Popkin has filed his own affidavit in the lawsuit, defending the city’s menu labeling plan.

The controversy highlights unresolved issues in the obesity field about industry ties and conflicts of interest, said Dr. Kelly D. Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University. “The field is incapable of policing itself,” Dr. Brownell said.

Spurred by Dr. Allison’s affidavit, the obesity group released a statement on Tuesday supporting calorie labeling on menus. “The Obesity Society believes that more information on the caloric content of restaurant servings, not less, is in the interests of consumers,” said the statement by the society, which is based in Silver Spring, Md.

Dr. Allison, a professor of biostatistics and nutrition at the University of Alabama, Birmingham, is scheduled to start a one-year term as president of the Obesity Society in October. He has defended his affidavit. In a telephone interview, he said he did not take a position for or against menu labeling in the document but merely presented the scientific evidence that the labeling might deter over-eating but might not and, in fact, might be harmful.

He also defended his work for the restaurant industry, but would not disclose how much he was paid for his efforts.

“I’m happy to be involved in the pursuit for truth,” Dr. Allison said. “Sometimes, when I’m involved in the pursuit for truth, I’m hired by the Federal Trade Commission. Sometimes I help them. Sometimes I help a group like the restaurant industry. I’m honored that people think my opinion is sufficiently valued and expert.”

The executive vice president for the restaurant association’s metropolitan New York chapters, E. Charles Hunt, said that Dr. Allison was retained by the association’s lawyers. “Obviously, a lot of it was in favor of our position,” Mr. Hunt said, “although he didn’t come right out and say that.”

Dr. Allison’s 33-page affidavit cites a study that found that dieters who were distracted while eating and presented with information that food was high in calories were more likely to overeat.

“To the extent that many NY diners consume food from restaurants while in a state of distraction or performing distracting tasks,” he writes, “we might hypothesize that the belief that the food is especially high in calories would trigger disinhibited increased consumption.”

He also says that for some people, the deterrent of a high-calorie label might be short-lived and end up making them even hungrier and likely to eat even more later — “inadvertently encouraging patrons to consume lower-calorie foods that subsequently lead to greater total caloric intake because of poor satiating efficiency of the smaller calorie loads.”

Dr. Allison was quoted advancing similar arguments in 2006 during a breakfast meeting sponsored by Coca-Cola at an international conference of obesity experts in Sydney.

Dr. Allison, who disclosed at the meeting that he was a consultant to Coca-Cola on obesity issues, warned that policies to restrict certain foods might backfire, citing research showing that birds put on weight when food is scarce, according to a newsletter article about the conference.

The new labeling rules by New York City’s Board of Health have support from a cross section of organizations, including consumer groups like Public Citizen and the Center for Science in the Public Interest, as well as doctor groups like the American Medical Association, the American Academy of Pediatrics, the American Diabetes Association and the American Heart Association.

While some chains already post calorie information on posters, fliers or on the Internet, public health officials argue that people may change their ordering habits or restaurants might change their menus if calorie labeling is more conspicuous.

The New York rule would require that chains with 15 or more restaurants nationally, including fast-food restaurants, put the information on their menus or menu boards.

This is the city’s second attempt to adopt such regulations. A judge struck down a menu-labeling plan last year, saying the law needed to be reworded. It has since been revised to comply with the judge’s order.

Similar requirements have been adopted in King County, Wash., which includes Seattle, and are under consideration by 21 other state and local governments.

New York’s health commissioner, Dr. Thomas R. Frieden, likened Dr. Allison’s claims to an argument that the world is flat.

“We don’t have 100 percent proof that it’s going to work, but we have a reasonable expectation it will be successful,” Dr. Frieden said.

“When places have to put ‘2,700 calories’ next to an appetizer,” Dr. Frieden said, “they might not have a 2,700-calorie appetizer anymore.”

*This article written by STEPHANIE SAUL, published at newyorktimes.com

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Cutting Cholesterol, an Uphill Battle

The HDLs, the so-called good cholesterol that protects against heart disease, were also high at 69, so that was good. My triglycerides, at 95, were well within the normal range of zero to 149. The VLDLs, also a potentially harmful form, measured 19, again within the normal range of 5 to 49.

But the LDLs, the bad guys that deposit plaque on artery walls, were 134 — “high” since they should be under 100 if I want to maintain a healthy cardiovascular system.

My doctor wasn’t too concerned because my blood pressure is low, I eat a healthful diet and I exercise every day for 60 to 90 minutes and run up and down scores of steps. Still, I decided to cut out cheese, lose a few pounds and return in three months for another test, this time after an all-night fast.

So in early March, three pounds lighter and taking a daily supplement of plant stanols, which are supposed to lower cholesterol, I had a second test. But now my total cholesterol had risen to 236 and the LDLs were up to 159.

Still, my doctor was not as alarmed as I was. My father and his father and his father’s brother had heart attacks in their 50s, and my father and grandfather died of their second attacks at 71. I was 65. Were my days going to be numbered by a surprise coronary or stroke? Not if I could help it.

Now it was time to further limit red meat (though I never ate it often and always lean), stick to low-fat ice cream, eat even more fish, increase my fiber intake and add fish oils to my growing list of supplements. But the latest test, in early June, was even more of a shock: total cholesterol, 248, and LDLs, 171.

My doctor’s conclusion: “Your body is spewing out cholesterol and nothing you do to your diet is likely to stop it.” I was not inclined to become a total vegetarian to see if that would help. The time had come to try a statin, one of the miraculously effective cholesterol-lowering drugs.

By studying the effects of statins in thousands of people who already had heart disease or were likely to develop it, researchers finally proved that lowering total and LDL cholesterol in people at risk was both health-saving and life-saving. I’ll know by fall if the low-dose statin I now take nightly will do the trick, or if I’ll need a higher dose. [See Fall Update, below.]

Lifestyle Changes

Americans tend to turn far too quickly to drugs to solve their health problems. Drugs should be the last resort, if there are reasonable measures people can take first to control a problem. And there are dozens of such measures that, individually or together, can help to lower LDLs.

High LDL cholesterol is an independent risk factor for coronary heart disease, and lowering it by 60 milligrams can reduce coronary events like heart attacks, angina and sudden death by 50 percent after only two years, experts from Oregon Health and Sciences University wrote recently in The Journal of Family Practice.

The Oregon specialists, Dr. Elizabeth Powers, Dr. John Saultz and Andrew Hamilton, recommended that doctors start with lifestyle modifications when a patient has high LDLs. And Dr. Vincent Lo of French Camp, Calif., suggested that the patient’s culture, preferences and practical issues like cost and availability be considered. Not everyone can afford to join a gym, and a traveling salesman may have a hard time sticking to a low-fat, calorie-controlled diet.

These are the measures that have been found to work, based on randomized, controlled clinical trials, the gold standard of clinical research.

Alcohol. Consuming one or two drinks a day can lower LDLs by 4 to 10 milligrams. Red wine is considered most effective. For those who cannot drink alcohol, purple grape juice may be a reasonable, albeit less effective, substitute.

Exercise. Aerobic exercise, like brisk walking, jogging, cycling and lap swimming, can reduce LDLs by 3 to 16 milligrams and raise the good HDLs. Consistency is important. Aerobic activities should be performed at least five times a week for maximum benefit.

Weight loss. When achieved through diet and exercise, weight loss can reduce LDL levels by as much as 42 milligrams. When achieved through drug therapy, weight loss has been associated with an LDL drop of 10 to 31 milligrams.

Yoga and tai chi. These forms of exercise, which are accessible to just about everyone who can walk, even the elderly, have reduced LDLs by 20 to 26 milligrams when done for 12 to 14 weeks.

Smoking. An analysis of several studies found that LDL cholesterol was 1.7 percent higher in smokers, but two smoking cessation studies found little or no difference. In any case, smoking is a strong independent risk factor for heart disease and sudden coronary death, so it is best avoided.

Modifying Your Diet

About 85 percent of the cholesterol in your blood is made in your body. The remaining 15 percent comes from food. But by reducing dietary sources of saturated fats and cholesterol and increasing consumption of cholesterol-fighting foods and drink, you can usually lower the amount of harmful cholesterol in your blood. My college roommate, for example, recently adopted a mostly vegetarian-and-fish diet, minus cheese but with occasional meat and chicken, and lowered her total cholesterol from 240 to 160 milligrams.

There are exceptions, of course, and I happen to be one of them. Still, I intend to continue to follow a heart-healthy diet, because that will enhance the effectiveness of the medication I’m taking.

Start by switching to low-fat and nonfat dairy products, like skim milk and, if you can stand it, fat-free cheese. Substitute sorbet, sherbet or fruit ices for ice cream, or choose ice milk or ice cream with half the fat.

For protein, choose fish and shellfish, poultry without the skin and lean meats, all prepared with low-fat recipes. Eat more dried beans and peas (cooked, of course), soy products like tofu, and nuts like walnuts and almonds. Grains should be mostly or entirely whole — 100 percent whole wheat bread and cereals made from whole wheat or oats, brown rice, bulgur and the like. Oats and oatmeal are rich in soluble fiber, which lowers cholesterol.

Pile on the vegetables and fruits. Especially helpful are those high in fiber like Brussels sprouts, cabbage, spinach, carrots, blueberries, oranges and apples.

Cook with canola or olive oil, and use margarine made from plant stanols.

And enjoy a glass of wine with dinner.

Equally important are the foods to limit or avoid: organ meats like liver, egg yolks, most fried and fast foods, doughnuts and pastries, full-fat cheeses and ice cream, processed meats like salami, bacon and other fatty cuts of pork, and untrimmed red meats.

Fall Update

The low-dose statin I’d been taking did the trick. After four months of taking 10 mg a day of Lipitor, my total cholesterol went from 248 to 159. The bad cholesterol, or LDL, went from 171 to 84. My good cholesterol also went up slightly. My ratio of total cholesterol to good cholesterol has me living forever!

This article written by By JANE E. BRODY, published at newyorktimes.com

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Do Cellphones Affect Fertility?

I wanted to ask a question I asked my science teacher today. Is it true that for boys who carry their phones in the pocket, it can cause problems with their sperm?

It sounds like an urban myth, but there is some limited data to suggest that cellphones can affect male fertility. In fact, last month a study in the medical journal Fertility & Sterility examined the cellphone use of 361 men at a fertility clinic. The results showed that the more men used cellphones, the lower the count, quality and motility of their sperm.

In October, the same medical journal reported on an animal study from Milwaukee researchers who found that rats exposed to six hours of daily cellular phone emissions for 18 weeks had a significantly higher incidence of sperm cell death than rats not exposed to such emissions. The study authors said the results suggest that carrying cellphones near reproductive organs could negatively affect male fertility.

However, as a review last fall in Reproductive Biomedicine Online points out, there simply isn’t enough quality research to know whether the effects seen in animal studies or observational data are meaningful. Even if cellphones do affect sperm quality and motility, is it enough to have a meaningful impact on a man’s fertility?

There are some global concerns about declining male fertility in industrialized countries, but issues like pollutants, exposure to chemicals and smoking are likely far more worrisome culprits than cellphones. If I had a teenage son, I think I would try to limit his cellphone use for broader reasons than worries about his future fertility. I would hope my teenager would be active enough in sports and school that his time spent on the phone would be minimal.

Source: nytimes

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