FREE HELP FOR SMOKERS

Most people who smoke want to quit, and the 2010 health-care law is supposed to make it easier for them by requiring many insurance plans to cover smoking-cessation treatments with no out-of-pocket cost to members. But a recent study found that details about what’s covered and who pays for it remain confusing and inconsistent.

“We were taken aback at the extent to which the policies were rife with confusing language, conflicting coverage and gaps in coverage,” says Matthew Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group that commissioned the study. The Affordable Care Act requires plans that are new or those whose coverage has changed enough to lose their grandfathered status to provide preventive benefits recommended by the U.S. Preventive Services Task Force without any cost-sharing by members.

The task force, a group of experts that evaluates medical evidence to guide consumers’ and doctors’ decisions about screening and preventive services, strongly recommends tobacco-cessation treatment for adult smokers. It describes several effective treatments, such as counseling (including brief behavioral counseling sessions and telephone quit lines) and medication (including nicotine-replacement gum, lozenges and the patch, as well as prescription non-nicotine drugs such as Zyban and Chantix). It says research shows that a combination of counseling and medication together is more effective at helping people quit than either type of treatment alone.

But when researchers at Georgetown University’s Health Policy Institute examined 39 health plans in six states, they found that coverage for smoking cessation was often confusing. Many contracts didn’t clearly state that the coverage was available, didn’t cover recommended treatments and/or didn’t provide it without cost-sharing.

“The study points out the need for the Department of Health and Human Services to provide much more specific guidelines,” Myers says.

Insurers offer a different perspective. “The final rules [for preventive services] recognized that there wasn’t necessarily a one-size-fits-all approach,” says Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group. “So we would expect to see variation around the methods that plans are using. Tobacco use kills an estimated 443,000 people in the US every year, accounting for about one in five deaths annually. It remains the No. 1 cause of preventable death.

If insurance coverage of smoking-cessation treatment isn’t enough to encourage people to quit, the health law provides an added incentive: Smokers’ premiums can be up to 50 percent higher than non-smokers’ in some plans. The Obama administration recently proposed soytening that rule by allowing smokers to avoid the higher rate if they participate in a stop-smoking program.

Cited by Washington Post

HPV VACCINE

One of the most preposterous arguments raised by religious and social conservatives against administering a vaccine to girls to protect them from human papillomavirus, or HPV, has been that it might encourage them to become promiscuous. That notion has now been thoroughly repudiated by a study published on Monday in Pediatrics, a journal of the American Academy of Pediatrics.

 

Although most women infected with HPV, the most common sexually transmitted virus, experience no symptoms, persistent infections with some strains of the virus can cause cervical and other types of cancer, as well as genital warts. Since public health officials began recommending in 2006 that young women be routinely vaccinated against HPV, many parents have hesitated over fears that doing so might give their children license to have sex.

Looking at a sample of nearly 1,400 girls, the researchers found no evidence that those who were vaccinated beginning around age 11 went on to engage in more sexual activity than girls who were not vaccinated.

“We’re hopeful that once physicians see this, it will give them evidence that they can give to parents,” said Robert A. Bednarczyk, the lead author of the report and a clinical investigator with the Kaiser Permanente Center for Health Research Southeast, in Atlanta. “Hopefully when parents see this, it’ll be reassuring to them and we can start to overcome this barrier.”

HPV, the most common sexually transmitted virus in the United States, can cause cancers of the cervix, anus and parts of the throat. Federal health officials began recommending in 2006 that girls be vaccinated as early as age 11 and last year made a similar recommendation for preadolescent boys. The idea is to immunize boys and girls BEFORE they become sexually active to maximize the vaccine’s protective effects.

According to research, nearly a third of children 14 to 19 years old are infected with HPV. But despite the federal recommendations, vaccination rates around the country remain low, in part because of concerns about side effects as well as fears the vaccine could make adolescents less wary of casual sex. In one study of parental attitudes toward the vaccine, Yale researchers found that concern about promiscuity was the single biggest factor in the decision not to vaccinate.

While there have been studies suggesting that the vaccine does not lower inhibitions in girls who receive it, most of them were based on self-reporting, which is not very reliable. So Dr. Bednarczyk and his colleagues looked instead at medical data collected by a large managed care organization.

They selected a group of 1,398 girls who were 11 or 12 in 2006 — roughly a third of whom had received the HPV vaccine — and followed them through 2010. The researchers then looked at what they considered markers of sexual activity, including pregnancies, counseling on contraceptives, and testing for or diagnoses of sexually transmitted diseases.

Over all, in the time that the girls were followed, the researchers did not find any differences in these measures between the two groups.

In addition to the HPV vaccine, federal guidelines also call for 11-year-olds to be immunized against meningitis, tetanus, diphtheria and pertussis. Dr. Elizabeth Alderman, president of the North American Society for Pediatric and Adolescent Gynecology, said parents almost never object to those vaccines for their preadolescents. But she regularly encounters parents who balk at the HPV vaccine “because of the nature of what it’s preventing.”

Dr. Jonathan Temte, chairman of the United States Advisory Committee on Immunization Practices, said he tells skeptical parents in his practice to think of vaccination no differently from wearing a helmet to ride a bike or play football.

“By providing this protection, are we encouraging kids to take more risky behaviors?” he said. “I don’t believe so.”

YET ANOTHER REASON TO GET YOUR BT TEST

WALL STREET JOURNAL August 2012

Nancy Cappello had annual mammograms for a decade and each time radiologists noted in their reports that she had dense breast tissue. But doctors never told Ms. Cappello, nor did they warn her that it could make her mammograms less reliable.

When her doctor found a suspicious ridge during a manual exam eight years ago, she had a mammogram and an ultrasound on the same day. The mammogram again spotted nothing amiss, but an ultrasound found a tumor the size of a quarter. Her breast cancer had also spread to 13 lymph nodes.

Ms. Cappello, then 51, was dismayed to learn that the tumor wasn't visible on a mammogram because dense breast tissue like hers can frequently hide cancer from view. "I kept asking my gynecologist, 'Why don't you routinely tell women this?' And the answer I got was, 'There is not a standardized protocol,' " she says. The industry is not on the same page.

In 2005, while still undergoing chemotherapy, radiation and surgeries, Ms. Cappello, an education administrator in Woodbury, Conn., started a campaign called "Are You Dense?" to educate other women about dense breast tissue.

Thanks in part to her efforts, last month, New York became the fourth state, after Connecticut, Texas and Virginia, to require radiologists to inform women if they have dense breasts along with their mammogram results. Similar bills are pending in 12 states and Congress. They face opposition from insurers and major medical groups concerned that the information could raise health-care costs and scare women unduly.

Studies show that having dense breasts raises the risk of developing breast cancer fourfold to sixfold. "It's a greater risk factor than having a mother or sister with the disease," but few women know this, says Deborah J. Rhodes, a preventive medicine specialist at the Mayo Clinic in Rochester, Minn. "Most of the physicians ordering these tests are also in the dark about this and the implications for women," she says.

Women's breasts are a mixture of dense tissue and fatty tissue (which is less dense), and generally become more fatty with age. Density can't be determined in a physical exam, only by imaging. An estimated 66% of premenopausal women, and 25% of postmenopausal women, have breasts that are dense enough to interfere with mammogram accuracy, according to a landmark 1996 study.

In studies of thousands of patients, Thomas Kolb, a New York radiologist who specializes in breast-cancer detection, showed that mammograms missed 60% of cancers in women with the densest breast tissue. Other studies have showed similar results.

"I, as a radiologist, have a problem telling a woman with dense breasts that her mammogram is normal when I know it could be inaccurate 60% of the time if she has cancer," says Dr. Kolb. Still, the American College of Radiology says there isn't enough evidence to recommend that women with dense breasts have alternative testing.

Jean Weigert, an executive with the Radiological Society of Connecticut, lobbied against the notification bill there on the grounds that it would increase costs and anxiety without much benefit. But once it passed, in 2009, she was impressed with its impact. Pooling data on 78,000 women in six different practices, Dr. Weigert found that about half of the women, or 8,651 patients, with dense breast tissue went on to have ultrasounds which found 28 cancers that weren't visible on mammograms. "We are definitely finding more cancers, most of them at very early stages," says Dr. Weigert

Connecticut, the first state to pass a notification bill, also requires insurers to pay for ultrasounds for women with dense breasts. According to Dr. Weigert's analysis, the additional screening for those 8,652 women cost $2.15 million, or $110,000 for each additional cancer found. Finding cancers early saves many times that amount compared with the cost of late-stage cancer treatment, she notes.

Even without legislation, some experts note that women can ask about their breast density, since radiologists routinely report that information to physicians. "If women are at all concerned, after a mammogram, they can call their doctors and say, 'Listen, do I have dense breasts? Do I need anything further?' " says Carol Lee, chair of the American College of Radiology's Breast Imaging Commission.

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NO THANK YOU... MORE KIDS SAY NO TO TOBACCO

Teens are more likely to turn down tobacco now than they were a decade ago, but rates of decline have slowed, government researchers said.

Between 2000 and 2011, use of tobacco among high schoolers fell from about 34% to 23%, and from 15% to 7% among middle schoolers, Rene Arrazola, MPH, of the CDC, and colleagues reported in the August 10 issue of Morbidity & Mortality Weekly Report.

But that downturn was nowhere near as dramatic as the one seen between 1997 and 2003, which saw a 40% decline, the researchers wrote.

"This report is further evidence that we need to do more to prevent our nation's youth from establishing a deadly addiction to tobacco," CDC director Tom Frieden, MD, MPH, said in a statement, adding that most long-term tobacco use is established in adolescence.

That's a challenge, however, as states continue to face drastic budgetary cuts, which has played a role in the underfunding of tobacco control programs.

Cigarette smoking was the most common form of tobacco use, with a prevalence of 15.8% among high schoolers and 4.3% among middle schoolers.

Cigars were the second most common form of tobacco use among both groups (11.6% and 3.5%, respectively), and their use rose among black high schoolers between 2009 and 2011, from 7.1% to 11.7%, the researchers noted.

"This finding is similar to prevalence trends found using other national data, with increases in cigar smoking observed among black female high school students," they wrote.

They added that cigar use among high school boys is more than twice as high as it is among high school girls (15.7% versus 7.4%) and is comparable to the use of cigarettes among high school boys (17.7%).

But a wider gender gap exists among high schoolers for smokeless tobacco, the use of which among boys is eight times that of girls (12.9% versus 1.6%).

Arrazola and colleagues warned that cigars can be taxed at lower rates than cigarettes and aren't subject to FDA regulation. Manufacturers can also add flavorings and can label their products with "misleading descriptors such as 'light' or 'low tar,'" they wrote.

The data come from the National Youth Tobacco Survey, which involved 178 schools and 18,866 students.

The researchers cautioned that the data may be limited by recall bias, and they didn't distinguish between infrequent tobacco users and heavy users.

Lets stay after it and become SMOKE-FREE!!!

http://www.medpagetoday.com/PrimaryCare/Smoking/34139

SPRAY TANNING: DHA HEALTH RISK - POTENTIAL LUNG COMPLICATIONS

The active chemical used in spray tans, dihydroxyacetone (DHA), has the potential to cause genetic alterations and DNA damage, according to a panel of medical experts who reviewed 10 of the most-current publicly available scientific studies on DHA for ABC News, including a federal report ABC News obtained through the Freedom of Information Act.

Six medical experts in areas ranging across the fields of dermatology, toxicology and pulmonary medicine said they "have concerns" after reviewing the literature and reports about DHA, the main chemical in the popular "spray-on" tan, which has conventionally been referred to as the "safe" alternative to tanning under ultraviolet lights.

None of the reviewed studies tested on actual human subjects, but some found DHA altered genes of multiple types of cells and organisms when tested in different labs by different scientists after the chemical was approved for use in the consumer market.

Click here to view a web extra video: "DHA Health Risk: Potential Lung Complications"

"I have concerns," said Dr. Rey Panettieri, a toxicologist and lung specialist at the University of Pennsylvania's Perelman School of Medicine. "The reason I'm concerned is the deposition of the tanning agents into the lungs could really facilitate or aid systemic absorption -- that is, getting into the bloodstream."
Panettieri, like all the experts ABC News consulted with, said more studies should be done. He emphasized the available scientific literature is limited. Still, he said, he has seen enough to say the warning signs of serious health concerns exist.

"These compounds in some cells could actually promote the development of cancers or malignancies," he said, "and if that's the case then we need to be wary of them."

The FDA originally approved DHA for "external" use back in 1977, when it was popular in tanning lotions. Those lotions, previously famous for turning skin orange, were never as popular as current products that produce better tans. In recent years, the use of DHA has exploded in the newer "spray" application of the product, which provides a more even tan for consumers.

SUGAR IS TOXIC

Walt Disney announced that it's going to stop advertising junk food to kids on its TV channels, radio station and website by 2015. It's eliminating ads for sugar-laden fruit drinks, candy and snack cakes.Recently, New York Mayor Michael Bloomberg outlined a plan to ban large-size sugary beverages sold at the city's restaurants, movie theaters, sports venues and street carts. Some states and cities are working on "soda taxes" on sugary drinks. And in recent years, major health groups have discouraged the consumption of large amounts of added sugars.

The motivation is clear: The US is in a full-fledged state of hand-wringing about overweight Americans who are among the most obese in the world and are heavier than they've ever been before.

Increasingly, the focus is being placed on sugar, the sweetener with a history that goes back 8,000 years. The American Heart Association says in a statement that research has tied a high intake of added sugars to many poor health conditions, including obesity, high blood pressure, type 2 diabetes and other risk factors for heart disease and stroke. Diabetes educators often advise people with diabetes and pre-diabetes to watch their sugar intake, especially their consumption of sugary beverages. Nutritionists have said for years that sugar represents empty calories with no nutritional value.

The consumption of added sugars, especially from sugar-sweetened beverages, among some people in the country "is out of control," says Rachel Johnson, a spokeswoman for the American Heart Association and a nutrition professor at the University of Vermont.
Americans adults consume an average of 22 teaspoons a day, or about 355 calories, from added sugars, Johnson says. Every teaspoon has 15 to 16 calories.

You don't remember adding 22 teaspoons of sugar to your coffee or cereal? People are downing table sugar, brown sugar, high-fructose corn syrup (in soda), maple syrup, honey, molasses and other caloric sweeteners. Added sugars make their way into many prepared and processed foods and beverages, from soda, sweet tea and lemonade to energy drinks and sports drinks.

One 16-ounce serving of regular soda, the proposed NYC cap, contains the equivalent of at least 12 teaspoons of sugar, says Cynthia Sass, a registered dietitia . "Many of my clients don't realize how much hidden sugar creeps into their diet, even in foods that don't seem sweet, like salad dressing, soups and crackers."

Sugar is "toxic" in the amount it's consumed by Americans, says pediatric endocrinologist Rob Lustig, a professor of pediatrics at the University of California-San Francisco and one of the country's most vocal critics of added sugars. A little bit is OK, but it's the quantity that people are consuming that's harmful, Lustig says. "Everyone knows the dose determines the poison. I agree with that. There is a threshold, and right now we are way above that threshold."

The heart association recommends that most American women consume no more than 6 teaspoons a day, about 100 calories, from added sugars, Johnson says. For men, it's 9 teaspoons or about 150 calories. Kids should limit their intake to about the same amount, she says.

BACK-ROOM DEALS HURT THE AMERICAN PUBLIC

WASHINGTON — It would seem a business executive’s dream: legally pay a competitor to keep its product off the market for years.

Congress has failed to stop it, and for more than a decade generic drug makers and big-name pharmaceutical companies have been winning court rulings that allowed it.

Until this month. On July 16, a federal appeals court in Philadelphia issued a decision that the arrangement is anticompetitive on its face. It potentially sets up a confrontation before the United States Supreme Court. If it were to accept the case, the outcome could profoundly affect drug prices and health care costs.

The Philadelphia ruling by the Third Circuit Court of Appeals conflicted with decisions from at least three other federal circuit courts, giving the Supreme Court a strong reason to hear the case within the next few years.

“The Third Circuit has rebalanced the issue and teed it up for the Supreme Court,” said Eleanor M. Fox, an antitrust expert and professor at the New York University Law School. The agreements between generic and branded drug manufacturers “are cases of competitor collaboration, which the Supreme Court has called ‘the supreme evil of antitrust.’ ”

The stakes are enormous for brand-name drug makers, which would face lower profits, and for pharmacies, insurance companies and patients, who could benefit from the savings.

In the case of Cipro, a powerful antibiotic with annual sales exceeding $1 billion, Bayer paid $400 million to a generic drug maker, Barr Laboratories, and other companies. In exchange, the generic makers said they would withhold their own lower-priced generic versions of the drug until 2003, when Bayer’s patent on the brand-name drug expired.

Last year, the Congressional Budget Office estimated that a Senate bill to outlaw such payments would save the federal government $4.8 billion over 10 years and would lower drug costs in the United States by $11 billion. The legislation remains stalled in the Senate. The federal government is a major buyer of drugs through Medicare and the Department of Veterans Affairs.

Jon Leibowitz, chairman of the Federal Trade Commission, which has greatly increased its scrutiny of what it calls “pay-for-delay settlements” between generic and branded drug companies, said that the appeals court decision “puts us one step — and a very important one — closer to solving this very real problem.”

Mr. Neas said that through 2010, generic drugs had reduced drug costs for Americans by $931 billion, a third of that resulting from patent settlements between big-name drug makers and generic manufacturers.

The agreements are the result of a 1984 law that made it easier for generic drugs to gain Food and Drug Administration approval and a 2003 amendment, which required branded and generic drug makers that entered into patent settlements to file their agreements for review to the F.T.C. and the Justice Department.

The agreements generally work like this: A generic-drug maker comes up with a chemical equivalent to a large-selling, patented drug and applies to the F.D.A. to sell it, arguing that the patent is invalid.

Rather than spend years and millions of dollars defending its patent, the branded company often offers a settlement: it pays the generic company to keep its drug off the market for a time period, perhaps also offering to let the generic company market an “authorized” generic version later on.

Pharmaceutical makers say that the agreements are a cost-effective way of settling patent litigation.

If the courts do not settle the issue, the pending Senate bill, supported by Senator Herb Kohl, a Wisconsin Democrat, and Senator Charles E. Grassley, an Iowa Republican, would do away with the payments between branded- and generic-drug makers. When the Senate Judiciary Committee approved the bill one year ago, Mr. Kohl said the deals undermined basic capitalism.“There’s no room in a competitive marketplace,” he said, “for these kinds of back-room deals.”

EATING DISORDERS IN OLDER WOMEN

A first-of-a-kind study looking at older women finds damaging eating disorders are common — and 62% of those surveyed say their weight or shape has a negative impact on their lives.

Historically, eating disorder research has focused on teens and young women, but the study out Thursday in the International Journal of Eating Disorders shows 13% of women ages 50 and older struggle with the problem — some for the first time in their lives. Eating disorders are more common in women than men and include purging, binge eating, excessive dieting and excessive exercising.

The researchers surveyed 1,849 women online from across the nation in attempt to find out how older women feel about their bodies and to estimate the prevalence of eating disorders. There are 53 million women in the USA older than age 50, the authors write, noting previous studies have reported a lower risk for eating disorders as women mature...Read more.