Dr Brett’s Blog

From The Mercury News

WASHINGTON—Health care continued to take up a greater share of the economy in 2007, as spending on hospitals, doctors and other services increased 6.1 percent to $2.2 trillion.

There was a silver lining in the numbers the government reported Monday: The increase in health spending was the smallest since 1998, thanks largely to the growing use of generic drugs.

Officials worry that devoting more resources to health care makes it harder for families to meet other priorities and for businesses to compete internationally.

Overall, health spending came to $7,421 per person for the year.

About 67 percent of medications dispensed in 2007 were generic drugs—up from 63 percent the year before. Generics can cost as little as one-third the price of brand-names.

Several factors helped drive the trend. First, insurers are steering consumers to lower-priced medicines by charging low co-payments for certain drugs. Meanwhile, they charge higher co-payments for medicines they want consumers to avoid for safety and financial reasons.

Large retailers and grocers are enticing consumers into their stores with low-priced generics.

Also, several blockbuster brand-name drugs lost their patent exclusivity in 2006, generating competition. Notable examples include Flonase, an allergy medicine; Zocor, a medicine used to lower cholesterol; and Zoloft, which is used to treat depression.

Federal officials said safety concerns also probably influenced spending on medicine as the Food and Drug Administration issued more of its most serious warnings than in previous years—68 in 2007 versus 58 the year before and 21 in 2003.

The overall spending slowdown in2007 came also from a decrease in administrative expenses for the new Medicare drug benefit. When the program kicked in during 2006, it generated a substantial uptick in administrative expenses.

Officials emphasized that the good news about slowing the increasing costs of health care extended only to prescription drugs. All other major health sectors—such as hospitals, physicians, nursing homes and home health—grew at the same rate or slightly faster than the year before.

Since prescription drugs generate only about 10 percent of all health spending, officials question how much longer the transition to generics would dampen the growth in health care costs.

“I wouldn’t expect the good news to continue,” said Richard Foster, chief actuary for the Centers for Medicare and Medicaid Services.

Historically, health spending has been somewhat insulated from the effects of a slowing economy, which means health care makes up an even greater share of the overall economy during recessions. In 2007, the health sector’s share came to 16.2 percent, up from 16 percent the year before.

Dr Brett Says: So basically in America they are spending more and more on drugs, even as the FDA is issuing warning about the safety of many of these drugs and the cost of drugs is decreasing due to lower priced generics. And for what? Are they getting any healthier? The rates of chronic disease and illness have never been higher!

From BBC News

One in five white people carries a gene fault which could raise their risk of high blood pressure, research suggests.

The STK39 gene variant was found after scanning the entire genetic code of hundreds of people in the US and Europe.

Those with the variant had raised blood pressure compared with those carrying other versions.

The US research was published in the Proceedings of the National Academy of Sciences.

High blood pressure, also called hypertension, is important because, over time, it can increase the chances of heart problems, strokes and kidney failure.

It is thought that one in four people living in western countries has high blood pressure, often undiagnosed.

Scientists looking for genetic vulnerabilities to the condition have explored dozens of possible genes, but STK39 has emerged as a front runner following the University of Maryland School of Medicine study.

The researchers concentrated their efforts on 542 members of the Amish community in Pennsylvania, looking at their entire genetic make-up while testing their blood pressure.

When this linked variants of the STK39 gene to high blood pressure, it made sense - the gene produces a protein which controls how the kidneys process salt - a key factor in changing blood pressure.

Lifestyle choices

The result was reproduced when other groups Caucasian volunteers were tested, and the researchers estimated that 20% from this ethnic group carried it.

Dr Yen-Pei Christy Chang, one of the researchers, said: “This discovery has great potential for enhancing our ability to tailor treatments to the individual - what we call personalised medicine.”

However, he added: “Hypertension is a very complex condition, with numerous other genetic, environmental and lifestyle factors involved.

“The STK39 gene is only one important piece of the puzzle.”

Professor Alan Shuldiner, also from the University of Maryland, said: “With this new scanning approach, we are able to uncover genes that have previously eluded us.”

Mike Rich, the executive director of the Blood Pressure Association, described the research as “interesting”.

“It may help us identify those individuals who may be more prone to hypertension,” he said.

“However, there are already indicators which can help us determine who is more likely to develop the condition, such as a family history of hypertension, heart disease, stroke, and poor diet and lack of exercise.

“The things you learn from your parents in terms of lifestyle and habits will probably have as much effect on your chances of developing hypertension as the genes they pass down to you.”

Dr Brett Says: Lifestyle factors really are the key here. There aren’t any genes that guarantee you high blood pressure. I like to think of it this way, if you make poor lifestyle choices it is going to show up somewhere. For people with this gene it may show up as high blood pressure, for others it may be cancer or for others it may be obesity. The genes only give you a predisposition to that particular condition, they do not cause the condition. If you live a healthy lifestyle your body will find the most appropriate bood pressure for you.

From YouTube

Dr Brett Says: Click on the above link, you must see this story! If interference to his nervous system can interfere with this guys vision, imagine what it is doing to you! Remember the effects of a subluxation are not always as obvious as reduced vision.

From The Wall Street Journal

The Food and Drug Administration called on Coca-Cola Co. to revise the label on a version of its Diet Coke brand containing vitamins and minerals, warning the beverage giant that it makes inappropriate nutritional claims, according to a warning later posted on the agency’s Web site Tuesday.

The FDA said the soft drink, Diet Coke Plus, doesn’t contain enough nutrients to qualify for use of the word “plus.” Foods may use that name only if they contain at least 10% more of the reference daily intake or daily reference value of a nutrient than a similar product. The FDA also invoked a longstanding rule under which it “does not consider it appropriate” to fortify snack foods such as carbonated beverages.

Regulators say Diet Coke Plus lacks enough nutrients to justify the word “plus.”

The warning letter, sent to Coke Dec. 10, comes as a growing number of nutrient-enhanced beverages, from energy drinks to enhanced waters, have appeared on store shelves, putting pressure on the FDA to police more aggressively the claims many of the products make about the benefits they can deliver.

Coke isn’t the only company to add nutrients to a soft drink. Cadbury PLC marketed a fortified version of 7UP with calcium, fruit juice and Vitamin C four years ago, and PepsiCo Inc. currently sells Diet Pepsi Max, a diet soda with ginseng.

The FDA called on Coke to “take prompt action to correct these violations” and asked the company to respond within 15 days of receipt of the letter.

A Coke spokesman, Scott Williamson, said the company will respond to the FDA in early January, but that it has no plans to change the label.

“We take seriously the issues raised by the FDA in its letter,” he said. “This does not involve any health or safety issues, and we believe the label on Diet Coke Plus complies with FDA’s policies and regulations.”

Coke launched Diet Coke Plus in March 2007 as a calorie-free soft drink and “a good source of vitamins B3, B6, and B12, and the minerals zinc and magnesium,” according to a press release. The drink hasn’t been a huge hit, however, selling the equivalent of 10.2 million 8-ounce cases in 2007, compared with 990 million 8-ounce cases of Diet Coke that year, according to Beverage Digest, an industry publication and data service.

Dr Brett Says: I got excited when I read this title. I assumed that the FDA was finally doing something about the neurotoxic aspartame that is in diet soft drinks, surely it is only a matter of time. I couldn’t believe it when I realised that coke were trying even harder to pass off their “diet coke” (which has been shown to promote weight gain) as healthy. The chances of actually absorbing the minute amounts of nutrients that they have added to this chemical and sugar cocktail are small to none.

From The Washingtom Post

MONDAY, Dec. 22 (HealthDay News) — Even a few extra pounds and just a little inactivity increased the risk of heart failure in a major study of American doctors.

“What this study shows is that even overweight men who are not obese have an increase in heart failure risk,” said Dr. Satish Kenchaiah, lead author of a report on the finding in the Dec. 23 issue of Circulation.

As for exercise, “even a little amount of physical activity appears to decrease the risk of heart failure,” said Kenchaiah, who did the research as a epidemiologist at Brigham and Women’s Hospital in Boston and is now at the U.S. National Heart, Lung, and Blood Institute.

The study has followed more than 21,000 doctors for two decades, measuring among other factors the influence of overweight and physical activity on development of heart failure, the progressive loss of ability to pump blood, which is often a prelude to major coronary events.

Outright obesity, defined as a body-mass index of 30 or over, has long been known as a risk factor for heart failure. The new report concentrated on men who were borderline overweight, with a body-mass index of 25 to 29.9.

About 5 percent of the doctors were obese, and 40 percent were overweight, when the study began. Adjusting for other risk factors such as high blood pressure and high cholesterol, the study found a 49 percent increased incidence of heart failure in overweight men compared to those with a body-mass index of 25 or less. Incidence of heart failure was 180 percent for the obese men compared to the leaner ones.

It was the same story for physical activity. “Men who engaged in physical activity anywhere from one to three times a month had an 18 percent reduction in heart failure risk,” Kenchaiah said. “For those who were active five to seven times a week, the reduction was 36 percent. The more you exercise, the more reduction you achieve.”

The association of even minimal physical activity with reduced risk could be explained as an indicator of good habits in general, he said. “It is possible that they have a healthier lifestyle in general,” Kenchaiah said.

The study found that doctors who rarely or never exercised were older, smoked cigarettes more often, and were more likely to have high blood pressure or diabetes.

“This new report reinforces what we’ve said in the past,” said Dr. Gerald Fletcher, a preventive cardiologist at the Mayo Clinic in Jacksonville, Fla. “Not being obese but being overweight is definitely a risk factor for heart failure.”

While Fletcher said he would have liked a more definitive indicator of physical activity — the report described it as simply breaking a sweat — he said the study showed again that “vigorous exercise makes the difference. The more you do, the better it is for you.”

Two-thirds of Americans have excess body weight, and only about 30 percent exercise regularly, Kenchaiah said. About 660,000 new cases of heart failure are diagnosed each year in the United States, he said, and 80 percent of the men and 75 percent of the women aged 65 and older who are diagnosed with heart failure die within eight years.

Dr Brett Says: This just goes to show why it is dangerous to focus purely on one measurement like weight or cholesterol. Even people with a “normal” weight can suffer from heart disease if they are no eating, thinking and moving in a healthy way.

From The Washington Post

MONDAY, Dec. 15 (HealthDay News) — A good night’s sleep really does a sick body good, new research says.

From Associated Press

WASHINGTON (AP) — For years, the federal government has recommended that pregnant women and young children limit their consumption of fish to avoid exposure to potentially harmful amounts of mercury.

Now, two top consumer protection agencies are at odds on whether that advice should be reconsidered to encourage all people to eat more fish, in order to promote healthy hearts.

The Food and Drug Administration has been circulating a draft report within the government that argues the health benefits of eating fish outweigh the potential ill effects of mercury. But the Environmental Protection Agency has fired off a memo to the White House calling the 270-page FDA study “scientifically flawed and inadequate” and an “oversimplification” lacking analytical rigor.

Environmental groups are crying foul. They say it’s a sneak attempt to undercut important public health advice in the waning hours of a Bush administration that has treated science as a stepchild.

“The FDA was once a fearsome protector of the public health. Now it’s nothing more than a patsy for polluters,” Richard Wiles, executive director of the Environmental Working Group, said in a statement.

The food industry is praising the FDA’s shift. One organization, the Center for Consumer Freedom, called it “long overdue and a huge public-health victory” that “just might be the best Christmas present health-conscious Americans could hope for.”

The interagency feud spilled into the open Friday when the Environmental Working Group released copies of the dueling memos. The dispute was first reported by the Washington Post.

The FDA is embroiled in another controversy over the science of food safety. Recently, a panel of outside advisers challenged the agency on bisphenol A, or BPA, a chemical used to make plastic for food packaging and other consumers goods. The independent experts said that FDA’s conclusion that low doses of BPA are safe was scientifically flawed.

The battle over mercury is now attracting the interest of Congress. “FDA should not change anything it cannot back up with the best science, because we know that mercury can cause brain and cardiovascular damage,” said Sen. Barbara Boxer, D-Calif., who chairs the Environment and Public Works Committee. “FDA should not play politics with the health of our families.”

At the FDA, officials sought to tamp down the controversy and dispel concerns that the agency is about to toss out the government’s current mercury guidance.

“It would be a mistake to assume that this draft report represents the FDA’s official position because a final determination on these matters has not been reached,” said spokesman Michael Herndon. “Following the discussion among government agencies, FDA intends to seek public comment. This will all be done in a very public and transparent manner, and the FDA will make no final determination until all the relevant comments and scientific analysis has been carefully considered.”

Mercury occurs naturally and is also released in the environment through pollution. Very high levels in the bloodstream can damage the nervous system of developing fetuses and young children, causing learning disabilities and other problems. Fish absorb mercury in the water and as they feed on plankton and other smaller fish. Some fish, like king mackerel and swordfish, accumulate higher levels of mercury.

Fish and shellfish are the biggest sources of human exposure to mercury. Fetuses and young children are the most susceptible to harm. About 8 percent of U.S. women of childbearing age have enough mercury in their blood to be at risk of having babies with subtle learning disabilities, the Centers for Disease Control and Prevention estimates.

Because of such concerns, the FDA and EPA have recommended that women of child-bearing age and young children not eat shark, swordfish, king mackerel or tilefish, which contain high levels of mercury. The agencies also advised that they eat no more than two meals a week of fish and shellfish that are lower in mercury, a total of 12 ounces. And since “white” albacore tuna has more mercury than chunk light tuna, they recommended no more than six ounces a week.

The FDA’s draft report said the latest studies seem to indicate that the risks may not be as dire as previously thought. The agency also sought to weigh the risk of mercury against the benefits of eating more fish.

Current research suggests “a beneficial impact on fetal neurodevelopment from the mother’s consumption of fish, even though they contain methylmercury,” the report said.

“The net effect is not necessarily adverse, and could in fact be beneficial,” it added.

But the EPA said, “this FDA report bases its conclusions on models that use very limited inputs from studies that have significant problems for risk analysis.”

Dr Brett Says: It is a tricky argument this one and one I don’t really know the answer to. Obviously ideally we would eat whole, fresh, un-polluted fish but that is no longer possible. Fish as a whole food contains many other things that cant be diluted into a capsule, the unique combination of ingredients that work in unison cannot be manufactured. On the other hand there is no safe level of mercury for the human body. My advice at this stage is for people to eat small fish (that contain less mercury) as I think the benefits of eating the whole food outweighs the risks, but I dont say that with any certainty.

Dr Brett Says: What? Why would Dr Brett be commenting on elephants in a zoo? Well it turns out that we have a lot in common with those elephants. Like them we have been placed in an artificial environment. Like them we no longer get as much exercise a we used to. Like them we no longer eat as much variety or as fresh as we used to and like them we no longer have the same quality social interactions that we used to. And guess what.. just like them we are also getting more chronic diseases, more infections, more fertility issues and more behavioral problems than we used to.

We really are like animals living on captivity and the more we can get back to eating, thinking and moving like we used to the better off we will be.

From In-daily

Stop treating pregnancy as an illness and respect women’s birth choices.

That is one of the main messages to a Federal Government review of maternity services.

More than 400 of the 900 submissions to the review were made public today.

Key suggestions include:

- Establishing a one-off payment to expectant mothers, similar to the baby bonus, to help fund a woman’s chosen birthing option

- Giving midwives in private practice professional indemnity insurance, access to a Medicare number and allowing them to prescribe government subsidised drugs

- Appointing a national breastfeeding coordinator with authority to establish a committee of representatives from government and relevant organisations

- Establishing standards for rural maternity services that will be included in future health funding agreements between the Commonwealth and the states.

A national snapshot of mothers and their babies released this week showed caesarean sections made up almost one-third of births in 2006, compared with 20 per cent in 1997.

This increase in caesareans and other birth interventions has the potential to push down breastfeeding rates, the Australian Breastfeeding Association says in its submission.

“It is well accepted that breastfeeding within the first hour after birth is a vital link to the successful establishment of breastfeeding,” it says.

“However, birth by caesarean section often means that mothers and babies miss this vital first hour together.”

Homebirth Australia says a lack of funding and professional indemnity insurance for midwives means homebirth is available to very few women.

It has also received anecdotal evidence there has been a rise in the number of women giving birth at home without any medical assistance, referred to as free birth.

“The increase in freebirth is largely an indictment on a broken maternity system that is not based on evidence and is not woman centred,” the submission reads.

Future Families said the current structure of maternity services encourages birth to be treated purely as medical condition.

“In no other area of society are our women treated with such a lack of respect,” the group’s submission reads.

The same sentiment was echoed by consumer Melissa Graham, who said: “Reinstate birth as a normal function of life.”

Health Minister Nicola Roxon said most submissions are from individual consumers.

“Their personal accounts of experiences with maternity care sound a strong note of concern that our maternity system has become too focussed on medical intervention,” she said.

The government expects to release the Maternity Services Review report in the new year.

Dr Brett Says: Sounds like there have been some great submissions to the review, the question now is will they listen? It will be interesting to see the conclusions that are drawn.

MONDAY, Dec. 8 (HealthDay News) — In older adults at risk for heart disease, a Mediterranean diet plus daily servings of mixed nuts may help manage metabolic syndrome, according to a Spanish study.

Metabolic syndrome describes a group of health problems that includes abdominal obesity, high cholesterol, high blood pressure and high glucose levels — all of which are risk factors for cardiovascular disease. Previous research suggests that a Mediterranean diet — which includes lots of cereals, vegetables, fruits and olive oil, moderate consumption of fish and alcohol, and low intake of dairy, meats and sweets — lowers the risk of metabolic syndrome.

This new study included 1,224 people, ages 55 to 80, at high risk for cardiovascular disease. They were randomly assigned to one of three groups. The control group received advice on a low-fat diet while the other two groups received quarterly education about the Mediterranean diet. One of the Mediterranean diet groups received one liter per week of virgin olive oil, while the other group received 30 grams per day of mixed nuts.

At the start of the study, 61.4 percent of the participants met criteria for metabolic syndrome. After one year, the prevalence of metabolic syndrome decreased by 13.7 percent in the mixed nut group, by 6.7 percent in the olive oil group, and by 2 percent in the control group.

There were no weight changes in any of the groups over the one-year study period. But the number of people with large waist circumference, high triglycerides or high blood pressure significantly decreased in the Mediterranean diet/mixed nuts group compared with the control group. This suggests that the Mediterranean diet with mixed nuts improves certain features of metabolic syndrome, such as oxygen-related cell damage, insulin resistance, and chronic inflammation, the researchers said.

“Traditionally, dietary patterns recommended for health have been low-fat, high-carbohydrate diets, which generally are not palatable. The results of the present study show that a non-energy-restricted traditional Mediterranean diet enriched with nuts, which is high in fat, high in unsaturated fat and palatable, is a useful tool in managing the metabolic syndrome,” concluded Dr. Jordi Salas-Salvado, of the University of Rovira i Virgili, and colleagues.

The study was published Dec. 8 in the journal Archives of Internal Medicine.

Dr Brett Says: So people with “metabolic syndrome” can have their heart disease rick factors reduced by eating a protein balanced diet. Not really a surprise if you really understand your body. We tend to give people lots of labels these days but people are rarely born with a true genetic condition (i.e. if they have the gene they always get the disease). Most of these conditions are brought about by our lifestyle (how we eat, move and think) and can often be reversed in exactly the same way. Hence eating a balanced healthy diet (and eating and thinking well) will drastically reduce your heart disease risk.