Friday Tidbits 06-08-12

When I first read the title “Diabetic Home Care Management”, I thought this could be interesting and presented in a way I may not have read before. The second part of the last sentence in true, but the article was only a rehash of old information that I already was aware of and presented no new ideas. Are publishers so desperate for items to publish that they rehash former articles. No, they are trying to reach new readers, which is good. Read the article here that appeared on May 31, 2012, but is left undated. Read the last sentence as this false. There is not a diabetic diet that is standard although dietitians want us to believe there is.

The second and third articles are about Herpes Zoster or shingles and are not something to be taken lightly. In the first study, they are telling us that we could have eye problems from shingles as well. So make a practice of seeing an ophthalmologist on a regular basis if you have had shingles.

Two significant conclusions were found in the study. First, those that have had the shingles vaccination showed a 51 percent reduced incidence of all herpes zoster disease and a 67 percent reduction in the incidence of postherpetic neuralgia, a potentially devastating complication of shingles.

The study found that patients between the ages of 59 to 70 have the best results from being vaccinated. Those older than 70 had a lower rate of effectiveness. It is still encouraging patients older than 50 to be vaccinated against shingles.

A second study found that the risk of adverse events for a period of 42 days of vaccination of adults 50 and older which was comparable to a large managed care cohort study.  The article also states that the vaccine is well tolerated in adults.

The fourth article for today is not one I like, but one that people need to be aware of and know that this may be the thing for some people. Other than medical reasons, I see no excuse for not exercising as even if you are confined to a wheel chair, you often can exercise. For a small seven percent minority it may increase heart and diabetes risk factors. Yes, for a small percent exercise is a health problem that needs consideration. The adverse responses were not explained by the health status of the participants, or their age, amount of exercise they did, or lack of improvement in cardiorespiratory fitness

The study authors do say they still recommend 150 minutes per week of moderate physical activity, or 75 minutes a week of vigorous activity. They did state that people doing exercise should have regular exams and consultations with their doctor.

The last article speaks to a common problem many of us have with our doctors. This I am agreement with and wonder when the day will come when we don't feel rushed through our appointments. I understand when lab reports are all good or improving that the doctor will not have a lot to do. Nevertheless, when I have questions, I like to ask them. Most of my doctors are now aware of this and know I have a list that I will leave, if they will answer them. One will email me the answers and the rest like to call, but one doctor insists on typing the answers and mailing them. All are acceptable to me.

A doctor's impatience, though, is often driven more by economics than ego. When a doctor has that pressure to see three, four, maybe five patients an hour, they can't wait for the exposition of the patient's story. That is exactly what they should do, but they can't. This is an interesting story of one doctor's struggle.

Friday Tidbits 06-01-12

Is this crying in the wilderness? From the comments to his blog, you would have to think that is true. Greed is the creed of many doctors and they will ride the current healthcare system to the end and take every dollar they can. At least Bob Doherty is talking about the issue on the Advocacy Blog.

There are efforts in many areas to reduce the rising costs, but little is being accomplished because of the attitudes of the medical profession. Almost every person in the medical profession believes that the current system is broken and needs to be fixed, but from the top down, they are unwilling to anything other than acknowledge the problem.

What surprises me is the opposition by many medical groups against groups that are attempting to lower costs. Two of attempts are shared medical appointments (SMAs) and concierge medicine. There are also small practices throughout the country attempting other experiments away from traditional medicine and the medical organizations are attempting to squash them early on. How backward do we have to become in our medical treatments before we have a patient uprising that will put some of the organizations out of business and demand better healthcare?

The second article is a different discussion that I have wondered about for some time. I am also happy to see this, as we need to finally sweep the low-fat mantra under the rug where it needs to be. I am not sure how accurate the research is as I am always suspicious of agendas from researchers. However, is written to show that certain fats are very beneficial for out brain activity.

This research is probably more reliable and evaluates almost 6200 women over the age of 65. It determined that consumed more monounsaturated fat than saturated fat retained greater levels of overall cognitive functioning. Those consuming more saturated fat actually had a decline in cognitive function. I do feel that there is an agenda associated with the study considering they singled out the saturated fat in butter, cheese, and red meats. These may not be the best, but in moderation should not be forbidden.

The third article disturbs me personally. Are our veterans considered second-class citizens or even third class? Veterans may be causing this themselves, but this is difficult to understand. I know when I was discharged, I was given no information about veterans benefits and it appeared like they were just glad to dump us on the street as the downsizing was already underway as the Viet Nam War was getting downsized.

Today, with a volunteer military force, this should not be happening. When discharged, those people should spend at least two days being taught about the benefits available to them. Handouts should be given explaining each benefit and the address and phone number for each local Veterans Affairs office.

It is shameful that so many veterans are without medical insurance and not availing themselves of medical services with the Veterans Administration. “It is true that the VA is “the nation’s largest health system and provides health care for many veterans through a system of medical centers, clinics, and other facilities…However, some veterans do not use VA health care services. Eligibility is based on veteran status, service-related disabilities, income level, and other factors, and even within the groups eligible for VA care, other factors, such as their proximity to VA facilities and the cost-sharing requirements, may affect the likelihood that they seek care in the VA system.””

Yes, there are hoops to jump through and some are tired of the treatment they have received by the military complex. Once you have been qualified, every year, you are required to submit a “means report” to determine your level of eligibility for benefits and the amount of your co-pay. Without this report, you may be denied benefits.

The last item is more for the political types and is indicative of what is happening in our government. If a sitting president can fund a campaign with government funds, then it is time to bring these funds back under an oversight committee and end the handouts.

Friday Tidbits 05-25-12

Normally I would do this in a regular blog, but it is becoming so disheartening the way the American Association of Clinical Endocrinologists is not updating the list of approved diabetes resources, that I must entreat them to add a few resources. It seems that a few of those on the current list are getting less traffic now than before they became listed.

Not only are they not listing additional resources, but now they will have to factor in the changes of the American Dietetic Association (past name) to Academy of Nutrition and Dietetics (current name) and their way of taking over the field of nutrition and forcing many in that profession to change to other professional organizations to be able to give nutritional advice to people in need.

I also think if the AACE cannot decide whether there are more websites that they can approve, then it is time to take down the page and stop portraying these as the only approved sites. I know there are other sites that deserve being mentioned and I will continue to visit them. Even professional organizations should act professionally. By not keeping their website vibrant and updated, they are doing a disservice to themselves and their profession. This says nothing about the patients that could benefit from some of the listings.

The site page listing the approved websites became active on September 27, 2011 and has not added another approve site since. Granted, the “experts” are probably busy earning a living, but does it take almost eight months with no additions. I am sorry, but this does not make for good public relations. I will continue to call attention to inaction on the part of the AACE. Endocrinologists should also be reminding their association that more needs to be done to expand the list as this could help them proudly point to the list of approved sites.

This is a very disturbing article to read. I had high hopes for telemedicine and thought it could be very useful in some cases. “In response to concerns about tele-medicine’s effect on patient safety, many states have begun prohibiting physicians from prescribing drugs without conducting a prior physical examination. In fact, more than 30 states have instituted this type of rule since 1998.” Apparently, some physicians and lawmakers do not want this to happen.

The laws in these states mandate that the patient be examined by physician before they can prescribe any drugs. This physical examination requirement (PER) has potential far-reaching effects for future programs. This may also be something that can be expanded to counter act the proposed FDA in their approval of over the counter (OTC) medications. It will be interesting to see how this plays out and if physicians can encourage lawmakers to expand these state laws.

Just the fact that the current regulations are costing lives should start making headlines, but will the news media even go there. This is something that needs attention of more bloggers, medical and patient. Also, read this by Jason Shafrin.

The last item is even bigger that the author may realize. He is talking about accountable care organizations (ACOs) that came into being under the Accountable Care Act of 2010. We should learn in June the possible outcome of these and much more when the US Supreme Court announces their decision. Will we still have ACOs or will they be a thing of the past. There have been many articles about the good and bad sides to ACOs and I chose this as one of the more positive writings

Unfortunately, what many writing about ACOs and like this one about health information technology (HIT) seem to ignore is the fact that health information technology is part of a law passed prior to 2010 to put computers in medicine so this will continue to be with us. Whether we like electronic medical records, electronic health records or other electronic care records, these are here to stay.

What we need is greater electronic security for our electronic medical records to prevent other people from gaining access to them and getting medical help at our expense. Yet this always takes a back seat in any discussion of the pros and cons of medical databases.

Friday Tidbits 05-18-12

Well, finally the American Medical Association decided they did not want this hung on their neck. I am talking about the over-the-counter medications the FDA is considering. Until recently, the AMA has been silent and it appeared that they were in favor of this happening. Apparently, there has been an up swell from within the ranks causing the AMA president to take an official stand.

Recently, Peter W. Carmel, president of the AMA published an article in USA Today and then repeated it in The Health Care Blog on May 13, 2012. Better late than never is apparently the motto of the AMA. Yet even this may not be enough as more in the medical community are speaking out against the FDA actions, both officially and in the news media and written word on the internet.

The next item that may interest you is a blog also on The Health Care Blog about our poor healthcare science status. Marya Zilberberg, MD wrote the article and has her own medical blog here. Dr. Zilberberg is not afraid of telling it like it is. She pulls together several blogs sources of good information; follow her links for additional good reading.

Dr. Zilberberg is refreshing in her analysis of “fast science.” She describes some of the problems science, especially medical science faces today. According to her, fast science is the reason people will not publish a second study that backs up a study that confirms a previous study and in many cases the funding dries up once something is proven. She sees a problem with the current trend of reputations and profits being the driving force behind the studies of today. This race to the finish line is ruining science and leaving much out of medical science that affects the clinical value.

She has no immediate answers, but knows that the future of medical use for clinicians is being damaged. She wishes “fast science” would slow down and become more valuable and maybe profitable in another way so that clinicians would find more value in it.

In my blog here, I covered some of the problems about studies not being published and Tom Ross covered the topic of false or as he says it, “bullshit” studies that cannot be replicated. This is some of the “fast science” that is causing many of the problems of today.

The third topic is about unpublished studies. It takes a slightly different tact than the one in my blog link above. It does list the same website for clinicaltrials dot gov. Unpublished trials are becoming a real problem and it is small wonder that doctors are complaining about missing information that could be vital in the treatment of patients.

The last item is about HSAs (health savings accounts) and if you have one, be prepared to have it invalidated. Three separate provisions in the new healthcare law plus its regulations will reduce access the HSA plans. The current healthcare law contains restrictions on deductibles and cost sharing. The medical loss ratio will also impose new restrictions on HSA plans and some cash contributions made under the new law will mean that the plan no longer qualifies as government approved. Read about the new snags that may make your HSA plan invalid.

Friday Tidbits 05-11-12

I have had this article for a while, but did not want to write an entire blog about it. I feel that it needs some exposure, especially since the president for medicine and science of the American Diabetes Association, Vivian Fonseca, MD, of Tulane University in New Orleans had to vehemently criticize it. If there is any truth to the study, you know that with the guidelines just issued, the ADA would have to criticize it to protect their newly published guidelines.

There does seem to be some discrepancies in the study, but it is still worth knowing about and pondering. Maybe this will encourage more studies that are more definitive rather than the multitude of short studies which cannot lead to accurate conclusions.  One thing that does stand out is noted by the authors - “an overlooked finding in the UK study was that in non-overweight diabetes patients, the drug, when combined with sulphonylurea, actually appeared to increase mortality.” This combination of medications (metformin and sulphonylurea) is part of the new guidelines and we should know about this.

The next items are all about the company Living Cell Technologies. Things are beginning to move rapidly for this Australian company, headquartered in New Zealand.  First – LCT has been successful in their patent applications to the United States and the European Union. This will allow them to begin FDA trials in the near future with their DIABECELL porcine cell transplantation into people with type 1 diabetes who are hypoglycemia unaware.

The product is already on the market in Russia and trials are underway in New Zealand and Argentina. DIABECELL will improve the quality of life of people with unstable type 1 diabetes though the normalization of blood sugar levels, a significant reduction in sometimes fatal episodes of unaware low blood glucose, as well as potentially allowing significant reduction of insulin dependency. The biggest plus is that no immunosuppressants are required (my emphasis).

I am continuing to read every press release I can to see what may be next and when. We know that when dealing with FDA, little or no information will be available until such time as it is coming out of trials and approval has been granted for use or it has been rejected.

Also recently Dr Andrea Grant has been named the new CEO of Living Cell Technologies. She replaces Dr Ross Macdonald.

Friday Tidbits 05-04-12 on Saturday

With so many things in the news this week, and many of them worth writing about, I felt it necessary to put Friday tidbits on a Saturday this time. I hope you think this is worth your time as much as I enjoyed reading and writing about these topics.

The first item is about using oxygen to regenerate bone. This could be very important for our soldiers, and then for others like those with diabetes having healing and amputation problems. The results of the Department of Defense-funded study were presented at the American Society for Biochemistry and Molecular Biology annual meeting, held in conjunction with the Experimental Biology conference in San Diego.

Multiple research teams have been trying to figure out what makes that huge difference between regrowth here and no regrowth there. The Tulane lab, in particular, has been investigating which genes are turned on, which proteins are expressed and which molecular activities change at the site of amputation over time.

The second article or blog exposes some of tricks our “caring” hospitals play on unsuspecting Medicare patients. Since Medicare will not cover some of the tricks hospitals commonly play, the full cost gets shoved on patients and some of these costs are exorbitant and falsely inflated as high as 800 percent for some over-the-counter pills.

What hospitals are doing is admitting patients as observational patients and not an inpatient status. This is their way of billing full costs to the patient and saving money for Medicare program payments. If there is a way to get the money, hospitals are finding ways of passing costs onto the patients and at the same time registering the patient for savings in the Medicare program. This is what I would term getting money in both hands and overcharging the patient and Medicare. Double dipping is another term that comes to mind.

What patients on Medicare are advised to do is check with their supplemental coverage plan to find out if indeed hospitals in their coverage can get by not notifying them of their status and billing requirements. Medicare does not care and will not cover, but in some states the supplemental plans require a hospital to notify the patient and get their signature before they can bill them.

I strongly suggest that you take the time to read this and then familiarize yourself with the rules in your state. Whether this is for yourself or another family member, know that forewarned is forearmed. This is one way to prevent being taken advantage of by our uncaring and unscrupulous hospitals.

The last item is on the American health care system and why we have less to say in our healthcare costs than any other developed country. What Americans do control in healthcare spending has declined faster than it has in any other developed country in the last few decades for which we have data.

The data shows that the United States has been moving in the wrong direction by removing health dollars from patients' control. In turn it has been putting your healthcare dollars in the hands of the government and insurers to spend. No other developed country has allowed its citizens to lose almost half of their healthcare dollars in the last twenty years.

In Canada, where a government monopoly over residents' access top health care is in place, the share of health spending controlled by patients has remained unchanged. With this happening, Canadians now enjoy more direct control over their health dollars than Americans do.

This tells us that we need to make some changes and regain the advantage by making long-term goals to return control of our healthcare funds and make this a top priority in the coming election.

Friday Tidbits 04-27-12

Even if I want to praise this study, I cannot. That is why I have included it in Friday Tidbits. There are too many unknowns and even the authors admit more studies are urgently needed because of the lack of evidence. I do not know if this was intentional, but the article even failed to identify where the study was published, right in the first paragraph. For an editor's choice, that is very poor.

The title says what I want it to say, “Insulin Usually Better Than Oral Drugs For Type 2 Diabetes.” Then the confusion starts about where it was published and even to the point of what the real reason is for comparing oral medications, specifically metformin to insulin. Those that follow my blogs know I am not one in favor of insulin being the medication of last resort for type 2 diabetes. All I can say about this study it that it is there and read it for yourself.

The second tidbit is about a different subject, but still should be interesting in many ways. While the stated purpose is to keep older drivers on the road, I can see many other possibilities, some good and some not so beneficial. It is a one-of-a-kind research auto that can monitor our concentration, stress levels, and driving habits while behind the wheel. The stated purpose is to develop new technologies to support older drivers.

The Intelligent Transport team at Newcastle University, UK have converted an electric car into a mobile laboratory. Named 'DriveLAB', the car is outfitted with tracking systems, eye trackers and bio-monitors in an effort to understand the challenges faced by older drivers and to identify where the key stress points are.

Research shows that giving up driving is one of the key factors responsible for a fall in health and well-being among older people, leading to them becoming more isolated and inactive.

The negatives I can see if this makes its way to the USA is many enforcement agencies and especially auto insurance companies will use this information to restrict drivers and raise auto insurance costs. In some areas of the country, this may indeed be a good thing. In the largely rural parts, this may be a help for drivers and if auto insurance companies are not allowed at the data, this could be a benefit to older drivers when other means of transportation are unavailable.

The last tidbit is an area that more people are learning about, but the doctors as a whole will not acknowledge or accept in most cases. It is interesting that the naturopathic and medical doctors did work together in this study. How well they did is an unanswered question and the only fault I can find that really bothers me about the study. From that, I may misinterpret some things, chiefly that they do not want to be identified by their medical professional organizations.

The other part of this is a blog by a type 1 blogger and her discussion about some of the trials and discoveries in treating her diabetes. This is well worth the time to read from her perspective.

Yes, some medical doctors will work with naturopathic, holistic, and complementary medicine doctors very well. I will not object to any doctor working with another doctor in a different type of medicine. There are many holistic, naturopathic, and complementary medicine doctors that will not work with other doctors of any type as they can also become so full of their own importance that they think they are the only answer. These are the personalities in any type of medicine that all of us can do without as they do more harm that good in the long-term.

A Few More Friday Tidbits

If you are a person that follows herbal and Chinese medicine, you may be interested in reading this article. I say great for the Australian researchers for uncovering some problems with “traditional” Chinese medicines. The new DNA sequencing technology developed by researchers at Murdoch University in Perth, Australia exposed some potentially toxic plant ingredients, allergens, and traces of endangered animals.

This was just the tip of the iceberg for these researchers as they also discovered animal impurities in some products and some cow DNA that in some countries may violate religious and cultural practices. Not only will this new procedure assist customs agents around the world, but should also help curb trafficking in endangered wildlife species.

The second tidbit comes from ADA and how they are patting themselves on the back for laws passed in Georgia and Alaska to protect school children with diabetes. I am not quite ready to give the American Diabetes Association full credit for these victories although this is what they want you to think. How much lobbying was done the ADA has not been reported by either state yet and the one small article I found in an Alaskan newspaper says the law was an effort by several individuals and no mention of ADA was given. I may have more in the future if I can find solid information.

The third tidbit also comes from the ADA and the European Association for the Study of Diabetes (EASD) because they have issued a joint position statement emphasizing patient-specific treatment of hyperglycemia in persons with type 2 diabetes. The new guidelines are reported concurrently in the April 19 online edition of Diabetes Care and in Diabetologia.

The last guidelines specific to management of hyperglycemia were published about 4 to 5 years ago, and developments that are more recent have now been incorporated into the new guidelines. Why the wait is a question I must ask, as it would seem with the developments that are coming at an ever increasing rate would demand new guidelines on a more frequent basis.

In the Medscape article, I do not understand why the ACCORD study has to be held up as a benchmark. Vivian Fonseca, MD, ADA president of medicine and science states, “On the basis of findings from ACCORD (Action to Control Cardiovascular Risk in Diabetes study) and other studies, the ADA has set the HbA1c goal at 7% in general, but with some individualization.” Hopefully, we are seeing a move away from the “one-size-fits-all” mantra, but while this statement is made, I am willing to say that the rank and file will continue in their old ways for several years.

"For patients with advanced cardiovascular disease, reduced life expectancy, and multiple medical problems, for example, the goal may be higher," Dr. Fonseca said. "For patients who are newly diagnosed and very motivated, the goal may be lower."

Another recent change underlying the new guidelines is the recognition that many people with diabetes will need multiple agents. Yes, that is the problem of the ACCORD study and why it was stopped early, too many problems developed with people dying from multiple agents and the aggressive nature of them being pushed on patients to manage blood glucose levels. When is the medical community going to understand that this will not always work and insulin may be the better route when multiple agents are required? This is more evidence that insulin should not be the medication of last resort.

I will be working on more about the new guidelines, but when I will have it ready is unknown. In the meantime, here is the full text PDF files for the ADA and for theEASD.

More Friday News Tidbits

Excellent study for healthy adults, but it has little or no value for anyone with type 2 diabetes. Even the small size of the study makes one have to ask if there is any value in studies like these. Of course, it is a preliminary study for determining the value for additional studies.

There is two pieces of information that I can take from this study. It explains why some people are able to eat more starchy foods than others. It also reinforces the abuse people are receiving in the one-size-fits-all approach that the American Diabetes Association, the Academy of Nutrition and Dietetics (formerly the American Dietetic Association), and the American Association of Diabetes Educators have as their mantra.

This second study is surprising from many aspects. A news organization (CNN) reporting something potentially this important and the leading medical news feeds completely ignoring the story. There have been other articles (see this ABC news article) like this in the past, but this is the most recent and seems the most promising.

I will echo the warning from the ABC news article – “The doctors expressed concern that news of this research could lead transplant patients to stop taking their immunosuppressants, which almost guarantees that they will experience organ rejection and loss of the transplant.”

So far, this has only been done for patients with kidney transplants and other organs may well be on the way for this procedure, but to date have not been openly attempted. The study was published March 7, 2012 in the journal Science Translational Medicine. The study describes the eight kidney transplant patients who each received a stem cell therapy that allowed donor and recipient immune cells to coexist in the same body thus eliminating the need for daily immunosuppressants.

The third article is about promoting breakfast that has foods with a low glycemic index that may help level out blood glucose throughout the morning and after the next meal. The researchers presented their findings at the Institute of Food Technologists' Wellness 12 meeting.

Researchers emphasized that the low glycemic index breakfast foods can increase the feelings of satiety and fullness and this may help people be less likely to overeat during the day. Even though they are emphasizing low glycemic index foods, they make no nutritional recommendations. They only state that these foods produce a gradual rise in blood glucose and insulin levels, which is considered healthier for people with diabetes.

The researchers did say the ideal breakfast has these attributes:

• Savory
• Portable
• Pleasing texture
• Fills you up for extended periods of time
• Satiates quickly so less is consumed
• Affordable for the whole family to eat every day
• Non-fried
• Delicious without making you feeling guilty

They then listed low-and non-glycemic foods that do promote satiety (feeling of fullness):

• Rolled oats and groats (hulled and crushed grain, usually oats)
• Pulses
• Whole grains
• Nuts and seeds
• Sweet potato
• Barley B-glucan
• Yam flour
• Glucomannan
• Durum pasta
• Vegetable flours
• Chia / flax seed
• Resistant starch

The researchers stated it may present challenges for food manufacturers, but it is well worth it to develop these products because of the prevalence of diabetes and prediabetes in the United States and beyond. It is estimated that by 2030, more than 16 percent of the global population will have a blood glucose problem.

A Few Tidbits from Medical Blogs

Many topics come across my computer screen and many times, I just read and forget about them. However, lately they have become more interesting and a few are worth blogging about.

The first short article really got my attention. Having diabetes and having much information shoved at me in a “one-size-fits-all” mantra by the ADA, AADE, and many other medical professions, this article makes me very happy. John Goodman titles his blog “Why One-Size-Fits-All-Medicine Doesn’t Work.”

The second short article is about healthcare acronyms. I actually laughed about the dilemma that doctors have with some acronyms. Just this short article was interesting by itself, but the reference link at the end is really what I want to emphasize. Do not be in a hurry to skim over it as it is a 51-page PDF file, and loaded with information. I have not yet read it all, but I will be later as there is a lot to digest, includes some very handy graphs, and charts.

The third blog is about generic insulins. Don't get excited. Apparently this will not be likely to happen under current FDA regulations. Too many hoops to jump through and Big Pharma is working hard to keep this from happening. Still, it does add to the problems people with diabetes will continue to face and the budget will not get relief soon.

The fourth and final item for this blog is about adding nurse practitioners to a doctor's office. In some states this is already working where there are not enough doctors to meet the demand. Still, this may have drawbacks unless the mindset of doctors is changed, states legislate this as a possibility, and nursing education is upgraded in some states.