May 5, 2012

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.

May 4, 2012

What Is Best for Young Type 2 Patients?

This was to have been part of my Friday tidbits, but this is getting fever pitched publicity so I am publishing this.

A youth study of type 2 diabetes patients to determine optimal potential glycemic control seems to have determined that a drug pulled from the market for adult type 2 patients is the drug of choice for our youth. The ages of people eligible for the study included youth from age of 10 to 17. In light of Avandia being pulled from the market, I have to wonder at the value of the study. Or, is this another attempt to bring it back on the market for the youth with type 2 diabetes. I can only hope this will not happen.

Realizing that the ages selected for the study is the age when our youth are trying to spread their own wings, find their own place in this world, and rightfully the most rebellious about authority, it is not surprising that overall failure rate is above 50 percent. I can also understand the need to establish evidence for clinical application in the treatment of young patients with type 2 diabetes.

The study was funded by the National Institutes of Health. Three groups were analyzed, one on metformin and Avandia, one on metformin only and one with metformin and intensive lifestyle intervention. None (that is right – none) of the groups did that striking well to clearly say one was better by far than the others. The two-drug regimen did do enough to be declared the better treatment option.

Some youth did lose weight at the start, but most did not and the majority actually gained some weight over the study period. Not a stellar performance by any standard. Read the results posted by NIH, and two articles in the New England Journal of Medicine here and here.

I am wondering, aloud or in writing if you prefer, why we expect our youth to lose weight on the information on food put out by the USDA and advocated by the American Diabetes Association, the Academy of Nutrition and Dietetics, the American Association of Clinical Endocrinologists, and the American Association of Diabetes Educators. Even a few nutritionists follow this, but more are finding it more important to actually teach nutrition and keep the preferred diet of many with diabetes nutritionally balanced rather than loaded with carbohydrates.

I also wonder why doctors prefer medications over any other form of treatment, when it is obvious that our youth needs to reduce their carbohydrates and whole grain consumption. Input some physical activity, less cell phone use, and less time spent sitting, and our youth may realize some real weight loss. There is some excellent discussion about this here. I am not a member so I can only read, but the discussion is good and some excellent points were raised.

Do keep your eyes open, this is making the rounds in the different medical circles and publications. Read the article in WebMD for a slightly different perspective. I suspect the newspapers will be featuring it also.

May 3, 2012

Finally, With Eyes Wide Open

This is an odd title, but an even odder message from an unexpected source. I guess if you believe in something long enough it may just happen. I have been saying that others should be promoting insulin earlier for the treatment of type 2 diabetes and not be the medication of last resort. Finally, Jonathan Marquess, PharmD, from the Institute for Wellness and Education Inc in Atlanta, Georgia is saying it.

I do not mind that it is a pharmacist saying this as long as this happens more frequently. He does not criticize the American Diabetes Association (ADA) for setting the A1c level at 7.0%, but at least he is saying, “We know that diabetic complications happen at a more prevalent rate when the A1c is above 7. Those diabetic complications are where we're really spending big, big money in this disease state.”

I agree, but would say that we need to ignore the ADA and adopt the American Association of Clinical Endocrinologists (AACE) level of 6.5%. At least then, there would be some room for error although even this could or should be lower. I also appreciate this statement by him, “All too often, physicians, nurses, and pharmacists, will advise patients to take oral agent #1, then oral agent #2, then oral agent #3, and then say, "Wow, I guess it's time to start insulin."”

He does cite some statistics that are alarming, but believable. Of the approximately 43 percent of people having A1c levels above 7% he does not make any statement about how important blood glucose testing should be. This I think is where he misspoke or possibly was misquoted as these people with diabetes need to be testing more and moved over to insulin to prevent or delay the development of complications.

It is true that people with diabetes need to be concerned with morning fasting blood glucose levels and their two-hour postprandial glucose levels. This should be important whether their A1c is above or below 7%.

When he answers the question about insulins, he is correct that we have some great basal insulins and rapid-acting mealtime insulins. His answer about misconceptions about insulin is a little outdated and he missed a great opportunity to dispel a few more of the insulin myths. He concentrated more on fear of needles and people being afraid of the past big needle size. He did mention that people think of insulin as inconvenient and many have the fear of hypoglycemia. I will give him credit for attacking the perception that going on insulin means you did something wrong and had been a bad patient. Sometimes this cannot be helped so it is not their fault.

He did mention insulin pens, which are not available to everyone, but are becoming more popular and available. These will be easier to teach and should help by reducing medication and dosing errors. Insulin pens may also help patients overcome dexterity problems.

Dr. Marquess did shine when talking about education and that it takes time. He talks about patients needing to watch what they eat, learn what the numbers mean in blood glucose monitoring. He talks about physical activity and the potential for problems of hypoglycemia and how to treat with glucose tablets. He did an excellent presentation about needing to go back and reinforce many ideas on a continuous basis and ask the patient how they are doing.

For such a short interview, he covered a lot of material fairly well and I commend him for that. I have heard doctors fumble and make a mess of less material. Read the interview here.

May 2, 2012

Military-Funded Neuroscience - Ethical Concerns

This is very disturbing and should be alarming for everyone with people in the military. This is something that has been happening since World War II. When I was in the military, I would hear whispers of this experiment and that experiment which left servicemen unstable and confined to locked down areas at certain bases. Why I was stationed at a few of the bases, I do not know, but more of what I am reading is very disturbing and unsettling to realize that the U.S. Military is still putting service personnel and ex-service personnel at risk for classified drug and mental experiments.

The military and intelligence department are experts at classifying medical experiments to prevent families from ever learning the truth about what happened to their loved ones. This is criminal at least and these experiments were carried out in secrecy, making disclosure a security breach and a prisonable offense.

I wish I knew more that I could disclose, but all I heard was whispers about some of the experiments so it is only hearsay. Unfortunately, until the current state of affairs, little was possible because of the cloak of secrecy.

The person that let this be published is probably wondering what happened to his/her career. While it is possible that someone in Congress wants this exposed, even they would be very careful because the military and intelligence departments have long memories and there are things that they will do.

If you have doubts, please read this about Dr. Sanjay Gupta and his investigative report about U.S. Soldiers used as drug test guinea pigs. Even when I was stationed in Maryland, we were told to stay away from Edgewood Arsenal. We all know that arsenal was a misnomer and that there was activity unlike any found at a true arsenal.

Both articles that I used as reference are good to read and are the type that needs exposure and serious concern by all U.S. Citizens. Even my blog here and here fits the context of how our military personnel are mistreated and abused by the military and intelligence department under the cover of national security.

I say it is time to end the reign of mad scientists in our military and intelligence department.

May 1, 2012

FDAs OTC Proposal – Bad for Patients

I hate to admit this, but did I miss something in the discussion of FDAs new over the counter drugs (OTC). Thank goodness, one doctor kept things in perspective and really exposed the true purpose. Most of us were looking at the advisability of doing this and the dangers in people self-prescribing drugs and the problems this would cause. This is still a valid concern, but pales in comparison to what this doctor exposes.

Dr. Matthew Mintz in his blog Dr. Mintz' Blog blows the lid off and does state the obvious quite well in fact. We as patients should be afraid and if this goes through, our costs for medications will go through the proverbial roof and keep on going up. Dr. Mintz points to the fact that insurance will no longer cover a drug that becomes OTC. Therefore, if you only had a small copay, now the cost will be 100 percent.  Take time to read his blog.

This is the technique of the current administration to reduce medical costs, but not for the consumer. By not having to see a doctor to get your prescription, that is the first cost savings for both the insurance companies and Medicare/Medicaid. It will be less costly to pay a pharmacist to advise you which may be the best medicine, but the entire cost will be on you. If the medication is normally $100 for a 30-day supply of pills, that is what you will pay to get the medication. Currently you might have a 20 percent copay and $80 would be covered by insurance.

The interesting fact is that many branded blood pressure, asthma, cholesterol, and diabetes medications will not be any cheaper just because the become over the counter medications. It is just that you, as the consumer will now pay the entire amount like the people without insurance. The insurance companies will not cover over the counter medications so this is one cost they will not have to be responsible for.

The government carefully kept this out of the press and is moving faster than the FDA normally does to slide this through. So be prepared and afraid for your pocket book in the near future if this does get the final approval. Most medical professions did not comment on this at all and the pharmacists were in favor of this action. The patients were not represented and we will be the ones paying the higher medication costs. The government will proclaim how they have been able to cut medical costs and expect you to vote for them in November.

You may not be able to vote if you spend all your money for over the counter medications and have nothing left for the high cost of fuel to get you to the voting booth. Go ahead and laugh, but come November, this may be what happened. This is what the current administration is counting on.

What I find amusing is the proposed use of kiosks. "For example, kiosks or other technological aids in pharmacies or on the Internet could lead consumers through an algorithm for a particular drug product."

Can you just imagine patients going up to an ATM-like machine, entering their conditions, allergies, blood levels, etc. and having the computer spit out exactly what dose of what medicine that they should be taking for their high blood pressure or high cholesterol?  Would there be a soda-like machine right beside it that could dispense the appropriate medication?”

If you think pharmacies are crowded now with very little privacy, what will a bank of kiosks do for the space. There will be kids wanting to punch buttons just for the fun of it. With all this more, how long will the electronics be functioning? This is one place I will want to avoid if at all possible.

April 30, 2012

Nutrition Needed To Improve Diabetes Diet

Again, those wanting to make a name for themselves use a small study and publicize as widely as possible. This time it is in the name of nutrition. The study is faulty because there was not a control group or a blinded study. Another weakness or fault of the study was not publishing the criteria for selection of study participants. Yes, a few qualifications were mentioned, but these should not have been the only criteria in selection.

Yes, I am being very critical of most studies proclaiming this and that about what people with diabetes should be consuming. Saying that we should be eating a set number of daily servings of low glycemic index foods is not saying that the nutritional needs of an individual are being met or that this is what their body can tolerate. What irritates the worst is a one-size-fits-all mantra that everyone keeps promoting.

Low glycemic index foods can help manage blood glucose levels, but should be used as a guide only as just selecting this type of food can be nutritionally deficient and not the selection we may need for minimum nutrition goals. Yes, low glycemic index carbohydrates that are digested slowly, and are less likely to spike blood glucose levels than would carbohydrates with a high glycemic index may help blood glucose levels, but are they nutritious enough?

The article does say the participants also ate about 500 fewer daily calories and added vegetables, fruits and nuts, and seeds to their diet - all foods that are on the low end of the glycemic index. Again, no nutritional information is given nor are the combinations even discussed.

Carla Miller, associate professor of human nutrition at Ohio State University and lead author of the study stated, "I think we have enough data to say that consuming a low-glycemic-index diet has beneficial outcomes for people with diabetes." “That's a significant statement because no guidelines currently exist for consumption of low-glycemic-index foods,” she noted. “Some experts think a focus on the glycemic index in foods rather than carbohydrates and sugars is too complicated for patients with diabetes to follow. Miller doesn't think that's the case as long as patients receive adequate nutrition education - which was another finding of hers in a study published in 2009.”

What I find amusing is they talk a good line and have good ideas, yet they will not publish this nutritional information online for people to educate themselves. This would not put any money in their pockets like a study. They give us findings that we can be led to believe that good nutrition was taught and people were allowed to make variations in the diet to fit what their meter told them. I doubt this was allowed or even considered. The mantra was low glycemic index level foods and only this.  They also do not mention whether the nutritional level of the food participants were asked to consume were monitored. Yes, at the start of the study, all 35 participants completed a baseline assessment and participated in a five-week group nutrition intervention. No mention is made about the extent or type of nutrition information given, but I can imagine the bulk was about the glycemic index and very little else.

Another disturbing fact missing is that to be eligible, the participants had to have a hemoglobin A1c value of 7 percent or higher; however, I can find no evidence that of a comparative A1c at the completion of the trial. This is disturbing on so many levels. Did they require people with high level A1c's at the beginning to make sure that they would be less likely to complain about their high or higher A1c's at the end of the trial?