[News item] Only half of patients take their medications as prescribed: Are there interventions that will help them? — ScienceDaily

Only half of patients take their medications as prescribed: Are there interventions that will help them? — ScienceDaily.

From the news article

Date:November 20, 2014

Source:Wiley

Summary:The cost of patients not taking their medications as prescribed can be substantial in terms of their health. Although a large amount of research evidence has tried to address this problem, there are no well-established approaches to help them.

The cost of patients not taking their medications as prescribed can be substantial in terms of their health. Although a large amount of research evidence has tried to address this problem, there are no well-established approaches to help them, according to a new systematic review published in The Cochrane Library. The authors of the review examined data from 182 trials testing different approaches to increasing medication adherence and patient health. Even though the review included a significant number of the best studies to date, in most cases, trials had important problems in design, which made it hard to determine which approaches actually worked.

Only about half of all patients who are prescribed medication that they must administer themselves actually take their medication as prescribed. Many stop taking medication all together and others do not follow the instructions for taking it properly. This has been the case in many different diseases for at least the last half a century. In conditions where effective drug treatments are available, patients who take their medications as per their provider’s instructions can see a real difference to their health. However, when researchers in the field have tried to draw together evidence on this, they have found it unreliable and inconsistent.

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[News item] Parents skipping needed care for children, pediatricians say | Association of Health Care Journalists

Parents skipping needed care for children, pediatricians say | Association of Health Care Journalists.

BY JOSEPH BURNS | NOVEMBER 26, 2014

High-deductible health plans (HDHPs) discourage families from seeking primary care for their children, according to the American Association of Pediatricians. The problem is so severe that the federal government should consider limiting HDHPs to adults only, the AAP said in a policy statement published in Pediatrics.

“HDHPs discourage use of nonpreventive primary care and thus are at odds with most recommendations for improving the organization of health care, which focus on strengthening primary care,” the association said in its statement. Under the Affordable Care Act, preventive services are covered in full without charge.

This is the second time in as many months that a report has shown consumers skipping needed care because of the cost. Last month, we reported that out-of-pocket health care costs force one out of every eight privately insured Americans to skip necessary medical treatment, according to the survey from the AP-NORC Center, “Privately Insured in America: Opinions on Health Care Costs and Coverage.” The Robert Wood Johnson Foundation funded the survey. In a report earlier this month, “Too High a Price: Out-of-Pocket Health Care Costs in the United States,” the Commonwealth Fund expressed similar concerns.

In an article about the policy statement, Alyson Sulaski Wyckoff, associate editor of Pediatrics, quoted Budd Shenkin, M.D., the lead author of the AAP’s policy statement on HDHPs, saying parents are so concerned about the cost of care that they don’t bring in their children when they should. “They’re reluctant to come in, they seek more telephone care, they’re reluctant to complete referrals, and they’re reluctant to come back for appointments to follow up on an illness,” he said.

For children with chronic conditions, foregoing care can exacerbate illnesses, said Thomas F. Long, M.D., chair of the association’s Committee on Child Health Financing. “If it’s going to cost them out-of-pocket money, they may say, ‘Well, it’s just a cold, I don’t need to see the doctor.’ And ‘just a cold, turns into ‘just pneumonia,’” he added.

The problem of delaying necessary care is one Paul Levy addressed in his blog, Not Running a Hospital, about HDHPs. “Beyond the sad impact on individual families in any given year, I fear that the economic backlash of these policies will be a deferment of needed health care treatments and a resulting future bulge of cost increases. We’re playing Whac-A-Mole here,” he wrote.

For the Commonwealth Fund, researchers found that among privately insured consumers across all income groups, low- and moderate-income adults were most likely to skip the health care they need because of high out-of-pocket costs.

It’s no surprise that adults with the lowest incomes were most likely to skip needed care, the fund reported. Among consumers earning less than $22,890 annually, 46 percent cited at least one example of skipping needed health care because of copayments or coinsurance: 28 percent did not fill a prescription; 28 percent skipped a medical test or follow-up treatment; 30 percent had a medical problem but did not see a doctor; and 24 percent did not see a specialist when needed.

When deductibles are high relative to income, consumers tend to skip care as well, and low- and moderate-income adults had the most trouble, the report showed. Consumers whose deductibles represent 5 percent or more of their income cited at least one example of skipping needed health care because of their deductible: 29 percent skipped a medical test or follow-up treatment; 27 percent had a medical problem but did not go to the doctor; 23 percent skipped a preventive care test; and 22 percent did not see a specialist despite their physician’s advice.

For an article in Modern Healthcare, Bob Herman covered this topic well. He cited the case of a woman in Indiana who was searching for a health plan on HealthCare.gov. A single, 40-year-old nonsmoker, this woman could choose from 29 plans and 24 of them were considered HDHPs, he wrote.

Under IRS rules, (PDF) an HDHP in 2015 is defined as one that has an annual deductible of at least $1,300 for an individual and $2,600 for a family coverage and annual out-of-pocket costs that do not exceed $6,450 for individual or $12,900 for a family.

The Commonwealth Fund report showed that 13 percent of consumers with private health insurance had plans with a deductibles equivalent to 5 percent or more of their income; that figure includes 25 percent of adults with low incomes and about 20 percent of adults with moderate incomes ($11,490 to $45,960 a year for a single person).

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Do probiotics work? | Science Life

Do probiotics work? | Science Life.

From the 25 November 2014 University of Chicago press release

Walk past the dairy case or health food section of any grocery store and you’ll see a variety of yogurts, milk, shakes and even granola bars that say they contain probiotics. These “good” bacteria are added to foods to promote a healthy environment of microorganisms in the digestive tract, supposedly to aid in digestion and promote good gastrointestinal health. Are these claims based in real science, or are they just another food fad to squeeze money out of consumers?

We spoke to Stefano Guandalini, MD, Section Chief of Pediatric Gastroenterology, Hepatology, and Nutrition and Medical Director of the Celiac Disease Center at the University of Chicago, about probiotics and prebiotics, the precursor that provides fuel for the supposedly beneficial bacteria. He and his colleagues published a review paper recently looking at various studies and clinical trials that used pre- and probiotics to treat symptoms of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) in children. The following is an edited version of that conversation.

Many people are familiar with the term probiotics, but what are prebiotics?

Prebiotics are basically the metabolic fuel for probiotics. It’s a term that encompasses a number of mostly carbohydrates that are present in vegetables and grains, for instance in wheat, artichokes, legumes, etc. They are only partially digested by the human intestinal tract, so they reach the colon where they are fermented by bacteria. We have trillions of bacteria happily living in our colon, and they ferment these substrates. They’re happy with them, and so they thrive. The idea of taking prebiotics is that you can encourage the growth of good bacteria in the gut by providing them the food they like.

Can you do that by changing your diet? Or is there a pill you can take?

You can do in both ways. If your diet is rich in things like onions, garlic, wheat, legumes and artichokes, then you ingest a lot of prebiotics already. But there are also chemically identifiable supplements that also serve the same purpose.

Are prebiotics effective for treating digestive diseases?

In theory these are a good way of promoting a healthy microflora in your gut, and one would expect beneficial effects, but in reality it has been quite disappointing. There’s not a lot of practical use for prebiotics as we speak, in terms of clinical effectiveness. The only niche in which we found them to be successful is as an additive to formula for premature babies, because human milk actually contains plenty of prebiotics. Other than that, there hasn’t been much practical use. In fact, in our review, we saw that prebiotics have been tried for treating irritable bowel syndrome, but actually with mostly negative results.

With inflammatory bowel disease, it’s likely different. Several preparations have been tried with mixed results, but again, nothing sticks out as important or with clinical relevance. So in spite of good conceptual reasons to expect good results, they have not been proven very effective.

How are probiotics different from prebiotics?

Probiotics are microorganisms that, if ingested in adequate amounts, confer a health benefit to the host beyond the nutritional value. In practical terms, it’s a class of mostly live bacteria that have been studied for a long time and found useful for treating or preventing a number of clinical conditions.

Our review paper focuses on the efficacy of probiotics for IBS and IBD, including both ulcerative colitis and Crohn’s disease. For IBS, we have some good evidence in adults that some probiotics actually seem to be effective in relieving some of the symptoms, mostly the bloating and abdominal pain that accompanies IBS, especially when there is either diarrhea or constipation that goes along with it.

And in the case of ulcerative colitis, there is a growing body of evidence supporting the efficacy of some specific strains as an adjuvant in the course of the therapy. Crohn’s disease is different, however. People have tried multiple ways of addressing the problem with different strains of probiotics, different clinical settings, different endpoints, but none of the researchers were able to show any efficacy with probiotics in Crohn’s disease patients.

You can go into any grocery store and find yogurt and other foods that have probiotics added to them. Do those products do any good?

Not all probiotics are equal, that’s an important thing to stress. People think they can walk into a store and pick any probiotic from the shelf and they’re just the same. That is not the case. Different probiotics have different strains and concentrations of bacteria that have different properties. Only a minority of them has been tested properly in clinical trials to find if they were indeed effective.

In reality, yogurt by definition has to have two strains of bacteria—Lactobacillus bulgaricus andStreptococcus thermophilus—to create the yogurt. However these strains do not pass the gastrointestinal tract intact. They are destroyed by the acidity of the stomach and the enzymes of the pancreas, so nothing reaches the colon and it’s not beneficial. However, like you said, some yogurts are now enriched with other live bacteria of different strains. Some of them indeed include strains that survive the passage through the intestinal tract and then can be beneficial, and some make that claim but they don’t, and it’s hard for the general public to discriminate. Activia, for instance, is one of the good preparations. These yogurts actually do have strains of live Bifidobacteria that have been studied and may be beneficial. Yakult, containing well-studied strains of Lactobacilli, is another one that does the same.

Is a food product the best way to treat symptoms of IBS or IBD, or do you need a special preparation in a pill?

The best way is to use specific strains that have been validated through clinical trials and published in peer-reviewed journals to show efficacy, and if possible reproduced by different groups using the same preparations. So the list of probiotics that have gone through this process is actually very short:

• There is a product called Align, based on a specific Bifidobacterium, which is mostly for adults with IBS.
• For infants and colicky babies there is some proof of effectiveness for a product called Biogaia, which has the bacterium Lactobacillus reuteri in it.
• Then we have Culturelle with Lactobacillus GG, another one with a long record of scientific, well conducted studies, which has been found effective in treating diarrheal diseases.
• Florastor, which contains a yeast [Saccharomyces boulardii] instead of bacteria, is also effective in treating and preventing antibiotic associated diarrhea. Children who get antibiotics often develop diarrhea, and in many cases that can be prevented by the use of Florastor.
• Finally there is a preparation called VSL #3, which is a highly concentrated preparation of 8 different strains of probiotics. This has received a great deal of attention by the scientific world to treat a number of conditions. It seems to be effective for ulcerative colitis, both in adults and children, and it has been found effective in irritable bowel syndrome as well.

Outside of this incredibly short list, however, there is nothing else. There is no other probiotic that has been found to be effective in rigorous, controlled clinical trials. This is not to say they aren’t working, it’s just to say we don’t have any scientific proof yet.

Are probiotics safe?

One thing that all these probiotics have in common is that they are relatively safe. They are very tolerable and basically create no side effects. One caveat is for premature babies and people with profoundly depressed immune systems. Some of these preparations might be contaminated by yeasts, which can be dangerous in those cases. But with these two exceptions, probiotics have been used in large amounts for generations now. So they are safe, but if there is no clear cut indication, I wouldn’t necessarily recommend them. That’s a question I often get from patients, “Could we use probiotics?” And if it’s not to treat a specific condition and they just think it will improve health, I tell them it’s not necessary.

Where is the research on prebiotics and probiotics headed?

It’s interesting. There was a boom for years and then it died down quite a bit. From a laboratory standpoint, we don’t understand a lot about how the probiotics work. So I think the attention of scientists now is more focused on understanding the mechanisms of the interactions between these bacteria and the host, which are different between different individuals. Each one of us has a unique composition of intestinal flora. The same probiotics may have a different effect for you and me, because they interact with trillions of other bacteria, which are different for each person. So all of these nuances are going back to basic science before moving further to the clinical arena.

That seems to be a theme of microbiome research. Everyone agrees on its profound effect on our health, but getting to where you could change something meaningfully to treat a disease is a different thing.

Right, we are not there yet. It’s very complicated. As we have said many times, the genome of the microbes is thousands of times more complex and more numerous than the human genome. When we are talking about personalized medicine, we are really talking about the microbiome: how to understand all the subtle interactions with the human host, and how to possibly exploit this for health reasons. It’s an incredibly interesting area, and my colleagues here at the University of Chicago,David Rubin, Eugene Chang, Cathryn Nagler, Bana Jabri and others are actively working on this. We aren’t there yet, but we will. I have great enthusiasm in this. I think this is the medicine of the future.

[TedTalk] How playing an instrument benefits your brain – Anita Collins

From the YouTube site

Published on Jul 22, 2014

View full lesson: http://ed.ted.com/lessons/how-playing…

When you listen to music, multiple areas of your brain become engaged and active. But when you actually play an instrument, that activity becomes more like a full-body brain workout. What’s going on? Anita Collins explains the fireworks that go off in musicians’ brains when they play, and examines some of the long-term positive effects of this mental workout. Lesson by Anita Collins, animation by Sharon Colman Graham.   http://youtu.be/R0JKCYZ8hng

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[News article] Web-savvy older adults who regularly indulge in culture may better retain ‘health literacy’ — ScienceDaily

Web-savvy older adults who regularly indulge in culture may better retain ‘health literacy’ — ScienceDaily.

From the news article

Date:November 25, 2014

Source:BMJ-British Medical Journal

Summary:Older people who are active Internet users and who regularly indulge in a spot of culture may be better able to retain their health literacy, and therefore maintain good health, suggests research.

…

There was a link between age and declining health literacy, and being non-white, having relatively low wealth, few educational qualifications, and difficulties carrying out routine activities of daily living.

Poorer memory and executive function scores at the start of the study were also linked to greater health literacy decline over the subsequent six years.

Around 40% of the entire sample said they never used the internet or email, while one in three (32%) said they did so regularly. Similar proportions said they had consistently engaged in civic (35%) and/or leisure (31%) activities over the six year follow-up period.

Almost four out of 10 (39%) said they had regularly engaged in cultural activities, such as going to the cinema, theatre, galleries, concerts or the opera, during this time.

Across all time points, internet use and engagement in civic, leisure, or cultural activities were lower among those whose health literacy declined.

After taking account of influential factors, only the links between regular internet use and engaging in cultural activities remained statistically significant.

But each factor appeared to exert an additive effect, and a combination of all four seemed to afford the best protection against health literacy decline, a finding that was independent of any tailing off in cognitive function.

This is an observational study so no definitive conclusions can be drawn about cause and effect.

,,,

[Reblog] Health Care for Dummies (and Innovators): In search of a practical definition of health | The Health Care Blog

Health Care for Dummies (and Innovators): In search of a practical definition of health | The Health Care Blog.

From the 25 November 2014 post

By LESLIE KERNISAN, MD

For a while now, I’ve been working on an ebook about making digital health more useful and usable for older adults.

(Don’t hold your breath, I really have no idea when it will be done. I can only work on it for about an hour every weekday.)

In reflecting on the health innovation conferences and conversations in which I’ve participated these past few years, I found myself musing over the following two questions:

1. What is health?
2. What does it mean to help someone with their health?

After all, whether you are a clinician, a health care expert, or a digital health entrepreneur, helping people with their health is the core mission. So one would think we’d be clear on what we’re talking about, when we use terms like health and health care.

But in fact, it’s not at all obvious. In practical parlance, we bandy around the terms health and health care as we refer to a wide array of things.

Actually defining health has, of course, been addressed by experts and committees. The World Health Organization’s definition is succinct, but hasn’t been updated since 1948:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

A more recent attempt to define health, described in this 2011 BMJ editorial, proposed health as “’the ability to adapt and self manage’ in the face of social, physical, and emotional challenges.”

This left me scratching my head a bit, since it sounded more like a definition of one’s resilience, or self-efficacy. Which intuitively seem much related to health (however we define it), but not quite the same thing.

I found myself itching for a definition of health that would help me frame what I perceive as the health – and life – challenges of my older patients.

Also, it seemed impossible to articulate how digital health tools might help us care for an aging population, if one didn’t start with a practical definition of health.

So after doing an hour of research in the literature (and finding endless scholarly rabbit holes), I ended up trying to sketch a model of health that felt true to my experiences.

In this post, I’d like to share what I came up with, and get your feedback. Then in a follow-up post, I’ll write about what this might mean for defining health care, and our efforts to improve or facilitate health care.

What is health?

Health is a dynamic state. For an individual, it involves three core components:

• How are you feeling? How do your body and mind feel? Are you experiencing any pain? Bothersome sensations? Mental distress? This component of health addresses the individual’s experience of suffering.

• How well are your body and mind outwardly working? Are your body and mind working as you expect them to, or need them to, or want them to? Can you get around physically as you usually do? Can you manage your thinking tasks? Can you see, hear, speak, and otherwise communicate effectively with others? This component addresses the individual’s ability to leverage body and mind in order to manage one’s usual activities and life tasks.

• How well are your body and mind internally working? This component relates to one’s inner physiology and function. When we peer inside, whether with modern technology, via the careful pulse auscultation used in some cultures, or any other method, is anything awry? Do we find signs of disease, disorder, or disruption? In Western medicine, we consider the workings of organs and cells, but other cultures have their own “inner workings” that they assess when evaluating health.

These three components are in constant interplay with each other. Right now I’ll refer to them your wellbeing, your macrofunction, and your microfunction. (But I’m not sure those are best terms.)

These three components of health are also in constant interplay with our social and physical environments, as well as with our nutrition and our “lifestyle choices.” For instance, rich social encounters and purposeful work improve wellbeing, as well as immune function and other aspects of our microfunction. Air pollution might make us cough, and can negatively impact our lung function, along with other less visible parts of our health.

Are these many external factors, and our behavior choices, synonymous with “your health”? I would call them influences on your health, or in certain cases “health care”, rather than your health itself. (And they aren’t diagrammed above, although I’d like to add them eventually.) These factors are incredibly important, but we confuse matters when we conflate things that influence health — such as access to clinicians, clean water, walkable cities — with the actual health of an individual.

Why does a person’s health matter?

Better health is an important end in of itself.

But to a large extent, health is a means to a more important end: that of living life.

In other words, being able to do the things we care about, need to do, and want to do. Being able to do things that give purpose, meaning, and pleasure to our lives. Being able to do the things that make us feel like our selves.

This is kind of obvious, but it’s actually fairly easy to lose sight of this when we get immersed in the weeds of health and health care. (Which is why the Unmentionables at Health 2.0 is so fantastic: it’s a much-needed reminder that health serves life.)

[Caveat: There is a lot of overlap between the life activities, but I haven’t yet figured out how to diagram this. Graphic design is not my forte.]

What is a health problem?

As a doctor, my job is to help people address their health problems. And I’d like for the digital health entrepreneurs to create tools that work better for this purpose.

So what is a health problem? How to define what people seem to need help with? How to define what digital health tools should help us – whether we are a patient, a clinician, or a family caregiver – address?

Here is a practical definition: a health problem is anything that is “wrong” with one or more of the three components of health above.

For instance:
• Wellbeing Problems: Examples include being in pain, being fatigued, having insomnia, feeling depressed, feeling anxious, feeling short of breath, and so forth. Many symptoms, pains, discomforts, and any other forms of suffering fall into this category.

• Macrofunction Problems: These might include having difficulty walking due to arthritis, problems exercising due to shortness of breath, or problems thinking due to dementia. You could also include vision problems, hearing problems, and speech difficulties due to stroke. These issues often cause noticeable functional impairments.

• Microfunction Problems: These would include problems such as having impaired glucose metabolism, high blood pressure, osteoporosis, kidney disease, as well as early stage cancer.

You’ll notice that problems with wellbeing and macrofunction are primarily person-defined. It’s the affected person – sometimes known as “the patient” – who experiences suffering, or difficulties in how the body and mind are working. Whereas microfunction problems are generally “expert-defined”: nobody knows they have osteoporosis until clinicians tell them.

Many diagnoses, diseases, or health stressors will cause problems in all three parts of health. For example, cancer symptoms and the related functional impairments (e.g. problems doing anything you can usually do) are the consequence of the cancer cells running amok within.

Congestive heart failure might cause uncomfortable dyspnea, as well decreased exercise tolerance, such that a person has difficulty managing usual ambulation and activities.

Of course, there is a lot of room to argue about what constitutes “wrong” with a given health component. Cultural and social factors influence how people perceive their own suffering, or overt impairments. And we could quibble endlessly about what is ideal blood pressure, and how we might otherwise assess how right or wrong a person’s body and mind are internally working.

Still, in many cases, if most of agree that something seems “wrong” with a given component of health, this should provide us with a decent practical starting point for identifying health problems.

Do we need to distinguish between microfunction and macrofunction?

I believe we do. Problems with macrofunction are the things that people notice in themselves (or in others, when it comes to cognitive macrodysfunction). These are what patients are often most concerned about.

Macrofunction problems, along with forms of suffering, are also what directly impacts people’s ability to participate in life tasks, and their short-term quality of life.

So helping people correct, mitigate, or adapt to these types of functional impairments is incredibly powerful, if you want to address health problems in a way that makes people’s lives materially better. This is an approach that is common in geriatrics, palliative care, physical and occupational therapy, and behavioral therapy.

Microfunction, on the other hand, is what people need technical assistance to assess. (Historically that assistance have been clinicians, but we’re on the cusp of seeing advanced diagnostic tools in the hands of the public.)

Much of the work that we doctors do in modern medicine, especially in primary care, is address physiologic problems that are scarcely perceptible to the affected person: high blood pressure, high cholesterol, type 2 diabetes, kidney disease, asymptomatic atrial fibrillation.

We do this work because we are trying to prevent or delay more overt health problems, such as those associated with suffering and macrodysfunction. So it’s certainly worthwhile work. But it doesn’t always feel satisfying or worthwhile to patients, especially if they are pre-occupied by other problems which are causing suffering or overt functional impairments.

In fact, it seems to be fairly common that patients and clinicians are focused on different aspects of health. A typical example: a doctor might decide to unilaterally prioritize tinkering with the microfunction, such as by prescribing more statins, even though a patient’s most pressing concern is falls or pain.

[Press release]NIH scientists determine how environment contributes to several human diseases

NIH scientists determine how environment contributes to several human diseases.
From the 25 November 2014 NIH Press Release

Using a new imaging technique, National Institutes of Health researchers have found that the biological machinery that builds DNA can insert molecules into the DNA strand that are damaged as a result of environmental exposures. These damaged molecules trigger cell death that produces some human diseases, according to the researchers. The work, appearing online Nov. 17 in the journal Nature, provides a possible explanation for how one type of DNA damage may lead to cancer, diabetes, hypertension, cardiovascular and lung disease, and Alzheimer’s disease.

Time-lapse crystallography was used by National Institute of Environmental Health Sciences (NIEHS) researchers to determine that DNA polymerase, the enzyme responsible for assembling the nucleotides or building blocks of DNA, incorporates nucleotides with a specific kind of damage into the DNA strand. Time-lapse crystallography is a technique that takes snapshots of biochemical reactions occurring in cells.

Samuel Wilson, M.D., senior NIEHS researcher on the team, explained that the damage is caused by oxidative stress, or the generation of free oxygen molecules, in response to environmental factors, such as ultraviolet exposure, diet, and chemical compounds in paints, plastics, and other consumer products. He said scientists suspected that the DNA polymerase was inserting nucleotides that were damaged by carrying an additional oxygen atom.

After the DNA polymerase (gray molecule in background) inserts a damaged nucleotide into DNA, the damaged nucleotide is unable to bond with its undamaged partner. As a result, the damaged nucleotide swings freely within the DNA, interfering with the repair function or causing double-strand breaks. These steps may ultimately lead to several human diseases. (Graphic courtesy of Bret Freudenthal)

 

“When one of these oxidized nucleotides is placed into the DNA strand, it can’t pair with the opposing nucleotide as usual, which leaves a gap in the DNA,” Wilson said. “Until this paper, no one had actually seen how the polymerase did it or understood the downstream implications.”

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[Reblog] MyFitnessPal Works If You Use It | The Health Care Blog

MyFitnessPal Works If You Use It | The Health Care Blog. (November 24, 2014)

By MIKE LEE

You may have seen some news regarding a study MyFitnessPalrecently did with UCLA.

I wanted to take a minute to address this study, since we participated in it directly. We are excited that we got to work with some very smart people to answer a question we also wanted to know the answer to. We jumped at the opportunity to find out—is having your physician introduce you to the app and help you sign up enough to kickstart a health journey?

What we learned is that just introducing people to MyFitnessPal wasn’t enough. People have to be ready and willing to do the hard work.

The app itself does work—if you use it. Our own data and the data from the study show that the more you log on, the more you use the app, the more success you will see. Users that logged in the most lost the most weight. In fact, we already know that 88% of users who log for 7 days lose weight.

We make tools designed to make it as clear and simple as possible for you to see the path to achieving your fitness goals. We are not, however, making a magic bullet—because there is no magic bullet. Ultimately, you’re the one who has to do the work.

And my, how much work you guys have done.

You have:

• lost over 180 million pounds
• logged over 14.5 billion foods
• burned 364 billion calories
• supported each other with over 82 million status likes in the last year alone
• and much more!

The first thing I say when people talk to me about MyFitnessPal is that user success is our true North. We are relentlessly focused on user success. We believe that if you are succeeding at reaching your goals then we will succeed as a company. We’re going to keep working to make our app even more accessible, simple to use, and motivating so we can help even more people succeed.

Of course, it’s our job to make the app as engaging and easy to use as possible. It’s not exactly where we want to be, yet. But we’ll keep working hard to get there. To that end, we’ve made lots of updates since this study was done. From a product perspective, in the last year and a half we’ve:

• streamlined the logging experience
• made logging streaks more visible
• added more ways to get push notifications and reminders
• added insights to help you get more out of logging
• made a recipe tool that allows you to quickly log recipes from anywhere across the web

As long as you keep working on your goals, we’re going to work on better ways to help you get there.

Thanks for everything you do, making the MyFitnessPal community so amazing, and helping us toward our vision of making an even healthier world.

Mike Lee is the Founder and CEO of MyFitnessPal

[Brookings Report] Pharma Pays $825 Million to Doctors and Hospitals, ACA’s Sunshine Act Reveals | Full Text Reports…

Pharma Pays $825 Million to Doctors and Hospitals, ACA’s Sunshine Act Reveals 

From the report

Disclosure of the financial relationships between the medical industry and health care providers is a very important step toward transparency. Patients heavily rely on the recommendations of their doctors to make any kind of decision regarding their health and thus should have full awareness of payments between their doctors and the medical industry. Patients have a right to be informed about possible conflicts of interests.

A not so well-known provision of the Affordable Care Act is the Sunshine Act. The purpose of this act is to increase the transparency in the health care market by requiring doctors, hospitals, pharmaceutical companies, and medical device manufacturers to disclose their financial relationships. Mandated by the Sunshine Act, on September 30th, Centers for Medicare and Medicaid Services (CMS) publicly released the first set of data, under the Open Payments title. This data includes $3.5 billion paid to over half a million doctors and teaching hospitals in the last five months of 2013.

A subset of Open Payments data that is individually identifiable  includes two categories of payments. The first category are the payments that are made for other reasons such as travel reimbursement, royalties, speaking and consulting fees and the second are payments which are made as research grants. These datasets together include more than 2.3 million financial transactions which amount to a total of more than $825 million.

Total Payments by Manufacturers of Drugs, Medical Devices, and Biologicals

General Payments

Teaching hospitals and physicians together received $669,561,563 in general payments from 949 different medical manufacturers. Interestingly, close to 70 percent ($460,369,403) of this amount was paid to individual physicians and the rest was paid to teaching hospitals. More than half of the total general payments were made by only 20 companies led by Genentech, which paid $130,065,012 in general grants to various hospitals and doctors and in particular, City of Hope National Medical Center.

Research Payments

Two hundred and ninety-four manufacturers awarded 23,225 research grants to teaching hospitals and physicians. The total value of these grants was $155,815,828. About 70 percent ($107,969,961) of these grants were awarded to teaching hospitals and the rest were awarded to physicians. The top 20 manufacturers contributed more than 75 percent of the total value of these grants. By awarding $17,973,563 in research grants Bristol-Myers Squibb, leads the pack.

The following chart breaks down the payments of the top 20 most generous manufacturers of drugs, medical devices and biologicals to teaching hospitals and individual physicians.

Not surprisingly, the release of the payments data was not immune from criticism. The harshest ones were from the American Medical Association (AMA). In particular, the AMA cited “inadequate opportunity for physician review” and “inaccuracy of the data” as the main problems with the release of open payments data. Moreover, AMA was so concerned about the “misinterpretation” of the data that it released an official “Guide for Media Reporting” in which it “strongly encourage[s] members of the media to… help the public understand the important role that appropriate relationships between physicians and industry has in advancing the practice of medicine.”

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[Press release] eScienceCommons: Athletes’ testosterone surges not tied to winning, study finds

eScienceCommons: Athletes’ testosterone surges not tied to winning, study finds.
From the press release

Friday, November 21, 2014

Athletes’ testosterone surges not tied to winning, study finds

Kathleen Casto, number 1931 in the center, shown competing in cross country as an undergraduate in North Carolina. She is now a graduate student in psychology at Emory, studying the hormonal correlates of competition in women.

By Carol Clark

A higher surge of testosterone in competition, the so-called “winner effect,” is not actually related to winning, suggests a new study of intercollegiate cross country runners.

The International Journal of Exercise Science published the research, led byDavid Edwards, a professor of psychology at Emory University, and his graduate student Kathleen Casto.

“Many people in the scientific literature and in popular culture link testosterone increases to winning,” Casto says. “In this study, however, we found an increase in testosterone during a race regardless of the athletes’ finish time. In fact, one of the runners with the highest increases in testosterone finished with one of the slowest times.”

The study, which analyzed saliva samples of participants, also showed that testosterone levels rise in athletes during the warm-up period. “It’s surprising that not only does competition itself, irrespective of outcome, substantially increase testosterone, but also that testosterone begins to increase before the competition even begins, long before status of winner or loser are determined,” Casto says.

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The sound of status: People know high-power voices when they hear them

From the Association for Psychological Science press release

Being in a position of power can fundamentally change the way you speak, altering basic acoustic properties of the voice, and other people are able to pick up on these vocal cues to know who is really in charge, according to new research published in Psychological Science, a journal of the Association for Psychological Science.

We tend to focus on our words when we want to come across as powerful to others, but these findings suggest that basic acoustic cues also play an important role:

“Our findings suggest that whether it’s parents attempting to assert authority over unruly children, haggling between a car salesman and customer, or negotiations between heads of states, the sound of the voices involved may profoundly determine the outcome of those interactions,” says psychological scientist and lead researcher Sei Jin Ko of San Diego State University.

The researchers had long been interested in non-language-related properties of speech, but it was former UK prime minister Margaret Thatcher that inspired them to investigate the relationship between acoustic cues and power.

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[Press release] Healthy gut microbiota can prevent metabolic syndrome, researchers say

Healthy gut microbiota can prevent metabolic syndrome, researchers say.

From the press release

Posted On November 25, 2014

ATLANTA—Promoting healthy gut microbiota, the bacteria that live in the intestine, can help treat or prevent metabolic syndrome, a combination of risk factors that increases the risk of heart disease, diabetes and stroke, according to researchers at Georgia State University and Cornell University.

Their findings are published in the journal Gastroenterology.

The study, a follow-up to the research team’s previous paper in Science, uses an improved technical approach, making the results more significant.

The research team includes Dr. Andrew Gewirtz, a professor in the Institute for Biomedical Sciences at Georgia State; Dr. Benoit Chassaing, a post-doctoral student at Georgia State; and Dr. Ruth Ley of the departments of Microbiology and Molecular Biology at Cornell.

“These results suggest that developing a means to promote a more healthy microbiota can treat or prevent metabolic disease,” Gewirtz said. “They confirm the concept that altered microbiota can promote low-grade inflammation and metabolic syndrome and advance the underlying mechanism. We showed that the altered bacterial population is more aggressive in infiltrating the host and producing substances, namely flagellin and lipopolysaccharide, that further promote inflammation.”

Metabolic syndrome is a serious health condition that affects 34 percent of American adults, according to the American Heart Association. A person is diagnosed with metabolic syndrome when he or she has three of these risk factors: a large waistline, high triglyceride (type of fat found in the blood) level, low HDL cholesterol level, high blood pressure and high fasting blood sugar. A person with metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes, according to the National Institutes of Health.

Because metabolic syndrome is becoming more common, scientists are exploring possible causes. In their previous study in Science, Gewirtz, Ley and other researchers showed altered gut microbiota play a role in promoting metabolic syndrome.

Gut microbiota perform key functions in health and when it becomes deregulated it can promote chronic inflammatory diseases such as Crohn’s disease and ulcerative colitis. In addition, altered gut microbiota promote inflammation that leads to metabolic syndrome.

“We’ve filled in a lot of the details about how it works,” Gewirtz said. “It’s the loss of TLR5 on the epithelium, the cells that line the surface of the intestine and their ability to quickly respond to bacteria. That ability goes away and results in a more aggressive bacterial population that gets closer in and produces substances that drive inflammation.”

Normally, the bacteria are in the mucous layer at a certain distance away from epithelial cells. The researchers showed altered gut microbiota is more aggressive in infiltrating the host and gets very close to the epithelium. This altered population produces flagellin and lipopolysaccharide, which further promote inflammation.

The research team improved the study by comparing mice that were siblings and littermates, making all conditions in the study the same. The mice only differed by whether they were missing a specific gene, TLR5. Previously, the researchers studied mice that were from two different strains and lived in separate environments. In this study, they found the absence of TLR5 on the intestinal surface leads to alterations in bacteria that drive inflammation, leading to metabolic syndrome.

This study was funded by the National Institutes of Health and the Crohn’s and Colitis Foundation of America.

[Medical Journal Article] The Lancet: Universal health coverage for US military veterans within reach, but many still lack coverage

 

The Lancet: Universal health coverage for US military veterans within reach, but many still lack coverage.

From the press release

Over a million US military veterans lacked healthcare coverage in 2012, according to new estimates published in The Lancet. While many people believe that all veterans are covered by the Veterans Affairs health care system, less than half (8.9 million) of the 22 million veterans in the US are covered by VA health benefits, and most veterans are covered by private health insurance. Uninsured veterans are more likely to be young, single, African American, and veterans of Iraq and Afghanistan.

However, the authors of this viewpoint estimate that universal health coverage for veterans is within reach, thanks to the Affordable Care Act and its Medicaid expansion and subsidies for private health care. According to the authors, 87% of currently uninsured veterans could be eligible for health coverage through the Medicaid expansion, via the subsidized private health insurance market, or by enrolling in VA health benefits. Uninsured veterans are more likely to be clustered in states that have rejected the ACA’s Medicaid expansion. Of the top five states with the highest number of uninsured veterans, four [1] are states that have rejected the expansion (the fifth, California, has accepted the expansion, but is also the most populous state in the union).

“Largely on account of the Affordable Care Act, the goal of universal health coverage for veterans is closer than ever,”* explains author Dave A Chokshi. “There remain political hurdles to achieving this goal, both in the false impression that the VA already provides universal coverage, and the decision by several states to reject the ACA’s Medicaid expansion. While eligibility for insurance is not tantamount to access to care, universal coverage is an important first step towards high-quality healthcare.”*

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NOTES TO EDITORS:

*Quotes direct from author and cannot be found in text of Article

[1] There are an estimated 126000 uninsured veterans in Texas, 95000 in Florida, 54000 in North Carolina, and 53000 in Georgia

[News article] A green transformation for pharmaceuticals — ScienceDaily

From the news article

#200548277-001 / gettyimages.com

Date:November 21, 2014

Source:The Agency for Science, Technology and Research (A*STAR)

Summary:




A more sustainable approach to a bond-forming reaction extensively used in the pharmaceutical and fine chemical industries has now been developed. The team used the solvent-free, catalytic reaction to produce high yields of a wide range of amides, including the antidepressant moclobemide and other drug-like molecules.