Scan Ban

That’s a pretty disturbing statistic published in the Archives of Internal Medicine. It just adds to the controversy stirring around CT (computed tomography) scan use. A tipping point that led to more investigation of CT scan use was this: General Electric applying for approval of CT scans as tests for colon cancer. It’s a request made because, even though the practice of screening healthy patients with CT scans has become commonplace, many insurers are hesitant to pay for the scans.
The FDA moved to approve GE’s request—until agency scientists had objections. They said that the increased cancer risk from CT scans’ radiation would outweigh any potential benefits. Gastroenterologist and former FDA consultant Julian Nicholas—who trained at Oxford University and the Mayo Clinic—was one of those objecting. He wrote in an e-mail that approval would “expose a number of Americans to a risk of radiation that is unwarranted and may lead to instances of solid organ abdominal cancer.”
That didn’t set too well. Nicholas says, “I was first ignored, then pressured to change my scientific opinion, and when I refused to do that, I was intimidated and ultimately terminated.”

Nicholas wasn’t alone in questioning the safety of CT scans. FDA medical officer Dr. Robert Smith of Yale and Cornell Universities said, “The increased radiation exposure to the population could be substantial and would raise a serious public health/public policy issue.” Smith’s input was dismissed, too.
At present, approval for G.E.’s request is still pending.

Even 1 Soda a Day Can Hike Your Diabetes Risk

A soda a day? That's not so bad—a 150-calorie blip, burned off with a brisk half-hour walk. But it's not only your waistline that's at stake. A study released today in the journal Diabetes Care found that people with a daily habit of just one or two sugar-sweetened beverages—anything from sodas and energy drinks to sweetened teas and vitamin water—were more than 25 percent likelier to develop type 2 diabetes than were similar individuals who had no more than one sugary drink per month. Since the overall rate of diabetes is roughly 1 in 10, an increase of 25 percent raises the risk to about 1 in 8. One-a-day guzzlers in the study also had a 20 percent higher rate of metabolic syndrome, a collection of indicators such as high triglyceride levels suggesting that diabetes is not far off.

"Previous studies have shown that sugar-sweetened beverages are strongly associated with weight gain," says lead author Vasanti Malik, a research fellow in the Harvard School of Public Health Department of Nutrition, who says the decision to examine the relationship between sugar-sweetened beverages and risk of diabetes was "the logical next step."

[To Cut Diabetes-Related Heart Risks, Diet and Exercise May Beat Drugs]

The researchers conducted a study of studies—a meta-analysis—to reach their conclusions. They identified eight studies with enough data to let them check for a link between sugary drinks and type 2 diabetes and three similar studies of metabolic syndrome. The largest diabetes study, which followed more than 91,000 American women ages 24 to 44 for eight years, made the strongest case for a relationship, and it wasn't just because higher consumption of sweetened drinks added excess calories that turned into pounds. While weight gain is a known diabetes risk factor, the diabetes-beverage link persisted even after adjusting for that. "Other factors independently put you at risk for developing diabetes," says Malik.

The main one is spikes in blood glucose and insulin because sweetened drinks are often consumed quickly and in large quantities and their sugar content is rapidly absorbed. Frequent spiking can lead to insulin resistance, inflammation, and hypertension—often precursors to diabetes. High-fructose corn syrup, the sugar in many sweetened drinks, is emerging as possibly riskier than other sugars because it seems to produce more belly fat. Fat that accumulates around the middle is closely tied to high blood pressure and other cardiovascular problems.

Americans love sweetened drinks. Consumption climbed to an average of 142 calories a day, or nearly one 12-ounce can of soda, in 2006, from 65 in the late 1970s. And many people down far more than that, notes Frank Hu, a senior author of the study and a professor of nutrition and epidemiology at Harvard, which puts them at a much greater risk of diabetes. A report from the Centers for Disease Control and Prevention released earlier this week projects that by 2050, 1 in 3 Americans will develop the disease. "Soft drink consumption has significant public health implications in terms of the diabetes epidemic," says Hu.

[Why Diabetes May Triple by 2050]

Earlier this year the American Heart Association issued a recommendation advising consumers to set a limit on sweetened drinks of 450 calories a week, or three 12-ounce sodas, in a 2,000-calorie diet. Calorie-counting is a convenient way to keep track, but it can be misleading. "Consumers are overly focused on calories," says Constance Brown-Riggs, a spokesperson for the American Dietetic Association, who would like people also to understand that a 12-ounce can of soda contains the equivalent of 15 teaspoons of sugar. "They think it's not that bad, without taking into consideration the other components that are putting them at risk."

Type 2 diabetes and metabolic syndrome aren't the only risks of a one-a-day habit. In a 2004 study published in the Journal of the American Medical Association of 88,000 women followed for 24 years, those who guzzled two or more sugary drinks a day had a risk of coronary artery disease 35 percent higher than non-guzzlers, even after adjusting for other unhealthy lifestyle factors. "You receive no benefits out of drinking these beverages," says Malik, who lists additional hazards from dental cavities to gout. "It's a wake-up call for the American public."

Blood Pressure Treatment on Rise in Younger Adults, Says CDC Report

Kristen Pessalano just turned 23, but has been on blood pressure medication for more than two years. Pessalano, a New Yorker who works in public relations, found out she had high blood pressure while getting a physical before heading abroad for an internship.

"[I] got upset when I first found out because I automatically associated it with people who are overweight or old," said Pessalano. "I would have never associated high blood pressure with someone my age, especially when I appeared to be totally healthy."

Pessalano has a lot of company, according to a new report by the Centers for Disease Control and Prevention. The report finds that while the percentage of Americans who have high blood pressure has remained steady over the past decade at 30 percent, the number of younger adults -- ages 18 to 39 -- who have high blood pressure and take medication to treat it has significantly increased from 27.6 percent in 1999 to 2000 to 49.1 percent in 2007 to 2008.
Doctors say they're not surprised because of other health problems that plague younger adults.

"I'm not surprised that more and more young people are being treated for high blood pressure since the incidence of obesity, a contributing cause for high blood pressure, is increasing in this age group," said Dr. Randal Thomas, a cardiologist at the Mayo Clinic in Rochester, Minn.

"With increasing obesity and diabetes in younger populations, clinicians may be more aggressive about recognizing risk factors for cardiovascular disease, like hypertension, and treating it," said Dr. Carol Horowitz, associate professor of medicine at Mount Sinai School of Medicine.

Although the news that she had high blood pressure was unexpected to Pessalano, the CDC report found most people with high blood pressure have become more aware of the condition, which is something physicians say they've noticed in their own practices.

"[I]ndividuals are taking their own health issues more seriously and noticing the increased blood pressure readings," said Dr. R. Scott Wright, also a cardiologist at the Mayo Clinic.

Exercise Your Depression Away

Good news all you exercise fanatics.

Researchers have found that the more people engage in physical activity, even very light exercise, during their spare time, the less likely they are to be depressed.

Surprisingly, the study showed that people who exert themselves at work by doing lots of walking or lifting are no less likely to be depressed than people with sedentary jobs.

People who were inactive during their leisure time were almost twice as likely to have symptoms of depression, compared with the most active individuals.

lead author of the study, said the findings underlined the importance of the context in which exercise was taken.

“Our study shows that people who engage in regular leisure time activity of any intensity are less likely to have symptoms of depression,” he said.

“We also found that the context in which activity takes place is vital and that the social benefits associated with exercise, like increased numbers of friends, are more important in understanding how exercise may be linked to improved mental health than any biological markers of fitness.

“This may explain why leisure activity appears to have benefits not seen with physical activity undertaken as part of a working day.”

Exercise 'can prevent a cold', a study shows

People who exercise regularly are less likely to get a cold, researchers say.


A study of 1,000 people found that staying active nearly halved the odds of catching cold viruses and, failing that, made the infection less severe.

Experts told the British Journal of Sports Medicine that this could be because exercise helps bolster the immune system to fight off bugs.

But you may not have to actually do much exercise - those who merely think they are fit enjoy the same lower risk.

Adults can expect to suffer two to five colds per year. This latest research suggests there are lifestyle choices you can make to improve your odds of either avoiding them, or suffering too badly from them.

For their study, US researchers asked the healthy volunteers to keep a record of any coughs and sniffles they experienced over a three-month period during the autumn and winter.

The volunteers were also asked to say how frequently in any given week they would do exercise lasting at least 20 minutes and intensive enough to break a sweat.

How should value be defined in spine surgery?

Introduction
In a health care economy with limited resources, providers and consumers of health care services need to be accountable for the end result and the cost of care. The value proposition in health care is an analysis of the benefits of care relative to the direct cost and risk of providing the care. Measurement of benefits and costs is challenging, and a consensus on the measures that encompass the relevant components of the value equation has not been reached. Traditional outcome measures in orthopedics including survival, radiographic outcomes, and disease-specific outcome tools do not adequately reflect the patient’s health care experience, or the impact of an intervention on health-related quality of life. Similarly, measuring cost of care is complex, and may encompass both direct costs of treatment and alternative treatments, and indirect costs including time from work or family role, loss of productivity, and cost of caretakers.

The value equation may vary depending on the perspective of the stakeholder in the health care economy. Hospitals and facilities providing care may measure outcome and costs by factors that affect their short-term, single admission interaction, including length of stay, implant utilization, and complications. Third-party payors may focus on a timeframe that is longer that a single admission, and may include factors in the value equation such as readmission within 90 days, or cost of outpatient care. Hospital- and payor-based quality measures may be misinterpreted as measures of outcome or value. Length of stay, surgical times, compliance with antibiotic or thromboembolic prophylaxis, and perioperative complications are process measures that may be useful to compare hospital and provider performance when appropriately matched and stratified. However, they are not useful in measuring a patient’s health care experience, or the impact of an intervention on long-term health-related quality of life. In fact, a focus on quality and process measures alone may be misleading in the pursuit of value in health care, and may provide incentive for counterproductive care strategies that serve the measurement system rather than the patient.

The health care provider and the patient measure outcome by the impact of an orthopedic intervention on health-related quality of life (HRQoL). The timeframe for the patient and provider is a lifetime, rather than a single admission. As Porter and Teisberg wrote in 2006, the right goal for health care delivery is superior patient value, which is measured at the level of specific medical conditions. Measurement of outcomes of care needs to reflect the patient’s long-term health care experience, and the impact of one intervention compared with alternatives on the patients self-assessment of HRQoL.

Study: Growing Rods for Childhood Scoliosis Treatment Likely to Cause Autofusion

While the use of growing rods has produced efficacy in the control of deformity within the growing spine, the surgery also has high rates of unintended autofusion, which can lead to a difficult and moderate correction, according to an article published in Spine.

Researchers conducted a retrospective review of the medical records and radiographs of young patients who received treatment for scoliosis using growing rods. The researchers collected data on complications, pre- and postoperative Cobb angles, total spine length, correction since initiation of treatment, total number of surgeries and the number of patients found to have autofusion at the time of device removal.

The rate of autofusion in the patients treated with growing rods was 89 percent. The average percent of the Cobb angle was 44 percent, and an average of seven osteotomies per patient were required at the time of definitive fusion due to autofusion.

Health In Your Hands – Scoliosis Exercises for Prevention and Correction DVD

Sneak Peek of DVD Cover Art

Get pillow smart

Thursday, 25 l 03 l 2010 ; Source: Mind Your Body, The StraitsTimes
By Stacey Chia

Investing in the right one can mean the difference between a good night’s sleep and waking up with neck ache. STACEY CHIA reports

Like most people, you probably spend about a third of your time in bed, so investing in the right pillow can be an asset to your health.

The right pillow can help you acquire better sleep and at the same time lower your risk of neck pain and headaches, said Dr Charles Siow, a consultant neurologist and pain specialist at Siow Neurology Headache and Pain Centre.

These aches and pains usually result from a lack of head and neck support from your pillow.

Dr Kenny Pang, the director of Pacific Sleep Centre, explained that the human neck curves slightly forward to take the weight of the head when upright and it is important that this curve is maintained while at rest.

Pillows help ensure that your head is kept in a neutral alignment.

This means that your head should not lean too far forward or backwards.

When buying a pillow, it is important to take into account your sleeping position, said Ms Karen Koh, a senior principal physiotherapist at the Singapore General Hospital (SGH).If you tend to sleep on your back, your pillow should be kept low so that your head and neck is fairly aligned with your body.

If you sleep on your side, you will need a higher pillow. Ms Koh said a higher pillow would be more suitable in maintaining the alignment as it fills the space between your head and the mattress.

Dr Kevin Lau, a chiropractor at Orchard Clinic, advised against sleeping on your stomach as it causes a strain on your back by exaggerating the arch at the base of your spine.

If you are particular about the type of pillow stuffing, Dr Lau recommends buying a memory foam pillow.

Such a pillow is said to reduce pressure points by moulding and adjusting itself as you move throughout the night, thus ensuring that your neck is always supported.

It is, however, not a necessity, he said.

Dr Lim Li Ning, the medical director of the Sleep Neurology and Sleep Centre agreed, adding that there is no good scientific evidence to support the use of one type of pillow over another.

“Most people can sleep on any type of pillow depending on their preference and no special stuffing is needed,” said Dr Lim.

Dr Lau said that pillows to avoid are those stuffed with feathers as they tend to lose firmness over time and become too flat to provide sufficient support.

Dr Pang said: “A large part of what makes a good pillow is personal preference. If the pillow feels comfortable, it is likely to help one become relaxed and thus get a good night’s sleep.”

When is a Placebo Not Really a Placebo? Maybe More Often Than You Think

By Katherine Hobson

When you read in a study that a drug performed better or worse than a placebo, you probably don’t give much thought to whether the ingredients of the placebo had anything to do with the results.

Beatrice Golomb, an associate professor of medicine at the University of California, San Diego, School of Medicine, was researching cholesterol when she came across some older drug studies that actually said what was in the dummy pills — corn oil and olive oil, which of course we know now may have their own cholesterol-fighting properties. Study researchers noticed that the mortality rate in the control group was unexpectedly low, and that the drug being studied showed no improvement over the placebo, but they didn’t connect the dots and hypothesize that the placebo might actually have been helping.

“We hear the word ‘placebo’ and think ‘inert,’” even though there no known substances that are completely physiologically inert, Golomb tells the Health Blog. Even “filler” ingredients that pass through the body without being absorbed can have effects, say, by also preventing other things from being absorbed, she says.

Substances in placebos can also bias findings in favor of the drug being studied, she says, pointing to a study of a drug aimed at helping cancer patients keep weight on. The placebo included lactose, and cancer patients are prone to lactose intolerance, leading to increased GI symptoms in the control group. That may have made the drug look better than it was, she says.

There are no regulations on what goes into placebos, and very few studies actually report the composition of dummy pills or capsules: just 8.2% of the two years’ worth of studies published in four major medical journals that Golomb and colleagues combed through. The results of their research appear in Annals of Internal Medicine. For all placebos, including injections and other treatments, the disclosure rate was 26.7%.

“There’s a lot of attention paid to making them look and taste similar, but there’s very little attention paid to the actual ingredients,” she says. The placebo and nocebo effects (the latter is when a study subject reports ill effects from a supposedly inert dummy pill) get chalked up to patient suggestibility rather than possible physiological effects, she says.

Given that there’s no perfectly inert placebo, Golomb and her co-authors suggest that disclosure is key and call for major journals to lead the way by instituting a reporting requirement. “We can just accept that among the range of things that are never perfect in a clinical trial, placebos are seldom perfect,” she says.

Clarification: Golomb is an associate professor of medicine in the division of general internal medicine at UCSD School of Medicine. A previous version of this post referred imprecisely to her title.