No Longer Just ‘Adult-Onset’
A study of diabetes in overweight and obese youngsters bears an ominous warning about future health care trends in this country. It found that Type 2 diabetes, a new scourge among young people, progresses faster and is harder to treat in youngsters than in adults. The toll on their health as they grow older could be devastating.
These findings provide more evidence of why the country must get the obesity epidemic under control — to improve health and to curb soaring health care costs.
Only two decades ago Type 2 diabetes was called “adult-onset diabetes” because it was seldom found in young people, who suffered primarily from Type 1, in which the patient’s immune system destroys cells that make insulin, a hormone needed to control blood sugar levels. Type 2 — thought to be brought on by obesity and inactivity in many people — has increased alarmingly and accounts for almost a fifth of newly diagnosed cases in young people.
Obesity increases the risk of many chronic diseases. And some 17 percent of American children from age 2 to 19 are now considered obese, roughly half the rate of obesity among adults.
The new study, published in The New England Journal of Medicine, tested three ways to attain durable control of blood sugar in youngsters between the ages of 10 and 17. None worked very well. Almost half of the 699 youngsters had to add daily shots of insulin within a few years to lower their blood sugar. Metformin, the standard drug used to treat Type 2 diabetes in children, failed to control blood sugar in more than half of the children. When lifestyle changes, including one-on-one counseling on how to lead a healthy life, were added to metformin, the results were only marginally better.
A Regime’s Tight Grip on AIDS
By DONALD G. McNEIL Jr.
HAVANA — Yudelsy García O’Connor, the first baby known to have been born with H.I.V. in Cuba, is not merely still alive. She is vibrant, funny and, at age 25, recently divorced but hoping to remarry and have children.
Her father died of AIDS when she was 10, her mother when she was 23. She was near death herself in her youth.
“I’m not afraid of death,” she said. “I know it could knock on my door. It comes for everyone. But I take my medicine.”
Ms. García is alive thanks partly to lucky genes, and partly to the intensity with which Cuba has attacked its AIDS epidemic. Whatever debate may linger about the government’s harsh early tactics — until 1993, everyone who tested positive for H.I.V. was forced into quarantine — there is no question that they succeeded.
Cuba now has one of the world’s smallest epidemics, a mere 14,038 cases. Its infection rate is 0.1 percent, on par with Finland, Singapore and Kazakhstan. That is one-sixth the rate of the United States, one-twentieth of nearby Haiti.
The population of Cuba is only slightly larger than that of New York City. In the three decades of the global AIDS epidemic, 78,763 New Yorkers have died of AIDS. Only 2,364 Cubans have.
Other elements have contributed to Cuba’s success: It has free universal basic health care; it has stunningly high rates of H.I.V. testing; it saturates its population with free condoms, concentrating on high-risk groups like prostitutes; it gives its teenagers graphic safe-sex education; it rigorously traces the sexual contacts of each person who tests positive.
Panel on Health Reform Focuses on Ditching the Insurance Industry
Prominent health care critics speaking in Portland staunchly support and defend a single-payer system
By Amanda WaldroupeThe Lund Report (Portland, Ore.), April 27, 2012
PORTLAND, Ore. -- Three prominent critics of the country’s current health care system and ardent reform advocates appeared in Portland today to discuss their views on health reform, President Obama’s Patient Protection and Affordable Care Act, and what ought to be done to ensure that everyone has access to quality health care.
Cathy Schoen, senior vice president of the Commonwealth Fund, spoke, as well as Drs. Arnold Relman and Marcia Angell, former editors of the New England Journal of Medicine. Dr. Bruce Goldberg, director of the Oregon Health Authority, also participated. The event was sponsored by the advocacy group, Mad As Hell Doctors and Physicians for a National Health Program.
Schoen put the United State’s health care system in the context of other Western, developed countries. “We are the most expensive country in the world in what we spend per person, and in our share of the economy,” she said. “And we don’t get the outcomes that you expect.”
The United States, she said, spends 18 percent of its gross domestic product (GDP) on health care.
“A very complicated system,” she said, and that complication requires time and resources to deal with certain parts, particularly the insurance system.
The insurance system was what Relman pointed his finger directly at as the sole reason for why the country’s health care system has become a “fragmented” “shambles.”
“We run our health care system as if it’s a business in the free market … and not like the social service it ought to be,” he said. “In no other country do they make that terrible mistake.”
http://www.pnhp.org/print/news/2012/may/panel-on-health-reform-focuses-on-ditching-the-insurance-industry
Having trouble finding a doctor? You're not alone. Tens of millions of adults under 65 — both those with insurance and those without — saw their access to health care dramatically worsen over the past decade, according to a study released Monday (Galewitz, 5/7).
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