Do Statins Make It Tough to Exercise?
By GRETCHEN REYNOLDSEpperson/Getty ImagesCan a statin ruin your workout?
For years, physicians and scientists have been aware that statins, the most widely prescribed drugs in the world, can cause muscle aches and fatigue in some patients. What many people don’t know is that these side effects are especially pronounced in people who exercise.
To learn more about the effect statins have on exercising muscles, scientists in Strasbourg, France, recently gave the cholesterol-lowering drug Lipitor to a group of rats for two weeks, while a separate control group was not medicated. Some of the rats from both groups ran on little treadmills until they were exhausted.
It was immediately obvious that the medicated animals couldn’t run as far. They became exhausted much earlier than the rats that had not been given statins.
The differences were even more striking at a cellular level. When the scientists studied muscle tissues, they found that oxidative stress, a measure of possible cell damage, was increased by 60 percent in sedentary animals receiving statins, compared with the unmedicated control group.
Better health, better budgets
Posted March 13, 2012, at 5:12 p.m.
Now is the time for pragmatism and policy creativity. Maine faces a difficult budgetary environment, made worse by cutting tax revenues, the bulk of which had come from the most well-off.
Proposed and passed cuts undermine health clinics, causing patients to lose access to ongoing care and screening and so increase preventable illnesses and deaths, swell emergency department use, shift costs to people with insurance and cause layoffs.
Down the road, much can be gained from the Affordable Care Act’s emphasis on programs that coordinate care for patients with significant — and expensive — medical problems. While it’s striking that 55 percent of MaineCare’s spending goes to 5 percent of those covered, Maine is by no means alone in having a small percentage of patients account for a majority of spending.
As Atul Gawande points out, with health care costs rising, we can afford education, transportation, medical and other needs if we adopt evidence-based, patient-centered methods to improve health care delivery systems. If the U.S. spent as much per person on health care as countries that cover more and have better outcomes, we’d have a long-term budget surplus.
Looking to Massachusetts, under Romneycare, one study found significant improvements in people’s health. Another study found that emergency room use and patients’ costs are down, with more needs met: “About nine million Americans lost health insurance in the downturn — and almost none of them lived in Massachusetts.”
More ‘Mediscare’ hooey, GOP version
By Glenn Kessler,
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“This IPAB board can ration care and deny certain Medicare treatments so Washington can fund more wasteful spending. ...Medicare will be bankrupt in nine years.”
— Musician Pat Boone, in a television ad sponsored by the 60 Plus Association
A number of readers asked us to examine the latest claims about Medicare, made this week by both GOP presidential contender Mitt Romney and a conservative advocacy group called the 60 Plus Association.
Actually, there is little new in either the 60 Plus Association’s $3.5 million ad campaign, featuring the venerable Pat Boone, or the “Five Questions for President Obama on Medicare” issued by the Romney campaign. We feel we have dealt with similar claims in the past, but apparently that has not deterred such attacks.
Getting Doctors to Think About Costs
By PAULINE W. CHEN, M.D.Getty ImagesA new program teaches doctors about weighing the costs of medical care.
My first formal lesson on health care costs occurred one afternoon on the wards when I was a medical student. The senior doctor in charge, a silver-haired specialist known for his thoughtful approach to patient care, had assembled several students and doctors-in-training to discuss a theoretical patient with belly pain. After describing the patient’s history and physical exam, he asked what tests we might order.
One doctor-in-training proposed blood work. A fellow student suggested a urine test. Another classmate asked for abdominal X-rays.
My hand shot up. “A CAT scan,” I crowed with confidence. “I’d get a CAT scan!”
There was complete silence. Everyone turned to stare at me.
The senior doctor coughed. “That’s an awfully expensive test,” he said, a grimace appearing on his face. Another student asked him just how much a CT scan cost, and he shifted uncomfortably in his seat and shrugged. “I don’t really know,” he said, “but I do know that we can’t just think about the patient anymore.” He took a deep breath before continuing, “We are now being forced to consider costs.”
Fact versus fiction on fixing MaineCare
Posted March 14, 2012, at 4:33 p.m.
In a recent BDN OpEd, state Rep. Mark Eves proposes to solve MaineCare’s financial problems by “better managing the costs of care.” I wish it were that simple.
Cost management should be a part of any welfare program. However, it will take more than that to get Maine out of a colossal fiscal mess that should have been addressed years ago. Unfortunately, the political party that ruled the state for decades refused to face the truth — MaineCare’s mushrooming growth was not sustainable. Now comes a reckoning.
This is not a matter of ideology. It is basic economics. Since 2000, MaineCare’s enrollment has grown by 78 percent while Maine’s population increased only 7 percent. Maine provides government health care for 35 percent more of its population than the national average.
If we were at the national norm, we would have 260,000 people on MaineCare, about where we were in 2004, and the budget would not be in crisis. Instead, enrollment in MaineCare and the related caseload has ballooned to 360,000 — more than a fourth of Maine’s population and twice as many people as students in public schools.
As explained in his March 26 column — “Coverage can remain, costs can be cut” — Rep. Eves says the solution does not lie in reducing enrollment. In fact, he calls that approach “morally wrong” and “unconscionable.” Democrats believe, he says, “the solution to the current shortfall is to maintain this important investment while better managing the cost of health care.”
I serve with Rep. Eves on the Health and Human Services Committee, which has jurisdiction over MaineCare, the state’s name for Medicaid. The committee has been immersed in the program for months due to its huge cost overruns. If “better cost management” alone could fix the problem, the whole Legislature would get behind that solution.
Feds release health overhaul blueprint for states
Posted March 12, 2012, at 8:50 p.m.
WASHINGTON — Fifty million people in America lack health insurance and the law says most of them must soon be provided coverage. But how to deliver?
The Obama administration Monday finalized an ambitious blueprint for new state-based markets that will offer consumers one-stop shopping along the lines of amazon.com.
It may sound simple enough, but getting there will be like running an obstacle course. The rule comes just two weeks before the Supreme Court takes up a challenge to the constitutionality of the law in a case brought by states. Many governors and legislators are on the sidelines awaiting the outcome, even as time is running out to act.
Starting Jan. 1, 2014, new health insurance markets called “exchanges” must be up and running in every state, the linchpin of a grand plan to make health insurance accessible and affordable to those who now struggle to find and keep coverage. Individual consumers and small businesses will be able to shop online for competitively priced coverage, and many will receive government subsidies to help pay premiums.
“More competition will drive down costs and exchanges will give individuals and small businesses the same purchasing power big businesses have today,” Health and Human Services Kathleen Sebelius said in a statement.
Experts say it’s anybody’s guess how the national rollout will go. If a state is not ready, the law requires the federal government to step in to run its exchange. But the Obama administration’s request for $800 million to operate federal exchanges has gotten a frosty reception from congressional Republicans.
http://bangordailynews.com/2012/03/12/health/feds-release-health-overhaul-blueprint-for-states/print/
Hospitals Aren’t Hotels
By THERESA BROWN
Pittsburgh
“YOU should never do this procedure without pain medicine,” the senior surgeon told a resident. “This is one of the most painful things we do.”
She wasn’t scolding, just firm, and she was telling the truth. The patient needed pleurodesis, a treatment that involves abrading the lining of the lungs in an attempt to stop fluid from collecting there. A tube inserted between the two layers of protective lung tissue drains the liquid, and then an irritant is slowly injected back into the tube. The tissue becomes inflamed and sticks together, the idea being that fluid cannot accumulate where there’s no space.
I have watched patients go through pleurodesis, and even with pain medication, they suffer. We injure them in this controlled, short-term way to prevent long-term recurrence of a much more serious problem: fluid around the lungs makes it very hard to breathe.
A lot of what we do in medicine, and especially in modern hospital care, adheres to this same formulation. We hurt people because it’s the only way we know to make them better. This is the nature of our work, which is why the growing focus on measuring “patient satisfaction” as a way to judge the quality of a hospital’s care is worrisomely off the mark.
Maine hits GOP roadblock in setting up health insurance exchange
Posted March 15, 2012, at 6:00 p.m.
AUGUSTA, Maine — Republicans followed through Thursday on their pledge to put a state health insurance exchange on ice despite looming federal mandates.
States are required to set up the exchanges by 2014 under President Barack Obama’s landmark health reform law. But the Republican majority on the legislative committee tasked with establishing Maine’s exchange hopes the U.S. Supreme Court will strike down the law on constitutional grounds this summer.
A Democratic bill, LD 1498, that would have set up Maine’s exchange failed Thursday in the Legislature’s Insurance and Financial Services Committee in a party line vote.
Republican Rep. Jonathan McKane of Newcastle said he won’t be “complicit” in the federal Affordable Care Act’s implementation.
“I personally don’t believe in the Affordable Care Act,” he said. “I don’t see how adding more bureaucracy to an already overburdened system of bureaucracy now is going to help things. What I do know is that the costs, although very, very high already, we’re still not sure of.”
Twenty-six states, including Maine, are challenging as unconstitutional the ACA’s requirement that nearly all Americans purchase health insurance by 2014 or pay a penalty. The U.S. Supreme Court will take up the case in less than two weeks, with a ruling expected in June.
New Guidelines Advise Less Frequent Pap Smears
By TARA PARKER-POPEThe annual Pap smear, a cornerstone of women’s health for at least 60 years, is now officially a thing of the past, as new national guidelines recommend cervical cancer screening no more often than every three years.
In recent years, some doctors and medical groups, including the American College of Obstetricians and Gynecologists in 2009, began urging less frequent screening for cervical cancer. Even so, annual Pap smear testing is still common because many women are reluctant to give up frequent screening for cervical cancer.
The new guidelines, issued on Wednesday by the United States Preventive Services Task Force, replace recommendations last issued in 2003 and use more decisive language to advise women to undergo screening less often. Other groups, including the American Cancer Society, released similar recommendations on Wednesday. The new guidelines were published in Annals of Internal Medicine.
“We achieve essentially the same effectiveness in the reduction of cancer deaths, but we reduce potential harm of false positive tests,” said Dr. Wanda Nicholson, a task force member and an associate professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill. “It’s a win-win for women.”
Health Law Hearings: Justices Plan Daily Tapes
By ADAM LIPTAK
WASHINGTON — The Supreme Court announced on Friday that it would release same-day audio recordings of the arguments over the constitutionality of the health care overhaul law. The arguments will be heard over three days starting on March 26.
The court’s recent practice has been to release audio recordings of arguments at the end of the week. It plans to alter that practice for the health care case, the court said in a statement, “because of the extraordinary public interest” in the arguments.
The court said the recordings would be available on its Web site around 2 p.m. each day for arguments held that morning, and around 4 p.m. for the argument to be held on the afternoon of March 28.
U.S. Clarifies Policy on Birth Control for Religious Groups
By ROBERT PEAR
WASHINGTON — The Obama administration took another step on Friday to enforce a federal mandate for health insurance coverage of contraceptives, announcing how the new requirement would apply to the many Roman Catholic hospitals, universities and social service agencies that insure themselves.
In such cases, the administration said, female employees and students will still have access to free coverage of contraceptives.
The coverage will be provided by the companies that review and pay claims — “third-party administrators” — or by “some other independent entity,” it said.
Kathleen Sebelius, the secretary of health and human services, said the government would guarantee women access to contraceptives “while accommodating religious liberty interests.”
The new proposal escalates the election-year fight over the administration’s birth control policy.
Groups Push For Tough Health Spending Targets In Massachusetts
Even as Massachusetts celebrates a dip in the growth rate of health care costs, state lawmakers are still working feverishly on cost-control bills.
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