Given that the US spends $2.4 trillion per year on health care, far more on a per capita basis than any other country, it’s hard to believe that we fare so poorly when it comes to “preventable deaths,” a smorgasbord  of illnesses that shouldn’t—but do—kill us before our time.

But that’s the disheartening conclusion of a study by the Commonwealth Fund which recently appeared in Health Affairs.

The study looked first at death rates compiled by the World Health Organization regarding diabetes, epilepsy, influenza, pneumonia, stroke and ulcers during 1997-1998. It showed that Uncle Sam ranked 15th out of 19 industrialized countries in death rates from such “preventable” conditions.

A repeat analysis for the years 2002-2003 revealed that we had dropped to dead last, even though US health care costs rose nearly 30% in the intervening years.

According to the scientists leading the analysis, nearly 100,000 lives could have been spared if our health system performed as well those in Australia, France or Japan.

The scientists defined “preventable deaths” as those secondary to illnesses or injuries that need not happen or for which we have therapies proven to extend life through a certain age. Measles is an example, at least in developed countries. So are fatal cases of epilepsy, skin cancer, and certain surgical complications.

“These are conditions where early care and the right care should be able to prevent an early death,” Cathy Schoen, a Commonwealth Fund executive told the Washington Post. “We shouldn’t see people dying of diabetes before age 50.”

Or, as Mark Pearson, who chairs the health division at the Organization for Economic Cooperation and Development Pearson concluded succinctly, “the US doesn’t take primary care very seriously.”

Tomatoes, leafy greens and berries have all sorts of beneficial effects on health and everybody from your mother to Mehmet Oz says you should eat them regularly. There’s one problem though—these delectables frequently make you sick.

That’s the depressing news from a study conducted by the Center for Science in the Public Interest, whose scientists reviewed FDA data from the past 20 years to identify the foods that were responsible for the greatest numbers of food-borne outbreaks.

In descending order, the top 10 riskiest foods were: leafy greens, eggs, tuna, oysters, potatoes, cheese, ice cream, tomatoes, sprouts and berries.

“These are products that people are eating every day,” Sarah Klein, an attorney for the Center told the Washington Post.

“We need the food industry and the FDA to make sure these products are arriving in our homes and restaurants in a way that’s safe for consumers.”

Bacteria and their byproducts were the main culprits, from spinach laced with E. coli O157:H7 to tuna marinated in scombrotoxin. The unfortunate people who consumed tainted foods suffered a range of symptoms from stomach discomfort to death.

The report did not account for poultry, meat and some egg products since they are regulated by the Department of Agriculture.

Potatoes were the most surprising entry on the list. Since many of the spud-associated outbreaks were traced to restaurants, the offending bacteria might have found their way there from other foods courtesy of food handlers or tainted equipment.

According to the CDC, nearly 25% of Americans are sickened and 5,000 die each year from food borne illnesses.

Last summer, the House passed a bill to increase FDA jurisdiction over the nation’s food producers. The Senate should get around to it this fall.

It had been known for decades that kids who are born during the winter test relatively poorly, drop out of school more frequently, earn less as adults and have a shorter life expectancy than those born at other times.

But no one knew why.

There were several theories, of course. One held that since winter babies reach age 16 earlier in the school year, they can legally drop out a bit earlier in their education. Another postulated that vitamin D played a role, since winter babies got less sunshine early in life. A third suggested that the cause was higher pesticide concentrations in the surface water during spring and summer, when winter babies were conceived.

These theories might have some validity, but Notre Dame economists Kasey Buckles and Daniel Hungerman have come up with another, more compelling explanation: winter babies are more likely to come from socioeconomically less-privileged families.

To reach this conclusion, the economists examined CDC birth-certificate data for 13 consecutive years beginning in 1989. In every year, winter babies were more likely to be born to teenage or unwed mothers, or mothers that hadn’t completed high school themselves.

For example, 13.2% of January babies are born to teen mothers, whereas the number is 12% for May babies, a statistically significant difference that, along with other findings like it, is large enough to explain at least 50% of the differences in earnings, education and mortality (according to Buckles and Hungerman).

The economists can’t explain the surprising link between socioeconomic status and the time of the year when babies are born.

Perhaps it’s related to seasonal variations in employment, since married women tend to conceive when they are unemployed, they say.  Or perhaps it is due to cooler springtime temperatures, since hot weather decreases fertility, but only for those who live in homes without air conditioning.

Then again…January is roughly 9 months after prom season!

Contrary to FDA warnings on the matter, a UK  study has found “no clear evidence” to support the claim that the cigarette cessation drug Chantix increases the risk of suicidal thoughts and suicide.

To reach these conclusions, David Gunnell and colleagues at the University of Bristol reviewed the records of 80,660 men and women aged 18-95 years that had received a smoking cessation product (Chantix, Zyban or nicotine replacement therapy) between September 2006 and May 2008.

The scientists found 166 episodes of nonfatal self-harm and 2 suicides — both occurring in patients receiving nicotine replacement therapy. An additional 37 subjects reported having suicidal thoughts.

Chantix and Zyban did increase the risk of such phenomena by 12% and 17% compared with nicotine replacement products in the study, but this difference did not achieve statistical significance. The authors were left to conclude there was no clear evidence that Chantix was associated with an increased risk.

The limited study power “means we cannot rule out either a halving or a twofold increase in risk,” according to the authors.

Chantix also did not appear to increase the risk of depression or suicidal thoughts, confirming a report last March.

The FDA issued black box warnings for both Chantix and Zyban last July, and regulatory agencies around the world followed suit after adverse event reports raised the possibility of such a relationship.

The authors noted that smokers have a nearly threefold increased risk of suicide, probably because people with psychiatric illnesses are far more likely to be smokers.

It’s possible, they said, that smoking “has a beneficial effect on psychiatric symptoms, such as anxiety, that may be lost with smoking cessation.”

The write-up is in the British Medical Journal.

Although Americans are increasingly worried about the H1N1 (swine) flu, they remain wary about getting the vaccine designed to protect them against it, according to a poll completed last week by Washington Post-ABC News.

A majority of survey responders, 52%, claim to be worried “a great deal” or “somewhat” that they or another household member will come down with the infectious disease. That number was 39% in August.

Adults between the ages of 18 and 29, who are particularly vulnerable to the virus, exhibited markedly increased concern about the pandemic over the last 2 months. Forty-seven percent of the respondents in this group expressed concern about contracting the infection, up from 26% in August.

Yet despite this growing concern, only a shade over 60% of survey respondents indicate they intend to get vaccinated, and a measly 52% of parents plan to have their children get the jab.

This illustrates the twin challenges faced by the Feds in their effort to control the impact of the world’s first flu pandemic since man landed on the moon.

The CDC has allocated $2 billion to vaccinate more than half the US population and has made a commitment to immunize everyone that wants a shot.

Unfortunately, vaccine production has been slow out of the gate which has forced public health officials into triage mode, allocating limited supplies to those at greatest risk for fuliminant complications.

That said, the Feds have been largely ineffective in their efforts to convince people the vaccine is both safe and necessary.

For example, although 67% of survey respondents believe the spike is safe, only 22% claim to be “very” confident that it is. And among the one-third or so respondents who are not confident in its safety, only 6% plan to get the shot.

Looking for another reason to avoid the Greasy Spoon on your lunch break?

Oxford University scientists have provided a doozy. In their study, rats receiving a fat-laden diet exhibited a 50% reduction in exercise capacity and diminished cognitive skills after just 9 days.

The findings could have implications for Average Joes who eat Sloppy Joes for lunch, athletes in search of an edge, and people at risk for metabolic syndrome and diabetes, say the authors who published their findings in the FASEB journal.
 
“We found that rats, when switched to a high-fat diet from their standard low-fat feed, showed a surprisingly quick reduction in their physical performance,” lead author Andrew Murray told BurrillReport.
 
The physiology behind the observations is fairly well understood. Exercise endurance is a function of the amount of oxygen that can be delivered to muscles and the efficiency with which muscles can extract the energy contained within the chemical bonds of the nutrients supplied to them (a process known as oxidation)

Fat oxidation is less efficient than the oxidation of simple carbohydrates like glucose.

For their study, Murray and Co. fed 42 rats a standard diet containing 7.5% fat, and measured exercise capacity as the maximal time they were able to run on a treadmill. They assessed short-term memory in the subjects using a maze task.

The scientists then switched half the rats to a diet in which 55% of the calories were derived from fat and reassessed the rats’ endurance and cognitive abilities.

Junk food diets can easily approach the 55% fat content used by the scientists.
 
By day 9, rats on the high fat diet managed to run only half as far as their counterparts. They were also making mistakes about 17% earlier in the maze task, suggesting diminished cognitive skills.

If given the opportunity, most female surgeons would choose the same career again, even though it had a major–and not altogether positive–impact on their lives, according to a study in the Archives of Surgery. 

For the study, Kathrin Troppmann and colleagues from UC Davis mailed surveys to all 3507 surgeons that received certification from the American Board of Surgery in the years 1988, 1992, 1996, 2000 and 2004.

The scientists received 895 responses; 178 from women, and 698 from men.

Although both sexes reported they worked too much, more than 82% of female respondents and 77% of male respondents said they would choose their profession again. More than 75% of the female surgeons and 91% of the male surgeons were married

Female surgeons were less likely to have children (64% vs 91%) than their male counterparts, and tended to have their first child at an older age—after they had entered practice. Men tended to have their first child during residency.

For 27% of female surgeons, the spouse was their child’s primary caretaker. The spouse of male surgeons assumed these responsibilities nearly 80% of the time.

Female surgeons were more than twice as likely to assert that time-off for child-rearing was important after the birth of a child, and that child care should be available at work. Only 9% of females and 3% of males actually took time off after the birth of a child.

“A career in surgery has significant lifestyle implications: the profession is associated with high degrees of patient acuity, significant on-call responsibility, and irregular work hours, all requiring a significant commitment of personal time,” wrote the authors.

They concluded that strategies to increase recruitment and retention of female surgeons should include flexible work schedules and improved maternity leave and child care options.

The FDA has been on a seek and destroy mission against Web sites that distribute products it has not approved for use in the fight against H1N1.

Since May in fact, the agency has warned at least 75 Web sites to stop selling more than 135 products with fraudulent claims of efficacy against H1N1.

The FDA’s latest move in this regard has been to issue a joint warning letter, along with the FTC, to a Web site that markets fraudulent supplements claiming to help prevent spread of the virus.

The letter advises the Web site owners to cease and desist within 48 hours or else face the heavy hand of the law, which could include an injunction by the FTC and seizure of products, an injunction or criminal prosecution by the FDA.

To date, the FDA has identified all sorts of bogus H1N1 products, including:
- A shampoo claiming to protect against H1N1,
- A dietary supplement claiming to protect infants and children from H1N1,
- A supplement claiming to cure H1N1 in 4-8 hours,
- A spray claiming to leave a layer of ionic silver on one’s hands that kills the virus
- Several tests claiming to detect the virus, and
- An electronic instrument costing thousands of dollars claiming to use “photobiotic energy” and “deeply penetrating mega-frequency life-force energy waves” to strengthen the immune system and prevent symptoms associated with H1N1.

“Products that are offered for sale with claims to diagnose, prevent, mitigate, treat or cure the 2009 H1N1 influenza virus must be carefully evaluated,” said FDA Commissioner Margaret Hamburg. Such products can “make matters worse by providing consumers with a false sense of protection,” she added.

The FDA has approved 2 anti-viral drugs for treatment and prophylaxis of the 2009 H1N1: Tamiflu and Relenza.  It has also issued Emergency Use Authorizations that extend their approved labeling to additional, specific authorized uses as the pandemic spreads.

When Pfizer coughed up $2.3 billion to settle criminal allegations that it promoted off-label use of Bextra, it was the biggest such settlement in history. But Pfizer is not the only drug company to have been nabbed for such activities.

Five years ago, Parke-Davis forked over $430 million to settle a similar suit involving Neurontin.

Now it has come to light that Parke-Davis took advantage of the half-baked policies of certain journals regarding ghostwriting and disclosure of the financial ties of authors to promote off-label utilization of the latter drug.

Between 1997 and 2000, these journals published 13 articles promoting off-label use of Neurontin that were ghostwritten and funded by Parke-Davis without disclosing such arrangements, according to Jenny White, a research analyst at UCSF, who spoke at last months’ Peer Review Congress.

The journals have beefed up their disclosure policies since that time, White added.

To reach these conclusions, White and colleagues reviewed internal industry documents regarding Neurontin that had been archived at her school’s Drug Industry Document Archive. They subsequently asked the journals to delineate current and former policies regarding ghostwriting, conflict of interest and so on.

White’s group identified 24 articles and correspondences with editors that had either been produced with support from grants that Parke-Davis or  by Parke-Davis ghostwriters.

At least 13 of these articles were published in journals that included no disclosure of the fact that Parke-Davis had a role in producing the paper. Only 2 of these articles revealed that the authors had received honoraria from Parke-Davis.

These journals “generally had less stringent requirements [regarding disclosures] than those where articles were not published,” according to White. None of them had a policy regarding disclosure of ghost authorship.

White recommended that peer-reviewed journals adopt uniform policies to prohibit such shenanigans in the future.

Boston Scientific Corp. has agreed to cut a $716 million check to Johnson & Johnson to settle more than a dozen patent infringement lawsuits, including one in which a judge had already ruled in favor of J&J.

The settlement wraps up all but 3 stent-related lawsuits involving the two companies. Stents are cage-like metal struts that prop open partially blocked arteries.

Stents are most frequently used in the coronary arteries, but they can be used in other arteries as well.

The market for cardiac stents now exceeds $4 billion. Boston Scientific leads the pack in this field, but J&J owns the original patents on the medical devices after acquiring them from Julio Palmaz, the radiologist who invented them.

Nine years ago, a judge ruled that a Boston Scientific stent known as the NIR infringed on one of J&J’s patents. Boston Scientific appealed, but announced last year that it expected to fork over more than $700 million to settle the claim. That includes interest dating from the original verdict.

Boston Scientific announced it will pay the settlement from cash holdings, which amounted to $1.2 billion as of last June.

The market for stents has leveled off in recent years after studies showed they weren’t that effective in many instances, and other studies raised concerns about bleeding from the anti-platelet therapy that is normally prescribed after stents are placed.

The J&J settlement comes shortly after Boston Scientific settled separate stent-related claims with Medtronic. For its part, Medtronic recently paid $400 million to Abbott Laboratories to settle a patent infringement case regarding…you guessed it, stents.

The Mediterranean diet may protect against age-related cognitive decline, according to 2 studies published in JAMA.

The diet, which is long on vegetables, fruits, whole grains and fish, and short on red meat and poultry, has already been lauded for its cardio-protective and cancer preventing effects.

The first of the 2 studies, organized by Nikolaos Scarmeas and colleagues at Columbia, showed that the diet and physical activity were independently associated with a reduced risk of Alzheimer’s disease.

Scarmeas’ team enrolled 1,880 older patients with no cognitive impairment at study onset, and performed neuropsychological testing every 18 months for a mean follow-up of 5.4 years.

Alzheimer’s disease was diagnosed in 282 subjects during the study. Subjects who followed the Mediterranean diet were 40% less likely to develop Alzheimer’s than those who did not.

Similarly, a high amount of physical activity, which the scientists defined for this elderly population to be 1.3 hours of vigorous, 2.4 hours of moderate, or 4 hours of light physical activity per week, cut the risk of Alzheimer’s by 33%.

In the second study, Catherine Feart and colleagues at Universite Victor Segalen showed that the Mediterranean diet slowed cognitive decline, though it did not decrease the risk of dementia per se.

In particular, Feart’s team found that those adhering to the diet had fewer errors on the Mini Mental State Examination, but performed no better on 3 other tests of cognition.

In an accompanying editorial, the Mayo Clinic’s David Knopman said the 2 studies “provide moderately compelling evidence that adherence to the Mediterranean-type diet is linked to less late-life cognitive impairment.”

Whether these findings “should be translated into recommendations for the public is the question,” added Knopman. “For now, it is reasonable to nibble on these findings and savor them, but not to swallow them whole.”

Four years ago, the Federal Communications Commission adopted “network neutrality” principles that protected consumers’ rights to use Internet-based applications, services, content and devices of their choosing, and to foster competition among Internet providers.

Last week, FCC chairman Julius Genachowski proposed formalizing these rules and adding an additional one designed to prevent Internet providers from discriminating against certain applications or content by using bans or service degradations against offerings that compete with their own.

Genachowski also proposed that the rules should apply to wireless networks, which had not heretofore been subject to the network neutrality principles.

The FCC invoked network neutrality last year when it called-out Comcast for attempting to degrade the Internet connections of users who were attempting to use a particular kind of file-sharing software. Comcast appealed the ruling on grounds that the neutrality principles had not been formally adopted.

Formal adoption of the rules promises to be a time consuming process since it requires an extended period for public comment. During this phase, the communications industry is sure to raise several objections.

In particular, some providers want to offer faster connections to companies that pay a premium for the service, such as those who provide high-definition movies online.

Public advocates fear that such services can transform the Internet into a tiered service in which premium offerings are available only to well-endowed users.

Genachowski will likely compromise in this area, allowing experimentation with premium services while assuring that sites which do not pay extra continue receiving service levels to which they have become  accustomed.

The formalization process should begin later this month. A final plan could be voted on by next spring.

Cal Tech scientists may have figured out why some people have a notably annoying tendency to get too close during conversations, on subway trains or in restrooms.

The culprit turns out to be a malfunction in an almond-sized structure known as the amygdala, which is located in both temporal lobes of the brain. The amygdala processes negative emotions like anger and fear, but its role in social interaction had not previously been studied.

Daniel Kennedy, Ralph Adolphs and colleagus made the association by studying a 42-year-old woman known as SM, who has severe, isolated damage to her amygdala.

The scientists had known that SM couldn’t recognize fear in the expressions of others, or judge their trustworthiness, and had shown these abnormalities to be caused by her amygdala lesions.
 
While observing SM over time, Adolphs also noticed that she seemed to be too friendly, and frequently violated what others perceived to be their own personal space.

“She is extremely friendly, and she wants to approach people more than normal. It’s something that immediately becomes apparent as you interact with her,” Kennedy told BurrillReport.
 
So the scientists decided to compare SM’s sense of personal space to normal volunteers using the stop-distance technique, in which subjects approach a person until they reach a point where they feel most comfortable, and this distance is recorded.

Among the normal volunteers, the mean preferred distance was about 2 feet, but SM came in much tighter than that, about a foot. And unlike normal subjects who reported feeling uncomfortable when the experimenter approached to a distance within their preferred range, SM never became uncomfortable.

Even cheek to cheek, she was relaxed, and her feelings changed not a whit regardless of who the experimenter was or how well she knew them.

The write-up appears in Nature Neuroscience.

Preventive services for patients with Type II diabetes do reduce future health-care costs, but even in the long term, the initial expenses are not completely recovered according to a study published in Health Affairs earlier this month. 

To reach these conclusions, Michael O’Grady and colleagues compiled data from several clinical trials that used an aggressive but doable program to manage all phases of the disease.

They found that federally-insured patients enrolled in such a program would cost over $1,000 per person per year, and that even after 25 years, only ¾ of those costs would be returned via reduced spending on dialysis, amputations and coronary heart disease.

The only group in whom preventive services actually reduced long-term costs were those in their mid-20s at study onset.

“There’s no free lunch here,” concluded O’Grady in an interview with the Washington Post.

President Obama, House Speaker Nancy Pelosi and others claim that health reform will save money, in part by preventing the costs of future diseases by increasing access to preventive services.

Pelosi and Senator Tom Harkin frequently criticize the Congressional Budget Office for adopting a long-enough time horizon in estimating the cost impact of such programs.

The new study supports their position. Most savings accrued well after the 10-year horizon typically used by CBO. The study authors propose a 25-year time horizon for calculating the impact of such programs.

CBO Director Douglas Elmendorf seemed open to the suggestion, indicating the study was “exactly the sort of research that we use in building our cost estimates. We will consider these findings in future estimates we do in this area.”

Earlier this month, the CBO concluded that the costs of widespread cancer screening and cholesterol management programs were going to far outweigh any savings, even in the long term.

In a finding that would be laughable if it weren’t so scary, scientists have determined that the chemicals which helped avoid a potential global environmental catastrophe—the hole in the ozone layer—are contributing to another one: global warming.

The compounds in question are hydrofluorocarbons, also known as HFCs.

They were introduced a decade ago as replacements for chlorofluorocarbons, ozone-depleting gases that had been used in refrigerators, air conditioners, and the production of foam insulation.

The ozone hole is shrinking all right, but hydrofluorocarbons are basically greenhouse gases on steroids: molecule for molecule, they have 5,000 times the heat-trapping power of carbon dioxide.

And unless we find replacements for the replacements, scientists warn these puppies can cancel out other efforts to combat global warming.

“Whatever targets you thought you were going to make,” David Fahey, a physicist at the National Oceanic and Atmospheric Administration told the Washington Post, “it will be undermined by the fact that you have . . . additional emissions that you hadn’t planned on.”

Hydroflurocarbons now account for nearly 2% of US-based climate-warming emissions, according to the EPA.  Good old carbon dioxide, a byproduct of burning fossil fuels, is responsible for 85% of the problem. Methane, which comes from farm animals (don’t ask) and decomposing trash causes most of the rest.

But the HFC problem is growing rapidly. By 2050, scientists believe, HFCs in the atmosphere will be equivalent to about 6 years’ worth carbon dioxide emissions.

“You have this moment when you could nip this problem in the bud and avoid this very large growth of a dangerous chemical,” David Doniger, a policy director at the Natural Resources Defense Council’s climate center told the Post. “Now, in the next couple of years, is when you have to do this.”

Not long ago, FDA deputy commissioner Joshua Sharfstein criticized the process his Agency used to approve ReGen’s Menaflex knee device,  claiming that “extreme” pressure from New Jersey Congressmen had compromised its integrity.

He added that the skullduggery was a factor in prompting his decision to review the FDA’s 510 (k) program, which fast-tracks approval of medical devices by requiring less rigorous clinical testing than the standard process.

“It’s autumn, and change is in the air. This is particularly true for our 510k program,” echoed Donna-Bea Tillman, head of the device evaluation office, in an email to her staff that was obtained by The Wall Street Journal.

The very thought of change to 510k goes over like a lead balloon for device makers like Johnson & Johnson, who warn that tampering with it would end up robbing the public of rapid access to a stream of live-saving, quality improving (not to mention money making) instruments.

J & J spokesperson Carol Goodrich said that 510k streamlines clearance for devices deemed “substantially equivalent” to those on the market, “builds on ever-expanding knowledge,” and accelerates innovation.

Tighter approval standards, she said, “would raise development costs substantially while also creating barriers to market entry that would reduce competition.”

About a third of J & J’s $64 billion in annual world-wide revenues derives from the sale of medical devices and diagnostic equipment.

The FDA’s move was just the latest bad news for the device industry.

Congressional Democrats for example, are pitching a tax on device makers to help pay for  health reform. If passed, the proposal could cost the industry $40 billion over 10 years.

To be sure, the Advanced Medical Technology Association, a lobbying group that represents device makers, is working overtime in Washington to set things straight on both counts.