HIV Cases Fall by 25% between 2001-1009. The data comes from a press release by the Joint United Nations Programme on HIV/AIDS. Researchers attribute the drop to safer sex behaviors in men and women, in part because of increased awareness and prevention campaigns.

Twitter Limited as a Tornado Warning Tool. Twitter has limitations as a means for notifying the public about imminent tornado danger, says Crisis Commons, an organization dedicated to developing innovations in crisis management through open data and volunteer technology communities.

Bomb Blast Damage Found in Brain Scans of GIs. Neuron damage in explosion-related “mild” traumatic brain injuries can be more extensive than previously thought and is not necessarily related to the severity of clinical symptoms, researchers said.

CBO Says Advertising Moratorium on New Drugs Will Have Little Effect. The Congressional Budget Office examined the consequences of proposals to place a moratorium on consumer advertising of newly approved drugs during their first two years and concluded such a measure would have little effect.

Rule Would Give Patients Access to Privacy-Related Data. Under HIPAA law, providers, health plans and other healthcare organizations must track electronic access to protected health information, but they are not required to share this information with patients. A rule proposed by CMS would require providers to inform patients that they can request this information.

Based on their experience during countless schleps to the market, moms know that kids pick cereals whose boxes have cartoon characters on them. Previous research by Yale scientists explained the phenomenon: kids say that the stuff poured from such boxes tastes better than the same stuff when poured from a cartoon-less box. The same thing happens when kids pick graham crackers, carrots and gummy fruit snacks.

Pictures of Shrek, Dora the Explorer, Scooby Doo and their kin make just about anything taste yummier, it seems.

Can this observation be leveraged to encourage kids to select healthier foods? Yes, it turns out. But the story isn’t as straightforward as you’d think.

To study the impact of licensed media spokescharacters and other nutrition cues on kids’ taste assessment of food products, scientists at the University of Pennsylvania fed cereal from a box that had been labeled either “Sugar Bits” or “Healthy Bits” to 80 kids. Half the boxes in each “brand category” were adorned with cute cartoon penguins, while the other half were not. The kids were between 4 and 6 years old.

The scientists then asked the kids to rate the taste of the cereals on a 1 to 5 smiley face scale. Surprisingly, kids loved the Healthy Bits, which scored 4.5 regardless of whether the penguin was present or not. However, the penguins had a marked impact on kids’ taste preferences for Sugar Bits. For this brand, the taste score sans penguins was below 3, whereas it was over 4 if the cereal was delivered from a box featuring the friendly penguins.

Lead author Matthew Lapierre didn’t know for sure why this happened. “One of the explanations we’ve been working with is that kids grow up with this negative association with sugar,” he reasoned in an interview.

To support his hypothesis, Lapierre noted that many cereal brands have replaced the word “sugar” with other words that imply a somewhat healthier message. Sugar Smacks are now called  Honey Smacks, for example. Sugar Crisps are now sold as Golden Crisps.

If Lapierre is right, then these healthier messages have been internalized by kids to the point that they have negative perceptions of the word ‘sugar’ in the faux brand created by his group.

Then again, a smiling cartoon penguin is all it took to boost the kids’ favorability ratings to match those of Healthy Bits. The penguin trumps the healthy message in the minds of kids.

Lapierre’s group concluded that “not only do appealing … characters manipulate young children’s subjective judgments, the resulting heightened preference for food products featuring these characters is likely to contribute to unhealthy eating habits.”

Expect consumer groups to demand an all-out ban on Tony the Tiger any day now! The write-up appears in the Archives of Pediatrics and Adolescent Medicine.

Most people know that sugary cola drinks have no nutritional benefits, promote weight gain, obesity and diabetes, and contain caffeine, a mildly addictive stimulant. Some people know these drinks contain phosphoric acid, which promotes tooth decay and bone loss, especially in females. But until last week, almost nobody knew that the artificial brown “caramel” coloring that gives cola drinks their familiar appearance contains carcinogens.

How can something as apparently benign as caramel coloring contain cancer-causing agents? Isn’t caramel coloring derived from caramel, that simple homemade treat created by melting sugar in a saucepan?

It turns out that there are several ways to create caramel coloring. The one used to create the caramel coloring found in Coca-Cola, Pepsi, and other foods involves chemical processes that include ammonia. This particular process produces so-called Caramel IV and a pair of byproducts, 2-methylimidazole and 4 methylimidazole, which have been shown to cause cancer of the liver, lung and thyroid, as well as leukemia in laboratory animals.

The disquieting news came in the form of a regulatory petition filed by the Center for Science in the Public Interest, which also called for the FDA to ban these substances from food and drinks that are consumed by US consumers. 

The petition cited studies from the National Toxicology Program which provided “clear evidence” that both substances are animal carcinogens. It also cited studies by scientists at UC Davis, which found the chemicals in several popular cola brands.

“Carcinogenic colorings have no place in the food supply, especially considering that their only function is a cosmetic one,” CSPI executive director Michael Jacobson said in a press release. “The FDA should act quickly to revoke its approval of caramel colorings made with ammonia.”

“Most people would interpret ‘caramel coloring’ to mean ‘colored with caramel,’ but this particular ingredient has little in common with ordinary caramel or caramel candy,” Jacobson continued. “It’s a concentrated dark brown mixture of chemicals that does not occur in nature. Regular caramel isn’t healthful, but at least it is not tainted with carcinogens.”

Several experts on animal carcinogenesis joined CSPI in asking the FDA to ban Caramel IV from foods and beverages. “The American public should not be exposed to any cancer risk whatsoever as a result of consuming such chemicals, especially when they serve a non-essential, cosmetic purpose,” these experts wrote in a letter to FDA Commissioner Margaret Hamburg.

In a related development, California health officials recently added 4 methylimidazole to its list of “chemicals known to the state to cause cancer.” The state’s Proposition 65 requires that foods or beverages containing more than certain amounts of cancer-causing chemicals must carry warning labels. In the case of 4 methylimidazole, the state has established 16 micrograms per person per day from a particular product as the level that would trigger the need for a label.

Most cola brands contain about 200 micrograms of 4 methylimidazole per 20-ounce bottle. Many people consume far more than that each day. It’s quite possible therefore, that cola products sold in that state will soon have to have a cancer warning label…unless, of course cola producers opt for a kind of “caramel coloring” produced using a non-ammonia-dependent process. 

NOTE: CSPI added in its release that the 10 teaspoons of calorie-leaden sugars in each can of non-diet cola constitutes a larger health risk than 4 methylimidazole. Still, CSPI estimated that the carcinogen was probably responsible for “causing thousands of cancers in the U.S. population.” For people who needed another reason to kick the cola habit, here it is.

Spring training 2011 is in full swing. With baseball’s regular season just 2 weeks away, pitchers are lengthening their starts and adding curveballs to the mix. Promising, but lamentably green prospects are being reassigned to Triple A. And word has it that Mariano Rivera is preparing to throw an inning or two, just to be sure his 4-seamer is game-ready before opening day.

People have said that Baseball is Life. That may be stretching it for folks not named Yogi, but surely the game holds lessons for us all…even health policy wonks! Before we highlight the top submissions to this week’s HWR, let’s review some of these lessons:

Lesson 1: People Will Believe Anything
Somewhere this spring, a local sports writer opined that the kid who touched 98 in the 6th inning of a Cactus League game is the next Tim Lincecum, even though he has never recorded a regular-season out above Double A. Another said this year’s Phillies’ rotation will match the prodigious ‘71 Orioles quartet of Cuellar, McNally, Palmer and Dobson. Others claimed that A.J. Burnett will win 20 this year, and that Vlad Guerrero (whose gait is reminiscent of the Tin Man in Wizard of Oz) will steal 20 bases.

And people believe it!

During the epic health reform debate of 2009-2010, Democrats tried to include provisions which authorized payments to physicians for time spent helping Medicare patients prepare living wills. But Sarah Palin claimed those provisions allowed the government to create “death panels,” and John Boehner warned that they would “start us down a treacherous path toward government-encouraged euthanasia.”

People believed that, too!

To this day, an astounding 30% of elderly Americans believe the new health law empowers government panels to make end-of-life decisions for Medicare beneficiaries.

Lesson 2: Sometimes You Get a Do-Over, Sometimes You Don’t
Umpire Jim Joyce robbed Tigers pitcher Armando Galarraga of a perfect game last year when he blew a call on what should have been the last out of the game. Although Joyce later admitted his mistake, there are no do-overs in baseball. The pitcher’s chance to make history was gone forever.

Meanwhile, GOP-appointed Federal District Judge Robert Vinson decided in January that since he found one provision of the Big O’s health law to be unconstitutional, he might as well trash the whole deal. The decision threatened to disrupt planning in 50 states and confused the bejesus out of the American public. But unlike baseball, the US judicial system does permit do-overs…sort of. Two weeks ago, Vinson issued a stay of his own ruling, effectively allowing the law to stand pending an appeal to the Supreme Court.

Galarraga would be immortal if Joyce could have done that!

Go figure. Anyway, the Yankees will rise again in 2011 (believe me!) and finally, thanks to the HWR All-Stars who contributed posts for this week’s edition. Here is the formidable line-up:

The Sluggers (Health Policy)
For his post on the Forbes website, Avik Roy produced a chart showing results from the Health Tracking Study Physician Survey. The chart confirms that physicians refuse to accept Medicaid patients at rates that far exceed those who are covered by Medicare and private insurance. Roy suggests this problem is responsible for poor clinical outcomes seen in Medicaid beneficiaries.

Between innings, Roy should have a beer with Austin Frakt, who pretty much blows-up the premise that Medicaid recipients receive poor quality health care. In a post for the Incidental Economist, Frakt shows that studies used to support the premise reveal an association between Medicaid and individuals with poor health… it’s their poor health, Frakt says, that is driving poor outcomes in this population, not lousy doctors or poorly designed care systems.

Now that President Obama has decided to support Wyden-Brown, disaffected governors and state legislators can craft PPACA alternatives that are more to their liking, writes Joe Paduda over at Managed Care Matters. According to Paduda, if Republicans actually have a better approach to the problems of health care access and cost, they are going to win big in 2012.

For his part, John Goodman predicts that the PPACA will encourage many patients and providers to opt-out of the third-party payer system. Posting on his own Health Policy Blog, Goodman visualizes a major shift toward concierge-type services and the creation of new markets in which providers compete for patients on price, quality and amenities.

Neil Versel is a huge fan of Don Berwick, but he deplores the way President Obama attempted to install the Quality Don as a recess appointment to head CMS in July, 2010. According to Versel, the underhanded nature of the appointment provided fodder for “uninformed ideologues and assorted nut jobs to attack Obama’s healthcare reform efforts.” Versel’s blog is Meaningful HIT News.

Over at BNet Healthcare, Ken Terry observes an accelerating trend in which insurers and providers are partnering to create Accountable Care Organizations. Terry believes the 2 groups actually can cooperate to form such organizations, and cites several recent acquisitions and partnerships which appear to support his position.

Marsha Gold has followed the Medicare Advantage program and its predecessors for years. In her post on the Health Affairs Blog, she summarizes the program and describes how its beneficiaries will be affected by the PPACA.

In a post for his Health Business Blog, David Williams reminds us that many folks want to overturn new rules restricting Flexible Spending Accounts. Williams ups the ante a bit by suggesting that we eliminate FSAs altogether, and get rid of those pesky tax deductions for health insurance while we’re at it.

David Kindig reviews the implications of Wisconsin Governor Scott Walker’s plan to eliminate the state’s $3.6 billion dollar deficit. Kindig argues that some of Walker’s proposed cuts (including reducing Medicaid eligibility) will have serious health implications for people in his state. His post appears at Improving Population Health.

The Lucidicus Project’s Jared Rhoads reacts to presentations he heard at the TEDxDartmouth 2011 conference. After hearing Al Mulley’s familiar argument that our health system needs to adjust more effectively to consumer preferences, Rhoads doesn’t believe we can pull it off.

Reconciling state and federal laws can be difficult, and according to Louise Norris of the Colorado Health Insurance Insider, Health Reimbursement Arrangements (HRAs) are a particularly nettlesome case-in-point in her home state. Her post clarifies the situation, thankfully.

The Starters (Providers)
Roy Poses describes how physicians who are employed by corporations can be pressured to put the corporations’ economic interests ahead of their patients’ interests. Writing for Health Care Renewal, Poses argues that the primary means of corporate control includes restrictive covenants in contracts that have been signed by naive physicians, or signed by physicians under duress.

The PPACA will eventually generate a huge increase in the number of ER visits, according to Amer Kaissi. He argues that better coordination between ER and primary care doctors will be required to address the coming deluge, and offers a roadmap for this effort. Kaissi posts on Healthcare Hacks.

Julie Ferguson of Workers Comp Insider writes that nurses, nurses’ aides and paramedics are facing a rising tide of on-the-job violence. In fact according to Ferguson, only police and correctional officers experience higher rates of on-the-job assaults. Ferguson explores whether this is emblematic of a dysfunctional health system or just a sign of the times.

Liz Borkowski reminds us that while palliative care teams can reduce costs associated with the care of seriously ill hospitalized patients, most people who are eligible for these services don’t receive them. Borkowski, who posts at The Pump Handle, concludes that we have to do more to encourage utilization of these teams.

On The Health Care Blog, Matthew Holt posts an interview with JD Kleinke concerning the latter’s new novel, Catching Babies. Holt describes the book as a “tour de force of health policy and medical soap opera–Health Affairs meets Grey’s Anatomy–wrapped up in the complex world of childbirth.”

The Closers (Quality and Safety)
There is limited evidence to support claims that pay for performance programs improve quality and reduce the costs of health care, according to Jason Shafrin, who posts on The Healthcare Economist. Shafrin reviews Massachusetts’ pioneering P4P program and several other ones that failed to improve care.

Jaan Sidorov laments that a one-size-fits-all approach to health care—characterized by guidelines and decision support—is woefully behind sociotechnical trends that make “mass personalization” possible. Writing for Disease Management Care Blog, Sidorov argues that those who embrace the latter approach (by tailoring treatments based on the health status, preferences and values of individual patients, for example) will win in the marketplace.

At The John A. Hartford Foundation Blog, Chris Langston discusses the problem of overmedicating the elderly. He reviews a study in which 42% of the Indiana Medicaid population who live in nursing homes received at least one “potentially inappropriate medication.” Not surprisingly, these patients had worse health outcomes.

-Seventh Inning Stretch-
Famed HWR Contributor Argues Against a Key Policy Decision:

www.youtube.com/watch?v=xs0SinIno7A

The Base-Stealers (Health IT)
Many CEOs and CIOs believe that their healthcare IT systems are secure because they “use SSL encryption” or “have a firewall.” That’s not the case, according to The Healthcare IT Guy, Shahid N. Shah. Shah offers a list of questions that executives can use in order to assure their systems really are secure.

Walking through the palatial vendor displays at this year’s HIMSS conference, Anticlue blogger Elyse Nielsen heard surprisingly little buzz about “the cloud.” In her post, Nielsen explains why this was the case, and opines that it won’t be long before the buzz picks-up.

The Slick Fielders (Pharmaceuticals)
Over at Nuts for Healthcare, Jeffrey Seguritan wonders what things would be like if drugs and their makers were forced to endure the same mano-a-mano competition that makes the NCAA basketball tournament such a good watch. Although the FDA does not require comparative trials like this before green-lighting drugs, Seguritan reviews a few such trials that are actually underway.

The Five-Tool Guys (Media)
Lately, health media watchdog Gary Schwitzer has focused on instances in which press releases drive what we call “news” in health care. In a pair of posts on his HealthNewsReview Blog (here and here), Schwitzer warns that when this happens, independently vetted journalism may not have taken place. 

The Stud Prospects (Consumerism)
Employers and health plans continually seek ways to contain health care costs. According to Dave Kerrigan, limiting the size of provider networks is a powerful and potentially beneficial tool in this regard. Kerrigan’s post appears on A Musing Healthcare Blog.

The Rabid Fans
Nobody is immune from DrRich’s sharp-tongued post on The Covert Rationing Blog. DrRich skewers, in no particular order, lying doctors, the right-wing media, the left-wing media, and quite possibly my Aunt Millie as well. We’re not sure what DrRich is for, but we know what he’s against, and it’s just about everything.

“Unions get waivers,” the InsureBlog’s Bob Vineyard exclaims. “Campaign contributors get waivers. Business owners and states get waivers. Why should consumers be left out?” In his post, Vineyard points out that some Michigan Representative wants to give consumers the right to opt out of “Obamacrap.” Obamacrap? Really? Obamacrap?

Whatever. Two weeks from today, Jason Shafrin hosts the Health Wonk Review over at the Healthcare Economist. Good luck Jason, and thanks to the all-stars who contributed to today’s edition!

Energy drinks represent the fastest growing segment of beverage sales in the US, with revenues predicted to surpass $9 billion this year. Children, teens and young adults consume at least half of all energy drinks.

Is there a problem with this? Perhaps so, according to the results of a new study. Many energy drinks contain high levels of unregulated ingredients and therefore could pose a health risk to the younger folks who consume them so avidly.

To review the effects and adverse consequences of energy drink consumption among children, adolescents, and young adults, Sara Seifert, of the University of Miami, and colleagues searched PubMed and Google for an assortment of terms including “energy drink,” “sports drink,” “guarana,” “caffeine,” “taurine,” “diabetes,” and “poison control center.” They reviewed the articles they found as well as manufacturer Web sites for product information.

The review suggested that 30-50% of young people consume energy drinks in the US, although there is considerable variation in the types of drinks consumed and the frequency with which they are consumed.

The adverse consequences of energy drink consumption, as documented by the scientists’ review, can be divided into 3 categories: caffeine overdoses, organ system dysfunction and interactions with drugs. Let’s review these briefly:

Caffeine Overdoses
Nearly half of the 5,448 caffeine overdoses in 2007 involved people who were 19 years old or less, the scientists reported. They weren’t able to determine which cases were caused by the consumption of energy drinks, but suggested that it is substantial.

Energy drinks typically contain between 70-80 mg of caffeine per 8-oz. serving, or about 3 times as much as is found in most cola drinks. Since energy drinks are classified as dietary supplements rather than food, producers aren’t required to specify the caffeine content on the label, or the amounts of other ingredients which could add more caffeine.

Caffeine is the primary active ingredient in most energy drinks, but other ingredients like kola nuts, guarana, cocoa and yerba mate can significantly increase overall caffeine content.

For example each gram of guarana adds 40 to 80 mg of caffeine to the drink, not to mention small amounts of the stimulants theophylline and theobromine.

Organ System Dysfunction
Seifert’s literature review revealed a long list of physiologic problems and symptoms that have been attributed to energy drinks. These included diabetes, cardiac arrhythmias, hypertension, rhabdomyolysis, kidney and liver damage, behavioral and mood disorders and seizures.

The scientists found that kids with baseline health problems (including liver or kidney disease, cardiovascular disease, behavioral problems and hyperthyroidism) were at particularly high risk for complications from energy drinks.

Deaths attributed to energy drinks have been documented in Germany and Ireland.

Drug Interactions
Seifert’s group said that energy drinks containing vinpocetine, 5-hydroxytryptophan, ginseng, L-carnitine and yohimbine were particularly likely to cause adverse drug reactions, though they didn’t provide much data on how often these events actually happened.

“Energy drinks have no therapeutic benefit, and many ingredients are…not regulated,” Seifert’s group concluded. “Both the known and unknown pharmacology of various ingredients, combined with reports of toxicity, suggest that these drinks may put some children at risk for serious adverse health effects.”

The write-up appears in Pediatrics.

In recent years, scientists discovered that blueberries were loaded with anthocyanins, resveratrol, flavonoids and other chemicals that slowed aging and cut cancer risk in mice.

Blueberries have never been shown to have these effects in humans, but the discoveries have nevertheless triggered quite a renaissance for the tasty fruit. In fact nowadays, you can find blueberries in nearly every aisle at the grocery store. You can buy blueberry bagels, blueberry ice cream and blueberry salad dressing for example, in addition their old-time hang-outs in muffins and cereal…and that’s not even counting the fresh, natural berries themselves.

But consumers need to exercise caution when purchasing these products. While many feature enticing pictures of blueberries on their labels, some don’t contain real blueberries at all, according to a recent report by the Consumer Wellness Center.

Take Blueberry Muffin-flavored Frosted Mini Wheats, for example. This Kellogg’s product contains not a whit of blueberries. Instead, it contains “blueberry flavored crunchlets” which are made from sugar, soybean oil, red #40 and blue #2.

Worse yet is the General Mills product, Total Blueberry Pomegranate Cereal. It contains neither blueberries nor pomegranates.

Many other products contain a trivial amount of blueberries, it’s true, but their recipes contain a host of of artificial colors, hydrogenated oils, liquid sugars and other ingredients that make their products look like they contain a lot more blueberries than they really do.

For example, Target brand blueberry bagels claims to contain “blueberry bits.”  Now, to be fair, the ingredients list does include actual blueberries, but those blueberry bits aren’t made from the real thing. Instead, they’re made from sugar, corn cereal, modified food starch, partially hydrogenated vegetable oil, artificial flavor, cellulose gum, salt and artificial colors like Blue #2, Red #40, Green #3 and Blue #1.

This appears to be false and deceptive advertising. Most consumers are under the impression that when they buy blueberry bagels, cereals and so on, they’re buying real blueberries. But real blueberries are expensive. These other ingredients are dirt cheap and have longer shelf-lives.

We’re confident that the FDA will eventually take action on the matter. Until then, consumers need to read the labels on these products. Tip-offs to the deception would be those artificial dyes, red #40 and Blue #2. Chances are that if you see them, you’re buying less blueberries than you think, and maybe no blueberries at all.

Almond milk may be the biggest thing to fly-off grocery store shelves since, well, sliced bread.

The toasty-tasting non-dairy product is produced by crushing roasted almonds into a buttery compound, and then adding water, stabilizers, vitamins, and a sweetener. A cup of almond milk contains about 60 calories, which is considerably lower than soymilk (90 calories) and less than half that contained in 2% milk (130 calories).

Enamored consumers have so far been willing to pay premium prices for almond milk. A 32 oz. container of almond milk costs approximately $1.80. That’s a few cents less than soy milk (still the leading dairy alternative), but far more than the cost of cow’s milk, which is roughly $1.25 per 32 oz. container.

Sales of almond milk and other milk substitutes topped $100 million last year. That’s trivial compared with the roughly $13 billion spent on cow’s milk. Still, its sales were up 15% year-over-year. Sales of cow’s milk are mired in a decades-old decline.

The increase in almond milk sales is driven by several factors aside from good taste and trendiness.  Increasing awareness of dairy allergies and a steady, though modest increase in vegan lifestyles play a role, for example. In addition, there has been some cannibalization of sales from soymilk after some studies suggested that estrogen-like compounds in the latter might predispose consumers to breast cancer.

The biggest factor however, has been the decision by grocery stores to sell almond milk in the refrigerator case, right next to cow’s milk. When that happened in 2009, consumer demand began to skyrocket.

“The beauty of the almond milk category is that almonds are so familiar to consumers, and there’s an expectation of great taste there,” Brooke Hansen a marketing expert at Silk, the second-leading brand of almond milk, said in an interview.

Almond Breeze, produced by Blue Diamond Growers of Sacramento, is the market leader. Blue Diamond rolled-out Almond Breeze in 2009 shortly after market testing showed huge uptake in Hispanic populations, which have high rates of lactose intolerance. Silk, which already had a soymilk product on the market, released its version of almond milk in January, 2010. Since then, the two entrants have been duking-it out in a marketing war reminiscent of the longstanding battle between Coke and Pepsi. 

Almond Breeze remains the market leader, with 2010 sales of $57.8 million. Sales of Silk were $47.1 million in 2010.

The surge in sales of almond milk has caught the attention of the dairy industry, by the way. Last spring, the National Milk Producers Federation, a lobby for dairy farmers, fired-off a letter to the FDA in which it requested that the regulatory agency ban the word “milk” from the names of these non-dairy products. The letter suggested that they should be called “plant-derived imitation products.”

How do you suppose Blue Diamond and Silk would feel about that?

Traditionally, people get blood tests when a doctor recommends them. This usually happens at the conclusion of an office visit. Nowadays however, people have begun deciding for themselves which lab tests to get and when to get them.

Folks have different reasons for making such independent decisions. Some want to keep track of cholesterol or hemoglobin A1C levels. Others want to assure their blood will screen negative for drugs prior to a job search, test for the presence of a disease like hepatitis C or AIDS, or obtain a chemistry panel that provides a broad picture of their overall health. The biggest reason for consumer-directed lab testing however, is an economic one. Uninsured people, and those with high-deductible insurance plans find it cheaper to do-it-themselves, since it avoids the cost of an office visit.

The savings can add up. A lipid profile (including cholesterol levels) obtained from an online lab testing company costs about $40. A hemoglobin A1C test usually runs a bit less. A visit to the doctor’s office typically costs $150 or more.

Although hundreds of tests can be obtained in this manner, the most commonly sought-after tests are lipid profiles, C-reactive protein (a new measure of cardiac risk), liver and kidney function tests, vitamin D levels, and hormone levels including estrogens and testosterone.

Consumers have plenty of ways to get lab tests done on their own. Many simple tests are available at drugstore clinics and health fairs, for example. Those interested in tracking their cholesterol levels over time can purchase either single-use devices for about $15 or reusable devices, usually for under $100.

The real growth in the do-it-yourself lab market however, involves online testing services such as HealthOne, Direct Laboratory Services, Health One, Personalabs and PrivateMD Labs.

According to one report, people spent nearly $20 million for lab tests through companies like these last year, and annual growth of 15-20% is expected in the next few years (although these projections may seriously underestimate demand if newer, lab-on-a-chip technology continues to develop. This technology promises to cut waiting times for lab test results from several days to less than 30 minutes, a feature that will surely capture the imagination of health consumers).

These Web-based companies permit consumers to order lab tests online. They contract with national laboratories like LabCorp to draw the blood and run the test. The firms usually have staff physicians that sign orders for tests without ever seeing patients. They also help consumers interpret the results, for example by emailing them with recommendations to see a doctor if their results fall outside normal ranges and by phoning anyone whose results suggest a serious abnormality.

A Word of Caution
All this is fine and good so long as consumers remember that lab results need to be evaluated in a larger clinical context. A mildly elevated cholesterol level means one thing in an otherwise healthy individual, and quite another in somebody who has multiple cardiac risk factors. As well, various factors influence test results and hence, the way these results should be interpreted. For example, an elevated C-reactive protein level can suggest increased cardiac risk, but it also can be caused by non-cardiac factors like a winter cold or some other minor infection. It’s always wise to consult a physician or another trained provider when it comes to interpreting lab results.

Millions of people consume red yeast rice to lower their cholesterol levels. The dietary supplement contains monacolins, which are known to inhibit cholesterol synthesis in the liver. A purified version of one member of the monacolin family, monacolin K, is also known as lovastatin, the widely prescribed, highly effective cholesterol-lowering drug.

Studies of some (but not all) red yeast rice formulations have shown that they do in fact reduce blood levels of low-density lipoprotein (LDL, or “bad”) cholesterol, and reduce the risk of heart attacks and cardiovascular disease.

Does anybody have a problem with this?

Well, yes. The problem is that since red yeast rice products are classified as dietary supplements and not drugs, they are not regulated by the FDA and hence not always subjected to quality and safety checks that legit drugs get before hitting the shelves. With dietary supplements, you don’t know how much of the “good stuff” you’re getting, and you don’t know what else you may be getting with it.

Ram Gordon and colleagues at the University of Pennsylvania highlighted the problem in a recent study, which they published in the Archives of Internal Medicine.  For their study, Gordon’s team asked an independent laboratory to measure monacolin levels in 12 commercially available formulations of red yeast rice. They also asked the lab to test for citrinin, a byproduct of fungal metabolism of red yeast rice, which is how monacolins are produced from rice in the first place.

Citrinin is toxic: it causes kidney damage, at least in animals.

The label on each formulation in Gordon’s study said it contained “600 mg capsules” of active product, yet Gordon’s team found that the total monacolins per capsule varied by more than 30-fold across the 12 preparations (lowest = 0.31 mg, highest = 11.15 mg). The range of monacolin K (a.k.a lovastatin) varied even more, by a remarkable 100 fold (lowest = 0.10, highest = 10.09 mg).

Four of the 12 products contained citrinin, in levels ranging from 24 parts per million to 189 parts per million.
 
Of interest, the average dose of lovastatin contained in the 12 red yeast rice formulations was 6 mg/day. The maximum dose was 14.5 mg/day. The normal dose of FDA-approved lovastatin is 10-80 mg/day.

“Our findings suggest the need for improved standardization of red yeast rice (RYR) products and product labeling. Until this occurs, physicians should be cautious in recommending RYR to their patients for the treatment of hyperlipidemia and primary and secondary prevention of cardiovascular disease,” the authors wrote.

Many emergency physicians and first responders suggest that people who have medical conditions that would not be obvious to providers in the event they couldn’t communicate should enroll in some form of medical-identification program.

This advice covers tens of millions of Americans who have diabetes, heart disease, serious food and drug allergies, and who take anticoagulants like Coumadin, among other conditions.

People who decide to heed the advice may be surprised to find the medical bracelet industry has made remarkable advancements of late. Those simple, silver ID bracelets containing a few engraved words saying “allergic to penicillin” have largely been replaced by a family of high-tech gadgets that can alert emergency medical providers about nearly all aspects of one’s medical history, including things like their full medication list, prior EKGs and so forth.

Perhaps the most well-known bracelet provider is MedicAlert, which markets engraved bracelets that include one’s member number and toll-free access to a medical hot line. The service costs about $30 per year. 

Kaiser Permanente offers some enrollees a  flash drive containing encrypted health information that is derived from its electronic health record.

MedInfoChip markets software that lets people create a medical record and download it to a thumb drive. American Medical ID offers a similar device that comes in the form of an engraved pendant.

For people who object to the bracelets on aesthetic grounds, there’s the Invisible Bracelet. Members of this program can affix cards to their driver’s license, carry a key fob or wear a sticker on their bike helmet. All these devices display a member ID and links to a secure web site that houses personal health records. 

Even jewelry companies have gotten into the act by providing “smart” bracelets, necklaces and pendants that mimic real bling. Tiffany sells a gold bracelet for $2,250, for example. Rich people get sick too, after all.