HPN Daily Update s3

September 13, 2016 Sugar industry manipulated heart studies, review finds A sugar industry group paid for studies that underplayed the role that added sugars play in heart disease, researchers reported Monday. Studies paid for by the lobbying group helped set the U.S. on a policy course that focused almost exclusively on fat as the main cause of heart disease, leaving out the considerable role that sugary foods play, the researchers said. They compare the sugar industry's approach to tactics used by the tobacco industry to shed doubt on research showing tobacco causes cancer and heart disease. And this kind of practice still goes on today, experts said in a pair of papers published in the Journal of the American Medical Association's JAMA Internal Medicine. "These tactics are strikingly similar to what we saw in the tobacco industry in the same era," said Stanton Glantz of the University of California San Francisco's Center for Tobacco Control Research and Education. Cristin Kearns, a University of California San Francisco researcher who is focusing on the sugar industry, made the discovery when she found a collection of papers at the University of Illinois library from the estate of Roger Adams, a chemistry professor who was a scientific adviser for the Sugar Research Foundation (SRF) - now the Sugar Association. Kearns and colleagues also found papers from Harvard professor Mark Hegsted, who directed Sugar Research Foundation studies. Both men, highly prominent nutrition researchers, are deceased. "Together with other recent analyses of sugar industry documents, our findings suggest the industry sponsored a research program in the 1960s and 1970s that successfully cast doubt about the hazards of sucrose while promoting fat as the dietary culprit in coronary heart disease," Kearns, Glantz and colleagues wrote. "By the 1980s, few scientists believed that added sugars played a significant role in coronary heart disease, and the first 1980 Dietary Guidelines for Americans focused on reducing total fat, saturated fat, and dietary cholesterol for coronary heart disease prevention," they added. The pressure can be subtle. But New York University nutritionist Marion Nestle, who wrote a commentary on the findings in JAMA Internal Medicine, said industry-funding and pressure can encourage researchers to look at one line of evidence while ignoring others. One result of the emphasis of fat alone as a cause of heart disease was a giant food industry push of "fat-free" products that were loaded with added sugars and processed carbohydrates — now shown to be as big a cause of heart disease as fat is, and also a direct cause of diabetes. Glantz found and publicized tobacco industry papers that helped the Department of Justice prosecute major tobacco companies and their research organizations under federal racketeering laws. That led to the 1998 Tobacco Master Settlement Agreement under which the companies were ordered to pay states $200 billion through 2025 in restitution for excess Medicaid spending on tobacco-related disease. The Sugar Association says it is "challenging" to comment on documents its members have not seen. What's clear is that too much added sugar and fat both play a role in heart disease, diabetes and cancer, research not paid for by industry groups has found. Visit NBC News for the story. Pregnant women anxious as Florida’s Zika test results take weeks MIAMI — So many pregnant women have taken advantage of Florida’s offer of free Zika testing that state laboratories have been unable to keep pace, doctors and patients say, leading to long delays for women anxious to know whether the virus has passed to their fetuses. The delays began with a well-intentioned and much-applauded offer. On Aug. 3, Gov. Rick Scott announced that the state would provide the costly Zika tests to all pregnant women, a move intended to quell fears and allow low-income or uninsured women to be tested. Babies infected with Zika can be born with microcephaly, a devastating brain malformation, or with eye and ear defects. But hundreds of women in Miami-Dade County, where Zika is spreading, have been waiting weeks for state results on the same kinds of tests that private laboratories are turning around in three to seven days, doctors said. For some women, the delays could complicate already distressing decisions about whether to terminate their pregnancies if they test positive. Florida forbids abortions after 24 weeks. State health officials declined to say how many tests had been done, provide a reason for the delay or explain how they planned to remedy it. But doctors and researchers attributed some of the delay to a lack of resources, with not enough staff members to analyze the test results. Acknowledging the delays, Dr. Lillian Rivera, the Florida Health Department administrator for Miami-Dade County, told a panel of Zika experts from the University of Miami last week that the reasons were complicated. Sometimes, she said, “tests are done and have been delivered, and sometimes there are bureaucratic reasons; they are in someone’s computer or fax machine.” The state has contracts for some of the work with two major private laboratories, LabCorp and Quest Diagnostics, she said. In a small number of Florida cases, the long wait can be traced to a final cumbersome test that must be analyzed by the Centers for Disease Control and Prevention or an approved laboratory to confirm the presence of the virus. For many women, the delays have added to the stress of pregnancy. The Health Department said in a statement that more than 6,649 people had been tested for Zika statewide as of Monday. So far, 86 pregnant women in the state have tested positive. In all, 771 Florida residents have tested positive for the virus; most were infected while traveling abroad. The long waits for pregnant women in Florida come as Congress continues to argue over a bill that would inject $1.1 billion into efforts to prevent Zika, test for the virus and develop a vaccine. Congress left for its August recess after the bill stalled in the House as Republicans and Democrats clashed over a measure that would exclude Planned Parenthood from the list of providers designated to combat the virus. Some doctors worry that the backlog could get worse. Doctors recommend that pregnant women receive a Zika test every trimester, and obstetricians in Miami-Dade County say that many of their patients will soon need to be retested without knowing the initial results. Dr. Christine Curry, an obstetrician at the University of Miami Health System, which is a partner with Miami’s only public hospital, and a director of the university’s Zika response team, said she had 400 pregnant patients who were waiting for results, some for as long as six weeks. Doctors and pathologists are urging that Florida increase the number of tests they are sending to private labs to be processed, which would take some of the pressure off the state. Pathologists said the backlog had grown tremendously, raising fears that if locally acquired Zika cases spread to other counties in Florida, the wait would grow considerably. Dr. David M. Anderson, the medical director of Pathology Laboratories at Jackson Memorial Hospital, said the hospital was waiting for the results of 800 to 900 specimens tested for Zika. Part of the backlog stems from the cumbersome testing process. Most people must undergo a series of tests to either rule out or confirm they have the virus. There is no one simple diagnostic test that does this, a complaint of doctors and researchers who are pushing for funding to develop a simpler, less costly kind of antibody test. The first blood or urine test, the PCR, is relatively straightforward but is effective only if a person currently has the infection, which stays in the body for about two weeks. A negative result requires a patient to move on to an antibody test called IgM, which can show if someone has had the virus in the last 12 weeks. Both of those tests take only hours to process, and private labs have a turnaround time of a week or less. Quest plans to offer the IgM test, which LabCorp already offers, in the next few weeks. Visit the New York Times for the story. Study details Zika virus disrupting fetal brain development during pregnancy For the first time, abnormal brain development following a Zika infection during pregnancy has been documented experimentally in the offspring of a non-human primate. The researchers' observations of how Zika virus arrested fetal brain formation in a pigtail macaque could provide a model for testing therapeutic interventions. The findings are reported Sept. 12 in the advanced online publication of Nature Medicine. "Our results remove any lingering doubt that the Zika virus is incredibly dangerous to the developing fetus and provides details as to how the brain injury develops," noted Dr. Kristina Adams Waldorf, the lead author of the study. She is a UW Medicine physician and researcher, and a University of Washington professor of obstetrics and gynecology who specializes in maternal and fetal infections. "This is the only direct evidence that shows that the Zika virus can cross the placenta late in pregnancy and affect the fetal brain by shutting down certain aspects of brain development," said one of the study's senior authors, Dr. Michael Gale, Jr., UW professor of immunology. An expert on how the body responds to viruses, he directs the UW Medicine Center for Innate Immunity and Immune Disease. Adams Waldorf, Gale and Dr. Lakshmi Rajagopal, UW associate professor of pediatrics, led the project. Rajagopal studies pregnancy and newborn infectious diseases at Seattle Children's Research Institute and UW Medicine. "We were shocked when we saw the first MRI [magnetic resonance image] of the fetal brain 10 days after viral inoculation. We had not predicted that such a large area of the fetal brain would be damaged so quickly," Rajagopal noted. "Our results suggest that a therapy to prevent fetal brain injury must either be a vaccine or a prophylactic medicine taken at the time of the mosquito bite to neutralize the virus." Previously, no experimental animal model closely emulated the effects of Zika virus infection during human pregnancy. While the virus can cause fetal demise in mice, mouse models have not enabled medical researchers to delve into the causal relationships between Zika virus infection and fetal brain injury. The Zika prenatal study took place during the equivalent of the third trimester of a human gestation. The amount of virus inoculated in this study approximated what a person might contract from the probing and biting of an infected, feeding mosquito. The pregnant animal did not show any significant symptoms of infection, such as fever or rash. The white matter of the fetal brain, which is important for coordinating communication between different parts of the brain, stopped growing about three weeks after viral inoculation. If the study continued one additional month with the same trajectory of brain growth, microcephaly, a condition where the brain is abnormally small, would have occurred. The researchers on the Nature Medicine study listed some brain development problems that could affect some infants whose mothers had a Zika virus infection during pregnancy. These might include a loss of brain cells and brain cell connections, enlargement of the fluid-containing brain cavities, a smaller-than-normal hindbrain (a part of the brain that controls movement and other functions), and vision problems from disruptions in the optic nerve. In addition, they found that the Zika viral genome was also present in other fetal tissues including, eye, liver, and kidney. This research revealed conclusively that the Zika virus had crossed from the mother through the placenta and into the fetal brain. In fact, Gale pointed out, the virus level in the fetus's brain was higher than that in the mother. Visit Medical Express for the study. Many parents are overdosing their kids, study says A sick child is worry enough, here's one way parents can avoid additional anxiety. Many parents are making dosing errors when giving medicine to their children, a new study suggests, but using a syringe instead of a cup or spoon could prevent many of those errors. "When parents used dosing cups, they had four times the odds of making a dosing error, compared to when they used an oral syringe," said Dr. Shonna Yin, an associate professor at NYU Medical School and a co-author of the study, published today in the journal Pediatrics. Pain relievers and other medications made specifically for children usually come in liquid formulations and, when accuracy is critical, oral syringes are considered the gold standard. Yet, even for this best practices tool -- and certainly for methods such as cups and spoons -- other factors can baffle the worried parents of a sick child. Packaging, labeling and dosing information, for example, are not standardized. "A range of measurement units (eg, milliliter, teaspoon, tablespoon), along with their associated abbreviations, are used as part of instructions on labels and dosing tools, contributing to confusion and multifold errors," wrote Yin and her co-authors. "Similar to what other studies have found, our study found that parents with lower health literacy are at greater risk for making dosing errors," said Yin. She said language was a hurdle for parents who didn't speak English. She also noted that unit mismatches -- when, say, the directions specified a teaspoon of medicine yet the provided tool shows units in milliliters -- confused most parents no matter their health literacy or native language. Yin and her co-authors concluded there would be a significant reduction in errors based on just one change: advising parents to use only oral syringes rather than dosing cups. As part of a larger study funded by the National Institutes of Health, the newly published research aimed to identify exactly what could reduce errors when dispensing medicine to a child. The researchers discovered 84.4% of caregivers made one or more dosing errors. And, no matter the health literacy level or language spoken, more errors were seen with cups than syringes, especially when it came to smaller doses. The most common mistake was overdosing: 68% of the study participants poured out too much, rather than too little medicine. Visit CNN for the report. Today September 13th, is World Sepsis Day World Sepsis Day, September 13th is officially recognized as World Health Day by the World Health Assembly. With every heartbeat someone around the world contracts sepsis. Only four hours after onset of sepsis the survival rate sinks dramatically. The best way to increase sepsis survival and quality of life after sepsis is to recognize the early signs of sepsis and start treatment immediately. Sepsis is an expensive global healthcare problem with an estimated 8 million deaths – which can be reduced. The best centers, mainly in industrialized countries, have doubled patients’ chances of survival and reduced their ICU costs significantly. They achieved this by simply recognizing the onset of sepsis early and responding rapidly. However, only 10-30% of patients with sepsis receive this excellent care. Every acute infection can lead to sepsis, commonly known as ‘blood poisoning’; saving lives depends on antimicrobial and other quick supportive treatments. Early recognition of sepsis, rapid antimicrobial therapy and resuscitation, and vital organ support is what matters. In short, sepsis is a medical emergency and each hour counts. Governments, the general public, healthcare professionals and scientists need to cooperate closely to fight this hidden healthcare disaster. Vaccination, good hand hygiene and avoidance of healthcare-associated infection are measures to prevent infections and help to reduce the burden of sepsis. The Global Sepsis Alliance World Health Day task force will coordinate the campaign and ensure that the global sepsis community speaks with one voice around the world. Visit www.world-sepsis-day.org for more information. Accountable care model savings on the upswing After a debut year marked by early promise but net losses, the Medicare Shared Savings Program went on to generate net savings in its second year of existence, according to research from Harvard Medical School. "The savings are modest, but they are growing," said study author J. Michael McWilliams, the HMS Warren Alpert Foundation Associate Professor of Health Care Policy at HMS. "It takes time for healthcare providers to change models of care delivery in response to new incentives." The federal program, established in 2012 as part of the Affordable Care Act, commonly known as Obamacare, sets global budgets for participating organizations and provides bonus payments to those that stay within budget while also improving the quality of patient care. To date, the program includes 460 participating organizations and covers one in four Medicare beneficiaries. In 2013, the first full year of the program, bonus payments to high-performing organizations exceeded the reductions in fee-for-service spending. As a result, Medicare suffered a net loss of $73.5 million, according to the analysis. But analysis of performance during 2014--the second year of the program--revealed more promising results. Specifically, reductions in fee-for-service spending grew from 1.5 percent in 2013 to 2.6 percent in 2014 among the 114 organizations that entered the program in mid-2012. Spending reductions achieved by the 106 organizations that joined the program on Jan. 1, 2013, were smaller, but did show a notable 1 percent growth between 2013 and 2014. In 2014, the overall net change in spending across all organizations--including 115 more joining the program in 2014-- amounted to a $628 million reduction in fee-for-service spending. This reduction exceeded bonus payments of $341 million, constituting a net savings of $287 million to Medicare from the program. The savings were generated primarily by independent physician groups without financial ties to hospitals, the analysis reveals. That finding, McWilliams said, challenges the common assumption that success for new payment systems is predicated on the formation of large integrated delivery systems. Visit EurekAlert for the study. Insurance data show a surge in spending on opioid treatment and testing The nation's opioid problem comes with staggering physical and emotional costs to patients and families. But the financial burden on the health system has been harder to peg. A report set to be released Tuesday shows a more than thirteenfold increase in spending by health insurers in a four- year period on patients with a diagnosis of opioid dependence or abuse. From 2011 to 2015, insurers' payments to hospitals, laboratories, treatment centers and other medical providers for these patients grew from $32 million to $446 million. While the latest figure represents a small portion of the overall spending on medical care in the United States, the rapid rise is cause for concern, says Robin Gelburd, president of Fair Health, a nonprofit databank that provides cost information to the health industry and consumers. The Fair Health study found a sharp difference in how much insurers spend on individual patients with such a diagnosis. On average, insurers spend $3,435 a year on an individual patient, but for those with an opioid dependence or abuse diagnosis, that amount jumps to $19,333. Those numbers reflect what insurers actually paid. The report also includes data on what providers charged, amounts that are lowered by their contracts with insurers. The study, out Monday, builds on one Fair Health released in early August that found a thirtyfold increase in the volume of insurance claims related to opioid dependence diagnoses between 2007 and 2014. The latest study by Fair Health — part of a series — looked at amounts associated with claims billed by providers and paid by insurers for the types of medical services used. Both studies use de-identified claims data from insurers representing more than 150 million insured Americans who either have insurance through work or buy coverage on their own. There have been other efforts by several researchers to quantify the cost of the opioid problem on the overall economy, estimated in the tens of billions of dollars. The new report adds to the available data "that it's not just the human cost associated with the opioid crisis that is enormous, but also that the economic costs are staggering," said Dr. Andrew Kolodny, senior scientist at Brandeis University. He didn't work on the study. The surge in spending on patients with opioid diagnoses is likely a combination of factors, the report notes. As media attention focuses on drug dependency, more people may be seeking treatment. At the same time, prescription and illegal use of narcotics may also be increasing. The study found that emergency room visits and laboratory tests accounted for much of the spending. Based on claims volume, the fastest-growing set of services in terms of utilization were for alcohol or drug therapy. Lab tests, including checks for barbiturate or opioid use, weren't far behind. Visit NPR for the article. Visit FAIR Health for the report. How modern medicine treats disease symptoms while ignoring underlying causes The greatest flaw in modern healthcare is that it aims to treat symptoms rather than the underlying causes of disease. Its inability to cure such diseases is the reason millions of Americans are now turning to alternative medicine and changing their lifestyles to ensure good health. Beating Cancer with Nutrition, written by Patrick Quillin, illustrates how Western medicine merely scratches the surface when it comes to understanding and treating disease. The following is an excerpt from the book. "There is a basic flaw in our thinking about healthcare in this country. We treat symptoms, not the underlying cause of the disease. Yet, the only way to provide long-lasting relief in any degenerative disease, like cancer, arthritis and heart disease, is to reverse the basic cause of the disease," writes Quillin. "For example, let's say that you developed a headache because your neighbor's teenager is playing drums too loudly. You take an aspirin to subdue the headache, then your stomach starts churning. "So you take some antacids to ease the stomach nausea, then your blood pressure goes up. And on it goes. We shift symptoms with medication, as if in a bizarre 'shell game,' when we really need to deal with the fundamental cause of the disease. Let's look at the millions of Americans with rheumatoid arthritis, such as Mrs. Smith whose condition is caused by eating too much sugar, plus an allergy to milk protein, and a deficiency of fish oil, vitamin C and zinc. "Mrs. Smith goes to Dr. A who recommends analgesics to better tolerate the pain. Dr. B suggests cortisone to reduce the swelling. And Dr. C recommends hip replacement surgery to cut off the defective parts. The real answer is to change the underlying cause of the disease. "A more common example is heart disease. There are over 60,000 miles of blood vessels in the average adult body. When a person develops blockage in the arteries near the heart, open heart bypass surgery will probably be recommended. In this procedure, a short section of vein from the leg is used to replace the plugged up vessels near the heart. "But what has been done to improve the other 59,999 miles left that are probably equally obstructed? A Harvard professor, Dr. E. Braimwald, investigated the records from thousands of bypass patients in the Veterans Administration Hospitals and found no improvement in lifespan after this expensive and risky surgery. "Why? Because the underlying cause, which could be a complex array of diet, exercise, stress, and toxins, has not been resolved." "Bypass surgery treats the symptoms of heart disease like chemo and radiation treats the symptoms of cancer. Each provides temporary relief, but no long term cure. "Meanwhile, Dr. Dean Omish was working as a physician doing bypass surgery in the early 1970s and watching some patients come back for their second bypass operation. Omish reasoned: 'Obviously, this procedure is not a cure for heart disease.' "At the time, there was convincing data that a low fat diet, coupled with exercise and stress reduction could lower the incidence for getting heart disease. Omish wondered if we took that same program and cranked it up a notch or two, making it more therapeutic, might it reverse heart disease? "And it did. His program recently was found effective in a clinical study. While the American Cancer Society was violently opposed to Dr. Max Gerson's nutritional program to treat cancer patients in the 1950s, the ACS then released in the 1980s their dietary guidelines for the prevention of cancer, which was very similar to the Gerson program.” Visit Natural News for the story.