Articles Posted in Primary Care

brady-281x300If you’re such a die-hard fan you slogged through that pro football championship that was perfect for the new Year of the Boar, please don’t be so sheepish in your celebrity adoration as to get gulled by quarterback Tom Brady’s health and diet bunk.

His oddball theories well might go into a flaming dumpster, along with  notions about special drinks and excess hydration, and yet more broadcast goop from that princess of health woo, Gwyneth Paltrow.

Sure, Brady’s Superbowl LIII win may have made him the goat (greatest of all time) in National Football League history with six rings. He got there, and may stay there, not only with rare individual gifts, hard work, and special talents, but also with peculiar practices, as Vox, an online news site reported:

conditionslowdowns-300x215Take heart, Americans. Taking care of ourselves makes a difference, making us healthier — and saving us money.  New research supports policies for spending on the wellness of the elderly, improving heart care, and how smart interventions can reduce rising overall health costs.

This evidence-based approach to figuring the government’s optimal role in individuals’ health also may provide a rebuke of sorts to the way that partisans are imposing draconian new rules to curtail medical assistance for the working poor, poor, aged, and chronically ill Americans.

The rare good news about the nation’s health care costs traces to investigators’ efforts to determine why, in contrast to expectations that spending would leap, Americans’ $3.5 trillion annual medical expenditures increased only slightly. They drilled down, focusing on an area where the “sharpest slowdown” occurred in their research period, 1999-2012: Medicare, a federal program that now enrolls roughly 15 percent of the U.S. population, with beneficiaries 65 and older.

hospitalprices-300x162Patients and reformers attacking skyrocketing health care costs may want to focus less on doctors and more on big, shiny hospitals, where in just five years prices soared by 42 percent for inpatient care versus the still sizable 18 percent price hikes that MDs scored.

Those findings are part of a new study that examined medical costs based on actual payments, focusing on common procedures like deliveries of babies (vaginal and cesarean), colonoscopies, and knee replacements.  “Hospital prices grew much faster than physician prices for inpatient and outpatient hospital-based care in the period 2007–14 … The same pattern was present for all four of our procedures,” wrote the researchers from Yale, MIT, and Carnegie Mellon. They found that hospital costs also spiked for outpatient care, increasing 25 percent, versus 6 percent for doctors.

This meant that for a knee replacement costing $30,000 or so, the doctors’ mean price was almost $4,900, while the hospital price was almost $25,000. For a $13,000 C-section, the doctor’s mean price was $4,600, while the figure for hospitals was $8,300. These numbers were derived from analyzing hundreds of thousands of procedures.

HepatitisCInvestigators have teased out yet another damaging thread in the villainous web of harms of the opioid crisis. A spike in hepatitis C infections is a costly, long-term, and major health consequence of the hype and disastrous reformulation of OxyContin, the powerful painkiller made by Purdue Pharmaceuticals owned by the wealthy Sackler family.

Purdue, in the 1990s, promoted and sold OxyContin to doctors and hospitals in a relentless campaign that stressed how this drug was supposedly safer and longer acting, releasing its potent effects over as long as a 12-hour span instead of requiring many pills that needed to be taken more often.

Although those claims of the drug’s benefits were dubious to start, patients — especially those abusing the highly addictive prescription medication — found they could get around OxyContin’s delayed release, getting an immediate jolt or walloping high, by crushing their pills. They then snorted Oxy as a powder or mixed it with a liquid and injected it.

measlesnhs-300x200The 44th President implored the members of his staff that a key aspect of their collective success could be summarized by a simple notion: Don’t do stupid stuff. If only many more parents nationwide would concur — and shun the anti-scientific nonsense peddled by anti-vaxxers.  As the new year advances, public health officials across the country are battling measles outbreaks, dozens of reported cases in the Pacific Northwest (Washington and Oregon) and in New York City.

The concern is rising because disease carriers are increasing in their number and mobility in areas where populations may be especially vulnerable due to low vaccination rates. Public health officials have likened the situation to “tossing a match into a can of gasoline,” or a disease spread “like a wildfire.”

As the New York Times reported of the risks this childhood infection poses: “Measles can cause permanent neurological damage, deafness and in relatively rare cases, death.”

puffdad-265x300The federal Food and Drug Administration failed to protect the nation’s young against Big Tobacco’s harms with slow-poke responses to the rise of e-cigarettes, as well as tardy regulation of flavorings for combustible cigarettes and liquids used in “smokeless” vaping, health advocates say.

The American Lung Association, in its annual “State of Tobacco Control” report, ripped FDA Commissioner Scott Gottlieb and his agency for postponing oversight of e-cigarettes and vaping — a hard-won crackdown approved in the Obama Administration — to further study the harms of the devices and practices.

While the agency dawdled, e-cigarette makers, notably the firm behind the small Juul device, stormed the youth market, luring American teens to a raging, e-cigarette fad. Many became addicted to vaping and harmful nicotine, as a result. As the lung association describes it:

With the nation fast graying, a long-term care crisis looms, and too many Americans may not realize that not only will nursing home care be tough to find and afford, it also may be less than ideal. But what happens if seniors themselves — especially the frail old — are asked how care-giving services might best serve them, so they not only can stay in their homes but also enjoy their lives more?

That’s the experimental approach taken by a health care team in Denver, working in the long-titled program, “Community Aging in Place — Advancing Better Living for Elders.” CAPABLE staff intervene with the aged, asking them how, even with disability and debilitation, to improve their lives. The program offers them six visits by an occupational therapist, four visits by a registered nurse, and home repair and modification services worth up to $1,300.

cbpbust-300x200If  anyone around doubts still the threat that the opioid crisis poses to the nation, a drug bust involving a vegetable truck in Arizona should provide powerful persuasion: Federal agents, suspicious about the vehicle’s floor, loosed a drug-sniffing dog, resulting in the seizure of not just 395 pounds of methamphetamines but also 254 pounds of fentanyl.

Fentanyl is a synthetic opioid, a lab-created super drug that experts say is 50 times stronger than heroin and up to 100 times more potent than morphine. It packs a wallop for users in tiny grains or flecks.

The record-setting seizure at the Arizona border stop amounted to 144 or so kilograms of fentanyl, with drug enforcement officials estimating that just 1 kilogram of fentanyl can produce 1 million fatal doses. That means just this one bust had the potential to cause 144 million deaths.

The Trump Administration has put out its latest prescription to try to slash out-of-control prescription drug prices: Officials want to call medication “rebates” what they say they’ve really become — “kickbacks” — and crack down on the crazy rise of profit-reaping middlemen in the drug business.

Alex Azar, secretary of the Health and Human Services Department, announced that Uncle Sam, via the giant Medicare and Medicaid plans, hopes to fix big flaws in the drug industry by barring prescription medication discounting to PBMs (prescription benefit managers). The discounts still would be available to patient-consumers. But eliminating them for PBMs could be a major step in cutting drug costs, not the least because this step could give parties in this medical “supply chain” more transparency on what products cost.

lajam-300x167If they didn’t create enough havoc already with the deaths and injuries they cause on the nation’s roads, Americans’ cars, trucks, and motorcycles also create other big consternations, including harmful commuting stress, rising pedestrian carnage, and tough calls about when seniors ought to be forced to give up driving.

Just how soon will it be before computers, robots, and autonomous vehicles ride to our rescue? Maybe not fast enough.

Too many motorists, especially in urban centers, may see their heads and bodies blow up — in figurative fashion — due to the daily strains of trying to navigate traffic gridlock, reported Austin Frakt, director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System, associate professor with Boston University’s School of Public Health, and adjunct associate professor with the Harvard T.H. Chan School of Public Health. He wrote in the New York Times’ research- and evidence-based “Upshot” column that Americans spend 42 hours annually stuck in rush-hour jams, and traffic’s toll for lost time and wasted fuel exceeds $100 billion.

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