HOW TO LOWER PROSTATE CANCER RISK

Harvard scientists have discovered that "drinking coffee may lower the risk of developing the deadliest form of prostate cancer." In fact, "the five percent of" study participants "who drank six or more cups a day had a 60 percent lower risk of developing the advanced form of the disease than those who didn't consume any."."

A Frontiers in Cancer Prevention Research conference" also touched on the "role that exercise...could play in the fight against prostate cancer. An analysis of activity levels among 2,686 prostate cancer patients showed that men who jogged, played tennis, or participated in other comparable exercise for an average of three or more hours per week had 35% lower mortality rates than those who exercised less frequently or not at all." As for walking, those who did so "for four or more hours per week" had "overall mortality rates [that] were 23% lower than those of men who walked for fewer than 20 minutes per week."


Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com

Gastric distress-related ED visits may increase during the holidays.

At hospitals, gastric distress is a part of the holiday tradition." Indeed, "in the early hours of Thanksgiving...emergency rooms are typically empty," but certain turkey-cooking practices "can easily strike a blow" to diners. Typically, a frozen turkey is left on a countertop for 12 hours, while a roasted bird may sit "for two or three hours before" reaching the table. "During that time, a virus or bacterium can land on the food and start growing," causing gastroenteritis. "Although bacteria will die" once the bird is reheated, "the toxins made by the bacteria that cause illness can survive even in a hot oven." Bones have also been known to trigger "trips to the hospital," and those "with heart conditions should avoid too much salt, which can trigger an accumulation of fluid in the lungs."

Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

For more health info and links visit the author's web site www.hookman.com

How to Find a Good Hospital

The reality is, says S.Balauf of US News, that not all hospitals—or doctors or nurses, for that matter—deliver high-quality care. The United States has a "very inconsistent, uneven quality of healthcare," says Anne Weiss, who leads the quality/equality healthcare team at the Robert Wood Johnson Foundation, a healthcare philanthropy based in Princeton, N.J. Even the type of treatment that similar patients get can vary from hospital to hospital and region to region. In some parts of the country, for example, heart patients are more likely to receive angioplasty than coronary bypass surgery, while in many places the opposite is true. (U.S. NEWS wrote about this phenomenon and the fact that some heart patients may get the less appropriate procedure because they may not be fully informed about their options.)

The time to find a good hospital is long before you need one. By tapping a few readily available resources, however, patients can make informed decisions about a good local hospital for the treatment they need. According to the National Committee for Quality Assurance, a healthcare nonprofit based in Washington, D.C., patients who make informed choices and get engaged in their care early ultimately reap better health outcomes.

• Your primary-care physician. Consult this trusted source if a specialist ever tells you that surgery or treatment is necessary, and ask your primary-care doc where he recommends you have it done. Primary-care physicians have a good working knowledge of the hospitals in their area, including each institution's overall reputation and how it stacks up against its local peers for specific procedures and treatments. Ideally, their reasoning will be based on other patients' outcomes

• Your insurance company. Inquire about the quality data they've collected on each facility where they would cover your treatment. That info can typically be found on the plan's website or by phone. The data might be limited to the pool of patients your plan covers and the doctors and hospitals in the plan's network, but it's nevertheless a source of details that can inform your choice.

• That friend of a friend who is a nurse. Your extended social network may include more hospital employees than you realize. "Most people know someone in the local healthcare system. But realize they provide a narrow view, seeing perhaps only one slice of all the variables that make up a hospital's level of care.

• A trusted family member or friend. Bringing someone you trust to an important appointment, or simply going through the hospital-selection process with another person, can be quite powerful. "Never go alone" and "Never stay alone."If nothing else, your companion is likely to be more clear-headed than you are when you're faced with daunting new information about your health. He or she need not be a medical professional.

• I would not trust highway billboards touting a hospital's latest award. They're hard to miss—and plentiful in many regions of the country. But beware the source. The prize may or may not have any real bearing on the real quality of care a patient could expect at that hospital. As an example Hospital Compare, hosted by the federal Centers for Medicare and Medicaid Services, focuses on how often hospitals give heart attack patients aspirin within 30 minutes of their arrival at the ED, give surgery patients the correct antibiotic at the right time prior to the procedure, and otherwise do the right thing in 23 "process measures." Some-I believe most of these criteria-- are relative lightweights. Most hospitals show great success, for example, at giving smoking-cessation advice to heart patients who smoke. (Nurse: "I see you're a smoker, Mr. Smith. You know it doesn't help your heart condition, don't you?" Mr. Smith: "Yes, I do." Nurse marks box on discharge form.)

• Hospital Compare also indicates whether a hospital's death rates in heart attack, heart failure, and pneumonia patients is better, no different, or worse than the U.S. average. That might seem useful, but the average is so broadly defined that only about 2 percent of hospitals are "better" or "worse." Clicking on the graph or table view of the page will reveal the actual death rates, as well as average state and national rates. Last year, the site began offering patient satisfaction data gleaned from surveys, such as the percentages of patients who reported their nurses always communicated well and of those who said they would definitely recommend the hospital. Look, but take with a grain of salt. Studies show that individuals whose medical care was successful tend to be more satisfied with a hospital in other ways.

• Some websites [www.hookman.com] have links to other sites that also rank or rate good hospitals across the country, and such sites have potential value to people who are seeking a good hospital in their area.

Is there a correlation between hospitals’ “quality”scores?

Unfortunately no! A study reported in the JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION found no correlation between how well hospitals scored on a 13-item set of Leapfrog quality and safety measures and death rates, adjusted for severity, of patients admitted to the hospitals. The study didn't look at rates of complications.The Leapfrog Group is a nonprofit business coalition that allows consumers to compare hospital safety and quality ratings based on results of a voluntary survey. Hospitals are rated on their ability to satisfy two sets of safety standards. One set, such as appropriate ICU staffing and a program to reduce bedsores, applies to the entire hospital. The other set reflects quality of care and cost for 10 specific procedures and conditions, including repairing an abdominal aortic aneurism and treating pneumonia. Hospitals can be compared directly. You may not be able to find yours, however. Roughly 1,300 hospitals out of more than 5,000 in the nation—two out of 16 in Baltimore, for example—responded to the most recent Leapfrog survey.

COMMENT:
In the end after you do all your research it then really comes down to luck and faith. Faith that you have a fine doctors who will make good decisions for you. Trust—but verify.
African medical facilities always have relatives in with patients. That’s a good thing.
Always have someone with you in the hospital—a friend or loved one who will stay with you and watch out for you.




Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for WHAT DIET IS EFFECTIVE IN REDUCING PROSTATE CANCER RISK?.

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

Drug Deals with Medical Insurance Carriers Tie Prices to How Well Patients Do.

So What’s in it for us?
Pressed by insurance companies, some drug makers are beginning to adjust what they charge for their drugs, based on how well the medicines improve patients’ health, reports A. Pollack. “Think of it as product guarantees by the drug industry.”

Traditionally, discounts and rebates that drug companies offer insurers have been based on how much drug is used, not how well patients do. But the emerging, outcomes-based contracts would — in theory — better align the incentives of insurers, drug companies and the employers that provide health coverage toward improving people’s health. Johnson & Johnson set what is considered the prototype deal in 2007 with Britain’s national health system, which had tentatively decided not to pay for the cancer drug Velcade. To avert that decision, the company offered essentially a money-back guarantee. If Velcade did not shrink a patient’s tumors after a trial treatment, the company would reimburse the health system for the cost of that patient’s drug.

In a current deal Merck will agree to peg what the insurer Cigna pays for the diabetes drugs Januvia and Janumet to how well Type 2 diabetes patients are able to control their blood sugar. Also the two companies that jointly sell the osteoporosis drug Actonel agreed to reimburse the insurer Health Alliance for the costs of treating fractures suffered by patients taking that medicine. “We’re standing behind our product,” said Dan Hecht, general manager of the North American pharmaceutical business of Procter & Gamble, which sells Actonel with Sanofi-Aventis. “We’re willing to put our money where our mouth is.” Under the Actonel deal, if a patient insured by Health Alliance suffers a nonspinal fracture despite faithfully taking Actonel, the drug makers will help pay for the medical care — spending $30,000 for a hip fracture, for instance, and $6,000 for a wrist fracture.

This clearly lowers the cost of the drug to Health Alliance, a small insurer in Illinois and Iowa. But Procter & Gamble and Sanofi-Aventis might benefit as well. The deal could reduce the pressure on the insurance company to move patients off Actonel, which costs about $100 a month, to less-expensive generic versions of Fosamax. And the insurer has kept Actonel in a tier of its drug list that requires a smaller co-payment than for a competing brand-name drug, Boniva.

Some experts hail such arrangements as a welcome step toward health care that rewards good outcomes for patients. “We’re going to see a growth in outcomes guarantees for pharmaceuticals, and it’s very healthy,” said Robert Seidman, a consultant who was formerly the chief pharmacy officer for WellPoint, an insurance company.

Such contracts started to take hold a few years ago in countries with national health systems, in which the government could effectively block a drug from being used if it was too costly. In the United States, where insurance companies do not have national monopolies — and where Medicare, by law, is precluded from negotiating drug prices — insurers have less leverage with drug makers. Even so, they can give favorable treatment to certain drugs, by reducing the required co-payments, for example.
The deal between Cigna and Merck is more complex.

Rather than getting paid more for good results, Merck will actually give Cigna bigger discounts on Januvia and Janumet. Some discounts will be granted if more people diligently take the drugs as prescribed. This helps both Cigna, because people who take their pills are likely to have fewer complications from the disease, and Merck, because it sells more pills. The assumption is that Cigna will push for patient-compliance programs that urge people to take their medicine at the right times and in the proper doses.

Moreover, in an unusual move, Merck will offer even greater discounts to Cigna on Januvia and Janumet if patients’ blood sugar is better controlled — regardless of whether the improvement comes through Merck’s drugs or other medications. In effect, though, Merck is betting not only that its drugs prove superior but that Cigna’s incentives to reap the benefits of the deeper Januvia and Janumet discounts will prompt the insurer to try to keep patients on those drugs. Januvia, approved in 2006, costs about $150 a month. Janumet, approved a year later, is a combination of Januvia and metformin, a widely used generic drug.

As part of the agreement, too, Merck will get better placement for Januvia and Janumet on Cigna’s formulary, meaning a lower co-payment for patients than for some other branded drugs. The deal was made with the pharmacy benefit management division of Cigna, which manages prescriptions for 7.1 million people.

So what’s in it for us patients?
If this does not translate to our pocketbooks there will be problems.
We’ll wait and see if and how much this will save we patients.

PART I of III: IN DEFENSE OF THE DOCTOR WITH A BAD REPORT CARD WHEN NOT ADHERING TO PAY FOR PERFORMANCE [P4P] GUIDELINES

Doctors suffer bad report cards by medical insurance carriers for not adhering to “quality of care guidelines.”

Doctors say these guidelines are more cost saving/profit making for the insurance companies than medical quality.

Who is correct?

Currently less than one tenth of 1% of the total. $2 trillion spent annually on health in the United States is spent on evidence based medicine to ascertain and establish competent medical clinical guidelines.

The demand for better evidence to guide healthcare decision-making is growing rapidly due to the variation of healthcare interventions, the frequency of medical errors, and the adverse consequences of care administered without adequate evidence.

The Roundtable on Evidence-Based Medicine in the office of the Institute of Medicine [IOM] have set a goal that, by the year 2020, ninety percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence on what works best for whom, and under what circumstances. http://www.iom.edu/CMS/28312/RT-EBM/55282.aspx.

To this end the American Recovery & Reconstruction Act of 2009 commits $1.1 billion to Comparative Effectiveness Research, and $19 billion to increasing health information technology.

Let’s look at an example of what such studies would look like in patients. --In this instance patients with Diabetes.

Almost 200 million people worldwide have type 2 diabetes. Coronary artery disease (CAD) is a major health concern and the leading cause of death in individuals with type 2 diabetes. CAD is often asymptomatic in these patients until the onset of myocardial infarction or sudden cardiac death. Type 2 diabetes is also widely recognized as a CAD risk equivalent. Thus endorsed by professional organizations screening of patients with type 2 diabetes and no symptoms of CAD were recommended in the absence of prospective outcome studies supporting its utility. Screening for CAD in patients with type 2 diabetes especially with 2 or more cardiac risk factors, though not an evidence based recommendation like many such guidelines had been also endorsed previously by an expert panel of the American Diabetes Association.

The strategy of routine screening for CAD in patients with type 2 diabetes is based on the premise that testing could accurately identify a significant number of individuals at particularly high risk and lead to various interventions that prevent cardiac events. However, in a study by Young L.H.et al, Cardiac Outcomes After Screening for Asymptomatic Coronary Artery Disease in Patients With Type 2 Diabetes;The DIAD Study: A Randomized Controlled Trial .JAMA. 2009;301(15):1547-1555 the results of the DIAD study would appear to refute this notion.

Although type 2 diabetes is considered to be a CAD equivalent participants had a low cardiac event rate (average, 0.6% per year) and the identification of participants with abnormal screening results did not serve to eliminate their risk over 5 years of follow-up.

The current standard of care for type 2 diabetes emphasizes the reduction of cardiovascular risk factors. However, there has also been substantial interest in the early detection of asymptomatic CAD by screening of patients with type 2 diabetes. Recent studies have shown that CAD can be detected noninvasively in a significant number of these individuals. Inducible ischemia and coronary artery calcium each have been shown to be associated with worse cardiac outcomes. However, the potential of routine screening to alter treatment and to prevent cardiac events in persons without clinically apparent CAD is largely unknown.

Thus, although endorsed by some professional organizations, screening of patients with type 2 diabetes and no symptoms of CAD remains highly controversial in the absence of prospective outcome studies supporting its utility.

In the light of the author’s findings, routine screening for inducible ischemia in asymptomatic patients with type 2 diabetes cannot be advocated for 4 reasons.

• First, the yield of detecting significant inducible ischemia is relatively low.
• Second, the overall cardiac event rate is low. Indeed, even our participants with moderate or large defects and the highest event rate would be conventionally assigned to an intermediate-risk category.
• Third, routine screening does not appear to affect overall outcome.
• Finally, routine screening of millions of asymptomatic diabetic patients would be prohibitively expensive.