I’ll take a pack of cigarettes, a large soda and a package of pork rinds

The following is a guest post by Harold DeMonaco, one of our expert editors on HealthNewsReview.org and Director of the Innovation Support Center at the Massachusetts General Hospital.

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While researching a totally different topic, I ran across a recent article published in the Journal of Occupational and Environmental Medicine. Researchers from the Mayo Clinic evaluated healthcare costs for employees and retirees of the Clinic who had continuous benefit coverage from 2001 through 2007. The Mayo Clinic funded the research project. Specifically, they looked at the incremental costs associated with obesity and with smoking. No surprises here, both increased healthcare costs. I found some of the data interesting.

The researchers collected data from a number of administrative sources including patient registration and information provided by employee patients during routine office visits.

Smoking status is routinely collected as part of office visits. The evaluation included over 25,000 current employees and about 5,500 retirees. The baseline characteristics of these healthcare workers are interesting in and of themselves.

Smoking status

No

Yes

Unknown

Employees

53.9%

13.3%

32.8%

Retirees

60.6%

17.5%

21.9%

Of those who responded, roughly one out of every eight employees smokes. Current and retiree employee healthcare costs were $1,274 (or 16%) and $1,401 (or about 12%) respectively more than their counterparts who do not smoke. There are probably other factors involved such as income and education, but the numbers speak for themselves. Smoking does add significantly to healthcare costs.

The researchers also looked at body mass index and healthcare costs. 57% of the current employees are overweight to morbidly obese as compared to 66% of retirees.

Body Mass Index

Overweight

Obese

Morbidly Obese 1

Morbidly Obese 2

Employee Costs

+$382

+$1,850

+$3,086

+$5,530

Retiree Costs

NS

NS

+$2,907

+$5,467

Like all studies, this one has several limitations. But the basic information is telling. According to Kaiser Family Foundation Minnesota is just about on average with the rest of the US in terms of overweight and obesity rates (63%). I’ll go out on a limb and suggest that the results are likely repeatable elsewhere. Healthcare workers don’t seem to be very good examples of a healthy lifestyle. It does not appear that we are taking our own advice.

Total healthcare costs exceeded $2.6 Trillion in 2010 or about 18% of our gross domestic product. We can expect those numbers to dramatically increase as the population ages, tobacco continues to be subsidized (to the tune of $194 Million in 2010) and our waistbands continue to expand. With the ongoing debate over Obamacare, I would have thought, as a non-journalist, that more in the mainstream media would have picked up on this story rather than chin implants.

View the original article here

Offitt on the offense against National Center for Complementary & Alternative Medicine budget

The Los Angeles Times wrote about an essay in this week’s Journal of the American Medical Association, stating:

“…many studies funded by NCCAM lack a sound biological underpinning, which should be an important requirement for funding. For example, NCCAM officials have spent $374 000 to find that inhaling lemon and lavender scents does not promote wound healing; $750 000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery; $390 000 to find that ancient Indian remedies do not control type 2 diabetes; $700 000 to find that magnets do not treat arthritis, carpal tunnel syndrome, or migraine headaches; and $406 000 to find that coffee enemas do not cure pancreatic cancer. Additionally, NCCAM has funded studies of acupuncture and therapeutic touch. Using rigorously controlled studies, none of these therapies have been shown to work better than placebo. Some complementary and alternative practitioners argue reasonably that although their therapies might not work better than placebos, placebos may still work for some conditions.

…

Although evaluating the research portfolio of any institute at the NIH is difficult, social and political pressures may influence area-of-interest funding, and decisions should be based on science. For complementary and alternative medicine, it seems that some people believe what they want to believe, arguing that it does not matter what the data show; they know what works for them. Because negative studies do not appear to change behavior and because studies performed without a sound biological basis have little to no chance of success, it would make sense for NCCAM to either refrain from funding studies of therapies that border on mysticism such as distance healing, purgings, and prayer; redefine its mission to include a better understanding of the physiology of the placebo response; or shift its resources to other NIH institutes.”

View the original article here

Patient satisfaction surveys don’t tell the whole story about health care quality

The following is a guest post by Harold DeMonaco, one of our expert editors for HealthNewsReview.org and director of the Innovation Support Center at the Massachusetts General Hospital.

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A recent study published in the Archives of Internal Medicine is turning a few heads in the health policy arena.  The cost of satisfaction: A national study of patient satisfaction, health care utilization, expenditures and mortality  study examined the records of more than 34,000 adults for 4 years.  The results are a surprise to say the least.

For years, patients, insurers and government programs have pushed hard for improvement in the level of satisfaction of patients receiving healthcare.  The most recent push involves the development of Accountable Care Organization (ACO)  initiated by the Centers for Medicare  and Medicaid Services(CMS).  ACO’s link the quality and cost of healthcare directly to the reimbursement to providers.  Quality, as defined by CMS, is measured in five domains: patient/caregiver experience, care coordination, patient safety, preventative health, and at-risk population/frail elderly health.

The study in The Archives came to some interesting conclusions:

The most satisfied patients had an 8% lower rate of visits to the emergency room compared to the least satisfiedThe most satisfied patients had a 12% higher hospital inpatient admission rate.The most satisfied patients had a 9% higher prescription and total healthcare costsAND a 26% higher mortality.

I will apologize up front for providing only relative and not absolute numbers.  Absolute numbers are not provided in the article.  I get the lower ER visits but the rest comes as a surprise especially the higher mortality rate.  The least satisfied patients differed from the most satisfied at baseline in several ways.  The least satisfied tended to have poorer self rated health and there were more smokers.  But even after controlling for confounders, the authors concluded, “The association between higher patient satisfaction and mortality remained significant in an analysis that excluded patients with poor self rated health and three or more chronic diseases.”

A brief report published last September provided the results of a survey of primary care physicians on the topic of appropriate care.  Forty two percent of those responding thought that their patients were receiving too much care.  Only 6% thought that their patients did not receive enough. The reasons for over treatment remain a mystery but likely lie in both the clinicians and patient/family hands.

The Archives paper may suggest how great is the challenge of educating American health care consumers that “More Is Not Always Better.”  And it also suggests – once again – that patient satisfaction surveys don’t tell the whole story of quality health care.

View the original article here

Off to Beijing for National Cancer Institute workshop for Chinese journalists

photo by Jorge Lascar on Flickr

The website will be on hold over the next week, as I’m traveling to Beijing to help lead a workshop for Chinese journalists hosted by the National Cancer Institute and the Cancer Institute and Hospital, Chinese Academy of Medical Sciences.

This will be the third international journalism workshop I’ve done with the National Cancer Institute – with several more on the horizon within the next year.

We are gratified to see the global reach of efforts like ours – built on the pioneering work done by an Australian team that founded the first Media Doctor site two years before we got started.  Now, as the yellow stars on the map below show, such projects have sprung up around the world.  And the invitations for talks and workshops, like the upcoming one in Beijing, continue to come in.

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heroin addiction

heroin addiction
Heroin, crystal white powder which are installed for the first time in 1874 from morphine, it is easy to fall into the clutches of human addiction used once .. As the dose increased orexcessive use of its future drinking alcohol with sedatives and stuffing the body with allthese toxins indicates the rights of death and destruction.http://www.encyclopediamedcal.com