Idea #163 for July 31st, 2009: Sunlight Is The Best Disinfectant or Eli Lilly Discloses Registry of Doctor Payments

Earlier this year, under mounting pressure from the Obama administration, industries in the health field including drug companies promised to make some concessions to do their part in reforming healthcare. Eli Lilly announced this month they will publish a registry of doctors who served as paid consultants during the first quarter of this year. A total of $22 million went to those providers earlier this year, with the average consultant making about $1000.

Payments to doctors by drug makers, device makers, and other industry groups always create the perception of conflict of interest. In the past few years, Eli Lilly has disclosed some of its other financial dealings like grants to non-profits and academic institutions. Increased transparency is always welcomed. This may be just the start of more concessions made by those in the healthcare industry in the coming months. Patients should be able, in the near future, to search for providers’ dealings with industry when deciding who to seek for treatment.

Read more about this in the Wall St Journal, and see Eli Lilly’s registry here.

Idea #162 for July 30th, 2009: Tightening The Belt or Reversing The Obesity Trend

There have been a number of posts here on the topic of obesity. It’s an epidemic in this country, and while it’s undoubtedly a health concern for those who suffer from it, it is also a major contributor to ever-growing health expenditures. The journal “Health Affairs” published a study that claimed health problems related to obesity were responsible for $147 billion in health spending in 2008 — about 10% of all medical spending.

The average obese person spends 42% more on healthcare than others. When you consider that an astounding 30% of Americans are obese (the highest rate in the world) you can start to see why this is a $147 billion problem. Of course, combating this problem will take a lot effort on several different fronts, including encouraging Americans to be more physically active and changing their eating habits. Kathleen Sebelius indicated that some of the $1 billion earmarked for preventive health in the stimulus package will go towards fighting obesity. That’s a start, but this new report underscores the need for major action on the obesity crisis if we want to reduce health expenditures in the upcoming years.

For more, see this article in the NY Times and this story in the LA Times.

Idea #161 for July 29th, 2009: Contributions Welcome or The NIH And Wikipedia

Like a lot of workers, employees at the NIH have been spending some of their workday perusing the pages of Wikipedia. While many employers would frown upon that kind of behavior, in this case the workers aren’t slacking off at all. Rather, the NIH is trying to contribute some of their knowledge on health issues to Wikipedia for the benefit of the public.

Volunteers from Wikipedia conducted a seminar at NIH headquarters in Bethesda, MD recently to familiarize scientists there with creating and editing articles in the online encyclopedia. The seminar also dealt with managing article quality and verifying information. If successful, this could go a long way towards making data and information from the NIH more accessible to the public. Hopefully, other government bodies will contribute their expertise in all areas of health and science. Unlike scientific journal, which often charge fees for users to access articles, Wikipedia is completely free. Additionally, the popularity of Wikipedia makes it an ideal means of delivering information to the public.

Read more about this in the Washington Post and in Wired.

Idea #160 for July 28th, 2009: A Whiter Shade of Pale or WHO Labels Tanning Beds Carcinogenic

After the release of a report on skin cancer from an international panel, there’s new focus on tanning beds. The World Health Organization’s International Agency for Research on Cancer says the beds are “carcinogenic to humans,” a change from the previous status of “probably” able to cause cancer. In fact, they now say that the UV in tanning beds is as carcinogenic as asbestos, radium, and cigarettes.

In the US, tanning salons have become more popular in recent years, with about 30 million customers using their services per year. Over the last 25 or so years, the number of white women under 40 who use tanning beds has increased by 50%. There’s also been a rise in occurrence of melanoma among women in recent years.

The panel also claims that using tanning beds before age 30 is tied to 75% higher risk of developing melanoma. Skin cancer is a prevalent condition; last year, 62,000 Americans were diagnosed with melanoma, and 8,000 died from it. Melanoma is becoming more common among younger people, whereas in the past it occurred mostly in the over-75 population. The solution to this isn’t necessarily outlawing tanning beds. However, making users aware of the potential danger of UV exposure is warranted, and preventing tanning salons from advertising that their UV-A bulbs are safer than UV-B, which is not true.

See more about this in the LA Times and from WebMD.

Idea #159 for 27th, 2009: The Laboratory Diet or Using Nanotechnology to Make Food Healthier

Maybe the key to fighting bad eating habits is not to convince Americans to drastically change our eating habits, but to alter the chemistry of the food we eat to make it healthier. That’s what some food scientists are researching now, using nanotechnology to solve the obesity crisis.

One area nanotechnology could help is in the case of butyric acid, a compound found in milk that may hold anticancer benefits for the colon. The problem is, the acid doesn’t normally make it far enough down our digestive tract to make it to the colon. Using nanotech, scientists would like to encapsulate the acid in a fiber coating, allowing it to reach the colon before being absorbed. Another possible target are omega-3 fatty acids, which are believed to help in the prevention of cancer and cardiovascular disease. However, their short shelf-life makes them difficult to deal with. Nanotechnology techniques are being used to wrap omega-3 fatty acids in a protective coating that would maximize their shelf-life and allow them to be incorporated into myriad foods.

There are many other potential benefits of using nanotechnology in food production. Things like extending the shelf-life of foods, integrating nutrients into foods in unconventional ways, and changing the nature of foods so that they are healthier, are all being considered. Of course, it will take time to develop these and test their safety, but it’s not unreasonable to think that we are headed towards an entirely new way to deal with the epidemic of obesity and other health problems that stem from our diets.

See the story about this in the Boston Globe.

Idea #158 for July 26th, 2009: Household Hazards or Preventing Elderly Falls At Home

When senior citizens begin finding it difficult to live at home, they are faced with a difficult decision. More often than not, they decide to remain at home, partly because the average annual cost of an assisted living facility is $34,000. The price they pay by remaining at home, though can be even costlier, as 7,000 seniors die each year in accidents at home, and millions more are injured. There are some things that can be done to delay an eventual move out of home by improving the safety of their surroundings.

Senior citizens can recruit an occupational therapist to assess their home environment and offer suggestions on how to improve its safety. They may suggest things like adding railings or ramps to make the home more accessible. While those types of physical adjustments to the home are not covered under health insurance plans, the total price is almost certainly less than the cost of moving into an assisted living facility. A 2008 study from Yale provided evidence that educating the elderly and providing fall risk assessment and management into their care reduced falls by 11%. Not only that, but hip fractures and head injuries dropped by 10% too. So if senior citizens decide that staying at home is the financially wise decision, they should at least seek the advice of their healthcare provider and occupational therapist on how to adjust their surroundings to make them as safe as possible.

See the AARP’s home safety checklist and this website about hazards in the homes of seniors, and see the article in the NY Times about the issue.

Idea #157 for July 25th, 2009: The Needle Debate or Federal Funding For Needle Exchange Programs

On the face of it, using federal money to buy new needles for drug addicts doesn’t seem like a wise move, especially amid the current budget crunch. But consider these facts: a quarter of HIV infections in this country are a result of drug use, an NIH study in 1997 found that needle exchange programs reduced HIV infection by 30% and risky behavior in general by 80%, and the exchange programs do not result in an increase in drug use. Funding needle exchange programs not only makes sense, it’s sound public health policy. For the last 20 years, though, there’s been a ban on federal funding of such programs — but that may soon change.

On Friday, the House passed a bill that would lift the federal ban on needle exchange funding. It also contains the reasonable provision that needles not be given out within 1,000 feet of schools, parks, day care centers, or other places where children might congregate. Providing clean needles to drug users not only affects the rate of HIV transmission, but also allows social workers an opportunity to steer potential HIV victims to healthcare facilities and programs. In that respect, needle exchange programs provide a valuable service to bring HIV positive individuals into treatment. Our minds may tell us that providing needles to drug addicts is a silly idea, but facts and science tell us another story.

Read more about the legislation here and here.

Idea #156 for July 24th, 2009: Pairing Off or Fighting The Kidney Shortage Through Paired Donation

The dearth of organ donations, especially kidneys, has been a much discussed topic in the healthcare world. One interesting idea to help solve the problem is called “paired donations.” Say that person X wants to donate a kidney specifically to person Y. Person X is found not to be a match for person Y, though, so he cannot make the donation. Also, another pair of people somewhere else — call them persons A and B — are in the same predicament. However, suppose that person X is a match for person B — someone he’s never met — and that person A is a match for person Y. So in this case, X can donate to B and A can donate to Y and all parties are happy. That is a paired donation, and it potentially could streamline the process of finding donor matches.

Still, as promising as this is in theory, only 80 such transplants were done all of last year in this country. But a remarkable feat was pulled off recently involving a chain of eight kidneys across sixteen people, rather than the four people used in the example above. It involved donors and doctors in four different states, and took ten days to complete, and it is the largest such chain on record. There’s promise for this type of mechanism, if more hospitals are willing to coordinate them, and if more donors are made aware that they don’t have to be a match for a loved one to donate a kidney. They can be a part of a chain that accomplishes the same goal.

Read about paired donation in the news here and here, and see the Alliance for Paired Donation site.

Idea #155 for July 23rd, 2009: The Air We Breathe or Prenatal Exposure to Air Pollution

Air pollution in cities is not just a concern for people who directly inhale the toxic air but also for unborn children, according to a new study.Researchers gave a number of pregnant women in New York City backpack air monitors during the latter stages of pregnancy to monitor the levels of pollution they were exposed to. Years later, when their children reached the age of five, researchers conducted IQ tests on the children and found that those who were exposed to higher levels of pollution during prenatal development had lower scores than others, by a few points.

The tests were conducted in low-income areas of the Bronx and Manhattan, where the primary air pollutants stem from exhaust fumes. This is alarming because it suggests that air pollution from automobiles, and not power plants or other bigger polluters, may be sufficiently toxic to cause problems in prenatal development. While more research is needed, these preliminary results show that the consequences of air pollution are wider-reaching than what we may have believed, and that exhaust is more dangerous to developing babies than we may have thought. Lowering exhaust pollution levels, as well as trying to reduce the amount of it that pregnant women are exposed to, should be priorities in bettering our cities’ health.

Read more about the study here and here.

Idea #154 for July 22nd, 2009: Smokeless Smoking or The E-Cigarette Lie

For long-time smokers, the idea of a smokeless cigarette that can deliver nicotine without the carcinogens associated with smoking must be appealing. That’s why some companies have had success marketing a new type of smoking device they claim is a less-dangerous alternative to cigarettes. It’s called an e-cigarette and it uses battery-power to heat and vaporize nicotine pellets. The user can supposedly inhale the nicotine vapor and get their nicotine fix without the danger associated with smoke. Advertisers claim they can be used in non-smoking areas like workplaces or restaurants because they don’t actually emit any smoke. However, the FDA has a different view about the safety of these products.

The FDA tested 19 brands of e-cigarettes, and about half contained the carcinogen nitrosamine. They’ve also found nicotine in some of the ones that claim to be nicotine free. Another concern the FDA has is that the e-cigarettes are available in fruit flavors, which has been a tactic employed by tobacco companies to lure young smokers in the past. While the FDA has not pulled these products from the market, the possibility of that kind of action remains (Hong Kong and Australia have already outlawed the sale and use of e-cigarettes). In the meantime, advertisers should not be permitted to make the health claims they are falsely making right now about these products. The public should be alerted to the scam that this is, and that quitting smoking entirely is a far wiser choice.

See more in the NY Times and the Washington Post.