Thursday, October 1, 2015

Why It Was Easier to Be Skinny in the 1980s - The Atlantic

There's a meme aimed at Millennial catharsis called "Old Economy Steve." It's a series of pictures of a late-70s teenager, who presumably is now a middle-aged man, that mocks some of the messages Millennials say they hear from older generations—and shows why they're deeply janky. Old Economy Steve graduates and gets a job right away. Old Economy Steve "worked his way through college" because tuition was $400. And so forth.

We can now add another one to that list: Old Economy Steve ate at McDonald's almost every day, and he still somehow had a 32-inch waist.

A study published recently in the journal Obesity Research & Clinical Practice found that it's harder for adults today to maintain the same weight as those 20 to 30 years ago did, even at the same levels of food intake and exercise.

The authors examined the dietary data of 36,400 Americans between 1971 and 2008 and the physical activity data of 14,419 people between 1988 and 2006. They grouped the data sets together by the amount of food and activity, age, and BMI.

They found a very surprising correlation: A given person, in 2006, eating the same amount of calories, taking in the same quantities of macronutrients like protein and fat, and exercising the same amount as a person of the same age did in 1988 would have a BMI that was about 2.3 points higher. In other words, people today are about 10 percent heavier than people were in the 1980s, even if they follow the exact same diet and exercise plans.

"Our study results suggest that if you are 25, you'd have to eat even less and exercise more than those older, to prevent gaining weight," Jennifer Kuk, a professor of kinesiology and health science at Toronto's York University, said in a statement. "However, it also indicates there may be other specific changes contributing to the rise in obesity beyond just diet and exercise."

Just what those other changes might be, though, are still a matter of hypothesis. In an interview, Kuk proffered three different factors that might be making harder for adults today to stay thin.

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Burned by flaming water-skis? Bitten by a macaw? There’s a medical code for that. - The Washington Post

So you've been burned by flaming water skis? Attacked by an orca? Sucked into a jet engine? Try to remember the details for your doctor, because there's now a medical code for your condition.

The crazy-sounding diagnostic codes are part of a huge change set to take place Thursday in doctor's offices, hospitals, nursing homes, insurance companies and just about every part of the U.S. health system. If things go according to the long-delayed plan, patients shouldn't notice and care shouldn't be affected.

[The 10 most bizarre medical codes for your injuries]

But providers, who must use the codes describing patients' illness and injuries to get paid, are braced for problems: The sweeping revision, more than a decade in the making, expands the current nomenclature from about 14,000 codes to 68,000.

Wednesday, September 30, 2015

NYTimes: Hearing Loss Costs Far More Than Ability to Hear

Mark Hammel's hearing was damaged in his 20s by machine gun fire when he served in the Israeli Army. But not until decades later, at 57, did he receive his first hearing aids.

"It was very joyful, but also very sad, when I contemplated how much I had missed all those years," Dr. Hammel, a psychologist in Kingston, N.Y., said in an interview. "I could hear well enough sitting face to face with someone in a quiet room, but in public, with background noise, I knew people were talking, but I had no idea what they were saying. I just stood there nodding my head and smiling.

"Eventually, I stopped going to social gatherings. Even driving, I couldn't hear what my daughter was saying in the back seat. I live in the country, and I couldn't hear the birds singing.

"People with hearing loss often don't realize what they're missing," he said. "So much of what makes us human is social contact, interaction with other human beings. When that's cut off, it comes with a very high cost."

And the price people pay is much more than social. As Dr. Hammel now realizes, "the capacity to hear is so essential to overall health."

Hearing loss is one of the most common conditions affecting adults, and the most common among older adults. An estimated 30 million to 48 million Americans have hearing loss that significantly diminishes the quality of their lives — academically, professionally and medically as well as socially.
One person in three older than 60 has life-diminishing hearing loss, but most older adults wait five to 15 years before they seek help, according to a 2012 report in Healthy Hearing magazine. And the longer the delay, the more one misses of life and the harder it can be to adjust to hearing aids.

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NYTimes: A Breast Cancer Surgeon Who Keeps Challenging the Status Quo

Late one afternoon this summer, Dr. Laura J. Esserman, a breast cancer surgeon at the University of California, San Francisco, sat in a darkened room scrutinizing a breast M.R.I. With a clutch of other clinicians at her side, she quickly homed in on a spot smaller than a pencil eraser.

She heard the words "six-millimeter mass." Her response was swift:


Meaning no biopsy.

Most doctors, including the radiologist seated next to her, would have said yes. But Dr. Esserman, who has dedicated much of her professional life to trying to get the medical establishment to think differently about breast cancer, foresaw only unnecessary anxiety for the patient, who had had several biopsies in the past — all benign.

Dr. Esserman, 58, is one of the most vocal proponents of the idea that breast cancer screening brings with it overdiagnosis and overtreatment. Her philosophy is controversial, to say the least. For decades, the specter of women dying for lack of intervention has made aggressive treatment a given.

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Tuesday, September 29, 2015

What caused a newborn twin’s badly swollen legs - The Washington Post

Heather Ferguson was beside herself.

The 34-year-old mother of 2-month-old twin boys had just spent several days in a Charlotte hospital with one son as he underwent diagnostic tests for heart failure and other life-threatening ailments. When nothing was found, doctors resorted to an Internet search. That yielded a possible diagnosis and a recommendation that Ferguson consult a pediatric surgeon.

But the surgeon who saw Dylan Ferguson in December 2006 offered little beyond a cursory exam of the infant's badly swollen legs and groin. "Let's just keep an eye on it and bring him back in six months," Ferguson remembers the surgeon telling her.

"That was the worst moment," she recalled. "It's so horrible to know that something's wrong and to get the brushoff. I felt like we were on our own and that the medical system had just washed its hands of us." Every time Ferguson looked at the normal legs of Dylan's fraternal twin, Devdan, the contrast was upsetting.

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Would I Accept My Patient's Gift? - The New York Times

In our first session after I returned from vacation, my patient Tim handed me a box of homemade candy. "I wouldn't eat this myself if I were in your place," he said. "After all, how do you know this candy hasn't been doctored? I might have put in some bad stuff."

Over the years, I have received many small presents from patients, especially around holidays and at the end of therapy. This was different.

I tried to mask my surprise. "So, you give me something sweet," I said, "yet you are warning me it might be bitter, even dangerous?" 

He smiled sadly.

Early in his therapy, Tim revealed that, when he was a child, his parents would give him food laced with sedatives. Then, when he could barely move or think, they would beat and molest him. He had become too afraid to eat most of the time and had been terribly skinny. (He still was.) He had trouble sleeping and had nightmares in which he was attacked by leopards and lions.

That day's session covered much of the same territory. At the end of the hour, Tim begged me: "Please believe I made the candy especially to thank you for our work and for your trying to understand me. I wouldn't really want to hurt you." 

I tried my best to be analytical. "I think you want me to worry the way you had to every time you were being fed, so I'll know how you felt," I ventured.

He nodded vaguely at my comment.

I wondered if it would be helpful for Tim to know that he had succeeded, that I was indeed afraid. Being sensitive, as people who have suffered trauma usually are, he probably knew anyway. 

Just before he walked out the door, Tim turned and asked me: "Did you have a good vacation? I had to work like a dog." The guilt-inducing nature of this question was not lost on me.

After Tim left, I took a moment to gather my thoughts. Was he getting back at me for being gone? Tim often expressed doubt that I would be able to help him recover from his past trauma and learn to trust people. To him, I, too, was potentially unreliable.

Yet there was also a tender aspect to Tim, a wish to connect to another person without fear. His gift seemed to symbolize so much — on one side, hostility and terror; on the other, yearning for love and care. 

What was I going to do? Could I trust that Tim, with this gift, wasn't repeating his family's cruelty?

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Monday, September 28, 2015

Big change ahead for early breast cancer treatment? - CBS News

Many women with early-stage breast cancer can skip chemotherapy without hurting their odds of beating the disease - good news from a major study that shows the value of a gene-activity test to gauge each patient's risk.

The test accurately identified a group of women whose cancers are so likely to respond to hormone-blocking drugs that adding chemo would do little if any good while exposing them to side effects and other health risks. In the study, women who skipped chemo based on the test had less than a 1 percent chance of cancer recurring far away, such as the liver or lungs, within the next five years.

"You can't do better than that," said the study leader, Dr. Joseph Sparano of Montefiore Medical Center in New York.

An independent expert, Dr. Clifford Hudis of New York's Memorial Sloan Kettering Cancer Center, agreed.

"There is really no chance that chemotherapy could make that number better," he said. Using the gene test "lets us focus our chemotherapy more on the higher risk patients who do benefit" and spare others the ordeal.

The study was sponsored by the National Cancer Institute. Results were published online Monday by the New England Journal of Medicine and discussed at the European Cancer Congress in Vienna.

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Sunday, September 27, 2015

How Marketing Turned the EpiPen Into a Billion-Dollar Business - Bloomberg Business

In a 2007 purchase of medicines from Merck KGaA, drugmaker Mylan picked up a decades-old product, the EpiPen auto injector for food allergy and bee-sting emergencies. Management first thought to divest the aging device, which logged only $200 million in revenue. Then Heather Bresch, now Mylan's chief executive officer, hit on the idea of using old-fashioned marketing in part to boost sales among concerned parents of children with allergies. That started EpiPen, which delivers about $1 worth of the hormone epinephrine, on a run that's resulted in its becoming a $1 billion-a-year product that clobbers its rivals and provides about 40 percent of Mylan's operating profits, says researcher ABR|Healthco. EpiPen margins were 55 percent in 2014, up from 9 percent in 2008, ABR|Healthco estimates.

How Mylan pulled that off is a textbook case in savvy branding combined with a massive public awareness campaign on the dangers of child allergies. Along the way, EpiPen's wholesale price rose roughly 400 percent from about $57 each when Mylan acquired the product. "They have done a tremendous job of taking an asset that nobody thought you could do much with and making it a blockbuster product," says Jason Gerberry, a Leerink Partners analyst.

But while EpiPen has given countless parents a sense of security that their children can go out in the world safely, the device's soaring price—up 32 percent in the past year alone—has forced some families to make difficult choices in order to afford the life-saving medicine. The price increases are among the biggest of any top-selling brand drug, according to DRX, a unit of Connecture that tracks drug pricing. After insurance company discounts, a package of two EpiPens costs about $415, DRX says. By comparison, in France, where Meda sells the drug, two EpiPens cost about $85. "There is a danger with that," says George Sillup, chairman of the pharmaceutical and health-care marketing department at Saint Joseph's University. If the company raises the price too much, "that could create some backlash."

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