Naseem S. Miller

Telemedicine for Stroke Care

A flagship hospital with an established stroke care program can legally set up telemedicine equipment in local community hospitals for stroke consultations, with the goal of reducing the transfer of patients with neuro-emergencies, according to an opinion issued by the U.S. Health and Human Services Department's Office of Inspector General. The opinion, which redacted the name of the requesting hospital, said that the collaboration would not violate federal antikickback laws. “For legal reasons, community hospitals frequently transfer suspected stroke patients to comprehensive stroke centers” even though the patients may not be in critical condition, according to background information in the opinion. The telemedicine consultation could reduce such unnecessary transfers. Under the agreement, the flagship hospital would provide the telemedicine equipment and 24-hour physician staffing, while the local hospitals will have to have at least one CT scanner and the ability to transmit imaging studies. Both hospitals would be allowed to use each other's trademarks for certain marketing activities, according to the opinion.

Specialty Work Intensity Equal

When neurologists are compared with physicians in several other specialties including primary care, their work intensity is relatively equal, according to a study published in the journal Medical Care and funded by the American Academy of Neurology (AAN). Researchers evaluated a sample of 45 family physicians, 20 general internists, 22 neurologists, and 21 surgeons located in Kansas, Kentucky, Maryland, Ohio, and Virginia. The physicians' responses to questionnaires were then measured via several statistical formulas. “The findings of this and other studies suggest that the instruments can be utilized in further investigation of clinical work intensity and that currently accepted assumptions of grossly differing work intensity among medical specialists may be flawed. These possibly incorrect assumptions have contributed to the development of current inequalities in relative value unit (RVU) distribution for procedures and evaluation and management (E/M) services,” said study author Dr. Jerzy P. Szaflarski in a statement on the AAN's website.

Stroke Rate Rises in Young

Risk of hospitalization due to ischemic stroke among children and young adults rose by nearly 37% between 1995 and 2008, according to a study published in Annals of Neurology. Researchers at the Centers for Disease Control and Prevention analyzed a nationwide hospital discharge databank, and broke down the data based on sex and three age groups. Results showed that “the prevalence of hospitalizations of acute ischemic stroke increased among all age and [sex] groups except females aged 5 to 14 years.” Hospitalization risk among boys and men between 5 and 44 had the highest increase, by roughly 50%. The authors indicated that the rate of common risk factors for stroke, such as hypertension and diabetes, has been on the rise in this age group. “Our results from national surveillance data accentuate the need for public health initiatives to reduce risk factors for stroke among adolescents and young adults,” they wrote.

More Medicare-Fraud Charges

The U.S. Department of Justice has charged 91 doctors, nurses, and other health professionals with Medicare fraud amounting to $295 million in false billing in eight cities. In Miami, a doctor, a nurse, and 43 other defendants were charged with a total of $159 million in false charges for home health care, mental health services, occupational and physical therapy, durable medical equipment, and HIV infusions. Some of those defendants are charged with coercing poor people to pose as Medicare beneficiaries at a community mental health care center. The indictments constitute the highest amount of false Medicare billings in a single takedown in the history of the Medicare Fraud Strike Force, HHS Secretary Kathleen Sebelius said in announcing the indictments with Attorney General Eric Holder. Secretary Sebelius added that “our efforts to stop criminals don't end here, because the Affordable Care Act gives us new tools to prevent Medicare fraud before it is committed,” according to an HHS statement.

Patients Think Newer Is Better

Patients are more likely to choose newer drugs over older when they're not provided information about the products' safety and effectiveness, according to a study published in Archives of Internal Medicine. The researchers gave participants a choice between two fictitious drugs for heartburn and two for high cholesterol. More people chose a drug described as older if they were also told the newer drug many not be as safe and effective. But for the heartburn drug, most people who were not given that warning chose the newer drug. In their Internet survey, the researchers also found that 39% of respondents believed that the Food and Drug Administration approves only “extremely effective” drugs, and 25% believed that the FDA approves only drugs without serious side effects.

Telemedicine for Stroke Care

A flagship hospital with an established stroke care program can legally set up telemedicine equipment in local community hospitals for stroke consultations, with the goal of reducing the transfer of patients with neuro-emergencies, according to an opinion issued by the U.S. Health and Human Services Department's Office of Inspector General. The opinion, which redacted the name of the requesting hospital, said that the collaboration would not violate federal antikickback laws. “For legal reasons, community hospitals frequently transfer suspected stroke patients to comprehensive stroke centers” even though the patients may not be in critical condition, according to background information in the opinion. The telemedicine consultation could reduce such unnecessary transfers. Under the agreement, the flagship hospital would provide the telemedicine equipment and 24-hour physician staffing, while the local hospitals will have to have at least one CT scanner and the ability to transmit imaging studies. Both hospitals would be allowed to use each other's trademarks for certain marketing activities, according to the opinion.

Specialty Work Intensity Equal

When neurologists are compared with physicians in several other specialties including primary care, their work intensity is relatively equal, according to a study published in the journal Medical Care and funded by the American Academy of Neurology (AAN). Researchers evaluated a sample of 45 family physicians, 20 general internists, 22 neurologists, and 21 surgeons located in Kansas, Kentucky, Maryland, Ohio, and Virginia. The physicians' responses to questionnaires were then measured via several statistical formulas. “The findings of this and other studies suggest that the instruments can be utilized in further investigation of clinical work intensity and that currently accepted assumptions of grossly differing work intensity among medical specialists may be flawed. These possibly incorrect assumptions have contributed to the development of current inequalities in relative value unit (RVU) distribution for procedures and evaluation and management (E/M) services,” said study author Dr. Jerzy P. Szaflarski in a statement on the AAN's website.

Stroke Rate Rises in Young

Risk of hospitalization due to ischemic stroke among children and young adults rose by nearly 37% between 1995 and 2008, according to a study published in Annals of Neurology. Researchers at the Centers for Disease Control and Prevention analyzed a nationwide hospital discharge databank, and broke down the data based on sex and three age groups. Results showed that “the prevalence of hospitalizations of acute ischemic stroke increased among all age and [sex] groups except females aged 5 to 14 years.” Hospitalization risk among boys and men between 5 and 44 had the highest increase, by roughly 50%. The authors indicated that the rate of common risk factors for stroke, such as hypertension and diabetes, has been on the rise in this age group. “Our results from national surveillance data accentuate the need for public health initiatives to reduce risk factors for stroke among adolescents and young adults,” they wrote.

More Medicare-Fraud Charges

The U.S. Department of Justice has charged 91 doctors, nurses, and other health professionals with Medicare fraud amounting to $295 million in false billing in eight cities. In Miami, a doctor, a nurse, and 43 other defendants were charged with a total of $159 million in false charges for home health care, mental health services, occupational and physical therapy, durable medical equipment, and HIV infusions. Some of those defendants are charged with coercing poor people to pose as Medicare beneficiaries at a community mental health care center. The indictments constitute the highest amount of false Medicare billings in a single takedown in the history of the Medicare Fraud Strike Force, HHS Secretary Kathleen Sebelius said in announcing the indictments with Attorney General Eric Holder. Secretary Sebelius added that “our efforts to stop criminals don't end here, because the Affordable Care Act gives us new tools to prevent Medicare fraud before it is committed,” according to an HHS statement.

Patients Think Newer Is Better

Patients are more likely to choose newer drugs over older when they're not provided information about the products' safety and effectiveness, according to a study published in Archives of Internal Medicine. The researchers gave participants a choice between two fictitious drugs for heartburn and two for high cholesterol. More people chose a drug described as older if they were also told the newer drug many not be as safe and effective. But for the heartburn drug, most people who were not given that warning chose the newer drug. In their Internet survey, the researchers also found that 39% of respondents believed that the Food and Drug Administration approves only “extremely effective” drugs, and 25% believed that the FDA approves only drugs without serious side effects.

Telemedicine for Stroke Care

A flagship hospital with an established stroke care program can legally set up telemedicine equipment in local community hospitals for stroke consultations, with the goal of reducing the transfer of patients with neuro-emergencies, according to an opinion issued by the U.S. Health and Human Services Department's Office of Inspector General. The opinion, which redacted the name of the requesting hospital, said that the collaboration would not violate federal antikickback laws. “For legal reasons, community hospitals frequently transfer suspected stroke patients to comprehensive stroke centers” even though the patients may not be in critical condition, according to background information in the opinion. The telemedicine consultation could reduce such unnecessary transfers. Under the agreement, the flagship hospital would provide the telemedicine equipment and 24-hour physician staffing, while the local hospitals will have to have at least one CT scanner and the ability to transmit imaging studies. Both hospitals would be allowed to use each other's trademarks for certain marketing activities, according to the opinion.

Specialty Work Intensity Equal

When neurologists are compared with physicians in several other specialties including primary care, their work intensity is relatively equal, according to a study published in the journal Medical Care and funded by the American Academy of Neurology (AAN). Researchers evaluated a sample of 45 family physicians, 20 general internists, 22 neurologists, and 21 surgeons located in Kansas, Kentucky, Maryland, Ohio, and Virginia. The physicians' responses to questionnaires were then measured via several statistical formulas. “The findings of this and other studies suggest that the instruments can be utilized in further investigation of clinical work intensity and that currently accepted assumptions of grossly differing work intensity among medical specialists may be flawed. These possibly incorrect assumptions have contributed to the development of current inequalities in relative value unit (RVU) distribution for procedures and evaluation and management (E/M) services,” said study author Dr. Jerzy P. Szaflarski in a statement on the AAN's website.

Stroke Rate Rises in Young

Risk of hospitalization due to ischemic stroke among children and young adults rose by nearly 37% between 1995 and 2008, according to a study published in Annals of Neurology. Researchers at the Centers for Disease Control and Prevention analyzed a nationwide hospital discharge databank, and broke down the data based on sex and three age groups. Results showed that “the prevalence of hospitalizations of acute ischemic stroke increased among all age and [sex] groups except females aged 5 to 14 years.” Hospitalization risk among boys and men between 5 and 44 had the highest increase, by roughly 50%. The authors indicated that the rate of common risk factors for stroke, such as hypertension and diabetes, has been on the rise in this age group. “Our results from national surveillance data accentuate the need for public health initiatives to reduce risk factors for stroke among adolescents and young adults,” they wrote.

More Medicare-Fraud Charges

The U.S. Department of Justice has charged 91 doctors, nurses, and other health professionals with Medicare fraud amounting to $295 million in false billing in eight cities. In Miami, a doctor, a nurse, and 43 other defendants were charged with a total of $159 million in false charges for home health care, mental health services, occupational and physical therapy, durable medical equipment, and HIV infusions. Some of those defendants are charged with coercing poor people to pose as Medicare beneficiaries at a community mental health care center. The indictments constitute the highest amount of false Medicare billings in a single takedown in the history of the Medicare Fraud Strike Force, HHS Secretary Kathleen Sebelius said in announcing the indictments with Attorney General Eric Holder. Secretary Sebelius added that “our efforts to stop criminals don't end here, because the Affordable Care Act gives us new tools to prevent Medicare fraud before it is committed,” according to an HHS statement.

Patients Think Newer Is Better

Patients are more likely to choose newer drugs over older when they're not provided information about the products' safety and effectiveness, according to a study published in Archives of Internal Medicine. The researchers gave participants a choice between two fictitious drugs for heartburn and two for high cholesterol. More people chose a drug described as older if they were also told the newer drug many not be as safe and effective. But for the heartburn drug, most people who were not given that warning chose the newer drug. In their Internet survey, the researchers also found that 39% of respondents believed that the Food and Drug Administration approves only “extremely effective” drugs, and 25% believed that the FDA approves only drugs without serious side effects.

ORLANDO ‑ When it comes to social media, physicians should remember one important rule: Do not write about your patients, even if you’re writing as an anonymous person or modifying the person's information, Dr. Mike Sevilla warned during a presentation at the American Academy of Family Physicians Scientific Assembly.

Another tip: To find out what your image is online, type your name into an Internet search engine and see what comes up first. Physicians can take control of their online image by starting a LinkedIn profile, and by encouraging their satisfied patients to leave comments about them on the physician rating sites, Dr. Sevilla advised his audience.

Dr. Sevilla has an active blog; he tweets (@DrMikeSevilla); he podcasts; and he posts videos online. And the driving force behind it all is his belief that family physicians should take advantage of social media to share their story and their message with patients, their community, and their legislators. Their participation in social media can also help correct health misinformation on the Internet, he added.

Not all physicians need to do as much as he does on social media, Dr. Sevilla noted, but he encouraged them to consider getting involved.

To hear his advice on friending patients on Facebook and other tips for getting started in social media, watch our video interview below. You can also see Dr. Sevilla’s presentation slides on his blog.

ORLANDO ‑ When it comes to social media, physicians should remember one important rule: Do not write about your patients, even if you’re writing as an anonymous person or modifying the person's information, Dr. Mike Sevilla warned during a presentation at the American Academy of Family Physicians Scientific Assembly.

Another tip: To find out what your image is online, type your name into an Internet search engine and see what comes up first. Physicians can take control of their online image by starting a LinkedIn profile, and by encouraging their satisfied patients to leave comments about them on the physician rating sites, Dr. Sevilla advised his audience.

Dr. Sevilla has an active blog; he tweets (@DrMikeSevilla); he podcasts; and he posts videos online. And the driving force behind it all is his belief that family physicians should take advantage of social media to share their story and their message with patients, their community, and their legislators. Their participation in social media can also help correct health misinformation on the Internet, he added.

Not all physicians need to do as much as he does on social media, Dr. Sevilla noted, but he encouraged them to consider getting involved.

To hear his advice on friending patients on Facebook and other tips for getting started in social media, watch our video interview below. You can also see Dr. Sevilla’s presentation slides on his blog.

ORLANDO ‑ When it comes to social media, physicians should remember one important rule: Do not write about your patients, even if you’re writing as an anonymous person or modifying the person's information, Dr. Mike Sevilla warned during a presentation at the American Academy of Family Physicians Scientific Assembly.

Another tip: To find out what your image is online, type your name into an Internet search engine and see what comes up first. Physicians can take control of their online image by starting a LinkedIn profile, and by encouraging their satisfied patients to leave comments about them on the physician rating sites, Dr. Sevilla advised his audience.

Dr. Sevilla has an active blog; he tweets (@DrMikeSevilla); he podcasts; and he posts videos online. And the driving force behind it all is his belief that family physicians should take advantage of social media to share their story and their message with patients, their community, and their legislators. Their participation in social media can also help correct health misinformation on the Internet, he added.

Not all physicians need to do as much as he does on social media, Dr. Sevilla noted, but he encouraged them to consider getting involved.

To hear his advice on friending patients on Facebook and other tips for getting started in social media, watch our video interview below. You can also see Dr. Sevilla’s presentation slides on his blog.

WASHINGTON – The number of Americans using illicit drugs increased by only 0.2% between 2009 and 2010, and the rate of smoking and drinking among youth aged 12 to 17 continued to decline, according to the 2010 National Survey on Drug Use and Health report, released Sept. 8.

That’s the good news.

The not-so-good news, said Pamela S. Hyde, administrator of the Substance Abuse and Mental Health Services Administration, is that overall, illicit drug use among Americans has continued to increase since 2008 or has remained flat – especially the rate of prescription drug abuse. That rate has hovered around 2.7 (or 7 million people) since 2002.

Overall, 8.9% of Americans aged 12 years or older, or 22.6 million people, were current illicit drug users in 2010, compared with 8.7% in 2009. The rate, however, is higher than the 8% estimated in 2008, according to the National Survey on Drug Use and Health, a federally funded annual survey of more than 67,000 people.

Marijuana remained the most commonly used illicit drug in 2010, with an estimated 17.4 million people (6.9% of the population) reporting to have used it during the past month. This rate was 14.4% in 2007. Marijuana also had the largest number of first-time users, with 2.4 million people 12 years or older initiating its use in 2010.

The drug use rates in almost all other categories, from cocaine to pain relievers, showed a decline or remained stable in most age groups. Meanwhile, two age groups, young adults aged 18-25 years, and baby boomers (50-59 years old), continued to show a steady increase in illicit drug use.

In 2010, 21.5% of young adults were current users of illicit drugs, up from 21.2% in 2009 and 19.6% in 2008. The main driver was marijuana, which rose from 16.5% in 2008 to 18.1% in 2009 to 18.5% in 2010.

The use of cocaine and methamphetamine declined among young adults, while the nonmedical use of prescription-type drugs remained at 5.9%, similar to what it’s been since 2002.

Illicit drug use among baby boomers, whose lifetime rate of illicit drug use has been higher than older groups, continued a steady increase from 2.7% in 2002 to 5.8% in 2010. "As baby boomers enter what I call the ‘age of pain,’ physicians should be aware that the potential for [drug] misuse goes up," said Dr. H. Westley Clark, director of the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse and Treatment.

Although the illicit drug use rate among youths aged 12 to 17 increased by only 0.1% to 10.1% between 2009 and 2010, the rate remains higher than the estimated 9.3% in 2008, and defies the decline observed between 2002 and 2008. Nonmedical use of prescription drugs, however, declined from 4% to 3%, while Ecstasy use increased by 0.5% between 2009 and 2010.

The rate of alcohol use among youths dropped from 14.7% in 2009 to 13.6% in 2010. The rate of tobacco use in this age group dropped from 11.6% in 2009 to 10.7% in 2010.

Friends and family remain as the main source (55%) of prescription pain relievers for nonmedical use. Only 4.4% used a dealer and 0.4% bought the pills online.

Among Americans 12 years or older, 1.5 million (0.6% of the population) reported using cocaine; 1.2 million (0.5%) used hallucinogens; and 7 million (2.7%) used prescription-type psychotherapeutic drugs nonmedically. The number of methamphetamine users decreased by 0.2% between 2006 and 2010 to 353,000 people.

Behind the statistics are an estimated 23.1 million people, or 9.1% of the U.S. population aged 12 years or older, who needed treatment for an illicit drug or alcohol use problem in 2010. Of those, only 2.6 million received treatment at a specialty facility.

The medical community should screen patients for alcohol and substance use, Dr. Clark advised. "That means that everybody who comes into the doctor’s office should be asked about alcohol use ... use of illicit drugs ... and how they’re managing their pain medications – or if they’re taking pain medications that have not been prescribed for them.

"So we need the medical community to participate in addressing this major public health problem."

WASHINGTON – The number of Americans using illicit drugs increased by only 0.2% between 2009 and 2010, and the rate of smoking and drinking among youth aged 12 to 17 continued to decline, according to the 2010 National Survey on Drug Use and Health report, released Sept. 8.

That’s the good news.

The not-so-good news, said Pamela S. Hyde, administrator of the Substance Abuse and Mental Health Services Administration, is that overall, illicit drug use among Americans has continued to increase since 2008 or has remained flat – especially the rate of prescription drug abuse. That rate has hovered around 2.7 (or 7 million people) since 2002.

Overall, 8.9% of Americans aged 12 years or older, or 22.6 million people, were current illicit drug users in 2010, compared with 8.7% in 2009. The rate, however, is higher than the 8% estimated in 2008, according to the National Survey on Drug Use and Health, a federally funded annual survey of more than 67,000 people.

Marijuana remained the most commonly used illicit drug in 2010, with an estimated 17.4 million people (6.9% of the population) reporting to have used it during the past month. This rate was 14.4% in 2007. Marijuana also had the largest number of first-time users, with 2.4 million people 12 years or older initiating its use in 2010.

The drug use rates in almost all other categories, from cocaine to pain relievers, showed a decline or remained stable in most age groups. Meanwhile, two age groups, young adults aged 18-25 years, and baby boomers (50-59 years old), continued to show a steady increase in illicit drug use.

In 2010, 21.5% of young adults were current users of illicit drugs, up from 21.2% in 2009 and 19.6% in 2008. The main driver was marijuana, which rose from 16.5% in 2008 to 18.1% in 2009 to 18.5% in 2010.

The use of cocaine and methamphetamine declined among young adults, while the nonmedical use of prescription-type drugs remained at 5.9%, similar to what it’s been since 2002.

Illicit drug use among baby boomers, whose lifetime rate of illicit drug use has been higher than older groups, continued a steady increase from 2.7% in 2002 to 5.8% in 2010. "As baby boomers enter what I call the ‘age of pain,’ physicians should be aware that the potential for [drug] misuse goes up," said Dr. H. Westley Clark, director of the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse and Treatment.

Although the illicit drug use rate among youths aged 12 to 17 increased by only 0.1% to 10.1% between 2009 and 2010, the rate remains higher than the estimated 9.3% in 2008, and defies the decline observed between 2002 and 2008. Nonmedical use of prescription drugs, however, declined from 4% to 3%, while Ecstasy use increased by 0.5% between 2009 and 2010.

The rate of alcohol use among youths dropped from 14.7% in 2009 to 13.6% in 2010. The rate of tobacco use in this age group dropped from 11.6% in 2009 to 10.7% in 2010.

Friends and family remain as the main source (55%) of prescription pain relievers for nonmedical use. Only 4.4% used a dealer and 0.4% bought the pills online.

Among Americans 12 years or older, 1.5 million (0.6% of the population) reported using cocaine; 1.2 million (0.5%) used hallucinogens; and 7 million (2.7%) used prescription-type psychotherapeutic drugs nonmedically. The number of methamphetamine users decreased by 0.2% between 2006 and 2010 to 353,000 people.

Behind the statistics are an estimated 23.1 million people, or 9.1% of the U.S. population aged 12 years or older, who needed treatment for an illicit drug or alcohol use problem in 2010. Of those, only 2.6 million received treatment at a specialty facility.

The medical community should screen patients for alcohol and substance use, Dr. Clark advised. "That means that everybody who comes into the doctor’s office should be asked about alcohol use ... use of illicit drugs ... and how they’re managing their pain medications – or if they’re taking pain medications that have not been prescribed for them.

"So we need the medical community to participate in addressing this major public health problem."

WASHINGTON – The number of Americans using illicit drugs increased by only 0.2% between 2009 and 2010, and the rate of smoking and drinking among youth aged 12 to 17 continued to decline, according to the 2010 National Survey on Drug Use and Health report, released Sept. 8.

That’s the good news.

The not-so-good news, said Pamela S. Hyde, administrator of the Substance Abuse and Mental Health Services Administration, is that overall, illicit drug use among Americans has continued to increase since 2008 or has remained flat – especially the rate of prescription drug abuse. That rate has hovered around 2.7 (or 7 million people) since 2002.

Overall, 8.9% of Americans aged 12 years or older, or 22.6 million people, were current illicit drug users in 2010, compared with 8.7% in 2009. The rate, however, is higher than the 8% estimated in 2008, according to the National Survey on Drug Use and Health, a federally funded annual survey of more than 67,000 people.

Marijuana remained the most commonly used illicit drug in 2010, with an estimated 17.4 million people (6.9% of the population) reporting to have used it during the past month. This rate was 14.4% in 2007. Marijuana also had the largest number of first-time users, with 2.4 million people 12 years or older initiating its use in 2010.

The drug use rates in almost all other categories, from cocaine to pain relievers, showed a decline or remained stable in most age groups. Meanwhile, two age groups, young adults aged 18-25 years, and baby boomers (50-59 years old), continued to show a steady increase in illicit drug use.

In 2010, 21.5% of young adults were current users of illicit drugs, up from 21.2% in 2009 and 19.6% in 2008. The main driver was marijuana, which rose from 16.5% in 2008 to 18.1% in 2009 to 18.5% in 2010.

The use of cocaine and methamphetamine declined among young adults, while the nonmedical use of prescription-type drugs remained at 5.9%, similar to what it’s been since 2002.

Illicit drug use among baby boomers, whose lifetime rate of illicit drug use has been higher than older groups, continued a steady increase from 2.7% in 2002 to 5.8% in 2010. "As baby boomers enter what I call the ‘age of pain,’ physicians should be aware that the potential for [drug] misuse goes up," said Dr. H. Westley Clark, director of the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse and Treatment.

Although the illicit drug use rate among youths aged 12 to 17 increased by only 0.1% to 10.1% between 2009 and 2010, the rate remains higher than the estimated 9.3% in 2008, and defies the decline observed between 2002 and 2008. Nonmedical use of prescription drugs, however, declined from 4% to 3%, while Ecstasy use increased by 0.5% between 2009 and 2010.

The rate of alcohol use among youths dropped from 14.7% in 2009 to 13.6% in 2010. The rate of tobacco use in this age group dropped from 11.6% in 2009 to 10.7% in 2010.

Friends and family remain as the main source (55%) of prescription pain relievers for nonmedical use. Only 4.4% used a dealer and 0.4% bought the pills online.

Among Americans 12 years or older, 1.5 million (0.6% of the population) reported using cocaine; 1.2 million (0.5%) used hallucinogens; and 7 million (2.7%) used prescription-type psychotherapeutic drugs nonmedically. The number of methamphetamine users decreased by 0.2% between 2006 and 2010 to 353,000 people.

Behind the statistics are an estimated 23.1 million people, or 9.1% of the U.S. population aged 12 years or older, who needed treatment for an illicit drug or alcohol use problem in 2010. Of those, only 2.6 million received treatment at a specialty facility.

The medical community should screen patients for alcohol and substance use, Dr. Clark advised. "That means that everybody who comes into the doctor’s office should be asked about alcohol use ... use of illicit drugs ... and how they’re managing their pain medications – or if they’re taking pain medications that have not been prescribed for them.

"So we need the medical community to participate in addressing this major public health problem."

Dr. Daniel P. Alford stumbled into addiction medicine after he finished his residency in internal medicine more than a decade ago.

He hesitantly took a part-time position as the medical director for a city-run methadone maintenance program and ended up staying for 10 years. "I loved it the minute I got there," he said.

Courtesy David Keough, BUSM Educational Media Center

"I realized that there’s a whole other world out there in terms of addiction treatment that I wasn’t exposed to. Generalist disciplines ... get exposed to the most severe forms of the problem, but when I got to the methadone maintenance program, I met all these patients who were doing great. Their problem was being treated with medication and counseling," he said.

Today, he’s the director for the addiction medicine residency program at Boston University, which is 1 of 10 training programs in the country that have recently become accredited by the American Board of Addiction Medicine (ABAM). One of his goals now is to eliminate the stigma that addiction treatment is always a losing proposition.

There’s a big push to educate nonpsychiatrists about the progress of addiction treatment, and one way to do that is by gaining subspecialty recognition, explained Dr. Richard D. Blondell, ABAM’s chairman of the Residency Accreditation Review Committee. The goal is to get an additional 10-15 addiction medicine programs accredited by July 2012 to reach the target 20-25 programs that are required for subspecialty recognition by the American Board of Medical Specialties (ABMS).

"We’re the largest group of physicians that doesn’t have a home," he said. Subspecialty accreditation is a "very important step. The goal is to bring the specialty of addiction medicine under the tent of organized medicine."

Although nonpsychiatrists have practiced addiction medicine for decades and thousands have been certified by ABAM and by the American Society of Addiction Medicine, none of the postresidency training programs has been accredited or recognized by the national bodies, ABMS, or the Accreditation Council for Graduate Medical Education (ACGME).

Dr. Blondell said that part of the reason that addiction medicine hasn’t become a recognized subspecialty is the fact that the field isn’t highly compensated. "So, there aren’t many resources to do all the paperwork. It’s taken us a bit longer, but we’ll get there."

Advocates say that having addiction medicine as a recognized subspecialty will open the door to physicians from various backgrounds to train in the field and will help increase patient access to addiction treatment. In addition, they say having more experts in the field will help educate the physician workforce, reduce the stigma among physicians, and help with existing reimbursement issues.

"In a sense no specialty wanted to claim addiction medicine," said Dr. Peter Friedmann, professor of medicine and community health at Brown University in Providence, R.I., and an ABAM-certified addiction medicine specialist. It really is a field that crosses disciplines, and "the establishment of residency really sets the wheels in motion to have specialists in medical centers and in communities recognized for this particular expertise. It also brings a level of legitimacy, and a certain body of knowledge that is important for all physicians to know and to integrate into their practices."

The American Academy of Addiction Psychiatry (AAAP) in concert with the American Psychiatric Association and other organizations succeeded in getting addiction psychiatry recognized as a subspecialty by the American Board of Psychiatry and Neurology (an ABMS member), and Addiction Psychiatry fellowships by the ACGME in the early 1990s. The majority of addiction psychiatry programs, however, accept psychiatry residents only.

"We’ve been supporting the ability of nonpsychiatrists to get postresidency training in addiction for a long time," said Dr. Richard Rosenthal, past president of AAAP and the current head of public policy at the association. "We’re glad that there’s finally a mechanism to get extra training for primary care doctors and others."

Dr. Rosenthal said he expects that there will be growing pains and tension between the two subspecialties, which overlap in many areas. "But my attitude is that given the patient density, there’s more than enough pie to go around. More and more we have to look at building care teams that address the broad array of medical problems," said Dr. Rosenthal.

In a 2009 report, the American Board of Addiction Medicine Foundation, which accredited the addiction medicine programs this year, estimated that 5,000 new physicians need to be certified by 2020 to meet demand.

Yet, the addiction psychiatry programs currently produce only 20-40 subspecialists annually, and the addiction medicine fellowship adds another 20-30 per year, leading to a shortfall of 30-60 physicians, according to a 2011 analysis of addiction medicine programs by Dr. Blondell and his colleagues. (Substance Abuse 2011;32:84-92).

"There’s an enormous population and not enough doctors," said Dr. Stuart Gitlow, acting president of the American Society of Addiction Medicine, the professional organization for addiction medicine specialists, which established ABAM in 2007.

Applicants to addiction medicine programs come from a wide range of backgrounds. Some are fresh out of a residency; others are midcareer. Dr. Blondell estimated that roughly 40% of fellows come from psychiatry, 25% from family practice, 25% from internal medicine, and the rest from a wide range of backgrounds, including ob.gyn., pediatrics, and surgery.

Some of the addiction medicine programs run in close collaboration with the addiction psychiatry residencies, and some say that there are benefits to having the two groups of residents side by side.

Boston University’s addiction medicine residency modeled itself after the existing addiction psychiatry residency. "We have a good relationship with the university’s addiction psychiatry residency," said Dr. Alford. "It was really critical for us to sit down with addiction psychiatry and figure out how to put it all together."

There’s overlap, but there are also significant differences between addiction medicine and addiction psychiatry. While addiction medicine specialists focus more on the medical treatment of patients with medical and/or surgical comorbidities, addiction psychiatrists tend to focus on the treatment of coexisting mental illnesses.

"The whole subspecialty is so young that we don’t have much experience on how this will play out," said Dr. Petros Levounis, chief of the division of addiction psychiatry at St. Luke’s–Roosevelt Hospital Center in New York. "Eventually, it will be clear who the patient needs to go to," he said, adding that for starters having medical vs. psychiatric comorbidity could serve as a designating role.

Under the ABAM accreditation, the addiction medicine training should have four components: training in inpatient settings; training in outpatient settings such as residential programs; program-specific training depending on the region and nearby facilities; and electives, which are based on the physicians’ backgrounds. "So, at the end of the year, they all will have similar knowledge, although they come from all sorts of backgrounds," Dr. Blondell said.

Despite the obvious need for an addiction medicine subspecialty, Dr. Friedmann added a note of caution.

"I think we have to be mindful that creating a subspecialty is not a substitute for physicians and other providers developing greater knowledge and skill in the addiction field," he said. "There are too many patients. We’re not going to be able to train enough specialists to treat all those folks. The general medicine field needs to accept that these are legitimate medical conditions for which they should take responsibility."

Dr. Daniel P. Alford stumbled into addiction medicine after he finished his residency in internal medicine more than a decade ago.

He hesitantly took a part-time position as the medical director for a city-run methadone maintenance program and ended up staying for 10 years. "I loved it the minute I got there," he said.

Courtesy David Keough, BUSM Educational Media Center

"I realized that there’s a whole other world out there in terms of addiction treatment that I wasn’t exposed to. Generalist disciplines ... get exposed to the most severe forms of the problem, but when I got to the methadone maintenance program, I met all these patients who were doing great. Their problem was being treated with medication and counseling," he said.

Today, he’s the director for the addiction medicine residency program at Boston University, which is 1 of 10 training programs in the country that have recently become accredited by the American Board of Addiction Medicine (ABAM). One of his goals now is to eliminate the stigma that addiction treatment is always a losing proposition.

There’s a big push to educate nonpsychiatrists about the progress of addiction treatment, and one way to do that is by gaining subspecialty recognition, explained Dr. Richard D. Blondell, ABAM’s chairman of the Residency Accreditation Review Committee. The goal is to get an additional 10-15 addiction medicine programs accredited by July 2012 to reach the target 20-25 programs that are required for subspecialty recognition by the American Board of Medical Specialties (ABMS).

"We’re the largest group of physicians that doesn’t have a home," he said. Subspecialty accreditation is a "very important step. The goal is to bring the specialty of addiction medicine under the tent of organized medicine."

Although nonpsychiatrists have practiced addiction medicine for decades and thousands have been certified by ABAM and by the American Society of Addiction Medicine, none of the postresidency training programs has been accredited or recognized by the national bodies, ABMS, or the Accreditation Council for Graduate Medical Education (ACGME).

Dr. Blondell said that part of the reason that addiction medicine hasn’t become a recognized subspecialty is the fact that the field isn’t highly compensated. "So, there aren’t many resources to do all the paperwork. It’s taken us a bit longer, but we’ll get there."

Advocates say that having addiction medicine as a recognized subspecialty will open the door to physicians from various backgrounds to train in the field and will help increase patient access to addiction treatment. In addition, they say having more experts in the field will help educate the physician workforce, reduce the stigma among physicians, and help with existing reimbursement issues.

"In a sense no specialty wanted to claim addiction medicine," said Dr. Peter Friedmann, professor of medicine and community health at Brown University in Providence, R.I., and an ABAM-certified addiction medicine specialist. It really is a field that crosses disciplines, and "the establishment of residency really sets the wheels in motion to have specialists in medical centers and in communities recognized for this particular expertise. It also brings a level of legitimacy, and a certain body of knowledge that is important for all physicians to know and to integrate into their practices."

The American Academy of Addiction Psychiatry (AAAP) in concert with the American Psychiatric Association and other organizations succeeded in getting addiction psychiatry recognized as a subspecialty by the American Board of Psychiatry and Neurology (an ABMS member), and Addiction Psychiatry fellowships by the ACGME in the early 1990s. The majority of addiction psychiatry programs, however, accept psychiatry residents only.

"We’ve been supporting the ability of nonpsychiatrists to get postresidency training in addiction for a long time," said Dr. Richard Rosenthal, past president of AAAP and the current head of public policy at the association. "We’re glad that there’s finally a mechanism to get extra training for primary care doctors and others."

Dr. Rosenthal said he expects that there will be growing pains and tension between the two subspecialties, which overlap in many areas. "But my attitude is that given the patient density, there’s more than enough pie to go around. More and more we have to look at building care teams that address the broad array of medical problems," said Dr. Rosenthal.

In a 2009 report, the American Board of Addiction Medicine Foundation, which accredited the addiction medicine programs this year, estimated that 5,000 new physicians need to be certified by 2020 to meet demand.

Yet, the addiction psychiatry programs currently produce only 20-40 subspecialists annually, and the addiction medicine fellowship adds another 20-30 per year, leading to a shortfall of 30-60 physicians, according to a 2011 analysis of addiction medicine programs by Dr. Blondell and his colleagues. (Substance Abuse 2011;32:84-92).

"There’s an enormous population and not enough doctors," said Dr. Stuart Gitlow, acting president of the American Society of Addiction Medicine, the professional organization for addiction medicine specialists, which established ABAM in 2007.

Applicants to addiction medicine programs come from a wide range of backgrounds. Some are fresh out of a residency; others are midcareer. Dr. Blondell estimated that roughly 40% of fellows come from psychiatry, 25% from family practice, 25% from internal medicine, and the rest from a wide range of backgrounds, including ob.gyn., pediatrics, and surgery.

Some of the addiction medicine programs run in close collaboration with the addiction psychiatry residencies, and some say that there are benefits to having the two groups of residents side by side.

Boston University’s addiction medicine residency modeled itself after the existing addiction psychiatry residency. "We have a good relationship with the university’s addiction psychiatry residency," said Dr. Alford. "It was really critical for us to sit down with addiction psychiatry and figure out how to put it all together."

There’s overlap, but there are also significant differences between addiction medicine and addiction psychiatry. While addiction medicine specialists focus more on the medical treatment of patients with medical and/or surgical comorbidities, addiction psychiatrists tend to focus on the treatment of coexisting mental illnesses.

"The whole subspecialty is so young that we don’t have much experience on how this will play out," said Dr. Petros Levounis, chief of the division of addiction psychiatry at St. Luke’s–Roosevelt Hospital Center in New York. "Eventually, it will be clear who the patient needs to go to," he said, adding that for starters having medical vs. psychiatric comorbidity could serve as a designating role.

Under the ABAM accreditation, the addiction medicine training should have four components: training in inpatient settings; training in outpatient settings such as residential programs; program-specific training depending on the region and nearby facilities; and electives, which are based on the physicians’ backgrounds. "So, at the end of the year, they all will have similar knowledge, although they come from all sorts of backgrounds," Dr. Blondell said.

Despite the obvious need for an addiction medicine subspecialty, Dr. Friedmann added a note of caution.

"I think we have to be mindful that creating a subspecialty is not a substitute for physicians and other providers developing greater knowledge and skill in the addiction field," he said. "There are too many patients. We’re not going to be able to train enough specialists to treat all those folks. The general medicine field needs to accept that these are legitimate medical conditions for which they should take responsibility."

Dr. Daniel P. Alford stumbled into addiction medicine after he finished his residency in internal medicine more than a decade ago.

He hesitantly took a part-time position as the medical director for a city-run methadone maintenance program and ended up staying for 10 years. "I loved it the minute I got there," he said.

Courtesy David Keough, BUSM Educational Media Center

"I realized that there’s a whole other world out there in terms of addiction treatment that I wasn’t exposed to. Generalist disciplines ... get exposed to the most severe forms of the problem, but when I got to the methadone maintenance program, I met all these patients who were doing great. Their problem was being treated with medication and counseling," he said.

Today, he’s the director for the addiction medicine residency program at Boston University, which is 1 of 10 training programs in the country that have recently become accredited by the American Board of Addiction Medicine (ABAM). One of his goals now is to eliminate the stigma that addiction treatment is always a losing proposition.

There’s a big push to educate nonpsychiatrists about the progress of addiction treatment, and one way to do that is by gaining subspecialty recognition, explained Dr. Richard D. Blondell, ABAM’s chairman of the Residency Accreditation Review Committee. The goal is to get an additional 10-15 addiction medicine programs accredited by July 2012 to reach the target 20-25 programs that are required for subspecialty recognition by the American Board of Medical Specialties (ABMS).

"We’re the largest group of physicians that doesn’t have a home," he said. Subspecialty accreditation is a "very important step. The goal is to bring the specialty of addiction medicine under the tent of organized medicine."

Although nonpsychiatrists have practiced addiction medicine for decades and thousands have been certified by ABAM and by the American Society of Addiction Medicine, none of the postresidency training programs has been accredited or recognized by the national bodies, ABMS, or the Accreditation Council for Graduate Medical Education (ACGME).

Dr. Blondell said that part of the reason that addiction medicine hasn’t become a recognized subspecialty is the fact that the field isn’t highly compensated. "So, there aren’t many resources to do all the paperwork. It’s taken us a bit longer, but we’ll get there."

Advocates say that having addiction medicine as a recognized subspecialty will open the door to physicians from various backgrounds to train in the field and will help increase patient access to addiction treatment. In addition, they say having more experts in the field will help educate the physician workforce, reduce the stigma among physicians, and help with existing reimbursement issues.

"In a sense no specialty wanted to claim addiction medicine," said Dr. Peter Friedmann, professor of medicine and community health at Brown University in Providence, R.I., and an ABAM-certified addiction medicine specialist. It really is a field that crosses disciplines, and "the establishment of residency really sets the wheels in motion to have specialists in medical centers and in communities recognized for this particular expertise. It also brings a level of legitimacy, and a certain body of knowledge that is important for all physicians to know and to integrate into their practices."

The American Academy of Addiction Psychiatry (AAAP) in concert with the American Psychiatric Association and other organizations succeeded in getting addiction psychiatry recognized as a subspecialty by the American Board of Psychiatry and Neurology (an ABMS member), and Addiction Psychiatry fellowships by the ACGME in the early 1990s. The majority of addiction psychiatry programs, however, accept psychiatry residents only.

"We’ve been supporting the ability of nonpsychiatrists to get postresidency training in addiction for a long time," said Dr. Richard Rosenthal, past president of AAAP and the current head of public policy at the association. "We’re glad that there’s finally a mechanism to get extra training for primary care doctors and others."

Dr. Rosenthal said he expects that there will be growing pains and tension between the two subspecialties, which overlap in many areas. "But my attitude is that given the patient density, there’s more than enough pie to go around. More and more we have to look at building care teams that address the broad array of medical problems," said Dr. Rosenthal.

In a 2009 report, the American Board of Addiction Medicine Foundation, which accredited the addiction medicine programs this year, estimated that 5,000 new physicians need to be certified by 2020 to meet demand.

Yet, the addiction psychiatry programs currently produce only 20-40 subspecialists annually, and the addiction medicine fellowship adds another 20-30 per year, leading to a shortfall of 30-60 physicians, according to a 2011 analysis of addiction medicine programs by Dr. Blondell and his colleagues. (Substance Abuse 2011;32:84-92).

"There’s an enormous population and not enough doctors," said Dr. Stuart Gitlow, acting president of the American Society of Addiction Medicine, the professional organization for addiction medicine specialists, which established ABAM in 2007.

Applicants to addiction medicine programs come from a wide range of backgrounds. Some are fresh out of a residency; others are midcareer. Dr. Blondell estimated that roughly 40% of fellows come from psychiatry, 25% from family practice, 25% from internal medicine, and the rest from a wide range of backgrounds, including ob.gyn., pediatrics, and surgery.

Some of the addiction medicine programs run in close collaboration with the addiction psychiatry residencies, and some say that there are benefits to having the two groups of residents side by side.

Boston University’s addiction medicine residency modeled itself after the existing addiction psychiatry residency. "We have a good relationship with the university’s addiction psychiatry residency," said Dr. Alford. "It was really critical for us to sit down with addiction psychiatry and figure out how to put it all together."

There’s overlap, but there are also significant differences between addiction medicine and addiction psychiatry. While addiction medicine specialists focus more on the medical treatment of patients with medical and/or surgical comorbidities, addiction psychiatrists tend to focus on the treatment of coexisting mental illnesses.

"The whole subspecialty is so young that we don’t have much experience on how this will play out," said Dr. Petros Levounis, chief of the division of addiction psychiatry at St. Luke’s–Roosevelt Hospital Center in New York. "Eventually, it will be clear who the patient needs to go to," he said, adding that for starters having medical vs. psychiatric comorbidity could serve as a designating role.

Under the ABAM accreditation, the addiction medicine training should have four components: training in inpatient settings; training in outpatient settings such as residential programs; program-specific training depending on the region and nearby facilities; and electives, which are based on the physicians’ backgrounds. "So, at the end of the year, they all will have similar knowledge, although they come from all sorts of backgrounds," Dr. Blondell said.

Despite the obvious need for an addiction medicine subspecialty, Dr. Friedmann added a note of caution.

"I think we have to be mindful that creating a subspecialty is not a substitute for physicians and other providers developing greater knowledge and skill in the addiction field," he said. "There are too many patients. We’re not going to be able to train enough specialists to treat all those folks. The general medicine field needs to accept that these are legitimate medical conditions for which they should take responsibility."

With Weight, Asthma Misdiagnosed

Obese people presenting with breathlessness and other symptoms may be misdiagnosed with asthma, according to a small study published in CHEST. Of 91 overweight people previously diagnosed with asthma and using inhalants, 36.3% did not have bronchial hyperresponsiveness, the researchers found. Obesity increases a person's doctor visits, “where patients have the opportunity to report respiratory symptoms and each visit can potentially lead to mis-classification of asthma diagnosis,” the authors said. They suggested further research on the impact of weight loss on obese patients and their health-related quality of life.

E-Records Improve Care

When it comes to treating adults with diabetes, primary care practices that use electronic health records achieve better outcomes than do those using paper-based systems, according to a study published in the New England Journal of Medicine. The research included more than 27,000 patients with various types of insurance or no insurance. More than half the patients in practices with electronic records received diabetes care that met standards. In contrast, 7% of patients in paper-based practices achieved that level of care. Given the incentives for the adoption of health information technology, the authors said the study's findings support the value of community-based partnerships to encourage the adoption of electronic health records and increases in care quality.

Dieting Outpaces Exercise

Weight loss with or without exercise significantly improved insulin resistance in a study of 439 postmenopausal women who were inactive and overweight at the beginning of the trial. The participants' insulin resistance improved significantly on regimens of diet or diet plus exercise, but not with exercise alone or no change. Reported in the American Journal of Preventive Medicine, the study supports previous findings that weight loss of 5%-10% of body weight is associated with improved insulin sensitivity and glucose tolerance, the authors said. Despite the relative failure of exercise alone, the authors said that “regular physical activity has the potential for health benefits among women with impaired fasting glucose.”

Calorie Counts Help Some

One in six lunchtime diners at fast food restaurants in New York City read the calorie counts posted alongside the menu items and ordered something lower in calories as a result, according to a study of the impact of the 2008 law that requires city restaurants to post calorie information. The 15% of customers who said they used the calorie information bought food containing an average of 106 fewer calories than the food that others purchased. Diners at three restaurant chains – McDonald's, Au Bon Pain, and KFC – ordered significantly fewer calories following implementation of the law, the study found. Customers at Subway actually increased their calories following the law's implementation. The study was jointly funded by New York City and the Robert Wood Johnson Foundation.

Physicians Seek Solid Data

Physicians should be able to review and challenge data on their individual performances before that information is released to the public, the American Medical Association and more than 80 other medical groups said in a letter. The organizations were commenting on a proposed federal rule allowing access to Medicare claims data for entities creating reports for patients on providers' care quality and efficiency. “Physicians and other providers must have the opportunity for prior review and comment, along with the right to appeal, with regard to any data or its use that is part of the public review process,” the groups said. “This is necessary to give an accurate and complete picture of what is otherwise only a snapshot, and possibly skewed or outdated view of the patient care provided by physicians and other professionals and providers.” In addition, the CMS needs a campaign to educate the public about the data and its limitations, the groups said in their letter.

Insurance Costs Vary Widely

Health insurance costs vary up to threefold state to state, with the average monthly, per-person price tag ranging from $136 in Alabama and $157 in California to more than $400 in Vermont and Massachusetts, according to an analysis by the Kaiser Family Foundation. Nationally, each insured person – including children and adults – pays an average of $215 a month for health insurance. Reasons for varying premiums include cost-of-living differences, health care costs, average age of state residents, plans' effectiveness at controlling costs, the benefits offered by plans, and patient cost-sharing required, the report said. Since people in low-premium states might have to pay higher copayments and deductibles, the monthly prices don't necessarily reflect value, the analysts added.

With Weight, Asthma Misdiagnosed

Obese people presenting with breathlessness and other symptoms may be misdiagnosed with asthma, according to a small study published in CHEST. Of 91 overweight people previously diagnosed with asthma and using inhalants, 36.3% did not have bronchial hyperresponsiveness, the researchers found. Obesity increases a person's doctor visits, “where patients have the opportunity to report respiratory symptoms and each visit can potentially lead to mis-classification of asthma diagnosis,” the authors said. They suggested further research on the impact of weight loss on obese patients and their health-related quality of life.

E-Records Improve Care

When it comes to treating adults with diabetes, primary care practices that use electronic health records achieve better outcomes than do those using paper-based systems, according to a study published in the New England Journal of Medicine. The research included more than 27,000 patients with various types of insurance or no insurance. More than half the patients in practices with electronic records received diabetes care that met standards. In contrast, 7% of patients in paper-based practices achieved that level of care. Given the incentives for the adoption of health information technology, the authors said the study's findings support the value of community-based partnerships to encourage the adoption of electronic health records and increases in care quality.

Dieting Outpaces Exercise

Weight loss with or without exercise significantly improved insulin resistance in a study of 439 postmenopausal women who were inactive and overweight at the beginning of the trial. The participants' insulin resistance improved significantly on regimens of diet or diet plus exercise, but not with exercise alone or no change. Reported in the American Journal of Preventive Medicine, the study supports previous findings that weight loss of 5%-10% of body weight is associated with improved insulin sensitivity and glucose tolerance, the authors said. Despite the relative failure of exercise alone, the authors said that “regular physical activity has the potential for health benefits among women with impaired fasting glucose.”

Calorie Counts Help Some

One in six lunchtime diners at fast food restaurants in New York City read the calorie counts posted alongside the menu items and ordered something lower in calories as a result, according to a study of the impact of the 2008 law that requires city restaurants to post calorie information. The 15% of customers who said they used the calorie information bought food containing an average of 106 fewer calories than the food that others purchased. Diners at three restaurant chains – McDonald's, Au Bon Pain, and KFC – ordered significantly fewer calories following implementation of the law, the study found. Customers at Subway actually increased their calories following the law's implementation. The study was jointly funded by New York City and the Robert Wood Johnson Foundation.

Physicians Seek Solid Data

Physicians should be able to review and challenge data on their individual performances before that information is released to the public, the American Medical Association and more than 80 other medical groups said in a letter. The organizations were commenting on a proposed federal rule allowing access to Medicare claims data for entities creating reports for patients on providers' care quality and efficiency. “Physicians and other providers must have the opportunity for prior review and comment, along with the right to appeal, with regard to any data or its use that is part of the public review process,” the groups said. “This is necessary to give an accurate and complete picture of what is otherwise only a snapshot, and possibly skewed or outdated view of the patient care provided by physicians and other professionals and providers.” In addition, the CMS needs a campaign to educate the public about the data and its limitations, the groups said in their letter.

Insurance Costs Vary Widely

Health insurance costs vary up to threefold state to state, with the average monthly, per-person price tag ranging from $136 in Alabama and $157 in California to more than $400 in Vermont and Massachusetts, according to an analysis by the Kaiser Family Foundation. Nationally, each insured person – including children and adults – pays an average of $215 a month for health insurance. Reasons for varying premiums include cost-of-living differences, health care costs, average age of state residents, plans' effectiveness at controlling costs, the benefits offered by plans, and patient cost-sharing required, the report said. Since people in low-premium states might have to pay higher copayments and deductibles, the monthly prices don't necessarily reflect value, the analysts added.

With Weight, Asthma Misdiagnosed

Obese people presenting with breathlessness and other symptoms may be misdiagnosed with asthma, according to a small study published in CHEST. Of 91 overweight people previously diagnosed with asthma and using inhalants, 36.3% did not have bronchial hyperresponsiveness, the researchers found. Obesity increases a person's doctor visits, “where patients have the opportunity to report respiratory symptoms and each visit can potentially lead to mis-classification of asthma diagnosis,” the authors said. They suggested further research on the impact of weight loss on obese patients and their health-related quality of life.

E-Records Improve Care

When it comes to treating adults with diabetes, primary care practices that use electronic health records achieve better outcomes than do those using paper-based systems, according to a study published in the New England Journal of Medicine. The research included more than 27,000 patients with various types of insurance or no insurance. More than half the patients in practices with electronic records received diabetes care that met standards. In contrast, 7% of patients in paper-based practices achieved that level of care. Given the incentives for the adoption of health information technology, the authors said the study's findings support the value of community-based partnerships to encourage the adoption of electronic health records and increases in care quality.

Dieting Outpaces Exercise

Weight loss with or without exercise significantly improved insulin resistance in a study of 439 postmenopausal women who were inactive and overweight at the beginning of the trial. The participants' insulin resistance improved significantly on regimens of diet or diet plus exercise, but not with exercise alone or no change. Reported in the American Journal of Preventive Medicine, the study supports previous findings that weight loss of 5%-10% of body weight is associated with improved insulin sensitivity and glucose tolerance, the authors said. Despite the relative failure of exercise alone, the authors said that “regular physical activity has the potential for health benefits among women with impaired fasting glucose.”

Calorie Counts Help Some

One in six lunchtime diners at fast food restaurants in New York City read the calorie counts posted alongside the menu items and ordered something lower in calories as a result, according to a study of the impact of the 2008 law that requires city restaurants to post calorie information. The 15% of customers who said they used the calorie information bought food containing an average of 106 fewer calories than the food that others purchased. Diners at three restaurant chains – McDonald's, Au Bon Pain, and KFC – ordered significantly fewer calories following implementation of the law, the study found. Customers at Subway actually increased their calories following the law's implementation. The study was jointly funded by New York City and the Robert Wood Johnson Foundation.

Physicians Seek Solid Data

Physicians should be able to review and challenge data on their individual performances before that information is released to the public, the American Medical Association and more than 80 other medical groups said in a letter. The organizations were commenting on a proposed federal rule allowing access to Medicare claims data for entities creating reports for patients on providers' care quality and efficiency. “Physicians and other providers must have the opportunity for prior review and comment, along with the right to appeal, with regard to any data or its use that is part of the public review process,” the groups said. “This is necessary to give an accurate and complete picture of what is otherwise only a snapshot, and possibly skewed or outdated view of the patient care provided by physicians and other professionals and providers.” In addition, the CMS needs a campaign to educate the public about the data and its limitations, the groups said in their letter.

Insurance Costs Vary Widely

Health insurance costs vary up to threefold state to state, with the average monthly, per-person price tag ranging from $136 in Alabama and $157 in California to more than $400 in Vermont and Massachusetts, according to an analysis by the Kaiser Family Foundation. Nationally, each insured person – including children and adults – pays an average of $215 a month for health insurance. Reasons for varying premiums include cost-of-living differences, health care costs, average age of state residents, plans' effectiveness at controlling costs, the benefits offered by plans, and patient cost-sharing required, the report said. Since people in low-premium states might have to pay higher copayments and deductibles, the monthly prices don't necessarily reflect value, the analysts added.

Kids Safe With Cell Phones

Cell phones do not, after all, appear to increase brain tumors in children and adolescents who use the devices, according to a study published in the Journal of the National Cancer Institute. The multicenter case-control study was conducted in Denmark, Sweden, Norway, and Switzerland, and included 352 children aged 7-19 years diagnosed with brain tumors between 2004 and 2008. Some of the subjects had used cell phones for more than 5 years. “The absence of an exposure-response relationship either in terms of the amount of mobile phone use or by localization of the brain tumor argues against a causal association,” the authors said.

Multiple Sclerosis Is Costly

Certain multiple sclerosis therapies result in modest health benefits but come at significant cost to patients, according to a study published in Neurology. “Using DMT [disease-modifying therapies] for 10 years resulted in modest health gains … compared to treatment without DMT,” the authors reported. They looked at the costs and effects of three beta interferons (Avonex, Betaseron, and Rebif) and glatiramer acetate (Copaxone). The cost-effectiveness ratio of all four therapies “far exceeded” $800,000 per quality-adjusted life-year, the team reported. Using any of the therapies for 10 years offered patients only about one extra quality-adjusted month of life. “Use of DMT in MS results in health gains that come at a very high cost,” the researchers concluded.

Emergency Scanning Way Up

Use of computed tomography in emergency departments more than quadrupled between 1996 and 2007, according to study published in Annals of Emergency Medicine. The authors analyzed data from the National Hospital Ambulatory Medical Care Survey representing 1.29 billion emergency department encounters, indicating that 97.1 million patients (7.5%) underwent at least one CT scan during that period. While 3.2% of the patients received CT in 1996, 13.9% did by 2007. The authors noted that the increase has been associated with a decline in hospital admissions but that that effect has stabilized in recent years. CT scanning increased most among patients with chest pain, shortness of breath, abdominal pain, and flank pain, the authors reported. “Research on understanding how and under what conditions CT is being performed in the ED and developing better strategies for optimizing its use in this setting is needed,” they said.

Haiti Volunteers Needed

The American Academy of Neurology is seeking neurologists to volunteer to ease Haiti's physician shortage since the country's devastating earthquake last year. The academy is working with Operation Blessing International, which provides housing, meals, and in-country transportation to volunteers. In Haiti, “there continues to be a lack of medical care to support those affected by the earthquake and poverty overall,” Dr. Anthony G. Alessi, an academy fellow and longtime volunteer with Operation Blessing International, said in a statement. Volunteers will diagnose, treat, and manage conditions such as brain injuries, multiple sclerosis, and stroke, he said. To see trip dates and to volunteer, visit

www.ob.org/haitiprojects/volunteer.asp

Physicians Delay Retirement

Slightly more than half of physicians have changed their retirement plans since the Great Recession hit in 2008, and 70% say they'll need to work longer until retirement, according to a survey by staffing firm Jackson & Coker. Many of the doctors said they're pursuing ways to augment their income as a result. Most of those who have changed their plans had intended to retire within 6 years, and 46% blame depletion in their personal savings or unexpectedly poor growth in their nest eggs for delay. Nearly one-third of physicians postponing retirement said they will pursue locum tenens or part-time assignments, while about one-quarter said they'll continue to work for their current employers. About one-fifth said they intend to move to another position in the same field, and another fifth said they'll leave medicine and try a new career.

Kids Safe With Cell Phones

Cell phones do not, after all, appear to increase brain tumors in children and adolescents who use the devices, according to a study published in the Journal of the National Cancer Institute. The multicenter case-control study was conducted in Denmark, Sweden, Norway, and Switzerland, and included 352 children aged 7-19 years diagnosed with brain tumors between 2004 and 2008. Some of the subjects had used cell phones for more than 5 years. “The absence of an exposure-response relationship either in terms of the amount of mobile phone use or by localization of the brain tumor argues against a causal association,” the authors said.

Multiple Sclerosis Is Costly

Certain multiple sclerosis therapies result in modest health benefits but come at significant cost to patients, according to a study published in Neurology. “Using DMT [disease-modifying therapies] for 10 years resulted in modest health gains … compared to treatment without DMT,” the authors reported. They looked at the costs and effects of three beta interferons (Avonex, Betaseron, and Rebif) and glatiramer acetate (Copaxone). The cost-effectiveness ratio of all four therapies “far exceeded” $800,000 per quality-adjusted life-year, the team reported. Using any of the therapies for 10 years offered patients only about one extra quality-adjusted month of life. “Use of DMT in MS results in health gains that come at a very high cost,” the researchers concluded.

Emergency Scanning Way Up

Use of computed tomography in emergency departments more than quadrupled between 1996 and 2007, according to study published in Annals of Emergency Medicine. The authors analyzed data from the National Hospital Ambulatory Medical Care Survey representing 1.29 billion emergency department encounters, indicating that 97.1 million patients (7.5%) underwent at least one CT scan during that period. While 3.2% of the patients received CT in 1996, 13.9% did by 2007. The authors noted that the increase has been associated with a decline in hospital admissions but that that effect has stabilized in recent years. CT scanning increased most among patients with chest pain, shortness of breath, abdominal pain, and flank pain, the authors reported. “Research on understanding how and under what conditions CT is being performed in the ED and developing better strategies for optimizing its use in this setting is needed,” they said.

Haiti Volunteers Needed

The American Academy of Neurology is seeking neurologists to volunteer to ease Haiti's physician shortage since the country's devastating earthquake last year. The academy is working with Operation Blessing International, which provides housing, meals, and in-country transportation to volunteers. In Haiti, “there continues to be a lack of medical care to support those affected by the earthquake and poverty overall,” Dr. Anthony G. Alessi, an academy fellow and longtime volunteer with Operation Blessing International, said in a statement. Volunteers will diagnose, treat, and manage conditions such as brain injuries, multiple sclerosis, and stroke, he said. To see trip dates and to volunteer, visit

www.ob.org/haitiprojects/volunteer.asp

Physicians Delay Retirement

Slightly more than half of physicians have changed their retirement plans since the Great Recession hit in 2008, and 70% say they'll need to work longer until retirement, according to a survey by staffing firm Jackson & Coker. Many of the doctors said they're pursuing ways to augment their income as a result. Most of those who have changed their plans had intended to retire within 6 years, and 46% blame depletion in their personal savings or unexpectedly poor growth in their nest eggs for delay. Nearly one-third of physicians postponing retirement said they will pursue locum tenens or part-time assignments, while about one-quarter said they'll continue to work for their current employers. About one-fifth said they intend to move to another position in the same field, and another fifth said they'll leave medicine and try a new career.

Kids Safe With Cell Phones

Cell phones do not, after all, appear to increase brain tumors in children and adolescents who use the devices, according to a study published in the Journal of the National Cancer Institute. The multicenter case-control study was conducted in Denmark, Sweden, Norway, and Switzerland, and included 352 children aged 7-19 years diagnosed with brain tumors between 2004 and 2008. Some of the subjects had used cell phones for more than 5 years. “The absence of an exposure-response relationship either in terms of the amount of mobile phone use or by localization of the brain tumor argues against a causal association,” the authors said.

Multiple Sclerosis Is Costly

Certain multiple sclerosis therapies result in modest health benefits but come at significant cost to patients, according to a study published in Neurology. “Using DMT [disease-modifying therapies] for 10 years resulted in modest health gains … compared to treatment without DMT,” the authors reported. They looked at the costs and effects of three beta interferons (Avonex, Betaseron, and Rebif) and glatiramer acetate (Copaxone). The cost-effectiveness ratio of all four therapies “far exceeded” $800,000 per quality-adjusted life-year, the team reported. Using any of the therapies for 10 years offered patients only about one extra quality-adjusted month of life. “Use of DMT in MS results in health gains that come at a very high cost,” the researchers concluded.

Emergency Scanning Way Up

Use of computed tomography in emergency departments more than quadrupled between 1996 and 2007, according to study published in Annals of Emergency Medicine. The authors analyzed data from the National Hospital Ambulatory Medical Care Survey representing 1.29 billion emergency department encounters, indicating that 97.1 million patients (7.5%) underwent at least one CT scan during that period. While 3.2% of the patients received CT in 1996, 13.9% did by 2007. The authors noted that the increase has been associated with a decline in hospital admissions but that that effect has stabilized in recent years. CT scanning increased most among patients with chest pain, shortness of breath, abdominal pain, and flank pain, the authors reported. “Research on understanding how and under what conditions CT is being performed in the ED and developing better strategies for optimizing its use in this setting is needed,” they said.

Haiti Volunteers Needed

The American Academy of Neurology is seeking neurologists to volunteer to ease Haiti's physician shortage since the country's devastating earthquake last year. The academy is working with Operation Blessing International, which provides housing, meals, and in-country transportation to volunteers. In Haiti, “there continues to be a lack of medical care to support those affected by the earthquake and poverty overall,” Dr. Anthony G. Alessi, an academy fellow and longtime volunteer with Operation Blessing International, said in a statement. Volunteers will diagnose, treat, and manage conditions such as brain injuries, multiple sclerosis, and stroke, he said. To see trip dates and to volunteer, visit

www.ob.org/haitiprojects/volunteer.asp

Physicians Delay Retirement

Slightly more than half of physicians have changed their retirement plans since the Great Recession hit in 2008, and 70% say they'll need to work longer until retirement, according to a survey by staffing firm Jackson & Coker. Many of the doctors said they're pursuing ways to augment their income as a result. Most of those who have changed their plans had intended to retire within 6 years, and 46% blame depletion in their personal savings or unexpectedly poor growth in their nest eggs for delay. Nearly one-third of physicians postponing retirement said they will pursue locum tenens or part-time assignments, while about one-quarter said they'll continue to work for their current employers. About one-fifth said they intend to move to another position in the same field, and another fifth said they'll leave medicine and try a new career.

The prevalence of gout has been skyrocketing and there are not enough physicians including rheumatologists around to manage the patients.

An estimated 8.3 million American adults are diagnosed with gout, reflecting a 1.2% rise in the prevalence of the disease in the past 2 decades, according to the analyses of national data by researchers at Boston University (Arthritis Rheum. 2011 [doi: 10.1002/art.30520]).

What adds to the burden of this disease are the growing aging population and physician shortage. Studies have shown that there is a shortages of rheumatologists, whose numbers continue to decline as they age out of the system. And some worry that primary care physicians, who are also in short supply and care for more than 90% of gout patients, need more education.

© Vasilis Varsakelis/Fotolia.com

Speaking of the increased gout prevalence, one of the study authors, Dr. Hyon K. Choi, said "To me, it’s substantial. Four percent of the population having gout is not ignorable."

Western diets, sedentary lifestyle, hypertension, the obesity epidemic, and increased use of diuretics and aspirin have been among the culprits for this increase, Dr. Choi and his colleagues reported.

"We're not surprised by the [findings]," said Dr. Christopher M. Burns, a rheumatologist at Dartmouth Medical School, Lebanon, N.H., who was not involved in the study. "The trend has been going on for quite some time now. It's more of a national health issue, because it correlates well with the obesity epidemic."

Studies have suggested that gout is strongly associated with the metabolic syndrome and may lead to myocardial infarction, diabetes, and premature death, the authors noted.

Findings from some studies have shown the incidence of gout is also increasing worldwide. This has occurred despite stepped up prevention efforts: findings from other studies have shown there was an 80% increase in the use of serum urate-lowering or other gout medications during the 1990s (J. Rheumatol. 2004;31:1582-7).

As for the physician shortage, "the relative loss of rheumatologists may make the overall care of gout patients worse unless we do a better job of educating our primary care colleagues about new diagnostic and therapeutic guidelines," said Dr. N. Lawrence Edwards, professor of medicine at the University of Florida, Gainesville.

Previous analyses of national data have documented the steady rise in the prevalence of gout since the 1960s. (Arthritis Rheum. 2008;58:26-35). Researchers suspected a continued rise since the most recent gout estimates from the 1988-1994 National Health and Nutrition Examination Survey III (Am. J. Kidney Dis. 2002;40:37-42).

To estimate the prevalence in the new millennium, they analyzed data from the Centers for Disease Control and Prevention’s 2007-2008 NHANES. They compared data from the 18,825 participants in NHANES III with 5,707 participants in NHANES, all of whom were at least 20 years old. They also analyzed the prevalence of hyperuricemia and the serum urate levels. The average age of participants was 47 years old, made up of 48% men and 69% women.

Results showed that the prevalence of gout, hyperuricemia, and high serum urate levels all significantly increased during the past 2 decades.

The prevalence of gout increased from 2.7% in NHANES III to 3.9% in NHANES (a 44% relative risk increase). The prevalence of hyperuricemia increased by 3.2%, affecting 43.3 million (21.4%) adults. (For more hyperuricemia and serum urate levels, see sidebar.)

Gout prevalence also increased by age, with people aged 20-29 years at 0.4% and those in the population aged 80 years and older at 12.6%. Prevalence among the Medicare population (65 years and older) was 9.8%.

To calculate the impact of risk factors, researcher conducted stepwise adjustments for body mass index and hypertension, which reduced the odds ratio to 1.21, and additional adjustment for diuretic use and alcohol further attenuated the association.

"Most of the [prevalence] increase falls out when you correct for BMI and hypertension," said Dr. Burns. "It's a major health issue in the country. And it’s not just gout, but also hyperuricemia."

The rising prevalence of gout in the elderly population is also of particular concern, said Dr. Choi. The study estimates that 1 in 10 men and 1 in 20 women 60 years and older have gout.

Dr. John W. Rachow, a geriatrician and rheumatologist who works with nursing home patients, said that in his 30-year career, he has seen a steady rise in the number of gout patients. "Morbid obesity in nursing homes is higher than when I started," said Dr. Rachow of the University of Iowa, Iowa City.

Given the rising rates of obesity and hypertension, Dr. Choi and other rheumatologists stressed the importance of taking a holistic approach to treating patients with gout and hyperuricemia, starting with preventive measures.

Dr. Edwards said that "Physicians should all be more aggressive in how we coach patients on weight reduction and other lifestyle modifications including exercise. We should be routinely monitoring serum urates in at-risk patients so that we can review the nonpharmacologic approaches to urate lowering and management of their comorbid diseases."

Dr. Choi and his associates recommend avoidance of heavy drinking, "while moderate drinking, sweet fruits, and seafood intake (particularly oily fish) should be tailored to the individual, considering their anticipated health benefits against cardiovascular disease." They added that coffee and vitamin C supplementation may be long-term preventive measures that can lower urate levels and reduce the risk of gout and associated comorbidities.

There remain unmet challenges.

Dr. Burns noted that "It’s easy to treat people for what they come to you for. The problem is getting people to change their lifestyle," especially for those who have arthritis for whom exercising is not easy.

Meanwhile, the increase in the number of gout patients, majority of whom are cared for by primary care physicians, raises some concerns among rheumatologists.

Dr. Maria Saurez-Almazor noted that the challenge for primary care is the management of more complex patients, particularly with the advent of new therapies with which they may not be familiar," said, head of rheumatology at the University of Texas M.D. Anderson Cancer Center. The solution? "Education, education, education," she said. "For physicians to treat hyperuricemia to target, often this goal is not pursued aggressively. For patients, understanding the role of lifestyle modifications, and the importance of adherence to therapy (non-adherence is very high in this population) is crucial."

The study has some limitations, Dr. Choi and his colleagues reported.

"Unlike estimates of serum urate levels that are based on objective measures, gout prevalence estimates in the NHANES studies are based on self-reports and are thus likely inflated, similar to other condition estimates based on the NHANES. On the other hand, we cannot rule out the possibility that the survey might have missed gout cases that have not been diagnosed by health care professionals," the authors wrote.

Dr. Choi predicted that the prevalence of gout has been rising since the NHANES data was collected. The next step, he said, "is to work on preventive strategies that now have been shown to be effective by multiple studies. So manipulation of these factors should be more aggressively implemented rather than ignored. Improvement in managing these factors can help slow down the escalation."

Dr. Choi has received research funding for other projects from Takeda Pharmaceuticals and has served on advisory boards for Takeda. The study was supported by Takeda Pharmaceuticals International Inc. Other physicians quoted had no relevant disclosures.

The prevalence of gout has been skyrocketing and there are not enough physicians including rheumatologists around to manage the patients.

An estimated 8.3 million American adults are diagnosed with gout, reflecting a 1.2% rise in the prevalence of the disease in the past 2 decades, according to the analyses of national data by researchers at Boston University (Arthritis Rheum. 2011 [doi: 10.1002/art.30520]).

What adds to the burden of this disease are the growing aging population and physician shortage. Studies have shown that there is a shortages of rheumatologists, whose numbers continue to decline as they age out of the system. And some worry that primary care physicians, who are also in short supply and care for more than 90% of gout patients, need more education.

© Vasilis Varsakelis/Fotolia.com

Speaking of the increased gout prevalence, one of the study authors, Dr. Hyon K. Choi, said "To me, it’s substantial. Four percent of the population having gout is not ignorable."

Western diets, sedentary lifestyle, hypertension, the obesity epidemic, and increased use of diuretics and aspirin have been among the culprits for this increase, Dr. Choi and his colleagues reported.

"We're not surprised by the [findings]," said Dr. Christopher M. Burns, a rheumatologist at Dartmouth Medical School, Lebanon, N.H., who was not involved in the study. "The trend has been going on for quite some time now. It's more of a national health issue, because it correlates well with the obesity epidemic."

Studies have suggested that gout is strongly associated with the metabolic syndrome and may lead to myocardial infarction, diabetes, and premature death, the authors noted.

Findings from some studies have shown the incidence of gout is also increasing worldwide. This has occurred despite stepped up prevention efforts: findings from other studies have shown there was an 80% increase in the use of serum urate-lowering or other gout medications during the 1990s (J. Rheumatol. 2004;31:1582-7).

As for the physician shortage, "the relative loss of rheumatologists may make the overall care of gout patients worse unless we do a better job of educating our primary care colleagues about new diagnostic and therapeutic guidelines," said Dr. N. Lawrence Edwards, professor of medicine at the University of Florida, Gainesville.

Previous analyses of national data have documented the steady rise in the prevalence of gout since the 1960s. (Arthritis Rheum. 2008;58:26-35). Researchers suspected a continued rise since the most recent gout estimates from the 1988-1994 National Health and Nutrition Examination Survey III (Am. J. Kidney Dis. 2002;40:37-42).

To estimate the prevalence in the new millennium, they analyzed data from the Centers for Disease Control and Prevention’s 2007-2008 NHANES. They compared data from the 18,825 participants in NHANES III with 5,707 participants in NHANES, all of whom were at least 20 years old. They also analyzed the prevalence of hyperuricemia and the serum urate levels. The average age of participants was 47 years old, made up of 48% men and 69% women.

Results showed that the prevalence of gout, hyperuricemia, and high serum urate levels all significantly increased during the past 2 decades.

The prevalence of gout increased from 2.7% in NHANES III to 3.9% in NHANES (a 44% relative risk increase). The prevalence of hyperuricemia increased by 3.2%, affecting 43.3 million (21.4%) adults. (For more hyperuricemia and serum urate levels, see sidebar.)

Gout prevalence also increased by age, with people aged 20-29 years at 0.4% and those in the population aged 80 years and older at 12.6%. Prevalence among the Medicare population (65 years and older) was 9.8%.

To calculate the impact of risk factors, researcher conducted stepwise adjustments for body mass index and hypertension, which reduced the odds ratio to 1.21, and additional adjustment for diuretic use and alcohol further attenuated the association.

"Most of the [prevalence] increase falls out when you correct for BMI and hypertension," said Dr. Burns. "It's a major health issue in the country. And it’s not just gout, but also hyperuricemia."

The rising prevalence of gout in the elderly population is also of particular concern, said Dr. Choi. The study estimates that 1 in 10 men and 1 in 20 women 60 years and older have gout.

Dr. John W. Rachow, a geriatrician and rheumatologist who works with nursing home patients, said that in his 30-year career, he has seen a steady rise in the number of gout patients. "Morbid obesity in nursing homes is higher than when I started," said Dr. Rachow of the University of Iowa, Iowa City.

Given the rising rates of obesity and hypertension, Dr. Choi and other rheumatologists stressed the importance of taking a holistic approach to treating patients with gout and hyperuricemia, starting with preventive measures.

Dr. Edwards said that "Physicians should all be more aggressive in how we coach patients on weight reduction and other lifestyle modifications including exercise. We should be routinely monitoring serum urates in at-risk patients so that we can review the nonpharmacologic approaches to urate lowering and management of their comorbid diseases."

Dr. Choi and his associates recommend avoidance of heavy drinking, "while moderate drinking, sweet fruits, and seafood intake (particularly oily fish) should be tailored to the individual, considering their anticipated health benefits against cardiovascular disease." They added that coffee and vitamin C supplementation may be long-term preventive measures that can lower urate levels and reduce the risk of gout and associated comorbidities.

There remain unmet challenges.

Dr. Burns noted that "It’s easy to treat people for what they come to you for. The problem is getting people to change their lifestyle," especially for those who have arthritis for whom exercising is not easy.

Meanwhile, the increase in the number of gout patients, majority of whom are cared for by primary care physicians, raises some concerns among rheumatologists.

Dr. Maria Saurez-Almazor noted that the challenge for primary care is the management of more complex patients, particularly with the advent of new therapies with which they may not be familiar," said, head of rheumatology at the University of Texas M.D. Anderson Cancer Center. The solution? "Education, education, education," she said. "For physicians to treat hyperuricemia to target, often this goal is not pursued aggressively. For patients, understanding the role of lifestyle modifications, and the importance of adherence to therapy (non-adherence is very high in this population) is crucial."

The study has some limitations, Dr. Choi and his colleagues reported.

"Unlike estimates of serum urate levels that are based on objective measures, gout prevalence estimates in the NHANES studies are based on self-reports and are thus likely inflated, similar to other condition estimates based on the NHANES. On the other hand, we cannot rule out the possibility that the survey might have missed gout cases that have not been diagnosed by health care professionals," the authors wrote.

Dr. Choi predicted that the prevalence of gout has been rising since the NHANES data was collected. The next step, he said, "is to work on preventive strategies that now have been shown to be effective by multiple studies. So manipulation of these factors should be more aggressively implemented rather than ignored. Improvement in managing these factors can help slow down the escalation."

Dr. Choi has received research funding for other projects from Takeda Pharmaceuticals and has served on advisory boards for Takeda. The study was supported by Takeda Pharmaceuticals International Inc. Other physicians quoted had no relevant disclosures.

The prevalence of gout has been skyrocketing and there are not enough physicians including rheumatologists around to manage the patients.

An estimated 8.3 million American adults are diagnosed with gout, reflecting a 1.2% rise in the prevalence of the disease in the past 2 decades, according to the analyses of national data by researchers at Boston University (Arthritis Rheum. 2011 [doi: 10.1002/art.30520]).

What adds to the burden of this disease are the growing aging population and physician shortage. Studies have shown that there is a shortages of rheumatologists, whose numbers continue to decline as they age out of the system. And some worry that primary care physicians, who are also in short supply and care for more than 90% of gout patients, need more education.

© Vasilis Varsakelis/Fotolia.com

Speaking of the increased gout prevalence, one of the study authors, Dr. Hyon K. Choi, said "To me, it’s substantial. Four percent of the population having gout is not ignorable."

Western diets, sedentary lifestyle, hypertension, the obesity epidemic, and increased use of diuretics and aspirin have been among the culprits for this increase, Dr. Choi and his colleagues reported.

"We're not surprised by the [findings]," said Dr. Christopher M. Burns, a rheumatologist at Dartmouth Medical School, Lebanon, N.H., who was not involved in the study. "The trend has been going on for quite some time now. It's more of a national health issue, because it correlates well with the obesity epidemic."

Studies have suggested that gout is strongly associated with the metabolic syndrome and may lead to myocardial infarction, diabetes, and premature death, the authors noted.

Findings from some studies have shown the incidence of gout is also increasing worldwide. This has occurred despite stepped up prevention efforts: findings from other studies have shown there was an 80% increase in the use of serum urate-lowering or other gout medications during the 1990s (J. Rheumatol. 2004;31:1582-7).

As for the physician shortage, "the relative loss of rheumatologists may make the overall care of gout patients worse unless we do a better job of educating our primary care colleagues about new diagnostic and therapeutic guidelines," said Dr. N. Lawrence Edwards, professor of medicine at the University of Florida, Gainesville.

Previous analyses of national data have documented the steady rise in the prevalence of gout since the 1960s. (Arthritis Rheum. 2008;58:26-35). Researchers suspected a continued rise since the most recent gout estimates from the 1988-1994 National Health and Nutrition Examination Survey III (Am. J. Kidney Dis. 2002;40:37-42).

To estimate the prevalence in the new millennium, they analyzed data from the Centers for Disease Control and Prevention’s 2007-2008 NHANES. They compared data from the 18,825 participants in NHANES III with 5,707 participants in NHANES, all of whom were at least 20 years old. They also analyzed the prevalence of hyperuricemia and the serum urate levels. The average age of participants was 47 years old, made up of 48% men and 69% women.

Results showed that the prevalence of gout, hyperuricemia, and high serum urate levels all significantly increased during the past 2 decades.

The prevalence of gout increased from 2.7% in NHANES III to 3.9% in NHANES (a 44% relative risk increase). The prevalence of hyperuricemia increased by 3.2%, affecting 43.3 million (21.4%) adults. (For more hyperuricemia and serum urate levels, see sidebar.)

Gout prevalence also increased by age, with people aged 20-29 years at 0.4% and those in the population aged 80 years and older at 12.6%. Prevalence among the Medicare population (65 years and older) was 9.8%.

To calculate the impact of risk factors, researcher conducted stepwise adjustments for body mass index and hypertension, which reduced the odds ratio to 1.21, and additional adjustment for diuretic use and alcohol further attenuated the association.

"Most of the [prevalence] increase falls out when you correct for BMI and hypertension," said Dr. Burns. "It's a major health issue in the country. And it’s not just gout, but also hyperuricemia."

The rising prevalence of gout in the elderly population is also of particular concern, said Dr. Choi. The study estimates that 1 in 10 men and 1 in 20 women 60 years and older have gout.

Dr. John W. Rachow, a geriatrician and rheumatologist who works with nursing home patients, said that in his 30-year career, he has seen a steady rise in the number of gout patients. "Morbid obesity in nursing homes is higher than when I started," said Dr. Rachow of the University of Iowa, Iowa City.

Given the rising rates of obesity and hypertension, Dr. Choi and other rheumatologists stressed the importance of taking a holistic approach to treating patients with gout and hyperuricemia, starting with preventive measures.

Dr. Edwards said that "Physicians should all be more aggressive in how we coach patients on weight reduction and other lifestyle modifications including exercise. We should be routinely monitoring serum urates in at-risk patients so that we can review the nonpharmacologic approaches to urate lowering and management of their comorbid diseases."

Dr. Choi and his associates recommend avoidance of heavy drinking, "while moderate drinking, sweet fruits, and seafood intake (particularly oily fish) should be tailored to the individual, considering their anticipated health benefits against cardiovascular disease." They added that coffee and vitamin C supplementation may be long-term preventive measures that can lower urate levels and reduce the risk of gout and associated comorbidities.

There remain unmet challenges.

Dr. Burns noted that "It’s easy to treat people for what they come to you for. The problem is getting people to change their lifestyle," especially for those who have arthritis for whom exercising is not easy.

Meanwhile, the increase in the number of gout patients, majority of whom are cared for by primary care physicians, raises some concerns among rheumatologists.

Dr. Maria Saurez-Almazor noted that the challenge for primary care is the management of more complex patients, particularly with the advent of new therapies with which they may not be familiar," said, head of rheumatology at the University of Texas M.D. Anderson Cancer Center. The solution? "Education, education, education," she said. "For physicians to treat hyperuricemia to target, often this goal is not pursued aggressively. For patients, understanding the role of lifestyle modifications, and the importance of adherence to therapy (non-adherence is very high in this population) is crucial."

The study has some limitations, Dr. Choi and his colleagues reported.

"Unlike estimates of serum urate levels that are based on objective measures, gout prevalence estimates in the NHANES studies are based on self-reports and are thus likely inflated, similar to other condition estimates based on the NHANES. On the other hand, we cannot rule out the possibility that the survey might have missed gout cases that have not been diagnosed by health care professionals," the authors wrote.

Dr. Choi predicted that the prevalence of gout has been rising since the NHANES data was collected. The next step, he said, "is to work on preventive strategies that now have been shown to be effective by multiple studies. So manipulation of these factors should be more aggressively implemented rather than ignored. Improvement in managing these factors can help slow down the escalation."

Dr. Choi has received research funding for other projects from Takeda Pharmaceuticals and has served on advisory boards for Takeda. The study was supported by Takeda Pharmaceuticals International Inc. Other physicians quoted had no relevant disclosures.

Mexican-Americans at Risk

About half of 1,787 Mexican American adults, surveyed because they were obese, reported never receiving advice from a health care provider to eat less fatty food (52% informed) or exercise more (45% informed). “Given the seriousness of obesity-related health risks and the increasing prevalence of overweight status and obesity among Mexican Americans, it is vital that providers are involved in finding ways to effectively educate and/or treat overweight patients,” the authors wrote in the American Journal of Health Promotions. The survey showed that men, respondents with little education, those who preferred to speak Spanish at home, and nonmarried respondents were least likely to receive advice on exercise and diet. Respondents with comorbidities were more likely than others to have gotten diet and exercise advice (79% vs. 43%).

New Drug Reviews Expected

The largest pharmaceutical company in Japan, Takeda Pharmaceuticals, has resubmitted applications for two type 2 diabetes drugs to the U.S. Food and Drug Administration. The FDA is expected to review the drugs within the next 6 months, according to the company. The applications are for alogliptin and a combination of alogliptin and pioglitazone. Both therapies are for adults and intended as adjuncts to diet and exercise. Interim results from a study of possible cardiovascular risks from alogliptin, a selective dipeptidyl peptidase IV inhibitor (DPP-4i), should satisfy FDA concerns in that area, said Dr. David Recker, a senior vice president for research and development at Takeda, in a company news release. “If approved, alogliptin/pioglitazone will be the first type 2 diabetes treatment option in the U.S. to include both a DPP-4 inhibitor and a thiazolidinedione in a single tablet,” he added. Alogliptin was rejected by the FDA in 2009, which asked for more data on its cardiovascular effects.

Managers Face Challenges

Managers of group practices say that preparing for risk-based reimbursement and implementing electronic health records are their biggest challenges, according to a survey from the Medical Group Management Association. Dealing with rising operating costs and implementing an accountable care organization or a patient-centered medical home are also significant challenges, according to the MGMA survey. Electronic health records and other technologies are increasingly problematic, said MGMA President and CEO William Jessee. “The pressure to adopt technology and the morass our members face in determining the best systems for their practices, and then complying with the various government programs to receive incentives and avoid penalties, are proving to be of particular concern,” he said in a statement.

Food Makers Pan Guidelines

Food manufacturers charged that voluntary guidelines proposed by the federal government ignore the industry's progress on responsible marketing of food to children. The proposal from the Federal Trade Commission says that only foods that contribute to a healthful diet should be marketed to children and offers targets for saturated fat, trans fat, added sugars, and sodium in such food. In a letter to the FTC, the FDA, and other agencies, 150 state, regional, and national food groups and manufacturers argue that there's no evidence the proposed restrictions would contribute to long-term changes in eating behavior or solve childhood obesity. Separately, the National Restaurant Association called for the voluntary standards to be withdrawn because they could become mandatory.

FDA May Change Consumer Ads

The FDA is considering changing how it regulates direct-to-consumer drug ads to reflect results of agency studies of how patients perceive and recall ad information. hhe research found that people better understood the “brief summary” section of prescription drug ads that are presented in a format similar to the simpler labels on over-the-counter drugs. Prescription drug ads use densely packed, small-type paragraphs to describe risks. The studies also found that noting a serious risk or providing extra details on side effects didn't hinder consumers' understanding of overall risk information.

Mexican-Americans at Risk

About half of 1,787 Mexican American adults, surveyed because they were obese, reported never receiving advice from a health care provider to eat less fatty food (52% informed) or exercise more (45% informed). “Given the seriousness of obesity-related health risks and the increasing prevalence of overweight status and obesity among Mexican Americans, it is vital that providers are involved in finding ways to effectively educate and/or treat overweight patients,” the authors wrote in the American Journal of Health Promotions. The survey showed that men, respondents with little education, those who preferred to speak Spanish at home, and nonmarried respondents were least likely to receive advice on exercise and diet. Respondents with comorbidities were more likely than others to have gotten diet and exercise advice (79% vs. 43%).

New Drug Reviews Expected

The largest pharmaceutical company in Japan, Takeda Pharmaceuticals, has resubmitted applications for two type 2 diabetes drugs to the U.S. Food and Drug Administration. The FDA is expected to review the drugs within the next 6 months, according to the company. The applications are for alogliptin and a combination of alogliptin and pioglitazone. Both therapies are for adults and intended as adjuncts to diet and exercise. Interim results from a study of possible cardiovascular risks from alogliptin, a selective dipeptidyl peptidase IV inhibitor (DPP-4i), should satisfy FDA concerns in that area, said Dr. David Recker, a senior vice president for research and development at Takeda, in a company news release. “If approved, alogliptin/pioglitazone will be the first type 2 diabetes treatment option in the U.S. to include both a DPP-4 inhibitor and a thiazolidinedione in a single tablet,” he added. Alogliptin was rejected by the FDA in 2009, which asked for more data on its cardiovascular effects.

Managers Face Challenges

Managers of group practices say that preparing for risk-based reimbursement and implementing electronic health records are their biggest challenges, according to a survey from the Medical Group Management Association. Dealing with rising operating costs and implementing an accountable care organization or a patient-centered medical home are also significant challenges, according to the MGMA survey. Electronic health records and other technologies are increasingly problematic, said MGMA President and CEO William Jessee. “The pressure to adopt technology and the morass our members face in determining the best systems for their practices, and then complying with the various government programs to receive incentives and avoid penalties, are proving to be of particular concern,” he said in a statement.

Food Makers Pan Guidelines

Food manufacturers charged that voluntary guidelines proposed by the federal government ignore the industry's progress on responsible marketing of food to children. The proposal from the Federal Trade Commission says that only foods that contribute to a healthful diet should be marketed to children and offers targets for saturated fat, trans fat, added sugars, and sodium in such food. In a letter to the FTC, the FDA, and other agencies, 150 state, regional, and national food groups and manufacturers argue that there's no evidence the proposed restrictions would contribute to long-term changes in eating behavior or solve childhood obesity. Separately, the National Restaurant Association called for the voluntary standards to be withdrawn because they could become mandatory.

FDA May Change Consumer Ads

The FDA is considering changing how it regulates direct-to-consumer drug ads to reflect results of agency studies of how patients perceive and recall ad information. hhe research found that people better understood the “brief summary” section of prescription drug ads that are presented in a format similar to the simpler labels on over-the-counter drugs. Prescription drug ads use densely packed, small-type paragraphs to describe risks. The studies also found that noting a serious risk or providing extra details on side effects didn't hinder consumers' understanding of overall risk information.

Mexican-Americans at Risk

About half of 1,787 Mexican American adults, surveyed because they were obese, reported never receiving advice from a health care provider to eat less fatty food (52% informed) or exercise more (45% informed). “Given the seriousness of obesity-related health risks and the increasing prevalence of overweight status and obesity among Mexican Americans, it is vital that providers are involved in finding ways to effectively educate and/or treat overweight patients,” the authors wrote in the American Journal of Health Promotions. The survey showed that men, respondents with little education, those who preferred to speak Spanish at home, and nonmarried respondents were least likely to receive advice on exercise and diet. Respondents with comorbidities were more likely than others to have gotten diet and exercise advice (79% vs. 43%).

New Drug Reviews Expected

The largest pharmaceutical company in Japan, Takeda Pharmaceuticals, has resubmitted applications for two type 2 diabetes drugs to the U.S. Food and Drug Administration. The FDA is expected to review the drugs within the next 6 months, according to the company. The applications are for alogliptin and a combination of alogliptin and pioglitazone. Both therapies are for adults and intended as adjuncts to diet and exercise. Interim results from a study of possible cardiovascular risks from alogliptin, a selective dipeptidyl peptidase IV inhibitor (DPP-4i), should satisfy FDA concerns in that area, said Dr. David Recker, a senior vice president for research and development at Takeda, in a company news release. “If approved, alogliptin/pioglitazone will be the first type 2 diabetes treatment option in the U.S. to include both a DPP-4 inhibitor and a thiazolidinedione in a single tablet,” he added. Alogliptin was rejected by the FDA in 2009, which asked for more data on its cardiovascular effects.

Managers Face Challenges

Managers of group practices say that preparing for risk-based reimbursement and implementing electronic health records are their biggest challenges, according to a survey from the Medical Group Management Association. Dealing with rising operating costs and implementing an accountable care organization or a patient-centered medical home are also significant challenges, according to the MGMA survey. Electronic health records and other technologies are increasingly problematic, said MGMA President and CEO William Jessee. “The pressure to adopt technology and the morass our members face in determining the best systems for their practices, and then complying with the various government programs to receive incentives and avoid penalties, are proving to be of particular concern,” he said in a statement.

Food Makers Pan Guidelines

Food manufacturers charged that voluntary guidelines proposed by the federal government ignore the industry's progress on responsible marketing of food to children. The proposal from the Federal Trade Commission says that only foods that contribute to a healthful diet should be marketed to children and offers targets for saturated fat, trans fat, added sugars, and sodium in such food. In a letter to the FTC, the FDA, and other agencies, 150 state, regional, and national food groups and manufacturers argue that there's no evidence the proposed restrictions would contribute to long-term changes in eating behavior or solve childhood obesity. Separately, the National Restaurant Association called for the voluntary standards to be withdrawn because they could become mandatory.

FDA May Change Consumer Ads

The FDA is considering changing how it regulates direct-to-consumer drug ads to reflect results of agency studies of how patients perceive and recall ad information. hhe research found that people better understood the “brief summary” section of prescription drug ads that are presented in a format similar to the simpler labels on over-the-counter drugs. Prescription drug ads use densely packed, small-type paragraphs to describe risks. The studies also found that noting a serious risk or providing extra details on side effects didn't hinder consumers' understanding of overall risk information.

Major Finding: Medicare Part D reduced nondrug medical spending for beneficiaries who had limited drug coverage prior to enrolling in the federal prescription drug plan by 10.6%.

Data Source: Data from the Health and Retirement Study survey linked with Medicare claims from 2004 to 2007.

Disclosures: The authors had no conflicts of interest to disclose. The study was supported by grants from several charitable foundations.

Medicare Part D coverage significantly reduced nondrug medical spending for beneficiaries who had limited drug coverage prior to the start of the federal prescription drug plan, Harvard Medical School researchers reported in JAMA.

The 10.6% savings was mostly due to a decrease in spending on acute and postacute care under Medicare Part A (JAMA 2011;306:402-9).

“These reductions in nondrug medical spending suggest that Part D has not cost as much as what we initially thought,” Dr. J. Michael McWilliams, the study's lead author, said in an interview.

The findings could also lend support to the Affordable Care Act's goal of closing the “doughnut hole,” the gap in drug coverage under Part D, he added. “The cost of closing the doughnut hole could be less than what we might expect because of these partially offsetting reductions in spending on nondrug medical care.”

The results also highlight a need for better coordination between all parts of Medicare, the investigators wrote.

“Even though Part D plans function completely separately from Part A and Part B of the Medicare program, and even though they have no financial incentive to lower copayments, particularly for beneficial medications, clearly providing this benefit to seniors through stand-alone Part D plans has been quite effective,” Dr. McWilliams said.

The authors used data from the Health and Retirement Study and linked it to Medicare claims data from 2004 to 2007 on 6,001 beneficiaries, then categorized the beneficiaries as having had generous (2,538) and limited (3,463) drug coverage prior to implementation of Part D. Nontraditional Medicare beneficiaries, such as those who qualified for Medicare before age 65 or those with veterans' health benefits, were excluded.

For the control cohort, they selected a similar group of 5,988 beneficiaries who had generous (2,537) and limited (3,451) drug coverage in 2002. They studied the group up to 2005.

The investigators found that total nondrug medical spending before Part D implementation was not significantly higher for beneficiaries with limited drug coverage compared with those who had generous drug coverage (7.6% relative difference).

However, after implementation of Part D, nondrug medical spending for beneficiaries who previously had limited drug coverage was 3.9% lower than for those who previously had generous drug coverage, leading to a significant differential reduction of 10.6%.

In dollars, Medicare spent nearly $306 per quarter less than expected on beneficiaries who previously had a limited drug coverage.

“The economic and clinical benefits suggested by these reductions may be enhanced by further expansions in prescription drug coverage for seniors, improvements in benefit designs for drug-sensitive conditions, and policies that integrate Medicare payment and delivery systems across drug and nondrug services,” Dr. McWilliams and his coauthors wrote.

Major Finding: Medicare Part D reduced nondrug medical spending for beneficiaries who had limited drug coverage prior to enrolling in the federal prescription drug plan by 10.6%.

Data Source: Data from the Health and Retirement Study survey linked with Medicare claims from 2004 to 2007.

Disclosures: The authors had no conflicts of interest to disclose. The study was supported by grants from several charitable foundations.

Medicare Part D coverage significantly reduced nondrug medical spending for beneficiaries who had limited drug coverage prior to the start of the federal prescription drug plan, Harvard Medical School researchers reported in JAMA.

The 10.6% savings was mostly due to a decrease in spending on acute and postacute care under Medicare Part A (JAMA 2011;306:402-9).

“These reductions in nondrug medical spending suggest that Part D has not cost as much as what we initially thought,” Dr. J. Michael McWilliams, the study's lead author, said in an interview.

The findings could also lend support to the Affordable Care Act's goal of closing the “doughnut hole,” the gap in drug coverage under Part D, he added. “The cost of closing the doughnut hole could be less than what we might expect because of these partially offsetting reductions in spending on nondrug medical care.”

The results also highlight a need for better coordination between all parts of Medicare, the investigators wrote.

“Even though Part D plans function completely separately from Part A and Part B of the Medicare program, and even though they have no financial incentive to lower copayments, particularly for beneficial medications, clearly providing this benefit to seniors through stand-alone Part D plans has been quite effective,” Dr. McWilliams said.

The authors used data from the Health and Retirement Study and linked it to Medicare claims data from 2004 to 2007 on 6,001 beneficiaries, then categorized the beneficiaries as having had generous (2,538) and limited (3,463) drug coverage prior to implementation of Part D. Nontraditional Medicare beneficiaries, such as those who qualified for Medicare before age 65 or those with veterans' health benefits, were excluded.

For the control cohort, they selected a similar group of 5,988 beneficiaries who had generous (2,537) and limited (3,451) drug coverage in 2002. They studied the group up to 2005.

The investigators found that total nondrug medical spending before Part D implementation was not significantly higher for beneficiaries with limited drug coverage compared with those who had generous drug coverage (7.6% relative difference).

However, after implementation of Part D, nondrug medical spending for beneficiaries who previously had limited drug coverage was 3.9% lower than for those who previously had generous drug coverage, leading to a significant differential reduction of 10.6%.

In dollars, Medicare spent nearly $306 per quarter less than expected on beneficiaries who previously had a limited drug coverage.

“The economic and clinical benefits suggested by these reductions may be enhanced by further expansions in prescription drug coverage for seniors, improvements in benefit designs for drug-sensitive conditions, and policies that integrate Medicare payment and delivery systems across drug and nondrug services,” Dr. McWilliams and his coauthors wrote.

Major Finding: Medicare Part D reduced nondrug medical spending for beneficiaries who had limited drug coverage prior to enrolling in the federal prescription drug plan by 10.6%.

Data Source: Data from the Health and Retirement Study survey linked with Medicare claims from 2004 to 2007.

Disclosures: The authors had no conflicts of interest to disclose. The study was supported by grants from several charitable foundations.

Medicare Part D coverage significantly reduced nondrug medical spending for beneficiaries who had limited drug coverage prior to the start of the federal prescription drug plan, Harvard Medical School researchers reported in JAMA.

The 10.6% savings was mostly due to a decrease in spending on acute and postacute care under Medicare Part A (JAMA 2011;306:402-9).

“These reductions in nondrug medical spending suggest that Part D has not cost as much as what we initially thought,” Dr. J. Michael McWilliams, the study's lead author, said in an interview.

The findings could also lend support to the Affordable Care Act's goal of closing the “doughnut hole,” the gap in drug coverage under Part D, he added. “The cost of closing the doughnut hole could be less than what we might expect because of these partially offsetting reductions in spending on nondrug medical care.”

The results also highlight a need for better coordination between all parts of Medicare, the investigators wrote.

“Even though Part D plans function completely separately from Part A and Part B of the Medicare program, and even though they have no financial incentive to lower copayments, particularly for beneficial medications, clearly providing this benefit to seniors through stand-alone Part D plans has been quite effective,” Dr. McWilliams said.

The authors used data from the Health and Retirement Study and linked it to Medicare claims data from 2004 to 2007 on 6,001 beneficiaries, then categorized the beneficiaries as having had generous (2,538) and limited (3,463) drug coverage prior to implementation of Part D. Nontraditional Medicare beneficiaries, such as those who qualified for Medicare before age 65 or those with veterans' health benefits, were excluded.

For the control cohort, they selected a similar group of 5,988 beneficiaries who had generous (2,537) and limited (3,451) drug coverage in 2002. They studied the group up to 2005.

The investigators found that total nondrug medical spending before Part D implementation was not significantly higher for beneficiaries with limited drug coverage compared with those who had generous drug coverage (7.6% relative difference).

However, after implementation of Part D, nondrug medical spending for beneficiaries who previously had limited drug coverage was 3.9% lower than for those who previously had generous drug coverage, leading to a significant differential reduction of 10.6%.

In dollars, Medicare spent nearly $306 per quarter less than expected on beneficiaries who previously had a limited drug coverage.

“The economic and clinical benefits suggested by these reductions may be enhanced by further expansions in prescription drug coverage for seniors, improvements in benefit designs for drug-sensitive conditions, and policies that integrate Medicare payment and delivery systems across drug and nondrug services,” Dr. McWilliams and his coauthors wrote.

WASHINGTON – In very obese women, treatment of menorrhagia with levonorgestrel intrauterine system may be slightly less effective, but the treatment's success rate justifies its use, according to a study conducted by researchers at the University of Michigan.

In addition, levonorgestrel intrauterine system (LNG-IUS) “may be an especially important treatment choice for women at high surgical risk,” the authors reported.

Although studies have shown the effectiveness of LNG-IUS in treatment of menorrhagia, most have not considered the role of body mass index (BMI), said Ms. Paige C. Fairchild, a medical student at the university who presented the study at the meeting.

The team conducted a retrospective chart review of 398 women with menorrhagia who were treated with LNG-IUS between 1999 and 2009 within the University of Michigan Health System, Ann Arbor. Nearly 50% had BMI of 30 kg/m

Also, removal of LNG-IUS because of continued menorrhagia was more common among women who had BMI greater than 34, compared with those in all BMI groups (6.9% vs. 4.1%).

The odds of surgery within 2 years of LNG-IUS removal also was higher in obese patients (2.6 times), compared with other groups.

Some factors that might contribute to the reduced effectiveness of LNG-IUS in obese women are a larger uterus, persistent unopposed estrogen endometrial stimulation, and poor placement/difficulty in achieving fundal placement, Dr. Vanessa Dalton of the departments of obstetrics and gynecology at the university and one of the study authors, said in an interview.

Despite the findings, the authors concluded that the high continuation rates of LNG-IUS and low surgery rates indicate that the treatment is still a good option for women with a high BMI.

Ms. Fairchild and Dr. Dalton had no relevant financial disclosures.

WASHINGTON – In very obese women, treatment of menorrhagia with levonorgestrel intrauterine system may be slightly less effective, but the treatment's success rate justifies its use, according to a study conducted by researchers at the University of Michigan.

In addition, levonorgestrel intrauterine system (LNG-IUS) “may be an especially important treatment choice for women at high surgical risk,” the authors reported.

Although studies have shown the effectiveness of LNG-IUS in treatment of menorrhagia, most have not considered the role of body mass index (BMI), said Ms. Paige C. Fairchild, a medical student at the university who presented the study at the meeting.

The team conducted a retrospective chart review of 398 women with menorrhagia who were treated with LNG-IUS between 1999 and 2009 within the University of Michigan Health System, Ann Arbor. Nearly 50% had BMI of 30 kg/m

Also, removal of LNG-IUS because of continued menorrhagia was more common among women who had BMI greater than 34, compared with those in all BMI groups (6.9% vs. 4.1%).

The odds of surgery within 2 years of LNG-IUS removal also was higher in obese patients (2.6 times), compared with other groups.

Some factors that might contribute to the reduced effectiveness of LNG-IUS in obese women are a larger uterus, persistent unopposed estrogen endometrial stimulation, and poor placement/difficulty in achieving fundal placement, Dr. Vanessa Dalton of the departments of obstetrics and gynecology at the university and one of the study authors, said in an interview.

Despite the findings, the authors concluded that the high continuation rates of LNG-IUS and low surgery rates indicate that the treatment is still a good option for women with a high BMI.

Ms. Fairchild and Dr. Dalton had no relevant financial disclosures.

WASHINGTON – In very obese women, treatment of menorrhagia with levonorgestrel intrauterine system may be slightly less effective, but the treatment's success rate justifies its use, according to a study conducted by researchers at the University of Michigan.

In addition, levonorgestrel intrauterine system (LNG-IUS) “may be an especially important treatment choice for women at high surgical risk,” the authors reported.

Although studies have shown the effectiveness of LNG-IUS in treatment of menorrhagia, most have not considered the role of body mass index (BMI), said Ms. Paige C. Fairchild, a medical student at the university who presented the study at the meeting.

The team conducted a retrospective chart review of 398 women with menorrhagia who were treated with LNG-IUS between 1999 and 2009 within the University of Michigan Health System, Ann Arbor. Nearly 50% had BMI of 30 kg/m

Also, removal of LNG-IUS because of continued menorrhagia was more common among women who had BMI greater than 34, compared with those in all BMI groups (6.9% vs. 4.1%).

The odds of surgery within 2 years of LNG-IUS removal also was higher in obese patients (2.6 times), compared with other groups.

Some factors that might contribute to the reduced effectiveness of LNG-IUS in obese women are a larger uterus, persistent unopposed estrogen endometrial stimulation, and poor placement/difficulty in achieving fundal placement, Dr. Vanessa Dalton of the departments of obstetrics and gynecology at the university and one of the study authors, said in an interview.

Despite the findings, the authors concluded that the high continuation rates of LNG-IUS and low surgery rates indicate that the treatment is still a good option for women with a high BMI.

Ms. Fairchild and Dr. Dalton had no relevant financial disclosures.