04 October 2013

Does the Public Need Medicare Education?

According to this Medpage Today article, YES. This Joslin blog also raises issues that people with Medicare and diabetes may not be aware are available. While I don't utilize them personally, some people may have the need of these services. Others that are in need of these services may not be able to receive them because of the shortage of certified diabetes educators in many areas of the US, and registered nutritionists are also in short supply. The CDEs are needed for the education and many doctors do not have them available or will not utilize them.

The medical nutrition therapy is a complementary benefit. You must be counseled by a registered dietitian or nutrition professional that is a Medicare provider. In addition, your physician must write a referral for you to receive this service. You should receive an individualized nutrition care plan and be monitored for changes in your diet and laboratory values.

Other preventive services are also funded by Medicare and should be utilized. My blog here covers this and a link to the list of preventive services.

The Medpage Today article takes off in another direction and has some comments that are not too complementary about Medicare. I do agree with the article that there is a need for public education when it comes to understanding what Medicare does and does not pay for and the why. We as Medicare beneficiaries will need to become more familiar with some of the provisions and reasons Medicare is tightening the purse strings.

Reform will need to happen and this may become painful in the pocket of many beneficiaries. I can only hope that the supplemental policies can cover the holes and not become too exorbitant in doing so. The following indicates current public opinion and are not completely on target.

Public opinion polls show that poor government management (30%), fraud and abuse (24%), and excessive charges by hospitals (23%) were top reasons voters cited for Medicare's rising costs. The cost of new drugs and treatments was the lowest-ranked reason, with 6% of respondents citing it.

Medicare's hospital insurance trust fund will be depleted by 2026 if current spending rates continue, the program's trustees said earlier this year. I am not sure where the author obtained the 2026, as I remember, probably incorrectly, the year of 2018 for Medicare to exhaust its funds under ACA.

“Increasing the public's understanding about how Medicare works, outside of just how to navigate the program as a patient, could raise the level public policy debate in the country, the authors said.” I think with the baby boom generation now increasing in the Medicare arena, that it is time for a public education campaign to begin.

03 October 2013

ED Use Might Go Up Under ACA

According to this article in Medpage Today, the author states that a study shows emergency department (ED) use could surge under ACA. This increase will happen under both the newly insured and those insured under Medicaid.

Causing some of this will be the shortage of primary care physicians and many states not accepting NPs, PAs, and Pharmacists to work in the primary care field independently.

Increases in California emergency department (ED) use were driven in large part by Medicaid patients. The researchers say this will be a precursor to increased burdens after the Affordable Care Act kicks in completely.

Many patients who will soon be insured under the ACA will be enrolled in Medicaid. While these people are generally healthier than current Medicaid enrollees, they may introduce a new and additional burden to treat undiagnosed and uncontrolled conditions.

These costs may represent a bigger picture of burdens on acute care across the U.S. under expansions to Medicaid under the ACA, according to David Howard, PhD, at the Department of Health Policy and Management at Emory University's Rollins School of Public Health in Atlanta.”

James McCarthy, MD, of the University of Texas Health Science Center at Houston, noted that additional healthcare burdens imposed by the ACA "will result in increased ED utilization in many markets because of inadequate primary care infrastructures to support the population."”

These two individuals that were not part of the study, state the problems patients will face under the Affordable Care Act (ACA). This is one more reason that I wrote my blog here to warn people about being careful of changing doctors at the present time. You don't want to be without a doctor when the problems start and the newly insured are looking for primary care physicians.

02 October 2013

Rodent Studies – Do They Really Mean Anything?

I admit I am tired of reading about studies involving rodents that are heralded as a breakthrough. Most often that is the last we hear about them and then we see no human trials or studies using the rodent data. To me this means there is no viability for these to move forward to humans and thus no meaning for the rodent studies recently heavily promoted.

Now we have two more rodent studies, one about an approved cancer drug that could treat diabetes and another that could potentially solve the loss of beta cell features that contribute to the onset of diabetes. Now will we see any human studies confirming these findings? It will be interesting, but doubtful.

The most interesting is the adapting of the cancer drug and this is probably the most promising as the researchers do state, "Anecdotally, there have been reports that diabetic patients who have been prescribed VEGF inhibitors to treat their cancer are better able to control their diabetes." They also state, "Much work remains to translate these mouse studies to human patients, but it will be interesting to explore VEGF inhibitors or drugs that can stabilize HIF-2alpha, such as prolyl hydroxylase inhibitors, for diabetes treatment, possibly in combination with pre-existing therapies to minimize toxicities."

"Targeting the Phd3/HIF-2 pathway represents a new therapeutic approach for the treatment of diabetes with little toxicity," said one of the researchers. "These studies indicate that Phd specific inhibitors, especially Phd3, should be more widely developed for clinical development."

The second article about the protein Nkx6.1, which is a beta-cell enriched transcription factor, is essential for maintaining the functional state of beta cells. The study shows that loss of Nkx6.1 in mice caused rapid onset of diabetes. Scientists have revealed the critical role of this protein in the control of insulin biosynthesis, insulin secretion and beta-cell proliferation.

The researchers have found that the loss of Nkx6.1 activity had an immediate on the expression of genes that give beta cells their ability to synthesize and release in insulin biosynthesis.

Whether this rodent study is worth the time reading is debatable.

01 October 2013

October Calendar of Monthly Events

Out of the many national topics for the month of October, I selected just two of the national month of October topics. The first is National Disability Employment Awareness Month (NDEAM).

In 1945, Congress enacted a law declaring the first week in October each year "National Employ the Physically Handicapped Week." In 1962, the word "physically" was removed to acknowledge the employment needs and contributions of individuals with all types of disabilities. In 1988, Congress expanded the week to a month and changed the name to "National Disability Employment Awareness Month." The theme for 2013 is "Because We Are EQUAL to the Task."

The Office of Disability Employment Policy (ODEP) was established in 2001 and assumed responsibility for NDEAM. ODEP has worked to expand its reach, scope, and make this a worthy national event.

This year's theme echoes the message of ODEP's ongoing Campaign for Disability Employment to promote positive employment outcomes for people with disabilities. They are striving to expand ideas about what youths with disabilities can do when they receive encouragement and support for their ambitions. Conducted in collaboration with business and disability organizations, the campaign emphasizes that, at work, it is what people can do that matters.

The second national event is Talk About Prescriptions Month (TAP Month). As a person with diabetes, prescriptions have become part of my life. While I don't like many prescriptions, I do need to take the medications. In reading some of the web sites about this, I like the fact that some straightforward ideas were presented.

"Too many times, people misuse medications, either by not following proper use instructions, or not taking them as directed by their physician, nurse practitioner, or physician assistant. This misuse often leads to other health problems. That's why NCPIE is launching the 3Rs for Safe Medicine Use program." Phillip Schneider, NCPIE Chairman. NCPIE stands for The National Council on Patient Information and Education and NCPIE

During ”TAP” Month, on October 15, 2013, NCPIE will launch a new national campaign called the Adherence Action Agenda (The A3 Project), with a particular emphasis on the need to call attention to and address improving adherence by Americans suffering from multiple chronic conditions (MCCs).

This theme was used in a prior year, but still in relevant today. The 3Rs for Safe Medicine Use, focusing on the following key safe medicine use messages for consumers and healthcare providers:
  1. Risk: recognize that all medicines (prescription and nonprescription) have risks as well as benefits; and you need to weigh these risks and benefits carefully for every medicine you take.
  2. Respect: respect the power of your medicine and the value of medicines properly used.
  3. Responsibility: take responsibility for learning about how to take each medication safely. Being responsible also means following this important rule: when in doubt, ask first. Your healthcare professional can help you get the facts you need to use medicines correctly.

Because most doctors bail on doing this, the pharmacists in many states are now required by law to provide this information.

The information at this link was last updated in October 2005, but is as important today as ever. Just understand that many doctors are listening to drug representatives and you need to be sure that the doctor has no conflicts of interest for prescribing a medication. There are some questions that need to be asked of the doctor, but be careful as some doctors are easily offended by the manner in which you chose to ask the question.

30 September 2013

Statins Are Linked to Cataract Development

Happy – no, but I am glad I questioned the science promoted in this blog and declared my belief that Big Pharma promoted the article and maybe even the research and they do not wish to have the results confirmed or denied. Sorry, but I couldn't accept the information as it is presented and viewed the information as unreliable and even possibly a farce.

This study confirms that the science has to be in error and the information was from less than reliable source. Big Pharma has to have been promoting it. This Medscape article does declare that there is a strong link between statins and their cause of cataract development. “At the recent European Society of Cardiology (ESC) 2013 Congress , Dr John B Kostis (Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ) presented the results of a random-effects meta-analysis, showing a 20% lower rate of cataracts with statin use compared with no statin use, with a more pronounced benefit seen when statins were started in younger patients.” At least they were able to identify Dr. Kostis and his academic school.

The meta-analysis published today, however, found the opposite. It matched 6972 statin users with nonusers within the San Antonio Military Multi-Market Area health system using propensity scores based on variables that increased the likelihood of receiving statins and increased the risk of developing cataracts. Statin users had to have been on the drugs for more than 90 days; simvastatin was prescribed in almost three-quarters of the patients.”

The author emphasizes that statins are very effective medications; therefore, side effects are to be expected. I am glad that this puts healthcare providers on notice and stresses that they should make sure there is justifiable indication to prescribed statins. Many doctors do not follow guidelines to confirm that the potential benefits outweigh the potential risks of side effects for individual patients.

The message for patients is one of understanding and that statins are a tool for treatment of heart disease and should not be stopped because of a small risk of association with other diseases. It is wise to commit to lifestyle changes, like stop smoking, and continue to be physically active than take a pill to lower your risk of heart disease. Until this can be accomplished, consult with your doctor to determine if it may be wise to remain on statins.