Kim’s public health blog

According to a study by researchers at the Johns Hopkins Bloomberg School of Public Health, although the number of people living with HIV has increased in the United States over time, the rate at which an infected person passes t he virus on to an uninfected person has dropped significantly since the peak of the epidemic. 95 percent or more of those living with HIV do not transmit the virus to others, which indicates that prevention efforts are having a real impact.

In an article in the NYT yesterday Dr. Paula Chin Continues to raise concern about the increasing lack of access to primary care doctors. The AMA continues to stick its head in the sand only saying that more scholarships are needed. There will be no change in access until policy makers require accrediting bodies for medical schools to focus on the epidemiology of primary care, and insist that medical schools ensure that all new doctors are capable of treating and preventing the common conditions seem in the community. Then the accrediting bodies for residency programs must place a premium on residencies in primary care, ensuring that enough graduates are competent in team practice so they to provide appropriate care. At the same time the federal funders that support medical education must place more resources into primary care and preventive medicine training. Finally. the insurers who pay for care must reward the care given by primary care physicians an focus on the value of counseling and prevention rather than technical procedures. . Without these changes no new program will make a difference. We only have to look at the problems in Massachusetts which has mandated universal access for its population but cannot deliver because it trains its physicians as specialists.

Scientists at UC Berkeley’s Helen Wills Neuroscience Institute and the School of Public Health report that normal 9- and 10-year-olds differing only in socioeconomic status have detectable differences in the response of their prefrontal cortex, the part of the brain that is critical for problem solving and creativity. The researchers suspect that stressful environments and cognitive impoverishment are to blame, since in animals, stress and environmental deprivation have been shown to affect the prefrontal cortex. UC Berkeley’s Marian Diamond, professor emeritus of integrative biology, showed nearly 20 years ago in rats that enrichment thickens the cerebral cortex as it improves test performance. And as Boyce noted, previous studies have shown that children from poor families hear 30 million fewer words by the time they are four than do kids from middle-class families. Comment: This association has been demonstrated previously. The issue should be whether this is due to perinatal environment or local environment after birth, including for example lead exposures and inadequate nutrition, as well as poor cognitive support.

To heal our ailing health care system, we need to stop thinking like Americans. That’s the message of two articles by UCLA’s Dr. Marc Nuwer, a leading expert on national health care reform.
The United States boasts the world’s most expensive health care system, yet only one-sixth of Americans are insured. Medical expenditures exceed $2 trillion annually, making health care the economy’s largest sector, four times bigger than national defense.
By 2015, the U.S. government is projected to spend $4 trillion on health care, or 20 percent of the nation’s gross domestic product.
An aging population will boost spending. Half of Medicare costs support very sick people in their last stages of life, and experts estimate that Medicare funds will be exhausted by 2018.
31 percent of U.S. health care funds go toward administration. “We push a lot of paper,” Nuwer says. “We spend twice as much as Canada, which has a more streamlined health care system that demands doctors complete less paperwork.”
10 percent of U.S. expenses are spent on “defensive medicine” — pricey tests ordered by doctors afraid of missing anything, however unlikely.

A study published in the Jan. 15, 2009 issue of the journal Cancer, “state laws meant to keep teens out of indoor tanning booths haven’t made a dent..” Study author Vilma Cokkinides, Ph.D. called for “more stringent legal measures and more education…to reduce indoor tanning by minors.” Dermatologist Elizabeth K. Hale, M.D., spokeswoman for the Skin Cancer Foundation, said that “indoor tanning bed use should be prohibited for those under 18.”

According to a report titled, Complementary and Alternative Medicine use United States, 2007, issued by the NIH. The researchers found that use of yoga, ‘probiotics,’ fish oil, and other ‘complementary and alternative’ therapies held steady among adults since the last national survey five years earlier, and that such treatments have become part of healthcare for many youngsters. Critics warned that “some studies have found some dietary supplements might increase that risk of some serious health problems, including cancer.” Comment: Why are the health professionals so bad at explaining which preventive services work that so many members of the public seek out scams, often dangerous ones, for themselves and their children. The Magic Medicine Peddlers still run their carnival shows, but on TV and the internet instead of travelling side shows.

The costs that health care providers are charged and reimbursed for childhood vaccines vary widely, and the high cost of some immunizations is leading to significant financial strain for some physicians, according to a pair of new studies from the University of Michigan Health System. The studies found that the price-per-dose of one brand of hepatitis B vaccine, for example, ranged from $4.26 to $13.06 at different medical practices. Reimbursements of the MMR (measles, mumps and rubella) vaccine ranged from $16.77 to $59.02. Many physicians in the survey expressed dissatisfaction with the price and reimbursement levels of vaccines. While few physicians in the survey indicated that they had considered no longer providing all vaccines to privately insured children (11 percent overall; 5 percent of pediatricians and 21 percent of family physicians), about half of them reported that they had delayed the purchase of some vaccines for financial reasons and experienced a decline in profit margins from immunizations.

Diets and beauty products which claim to have anti-oxidant properties are unlikely to prevent aging, according to research funded by the Wellcome Trust. Researchers at the Institute of Healthy aging at UCL (University College London) say this is because a key fifty year old theory about the causes of aging is wrong. ‘Superoxide’ free radicals – oxygen molecules which have an imbalance of electrons to protons – are generated in the body through natural processes such as metabolism. These free radicals can cause oxidation in the body, analogous to rust when iron is exposed to oxygen. Biological systems, such as the human body, are usually able to restrict or repair this damage. Dr Gems believes the study suggests that anti-ageing products, that claim to have anti-oxidant properties, are unlikely to have any effect. “A healthy, balanced diet is very important for reducing the risk of developing many diseases associated with old age, such as cancer, diabetes and osteoporosis,” he says. “But there is no clear evidence that dietary antioxidants can slow or prevent ageing. There is even less evidence to support the claims of most anti-ageing products.”

Universal and annual voluntary testing followed by immediate antiretroviral therapy treatment (irrespective of clinical stage or CD4 count) can reduce new HIV cases by 95% within 10 years, according to new findings based on a mathematical model developed by a group of HIV specialists in WHO.

ScienceDaily (Dec. 1, 2008) — Acupuncture works – but it works equally well with or without needle penetration. This conclusion can be drawn from a treatment study involving cancer patients suffering from nausea during radiotherapy. The acupuncture study of 215 patients who were undergoing radiation treatment in the abdomen or pelvic region chose by lot one of these two acupuncture types. 109 received traditional acupuncture, with needles penetrating the skin in particular points. According to ancient Chinese tradition, the needle is twisted until a certain ‘needle sensation’ arises. The other 106 patients received a simulated acupuncture instead, with a telescopic, blunt placebo needle that merely touches the skin. The effects therefore seem not be due to the traditional acupuncture method, as was previously thought, but rather a result of the increased care the treatment entails. COMMENT: Like most complementary medicine, well conceived studies rarely show the ‘treatment’ makes as much difference as the enhanced links between the therapist and patient