Labeling Calories, Saturated Fat and Sodium on Restaurant Menus Leads to Lower Levels of Each

One of the many policies included in the Patient Protection and Affordable Care Act is a requirement that chain restaurants list the calories, saturated fat, and sodium levels in their offerings.

A study just published in the Journal of the Academy of Nutrition and Dietetics (formerly known as the Journal of the American Dietetic Association) demonstrates that when forced to list the amounts of these problematic dietray components, restaurants change their recipes so that they contain lower amounts.

This is not rocket science. It’s common sense. Unless required to do the right thing, corporations will too often keep doing the wrong thing.

People should have the right to know what’s in their food.

Bruemmer B, Krieger J, Saelens BE, Chan N. Energy, Saturated Fat, and Sodium Were Lower in Entrées at Chain Restaurants at 18 Months Compared with 6 Months Following the Implementation of Mandatory Menu Labeling Regulation in King County, Washington. Journal of the Academy of Nutrition and Dietetics. 2012;112(8):1169-1176.

 

“Watchful Waiting” Yields Outcomes Equal to Surgery for Early Stage Prostate Cancer

Unnecessary and/or overaggressive treatment is one of the great weaknesses of the healing arts. Prostate cancer treatment is one of the current flashpoints, because most prostate cancers are slow to grow and begin when the men are old enough that they will eventually die “with prostate cancer” rather than “of prostate cancer.”

This article from the New York Times Well Blog sums it up well:

This year, about 240,000 men will be given a diagnosis of prostate cancer. Although 81 percent of them will discover the disease at a very early stage, and although prostate cancer usually grows very slowly, most of these men will choose aggressive treatment, opting for removal of the prostate, or radiation treatments that often render them impotent or incontinent — or both.

But about 10 percent of men choose a different strategy: no treatment at all. The decision to forgo surgery or radiation is controversial, and is often met with resistance from a man’s own doctors and family members.

The strategy is often called “watchful waiting,” but some experts term it “active surveillance” or “expectant management.” In older men, watchful waiting may mean that nothing at all is done; doctors intervene only for pain relief or minor procedures if there are signs the cancer has spread.

In younger men, doctors typically conduct regular blood tests and biopsies to monitor the cancer. The idea is that they may recommend surgery or treatment later if it appears the cancer is aggressive and beginning to spread.

Few men choose watchful waiting and few doctors recommend it, but that may soon change. Last week, a groundbreaking new study showed that men with early-stage disease who opt for watchful waiting are just as likely to survive as men who undergo surgery.

The findings, published in The New England Journal of Medicine, come from a 15-year study of 731 men with early-stage prostate cancer who, surprisingly, had agreed to be randomly assigned to surgery or a program of watchful waiting. The fact that so many men had agreed to leave their treatment to chance is remarkable in itself. But so were the findings.

During the study, the largest of its kind, 52 men, or about 7 percent of the study subjects, died of prostate cancer. There was no statistical difference in the prostate cancer mortality rate or the overall death rate between the groups. Most men survived the disease whether they had surgery or did nothing.

And some men who had surgery died, as did some men who did nothing.

 

Obamacare Has Saved Seniors $4 Billion On Drug Costs

While I would love to see much less dependence on medications and much more on healthy lifestyle changes, the fact that the Affordable Care Act has already kept $4 billion in the bank accounts of American seniors and out of the hands of the drug companies strikes me as a positive development that deserves to be widely publicized.

That’s what a new report from the Centers of Medicare and Medicaid Services has documented.

The Medicare agency released figures showing that millions of seniors and people with disabilities have saved $3.9 billion on medications since the law was enacted.
The data also showed that since the beginning of the year, more than 1 million Medicare beneficiaries have saved an average of $629 on prescriptions in the “doughnut hole” coverage gap. 

“Millions of people with Medicare have been paying less for prescription drugs thanks to the healthcare law,” said Marilyn Tavenner, the head of the Centers for Medicare and Medicaid Services.

“Seniors and people with disabilities have already saved close to $4 billion. In 2020, the doughnut hole will be closed thanks to the Affordable Care Act.”

To close the doughnut hole, the government will cover more and more of the value of brand-name and generic drugs until 2020, when seniors will be responsible for 25 percent of the cost for each.

When the Medicare drug benefit was passed by the Republican-controlled Congress in 2004, it was structured so that 100% of the costs were added to the federal deficit. In contrast, the Affordable Care Act of 2010 (aka Obamacare) was structured so as to decrease the deficit, in accordance with the estimates by the nonpartisan Congressional Budget Office.

 

 

More Confirmation That Affordable Care Act Lowers Deficits While Bringing Insurance to 30 Million Uninsured Americans

The Affordable Care Act is the opposite of an unaffordable new entitlement; it is a way to insure 30 million more people while reducing the federal government’s deficit at the same time, according to today’s report from the nonpartisan Congressional Budget Office, which is the closest thing that the United States has to an unbiased financial umpire.

CBO also scored the budgetary impact repealing the health reform law, as endorsed by Mitt Romney and House and Senate Republicans. They found that repeal would add to the deficit while also taking away the insurance that those 30 million people would have gained. In addition, repeal would overturn rules that bar insurance companies from denying coverage due to pre-existing conditions, from canceling coverage when people become ill, and from placing a lifetime dollar limit on coverage. Other provisions that repeal would reverse are the phase-out of the “donut hole” where seniors have no Medicare coverage for prescription drugs, the right of young adults to remain on their parents’ insurance policies through age 26, and the requirement that insurance companies spend at least 80 or 85% of premium dollars (depending on the type of policy) on health services rather than administration and profits.

Also prohibited under the law starting in 2014 will be annual coverage limits and gender discrimination (women currently can be charged higher rates than men for the same coverage).

From Jon Cohn’s new article in The New Republic:

The Congressional Budget Office just published a newly updated estimate of the Affordable Care Act and its impact on the budget. The estimate largely tells us what we already knew: The law, when fully implemented, will dramatically reduce the number of Americans without health insurance. It will also reduce the deficit.

This last part remains a big deal, if only because so many conservatives—and, yes, so many members of the public—refuse to believe it. Over and over again, you hear people saying that Obamacare will run up the deficit. The CBO, which is our most reliable guide on such matters, begs to differ. 

CBO can’t be certain, because nobody can be certain, how exactly the law will play out. But the best available evidence suggests that, in the end, the law will leave the federal treasury with more money than it would have otherwise. And that’s just in the short- to medium-term. If the program’s efforts at re-engineering the health care system really work, then all spending on health care—from the federal government, corporations, and individuals alike—will stop rising so quickly, freeing up more money for other purposes (like, for example, raises to employees).

Milk, Particularly Skim Milk, Associated with Acne

In a finding that contradicts longstanding claims by the American Dairy Council, the Harvard Nurses health study has found an association between milk, particularly skim milk, and acne.  The most likely explanation is the hormone content in the milk, which is present in both organic and conventional milk.

From the accompanying editorial in the Journal of the American Academy of Dermatology:

“The papers…from the Harvard School of Public Health establish an association between milk consumption and acne. But how could milk cause acne? Because, drinking milk and consuming dairy products from pregnant cows exposes us to the hormones produced by the cows’ pregnancy, hormones that we were not designed to consume during our teenage and adult years. It is no secret that teenagers’ acne closely parallels hormonal activity…So what happens if exogenous hormones are added to the normal endogenous load? And what exactly is the source of these hormones? Consider that, in nature, milk is consumed from a mother, whether human or bovine, until weaning occurs. Normally, the mother then ceases lactation before the next pregnancy occurs—so that consuming milk from a mother pregnant with her next offspring is not a common occurrence. We’ve all seen nature films of animals chasing their offspring away to encourage weaning at the appropriate time. Further, in nature the offspring consumes only the milk of its own species—but both of these natural rules are broken by humans. Viewed objectively, human consumption of large volumes of another species’ milk, especially when that milk comes mainly from pregnant cows during the human’s normally post-weaned years, is essentially unnatural.”

FDA Endorses Industry-Sponsored Physician Education on Opioid Prescribing

The upside is that there is a clear recognition of the scale of the problem of over-prescription and inappropriate use of addictive painkillers. As noted in this Medpage article, “the prescription painkiller epidemic … was responsible for about 15,600 deaths in 2009, the latest year for which there are data.”

But industry sponsorship is a major red flag, leading some to opine that these educational programs fall far short of constituting an adequate response to the problem.

“The FDA’s goal is to ensure that healthcare professionals have the education they need to prescribe opioids and that patients have the know-how to safely use these drugs,” FDA Commissioner Margaret Hamburg said during a press call.

But critics cite a number of problems with the guidance, including its reliance on industry sponsorship of education, even with middle-man medical education companies. Also, extended-release and long-acting opioid analgesics training will not be mandatory for prescribers.

Finally, the program will not cover powerful short-acting opioids such as hydrocodone (Vicodin) that have an equally high potential for abuse.

“These educational programs are likely going to do more harm than good,” said Andrew Kolodny, MD, chair of psychiatry at Maimonides Medical Center in New York City. “Nowhere does it say that prescribers should tell patients these drugs are addictive. And these programs give the implied message that there’s evidence for using opioids in long-term, noncancer chronic pain.”

The Supreme Court Speaks, Health Reform Continues

My editorial on the health reform law has been posted as part of the new issue of Health Insights Today, here. There’s a focus on the potential effects of the law for chiropractic and CAM, along with broader societal effects that will come with implementation (or repeal).

I hope you all click through to the full editorial. Here’s an excerpt.

First, the landmark provider nondiscrimination rule, Section 2706:

Since most readers of Health Insights Today have a strong interest in chiropractic and complementary and alternative medicine (CAM), let’s begin with the provisions directly related to those fields. First and foremost, the Affordable Care Act’s Section 2706 enacts for the first time a nationwide provider nondiscrimination policy, prohibiting insurance companies from denying coverage based on provider type for services provided by licensed health care practitioners. For example, this policy appears to indicate that if spinal manipulation or acupuncture (or any other service within a practitioner’s scope of practice) is covered when performed by a medical or osteopathic physician, insurers cannot have a policy denying such coverage when the service is performed by a chiropractor or acupuncturist. In the past, such discriminatory policies have had the effect of routing patients away from DCs, LAcs and other non-MD/DO practitioners.

The nondiscrimination rule is a landmark step forward and marks the first time that legislation applies such a policy across the entire nation. However, it does not bar all forms of discrimination. Importantly, insurers are not barred from paying some types of practitioners more than others for the same services. Chiropractors and a variety of other non-MD/DO practitioners sought such a ban but did not achieve it in this legislation. Success on that front will have to wait until later.

The full ramifications of Section 2706 will become clearer over time, as uncertainties are resolved through state and/or federal regulatory actions or litigation. For now, it is seen by chiropractic and CAM leaders and attorneys as the most significant piece of federal legislation in many years. The American Medical Association House of Delegates approved a resolution at its June 2012 national meeting that calls for the repeal of the nondiscrimination policy. While vigilance on the part of chiropractic and CAM organizations remains necessary, this AMA repeal effort faces a steep uphill climb unless the November 2012 election brings a president, House, and Senate that repeals the entire Affordable Care Act. Senate Republican Leader Mitch McConnell and House Speaker John Boehner have pledged to seek full repeal in early 2013. 

I ask each of our readers … please familiarize yourself with what is in the law, so that you will be able to evaluate all claims — pro or con — based on facts rather than distortions.  

 

 

 

Despite Decline in Meat Consumption, America Is Still #1

Per capita meat consumption is not one of the categories where you want to lead the world, if you’re concerned about the health of your people.

Agricultural subsidies and other policies that continue to encourage overconsumption are damaging to the environment, our health, and, of course, the animals.

Americans are eating less and less meat: Consumption is projected to drop 12.1 percent just between 2007 and 2012.

That being said, we still eat a lot of meat, about three times more than your average Ukrainian and 12 times more than a Bangladesh resident. In fact, the United States holds the title for highest per capita meat consumption, just barely edging out Australia. Here’s what that looks like in map form, via NPR: