Frequent Chocolate Consumption Reduces BMI

March 26, 2012 — Ron Chusid

This might be the most important scientific finding ever: A study in the March 26 issue of the Archives of Internal Medicine found that frequent chocolate consumption was associated with lower body mass index (BMI). Here is a summary from Medscape:

A recent study showed that frequent chocolate consumption was associated with lower body mass index (BMI), even when adjusting for calorie intake, saturated fat intake, and mood.

Beatrice A. Golomb, MD, PhD, associate professor of medicine at the University of California, San Diego, and colleagues described their findings in a research letter published in the March 26 issue of the Archives of Internal Medicine.

The authors used data from 1018 patients already being screened for inclusion in a widely sampling clinical study evaluating noncardiac effects of statin medications. Of the 1018 participants, 1017 answered the question, “How many times a week do you consume chocolate?” BMI was calculated for 972 participants (95.6%); and 975 (95.8%) answered the validated Fred Hutchinson Food Frequency Questionnaire.

The investigators performed analyses with and without adjustment for calorie intake, saturated fat (satfat) intake, and mood. Fruit and vegetable intake was not associated with chocolate consumption (β, 0.004; P = .55), but satfat intake was significantly related to both chocolate consumption (β, 0.035; P < .001) and higher BMI.

The amount of chocolate consumed was examined, in addition to the frequency of chocolate consumption. Activity (number of times in a 7-day period the participant engaged in vigorous activity for at least 20 minutes) and mood (Center for Epidemiological Studies Depression scale [CES-D]) were also examined.

The relationship between chocolate consumption frequency and BMI was calculated in unadjusted models, in models adjusted for age and sex, and in models adjusted for activity, satfats, and mood.

Study participants consumed chocolate a mean 2.0 (SD, 2.5) times per week and exercised 3.6 (SD, 3.0) times per week. Frequency of chocolate consumption was associated with greater intake of calories and satfats and higher CES-D scores (P < .001 for each of these 3 associations); these all related positively to BMI. Chocolate consumption frequency was not associated with greater activity (P = .41), but it was associated with lower BMI (unadjusted P = .01). This association remained with and without adjustment for age and sex, as well as for calories, satfats, and depression.

Although chocolate consumption frequency was associated with lower BMI, the amount of chocolate consumed was not (eg, per medium chocolate serving or 1 oz [28 g], β, 0.00057 and P = .97, in an age- and sex-adjusted model).

“The connection of higher chocolate consumption frequency to lower BMI is opposite to associations presumed based on calories alone, but concordant with a growing body of literature suggesting that the character — as well as the quantity — of calories has an impact on [metabolic syndrome (MetS)] factors,” write the authors.

They further explain that as chocolate products are frequently high in sugar and fat, they are often assumed to contribute to an increased BMI. The authors note that this may still be true in some cases.

“[O]ur findings — that more frequent chocolate intake is linked to lower BMI — are intriguing,” write the authors. “They accord with other findings suggesting that diet composition, as well as calorie number, may influence BMI. They comport with reported benefits of chocolate to other elements of MetS,” the authors write, noting that a randomized trial studying the metabolic benefits of chocolate in humans may be warranted.

Posted in Health Care. Tags: , . 2 Comments »

AMA Calls For Blocking Required Coding Change To Reduce Unnecessary Practice Expenses

November 15, 2011 — Ron Chusid

One of the many reasons that health care costs so much is that billing is an enormous expense for physician offices and all health care facilities.  There are complexities to billing for services in health care which are not present in most industries. If most people want to send out a bill, they can just list the services in plain English. In health care everything has a number, both for the diagnosis and for the services provided. The current ICD-9 diagnosis system used in the United States uses up to five digits to describe every medical problem. Much of the world has already changed to ICD-10, which has a whole new set of codes and goes out to six digits, allowing for even greater specificity.  The United States plans to convert in October, 2013, resulting in a tremendous increase in medical practice expenses.

Bureaucrats think that the five digit numbers are not enough and we need six digit numbers to describe more exactly what diagnosis is involved. They don’t seem to have questioned whether this degree of specificity is needed, or if the results they get are accurate. It is somewhat like the game of telephone. By the time diagnoses go from the doctor, who writes them in English, through staff members and on to the payers, many inaccuracies enter into the system. Any type of study based upon ICD-9 codes is likely to have a tremendous amount of erroneous data.  The ICD-9 codes typically have choices for the fifth digit of “other” or “unspecified” which are commonly used. This practice will continue, defeating the purpose of adding yet a sixth digit to describe a diagnosis.  Besides, if anyone really needs to see the exact details before paying, they could always review the actual notes (as  is commonly done by payers such as auto insurance and workers compensation).

The ICD-9 system is in place and is working. In an era of trying to cut unnecessary expenses it is foolish to spend the money it would take to convert to ICD-10. The goal should be to reduce complexity to reduce costs, not to increase complexity or to require costly changes. The AMA House of Delegates voted today to attempt to block the implementation of ICD-10.

The AMA House of Delegates voted today to work vigorously to stop implementation of ICD-10 (The International Classification of Diseases and Related Health Problems, 10th Revision), a new code set for medical diagnoses. ICD-10 has about 69,000 codes and will replace the 14,000 ICD-9 diagnosis codes currently in use.

“The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients’ care,” said Peter W. Carmel, M.D., AMA president. At a time when we are working to get the best value possible for our health care dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions. The timing could not be worse as many physicians are working to implement electronic health records into their practices. We will continue working to help physicians keep their focus where it should be — on their patients.”

A 2008 study found that a small three-physician practice would need to spend $83,290 to implement ICD-10, and a 10-physician practice would spend $285,195 to make the coding change.

As noted above, the timing is especially bad as the government is now pushing medical offices towards changing to electronic medical record system. Such implementation is made more difficult when the systems have to be set up to handle ICD-9 until October, 2013 and then abruptly change to an entirely new system. Besides the costs resulting from changing system, the government is also requiring a change in electronic billing formats in January, 2012 which is also causing added expense.

Posted in Health Care. Tags: . No Comments »

Disease Management Models Fail To Show Cost Savings

November 6, 2011 — Ron Chusid

Winston Churchill’s view of democracy is well known: “Democracy is the worst form of government, except for all those other forms that have been tried from time to time.” Something similar might be said about fee for service health care. The system has frequently, and erroneously, been blamed for the the high cost of health care, ignoring the simple economic facts such as that you get what you pay for and there is no such thing as a free lunch. There have been multiple attempts at finding alternatives, such as the disastrous trend toward HMO’s which led to restrictions in health care availability while often leading to increased costs due to the increased bureaucracy. Other efforts, such as the disease management model, attempt to modify fee for service plans.

The Medicare Modernization Act of 2003 requires that the Centers for Medicare and Medicaid Services test a commercial disease management model in the fee-for-service program. A study in the November  3 issue of the New England Journal of Medicine entitled Results of the Medicare Health Support Disease-Management Pilot Program found no demonstrable savings. (If this report is not available to non-subscribers, there is a summary in Medical News Today). From the results:

The study included 242,417 patients (163,107 in the intervention group and 79,310 in the control group). The eight commercial disease-management programs did not reduce hospital admissions or emergency room visits, as compared with usual care. We observed only 14 significant improvements in process-of-care measures out of 40 comparisons. These modest improvements came at substantial cost to the Medicare program in fees paid to the disease-management companies ($400 million), with no demonstrable savings in Medicare expenditures.

From my personal experience, such programs when utilized by third party payers, typically based upon reviews of claims with zero knowledge of the actual patient, lead to the generation of large amounts of letters which quickly wind up in the trash due to their lack of applicability to the actual patient. Lately an increased number of payers have been paying to obtain further information on patients in their plans with the hopes of better managing their care. This leads to a small amount of additional income, more paperwork, but it remains questionable if this has any impact on health care.

The discussion included five reasons for the failure of the programs. I found two to be particularly of interest:

Second, the care of elderly, chronically ill patients is difficult to manage. They are much more likely than younger persons to have new acute conditions such as stroke, pneumonia, and hip fracture. Although each of the companies in our study intended to manage the care of the “whole person,” the health coaches were surprised by the number of health and psychosocial problems that were prevalent among Medicare fee-for-service beneficiaries.

Yes, the patients who account for the highest costs under fee for service plans account for these costs for a reason. They are sicker and are more difficult to manage. A nurse calling from an insurance company’s call center who has never examined the patient is not likely to know how the patient should be handled. Giving cook-book medicine recommendations based upon one diagnosis can often cause serious problems rather than be of benefit if all the other problems of that patient are not considered. Systems which do not provide adequate fee for service will lead to these sicker patients not being able to receive the amount of care they need.

Fifth, the health coaches were not integrated into the beneficiary’s primary health care team. This hindered their ability to interact directly with the beneficiary’s primary care provider and facilitate changes in medical care plans made by the primary care provider to mitigate deterioration in health status and avoid the need for acute care services.

Insurance company health coaches frequently have no idea as to why a patient is having problems or not responding to their physician’s treatment. Recommendations from such people are often worthless. Therapeutic failures might be due to a physician not following the proper treatment guidelines, but often the problem is that the patient does not follow their doctor’s advice. People often don’t follow medical recommendations because they cannot afford the medications needed, or afford the out-of-pocket expenses required for their health care. When insurance plans are operating with no coordination with the patient’s physician they are not going to be aware of the actual problems.  On the other hand, if these programs were better organized to take recommendations from the physician and work with the physician, as opposed to trying to tell the physician what should be done, they might be able to provide a service which actually does help the patient and lower management costs.

Posted in Health Care. Tags: . 2 Comments »

Conservatives Again Show That They Are The Supporters Of Big Government, Opposing Trend Towards Support For End Of Marijuana Prohibition

October 17, 2011 — Ron Chusid

The medical marijuana laws are failing at ensuring that people can use marijuana if it helps with symptoms of various diseases. In some states individuals can obtain a card allowing for the legal possession of marijuana. This might be obtained from a physician who is familiar with their medical history, or it might have been purchased from doctors who will give approval for marijuana use for $100. The laws typically do a poor job of stipulating how marijuana can be obtained. There is no doubt that many people are taking advantage of the program to obtain legal access to marijuana without legitimate need, leading to government crack-downs which make it  more difficult  to obtain marijuana.

With all the problems caused by these laws there is one obvious solution–legalize marijuana and eliminate the need for the poorly-constructed medical marijuana programs. The California Medical Association agrees:

The state’s largest doctor group is calling for legalization of marijuana, even as it pronounces cannabis to be of questionable medical value.

Trustees of the California Medical Assn., which represents more than 35,000 physicians statewide, adopted the position at their annual meeting in Anaheim late Friday. It is the first major medical association in the nation to urge legalization of the drug, according to a group spokeswoman, who said the larger membership was notified Saturday.

Dr. Donald Lyman, the Sacramento physician who wrote the group’s new policy, attributed the shift to growing frustration over California’s medical marijuana law, which permits cannabis use with a doctor’s recommendation. That, he said, has created an untenable situation for physicians: deciding whether to give patients a substance that is illegal under federal law.

“It’s an uncomfortable position for doctors,” he said. “It is an open question whether cannabis is useful or not. That question can only be answered once it is legalized and more research is done. Then, and only then, can we know what it is useful for.”

While the medical benefits remain uncertain, it is best to keep the government out of this issue and let people decide for themselves whether it is helping them. Prohibition does not work, and creates many problems. A Gallup poll today showed that a record high of 50 percent now support legalization. Not unexpectedly, conservatives who falsely claim they support smaller government are less likely to support legalization:

Support for legalizing marijuana is directly and inversely proportional to age, ranging from 62% approval among those 18 to 29 down to 31% among those 65 and older. Liberals are twice as likely as conservatives to favor legalizing marijuana. And Democrats and independents are more likely to be in favor than are Republicans.

 

Posted in Drug Policy, Health Care, Polls, Republicans. Tags: , , . 5 Comments »

Right Wing Health Care Lie Of The Day: Ban On Asthma Inhalers

September 24, 2011 — Ron Chusid

Many conservative sites are spreading a false claim today that the Obama administration is banning over-the-counter asthma inhaler over environmental concerns. In actuality, the ban on chlorofluorocarbon in inhalers was passed in 2008 when George Bush was president. Since that time the manufacturers of virtually all inhalers have switched to the more environmentally-friendly hydrofluoroalkane as the propellant. Epinephrine inhalers using chlorofluorocarbon have been an exception.

On the one hand, these ephedrine inhalers are less expensive than prescription inhalers. On the other hand, these over-the-counter inhalers are universally considered to be extremely poor choices for asthma treatment, being both less effective than prescription medications and having far more side effects. While the safer and more effective prescription bronchodilators are more expensive, their use should be minimized by asthma patients with the use of prophylactic medications such as inhaled steroids.  Regardless of their legal status, I had strongly advised my asthma patients not to use these products even well before the ban (which, once again, was passed under George Bush).

Update: The real problem is that many asthmatics have resorted to this type of treatment because of lack of health care coverage. Obama does deserve credit for addressing this problem.

Posted in Barack Obama, George Bush, Health Care. Tags: , , , . 12 Comments »

What Freedom Is All About To The Lunatic Fringe

September 13, 2011 — Ron Chusid

Ron Paul and many on the right advocate a form of  freedom which is not recognizable as freedom to anyone not indoctrinated in their bizarre and irrational philosophy. For the most part I’ve thought of Paul as a well-meaning but not very bright man who fails to recognize that reorganizing society along his ideas would be more likely to  lead to fascism and not liberty. This is why so many neo-Nazis back Paul, understanding his philosophy far better than Paul and his followers do. After seeing the above video clip, I’m not even sure I would say anymore that Ron Paul is well-meaning. He is certainly a disgrace to the medical profession, as well as all decent human beings, in considering  it to be “freedom” to allow a thirty-year old to die because of not purchasing health insurance. The Tea Party crowd screamed out in approval of Paul’s claim that “this is what freedom is all about.” As Andrew Sullivan said, this is indecent,  “not something a decent person cheers.”

As a physician, Ron Paul didn’t give the only response which I highly object to during last night’s debate. Michele Bachmann spread a claim that Gardasil, which is recommended to protect against the virus which causes cervical cancer, causes mental retardation. The claim is not only wrong, but dangerous if it dissuades women from having the vaccine.  Such ignorance is not surprising coming from Bachmann. Many in the religious right opposed the vaccine because it reduces risks from having sex, and the religious right sees no contradiction between claiming to support small government and using government to impose their religious views on others.  False claims which contradict science are common regarding vaccines. It is not surprising that those on the religious right who reject science in other areas such as evolution and climate change would also reject science regarding vaccines.

Posted in Health Care, Libertarianism, Michele Bachmann, Ron Paul, Science. Tags: , , , . 6 Comments »

Government Take Over Of Health Care–GOP Style

May 8, 2011 — Ron Chusid

Republicans have repeated the lie many times that virtually any government involvement in health care policy, regardless of how necessary, represents a “government take over of health care.” They ignore the fact that it is the authoritarian right which regularly has government extend into personal matters where it does not belong. This has included their opposition to abortion rights, support for restrictions on the availability of contraception, and intrusion in end of life decisions as in the Terri Schiavo case. Republicans in Florida are expanding this policy even further in Florida, prohibiting doctors from discussing whether there are guns in the home. NPR reports:

Florida Gov. Rick Scott is expected to sign a bill that will make the state the first in the nation to prohibit doctors from asking patients if they own guns. The bill is aimed particularly at pediatricians, who routinely ask new parents if they have guns at home and if they’re stored safely.

Pediatricians say it’s about preventing accidental injuries. Gun rights advocates say the doctors have a political agenda.

As parents know, pediatricians ask a lot of questions. Dr. Louis St. Petery says it’s all part of what doctors call “anticipatory guidance” — teaching parents how to safeguard against accidental injuries. Pediatricians ask about bike helmets, seat belts and other concerns.

“If you have a pool, let’s talk about pool safety so we don’t have accidental drownings,” he says. “And if you have firearms, let’s talk about gun safety so that they’re stored properly — you know, the gun needs to be locked up, the ammunition stored separate from the gun, etc., so that children don’t have access to them.”

For decades, the American Academy of Pediatrics has encouraged its members to ask questions about guns and how they’re stored, as part of well-child visits.

But Marion Hammer, the National Rifle Association’s lobbyist in Tallahassee, says that’s not a pediatrician’s job.

“We take our children to pediatricians for medical care — not moral judgment, not privacy intrusions,” she says.

NRA lobbyists helped write a bill that largely bans health professionals from asking about guns. Hammer says she and other NRA members consider the questions an intrusion on their Second Amendment rights.

“This bill is about helping families who are complaining about being questioned about gun ownership, and the growing anti-gun political agenda being carried out in examination rooms by doctors and staffs,” Hammer says.

It’s not just questions in the examining room that lead the NRA to charge pediatricians with a political agenda. Out of concern for the high number of firearms injuries among children and adolescents, the American Academy of Pediatrics is also on record supporting gun control.

Why do Republicans hate children?

Posted in Health Care, Republicans, Social Issues. Tags: , , . 9 Comments »

Quote of the Day

April 27, 2011 — Ron Chusid

“A study found Americans spend $1.2 trillion every year on stuff they don’t need. Or as Republicans call it, health care.” –Jimmy Fallon

Posted in Health Care, Humor and Satire, Republicans, Television. Tags: , , . No Comments »

Watson To Provide Uses Beyond Winning On Jeopardy

February 17, 2011 — Ron Chusid

Accessing large amounts of information is an area where computers have an obvious advantage over humans. This, along with being better at playing the buzzer, allowed Watson to win on Jeopardy this week. Watson had an advantage in answering questions due to being programed with the information from a massive number of reference books, but even simpler systems are providing benefits to us mere humans.

At present I can ask my Droid a question out loud. While I do not receive a verbal response like those given by Watson, the screen does display the results of a Google search with pertinent information along with information within the Droid. Besides typing in or speaking questions, searches can even be done based upon pictures. For example, yesterday I was wondering where a picture on the cover of a book was taken. The Droid ran a search and gave me  information on the resort where the picture was taken along with identifying the picture as the cover of the book where it was obtained.

There is obvious commercial use for a device such as Watson which can answer questions out loud. This includes providing information for physicians:

For I.B.M., the future will happen very quickly, company executives said. On Thursday it plans to announce that it will collaborate with Columbia University and the University of Maryland to create a physician’s assistant service that will allow doctors to query a cybernetic assistant. The company also plans to work with Nuance Communications Inc. to add voice recognition to the physician’s assistant, possibly making the service available in as little as 18 months.

“I have been in medical education for 40 years and we’re still a very memory-based curriculum,” said Dr. Herbert Chase, a professor of clinical medicine at Columbia University who is working with I.B.M. on the physician’s assistant. “The power of Watson- like tools will cause us to reconsider what it is we want students to do.”

I will be looking forward to purchasing one for my office. At present, simply having a Droid in my pocket with web access and several medical references, along with computers in the exam rooms, makes things much simpler than in past decades to quickly obtain whatever information is necessary.

For those who are worried, Watson apparently has no tendencies towards throwing people out of air locks:

“People ask me if this is HAL,” he said, referring to the computer in “2001: A Space Odyssey.” “HAL’s not the focus, the focus is on the computer on ‘Star Trek,’ where you have this intelligent information seek dialog, where you can ask follow-up questions and the computer can look at all the evidence and tries to ask follow-up questions. That’s very cool.”

Or course the fictitious inventors of HAL probably intended to develop a computer to assist the crew as opposed to killing most of them.

Posted in Gadgets, Health Care, Science Fiction. Tags: , . 1 Comment »

Sicko Banned In Cuba To Prevent “Popular Backlash” From Moore’s Inaccuracies (Or Maybe Not, See Updates)

December 18, 2010 — Ron Chusid

Michael Moore’s health care documentary Sicko did a good job of showing the problems of  American health care but unfortunately Moore resorted to Fox standards of truthiness when looking at foreign health care systems. The most blatantly dishonest section of the documentary (as I’ve mentioned previously) was the segment on a Cuban hospital. A  hospital for foreign tourists was shown with the implication that it represented the type of health care available to Cubans. The Guardian reports that, according to WikiLeaks, Cuba banned Sicko out of fear that it  might lead to a “popular backlash” from Cubans who were denied access to the health care portrayed in the movie.

The secret 2008 cable is based on reports from the USINT’s foreign service health practitioner (FSHP) of her conversations with local people, unauthorised visits to Cuban hospitals, and experience of helping USINT American and Cuban personnel access healthcare.

The cable describes a visit made by the FSHP to the Hermanos Ameijeiras hospital in October 2007. Built in 1982, the newly renovated hospital was used in Michael Moore’s film as evidence of the high-quality of healthcare available to all Cubans.

But according to the FSHP, the only way a Cuban can get access to the hospital is through a bribe or contacts inside the hospital administration. “Cubans are reportedly very resentful that the best hospital in Havana is ‘off-limits’ to them,” the memo reveals.

According to the FSHP, a more “accurate” view of the healthcare experience of Cubans can be seen at the Calixto Garcia Hospital. “FSHP believes that if Michael Moore really wanted the ‘same care as local Cubans’, this is where he should have gone,” the cable states.

A 2007 visit by the FSHP to this “dilapidated” hospital, built in the 1800s, was “reminiscent of a scene from some of the poorest countries in the world,” the cable adds.

The memo points out that even the Cuban ruling elite leave Cuba when they need medical care. Fidel Castro, for example, brought in a Spanish doctor during his health crisis in 2006. The vice-minister of health, Abelardo Ramirez, went to France for gastric cancer surgery. The neurosurgeon whoheads CIMEQ [Centro de Investigaciones Médico-Quirúrgicas] hospital – widely regarded as one of the best in Cuba – came to England for eye surgery, returning periodically for checkups

Update: Michael Moore Responds

Writing at his website and Huffington Post, Michael Moore states that Sicko was not banned in Cuba. Moore accuses the diplomat who wrote the previously secret cable of lying. It is certainly possible that  diplomats in Cuba might send home reports which are negative of Cuba but we cannot be certain the author was actually lying. The cable was written January 31, 2008 and Moore reports that Sicko aired in Cuba  on April 25, 2008. The author of the cable might have been lying, but it is also possible that the Cuban government changed their policy after this was written.

Moore did not respond to the real problem with the Cuban segment. He portrayed a Cuban hospital which is used for tourists and diplomats as an example of Cuban health care. Moore only looked at the worst aspects of American health care, which by itself is fine as there are enough problems to necessitate a change. However, when he selectively shows the worst of American health care and an atypical example of Cuban health care he is really not being honest. He also took a selective view of health care in other countries.  This is no better than the reports in the conservative media which highlight the best aspects of American health care while concentrating on (and often exaggerating)  problems in other countries.

Not having been to Cuba and basing my view on what appears to be reports which are not based upon ideology, I get the impression that health care varies tremendously for Cuban citizens. At least it is available to all. Michael Moore’s portrayal is false, but I also believe that the description in the cable  highlights the worst.

Update II: Sicko Was Banned, Maybe

In the above section I questioned whether Michael Moore was right that the diplomat in Cuba lied about Sicko being banned versus this being a change in policy after the report was written. It might have been latter. Ed Morrissey demonstrated this with a simple Google search showing numerous reports of Sicko initially being banned.

However it might not be this simple. Reason found evidence suggesting that there was another reason the story spread that the movie was banned, regardless of whether or not it was:

I may have found the origins of the error. The dissident Cuban doctor Darsi Ferrer Ramírez wrote an editorial in 2007 predicting that the government would censor the film. Some writers outside Cuba misread this as a statement that the film had been banned. I suspect that the author of the cable then heard that version of the story and passed it along.

I was already disappointed in Moore for his erroneous portrayal of the Cuban health care system. Such dishonesty really was not necessary to make the case for needing reform in the United States. I would also think that Moore would be aware of this information showing either that the movie was banned or that there was reason for people to believe it was banned, making it unfair to accuse the original author of the report of intentionally lying.

I am also disappointed in Moore for also being deceitful in his response by citing a World Health Report ranking of Cuba as being just two places behind the United States. This report is ten years old and the World Health Organization has since stopped issuing such rankings, realizing the complexity of such rankings and that they are of questionable validity. Besides, even if true this still would not excuse Moore’s dishonest portrayal of Cuban health care in Sicko.

Posted in Entertainment & Leisure, Health Care, International. Tags: , . 9 Comments »
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