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Friday, 7 March 2014

Princess Health and Princess Health andNew research argues that Alzheimer's disease should rank as third most common cause of death in the U.S..Princessiccia

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Alzheimer's disease may contribute to almost as many deaths in the U.S. as heart disease or cancer, says a recent study published in Neurology.

Alzheimer's is listed as the nation's sixth leading cause of death, far behind the leading causes of death, heart disease and cancer, according to the federal Centers for Disease Control and Prevention. But the study says it should rank third.

Because death certificates provide the information used for these statistics, the overall picture of what causes death is often not told, especially in the elderly. This creates a system of under-reporting the complete reason for the death, lead author of the study Bryan D. James of Rush University Medical Center in Chicago said in Newswise, a research-reporting service.

�The estimates generated by our analysis suggest that deaths from Alzheimer�s disease far exceed the numbers reported by the CDC and those listed on death certificates,�James said.

The study supports contentions of the Alzheimer's Association, which estimates that the disease causes about a third of the deaths in Kentucky. In 2010, 8 percent of Kentuckians age 65 and older, or 80,000, had Alzheimer's, with a projected number of 97,000 in 2025.

The study did annual testing for dementia on 2,566 people ages 65 and older. It found that 559 participants without dementia at the start of the study developed Alzheimer�s. Within eight years of the study, 1,090 participants died. Those diagnosed with Alzheimer's between ages 75 to 84 had a death rate more than four times higher after the diagnosis and people 85 and older nearly three times higher than the whole.

Researchers concluded that More than one-third of all deaths in those 75 and older were caused by Alzheimer's, and that an estimated 503,400 Americans over age 75 in 2010 died from it. That's five to six times higher than the 83,494 number reported by the CDC. That would move the disease from the sixth leading cause of death and to the third; chronic lung disease, stroke and accidents now rank third, fourth and fifth.

Thursday, 6 March 2014

Princess Health and Princess Health andStatewide smoking ban dead for this year, as House Democrats worry about political ramifications in fall elections.Princessiccia

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The sponsor of a bill for a statewide ban on smoking in enclosed public places said it is dead for this year, Tom Loftus reports for The Courier-Journal.

Westrom
"It's dead," Rep. Susan Westrom, D-Lexington, told Loftus. "I've been told that there aren't enough votes and we're just going to have to wait until next year. That came from the governor's office."

Westrom said that after she met last week with Gov. Steve Beshear, who supports a ban, he called House members to get more votes for the bill, but "now the governor is saying that it might be risky for some people if they had to vote on it."

Last week, Westrom said House Speaker Greg Stumbo and other leaders of the House's tenuous Democratic majority were not calling the bill for a floor vote because some members who had told her they would vote for it had told the leaders that they didn't want a vote for fear of political repercussions. Control of the House is up for grabs in this fall's elections.

Stumbo denied that, saying he still supported House Bill 173, but acknowledged, "Others in leadership have problems." But when the bill died, he told The Courier-Journal, "A lot of members that we spoke with � both Democrats and Republicans � didn�t really want to address the issue in an election year. . . . A lot of our members, most of whom live in rural areas, were intimidated by it."

Westrom told Ryan Alessi of cn|2's "Pure Politics" that Beshear told her that Republican votes were contingent on GOP representatives seeing that Democrats were taking the lead to pass the bill as the House voted. �Nobody seemed comfortable with how many Democratic votes would light up the board which would entice the Republicans,� Westrom said.

Princess Health and Princess Health andRural health advocate pleads with legislature to 'end the tobacco epidemic in rural Kentucky'.Princessiccia

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Sen. Julian Carroll, D-Frankfort, looks at a Smoke Free Kentucky
display in the state Capitol. The group added black wreaths after the
smoking-ban bill died. (Courier-Journal photo by Jonathan Palmer)
The day that the bill for a statewide smoking ban died, the Kentucky Rural Health Association published a column in KyForward calling on legislators to "step up to the plate to help us save future generations from the scourge of tobacco use, disease and early death."

Tina McCormick of Henderson, the group's executive director, began her piece this way: "We have an epidemic right here at home and rural Kentuckians are the hardest hit." She added later, "The General Assembly must act now to fix the tobacco epidemic in rural Kentucky. Those of us who live in rural areas start using tobacco at a younger age, we use it more heavily, and we are more likely to breathe secondhand smoke at work and at home than those who live in the cities and suburbs in the commonwealth."

McCormick concluded, "This is a cry for help from rural Kentucky. We are tired of waiting for clean air. The facts are there. We need and want smoke-free air. Let�s make the tobacco epidemic history in rural Kentucky so that our children can expect a long, prosperous and healthy future. Please help us clear the air and end the tobacco epidemic in rural Kentucky." For the full column, click here.

Princess Health and Princess Health andSenate OKs bill to regulate e-cigarettes just like tobacco products.Princessiccia

Princess Health and Princess Health andSenate OKs bill to regulate e-cigarettes just like tobacco products.Princessiccia

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A bill to limit the sale of electronic cigarettes in the same way as sales of tobacco products passed the state Senate on Thursday, March 6. Senate Bill 109, sponsored by Sen. Paul Hornback, R-Shelbyville, would prohibit the sale of e-cigarettes and vaporized nicotine to minors. The vote was 36-2.

The bill now goes to the House. House Bill 309, which would regulate e-cigarettes as tobacco products, was approved by a House committee last month but has been awaiting action on the floor for several weeks.
Princess Health and Princess Health andHouse passes bill creating new type of order for end-of-life care, to be signed by patient and physician.Princessiccia

Princess Health and Princess Health andHouse passes bill creating new type of order for end-of-life care, to be signed by patient and physician.Princessiccia

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An end-of-life order known as �medical order for scope of treatment� would be allowed in Kentucky under a bill that passed the Kentucky House on an 86-7 vote Thursday, March 6.

Unlike advance directives, such orders spell out a patient�s wishes for end-of-life care are also signed by the patient�s physician. A standard form for the orders would be developed by the Kentucky Board of Medical Licensure for use statewide.

�As a physician, I want to help people live and have a quality of life as long as they can,� said Rep. David Watkins, D-Henderson, the sponsor of House Bill 145. �But I sure don�t want to prolong suffering and agony � It�s our duty to make sure we keep our people in the final hours and final days of their life as comfortable as possible, and also to follow their wishes as close to the letter of the law as we can.�

The House defeated, 18-69, an amendment by Rep. Joe Fischer, R-Fort Thomas, that would have prohibited such orders from allowing food and water to be withheld from a patient unless death was �inevitable and imminent.� The bill now goes to the Senate.

Princess Health and Princess Health andPrimary care, a big focus of health reform, faces challenges as Kentucky doctors deal with change.Princessiccia

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Craig Dooley, newly covered by Medicaid under health
reform, got an X-ray in Dr. Sven Jonsson's Baptist Health
office. (Photo by Luke Sharrett for The New York Times)
Primary-care doctors are key to the nation's health by providing preventive care to people who haven't been getting it but are now under federal health reform. However, some independent physicians in Kentucky and other states are struggling to run their businesses due to "flat or dropping reimbursement rates and new federal rules," many related to reform, Abby Goodnough writes for The New York Times. Goodnough's story is the latest in a series lookine at health reform through Kentucky examples.

Dr. Sven Jonsson joined Kentucky's Baptist Health System two years ago after leaving private practice in Louisville, fearing the law's often-expensive requirements. Now he is treating more patients, in the rural exurb of Taylorsville, and Baptist is handling all the details of the transition into the new health-care system.  "This is just a much saner place for me right now," he said. Primary care is more in demand because many states used it to expand Medicaid to people earning up to 138 percent of the poverty line.

Conversely, Dr. Tracy Ragland owns a small private practice in the wealthy suburb of Crestwood, and is concerned about the rules and payments associated with the new system. "The possibility of not being able to survive in a private practice, especially primary care, is very real," she said.

According to the American Medical Association, 40 percent of family doctors and pediatricians are independent. Ragland supports the idea of providing health coverage to more Americans, but says Medicaid and some private plans offered through Kentucky's health-insurance exchange don't pay enough, so she does not treat those patients. She says she values the flexibility of her private practice and the ability to spend as much time with patients as they need.

However, Ragland did join an "accountable care organization," a group of independent physicians who arrange care for a number of patients. "These networks, encouraged by the new law, reap financial rewards if they improve patients' health and spend less doing it," Goodnough notes. Ragland and her associates know that primary-care doctors can receive higher, Medicare-level reimbursements for seeing Medicaid patients, but this only lasts through 2014 and they didn't take the bait.

Doctors who have joined hospitals, like Jonsson, receive a baseline salary with bonuses for extra productivity, but that will probably change because the reform law will base payments on results. When Jonsson owned his own practice, he didn't accept Medicaid. At his new workplace at Baptist Medical Associates, he can treat Medicaid patients because the practice has space to grow, said Donna Ghobadi, an assistant vice president at the hospital.

Recently Kentucky passed a bill that will "give experienced nurse practitioners more leeway to practice independently," Goodnough reports. Ragland went to the state Capitol to ask legislators to give scholarships to medical and nursing students who will practice in under-served areas. "I don't get the emphasis on primary care is so important, but primary care physicians aren't," she said. Lawmakers said they will consider her ideas next year. (Read more)

Here's a video version of Goodnough's story:

Princess Health and The Ultimate Detox: Your Kidneys. Princessiccia

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The specter of unseen, unspecified toxins eroding our health is worth many millions of dollars in the United States and abroad.  Companies offer "detox" supplements, beverages, and creams that supposedly rid us of supposed toxins, despite a complete lack of evidence that these products do anything at all*.  This comes from an industry that excels at creating boogeymen and offering costly solutions for them.

If your wallet needs to lose weight, then these products are highly effective, otherwise it's probably best to save your money.  Here's why.

The body is equipped with an extremely advanced system for excreting toxins.  The kidneys are part of this system, and their design is genius.  The basic functional unit of the kidney is the nephron, and the average kidney contains about a million of them.  Nephrons have two major parts: a renal corpuscle and a renal tubule. 

A nephron.  In this image, the Bowman's capsule and glomerulus make up the renal corpuscle, and the proximal/distal tubules and the loop of Henle (#1-3) make up the renal tubule.  Note the network of blood vessels (capillaries) that allow the transfer of water and other goodies from the tubule back into the blood.  Image source.
The renal corpuscle is the interface between the blood and the fluid that will eventually become urine.  Blood is filtered by a fine "sieve" of cells that prevents everything larger than a small protein from passing into the renal tubule.  Red blood cells, platelets, and most proteins stay on the blood side, while small proteins such as albumin, minerals, urea, glucose, water, and almost anything that would be considered a toxin** are allowed through into the renal tubule.

The renal tubule is a long tube that re-absorbs everything in this filtered blood that the body wants to keep.  Water, minerals, albumin, glucose, amino acids, and other useful molecules are re-absorbed.  Everything else ends up as urine and is excreted. 

Can you see the genius of this design?  Urine is blood, minus all the good stuff.  Everything that isn't specifically recognized by the body as useful is excreted by default, no matter what it is.  The body doesn't have to recognize each of the thousands of foreign compounds that make their way into our circulation each day.  These substances are all out the door, by default.

Are you impressed by your kidneys yet?  If not, consider this.  Your kidneys filter your entire blood volume roughly 70 times per day.  The reason you don't have to pee a liter a minute is that urine volume is reduced by 99 percent due to water reabsorption in the renal tubules.

This is why most drugs have to be taken on a regular basis, often several times per day.  In concert with the detoxification enzymes of the liver, which tend to make drugs easier for the kidneys to excrete, the kidneys rapidly reduce the circulating concentration of drugs simply by excreting everything they don't recognize as useful.

Can a detox product improve upon 500 million years of kidney evolution***?  I have my doubts.


* Exception: chelation therapy offered by a licensed medical practitioner for actual, diagnosed heavy metal poisoning.  Second exception: strategies that use the word "detox" loosely to refer to removing unhealthy foods from the diet.

** Toxins tend to be very small-- either small organic molecules or minerals such as arsenic.  Larger toxins such as proteins are uncommon in the circulation because proteins are generally not absorbed by the digestive tract.  Toxic proteins have to be injected or otherwise directly introduced into the circulation, e.g. by a snake bite or a bacterial infection.  But if you're bitten by a rattlesnake, I hope your first line of treatment won't be a detox kit from your local supplement store.

*** Kidneys are present in hagfish and lampreys, the most "primitive" living vertebrates.
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