From Medicine and Health

Doctors Who Treat Gunshot Victims Tell NRA Why Gun Safety Is Their ‘Highway’

After the NRA said “anti-gun” physicians should stay in their lane, a growing number of doctors join the social media campaign with the hashtag “#ThisIsOurLane,” gaining support from the U.S. Surgeon General Jerome Adams. Other gun violence news looks at a lack of CDC gun studies, a faulty high school active shooter drill and disturbing writings from the Sandy Hook shooter.

Hospital-Acquired Infections Dip, But Experts Say That There’s Still More Work To Do

Experts say there are certain infection types–such as pneumonia or C. diff–that aren’t showing any progress. Meanwhile, health care executives weigh in on what a politically divided Congress will mean to the hospital industry. And other hospital news comes out of Illinois, Florida, Massachusetts, and Texas.

Hospital-Acquired Infections Dip, But Experts Say That There’s Still More Work To Do

Experts say there are certain infection types–such as pneumonia or C. diff–that aren’t showing any progress. Meanwhile, health care executives weigh in on what a politically divided Congress will mean to the hospital industry. And other hospital news comes out of Illinois, Florida, Massachusetts, and Texas.

Young Pa. Mayor’s Fatal Fentanyl Overdose A Snapshot Of Epidemic That Is Still Gripping Nation

Brandon Wentz was only 24 when he had to resign as mayor from a small Pennsylvania town because his family was moving. The day after he wrote his resignation letter, he died of an overdose. Other news on the national drug crisis is reported from Michigan, Wisconsin, Massachusetts, Texas and California.

Young Pa. Mayor’s Fatal Fentanyl Overdose A Snapshot Of Epidemic That Is Still Gripping Nation

Brandon Wentz was only 24 when he had to resign as mayor from a small Pennsylvania town because his family was moving. The day after he wrote his resignation letter, he died of an overdose. Other news on the national drug crisis is reported from Michigan, Wisconsin, Massachusetts, Texas and California.

Need Health Insurance? The Deadline Is Dec. 15

The woman arrived at the University of South Florida’s navigator office in Tampa a few weeks ago with a 40-page document describing a short-term health insurance plan she was considering. She was uncomfortable with what the broker had said about the coverage, she told Jodi Ray, a health insurance navigator who helps people enroll in coverage, and she wanted help understanding it.

The document was confusing, according to Ray, who oversees Covering Florida, the state’s navigator program. It was hard to decipher which services would be covered.

“It was like a bunch of puzzle pieces,” she said.

Encouraged by her wife, the woman eventually opted instead for a marketplace plan with comprehensive benefits.

The annual open-enrollment period for people who buy their own insurance on the Affordable Care Act’s marketplaces ends Dec. 15 in most states. Enrollment in states that use the federal platform has been sluggish this year compared to last. From Nov. 1 through Dec. 1, about 3.2 million people had chosen plans for 2019. Compared with the previous year, that’s about 400,000 fewer, or a drop of just over 11 percent.

The wider availability of short-term plans is one big change that has set this year’s apart from past sign-up periods.

Another is the elimination of the penalty for not having health insurance starting next year. The Congressional Budget Office has estimated that as many as 3 million people who buy their own coverage may give it up when they don’t face a tax penalty.  But experts who have studied health insurance enrollment say that surveys so far indicate that the penalty hasn’t typically been the pivotal factor in people’s decision on whether to buy insurance.

They also caution against reading too much into the preliminary enrollment totals.

“There typically is a surge in enrollment at the end,” said Sabrina Corlette, research professor at Georgetown University’s Center on Health Insurance Reforms. “It’s hard to know whether it will make up for the shortfall.”

If they don’t pick a new plan, people who are enrolled in a 2018 marketplace plan may be automatically re-enrolled in their current plan or another one that is similar when the open-enrollment period ends. About a quarter of people who have marketplace plans are reassigned in this way.

Another factor that may be affecting enrollment is tighter federal funding for the health insurance navigators, like Jodi Ray in Tampa, who guide consumers through the complicated process. With fewer experts available to answer questions and help fill out the enrollment forms, consumers may fall through the cracks.

Across the country, funding for navigators dropped from $36 million in 2017 to $10 million this year. In Florida, federal funding for the Covering Florida navigator program was slashed to $1.25 million this year from $4.9 million last year, Ray said. The program was the only one to receive federal funding in the state this year.

The Covering Florida program reduced the number of open-enrollment navigators to 59 this year, a nearly 61 percent drop, Ray said. Navigators this year are available in only half of Florida counties; the organization is offering telephone assistance and virtual visits to people in counties where they can’t offer in-person help.

“It’s all we can do,” Ray said. So far, the group’s navigators have enrolled about half the number of people this year as they had last year.

It’s unclear the extent to which the Trump administration’s efforts to reduce health care costs by expanding access to short-term plans is affecting marketplace plan enrollment.

These plans, originally designed to cover people who expected to be out of an insurance plan for a short time, such as when they change jobs, can be less expensive. Unlike marketplace plans, short-term plans don’t have to provide comprehensive benefits or guarantee coverage for people who have preexisting medical conditions.

The Obama administration limited short-term plans to a three-month term. But in August, the federal government issued a rule that allowed their sale with initial terms of up to a year, and the option of renewal for up to three years.

Ten states either ban short-term plans or restrict them to terms of less than three months, said Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities.

Many people are seemingly not focused on their options this open-enrollment season, however. According to a recent survey, about half of adults under age 65 who were uninsured or who buy their own coverage said they planned to buy a plan for 2019. But only 24 percent of people in that age group said they knew what the deadline was to enroll in health insurance, according to the Kaiser Family Foundation’s November health tracking poll.

Must-Reads Of The Week On Health Care

Your regular Breeze correspondent, and its creator, Brianna Labuskes, is taking a break, but we didn’t want you to be without some semblance of a report today of things you don’t want to miss in health care.

So I’ll do my best at filling in. Be kind, and check back next week for the really good stuff.

One of the biggest bits of news this week was a coughed-up blot clot from the lung. Not sure why that seemed to fascinate people. We can skip that, but feel free to look.

The Atlantic: Doctors Aren’t Sure How This Even Came Out of a Patient

A more authentic bit of news was the report that health care spending slowed in 2017. It’s still growing, mind you, but growing more slowly. That’s not terribly surprising, because it has been slowing for a number of years. What Dan Diamond over at Politico calls “slowth.” It increased 3.9 percent to $3.5 trillion, while the year before it had grown 4.8 percent. Another way to look at it: Americans spend $10,739 per person on health care. HuffPost had a nice analysis:

HuffPost: America’s Health Care Spending Keeps Rising Really Slowly. Seriously.

Read the full report here.

The New York Times attempts to explain why enrollment in Obamacare is down. Any number of things could factor in, like higher employment at places that offer health insurance, no mandate forcing people to enroll or people signing up for Medicaid. Further study may present an answer.

The New York Times: Why Is Obamacare Enrollment Down?

This week, the Annals of Internal Medicine retracted a 2009 paper by Brian Wasinick, the now-discredited Cornell University researcher. The half-baked paper had claimed that the recipes in the more modern editions of the classic “Joy of Cooking” cookbook had more calories than the original. The always enlightening Retraction Watch website, which tracks medical and scientific research that has been undermined, has the whole story of the delightful sleuthing that led to the debunking. (And while you are on the site, peruse all the other Wasinick papers on food research that have been rescinded.)

Retraction Watch: The Joy of Cooking, Vindicated: Journal Retracts Two More Brian Wansink Papers

One of my favorite writers on health care makes an often overlooked point about health insurance: Its goal ought to be the same as other insurance, that is, to safeguard the financial health of beneficiaries. And Aaron Carroll, who is also a professor of pediatrics at Indiana University School of Medicine, says that several studies show it does exactly that.

Read the whole piece for yourself:

JAMA Forum: Medicaid as a Safeguard for Financial Health

As a bonus on this topic, here is an academic paper surfacing this week on the effects of the Affordable Care Act on mortgage delinquencies. Spoiler: The value of fewer evictions and foreclosures is substantial compared to the cost of the ACA subsidies.

The Effect of Health Insurance on Home Payment Delinquency: Evidence from ACA Marketplace Subsidies

The Commonwealth Fund, a foundation that seeks to improve health care,  wanted to know how the Affordable Care Act affected the uninsured and the insured. As its chart that summarizes its findings issued this week shows, there was considerable movement. The main finding was the number of young adults who switched from Medicaid to individual insurance — and the other direction as well.

The Commonwealth Fund: Who Entered and Exited the Individual Health Insurance Market Before and After the Affordable Care Act?

Commonwealth also conducted a forum on “Being Seriously Ill in America,” which dealt with the financial consequences.

Forbes likes to compile those “30 under 30” lists. (I’ve long wished someone would go back and look at one of those lists from 20 or 25 years ago to see how the luminaries are doing now.) Anyway, it put together a list of people in the health care industry. Most are on the cusp of 30, which might tell you something about how hard it is to get a fast start in the industry. But one person on the honor roll is only 18. In case you were wondering, because I was, Elizabeth Holmes, the founder of the ill-fated Theranos, was on a different “40 under 40” Forbes list in 2014. We hope these folks fare better.

Forbes: 30 Under 30 in Healthcare

This article ran a while back, but I got a kick out of it and just had to mention it. It looked at prehistoric health care. Researchers will never know how much Stone Age dwellers bored their hut mates with discussions of a paleo diet, but they are learning how they performed medical procedures that appeared to have worked.

The Atlantic: Neanderthals Suffered a Lot of Traumatic Injuries. So How Did They Live So Long?

May you survive another whirlwind week of health care news, until next Friday’s breezy recap.

Even When Not In Rome, Eat A Mediterranean Diet To Cut Heart Disease Risk

Once again, your mother was right. You really do need to eat your vegetables. And while you are at it, put down the bacon and pick up the olive oil, because new research supports the contention that switching to a Mediterranean diet could significantly decrease the risk of heart disease.

According to a study published Friday in JAMA Network Open, people who followed this type of diet had 25 percent less risk of developing cardiovascular disease over the course of 12 years.

The diet’s components make sense to anyone who follows nutrition news. Avoid red meat in favor of “good” fats like fish and poultry. Swap out salt for herbs and spices. Ditch butter and margarine and opt for olive oil instead. Most important, eat a lot of fruits and vegetables. Nuts are good, so are whole grains. And, every once in a while, have a glass of red wine.

Since the 1950s, researchers have pointed out this diet’s possible cardiovascular benefits. More recently, it has been credited with addressing any number of ills, including Alzheimer’s disease, asthma and helping pregnant women control factors that lead to high-birth-weight babies and contribute to obesity risk factors as kids grow.

Until Friday’s study, though, no randomized trials had been conducted in the U.S. to determine this diet’s long-term effects. This research also sought to shed light on the molecular underpinnings of why.

The mechanisms by which the Mediterranean diet reduced cardiovascular disease “were sort of a black box,” said Shafqat Ahmad, the lead author of the paper and a researcher in the department of nutrition at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. “We know it reduced cardiovascular risk,” he added, but the precise ways it had this effect over time “are not well understood.”

Ahmad and his co-authors, using a panel of nine biomarkers in blood tests, were able to isolate exactly why the diet reduces heart disease.

The three biggest biological mechanisms were changes in inflammation, blood sugar and body mass index.

Inflammation was the issue for Meg Grigoletti, a 23-year-old graduate student from New Jersey who switched to a Mediterranean diet when she was recovering from back surgery in 2014. Her doctors recommended it to reduce swelling, hoping it would ease the pain in her back and help her migraines.

“It’s more of a lifestyle than a diet,” Grigoletti said. “It taught me what food is good for me and what’s not.”

Researchers followed more than 25,000 women who were part of the Women’s Health Study, a survey of female health professionals older than 45. At the beginning of the study, participants completed a questionnaire on 131 different foods to assess their diets. They were then assigned different “MED scores” on a scale of 1 to 9, based on how closely they followed the Mediterranean diet.

There were three levels, people who scored between zero and 3 were on the low end, 4 to 5 was in the middle and 6 and up was categorized as a high intake of Mediterranean diet foods.

The participants’ cardiovascular health was then tracked for 12 years.

When all was said and done, those in the middle category saw a 23 percent reduction in risk, and the upper category had 28 percent less risk of cardiovascular disease.

Heart disease is the leading cause of death for both men and women, according to the Centers for Disease Control and Prevention — claiming about 600,000 lives each year. Coronary heart disease is the most common form, killing more than 370,000 people annually. Each year, about 735,000 Americans have a heart attack.

The authors pointed out that these findings do have limitations. For instance, the study relied on self-reported data, which isn’t always accurate — especially when it involves diet choices. The participants, all of whom were female health professionals, also might lean toward healthier behaviors than the rest of the population.

The results of the study weren’t a shock to Dr. Andrew Freeman, the director of cardiovascular prevention and wellness at National Jewish Health hospital in Denver. He wasn’t involved in the study but has been recommending a Mediterranean diet, or a similar version of it that emphasizes vegetables and fruit, to his patients for years.

“There’s a lot of noise out there, but the signal that’s been out there the longest is this kind of plant-based diet is the best.”

He also acknowledged that there is a lot of competing nutritional information swirling around the airwaves and the internet, which amounts to “a whole lot of hype” that makes healthy eating habits a difficult regimen for many consumers.

And doctors often don’t have clear information, either. “The vast majority of cardiologists and health providers in general have very little nutrition training,” Freeman said.

He switched to a mostly plant-based diet after his residency, and lost 35 pounds. He now recommends this approach to his patients, too. He said he has seen his patients’ conditions — heart disease, high blood pressure and diabetes — improve.

“Nutrition and lifestyle medicine is the place where there’s a chance of a cure,” Freeman said.