Health Center | The current conditions without health insurance has become possible after the 2010 health reform

The recent reform of the U.S. global health is the hottest topic in the city today. This reform will bring American families and individuals more control over their health.

Here are some important changes will be institutionalized after the reform of health care:

1st The increase in the provision of health services $ 995,000,000 for community health centers provide more support in disadvantaged areas. Some of the funds for scholarships for minority health diversity. This is a good opportunity for the training of doctors, nurses, doctors, or continue to contribute to the health sector.

Second. increased premium subsidies for low-income families work and reform of Medicare costs, so that it more accessible to wider society. This will protect low-income households from the high debt in relation to the growth of health spending, while the same as themself to receive medical care.

3rd And offer 'mandatory for companies, health insurance for their employees, while the size of more than 50 This is one of the strategies to protect workers' health insurance, "but the change of employer.

4th Increased tax credits for health insurance for low income families. It also helps to improve the sharing of costs for low-income households and individuals. In this position, the cost of premiums for people on lower incomes will be low, while those with high income range, their prices remain a premium or higher than before.

5th The last one in 2010 is the health care reform to the health benefits of eliminating these overcome that pre-existing conditions:

    * The reform of all Americans to enjoy the same benefits as health care reform the same way. This ensures equality in society, as well as reduce the number of uninsured as possible.
    * Before the reform of patients with underlying medical conditions were largely discriminated against by health insurance. Recent reforms of the disease, prohibited discrimination based insurer to deny or reject an insurance for people with underlying medical conditions.

In general, a key objective of the reform Wen's number of uninsured Americans who are now at high cost in health care and exposed to expensive to reduce costs. We hope that this reform will help to increase the awareness of healthcare in the American society in order to ensure for instance, to create a stronger and healthier community a strong nation.

Health Center | What will change health

Sunday, passed March 21, 2010, the U.S. Congress bill landmark health. Was not adopted in the usual manner in which the House and the Senate version gives his version, which later merged with the 2 to compromise re-elected to both houses and then to the president for his signature and to the right.

This is a known fact that Republicans took their instructions from the health insurance funds, which are largely to finance his campaign, and that the bill of health does not want. The change means that they have millions of healthy people in the periphery, as with health records (medical history) insurance.

Once a place in the Senate without change. Health Services Act was that the president signed on Tuesday, 03.23.

To fulfill the promises to the house of legislators, reconciliation of the most important health care bill takes the first passed by the Senate, and then into the house. Republicans have proposed 40 amendments to the bill in the last desperate attempt to bill enough to the house again to change the power to vote, but Democrats rejected all constantly changing.
At the end of the Republicans voted against the reconciliation, the threat to take the issue of their campaign to win enough seats to take off health.

Every year in November, the whole house and one third of the Senate elected. Many of the amendments the Republicans especially for items that revolves around the blades can last for re-election of Democratic legislators uncomfortable.

The main direction of reform legislation in the field of health care:

- New Consumer Protection for the authorities' refusal to cover the existing conditions (in force for adults was established in 2014, but the children in 2010). Currently, uninsured adults with pre-existing conditions for a minimum of 6 months, the temporary pool at high risk, financed by insurance premiums (as at June 2010) on the site.
- Limits on coverage of life have been eliminated (effective 2010).
- The roof is made of a sick prohibited.
- Comprehensive insurance for children under their parents plan Age 26 (September 2010).
- People aged under 30 without insurance coverage can have catastrophic consequences for health, to close the bag.
- Medical Insurance Exchange (effective 2014) will meet the minimum requirements.
- New guidelines issued after September 2010, includes all visits to board and demonstrations.
- Companies with fewer than 25 employees are entitled to receive compensation in the form of taxes 35 percent of insurance premiums of health insurance.
- Employer health insurance costs for employees to identify the W-2 (2011)
Medicare Part D drug benefit recipients who fall under the coverage gap ("donut hole"), a bonus of $ 250 in 2010. Since 2011 they will receive a 50% discount on brand-name drugs to fill the void in 2020.
- Medicaid will be expanded to provide approximately 16 million people with incomes up to third above the poverty line, the poverty line, including adults without dependent children. community health centers receive more money.
- Fellowships, which will be in the next 10 years with low and middle income countries without the health benefits that employers buy about 32,000,000 uninsured medical insurance plans for trade.
- Medical expenses tax threshold increased to 10% of adjusted gross income (effective 2013). Seniors (65 years) will have a detailed derivation of the current level of 7,5% (2016 in accordance with the requirements).
- New rules for health care costs have remained unchanged for three years. The limit of $ 2500 in contributions (in the cost of living adjustments), it is likely to come into force in 2013.
- Health savings account penalties on withdrawals for qualified medical expenses of 20% (effective 2011).
- All citizens and legal residents must have health insurance will be. Scholarships on the head four times the poverty line.
- Fines imposed on those who decline health insurance (2014) more than $ 95, or 1% of revenues, an increase of $ 695 or 2,5% of revenues (2016).
- For people with incomes over $ 200,000 and couples earning more than $ 250,000 in Medicare taxes on the increase over the next two years at 2.35%. The new tax is 3.8% will be applied to Medicare income (including interest, dividends and capital gains), that these thresholds.
taxed, -) for work on "Cadillac" plans (annual premiums of more than $ 10,200 for individuals or families for $ 27,500, administrators plan to 40 percent (due in the coming years). limit is higher for high-risk jobs and retirees.

Health Center | How Medicare Advantage reform has an impact in 2010?

In the final statement for health care, Medicare beneficiaries in 2010 will be amended and the earlier effects.

What is being proposed? Currently, bills the House and Senate plans, the following changes to Medicare Advantage Plan for 2010:

    * Remove the Open Enrollment period 01/1-3/31 2011th If this is approved, Medicare beneficiaries have a chance of a change in Medicare coverage during the annual election period each year, from 11.01 bis 12.15 clock.
    * The payment to the company plan, about 5% cut in 2011 compared to the year 2010 expected budget cuts and will probably also for those involved in the plans for free. It is that very little or nothing "zero premium" is offered likely Advantage plans in 2011.

Centers of Medicare and Medicaid Services (CMS), recently on the plans in 2010. On average, Medicare beneficiaries can choose from more than 30 Medicare Advantage plans to choose in 2010 to choose a few to up to 73 different programs in their area. A combination of plans is scheduled to air carriers in response to changes in progress in the program to change.

Taken from the market companies continue to offer coordinated care PFFS plans (mostly HMOs) and new plans of various kinds. Some companies, like Kaiser Permanente, the changes to their offerings in 2010. Kaiser Permanente and will continue to cost, but the HMO plans offered.

MA-PD members have fewer plans that no bonus in 2010 compared to 2009, remain in their plans. However, not necessarily the best value plan premiums for the members due to the out-of-pocket costs will be influenced by a combination of premiums, benefits and cost sharing requirements.

Recipients who can be expected in the same Medicare Advantage plan in 2010 premium increases on average 32 percent choose to remain, although the amount of increase is determined from plan to plan all.
Therefore, you can find in their social assistance recipients for their choice of research and compare health insurance, taking into account the premiums, benefits, cost sharing, and networks of providers, the choice is likely, individual needs and circumstances.

For more information on the proposed changes, you can get additional coverage for medical care, and benefits from Medicare plans available in comparison to you, Medicare Advantage, visit my 2010th

Health Center | Student Health Center, Bill entered the insurance business plan

College health centers face significant costs in providing assistance and reduce their budgets, many of which health administrators need to talk outside the box to expand the budget and high quality patient care, consider their students. As a result, more jobs, and college administrators and health professionals for their commercial insurance programs.

"Community health centers are in many public buildings will be used up to 100 percent of their annual budgets, but times change, said:" Jennifer rabbit, director of University Health Services at the University of Maryland - Baltimore County.

BC) Student Health Center, one of hundreds of countries through the reduction of the budget is concerned. Health centers in schools can be a number of funds received by students is not sufficient to Affect the health insurance plan, but the benefits of these programs - some companies offer unique value of the Contact Group for the students at the University of cover - usually behind the health budget.

It was "our problem is the reform program of group insurance that was enough to voluntarily register their interest is not, says:" Western Kentucky University Health Services Director Greaney Libya. "Those that accept wku solution for commercial security and file claims.

Wku start billing the insurance company in 2001, the costs of health insurance for students are cut from last year.

"If you, doctor and accredited certificate, They are just like those involved in Establish. Provide patients with a network of community programs that will see the wellness center will be accepted. If Properly balanced, improve services net sales to increase."

According to Greaney, schools increasingly open to trade to benefit their health, taking the same approach is wku.

"People are starting to see necessary. They talk about it and resolve," he said. 'The idea that school safety can be displayed are old school if you do not accept the concept. "

"Increasingly, senior vice presidents of the universities about this practice and give guidance on its medical centers felt. I call the health center staff is on the driver's seat."

Greaney, but also to recognize the mystery is natural. While accepting the extra income from commercial carriers, Open University medical centers, may also affect access to health care. The fact is that every student is not registered in schools are covered by insurance. Students without coverage or go without care, or pocket medical expenses are always more expensive each year you pay.

American College Health Association and some states require insurance health colleges and universities to provide all students, some schools offer many options.

Therefore, the rabbit and her personal work, BC), decides to health plans for students and insurance programs to commercial airlines.

"If the goal is to cover for each student, you can get two options, said" rabbit. "School programs are less expensive for the people, but we found that many young parents today of a security covered, while those of 23 years. This means that many students under is through private institutions, and it seems reasonable that if they come to see us and insurance can be obtained. "

University of Utah in Salt Lake City is another example of a community center for health, the billing for commercial insurance companies, insurance and students through university found traditional win situation for both students and Health Care Center.

"By offering both options, but our pool or a student with an average of your insurance with us, but we also affordable and convenient for students to ensure that the state of network privileges or excess payment, said: Tiffany Smith, office manager / patient representative at the University of Utah in Salt Lake City Health Center, where about 7,000 students each year attracts. "When the insurance business, we process easier for our students, patients, and we are the future."

And when he returned, it means extra income for the community health center.

Despite the overwhelming approval of commercial insurance companies, Greaney offers some advice to other health center managers, who are given:

"You start small and use existing resources," he said. "Those with experience of both the Academy of Health or in society."

Health Center | Natural Health Center - Living Well and training

Looking for a Natural Health Center (s) in the U.S. and Canada. The center of natural medicine, natural treatments to cure anyone, and can also acquire knowledge of the various natural resources now available. When you do your first trip to the Natural Health Center, or go to make back for more information on the health insurance are innovative learning, you sure to be admired some of the old and new, additional products are offered.

For example, a center for natural health that the development of preventive medicine and promoting health through natural medicine. Some of the many arts of handling stolen goods and services of each health center include naturopathy, acupuncture and oriental medicine, herbs, essential oils and supplements, Bach flower remedies, chiropractic and massage, including the corresponding mechanisms.

Natural Health Center offers chiropractic often helps patients to know and understand the various aspects of the treatment. Normal visit to the center of chiropractic with the natural synthesis of information on chiropractic, what philosophy and the patient. Most doctors of chiropractic (DC) in the center of natural health that patients be informed about various conditions, including the "disease" and "subluxation". In addition to having X-rays find the vertebral subluxations MS, often to help patients to the health center for physics classes back in the public schools, welcome for more information about the handbook to study medicine. Sometimes other natural therapies such as chiropractic services, massage, counseling and natural nutrients.

Natural Wellness Center for Health Services strict, such as massage, aromatherapy and beauty is attractive to spectators at Day Spa, to the look and feel younger and healthier want. Massage Therapy for Natural Day Spa and is often combined with essential oils and aromatherapy, facials and herbal wraps. People who visit the centers of the natural health, how often a natural medicine and skin care products such as herbal medicines, vitamins, supplements, lotions and oils.

In the Eastern Health Center of natural medicine, the patients learn the different methods and the philosophy of TCM (Traditional Chinese Medicine), such as acupuncture and herbs in Chinese medicine can be recommended to be delivered. In some cases, to treat a doctor of oriental medicine patients with burns, bloodshed, Tai Chi, Tuina (Chinese medical massage) and Qi Gong and other related techniques.

Iris diagnosis and herbs often work together in the middle of the natural health, where the analysis to the eye health study, the pH balance and kinesiology. Customers who learn fast, some indicators and benchmarks in the iris may be a breach of health and the environment. Herbs and additional requirements are often used for therapeutic treatment is recommended.

Despite the variety of holistic spa and wellness clinics in the U.S. and Canada can be sure that one trip to a natural health center, non-invasive, and education. In most cases, patients and customers to visit a health center, a natural feeling of well being and a better understanding of these often give field of integrative medicine misunderstood.

If you (or someone you know) are in the search for natural health center (s interested) and schools of natural healing can, vocational training in fast-growing industries like massage, acupuncture, oriental medicine, cosmetology, Reiki and other start! Explore career school programs near you.

The importance of praciticing

Tai Chi, Kung Fu, Bagua, and Xing Yi are all part of the Chinese martial arts. Kung Fu is an external art and is divided mainly into Northern and Southern styles. Tai Chi, Bagua, Xing Yi are internal arts. In order to master the Chinese martial arts, the most important thing to do is practice.

In our western society, we tend to always be in a hurry to learn, and to talk a lot on different philosophies especially with the Chinese martial arts. Chinese culture within the martial arts is a takes a total opposite look. When a student wants to learn Tai Chi for example the student will go to the park where a class is being held and the master will just tell the student to follow. There is no talking involved. Many Chinese masters in the martial arts have always emphasized about the practicing. Through the practicing of Chinese martial arts such as Tai Chi, then one can discover the philosophy of Tai Chi. There is a Taoist philosophy called Wu Wei which is the action within inaction or to say let the natural course of things happen and you will be successful. You can say when you practice Chinese martial arts naturally and diligently then your Kung Fu will naturally deepen and you will understand the philosophy.

The important thing to always practice is the basics. One Chinese doctor has his famous quote of saying the mastery of anything is the mastery of the basics. We should always practice the basics. The basics will help you to become stronger and develop naturally your Kung Fu.

Practicing diligently is the most important aspect of Chinese martial arts. The old masters in history would always emphasize practicing. Master Lu does the same. Many students want to learn the secrets or go deeper, and Master Lu will always say practice. Through the physical practice, the philosophy and so called secrets will manifest.

All are welcome to come and try out our Tai Chi and Kung Fu classes anytime. If you have been here before we welcome you back. Hope to see you soon.

Master Lu Health Center
www.luhealthcenter.com
3220 South State Street
Salt Lake City, UT 84115
(801) 463-1101

You Healthy Life Solution

Life with a healthy body is the greatest gift that a human can give thanks to. With a healthy body you can move everywhere since you have good stamina to do all the activities. Life healthy means that there are no diseases or illnesses that live inside your body.

If you want to have strong body without any diseases, you must consume balanced nutrient and vitamins every day. People think eating vegetables and much fruits are enough to fulfill their nutrition needs. But, actually they are wrong. Even you eat them every day, it only fulfill 30% of the total nutrition needs. To get 100% full nutrition you can consume Herbalife products.

This company works to provide natural nutrition that is safe to consume every day. Herbalife products consists of many types, such as skin care, fat burner, cholesterol lowering pills, etc. To get complete information, you can visit Sundkost.herbalife dk.

Key To Preventing Suicides : Male Desire To Be Strong And Protect Family

Masculine ideals of strength coupled with strong loved ones ties can assist men combat depression and overcome thoughts of suicide, according to University of British Columbia study.

In a research to appear in a forthcoming issue of Social Science and Medicine, UBC researchers John Oliffe and John Ogrodniczuk looked at how men's ideas of masculinity served or hindered them during bouts of severe depression. Their findings shed light on risk factors and prevention strategies for suicide.

The authors analyzed qualitative data from interviews with 38 guys between 24 and 50 years of age living in Vancouver and Prince George. The participants were self-identified or were formally diagnosed with depression.

The analyze suggests that males can finest counter suicidal thoughts by connecting with other people - namely intimate partners and loved ones - to regain some stability and to secure emotional help from other people.

"Support from friends and connecting to other things including spirituality is often the conduit to men seeking professional help to overcome the suicidal thoughts that can accompany severe depression" says lead author Oliffe, an associate professor in the School of Nursing.

Men die by suicide at least three times more than ladies even though it's ladies who are diagnosed at twice the rate of men for depression. Guys aged 20-29 have the highest rate of suicide. Statistics Canada reports that in 2003, the last year for which data is obtainable, more than 2,900 guys committed suicide.

The investigators found that most study participants expressed a strong commitment to their families and turned away from suicide for the hurt and trauma it would cause loved ones.

"Here, men's strong sense of masculine roles and responsibility as a provider and protector enables men to hold on while seeking support to regain some self-control," says Oliffe.

But Ogrodniczuk says the "stoic warrior" ideal also presents a downside that may lead guys to shut down and look for escape. In these situations, analyze participants chose to mute their feelings or disconnect from others. They usually overused alcohol and other drugs.

"Instead of finding respite from their emotional, mental and physical pain, self-harm emerged as the most common outcome of these actions," says Ogrodniczuk, an associate professor in the Dept. of Psychiatry

The analyze received assistance from the Canadian Institutes of Health Study (CIHR)

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Sexual Trauma Might Spark Mental Health Problems

Traumatic sexual incidents may cause serious mental health problems inside the years after the events, investigation at the University of Ulster has shown.

Using a distinctive investigative approach, researchers on the University's Psychology Research Institute examined the mental health of women who had visited rape crisis centres and it showed that sexual trauma plays a role in the development of psychotic disorders such as schizophrenia.

The propensity for trauma victims to move away from the region in which the traumatic incident took location thus disrupting their social support networks might also expose them to further mental health risks.

Outcomes with the analysis have recently been published within the prestigious journal Schizophrenia Bulletin.

The collaborative analyze saw the University of Ulster link up while using University of Southern Denmark to examine the information gathered from the Danish Civil Registration System (CRS), which is really a database of official details held on Danish citizens since 1968.

Professor Mark Shevlin, from Ulster's School of Psychology, said that using the CRS was a distinctive sort of investigation by no means undertaken in this area just before.

Professor Shevlin said: "Trauma research is fraught with methodological difficulties. The use of the CRS has allowed us to conduct case-control prospective studies in a very efficient way. Our most recent study identified an association between rape and subsequent diagnosis of a psychotic disorder over a 10-year period. This study would have been virtually impossible without the use of CRS data."

Professor Shevlin has been working alongside Professor Ask Elklit in the University of Southern Denmark, and he mentioned that the investigation has essential implications on treatment and developing therapies for those with schizophrenia.

Professor Elklit said: "The CRS provides researchers with information on a large number of variables related to physical and psychological health, education, employment, income, and housing. Collaborating with Ulster has provided us with the skills and expertise to link separate databases and conduct statistical analyses to help answer important psychological questions.

"For example, this has allowed us to identify social factors that increase the risk of rape or sexual victimization, and estimate the costs in terms of physical and psychological problems."

Professors Elklit and Shevlin are planning to continue and extend their CRS research. They have commenced a project that aims to model multiple traumatic childhood experiences and subsequent psychological and behavioural problems.

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Record Reveals Substance Abuse And Mental Illness Issue Information In Each US State

A new report providing state-by-state analyses of substance abuse and mental illness patterns reveals that despite broad variations amongst the states inside the sorts and levels of behavioral health problems they encounter -- every state suffers from these difficulties. As an example, amongst those aged 12 and older, Iowa had less than a single third the current illicit drug use rate of Rhode Island (4.1 % vs. 13.3 percent) - yet Iowa's population aged 12 and older was among the group of states with the nation's highest levels of individuals participating in binge drinking in the past month (27.2 %).

The statement gives talk about public health authorities and service providers with useful details on a wide range of substance use and mental illness issues affecting their states. The report is component of SAMHSA's strategic initiative on information, outcomes, and quality - an effort to inform policy makers and support providers on the nature and scope of behavioral health concerns.

Among the report's other notable findings:

• Cigarette use by adolescents has decreased in 35 states since 2002 -- no increases in cigarette smoking were observed in any state during this period.
• Minnesota had the nation's highest rate of past year dependence on, or abuse of, alcohol among those age 12 or older (10 percent), while Kentucky had the lowest (5.7 percent).
• Nine of the ten states having the highest levels of past month illicit drug use among persons age 12 or older also had the highest levels of past month marijuana use (in alphabetical order -- Alaska, Colorado, District of Columbia, Montana, New Hampshire, Oregon, Rhode Island, Vermont and Washington).
• Thirteen states showed significant declines in past year cocaine use among persons age 12 or older from 2006-2007 (in alphabetical order -- Alabama, Florida, Georgia, Iowa, Kansas, Massachusetts, Nebraska, New Mexico, Ohio, Oklahoma, South Dakota, Utah and Wyoming).
• Wyoming had the nation's highest rate of adolescents aged 12 to 17 experiencing a major depressive episode in the past year (10.0 percent) while Maryland had the lowest (7.0 percent).

"This report provides valuable insight into the exact nature and scope of the behavioral health problems affecting each state, and should help state public health authorities determine the most effective ways of addressing them," said SAMHSA Administrator Pamela S. Hyde, J.D. "These findings remind us that reducing the impact of substance abuse and mental illness is a national challenge and as we work to reform health care behavioral health services are part of the solution in every state."

The report was developed by the Substance Abuse and Mental Health Services Administration based on the 2007 and 2008 National Surveys on Drug Use and Health (NSDUH). Using data drawn from interviews with 136,606 persons from throughout the country the report provides a state-by-state breakdown along 22 different measures of substance abuse and mental health problems including illicit drug use, binge drinking, alcohol and illicit drug dependence, tobacco use, and major depressive episode. The full report is available online at http://oas.samhsa.gov/2k8state/toc.cfm.

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Initial Study To Show That Highly Variable Sleep Schedules Predict Elevated Suicide Risk

Highly variable sleep schedules predict an elevated threat for suicide independent of depression in actively suicidal young adults, according to a investigation abstract presented Tuesday, June 8, 2010, in San Antonio, Texas, at SLEEP 2010, the 24th annual meeting of the Associated Professional Sleep Societies LLC.

Results indicate that a sample of actively suicidal undergraduate students had a delayed mean bedtime of 2:08 a.m.; restricted total sleep time of 6.3 hours; and very variable sleep schedules, with time of mean sleep onset different by three several hours and time of sleep offset different by 2.8 several hours. Nonetheless, accounting for baseline depression severity, sleep variability was the only sleep measurement to individually predict increases in suicidal risk at one week and three weeks. Sleep irregularity also was the only sleep-related variable to predict greater mood lability, which in turn predicted elevated suicidal symptoms.

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Chinese Medicine and Weight Loss

Obesity and overweight in the past few years has become a major health concern not only among adults but also among children. Roughly around two thirds of the US population is overweight. There are many different major health conditions that can come as a result of being overweight. Some of the major health conditions include diabetes, hypertension, thyroid problems, and even cancer. Many people who are overweight also tend to have joint problems and low back pain. There can be many factors that relate to weight such as genetic factors, lack of exercise and improper diet. The main cause of weight gain in the body is an imbalance of energy within the body. When the body is not burning off the calories that it gains then it will be easier to gain weight. How do we solve or manage this problem? One method of weight management has been used for over two thousand years. Chinese medicine is an effective method for the treatment of weight loss and obesity.

Chinese medical view of overweight is different than the western medical view. According to Chinese medicine the main cause of weight gain in the body is an excess of what we call turbid phlegm and dampness in the body. How does this phlegm or dampness in the body come about? Some of the causes of phelgm and dampness can occur when one has lack of exercise, stress, improper diet, and insufficient qi. All of these factors can affect the spleen and stomach causing and excess of phlegm and dampness in the body.

Chinese medicine uses acupuncture, herbs, and exercise to help manage weight. Utilizing these modalities will help increase the metabolism and reduce the appetite. Though acupuncture and herbs are effective, one must still exercise. Exercise is an essential part of weight loss in Chinese medicine. Exercise will not only help burn off calories, but also reduce your stress and improve metabolism.

Chinese medicine is effective for weight management. For more information about how you can start a weight loss program using Chinese medicine please give us a call at (801) 463-1101.
You can also visit us at www.luhealthcenter.com

Call us for you free consultation!

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Nature has supplied the greatest options for you. It gives you the most excellent things in life that can maintain your health. Produits.herbalifefrance.fr has the best suggestion that you should include in your life. Here, you can get Herbalife products that will help you out to keep you healthy. The products are created from all natural supplies. It gives excellent nutrition to your body that will keep you strong and fit to carry out your activities on a daily basis.

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Choose Herbalife for Herbal Product

There is a lot of health product that use to maintain the stamina. People can easily find many companies which produces the health product. However, it is better not to use the chemical health product and only use the natural or herbal health product because is made from the herbal plants or other natural ingredients.

One of the high quality herbal health products is Herbalife. The entire Herbalife product is made from fresh herbal plants that will safe and there will be no side effect. The natural ingredients on the product do not contain the chemical ingredients and dangerous ingredients. One of the natural health products which the company produces is the food supplement. The food supplement product contains a lot of nutrition and vitamin that will perfectly protect the body from disease. The product is also suitable to support the weight loss program.

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What is Asperger's Syndrome?

Asperger's syndrome, also called Asperger's disorder, is a type of pervasive development disorder (PDD). PDDs are a group of conditions that involve delays in the development of many basic skills, most notably the ability to socialize with others, to communicate, and to use imagination.

Although Asperger's syndrome is similar in some ways to autism -- another, more severe type of PDD -- there are some important differences. Children with Asperger's syndrome typically function better than do those with autism. In addition, children with Asperger's syndrome generally have normal intelligence and near-normal language development, although they may develop problems communicating as they get older.

Asperger's syndrome was named for the Austrian doctor, Hans Asperger, who first described the disorder in 1944. However, Asperger's syndrome was not recognized as a unique disorder until much later.

What Are the Symptoms of Asperger's Syndrome?

The symptoms of Asperger's syndrome vary and can range from mild to severe. Common symptoms include:

• Problems with social skills: Children with Asperger's syndrome generally have difficulty interacting with others and often are awkward in social situations. They generally do not make friends easily.
• Eccentric or repetitive behaviors: Children with this condition may develop odd, repetitive movements, such as hand wringing or finger twisting.
• Unusual preoccupations or rituals: A child with Asperger's syndrome may develop rituals that he or she refuses to alter, such as getting dressed in a specific order.
• Communication difficulties: People with Asperger's syndrome may not make eye contact when speaking with someone. They may have trouble using facial expressions and gestures, and understanding body language. They also tend to have problems understanding language in context.
• Limited range of interests: A child with Asperger's syndrome may develop an intense, almost obsessive, interest in a few areas, such as sports schedules, weather, or maps.
• Coordination problems: The movements of children with Asperger's syndrome may seem clumsy or awkward.
• Skilled or talented: Many children with Asperger's syndrome are exceptionally talented or skilled in a particular area, such as music or math.
  

What Causes Asperger's Syndrome?

The exact cause of Asperger's syndrome is not known. However, the fact that it tends to run in families suggests that a tendency to develop the disorder may be inherited (passed on from parent to child).

How Common Is Asperger's Syndrome?

Asperger's syndrome has only recently been recognized as a unique disorder. For that reason, the exact number of people with the disorder is unknown, although it is more common than autism. Estimates suggest Asperger's syndrome affects from 0.024% to 0.36% of children. It is more common in males than in females, and usually is first diagnosed in children between the ages of 2 and 6 years.

How Is Asperger's Syndrome Diagnosed?

If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical exam. Although there are no tests for Asperger's syndrome, the doctor may use various tests -- such as X-rays and blood tests -- to determine if there is a physical disorder causing the symptoms.

If no physical disorder is found, the child may be referred to a specialist in childhood development disorders, such as a child and adolescent psychiatrist or psychologist, pediatric neurologist, developmental pediatrician, or another health professional who is specially trained to diagnose and treat Asperger's syndrome. The doctor bases his or her diagnosis on the child's level of development, and the doctor's observation of the child's speech and behavior, including his or her play and ability to socialize with others. The doctor often seeks input from the child's parents, teachers, and other adults who are familiar with the child's symptoms.

How Is Asperger's Syndrome Treated?

There currently is no cure for Asperger's syndrome, but treatment may improve functioning and reduce undesirable behaviors. Treatment may include a combination of the following:

• Special education: Education that is structured to meet the child's unique educational needs.
• Behavior modification: This includes strategies for supporting positive behavior and decreasing problem behavior by the child.
• Speech, physical, or occupational therapy: These therapies are designed to increase the child's functional abilities.
• Medication : There are no medications to treat Asperger's syndrome itself, but drugs may be used to treat specific symptoms, such as anxiety, depression, hyperactivity, and obsessive-compulsive behavior.
  

What Is the Outlook for People With Asperger's Syndrome?

Children with Asperger's syndrome are at risk for developing other mental illnesses, such as depression, ADHD, schizophrenia, and obsessive-compulsive disorder. But, there are various treatment options available for these conditions.

Because the level of intelligence often is average or higher than average, many people with Asperger's syndrome are able to function very well. They may, however, continue to have problems socializing with others through adulthood.
Can Asperger's Syndrome Be Prevented?

Asperger's syndrome cannot be prevented or cured. However, early diagnosis and treatment can improve function and quality of life.

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Full-fat Dairy for Cardiovascular Health

I just saw a paper in the AJCN titled "Dairy consumption and patterns of mortality of
Australian adults". It's a prospective study with a 15-year follow-up period. Here's a quote from the abstract:

There was no consistent and significant association between total dairy intake and total or cause-specific mortality. However, compared with those with the lowest intake of full-fat dairy, participants with the highest intake (median intake 339 g/day) had reduced death due to CVD (HR: 0.31; 95% confidence interval (CI): 0.12–0.79; P for trend = 0.04) after adjustment for calcium intake and other confounders. Intakes of low-fat dairy, specific dairy foods, calcium and vitamin D showed no consistent associations.

People who ate the most full-fat dairy had a 69% lower risk of cardiovascular death than those who ate the least. Otherwise stated, people who mostly avoided dairy or consumed low-fat dairy had more than three times the risk of dying of coronary heart disease or stroke than people who ate the most full-fat diary.

Contrary to popular belief, full-fat dairy, including milk, butter and cheese, has never been convincingly linked to cardiovascular disease. In fact, it has rather consistently been linked to a lower risk, particularly for stroke. What has been linked to cardiovascular disease is milk fat's replacement, margarine. In the Rotterdam study, high vitamin K2 intake was linked to a lower risk of fatal heart attack, aortic calcification and all-cause mortality. Most of the K2 came from full-fat cheese. In my opinion, artisanal cheese and butter made from pasture-fed milk are the ultimate dairy foods.

From a 2005 literature review on milk and cardiovascular disease in the EJCN:

In total, 10 studies were identified. Their results show a high degree of consistency in the reported risk for heart disease and stroke, all but one study suggesting a relative risk of less than one in subjects with the highest intakes of milk.

...the studies, taken together, suggest that milk drinking may be associated with a small but worthwhile reduction in heart disease and stroke risk.

...All the cohort studies in the present review had, however, been set up at times when reduced-fat milks were unavailable, or scarce.

The fat is where the vitamins A, K2, E and D are. The fat is where the medium-chain triglycerides, butyric acid and omega-3 fatty acids are. The fat is where the conjugated linoleic acid is. So the next time someone admonishes you to reduce your dairy fat intake, what are you going to tell them??

Everybody's Doing It - Health Care Leaders Appeal to Common Practice

There were two examples in the recent news about how health care leaders employ logical fallacies to advance their positions.

Caritas Christi / Cerberus

We posted recently about the proposed takeover of the not-for-profit Caritas Christi hospital system by the Cerberus Capital Management private equity firm. We proposed skepticism about the idea. For-profit hospitals have not been shown to provide better, cheaper, or more accessible care than not-for-profit hospitals. There is reason to worry that a private-equity firm would put margin ahead of mission. The Boston Herald interviewed Dr Ralph de la Toree, the current CEO of Caritas Christi, who would continue to run the health system after the takeover. Asked about the role of Cerberus,

De la Torre dismissed concerns that Cerberus’ executives - and their investments - may not jibe with Caritas’ social justice mission.

Cerberus investor J. Ezra Merkin, for example, is facing civil fraud charges because of his ties to disgraced money manager Bernard Madoff. Besides its failed Chrysler investment, Cerberus has also invested in companies, such as gunmaker Remington Arms, that some Catholics may not support.

De la Torre admitted Cerberus has a diverse portfolio and said most boards of local nonprofits have members who have made their money through questionable means.

The last sentence is a good example of the appeal to common practice. Basically, the logical fallacy is that because many do it, doing it must be good.

Although we are often critical of the cronyism of boards of for-profit corporations and not-for profit organizations, even I would not go so far as to suggest that most boards include people who have made money unethically. Regardless of the prevalence of this pheonomenon, however, boards of health care organizations should be composed of people of integrity and honesty who support the mission of the organizations.

Professor Uwe Reinhardt

We recently posted about how prominent health economist and public health care intellectual Professor Uwe Reinhardt of Princeton University has failed to disclose conflicts of interest when opining about health policy. A follow-up interview of Reinhardt on SFGate.com included:

I invite you to look at the Wall Street Journal [reporters] and see their list of boards.

I have no idea whether Wall Street Journal reporters fail to disclose their memberships on boards of companies relevant to the subject of their reporting. We have frequently discussed conflicts of interest and how they can influence medical care, teaching and research, and health care research and policy. I agree that  such conflicts are frequent, and often go undisclosed. Again, however, Prof Reinhardt seemed to be using an appeal to common practice. Just because others have failed to disclose conflicts of interest does not make such failure right.

Interested readers may want to review the interviews of De La Torre and Reinhardt to see if they can find other logical fallacies.

Note that we have frequently quoted Dr Joe Collier, "people who have conflicts of interest often find giving clear advice (or opinions) particularly difficult."  [Collier J. The price of independence. Br Med J 2006; 332: 1447-9. Link here.] We have discussed examples of how conflicted people seem to easily resort to logical fallacies to defend their conflicts (e.g., see post here.)

I do not think it is too much to ask prominent health care leaders to use evidence and logic, not logical fallacies to make their arguments.

Those who do use logical fallacies are inviting even more skepticism about their arguments and the agenda behind them.

What Me Worry? - Leaders Prosper Despite Questions About Their Organizations' Ethics and Performance

There were two examples in the recent news about how the leaders of health care organizations seem to prosper no matter what questions are raised about their organizations' ethics or performance.

WellPoint

It seemed that anger over a rate increase by a subsidiary of the huge insurance company/ managed care organization WellPoint was one reason for the revival of efforts in the US to enact some sort of health care reform legislation.  In our comment on this controversy, we noted that questions about the ethics of WellPoint's actions have appeared again and again.  Wellpoint...

• settled a RICO (racketeer influenced corrupt organization) law-suit in California over its alleged systematic attempts to withhold payments from physicians (see post here).
• subsidiary New York Empire Blue Cross and Blue Shield misplaced a computer disc containing confidential information on 75,000 policy-holders (see story here).
• California Anthem Blue Cross subsidiary cancelled individual insurance policies after their owners made large claims (a practices sometimes called rescission).  The company was ordered to pay a million dollar fine in early 2007 for this (see post here).  A state agency charged that some of these cancellations by another WellPoint subsidiary were improper (see post here).  WellPoint was alleged to have pushed physicians to look for patients' medical problems that would allow rescission (see post here).  It turned out that California never collected the 2007 fine noted above, allegedly because the state agency feared that WellPoint had become too powerful to take on (see post here). But in 2008, WellPoint agreed to pay more fines for its rescission practices (see post here).  In 2009, WellPoint executives were defiant about their continued intention to make rescission in hearings before the US congress (see post here).
• California Blue Cross subsidiary allegedly attempted to get physicians to sign contracts whose confidentiality provisions would have prevented them from consulting lawyers about the contract (see post here).
• formerly acclaimed CFO was fired for unclear reasons, and then allegations from numerous women of what now might be called Tiger Woods-like activities surfaced (see post here).
• announced that its investment portfolio was hardly immune from the losses prevalent in late 2008 (see post here).
• was sanctioned by the US government in early 2009 for erroneously denying coverage to senior patients who subscribed to its Medicare drug plans (see post here).
• settled charges that it had used a questionable data-base (builty by Ingenix, a subsidiary of ostensible WellPoint competitor UnitedHealth) to determine fees paid to physicians for out-of-network care (see post here). 
• violated state law more than 700 times over a three-year period by failing to pay medical claims on time and misrepresenting policy provisions to customers, according to the California health insurance commissioner (see post here).

But a few days ago, according to the Indianapolis Star:

Large stock awards helped boost total compensation to top executives at WellPoint by 51 percent to 75 percent last year over 2008.

The big jumps in take-home pay are detailed in the Indianapolis health insurer's annual proxy report to shareholders filed Friday.

Angela Braly, who is chair of the board, president and chief executive, saw her 2009 total compensation rise 51 percent, to $13.1 million. That compares with $8.67 million in 2008 and $14.8 million in 2007.

Braly's salary of $1.14 million barely budged from 2008, but she earned a $6.2 million stock award, almost triple the award she got in 2008.

Total compensation to other top executives:

Wayne DeVeydt, chief financial officer, $7.25 million, up 75 percent from 2008.

Ken Goulet, executive vice president, $4.43 million, up 62 percent.

Dijuana Lewis, executive vice president, $4.46 million, up 64.5 percent.

So whatever top WellPoint executives are paid for, it is not insuring that the company avoids ethical questions about its conduct, or controls health care costs or mdoerates premiums, for that matter. 

Boston Scientific, and Zimmer Holdings

We just commented on the generous compensation given the new and former CEOs of Boston Scientific, despite a series of ethical questions about that company's conduct, culminating in a guilty plea by the company to charges that it concealed information about important and potentially dangerous defects in its products.

A few days ago, I found a reminder, buried in an article in the Minneapolis Star-Tribune about a dispute between Boston Scientific and St Jude Medical, that current Boston Scientific CEO Ray Elliott has a track record of collecting generous compensation despite ethical questions about the companies he has lead.

Elliott is certainly familiar with the potential ethical minefield surrounding the relationships between sales reps and doctors. He was CEO at orthopedic devicemaker Zimmer Holdings Inc., which paid (along with four other companies) $311 million in 2007 to settle a Department of Justice investigation into the consulting fees paid to doctors.

As we discussed back in 2007, Zimmer Holdings Inc was one of four medical device companies which submitted to deferred prosecution agreements in response to charges that the companies implemented criminal conspiracies to violate federal anti-kickback laws. We posted several times about one aspect of this settlement, the mandate that the companies make public the payments (often huge) to orthopedic surgeons, academic institutions, and medical associations. (See posts here, here, here, here, here.) At the time, I did not think to look into what happened to the leadership of these companies thereafter.

According to the 2008 proxy statement by Zimmer Holdings, Ray Elliott conveniently retired in 2007, just before the deferred prosecution agreement was announced. Since he had been President of Zimmer since 1997 and CEO since 2001, according to the 2007 proxy statement, he appeared to have been in the top leadership of the corporation during the time the actions were performed that resulted in the deferred prosecution agreement. Nonetheless, again according to the 2008 statement, for the part of 2007 during which he served as CEO, his total compensation was $7,987,158. For 2006, his total compensation was $11,998,121. In 2007, the present value of his two pension plans were $269,764 and $5,302,050. In 2007, he owned 1,235,859 shares of stock (now worth $72,952,757 at the current price of $59.03 /share), and had the right to acquire 1,169,987 more within 60 days.

And of course, as we posted earlier, Boston Scientific paid him over $30 million for working part of 2009.

So Mr Elliott prospered mightily from his leadership of ethically challenged Zimmer Holdings, and was then further rewarded by ethically challenged Boston Scientific.

Summary

We have commented again and again that while numerous health care organizations have been charged with unethical, and sometimes illegal behavior, the people who oversaw, directed, or implemented the behavior almost never have had to suffer any negative consequences.  Now we see that while some large health care organizations have been subject to penalties for unethical and illegal behavior, the leaders of these organizations have been compensated so well as to make them rich, rich beyond the dreams of most people.  So the problem is not merely that captaining an organization onto the ethical rocks costs one nothing, but that it can make one very rich.

Clearly we see examples of both profoundly perverse incentives and a complete lack of accountability and responsibility affecting the leadership of major health care organizations.  Is it any wonder that these organizations continue to act unethically, and that the costs of the goods and services they provide rise continuously?

If we truly want health care that is accessible, of high quality, at a fair price, and more importantly, if we want health care that is honest and focused on patients, we need to provide health care leaders with clear, rational incentives in these directions, and make them fully accountable for their actions, and the courses of their organizations under their leadership.

Who Guards the Guardians? - the Case of Boston Scientific

The fallout from the case of the faulty implantable cardiac defibrillators continues.  To summarize the story thus far,

We started posting about Boston Scientific's travails in 2005, starting with allegations that Guidant, which is now a Boston Scientific subsidiary, hid information about defects in the implantable cardiac defibrillators (ICDs) the company manufactured. As we noted in early 2005 here, Guidant executives allegedly knew that ICDs made from 2000-2002 were at risk for short-circuiting and failing, thus making them unable to deliver potentially life saving electrical shocks meant to prevent cardiac arrests, but the company only revealed the problem in 2005. By failing to notify physicians and the public, Guidant executives let expensive and profitable, but potentially useless devices to continue to be implanted, potentially increasing the risk of sudden death for the patients who received them. Then here we noted reports that Guidant continued to ship failure-prone devices even after it had designed and started to manufacture new ICDs that were supposed to be less likely to fail. By June, 2005 we posted that Guidant had recalled thousands of ICDs, including models that were previously not identified as likely to fail. Later that year, the case rated an article by Robert Steinbrook in the New England Journal of Medicine. Towards the end of 2005, we noted that Eliot Spitzer had sued Guidant for fraud.  At the end of the year, more information appeared, suggesting that Guidant knew the ICDs were flawed, but continued to sell them. Still more appeared early in 2006. Then the business media became interested in the bidding war between Johnson and Johnson and Boston Scientific for Guidant, provoking a bit more interest in the tale of the suppression of data about the flawed ICDs.

Then all was quiet until 2009, when Guidant, now a Boston Scientific subsidiary, pleaded guilty to two criminal misdemeanor charges that it failed to properly notify the FDA about problems with its ICDs (see post here). Later, the Guidant subsidiary of Boston Scientific settled charges that it gave doctors kickbacks as part of a "seeding study" to use its devices. At that time, it came to light that Boston Scientific had made another settlement, in 2007, of civil lawsuits alleging that the company hid problems with its products (see post here).

More details about this guilty plea have just been reported.  As noted by the Minneapolis Star-Tribune,

A federal judge on Monday delayed a decision on whether to accept a $296 million plea agreement between the U.S. Justice Department and Boston Scientific Corp.'s Guidant subsidiary, which was charged with concealing critical safety information involving some of its top-selling heart devices.

If approved, the criminal penalty would rank as the largest ever in medical technology for a company that violated the federal Food, Drug and Cosmetic Act. But lawyers representing victims implanted with the potentially faulty devices threw a wrench into what was expected to be a routine hearing by demanding a piece of the settlement.

It appears that this settlement would not do any specific good for patients who claim to have been harmed by being implanted with a device that the manufacturer knew at the time to be faulty.

Also, the Star-Tribune noted:

Boston Scientific bought Guidant Corp., whose cardiac rhythm division is based in Arden Hills, for $27 billion in 2006. Though troubled, the division that makes pacemakers and defibrillators reported $2.6 billion in sales last year and still employs 2,000 people locally.

Thus, the financial penalty to be paid by Boston Scientific only would amount to little over ten percent of the yearly sales generated by the division which failed to disclose the faulty devices.

Adding to the sense that Boston Scientific and its leadership will feel little pain from the "largest criminal penalty ever assessed against a medical device company" (see this AP report) was this op-ed in the Boston Globe. It summarized just how richly the former CEO of Boston Scientific, Jim Tobin, who presided over the acquisition of Guidant and thus became responsible for its ethical lapses, and the current CEO, Ray Elliott have been compensated, in contrast to this supposedly large penalty. Re Tobin:

Tobin came to Boston Scientific in 1999 with similar instructions to clean up somebody else’s mess. He had to close facilities, ward off competitors, and, yes, settle patent lawsuits even back then. His carrot: A million stock options, a big deal in those days.

Tobin did fix some problems, and he brought the company’s new drug-eluting stent to market. Boston Scientific shares climbed, and he made about $39 million on options over the years. But Tobin also collected problems, the ones now in Elliott’s lap, and Boston Scientific shares fell again.

So here’s what the board did in February last year: It awarded Tobin 2 million more stock options, just a few months before announcing his retirement.

Adjusting for a stock split, the second option grant is the same size as what he got upon arrival.

And re Elliott:

Elliott, the man named as CEO of Boston Scientific Corp. last summer, became one of the best-paid chief executives in America in 2009. Separate national surveys published in the past week by The Wall Street Journal and The New York Times, although incomplete, come up with just one or two large-company CEOs with compensation packages that could outdo Elliott’s $33.5 million payday.

And see also this Health Care Renewal post. 

TheBoston Globe editorialist asked "so what exactly was the point of the second award [to Tobin]?"  Perhaps this question should be directed to the Boston Scientific board who approved it, and also approved Elliott's outsize pay package. 

The current board includes two co-founders of the company and the current CEO, two retired politicians, a few others with whom I am not familiar, but also two academics who may be quite familiar to Health Care Renewal readers. 

Recalling that Boston Scientific tried to plead guilty to charges of "making false statements ... to the FDA," and "failing to promptly notify regulators," it is striking that both these academics have had issues with transparency and free speech.  We just posted about the repeated failure of Prof Uwe Reinhardt to acknowledge the conflict of interests generated by his numerous memberships in the boards of health care companies, including Boston Scientific, when writing about health policy issues.  We have previously posted about the the conflicts of Marye Anne Fox, the Chancellor of the University of California - San Diego and hence leader of its medical school and academic medical center.  Chancellor Fox has just been criticized by FIRE (the Foundation for Individual Rights in Education) for allowing the silencing of a student publication and television station which had published or broadcast opinions that apparently offended university leaders.

So who in this sorry tale will stand up for quality care of patients?  The US Department of Justice is to be commended for pursuing deception by a large medical device company, but apparently could not bring itself to request a punishment for unethical practices likely to even inconvenience those responsible for the bad behavior.  The previous and current company CEOs have become quite rich without having to stand up for honesty, or patient safety.  The board of directors who are supposed to take responsibility for the overall direction of the company seem to have been happy just to go along.

As I have said before, endlessly, we will not deter unethical behavior by health care organizations until the people who authorize, direct or implement bad behavior fear some meaningfully negative consequences.  Relatively small fines imposed on large corporations pain workers on the line and stockholders while sparing the richly paid top hired management and the boards that will not reign them in. 

Real health care reform needs to make health care leaders accountable, and especially accountable for the bad behavior that helped make them rich. 

Mainstream Media "Discovers" Conflicts of Interest of Prominent Health Policy Pundit

The main-stream media, in this case the San Francisco Chronicle, just "discovered" an important case of a conflicted health policy pundit,

Uwe Reinhardt, a Princeton economic professor who often writes about health care for the New York Times' Economix blog, earns more than $500,000 a year working for a number of health care companies. He also holds more than $5 million worth of related stock.

Reinhardt's NYT bio does not mention these financial relationships.

As the NYTPicker points out, Reinhardt's various incomes break the New York Times rules, which ban anyone who writes for the paper from having any financial interest 'in a company, enterprise or industry that figures or is likely to figure in coverage that he or she provides, edits, packages or supervises regularly.'

We asked the New York Times for comment. They sent us this email:

'Professor Reinhardt is a leading expert on the economics of health care, and has provided valuable and independent insights in his blog posts. He has mentioned his service on corporate boards in the blog, but we are reviewing how to more fully describe his activities for readers of Economix.'

We also asked Reinhardt for comment. He is working on one for us and we will post it here as soon as possible.

Here's the breakdown of what he owns, according to NYTPicker:

* Reinhardt either earns an income or stock options from the five different private health care companies for which he sits on the board of directors/serves as a trustee.
* He has sat on the board of health care company, Amerigroup, since 2003. This tenure has resulted in Reinhardt's accumulation of 144,558 shares in the company and $226,531 in cash-and-stock compensation. These shares are currently valued around $4.8 million.
* Reinhardt also holds 75,625 shares of Boston Scientific (worth more than $500,000 in value) and earned $213,132 from the company in 2009. He has sat on the board of this medical device manufacturing company since 2005.
* Reinhardt serves as a trustee for H&Q Healthcare Investors and H&Q Life Science Investors. His 2008 income from the companies included $43,000 in income and between $1 and $10,000 worth of securities.
* He also made $2.3 million from the 2007, $5.1 billion sale of Triad Hospitals to Community Health Systems.

It only took four years for this to get into the main-stream media. The reason "discovered" is in quotes is that we have been writing about Reinhardt's conflicts of interests vis a vis his prominent opinions on health policy since 2006 on Health Care Renewal.

As I wrote in a comment on the original NYTPicker post, in 2006, we first wrote about a letter to the editor of the NY Times by Reinhardt dismissing a physician op-ed writer's concerns about what has gone wrong with health care.  Reinhardt's letter failed to disclose the board memberships he held at that time. In 2009, we wrote about how Reinhardt left out some crucial facts in his discussion in the Economix blog of how physicians are paid. That year we also wrote about how Reinhardt defended Ms Karen Ignagni, CEO of America's Health Insurance Plans (AHIP) in an interview quoted in a Washington Post article.

In neither case above did Reinhardt or the newspaper reveal his conflicts.

Note that Reinhardt is not the only case of a prominent health policy expert with undisclosed conflicts of interest. See this post for some examples we had found in 2006.

In fact, in my humble opinion, the public discourse about health care policy in general, and health care reform in particular has been seriously distorted by various commentators, pundits, and experts who have major conflicts of interest, usually in the form of important financial relationships with large health care organizations.  In many cases, these conflicts are not disclosed.  A related problem is the influence of various non-profit organizations that are heavily funded by those with vested interests, usually in selling particular health care products or services.  Such funding is also rarely disclosed. 

I further submit that this distortion has overwhelmingly been in favor of various aspects of the status quo that have been so profitable for the discussants, and their commercial sponsors.  This distortion has meant that certain important problems, especially those that we discuss on Health Care Renewal, are rarely even mentioned in the mainstream media, in journals on health care and services research and health policy, and in political discussion.  Try, for example, to find any discussion of the impact of ill-informed, self-interested, conflicted or corrupt leadership of prominent health care organizations on costs, access and quality, or on patient outcomes.  It is simply not done to discuss the shortcomings of leadership, maybe because it is this leadership who subsidizes many of the pundits, commentators and experts. 

At a minimum, participants in the health policy discussion, starting with the most prominent, should fully disclose all financial relationships that could constitute conflicts of interest. 

Meanwhile, those listening to the discussion should be extremely skeptical about the opinions expressed. 

Copper and Cardiovascular Disease

In 1942, Dr. H. W. Bennetts dissected 21 cattle known to have died of "falling disease". This was the name given to the sudden, inexplicable death that struck herds of cattle in certain regions of Australia. Dr. Bennett believed the disease was linked to copper deficiency. He found that 19 of the 21 cattle had abnormal hearts, showing atrophy and abnormal connective tissue infiltration (fibrosis) of the heart muscle (1).

In 1963, Dr. W. F. Coulson and colleagues found that 22 of 33 experimental copper-deficient pigs died of cardiovascular disease. 11 of 33 died of coronary heart disease, the quintessential modern human cardiovascular disease. Pigs on a severely copper-deficient diet showed weakened and ruptured arteries (aneurysms), while moderately deficient pigs "survived with scarred vessels but demonstrated a tendency toward premature atherosclerosis" including foam cell accumulation (2). Also in 1963, Dr. C. R. Ball and colleagues published a paper describing blood clots in the heart and coronary arteries, heart muscle degeneration, ventricular calcification and early death in mice fed a lard-rich diet (3).

This is where Dr. Leslie M. Klevay enters the story. Dr. Klevay suspected that Ball's mice had suffered from copper deficiency, and decided to test the hypothesis. He replicated Ball's experiment to the letter, using the same strain of mice and the same diet. Like Ball, he observed abnormal clotting in the heart, degeneration and enlargement of the heart muscle, and early death. He also showed by electrocardiogram that the hearts of the copper-deficient mice were often contracting abnormally (arrhythmia).

But then the coup de grace: he prevented these symptoms by supplementing the drinking water of a second group of mice with copper (4). In the words of Dr. Klevay: "copper was an antidote to fat intoxication" (5). I believe this was his tongue-in-cheek way of saying that the symptoms had been misdiagnosed by Ball as due to dietary fat, when in fact they were due to a lack of copper.

Since this time, a number of papers have been published on the relationship between copper intake and cardiovascular disease in animals, including several showing that copper supplementation prevents atherosclerosis in one of the most commonly used animal models of cardiovascular disease (6, 7, 8). Copper supplementation also corrects abnormal heart enlargement-- called hypertrophic cardiomyopathy-- and heart failure due to high blood pressure in mice (9).

For more than three decades, Dr. Klevay has been a champion of the copper deficiency theory of cardiovascular disease. According to him, copper deficiency is the only single intervention that has caused the full spectrum of human cardiovascular disease in animals, including:

• Heart attacks (myocardial infarction)
  
• Blood clots in the coronary arteries and heart
• Fibrous atherosclerosis including smooth muscle proliferation
• Unstable blood vessel plaque
  
• Foam cell accumulation and fatty streaks
  
• Calcification of heart tissues
  
• Aneurysms (ruptured vessels)
• Abnormal electrocardiograms
• High cholesterol
• High blood pressure
  

If this theory is so important, why have most people never heard of it? I believe there are at least three reasons. The first is that the emergence of the copper deficiency theory coincided with the rise of the diet-heart hypothesis, whereby saturated fat causes heart attacks by raising blood cholesterol. Bolstered by some encouraging findings and zealous personalities, this theory took the Western medical world by storm, for decades dominating all other theories in the medical literature and public health efforts. My opinions on the diet-heart hypothesis aside, the two theories are not mutually exclusive.

The second reason you may not have heard of the theory is due to a lab assay called copper-mediated LDL oxidation. Researchers take LDL particles (from blood, the same ones the doctor measures as part of a cholesterol test) and expose them to a high concentration of copper in a test tube. Free copper ions are oxidants, and the researchers then measure the amount of time it takes the LDL to oxidize. I find this assay tiresome, because studies have shown that the amount of time it takes copper to oxidize LDL in a test tube doesn't predict how much oxidized LDL you'll actually find in the bloodstream of the person you took the LDL from (10, 11).

In other words, it's an assay that has little bearing on real life. But researchers like it because for some odd reason, feeding a person saturated fat causes their LDL to be oxidized more rapidly by copper in a test tube, even though that's not the case in the actual bloodstream (12). Guess which result got emphasized?

The fact that copper is such an efficient oxidant has led some researchers to propose that copper oxidizes LDL in human blood, and therefore dietary copper may contribute to heart disease (oxidized LDL is a central player in heart disease-- read more here). The problem with this theory is that there are virtually zero free copper ions in human serum. Then there's the fact that supplementing humans with copper actually reduces the susceptibility of red blood cells to oxidation (by copper in a test tube, unfortunately), which is difficult to reconcile with the idea that dietary copper increases oxidative stress in the blood (13).

The third reason you may never have heard of the theory is more problematic. Several studies have found that a higher level copper in the blood correlates with a higher risk of heart attack (14, 15). At this point, I could hang up my hat, and declare the animal experiments irrelevant to humans. But let's dig deeper.

Nutrient status is sometimes a slippery thing to measure. As it turns out, serum copper isn't a good marker of copper status. In a 4-month trial of copper depletion in humans, blood copper stayed stable, while the activity of copper-dependent enzymes in the blood declined (16). These include the important copper-dependent antioxidant, superoxide dismutase. As a side note, lysyl oxidase is another copper-dependent enzyme that cross-links the important structural proteins collagen and elastin in the artery wall, potentially explaining some of the vascular consequences of copper deficiency. Clotting factor VIII increased dramatically during copper depletion, perhaps predicting an increased tendency to clot. Even more troubling, three of the 12 women developed heart problems during the trial, which the authors felt was unusual:

We observed a significant increase over control values in the number of ventricular premature discharges (VPDs) in three women after 21, 63, and 91 d of consuming the low-copper diet; one was subsequently diagnosed as having a second-degree heart block.

In another human copper restriction trial, 11 weeks of modest copper restriction coincided with heart trouble in 4 out of 23 subjects, including one heart attack (17):

In the history of conducting numerous human studies at the Beltsville Human Nutrition Research Center involving participation by 337 subjects, there had previously been no instances of any health problem related to heart function. During the 11 wk of the present study in which the copper density of the diets fed the subjects was reduced from the pretest level of 0.57 mg/ 1000 kcal to 0.36 mg/1000 kcal, 4 out of 23 subjects were diagnosed as having heart-related abnormalities.

The other reason to be skeptical of the association between blood copper and heart attack risk is that inflammation increases copper in the blood (18, 19). Blood copper level correlates strongly with the marker of inflammation C-reactive protein (CRP) in humans, yet substantially increasing copper intake doesn't increase CRP (20, 21). This suggests that elevated blood copper is likely a symptom of inflammation, rather than its cause, and presents an explanation for the association between blood copper level and heart attack risk.

Only a few studies have looked at the relationship between more accurate markers of copper status and cardiovascular disease in humans. Leukocyte copper status, a marker of tissue status, is lower in people with cardiovascular disease (22, 23). People who die of heart attacks generally have less copper in their hearts than people who die of other causes, although this could be an effect rather than a cause of the heart attack (24). Overall, I find the human data lacking. I'd like to see more studies examining liver copper status in relation to cardiovascular disease, as the liver is the main storage organ for copper.

According to a 2001 study, the majority of Americans may have copper intakes below the USDA recommended daily allowance (25), many substantially so. This problem is exacerbated by the fact that copper levels in food have declined in industrial nations over the course of the 20th century, something I'll discuss in the next post.

Quis Custodiet Ipsos Custodes?

HAPPY TIMES AT NIMH

Two weeks ago I discussed a Commentary in JAMA by Dr. Thomas Insel, Director of the National Institute of Mental Health. Over on Danny Carlat’s blog, Dr. Insel took exception to my linking him with Charles Nemeroff, and appeared to be putting distance between himself and Dr. Nemeroff. So, I did some checking, and a correction to one of my statements is in order.

I had said, “ … that Insel appointed Nemeroff as an advisor soon after he (Insel) moved to NIMH.” That was my recollection. It turns out what I recalled was instead Insel showcasing Nemeroff in the NIMH Director’s 7th Annual Research Roundtable June 10, 2003, a few months after Insel moved from Emory University to NIMH. Let the record stand corrected.

At that gala meeting, held at the National Press Club in Washington, DC, Dr. Insel characterized Nemeroff as one of the “real stars of NIMH’s research community…” Nemeroff used the occasion to pimp GlaxoSmithKline’s drug paroxetine (Paxil), showing data on change in platelet stickiness after Paxil in patients with heart disease and depression. This highlighting of Paxil by Nemeroff focused on the surrogate outcome of platelet function, and contained no evidence that Paxil modified any important clinical endpoints. Nevertheless, Nemeroff speculated liberally about the place of antidepressant drugs in managing heart disease. This is the sort of stuff Insel described at the Roundtable as “ … an excellent sampling of the Institute’s exciting research endeavors.”

My general point two weeks ago was that Dr. Insel, the Director of an NIH Institute, downplayed the seriousness of the ethics issues surrounding the seven academic psychiatrists he mentioned in his Commentary in JAMA. Though he spoke in platitudes about the need for transparency, the spirit of transparency did not move him to disclose his own close ties with Dr. Nemeroff, who is one of the seven. Lest there be any remaining doubt about those ties, here is Dr. Nemeroff lauding Dr. Insel at the 201st meeting of the National Advisory Mental Health Council September 13, 2002 in the presence of the NIH Director, Elias Zerhouni, MD. From the Minutes: Dr. Charles Nemeroff, Reunette W. Harris Professor and Chair, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, commended Dr. Zerhouni’s selection of Dr. Insel as the next NIMH Director and added that Dr. Insel is the epitome of courage defined as grace under pressure. Dr. Nemeroff added that Dr. Insel will leave his current position as a most beloved professor, a respected scientist, and a great person.

In the comments on Danny Carlat’s blog I called Dr. Insel’s objections to my linking him with Nemeroff disingenuous. I still think that. Dr. Insel and Dr. Nemeroff are closer than Insel now seems comfortable acknowledging. Their record of talking up each other is hard to ignore. The irregularities identified by Senator Grassley involving Nemeroff’s reporting to NIH, his conflict of interest, and his conflict of commitment occurred on Insel’s watch. Considering the appearance of cronyism in their relationship, is it even possible for Dr. Insel to investigate Dr. Nemeroff’s performance in areas like the Emory-GlaxoSmithKline-NIMH Collaborative Mood Disorders Initiative?

Bernard Carroll