U.S. health care system headed for perfect storm

Number of uninsured, rising costs, long term care and an aging population could force a major system overhaul, says leading health economist

Aug. 20, 2008 — “We are headed into a time when a confluence of changes are going to lead to a perfect storm, making us finally realize that our health care system needs a major overhaul,” says Timothy D. McBride, Ph.D., leading health economist and professor of social work at Washington University in St. Louis.

“As the elderly population doubles between now and about 2030, projections are that we will see at least a doubling of the costs of the federal and state health and retirement programs,” he says. “That will likely be when the perfect storm hits. But if we miss it then, we will likely have missed all the storm clouds for the foreseeable future.”

McBride is available to discuss the current state of health care in the U.S. as well as the presidential candidates’ health care plans. Washington University in St. Louis is the site of this year’s vice presidential debate.

Familiar trends associated with the current health care crisis are the high rate of uninsured Americans and rising health care costs. The number of ever-rising uninsured is 47 million or about 16% of the U.S. population. National health expenditures exceed $2 trillion, accounting for 16% of the U.S. economy — more than three times the share health care took in 1960.

“While attention focuses on these two major trends, other storm clouds are brewing,” McBride says. “A long term care crisis looms, grows, and receives little attention, despite problems with the affordability, quality and access to long term care. These problems will only become much worse as the aging population doubles by 2030.

“Much attention also has been paid to the problems of financing Social Security, but the financial problems of the Social Security program pale in comparison to the burden of the Medicare and Medicaid programs on our economy.”

According to McBride, the growth of the elderly population will heighten concerns about the workforce needs in health care. “There are already shortages of nurses, and open nursing positions are sometimes filled by the expensive practice of recruiting migrant nurses into communities,” he says. “Added to this problem now are reports of shortages of other health professionals, including therapists, social workers, health aides and even some categories of physicians.

“Overall, we continue to worry about the general quality of health care as well as the problems of health disparities, as the inequities of our economy and culture flow into the health care system.”

Source: Washington University in St. Louis, Jessica Martin (http://news-info.wustl.edu/tips/page/normal/12183.html)

Low Vitamin D Levels Pose a Large Threat to Health, Researchers Say

Researchers at Johns Hopkins are reporting what is believed to be the most conclusive evidence to date that inadequate levels of vitamin D, obtained from milk, fortified cereals and exposure to sunlight, lead to substantially increased risk of death.

In a study appearing in the Archives of Internal Medicine online Aug. 11, the Johns Hopkins team analyzed a diverse sample of 13,000 initially healthy men and women participating in an ongoing national health survey and compared the risk of death between those with the lowest blood levels of vitamin D to those with higher amounts. An unhealthy deficiency, experts say, is considered blood levels of 17.8 nanograms per milliliter or lower.

Of the 1,800 study participants known to have died by Dec. 31, 2000, nearly 700 died from some form of heart disease, with 400 of these being deficient in vitamin D. This translates overall to an estimated 26 percent increased risk of any death, though the number of deaths from heart disease alone was not large enough to meet scientific criteria to resolve that it was due to low vitamin D levels.

Yet researchers say the finding does highlight a trend, with other studies linking shortages of vitamin D to increased rates of breast cancer and depression in the elderly. And earlier published findings by the team, from the same national study, have established a possible tie-in, showing an 80 percent increased risk of peripheral artery disease from vitamin D deficits.

Researchers note that other studies in the last year or so in animals and humans have identified a connection between low levels of vitamin D and heart disease. But these studies, they say, were weakened by small sample numbers, lack of diversity in the population studied and other factors that limited scientists’ ability to generalize the findings to the public at large.

“Our results make it much more clear that all men and women concerned about their overall health should more closely monitor their blood levels of vitamin D, and make sure they have enough,” said study co-lead investigator Erin Michos.

“We think we have additional evidence to consider adding vitamin D deficiency as a distinct and separate risk factor for death from cardiovascular disease, putting it alongside much better known and understood risk factors such as age, gender, family history, smoking, high blood cholesterol levels, high blood pressure, lack of exercise, obesity and diabetes,” she said.

Vitamin D is well-known to play an essential role in cell growth, in boosting the body’s immune system and in strengthening bones.

“Now that we know vitamin D deficiency is a risk factor, we can better assess how aggressively to treat people at risk of heart disease or those who are already ill and undergoing treatment,” said Michos, who added that test screening for nutrient levels is relatively simple. It can, she said, be made part of routine blood work and be done while monitoring other known risk factors, including blood pressure, glucose and lipid levels.

Heart disease remains the nation’s leading cause of death, killing more than a million Americans each year. Nearly 10 percent of those with the condition have not one identifiable, traditional risk factor, which the experts say is why a considerable extent of the disease goes unexplained.

Michos, an assistant professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute, recommends that people boost their vitamin D levels by eating diets rich in such fish as sardines and mackerel, consuming fortified dairy products, taking cod-liver oil and vitamin supplements and in warmer weather briefly exposing skin to the sun’s vitamin D — producing ultraviolet light.

Aware of the cancer risks linked to too much time spent in the sun, Michos says that as little as 10 to 15 minutes of daily exposure to the sun can produce sufficient amounts of vitamin D to sustain health. The hormonelike nutrient controls blood levels of calcium and phosphorus, essential chemicals in the body.

Michos says that if vitamin supplements are used, there is no evidence that more than 2,000 international units per day do any good. Study results show that heart disease death rates flattened out in participants with the highest vitamin D levels (above 50 nanograms per milliliter of blood), signaling a possible loss of the vitamin’s protective effects at too-high doses.

The U.S. Institute of Medicine suggests that an adequate daily intake of vitamin D is between 200 and 400 international units (or blood levels nearing 30 nanograms per milliliter). Previous results from the same nationwide survey showed that 41 percent of men and 53 percent of women are technically deficient in the nutrient, with vitamin D levels below 28 nanograms per milliliter.

Michal Melamed, study co-lead investigator, who started the research as a clinical fellow at Johns Hopkins, says that no one knows yet why or how vitamin D’s hormonelike properties may protect the heart, but she adds that there are plenty of leads in the better known links the vitamin has to problems with muscle overgrowth and high blood pressure, in addition to its control of inflammation, which scientists are showing plays a stronger role in all kinds of heart disease. But more research is needed to determine the nutrient’s precise biological action.

Researchers say their next steps are to test various high doses of vitamin D to find out if the nutritional supplementation results in fewer deaths and lower incidence of heart disease, including heart attack or moments of prolonged and severe chest pain.

The team also plans to investigate what biological triggers, such as obesity or hypertension, might offset or worsen the action of vitamin D on heart muscle, or whether vitamin D sets off some other reaction in the heart.

Melamed says that because vitamin D levels are known to fluctuate in direct proportion with daily physical activity, the growing epidemic of obesity and indoor sedentary lifestyles lend more urgency to act on the vitamin D factor.

Funding for this study was provided by the National Institutes of Health, P.J. Schafer Cardiovascular Research Fund and Paul Beeson Physician Faculty Scholars in Aging Program. Michos has received previous consulting fees from vitamin D therapeutics manufacturer Abbott Pharmaceuticals. The terms of these arrangements are being managed by The Johns Hopkins University in accordance with its conflict of interest policies.

Other Johns Hopkins researchers involved in this study, conducted solely at Johns Hopkins, were Wendy Post and Brad Astor. Melamed is now an assistant professor at the Albert Einstein College of Medicine of Yeshiva University.

Source: John Hopkins Medicine, David March (http://www.jhu.edu/~gazette/2008/18aug08/18vitamind.html)

Study finds exercise key to aging well, living long

“We statistically adjusted for many factors such as obesity and age,” Chakravarty said. “We also chose pretty healthy people in our control group. They were not obese, had normal body weight, had the same education levels as the runners and didn’t drink or smoke much. We tried to restrict it so that the main difference between the two groups was running.”

The basic message of the study, however, is simple: Exercising, at any age, is very important.

“People shouldn’t be discouraged from exercising because they’re older,” Chakravarty said. “Adopting an exercising program — even in the 50s or 60s will be beneficial down the road. We’re just really excited that we’re able to show benefits of exercise, not only in living longer, but living healthier up into the 80s.”

Of course, swimmers, bikers and other exercise fiends need not fret over the study’s emphasis on running; other forms of cardiovascular exercise serve a similar purpose.

“We think it’s probably vigorous exercise in general [that produce these results],” Chakravarty said. “Even though we chose the groups for running and non-running, we don’t necessarily think that there is anything specific to running — that running is better than cycling or swimming or any other form of regular aerobic exercise.”

Source:The Stanford Daily, Melanie Kim (http://daily.stanford.edu/article/2008/8/14/studyFindsExerciseKeyToAgingWellLivingLong)

Special Olympics and UIC team up to research aging individuals with disabilities

The University of Illinois at Chicago will receive $4.25 million over the next five years for research on aging individuals with disabilities, and the award will be partially matched by Special Olympics International.

UIC’s Rehabilitation Research and Training Center on Aging with Developmental Disabilities (RRTC) will start receiving its money on October 1 from the National Institute on Disability and Rehabilitation Research (NIDRR), which is part of the U.S. Department of Education.

“This new funding that starts in October is going to build on [our previous research] but it has more of a lifespan focus,” said professor and head of RRTC, Tamar Heller, Ph.D. She added that not much research has been done on adults with intellectual and developmental disabilities.

The UIC center received a similar grant in 2003, according to a spokesman from the Department of Education.

The RRTC received the grants in 2003 and in 2008 due to its well-received proposals in peer review and the progress it made in its activities, he said.

One out of the seven studies that will make use of the grant money will also use health screening data collected from athletes participating in the Special Olympics, a project partner with RRTC.

“The Special Olympics does screenings for thousands of people around the world and we’re going to be working with them to look at some of that screening data,” Heller said.

Heller and her research team will use this data to determine, over time, what risks or secondary conditions people with disabilities have that may be related to their disability. For example, Heller explains that individuals with Down’s syndrome have a higher propensity for osteoporosis.

“The Special Olympics population is very much a convenience sample for UIC,” said Special Olympics’ senior vice president for constituent services and support, Stephen Corbin. He agrees with Heller that more research needs to be done on adults with disabilities, especially in terms of what risk factors and environmental variables affect overall health.

So for the next several years, RRTC will use Special Olympic athletes’ health screening data to track long-term health trends.

“It’s one thing to show something in a lab or a clinic, but we will want to show how to improve lives in the real world,” Heller said.

Source: MedIll NorthWestern University, Elyse Russo (”http://news.medill.northwestern.edu/chicago/news.aspx?id=97197“)

Aspirin, acid blocker a-day keeps GI bleeding at bay

U-M study finds proton pump inhibitors are cost-effective
way to prevent upper GI bleeding in patients who regularly take aspirin
to prevent cardiac events

For patients with clogged heart arteries who take long-term, low-dose aspirin to prevent a cardiac event, adding a stomach acid-blocking drug to their daily routine has been shown to reduce their risk for upper gastrointestinal bleeding – an infrequent, but serious side-effect of regular aspirin use.

• At OTC prices, PPI cotherapy is cost-effective for patients older than 65 who are taking low-dose aspirin, and may also be cost-effective for patients as young as 50.
• Even for patients who have an average risk of bleeding, OTC PPIs are cost-effective.
• Aspirin plus prescription PPI was only cost-effective for the patients at the highest risk for upper GI bleeding, including much older patients. Starting PPI therapy at age 65 costs $40,000 per year of life saved. Beginning PPI therapy at age 50 is estimated to cost $80,000 per year of life
  saved.
• For patients at average risk for upper GI bleeding, starting prescription PPI therapy was only cost-effective if started later in life (age 80 or later).