Traveling for Treatment

(HealthDay News) -- David Boucher celebrated his 50th birthday this year by jetting to Bangkok for his first colonoscopy.

There he was seen by a California-educated physician and no shortage of nurses, who verified his identity 15 times before the procedure.

To be sure, Boucher had a secondary motive: He is founder and president of Companion Global Healthcare, a subsidiary of Blue Cross Blue Shield of South Carolina that includes in its network 13 hospitals around the world that have been accredited by the Joint Commission International (JCI).

The JCI, which calls itself the "Good Housekeeping Seal of Approval," has accredited more than 170 hospitals outside of the United States.

An estimated 6 million Americans are traveling each year to such countries as India, Costa Rica, Mexico and Thailand in search of less-expensive treatments for simple and complex procedures. Even France and Belgium tend to be cheaper than the United States.

"People are going abroad for necessary medical treatments such as knee and hip replacements and cardiac procedures," said Devon Herrick, senior fellow with the National Center for Policy Analysis, in Dallas. "And in many countries, especially places like India, the quality is very high and the price can be up to 80 percent less expensive."

And that often includes the airline ticket.

Major U.S. health-care players are jumping on the train, including BlueShield of California. Its "Access Baja" health plan caters to Americans and Mexicans wanting to get medical care in northern Mexico. BridgeHealth International, based in Denver, also has an overseas network.

What's driving the trend?

"The cost of health care in the U.S., combined with the fact that we have a shortage in this country of physicians and, probably more acutely, nurses," responded Boucher. "At the same time, 2008 was the first year of the 'silver tsunami,' with Americans turning 62 at [a rapid] rate," he noted.

"Over half of folks turning 62 opted for early Social Security, and most do not have an employer-sponsored medical program," Boucher added. "There's going to be a sharply increasing number of people that need bypass surgery and hip and knee replacements."

According to the National Center for Policy Analysis, costs for treatment abroad can be as little as one-half to one-fifth the going rate in the United States. As an example, it cited New Delhi's Apollo Hospital, which charges $4,000 for heart surgery, compared with an average of $30,000 in the United States.

A "nose job" might cost $850 in India and $4,500 in the United States. An MRI in Brazil, Costa Rica, India, Mexico, Singapore or Thailand ranges from $200 to $300, but it can be three or four times that much stateside.

To be sure, the trend can have a downside. According to one study from researchers at the David Geffen School of Medicine at the University of California, Los Angeles, people getting kidney transplants overseas tend to experience more complications, including rejection of the organ and severe infections, than do people opting to undergo the procedure in the United States.

And what happens with follow-up care once a so-called medical tourist returns to the United States? And which country's laws prevail if there's a problem?

For the most part, those questions have no standard answers, leaving each person to resolve the issues, and any similar ones, that might come up.

But Herrick says that a little planning and common-sense precautions can minimize the risks. He advises anyone contemplating medical treatment abroad to:

Make sure the facility is accredited by JCI or an equivalent standard-setting organization in the destination country.
Check the credentials of the physicians; many doctors in other countries have been trained in the United States, Europe, Japan, Australia and New Zealand.
Find a good intermediary to help choose the right facility in the right country. Some hospitals overseas have lower mortality rates than those in so-called developed nations.
Compare outcomes with other institutions, regardless of where you go.
Herrick said that cost and quality-of-care tend to be higher in Singapore than in Thailand or India, but all three offer extremely good quality and could be considered for more complex procedures.

But he suggested that people go somewhere closer to home -- such as Costa Rica or Mexico -- or stay in the United States for procedures that are generally less exorbitant. Airfare and hotel costs can be prohibitive. Also, Herrick said, "most people would prefer to find a place not quite so far away as a 16-hour plane ride."

Traveling to other countries for medical care "is in its infancy," Herrick said. "I don't think any insurer is doing it in a major, major way. People are testing the waters slowly. Most of the interest really seems to lie with self-insured plans."

According to a small survey conducted by the International Foundation of Employee Benefit Plans, about 11 percent of employers offer overseas benefit options, although it was unclear how extensive the benefits were or if employees were using them.

The goal, proponents of the concept say, is for everyone -- patients, employers, insurance companies -- to end up paying less.

More information
To learn more about this phenomenon, visit the Medical Tourism Association.

2008’s Top 20 Medical Breakthroughs

By Ross Weale

Viable frozen embryos. A pill that could help you keep off weight. A gel to rev your sex drive. It’s clear that 2008 was full of good medical news for women. Health magazine’s medical expert, Dr. Roshini Raj, went on the Today show to talk about the ways in which 2008’s news could bring you a healthier 2009.



You can read about all 20 medical breakthroughs in our Healthy Living Journey.

Do Patients Get Better Care When They Look Like Their Doctors?

By Dena Rifkin, MD
Getty Images
I saw a young man from Portugal, a new immigrant to the United States who didn’t speak English, a couple weeks ago in the hospital. He really needed a long-term physician. Like many such patients, he didn’t have access to health insurance here, and he hadn’t seen a doctor for more than three years. He had lots of issues that weren’t going to be resolved during the hospital stay.
So I set about looking for a physician for him. And from the 15 or so available choices in the clinic, I picked a doctor who was a young Latino man, the most similar to him. Read More

The Soaring Cost of Dental Care Is Nothing to Smile About

Let’s drill down into why it’s so expensive to have a healthy mouth
by Amy O'Connor

This is me holding my $1,200 crown (it recently popped out, hence this blog), my husband’s $450 mouth guard, and the retainer I have worn since I was a teenager.

Notice that I am not smiling. We spend far more on dental care and devices than we do on doctors, and it’s getting more expensive as we get older. Continue reading »

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Meet the War Doctors Saving Our Soldiers' Lives

A new documentary film puts a face—and a price—on battlefield medicine
by Sally Chew

The original inspiration for the new documentary Fighting for Life was a pre-Iraq War threat in Congress to shut down the Uniformed Services University in Bethesda, Md., which has trained one of every four current active-duty military physicians. It’s hard to imagine lawmakers will try that again anytime soon, considering the tens of thousands of Iraq vets who will likely need physical and/or psychological care for decades to come, but director Terry Sanders won’t rest easy. He wants those of us caught up in our own health issues or waiting for the next installment of House to appreciate the brutality and the accomplishments of modern military medicine while getting to know a few of these docs, along with their shrapnel-pocked charges.

Among the latest high-tech advances in battlefield care is the ability to move patients neatly and quickly in mobile hospitals (aka airplanes): Continue reading »

The Hidden Costs of Your Doctor Visit

Are parking fees, co-pays, plus the half-day’s wages you lose sitting in my waiting room keeping you from getting the health care you need?
by Dena Rifkin, MD

I was commiserating with a patient about the cost of parking at our medical center. Depending on the length of a visit, the ticket in the garage here can cost $5 to $10. Not a fortune, but if you need to see your doctor monthly, it adds up. “Ah, doctor,” she said, “this is the problem: It is too expensive to stay healthy!”

Her comment made me think again about co-payments, that $10, $15, or $25 you fork over to see someone like me even before your insurance company decides if it will cover your entire visit and all the tests you need.

The actual charge for the visit and associated tests is much more than that, of course, though people with health insurance rarely see the actual charge for the visit. So why does the co-pay exist, if it’s such a small fraction of the total cost? Continue reading »

Rare Gene Mutation Plays Role in Longevity

(HealthDay News) -- A rare gene mutation that restricts a particular growth factor may be one of the keys to living to 100 and beyond, a new study suggests.

This mutation, which seems to decrease the activity of insulin-like growth factor (IGF-1), results in short stature but longer life. Exactly why this might lengthen someone's life isn't known, but the researchers say the finding might prove useful in developing anti-aging drugs.

"We found that people of a hundred years old have mutations in a gene that is related to the growth hormone pathway," said lead researcher Dr. Nir Barzilai, director of the Institute for Aging Research at the Albert Einstein College of Medicine in New York City. "We think this is important, because that's what now happens in nature. The pony lives longer than the horse, the small dog lives longer than a large dog. Apparently, it's true for humans also."

Interestingly, this particular mutation has been found mostly among women, he added.

It might be possible, given these findings, to develop drugs that can prevent aging and age-related disease, Barzilai noted. "There are drugs being developed to decrease growth hormone in patients with tumors, because sometimes cancer is dependent on growth hormones," he said.

"Maybe we can adopt the strategy to slow aging."

The report was published in this week's online issue of the Proceedings of the National Academy of Sciences.

In the study, Barzilai's team looked for this mutation among a population of Ashkenazi Jews who were 100, and their offspring. They also matched these offspring with people who had no history of longevity in their family. The researchers found this particular mutation was more common among those who were centenarians and their offspring. The same research team reported in December 2006 that a particular gene variant that is linked to longevity is also associated with improved mental function in the elderly.

How long growth hormones need to be restricted to produce the slowing of aging isn't known. "Do you have it during early development in the womb, in puberty, or can you have it at any stage that you wish?" Barzilai asked.

Barzilai noted that growth hormone is a very popular anti-aging therapy. Growth hormone changes the tone of the skin and fat distribution, and increases muscle mass.

"However, this study and other studies suggest that, for the purpose of aging and longevity, growth hormone might do exactly the opposite," he said. "In the short run, growth hormones are going to have positive effects, but certainly in elderly people I would suggest, and this study supports the notion, that we will kill them sooner rather than later."

One expert thinks the findings are intriguing but inconclusive.

"This is an interesting study, which has to be replicated by other researchers using a different dataset, because studies on exceptional longevity often cannot be replicated," said Leonid Gavrilov, a research associate at the Center on Aging at the University of Chicago.

The study found a sex-specific increase in IGF-1; it showed up only among the daughters of centenarians, while sons were not affected, Gavrilov noted. "The study does not suggest any explanation, or even a hypothesis, for this sex-specific effect. General conclusions suggested in this paper may be questionable if they are not applicable to men," he said.

"It may be interesting to put this study in a context of other findings, such as being born to a young mother helps to live to 100 years," Gavrilov said.

More information
For more on aging, visit the National Institute on Aging.

Balancing Your Hormones Without Drugs... You Can Feel Good Again $19.95 [ learn more ] Hormone imbalance can be reversed! Look and feel better than ever, just take the time to learn about yourself and read the information contained in this just released e-book about reversing hormone imbalance. Are you ready to finally look and feel great? If so... read on... - E-Book Version.(BH)

Heart Hormones Beat Back Cancers in Mice

(HealthDay News) -- New research offers early evidence that hormones produced by the heart to control both blood pressure and volume could be harnessed to treat -- and possibly cure -- a wide range of cancers.

Following a month of intravenous treatment with any of four human cardiac peptide hormones, mice engineered to develop human pancreatic and breast cancer experienced dramatic results:

On average, 54 percent of those with breast cancer and 37 percent of those with pancreatic cancer were cured, without tumor recurrence or treatment side effects.

Even tumor shrinkage among non-cured mice was striking, with size reductions of 90-plus percent. And a more detailed analysis, hormone-by-hormone, revealed even stronger anti-cancer properties among certain hormones. In such best-case scenarios, the most effective hormones provoked full tumor elimination -- without surgery, chemotherapy or any other additional treatment -- in two-thirds of the mice with breast cancer and 80 percent of the mice with pancreatic cancer.

"This raises hope for turning cancer -- even when not fully cured -- into a chronic disease," said study author Dr. David L. Vesely, director of the department of molecular pharmacology and physiology at the University of South Florida's Cardiac Hormone Center, in Tampa.

Vesely is scheduled to present his findings April 9 at the Experimental Biology annual conference in San Diego. The findings were originally published in the journal in vivo last year.

"For 350 years, the heart has been thought of simply as a pump," Vesely said. "But we now know it makes hormones that lower your blood pressure and get rid of salt and water. So, first we took four of them that all come from the same gene, and looked at them in laboratory cell cultures, and found that they essentially eliminated 97 percent of exposed cancer cells within 24 hours."

With funding largely from the U.S. Veteran's Administration, the research team then grew human cancer cells in 1-month-old male and female mice, focusing first on pancreatic cancer, which Vesely described as the "worst of all," given the fast pace of its development, its poor treatment track record, and a mean survival rate of just four months.

Nearly 34,000 Americans are diagnosed with pancreatic cancer each year, and 32,000 die of the disease annually.

Some of the pancreatic cancer mice received a saline solution, while others were exposed to a month-long regimen of one of four cardiac hormones: long acting natriuretic peptide (LANP), vessel dilator (VDL), kaliruretic peptide (KP), or atrial natriuretic peptide (ANP).

ANP was found to provide the best anti-cancer effect, eliminating tumors in four of five treated mice. Among those not fully cured, VDL provided the best cancer reduction -- bringing exposed tumors down to just 2 percent of their largest size.

After a year, the researchers found that all the cured mice remained cancer-free. Based on the fact that the normal life span for a mouse is about one year, Vesely and his colleagues concluded that all the treated mice ended up dying of old age, not cancer.

Vesely, who noted that his wife died of breast cancer about five years ago, then turned his focus to that cancer.

He said that in similar mouse experiments, treatments with VDL and KP hormones both produced a 67 percent tumor elimination rate.

"We never expected results this good, of course," he said. "And I don't want to get too carried away here. But if this works in humans, it would be spectacular. Because, of course, one out of every two families [experiences] cancer."

Human trials -- funded by the private San Diego-based firm Kalos Therapeutics -- are to begin within 12 to 18 months. If all goes well, Vesely predicted that a hormone treatment could become available within three years.

However, Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, cautioned that while the notion of a heart hormone cancer treatment has a "seductive" appeal, much more research is required.

"Unfortunately, in general, we see a lot of experiments that seem promising in test tubes and animals but for whatever reason don't translate into anything that has treatment benefit," he said. "And specifically, in this case, we're talking about normal hormones already in circulation in our body, and normal receptors on cancer cells.

"So, in a perhaps simplistic, but nonetheless important, way, the question then arises: Why do people get cancer in the first place if this hormonal mechanism is so effective?" Lichtenfeld said. "And I do not see that the researchers clearly suggest an underlying rational mechanism to explain why this would happen and work in humans.

"So, I understand here that a researcher has lost a wife and a mother to cancer, and I know it's personal," he acknowledged. "And I've certainly learned to never say never. But it would take considerably more replication of this work before I could say this theory will gain traction."

More information
For additional information on current cancer treatment options, visit the American Cancer Society.

Balancing Your Hormones Without Drugs... You Can Feel Good Again $19.95 [ learn more ] Hormone imbalance can be reversed! Look and feel better than ever, just take the time to learn about yourself and read the information contained in this just released e-book about reversing hormone imbalance. Are you ready to finally look and feel great? If so... read on... - E-Book Version.(BH)

Chemotherapy After Breast Cancer Surgery Effective for Older Women, Too

HealthDay News) -- It's clear that chemotherapy after breast cancer surgery increases survival rates. But many older women aren't being offered this potentially lifesaving treatment.
But, age shouldn't be a deciding factor -- an older woman's general health appears to be a better predictor of positive results after chemotherapy, according to a study published recently in the Journal of the American Medical Association.

"Age alone should not be a contraindication to the use of optimal chemotherapy regimens in older women who are in good general health," the study authors said.

About half of all breast cancers in the United States occur in women older than 65. Past studies have shown that chemotherapy after breast cancer surgery increases the odds of disease-free survival in women between the ages of 50 and 69. But little information has been available for treating women over 70, the study authors said.

One important concern is that older women may experience more toxic side effects from chemotherapy. That's because the kidneys often function less effectively with age, and there's not as great a bone marrow reserve for generating new blood cells in older people.

"There's always been a concern that older women with breast cancer might be under-treated," said Dr. Yelena Novik, an oncologist at New York University Medical Center in New York City. "In clinical trials, the proportion of women over 70, and especially over 75, is very small, so it's hard to know the benefits and the risks. It's understood that older women are more likely to have other medical problems, such as heart disease, hypertension and diabetes, so the question is, should they be offered the same treatment as younger women?"

To answer that question, researchers from cancer centers around the country reviewed data from four previous trials that included almost 6,500 women with lymph-node positive breast cancer. Five hundred and forty-two of the women in the studies were over 65, and 159 were over age 70.

Each of the studies looked at various doses and regimens of chemotherapy, including regimens considered to be potentially more toxic than the others.

A number of factors influenced survival rates, including smaller tumor size, fewer positive lymph nodes, having more chemotherapy, and using the breast cancer drug tamoxifen. Age alone, however, didn't appear to influence survival rates, the study authors found.

Women over 65 were more likely to die of causes other than breast cancer. And they were slightly more likely to die as a result of the treatment than younger women were. Overall treatment-related mortality was 0.5 percent, and 1.5 percent for those women over 65.
"What this study basically showed is that we shouldn't prejudice our treatment decisions based on chronological age," said Dr. Jay Brooks, chairman of hematology and oncology at Ochsner Health System in Baton Rouge, La. "We have a lot of very healthy, older individuals, and to simply preclude someone from taking potentially lifesaving therapy because they've reached some chronological age is just wrong. Would you tell someone who's 68 with coronary vessel disease not to get a bypass?"

Both Novik and Brooks said that recent advances in tailoring breast cancer treatments to the individual patient have likely made the age disparity less of an issue.

"We're hopefully getting smarter in understanding cancer behaviors, which gives us better insight into which drugs to use," Novik said.

Brooks advised older women with breast cancer to "sit down and talk with their doctor about what their individualized risk of recurrence is. We have good tools to offer individualized treatment options, whatever your age."

More information
To learn more about chemotherapy treatment for breast cancer, visit the American Cancer Society.

Hormone Therapy Only Helps Some Older Men With Prostate Cancer

(HealthDay News) -- Adding hormone therapy to radiation treatment for fast-moving prostate cancer can save lives, but the benefit often doesn't apply to men who have other serious medical problems, a new study shows.

"The new message from this study is that there definitely is a difference in outcome, depending on the gentleman's health," said Dr. Anthony V. D'Amico, chief of genitourinary oncology at Brigham and Women's Hospital in Boston. His report is published in the Jan. 23 issue of the Journal of the American Medical Association.

The old message, reported in 2004 on the five-year point of the study, was that treatment to suppress the activity of male hormones known as androgens improved survival of older men with aggressive prostate cancer, D'Amico said.

But the new report showed the benefit was limited to men without other serious medical problems. Adding hormone therapy to radiation treatment in the 206-man study decreased the rate of death significantly, but the benefit was confined to men without other health issues.

"This report is important, because it is part of a story that is emerging about hormone therapy in men with prostate cancer who are elderly," D'Amico said. "If a man is 75 and otherwise healthy, adding hormone therapy is likely to help. If the same man has had a heart attack or stroke, or if he is a smoker or diabetic, adding hormone therapy makes it worse."

In terms of clinical practice, the finding means that "before I treat him, I get him to a specialist and try to get his health cleared up as much as possible before giving the hormone therapy," D'Amico said. "If he has heart disease, I would consult a cardiologist; if a stroke, I would consult a neurologist; if diabetes, a diabetologist."

The idea is not anything new in medicine, he added. "It is the same as with a surgical procedure," D'Amico said. "You do not give the therapy until it is cleared by the appropriate specialist."

The study is relatively small and requires further confirmation, said Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society.

"But for men trying to make a decision about prostate cancer treatment, it provides useful information for the men and their physicians," Brooks said. "A man who has had radiation treatment, if he and his doctor talk about the results of this study, it can help them make a decision about hormone treatment in a more informed way."

The results apply to "a significant percentage of older prostate cancer patients," Brooks said, noting that the average age of men in the study was over 70.

Until now, only general advice about hormone treatment could be given to such men, he said. "Now we can be a little more specific and say, 'If you don't have underlying cardiac disease or other major co-morbid conditions, the chance of having a good response to the treatment is better.' But many men with heart disease or other problems may decide they do not want to deal with the side effects of hormone treatment."

More information
Learn more about prostate cancer and its treatment from the American Cancer Society.

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Relatives of Parkinson's Patients at Higher Psychiatric Risk

(HealthDay News) -- The close relatives of people with Parkinson's disease are at increased risk for depression and anxiety disorders, new research suggests.

The risk is particularly high in the brothers, sisters, parents and children of people who develop Parkinson's before age 75, said a team from the Mayo Clinic in Rochester, Minn.

The study included 1,000 immediate relatives of 162 Parkinson's patients and 850 immediate relatives of 147 people without Parkinson's. It's the first large population-based study to identify this kind of association.

"Studies by our group and others have shown that relatives of patients with Parkinson's disease have an increased risk of Parkinson's disease. Recently, we showed they also have increased risk of essential tremor and of cognitive impairment or dementia. However, the risk of psychiatric disorders was unknown," senior author Dr. Walter Rocca, a neurologist and epidemiologist, said in a prepared statement.

"Because many patients with Parkinson's disease develop anxiety and depression after and even before the onset of the disease, we explored whether this tendency was present to a greater extent in family members of people with Parkinson's disease compared with people without the disease. We found that, indeed, relatives of patients with Parkinson's disease are at increased risk for anxiety and depressive disorders, which suggests a genetic or other relationship between those disorders and Parkinson's disease," Rocca said.

Further research is needed to determine the exact cause or causes that boost the risk, he said.

The study was published in the December issue of the journal Archives of General Psychiatry.

More information
There's more on Parkinson's disease at We Move.

Chronic Coughs Need a Doctor's Attention

(HealthDay News) -- If you wake up due to coughing or have a cough that lasts for weeks, you may have a potentially serious problem that requires medical attention.

"Cough is the most common respiratory symptom for which patients seek medical attention," Dr. Alan B. Goldsobel, chairman of the American Academy of Allergy, Asthma & Immunology's cough committee, said in a prepared statement.

"Cough protects the body by removing mucus and irritating particles from the respiratory tract. Coughing is a useful function and does not always mean there is a problem ...," Goldsobel explained. "However, coughing at night, after going to sleep indicates the need for medical attention."

Common causes of coughing include: viral upper respiratory tract infections; asthma; nasal and sinus disease; stomach and esophageal problems; an inhaled foreign body; habit; and environmental irritants.

People should see an allergist/immunologist if they have:

• a cough that lasts three to eight weeks or more;
• a cough that coexists with asthma;
• coexisting chronic cough and nasal symptoms;
• a chronic cough and tobacco use or exposure.

More information
To learn more about cough and children, visit the American Academy of Allergy, Asthma & Immunology.

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'Easy Does It' Eases Holiday Stress

(HealthDay News) -- It's supposed to be the happiest time of the year, but don't tell that to the patients who mob the offices of San Diego cardiologist Dr. Mimi Guarneri between Thanksgiving and New Year's.

Some complain of what doctors call "holiday heart" -- skipped beats, high blood pressure and angina due to stress or overindulgence. Others feel physically and emotionally overwhelmed, distracted by thoughts of difficult relatives or missing loved ones.

Guarneri, medical director of the Scripps Center for Integrative Medicine, has different advice for her patients, depending on their situations. But she's always sure to emphasize one theme: relaxation.

"The one thing is do is to take time out, take a deep breath, connect your mind with your body by simple breathing," she said. "And remember to not sweat the small stuff."

Easier said than done, of course. But when it comes to crippling holiday stress, specialists say the simplest pieces of advice are also the best.

Dr. Redford Williams, director of the Behavioral Medicine Research Center at Duke University in Durham, N.C., advises people to be reasonable with their expectations from the season, and to anticipate trouble -- ranging from long lines at stores and airports, to bouts of sadness when images of absent loved ones come to mind.

By readying yourself for these moments, "they won't come as a shock when you realize, 'I'm getting ready to honk my horn or get steamed over this person who just pulled in front of me.' If you can do that, you can probably head off some of it," Williams explained.

He said it's not clear how many people get the blues around the holidays, but it's probably not uncommon. "It's perfectly normal to get a little bit depressed or a little sad during the holidays at one point or another," Williams said.

However, it may not be as bad as some might assume. In recent years, American researchers have looked at local statistics and debunked the long-held assumption that suicide rates shoot up around the holidays.

Not every episode of Christmastime depression is minor, however. If you find yourself early in the new year having trouble with sleeping or eating -- doing either one too much or too little -- it's possible that you've fallen into a clinical depression.

If that might be the case, "You should seek some professional evaluation and possibly treatment," Williams said.

In other cases, a little self-help can be key. "In the grand scheme of life, we say, 'Don't sweat the small stuff,'" Guarneri said. "We have to realize that a lot of stress is what we put on ourselves, not what other people are putting on us."

If you're alone and feeling isolated, she said, "get out and do service work, which brings joy to people." And, if you have the opposite problem -- too much to do and too many people to worry about pleasing -- learn to do less. "None of this is worth dying for," she said.

More information
Learn more about holiday stress from the American Psychological Association.

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'Hospitalist' Physicians Help Shorten Patient Stays

(HealthDay News) -- A new breed of medical specialists, called hospitalists, can make a small but significant difference in shortening how long a patient needs to stay in the hospital, a new study shows.

The 2002-2005 study of almost 77,000 hospital stays at 45 centers showed that treatment by a hospitalist, rather than a general internist, resulted in about a half-day reduction in overall hospital stays on average, along with an average $268 drop in costs.

At the same time, researchers found no difference in the rate of either patient death or readmission when hospitalists were involved, according to the report in the Dec. 20 issue of the New England Journal of Medicine.

A hopsitalist refers to a physician who cares solely for hospitalized patients.

The term may be new to the general public, but, in the medical profession, "hospitalist has been a recognized and accepted term that has been around for about a decade," said study author Dr. Peter K. Lindenauer, an associate professor of medicine at Baystate Medical Center and Tufts University, in Boston.

In fact, "There is a Society of Hospital Medicine with 5,000 to 10,000 members, and it is estimated that there may be 20,000 hospitalists across the United States now," Lindenauer said.

"What you can't debate is the number of hospitalists around the country -- there is no going back," added Dr. Laurence McMahon, chief of the division of general medicine at the University of Michigan, in Ann Arbor.

"We need to think about how these new doctors get into the health-care system and how they care for patients who are hospitalized," said Mcmahon, who also authored an accompanying editorial on the issue.

Traditionally, a person's private physician has been responsible for care after hospitalization, he said. That began to change about 30 years ago, with the emerging role of emergency room physicians and critical care physicians, Lindenauer said. "They have been assuming the role of attending physician in those situations," he said. "In some respect, the growth of the hospitalist model of care represents the completion of a series of steps toward specialization that began 30 years ago."

According to Lindenauer, the advent of the hospitalist means another question should be asked when individuals choose a private physician: Will that doctor turn over care to a hospitalist, if and when someone needs hospital care?

"It is a discussion that a patient should have with a primary-care physician when he is thinking about enrolling with that physician," Lindenauer said.

The differences shown in the study -- a shortening of length-of-stay by 0.4 days, on average -- are not great, he acknowledged, but they do add up over time.

"Shortening the length of stay by 0.4 days is small, but when you multiply it out over time by thousands of physicians, the effects can be very large. With 5,000 cases a year, [that's] a savings of 2,000 bed-days," he said.

The study was not able to assess patient satisfaction with treatment by a hospitalist rather than a primary-care physician, Lindenauer said, "But we know that efficiency is important, as important to patients as to physicians." he said.

And while full official recognition of the hospitalist speciality is yet to come, the Society of Hospital Medicine is working closely with the of American Board of Medical Specialties toward such an end, Lindenauer said.

"The differences between hospitalists and other doctors who take care of patients in hospitals are pretty minor," McMahon said. "What really is quite revolutionary is the change in how we take care of patients in the hospital."

More information
There's more on hospitalists at the Society of Hospital Medicine.


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Blackberries, Broccoli Sprouts Battle Cancer

(HealthDay News) -- Your local farmer's market might hold the key to cancer prevention, since new research shows that black raspberries, broccoli sprouts and some raw vegetables reduce the risk of esophageal and bladder cancers.

Data from three studies on the subject was presented Thursday at the American Association for Cancer Research's Sixth Annual International Conference on Frontiers in Cancer Prevention, in Philadelphia.

Fruits and vegetables have long been known to help reduce the risk of certain cancers. Based on prior research, the American Cancer Society recommends eating five servings of fruits and vegetables daily.

In the first study, Ohio State University researchers found black raspberries may protect against esophageal cancer by reducing the oxidative stress that results from Barrett's esophagus, a precancerous condition usually caused by gastroesophageal reflux disease. The esophagus is a long tube that connects the throat to the stomach. Reflux disease causes stomach acid to continually splash back up into the esophagus.

"Specifically in the case of Barrett's patients, reflux of the stomach and bile acid contribute to ongoing oxidative damage. Thus, our hypothesis is that feeding a food that is high in potential protective constituents, such as antioxidants, vitamins, minerals and other phytochemicals, may help restore the oxidative balance," lead researcher Laura Kresty said.

People with Barrett's esophagus typically are 30 to 40 times more likely to develop esophageal cancer, which has a poor five-year survival rate of 15 percent.

The team gave 32 grams to 45 grams of black raspberries daily for six months to 20 patients with Barrett's esophagus. They analyzed changes in blood, urine and tissue before, during and after the treatment, and found lower levels of some of the chemical markers of oxidative stress in both urine and tissue samples.

Black raspberries previously have been shown to reduce the risk of oral, esophageal and colon cancer in animal models, according to the researchers, who called for further study in humans.

Dietitian Wendy Demark-Wahnefried, a professor of behavioral science at M.D. Anderson Cancer Center at the University of Texas in Houston, said she would feel comfortable advising people with Barrett's to eat black raspberries. "It couldn't hurt," she said, but added that further studies need to find out if the berries really do prevent cancer.

In other research presented at the meeting, broccoli sprouts and cruciferous vegetables both showed promise in the fight against bladder cancer, according to two separate teams from the Roswell Park Cancer Institute in Buffalo, N.Y.

Using a rat model, a team lead by Dr. Yuesheng Zhang, a professor of oncology, demonstrated that a broccoli sprout extract reduced bladder cancer in rats by 70 percent.

"Our present study shows that broccoli sprout extracts fed to rats in the diet inhibits bladder cancer development induced by a carcinogen. We don't yet know if the extracts inhibit the growth of a existing bladder cancer," said Zhang, who explained that broccoli sprouts are a rich source of a well-known cancer preventive agent known as sulforaphane.

"We next plan to find out if broccoli sprout extracts can fight bladder cancer in humans," Zhang noted.

A second team at the institute found that people who ate three or more servings of raw, cruciferous vegetables per month reduced their risk of bladder cancer by 40 percent.

Cruciferous vegetables include broccoli, cabbage and cauliflower.

The team analyzed the dietary habits of 275 people with early bladder cancer and 825 people who were cancer-free. The researchers specifically asked how many servings of raw or cooked cruciferous vegetables they ate before their diagnosis and whether they smoked.

Analysis of the data showed that the more raw, cruciferous vegetables people ate, the lower their risk of bladder cancer. In comparison to people who smoked and ate fewer than three servings of raw vegetables a day, nonsmokers eating at least three servings of cruciferous vegetables daily were 73 percent less likely to develop bladder cancer.

"In our study, we do find intake of raw cruciferous vegetables showed risk reduction of bladder cancer in smokers, and even the heavier smokers," said lead researcher Li Tang.

The researchers stressed that the benefits are derived from raw cruciferous vegetables, giving cole slaw the edge over cabbage soup when it comes to cancer prevention.

"This confirms that there are a variety of compounds within fruits and vegetables that contribute to reducing the risk of cancer. Research like these studies contribute to our knowledge about what the impact of specific nutrients may be on specific types of cancer," said Colleen Doyle, director of nutrition and physical activity for the American Cancer Society.

"Cooking leaches out some nutrients but makes others more absorbable. Until we know more in this regard, the bottom-line message for consumers is eat at least five servings of fruits and vegetables each day, raw and/or lightly cooked. Focus on those with the most color, since, in general, fruit and vegetables with the most color have the most cancer-fighting antioxidants and phytochemicals."

"Surveys we've done indicate many people don't think they have control over their cancer risk, but studies clearly indicate they do. For the majority of people who don't smoke, watching their weight, being more active and eating a healthy diet are the most important ways to reduce cancer risk," Doyle said.

More information
To learn how diet and physical activity can help prevent cancer, visit the American Cancer Society.

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'Tis the Season For Allergy, Asthma

(HealthDay News) -- It's easy for the holidays to become the season of sneezing, congestion and other woes for people with food or other allergies and asthma, say experts at the American Academy of Allergy, Asthma & Immunology (AAAAI).

But some preventive measures can cut symptoms to a minimum, they say.

"Whether it's feasting on holiday meals, setting up your Christmas tree, or visiting your pet-owning relatives, allergy triggers may be lurking inside of our warm, cozy homes this time of year," Alisa M. Smith, vice-chairwoman of the AAAAI's indoor allergen committee, said in a prepared statement. "Unfortunately, with busy schedules, travel time and the stress of the holidays, it is easy to forget to take the proper care when dealing with allergies and asthma.

However, avoiding potential triggers and taking the proper precautions is necessary to keep symptoms under control."

The AAAAI offers the following tips for people with asthma and different types of allergies:
When you're at parties or family gatherings, inform your hosts about your food allergy and ask about the ingredients used to prepare the meal.

Always carry an injectable dose of epinephrine. Homemade meals/snacks don't have ingredient lists and may be contaminated with trace of amounts of allergenic foods through contact with storage containers or kitchen utensils.

Remind family and friends that strict avoidance is the only way for you to manage food allergies and that even a tiny bit of allergenic foods can trigger a dangerous allergic reaction.
If you're visiting homes where there are pets, take your allergy medication beforehand.

Real Christmas trees often carry microscopic mold spores that can cause allergic symptoms such as sneezing, water eyes, and an itchy nose.

Decorations and artificial trees can gather mold and dust while in storage. Clean them before you start putting them up.

Artificial snow can irritate your lungs if you inhale it. Be sure to follow directions when spraying artificial snow on windows or other surfaces.

The stress of the holiday season can sometimes trigger an asthma attack. Monitor your stress levels. If you do feel stressed, deep breathing and relaxation may help.

If you're sleeping away from home, bring your own pillow with an allergen-proof cover. Ask for down-free pillows.

Avoid wood smoke, which can trigger an asthma attack.

More information
The American Academy of Family Physicians has more about controlling allergy symptoms.

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Gene Tweak Reverses Aging in Mouse Skin Cells

(HealthDay News) -- Scientists say they've been able to temporarily return old skin cells to their youthful state by blocking the activity of a single gene.

"This gene gets more and more active with age," said lead researcher Dr. Howard Chang, an assistant professor of dermatology at Stanford University. "It doesn't exist to make us old. It is active in a number of processes, including the immune system and inflammation."

Chang said tweaking the gene, which produces a protein called NF-kappa-B, will not serve as a "fountain of youth" for the foreseeable future. The protein has a number of functions, some involved with cancer, and as-yet-unknown side effects must be explored before its safety is known. But one possible use is to help heal wounds more quickly in older people, he noted.

What's exciting about the discovery is that a single gene can have an immediate effect on older cells, Chang said. "People have known that you can affect the aging process with drastic interventions, like calorie restriction. Now we are talking about a single gene that, if blocked in an individual who is already old, can return cells to a youthful status, at least temporarily."

The researchers came across NF-kappa-B by searching existing data on genes that become more or less active as people get older. They found that the activity of a number of those genes is regulated by the protein.

They then used a genetically engineered mouse model to test the effect of inhibiting NF-kappa-B activity in a patch of skin cells.

After two weeks, a patch of treated skin from a 2-year-old mouse not only had the same genetic activity as that of a newborn animal but also looked more youthful, with more dividing cells.
It's fascinating "to engineer a mouse so that the rest of the mouse is old, but that one patch is young, to see that even locally, in a targeted way, you can affect the aging process," Chang said.

The finding also adds support to the theory that aging is not simply a process of wear-and-tear but the result of specific genetic changes, he said. And it shows that at least locally and temporarily, those changes can be stopped, Chang added.

The gene treatment has to be used cautiously, because NF-kappa-B is involved in so many different processes in the body, he noted.

A question to be asked now is, "What is the long-term effect of blocking the aging process for a while?," Chang said. "Would the tissue age rapidly again after the treatment stopped, or would they take much longer to age? It's important to sort these things out."

Long-term blockage of the gene would raise serious issues in terms of side effects, Chang said, since the gene is involved in so many body processes. Short-term use -- for wound healing, for example -- might sidestep those problems.

More information
There's more on skin aging at the U.S. National Library of Medicine.

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Depression Linked to Bone Loss in Younger Women

(HealthDay News) -- Premenopausal women struggling with depression have lower bone mass than do non-depressed women in the same age range, a new study found.

The bone loss was most pronounced in certain regions of the hip, which is troubling given that hip fractures are one of the most serious -- and potentially fatal -- consequences of osteoporosis.

The level of bone loss seen in the depressed women was the same or higher than that associated with other, established risk factors for osteoporosis, including smoking, low calcium intake and lack of physical exercise, the researchers said.

The findings, published in the Nov. 26 issue of the Archives of Internal Medicine, could have implications for the prevention of osteoporosis.

"Premenopausal women with depression should be screened for low bone mass," said Dr. Giovanni Cizza, senior author of the study who conducted the research while at the U.S. National Institute of Mental Health. "They should do a bone mineral density measurement, because osteoporosis is a silent condition. Until someone fractures, you don't know you have osteoporosis."

Cizza is now a staff clinician at the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

A woman's bone mass peaks during youth then thins after menopause. Previous, preliminary studies had suggested that depression might be a risk factor for low bone mass in older women.

For this study, Cizza and his colleagues looked at 89 women with depression and 44 women without depression. The women ranged in age from 21 to 45. The depressed women were taking antidepressant medications.

Seventeen percent of the depressed women had thinner bone density in the femoral neck, a vulnerable part of the hip. Only 2 percent of non-depressed women, by contrast, had thinner bone in this area.

Twenty percent of depressed women also had low bone density in the lumbar spine, compared with 9 percent of the non-depressed women.

Blood and urine samples also revealed that the depressed women had lower levels of "good" proteins called cytokines. "The bad cytokines that may cause bone loss are higher," Cizza said.

It's not clear what role antidepressants might play, but by relieving the depression, the drugs may also help bone mineral density, the researchers said.

More information
To learn more about bone health, visit the National Osteoporosis Foundation.

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Sleep Problems Plague the Older Set

(HealthDay News) -- Older Americans often have difficulty getting a good night's rest. It's a huge quality-of-life problem, experts say, because contrary to popular belief, seniors require about the same amount of sleep as younger adults.

"Sleep problems and sleep disorders are not an inherent part of aging," said Dr. Harrison G. Bloom, a senior associate at the International Longevity Center-USA and associate clinical professor of geriatrics and medicine at the Mount Sinai School of Medicine in New York City.

"It's pretty much of a myth that older people need less sleep than younger people."

Yet, in a study published recently in The American Journal of Medicine, researchers found that more than half of older Americans have problems getting the shuteye they need.

Older people tend to have "sleep fragmentation," meaning they wake up more often during the night, said study author Dr. Julie Gammack, an assistant professor of medicine in the Division of Geriatric Medicine at St. Louis University.

They also seem to get less "REM" sleep, the type of sleep during which rapid eye movement occurs, Bloom added.

It's unclear what role these naturally occurring changes in sleep patterns have on a person's quality of life, Bloom said. "What is important, though, is that older people often have actual sleep disorders and problems with sleep," he said.

And, experts say, there is usually more than one cause.

"Sleep disturbance in older adults is typically associated with acute and chronic illnesses, including specific sleep disorders like sleep apnea and restless leg syndrome that appear with greater frequency in older populations," said Michael V. Vitiello, a professor of psychiatry and behavioral sciences and associate director of the University of Washington's Northwest Geriatric Education Center.

As people age, they typically develop more diseases and suffer from aches and pains. "These things can disrupt sleep, so what they may perceive as a sleep disorder may actually relate to the effects of some of their other medical problems," Gammack noted.

Taking multiple medications, as many older people do, can also lead to fatigue and "hypersomnia," or being tired all the time, Bloom added.

Another big problem, he noted, is depression and anxiety. "Those are very commonly associated with sleep problems."

Despite the prevalence of sleep difficulties in older adults, many patients aren't getting the help they need.

"The average physician receives very little training about sleep disorders and typically does not routinely screen patients for them," said Vitiello, who serves on the board of directors of the National Sleep Foundation. This may be due to a lack of time or training or the belief that there is little that can be done to improve sleep, he explained.

As a result, problems like insomnia, restless leg syndrome, sleep apnea and circadian rhythm disorders are underdiagnosed and undertreated, Bloom said.

To rectify the problem, a national coalition of aging, geriatric medicine and sleep organizations is currently developing guidelines to promote prevention, diagnosis and treatment of sleep problems in older adults. The National Coalition for Sleep Disorders in Older People expects to publish its recommendations by mid-2008.

"The reason we're concerned with these [problems], besides a major issue on quality of life and being tired the next day and not functioning properly, is that these sleep disorders are associated with hypertension, diabetes, pulmonary disease, heart disease, depression and anxiety," said Bloom, chairman of coalition's expert task force.

A cause-and-effect relationship has yet to be established between sleep disorders and these chronic health problems, but Bloom suspects they at least contribute to each other. And he believes a causal relationship may be found in years to come.

"This is very, very much a tip-of-the-iceberg problem," he said.

More information
For tips on better sleep, visit the National Sleep Foundation.

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Energy Drinks Could Pose Blood Pressure Risks

(HealthDay News) -- Energy drinks boost blood pressure and heart rate and could pose risks to people with hypertension and heart disease, say Wayne State University researchers.

They found that drinking two cans of a popular energy drink increased blood pressure and heart rate in 15 healthy adults, average age 26.

Within a few hours of having the energy drinks, the volunteers' systolic blood pressure (top number) increased by as much as 9.6 percent, and diastolic blood pressure increased by as much as 7.8 percent. Heart rate increased by as much as 11 percent.

"This occurred while participants were sitting in chairs watching movies," study leader James Kalus noted in a prepared statement. "The increase in heart rate and blood pressure weren't enough for something to happen acutely, but a person on hypertension medication or who has a cardiovascular disease may not respond as well."

"While energy drinks increase concentration and wakefulness, people with risk factors for heart disease could have a bad reaction. The subjects in this study were healthy with low blood pressure," Kalus added.

He and his colleagues noted that most energy drinks contain high levels of caffeine and an amino acid called taurine, both of which have been shown to have effects on heart function and blood pressure. The researchers emphasized that energy drinks are different from sports drinks, which don't contain ingredients designed to heighten alertness.

The study was expected to be presented Nov. 6 at the American Heart Association annual meeting, in Orlando, Fla.

More information
The Nemours Foundation has more about energy drinks and food bars.

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