Health

Heartburn drugs linked to increased pneumonia risk

(Reuters Health) - People on two types of widely prescribed heartburn medications may have a higher-than-average risk of developing pneumonia, a new research review finds.

The drugs in question belong to two classes frequently used to treat heartburn or stomach ulcers: proton pump inhibitors, which include drugs like Nexium, Prevacid and Prilosec; and H2-receptor blockers, such as Pepcid and Zantac.

In the U.S. alone, people spent $27 billion on these medications in 2005.

Some studies have found a connection between the heartburn drugs and a heightened risk of pneumonia. One theory is that by curbing stomach acid, the medications allow ingested bacteria that would otherwise be killed to instead survive and thrive -- and potentially get into the lungs.

For the new analysis, South Korean researchers pulled together 31 international studies looking at the connection between heartburn drugs and pneumonia.

When they combined the studies' results, they found that people on either proton pump inhibitors or H2 blockers were about one-quarter more likely than non-users to develop pneumonia.

Some studies focused on people who became infected while in the hospital, where pneumonia is a common, and often deadly, problem. Other studies focused on

out-of-hospital infections. People who used heartburn drugs were at increased risk in either case.

The risks to any individual medication user were not huge. The researchers estimate, for example, that among hospital patients on the heartburn drugs, there would be about 25 cases of pneumonia per 1,000 patients. That compares with 20 cases per 1,000 among hospital patients not on the drugs.

And it's not certain that the drugs themselves are to blame, Dr. Sang Min Park, one of the researchers on the study, told Reuters Health in an e-mail.

It's possible that chronic acid reflux itself could at least partly account for the link,

according to Park, of Seoul National University Hospital. Acids that back up out of the stomach can sometimes be sucked into the airways, where they could cause pneumonia.

Still, Park said the findings suggest that doctors and heartburn sufferers should use some caution when it comes to acid-suppressing drugs.

Discuss the pros and cons with your doctor, the researcher advised, and use the

medications only if necessary to control your symptoms -- in cases where diet and other lifestyle changes don't work, for example -- and at the lowest dose possible.

Caution would be especially important for people already at higher-than-average risk of pneumonia, such as the elderly and people with emphysema or other chronic lung diseases, according to Park.

The findings, reported in the Canadian Medical Association Journal, are based on 31 studies from Europe, Asia and North America.

Based on the hospital studies, Park's team estimates that acid-suppressing drugs could contribute to an extra four to five cases of pneumonia for every 1,000 hospital patients. The researchers point out that anywhere from 40 percent to 70 percent of hospital

patients are on one of these drugs. This, they say, suggests that the medications could account for a \"considerable\" portion of hospital-acquired infections.

The researchers could not perform a similar overall estimate for out-of-hospital infections. But one study they reviewed gives an idea of the drugs' potential contribution to pneumonia cases outside hospitals.

In that study, Dutch researchers looked at out-of-hospital pneumonia rates among nearly 365,000 adults over seven years. Of the people on proton pump inhibitors or H2 blockers, 2.5 percent developed pneumonia per year, versus 0.6 percent of those not on the drugs. Alternative ways to manage frequent heartburn include lifestyle changes, like avoiding foods that trigger symptoms, eating smaller meals and losing weight, and quitting smoking. Over-the-counter antacids, which neutralize stomach acids, can bring quick symptom relief.

Some people with frequent or severe heartburn, however, may need an acid-suppressing medication to control their symptoms and prevent or treat damage to the esophagus or stomach lining.

Exercise, vitamin D tied to fewer

falls

(Reuters Health) - Vitamin D supplementation and exercise may help prevent older men and women from falling, suggests a new review of 54 studies by the U.S. Preventative Services Task Force (USPSTF).

Falls are the leading cause of death, disability and loss of independence for people 65 years and older. About one in every three adults in this age group who are not

institutionalized will fall in a given year. More than $20 billion in annual health care costs may be associated with those events.

\"The number of falls among older adults is increasing significantly every year, and it's not because the percentage who fall is increasing. Rather, it's because the number of older adults is growing and will continue to grow,\" lead researcher Dr. Yvonne Michael of Drexel University in Philadelphia, told Reuters Health.

\"Understanding how to prevent falls is crucial,\" added Michael, who started the review while at Kaiser Permanente Center for Health Research, in Portland, Oregon. Michael and her colleagues set out to determine what interventions might be useful for primary care physicians to prescribe to their older patients. They identified 54 relevant studies, which included a total of more than 26,000 participants.

Getting exercise and taking vitamin D supplements appeared to offer the most potent prevention among the interventions investigated, which also included vision correction and modifying the home environment, report the researchers in Annals of Internal Medicine.

No risks of other physical harms were found to be associated with any of the strategies. Exercise, on average, cut the seniors' risk of falls by 13 percent. Specific interventions ranged from programs that improve balance, strength and flexibility to weight training, general physical activity such as walking or aerobics.

Vitamin D supplementation -- with or without calcium -- reduced the risk of falling by an average of 17 percent. Half of the trials used daily doses above 800 international units (IU).

A previous review had found vitamin D to be ineffective in preventing falls. However,

Michael pointed out, one of the large studies included in that analysis was determined not to be of high enough quality to be incorporated into the new review. In its place, the researchers included four other studies they deemed more appropriate.

\"We need to do more study,\" Michael said. \"But, on the basis of this review, I think there is fairly stable evidence that physicians can successfully reduce the percent of (those who fall) through vitamin D supplementation.\"

The researchers acknowledge some limitations to their review, including the issues inherent in any effort to combine results from multiple studies, such as a lack of consistency in terminology, interventions and measurements.

The current findings will serve as the basis for recommendations from the USPSTF, an independent panel of experts in prevention and evidence-based medicine. A draft, expected soon, will be available for public comment before becoming finalized.

In an accompanying article in the same issue of the Annals, researchers addressed the unique challenges in formulating any prevention-related recommendations for older adults.

\"As we age, prevention is no longer a 'one size fits all' endeavor,\" lead author Dr.

Rosanne Leipzig of the Mount Sinai School of Medicine, in New York City, told Reuters Health in an e-mail.

Older men and women are often burdened by an array of complicating conditions and other issues.

\"We can't point to just one thing that is the cause of a fall in an older adult. A number of factors can come together to lead to a fall,\" added Michael. \"Still, there are still some things that physicians are able to recommend or prescribe to their patients.\" \"Hopefully this will make it easier for physicians to make treatment plans that include exercise and vitamin D, and will be covered by insurance,\" she said.

Health insurers face new rules over price hikes

(Reuters) - U.S. health insurance companies that want to increase premiums by 10 percent or more next year would face tougher government scrutiny under new rules proposed on Tuesday.

The rules, called for under the sweeping healthcare law passed in March, would require insurers with price increases of 10 percent or more in 2011 to submit data justifying the higher rates for states or, in some cases, the federal government to assess.

While regulators cannot set health insurance rates, they can determine whether proposed increases are \"unreasonable.\"

The rules put further pressure on health insurers such as Aetna Inc, UnitedHealth Group Inc and WellPoint Inc, which suffered bad press and drew closer scrutiny by the U.S. Congress and regulators this year when prices for some individual plans in certain areas rose more than 30 percent.

Tuesday's proposal offers Wall Street and insurers more details on the rules, which analysts said were better than expected and lifted some uncertainty hanging over the industry.

Shares of insurers, represented by the S&P Managed Health Care Index, rose 1.5 percent after the proposal was announced, but later pared their gains and were up 0.5 percent, in line with the overall market.

The rule is \"not as bad as it could have been,\" Capital Alpha Partners analyst Kim Monk told Reuters. With its emphasis on the states' role, less federal oversight is likely over time and the U.S. Department of Health and Human Services (HHS) \"will get out of the rate review business entirely, with this just being a stopgap.\"

The proposal also pushes back implementation until July, which gives companies more time to seek possible changes, she added.

Health insurers largely fought Democrats' healthcare overhaul but have since said they will work to implement it. Republicans, who are set to take over the U.S. House of Representatives next month, have vowed to repeal the law.

Karen Ignagni, head of the healthcare industry lobbying group America's Health Insurance Plans, said the 10 percent threshold does not adequately account for all the factors insurers face when setting rates and that overall higher healthcare costs are a major factor.

\"The public policy discussion on healthcare costs has focused on health insurance premiums while ignoring the root causes that are driving up the cost of coverage,\" said Ignagni.

Jay Angoff, head of the Office of Consumer Information and Insurance Oversight at HHS, said the proposed rule \"strikes the right balance\" between companies and consumers as well as state and federal roles.

\"We believe that it maximizes consumer protection and transparency without unduly burdening the industry,\" he told a news conference.

Under the draft, healthcare insurance plans for large groups, such as those offered by many big employers, are not subject to the review.

Still, insurers would have to submit a host of data to regulators about how they set their higher prices, including a three-year history of rate increases for the specific insurance plan, details on the plan's medical-loss-ratio spending, and data on employee and

executive compensation. The requirements are likely to add to health insurers' paperwork burden, Monk said.

Various consumer groups applauded the proposal, which they said would help rein in skyrocketing health plan prices and give buyers better information, although some advocates said the rules could be stronger.

\"No longer will the insurance industry be able to operate in a wild, wild West through

unreasonable premium increases without any accountability for their actions,\" Ron Pollack, executive director of Families USA, said in a statement.

After a rate review, federal officials would post the findings on the HHS website. If a rate hike was deemed too high, insurance companies would also have to post the verdict on their own websites.

States with their own health insurance review systems would evaluate companies' rates, with HHS stepping in to assess proposed increases in states without such systems. Different state-by-state thresholds -- rather than the blanket 10 percent one next year -- would be set after 2011, officials said.

The proposal, online at link.reuters.com/ker23r, will be finalized after a 60-day public comment period.

Explaining Why Meditators May Live Longer

The image of the ancient but youthful-looking sage meditating on a mountaintop might be closer to reality than you think, according to a new study that found that after a three-month stay at a meditation retreat, people showed higher levels of an enzyme associated with longevity.

The study is preliminary and didn't show that meditation actually extends life, but the findings suggest a possible means by which it could.

Researchers led by Tonya Jacobs of the University of California-Davis compared 30

participants at a meditation retreat held at the Shambhala Mountain Center in Colorado with matched controls on a waiting list for the retreat. Participants meditated six hours per day for three months. Their meditation centered on mindfulness — for instance, focusing solely on breathing, in the moment — and on lovingkindness and enhancing compassion towards others. (More on Time.com: Empathy Beats Bullies)

After the three-month intervention, researchers found that the meditators had on average about 30%* more activity of the enzyme telomerase than the controls did. Telomerase is responsible for repairing telomeres, the structures located on the ends chromosomes, which, like the plastic aglets at the tips of shoelaces, prevent the chromosome from

unraveling. Each time a cell reproduces, its telomeres become shorter and less effective at protecting the chromosome — this, researchers believe, is a cause of aging. As the chromosome becomes more and more vulnerable, cell copying becomes sloppier and eventually stops when the telomeres disintegrate completely. Telomerase can mitigate — and possibly stop — cell aging.

\"Something about being on a retreat for three months changed the [amount of]

telomerase in the retreat group,\" says Elizabeth Blackburn, a study author who has won a Nobel Prize for her previous work on telomerase. \"We didn't prove that it was meditation [that caused the change]. A lot of things happened during the retreat. But the interesting

thing was that the changes we saw tracked quantifiably with the change in people's psychological well-being and outlook.\" (More on Time.com: Can Meditation Ease Pain?)

In other words, people with higher levels of telomerase also showed more increases in psychological improvement. In retreat participants who showed no psychological change, telomerase levels were not any higher than in controls. (Researchers were unable to compare telomerase levels in the groups both before and after the retreat for logistical reasons.)

\"It's a very good study with interesting results in terms of health implications,\" says Alan Marlatt, a professor of psychology at the University of Washington who has studied meditation for decades but was not associated with this research.

Of course, the relationship between health and telomerase is complex. In a recent study in mice by Harvard researchers, they found that boosting levels of telomerase reversed signs of aging, restoring graying fur and fertility, increasing brain size and sharpening scent perception. Too much telomerase activity can also be a problem, however. A cell that reproduces endlessly sounds like a good thing at first — that cell would be immortal. But this is exactly what happens with cancer cells — infinite replication. \"If telomerase levels go too far up, that's [associated with] cancer,\" says Clifford Saron, associate

research scientist at the University of California-Davis Center for Mind and Brain and a co-author of the new paper. He notes, however, that the difference is one that is orders of magnitude higher—so that meditation could not possibly cause cancer*. (More on Time.com: Want to Eat Less? Imagine Eating More)

So how does meditation affect the machinery of cellular reproduction? Probably by

reducing stress, research suggests. Severe psychological stress — particularly early in life and in the absence of social support — has been linked with poorer health, increasing risk for heart disease, stroke and some cancers. This is likely due to the negative effects of high levels of stress hormones on the brain and body. By reducing stress hormones, perhaps meditation contributes to healthier telomeres.

In a study published a few years ago in Lancet Oncology, researchers compared 30 men before and after adopting lifestyle changes following a diagnosis of low-risk prostate

cancer. The patients started meditating, switched to a healthy plant-based diet, exercised and attended a support group. Like the new study, the Lancet Oncology paper found increases in telomerase linked with reduced psychological distress.

\"The mind has a big influence on the body. If you get anxious, your heart beats faster and your stomach churns,\" says Blackburn. \"But we don't know yet [if meditation is linked to] a reduction in stress hormones. The physiology is very complex.\"

Recent evidence supports a connection: a study published this month in the Archives of General Psychiatry showed that mindfulness meditation can reduce relapse in patients who recovered from depression just as well as antidepressants. (More on Time.com: Is a Wandering Mind an Unhappy One?)

Of course, the increases in telomerase seen in the current study could be due to some other unknown factor that separates the meditators from the controls. That's another reason why it's too early to suggest that stress-reducing mind-body interventions like meditation be prescribed as a treatment for any diseases or disorders. The study also did not show that meditation actually extends life, only that it may increase the activity of an enzyme that is associated with longevity.

Still, research on meditation is expanding dramatically, with studies finding it helpful for pain, depression, addiction and many other conditions. \"There's a very exciting dialogue going on,\" Marlatt says of the research. \"It works for many different kinds of clinical problems. It's very promising.\"

That noise you hear in the background? Millions of new meditators chanting, \"Om.\"

Middle Age: It's Not Downhill from Here — At Least in Terms of Mood

In what seems like an unrelenting year of bad news, the Economist has a lovely and uplifting feature headlined \"The U-Bend of Life.\"

Although the plumbing metaphor might sound uninviting, in fact the piece is a cheery paean to older age. It explores the surprisingly well-replicated findings that unhappiness peaks in middle age, and that older age seems to bring increasing emotional well-being. The author writes:

[M]ankind is wrong to dread ageing. Life is not a long slow decline from sunlit uplands towards the valley of death. It is, rather, a U-bend.

When people start out on adult life, they are, on average, pretty cheerful. Things go

downhill from youth to middle age until they reach a nadir commonly known as the mid-life crisis. So far, so familiar. The surprising part happens after that. Although as people move towards old age they lose things they treasure — vitality, mental sharpness and looks — they also gain what people spend their lives pursuing: happiness.

The article cites supporting research across disciplines, and is spiked with such piquant observations as \"Young people will go to cocktail parties because they might meet

somebody who will be useful to them in the future, even though nobody I know actually likes going to cocktail parties.\" And, from William James, \"How pleasant is the day when we give up striving to be young — or slender.\"

It's well worth a read, especially if you are in your 40s, which is apparently life's peak time for unhappiness.

Little screening of kids for obesity complications

(Reuters Health) - Only a minority of obese youths are screened for diabetes, liver problems and high cholesterol, electronic medical records from an Ohio healthcare system show.

Researchers say the findings are a call for action, since such complications could be part of the reason why heavy kids appear to have shorter lives than their slimmer peers. Other experts, however, say there is no proof that stepping up routine screening tests will improve the prospects for the more than one in six American youngsters who are obese. The new study, published in the journal Obesity, found that among nearly 70,000 children and adolescents with data on height and weight, a quarter were obese. That means they were among the top five percent of heaviest kids, according to their body mass index, a measure of weight in relation to height.

Obesity is a risk factor for several illnesses, including liver, cholesterol and blood sugar problems, and many medical groups, though not all, recommend screening obese kids for such conditions on a routine basis.

In the Ohio study, less than a quarter of the heaviest kids were screened for all three

conditions. Even among those with a diagnosis of obesity, only 30 percent had liver tests, 41 percent had their cholesterol and other lipids checked, and 52 percent had blood sugar tests.

The numbers did climb over the past decade, the researchers found, but appeared to level off around 2004 and may even be declining.

\"Lack of knowledge of current guidelines likely contributes to underscreening, as guidelines have varied throughout the study period, beginning with vague

recommendations in 1998 to more complete guidelines published in 2005 and 2007,\" Dr. Lacey Benson, of the Denver Children's Hospital, and her colleagues write. \"After an obese child is diagnosed with obesity, diagnosis should be followed by an assessment for obesity-related conditions that may require treatment or further intervention,\" they add. But not all guidelines agree.

The U.S. Preventive Services Task Force, a federal expert panel, recommends screening for obesity itself and suggests targeting diet and physical activity to help kids shed the extra pounds.

But according to the task force, there simply aren't enough data to show that benefits of further screening tests outweigh the harms -- or are worth the extra cost, for that matter. The drugs used to correct potential problems all have side effects, for instance, such as the muscle pain and occasional liver damage caused by the cholesterol-lowering statins. \"There is so much uncertainty about the long-term impacts -- benefits and harms -- of putting kids on statins for decades,\" said Dr. David Grossman, a member of the USPSTF. \"We do know that you can have some impact on lipid levels, but whether or not that

improves outcomes and quality of life, or whether or not you could wait until later to start treatment, that is unclear,\" he added. \"Some people are willing to make that assumption, but our standard is such that we need to prove it.\"

In the meantime, Grossman said, the decision to do lab tests should be an individual one, taking into consideration each person's symptoms as well as disease among close relatives.

Gene codes cracked for strawberries and chocolate

LONDON | Sun Dec 26, 2010 1:02pm EST

(Reuters) - Teams of scientists have cracked the genetic codes of the wild strawberry and a certain type of cacao used to make fine chocolate, work that should help breeders develop better varieties of more mainstream crops.

The wild strawberry is closely related to important food crops such as apples, peaches, pears and raspberries, as well as cultivated strawberries, so its gene map will help breeders of these plants to produce new varieties, the researchers said.

\"Because farmers have been cross-breeding and hybridizing food crops for centuries to improve traits, they tend to have large complicated genomes but the wild strawberry's is relatively small so we can get access to all of these useful genes comparatively easily,\" said Dan Sargent of Britain's Biotechnology and Biological Sciences Research Council (BBSRC) Crop Science Initiative, who worked on the project.

In a study published in the journal Nature Genetics on Sunday, Sargent and an

international team of researchers found that the wild strawberry genome has around 35,000 genes, about one and a half times the number that humans have, and most of these will also be in cultivated varieties, they said.

\"This will accelerate research that will lead to improved crops, particularly commercial strawberries,\" said Todd Mockler, of Oregon State University, one of the lead researchers on the team in the United States.

\"It could lead to fruit that resists pests, smells better, tolerates heat, requires less fertilizer, has a longer shelf life, tastes better or has an improved appearance.\"

In a separate study in the same journal, French researchers said they had sequenced almost all of the genome for the Criollo variety of the cacao plant, Theobroma cacao -- a tropical tree crop used to make chocolate.

The work, which the scientists said found almost 29,000 genes and covered 76 percent of the estimated full genome, should help the genetic improvement of cacao crops. The

cocoa tree was first cultivated approximately 3,000 years ago and about 3.7 million tons of cocoa is currently produced each year.

The group working on the strawberry genes, which involved more than 70 researchers in five continents, sequenced the wild plant's genome by breaking it up into millions of short segments which were sequenced individually and then reassembled.

Plants tend to have far more complex DNA than animals, and the scientists identified 34,809 genes in the wild strawberry. Humans have around 20,000 to 25,000 genes. Scientists said in August they had decoded and published almost all of the highly complex genome of wheat, a staple food for more than a third of the world's people.

Family history of alcoholism raises obesity risk

(Reuters) - People with a family history of alcoholism may be turning to high-calorie treats instead of booze to satisfy their addiction, U.S. researchers say, a change that could be fueling the obesity epidemic.

Because alcohol and bingeing on junk foods stimulate the same parts of the brain, it may be that people with a predisposition to alcoholism are replacing alcohol with junk foods, says the team from Washington University in St. Louis. This is especially true for women, they said.

\"Much of what we eat nowadays contains more calories than the food we ate in the 1970s and 1980s but it also contains the sorts of calories -- particularly a combination of sugar, salt and fat -- that appeal to what are commonly called the reward centers in the brain,\"

Richard Grucza, who worked on the study published this month in the Archives of General Psychiatry, said in a statement.

\"Alcohol and drugs affect those same parts of the brain and our thinking was that because the same brain structures are being stimulated, overconsumption of those foods might be greater in people with a predisposition to addiction.\"

Grucza's team compared addiction and obesity trends from a national survey conducted in 1991 and 1992 and in 2001 and 2002. Almost 80,000 people took part in the two surveys.

The team found that in 2001 and 2002, women with a family history of alcoholism were 49 percent more likely to be obese than those without a family history of alcoholism. The same was true of men to a lesser degree.

Grucza said the study suggests alcoholism and obesity are cross-heritable, much like alcoholism and drug addiction are. He said some of this may be related to changes in the environment, such as increased consumption of junk foods.

The study is part of a body of growing evidence for a link between alcohol abuse and obesity, particularly for women.

The alcoholism-overeating link might help explain rising obesity in the United States, which has doubled from 15 percent of the population in the late 1970s to 33 percent in 2004.

Drug firms are eyeing the alcohol-obesity link in hope of reaching the potentially huge U.S. market for obesity drugs.

Earlier this month, Orexigen Therapeutics and Takeda Pharmaceutical won backing from a U.S. advisory panel for the diet drug Contrave, which combines naltrexone, used to fight alcohol and drug addiction, and the antidepressant bupropion. The drug aims to target cravings, curb appetite and boost metabolism.

If approved by the U.S. Food Administration, the drug would be the first new weight-loss pill in a decade.

Eating lots of red meat ups women's stroke risk

(Reuters Health) - Women who eat a lot of red meat may be putting themselves at increased risk of stroke, a new study in more than 30,000 Swedish women hints.

The study team found that those in the top tenth for red meat consumption, who ate at least 102 grams or 3.6 ounces daily, were 42 percent more likely to suffer a stroke due to

blocked blood flow in the brain compared to women who ate less than 25 grams (just under an ounce) of red meat daily.

Diets heavy in red meat have been linked to a number of ill effects, including an increased risk of certain cancers, heart disease, and high blood pressure. Yet, just three studies have looked at red meat and stroke risk. One study found a link, but the others did not. To investigate further, Dr. Susanna Larsson of the Karolinska Institutet in Stockholm and her colleagues looked at 34,670 women 39 to 73 years old. All were free of cardiovascular disease and cancer at the beginning of the study, in 1997.

During 10 years of follow-up, 1,680 of the women (4 percent) had a stroke.

Stroke caused by blockage of an artery that supplies blood to the brain -- also known as \"cerebral infarction\" -- was the most common type of stroke, representing 78 percent of all strokes in the study. Other types of strokes were due to bleeding in the brain, or unspecified causes.

When the researchers divided women into five groups based on how much red meat they reported eating, they found that those in the top fifth, who ate at least 86 grams daily (3 ounces) were at 22 percent greater risk of cerebral infarction than women in the bottom fifth (less than 36.5 grams, or 1.3 ounces, daily).

Women who ate the most processed meat (at least 41.3 grams, or 1.5 ounces, a day) were at 24 percent greater risk of this type of stroke than women who consumed the least (less than 12.1 grams, or less than half an ounce a day).

However, there was no link between consumption of red or processed meat and risk of other types of stroke, nor was there any relationship between fresh meat consumption or poultry consumption and any type of stroke.

Red meat increased stroke risk in non-smokers, but not smokers, and in women who didn't have diabetes, but not in women with diabetes. For non-smokers and non-diabetics in the top tenth of red meat consumption, the risk of cerebral infarction was 68 percent greater.

Several mechanisms could explain the link between red meat and processed meat and stroke risk, the researchers say.

For example, both types of meat have been tied to high blood pressure, the main cause of stroke. The iron contained in red meats might also accelerate the production of

tissue-damaging free radicals. Further, Larsson and her team point out, processed meats are high in sodium, which can increase blood pressure.

Sleep apnea device eases fatigue in three weeks

CHICAGO | Sat Jan 1, 2011 12:18am EST

(Reuters) - People with breathing problems that disrupt their sleep were less tired after three weeks of treatment with a breathing device compared to those treated with a placebo, U.S. researchers said on Saturday.

The findings show that regular use of treatment with continuous positive airway pressure (CPAP) masks reduces fatigue caused by obstructive sleep apnea, a chronic disorder that affects 12 million Americans.

Sleep apnea raises the risk of high blood pressure, heart attack, stroke, irregular heartbeat and diabetes.

It occurs when soft tissue in the back of the throat collapses during sleep, blocking the airway and causing the brain to rouse the sleeper, who gasps for air -- a cycle that can occur as many as 30 times in an hour.

CPAP disrupts this cycle by providing a steady stream of air through a mask that keeps the airway open during sleep.

Companies that make CPAP treatments include Graymark Healthcare and ResMed Inc. \"These results are important as they highlight that patients who comply with CPAP

therapy can find relief from fatigue and experience increases in energy and vigor after a relatively short treatment period,\" Lianne Tomfohr of San Diego State University and the University of California, San Diego, whose study appears in the journal Sleep, said in a statement.

Several studies have shown that CPAP treatment can reduce other health risks, such as lowering the risk of stroke, but few have studied the impact on fatigue, which can reduce work performance and increase the risk of accidents.

For the study, Tomfohr and a team at the University of California, San Diego, studied 59 adults in their late 40s who had at least 10 partial or complete pauses in breathing per hour of sleep.

These volunteers were randomly assigned to get either CPAP or a sham therapy. Both groups were trained on the proper use of the equipment and filled out questionnaires. After three weeks, volunteers who got CPAP treatment had significantly less fatigue on two independent scales measuring fatigue and they reported having more energy. There was no such improvement among those who got the placebo treatment. CPAP treatment is the most common treatment for sleep apnea.

Losing a child to cancer takes financial toll, too

NEW YORK | Tue Jan 4, 2011 4:42pm EST

(Reuters Health) - Many families who lose a child to cancer face not only emotional devastation, but serious financial problems as well, a new study suggests.

Interviewing U.S. and Australian parents who had lost a child to cancer, researchers found that most had needed to cut down on work during their child's illness -- resulting in sometimes severe income loss.

Overall, one-quarter of U.S. and 39 percent of Australian families said they had faced a \"great deal\" of financial hardship during their child's treatment.

One-third of Australian families and 19 percent of those in the U.S. lost more than 40 percent of their income because at least one parent had to quit or cut down on work. And that kind of income loss is generally considered \"catastrophic,\" lead researcher Dr. Veronica Dussel, of the Dana-Farber Cancer Institute in Boston, said in an e-mail. \"Our results underscore that the cost of losing a child to cancer exceeds emotional grief,\" Dussel and her colleagues report in the Journal of Clinical Oncology.

The study, the researchers say, is one of the first to look at the financial toll of losing a child to cancer. And it suggests that their economic strains may be even greater than those of families with children who survive cancer, although the reasons are unclear. In addition, Dussel pointed out, the toll was greatest for families who already had relatively low incomes.

These families generally lost the greatest percentage of income, and 16 percent of U.S. families and 22 percent of Australian families slid below the poverty line during their child's illness.

The findings are based on 141 families with a child treated at one of two U.S. children's hospitals, and 89 families from one Australian medical center.

In general, the Australian families reported greater financial difficulties. Dussel noted that low-income U.S. families were more likely than their Australian counterparts to use fundraisers as a way to cope. \"But it is hard to know if this accounts for some of the difference in perceived financial hardship,\" she said.

What the findings do suggest, she and her colleagues write, is that the policies and

resources in place at all three study sites were not enough to keep families from suffering financially as well as emotionally.

\"The results from our study suggest that actions intended to prevent or reduce income loss may improve family distress,\" Dussel said.

Compared with the experience of families whose children survived cancer treatment, \"the end-of-life period brings more frequent hospitalizations and increased care-giving

demands,\" the authors note. Variable insurance coverage for palliative measures, home care assistance and funeral expenses may also account for potentially higher costs to bereaved families, they add.

Work disruptions were also more common than reported by families with children who survived.

Overall, the researchers found, the type of cancer and duration of illness did not explain the level of financial hardship experienced by a bereaved family. Younger parents and those with lower education levels were more likely to report hardships, and poverty level before the illness was strongly associated with subsequent financial distress. Exactly what preventive actions would be most effective requires further study, the researchers say. But helping families take advantage of existing resources is also important.

Dussel noted that financial counselors -- sometimes available at children's hospitals -- can help parents find ways of coping that do not involve draining their savings and assets. Some medical centers, she said, also have \"resource specialists\" who can help families find out if they are eligible for government benefits or support from private foundations. But Dussel and her colleagues say their findings also point to a need for wider policy reform -- specifically when it comes to medical leave from work.

They note that both the U.S. and Australia have laws that protect people from losing their jobs when they take leave to care for a sick family member. But there's little protection against financial hardship.

The U.S. Family Medical Leave Act mandates 12 weeks of unpaid leave, while Australia's law requires a minimum of two weeks paid and two weeks unpaid leave.

A Gene to Explain Depression

As powerful as genes are in exposing clues to diseases, not even the most passionate geneticist believes that complex conditions such as depression can be reduced to a tell-tale string of DNA.

But a new study confirms earlier evidence that a particular gene, involved in ferrying a brain chemical critical to mood known as serotonin, may play a role in triggering the mental disorder in some people.

Researchers led by Dr. Srijan Sen, a professor of psychiatry at University of Michigan, report in the Archives of General Psychiatry that individuals with a particular form of the serotonin transporter gene were more vulnerable to developing depression when faced with stressful life events such as having a serious medical illness or being a victim of

childhood abuse. The form of the gene that these individuals inherit prevents the

mood-regulating serotonin from being re-absorbed by nerve cells in the brain. Having such a low-functioning version of the transporter starting early in life appears to set these individuals up for developing depression later on, although the exact relationship

between this gene, stress, and depression isn't clear yet. (More on Time.com: How to Win Friends: Have a Big Amygdala?)

Sen's results confirm those of a ground-breaking study in 2003, in which scientists for the first time confirmed the link between genes and environment in depression. In that study, which involved more than 800 subjects, individuals with the gene coding for the less functional serotonin transporter were more likely to develop depression following a stressful life event than those with the more functional form of the gene. But these findings were questioned by a 2009 analysis in which scientists pooled 14 studies

investigating the relationship between the serotonin transporter gene, depression and stress, and found no heightened risk of depression among those with different versions of the gene.

Sen's group decided to put the continued controversy to rest by culling all of the available studies on the subject, 54 total, which included data from nearly 41,000 volunteers. Based on this broader analysis, the team concluded that the less functional form of the transporter gene does indeed confer a greater risk of depression when combined with stress. And to determine why the 2009 team found contradictory results, Sen also re-evaluated their data using his analytical model and found that when he limited his investigation to their 14 studies, he also found no relationship between the gene and depression. (More on Time.com: Placebos Work Even if You Know They're Fake: But How?)

“One of the hopes I have is that we can settle this story, and move on to looking more broadly across the genome for more factors related to depression,” he says. “Ideally we would like to find a panel of different genetic variations that go together to help us predict who is going to respond poorly to stress, and who might respond well to specific types of treatment as opposed to others.”

He believes that the 2009 findings do not contradict those from 2003, or the latest results, but rather reflect a difference in the way the study was conducted. In order to conduct a consistent analysis with similarly collected data, the 2009 analysis focused only on the 14 studies that included stressful life events, and did not incorporate other stressors, such as childhood abuse or medical illness. The more complete set of 54 studies, which folded in these stressors as well, showed a robust interaction between the serotonin gene, stress and depression.

Sen stresses, however, that this gene is only one player in the cast of genetic and

environmental factors that contribute to depression. “All things considered, this [gene] is a relatively small factor, and for this finding to be clinically useful, we really need to find many, many more factors. Ultimately we may identify new pathways that are involved in depression to come up with new and better treatments.”

Prozac shows promise in recovery from

stroke

LONDON | Sun Jan 9, 2011 7:03pm EST

(Reuters) - Giving the antidepressant drug Prozac to people who have just had a stroke could help them to regain more control over their movements and allow more of them to live independently, scientists said Monday.

In the largest study yet of the effect of this type of antidepressant on stroke recovery, French researchers found that stroke patients given Prozac improved their scores in motor skills tests more than those given a placebo, or dummy pill.

Experts commenting on the findings said they had \"enormous potential to change clinical practice\" and raised the question of whether most stroke patients with motor skill problems should be treated with this relatively cheap type of antidepressant.

Stroke is the single largest cause of adult disability and the third-largest cause of death in the developed world.

The cost of caring for its victims, who often have motor function difficulties like paralysis or weakness on one side, puts a heavy burden on already stretched healthcare systems. A few previous small trials had already suggested that giving drugs like Prozac, which belongs to a drug class known as selective serotonin re-uptake inhibitors (SSRIs), might improve motor skill recovery after stroke.

Prozac was developed by Eli Lilly and is now available in a cheaper generic form as fluoxetine.

Hemiplegia -- paralysis to one side of the body -- and hemiparesis -- weakness on one side of the body -- are the most common disabilities after stroke and scientists believe SSRIs might help improve movement by increasing the level of the brain chemical serotonin in the central nervous system.

\"The positive effect of the drug on motor function... suggests that the neuronal ... action of SSRIs provides a new pathway that should be explored further,\" said Francois Chollet of Toulouse University Hospital, who led this research.

In the study, conducted between March 2005 and June 2009 and published in The Lancet Neurology journal Monday, 118 patients in France were given either Prozac or a placebo for three months starting between five and 10 days after they had suffered a stroke. All patients were also given physiotherapy, and had their motor skills tested at the start of the trial and on day 90.

Significantly greater improvements in motor function were recorded after three months in patients taking Prozac, where the average test score improved by 34.0 points, than in the placebo group, where the average improvement was 24.3 points.

There were also more independent patients and depression was less common in the Prozac group than in the placebo group, and side effects of the drug were rare and mild, researchers said.

Commenting on the study, Robert Robinson and Harold Adams from the University of Iowa in the United States, said it could change the way doctors treat stroke victims in future, but more research is needed to see if the effects continue over time.

Roger Bonomo, director of stroke care at Lenox Hill Hospital in New York, said another way to look at the implications of this trial would be as justification for treatment of post-stroke depression before it progresses.

\"Depression after stroke is a common enough complication to have raised the question of treating with antidepressants early after stroke,\" he said in an emailed comment. \"If motor function is also more likely to improve, then treating before symptoms of depression emerge is likely to be even more beneficial.

Major funders to share study data for public health

LONDON | Sun Jan 9, 2011 7:07pm EST

(Reuters) - Health research data must be made more widely available in the scientific community if researchers are to unlock its full potential and make progress in public health, the world's top health funding agencies said Monday.

In a joint statement, 17 major health research funders from around the world pledged to work together to support \"timely and responsible\" sharing of data gathered during studies on health.

\"We have a duty to those populations who participate in research to ensure maximum benefit is derived,\" said Sir Mark Walport, director of Britain's Wellcome Trust and one of the signatories to the statement.

Walport, who wrote a commentary in The Lancet medical journal about the pledge, said it marked an important step toward improving access to data \"which has the potential to improve the lives of many millions of people worldwide.\"

Signatories to the statement, including the U.S. National Institutes of Health, Britain's Medical Research Council, the U.S. Centers for Disease Control and Prevention, the

World Bank and the Bill and Melinda Gates Foundation, noted that in some research fields, such as genetics and physics, data sharing is well established and has helped research to progress.

But in public health research, \"the sharing of data is not yet the norm, even within the scientific community,\" they said.

\"Informatics and the ability to mine large datasets and combine them with information from many other sources presents a huge potential to advance developments in public health,\" the joint statement said.

Other signatories include the U.S. Hewlett Foundation, Australia's National Health and Medical Research Council, the Canadian Institutes of Health Research, France's National Institute for Health and Medical Research (INSERM) and the German Research Foundation (DFG). The full statement can be found at www.wellcome.ac.uk/publichealthdata.

Medicine

A Single Cigarette Can Raise the Risk of Cancer and Heart Disease

We all know that smoking is bad for us, but a new report from the U.S. Surgeon General concludes that even a single cigarette can cause immediate harm and raise the risk of diseases like cancer and heart disease.

That means that you don't have to be a heavy smoker to suffer the effects of tobacco use. The report finds that any exposure to smoking — a single drag of a cigarette, occasional smoking or secondary exposure to cigarette smoke — can damage the body's cells, tissue and DNA, raising the risk of cancer. (More on Time.com: Gallery: Cigarette Warning Labels From Around the World)

\"Low levels of smoke exposure, including exposures to secondhand tobacco smoke, lead to a rapid and sharp increase in dysfunction and inflammation of the lining of the blood vessels, which are implicated in heart attacks and stroke,\" said the report, released on Dec. 9 by Surgeon General Regina Benjamin. \"The chemicals in tobacco smoke reach your lungs quickly every time you inhale. Your blood then carries the toxicants to every organ in your body.\"

More than 7,000 chemicals and compounds are contained in each cigarette, 1% of which are known carcinogens. The Surgeon General's report further notes that cigarette

manufacturers have recently changed the design and ingredients in cigarettes to deliver

toxic ingredients more effectively and make smoking more addictive. USA Today reports that changes include:

•Ammonia added to tobacco, which converts nicotine into a form that gets to the brain faster

•Filter holes that allow people to inhale smoke more deeply into the lungs

•Sugar and \"moisture enhancers\" to reduce the burning sensation of smoking, making it more pleasant, especially for new cigarette users

The report also finds that the presumably safer or lower-impact cigarettes that

manufacturers have marketed are actually just as dangerous as any other cigarette. \"The evidence indicates that changing cigarette designs over the last five decades, including filtered, low-tar, and 'light' variations, have NOT reduced overall disease risk among smokers and may have hindered prevention and cessation efforts,\" the report reads. (More on Time.com: Study: Moms Who Smoke During Pregnancy Might Have Criminal Kids)

It's no wonder that 443,000 Americans die of smoking-related disease each year. These deaths make up 20% of all deaths in the U.S. and cost the nation $193 billion per year in health-care costs and lost productivity. Currently, 23% of U.S. adults and 17% of

teenagers smoke, according to data from the Centers for Disease Control and Prevention (CDC).

To read the Surgeon General's full report, click here.

Is Eating Fish Good For You — Even If It's Fried?

Among the most familiar foods on the good-for-you list are fruits, vegetables and fish. But does fried fish count?

Umm, no, at least not according to the latest results of a study on fish consumption and stroke. The survey found that people who live in the so-called “stroke belt” of the United States, which stretches from the Carolinas to Arkansas and Louisiana and where stroke rates are among the highest in the country, are less likely to eat the recommended two servings of fish per week. And when residents in these states do eat fish, they are more likely to have it in fried form. (More on Time.com: Overeating: Is It an Addiction?) That's not a surprise, says the study's lead author, Dr. Fadi Nahab, director of the stroke program at Emory University Hospital, given the popularity of fried foods in the South. But the results highlight one of the major contributors to the higher rates of stroke in the region, and that involves diet.

Strokes can result when blood vessels feeding the brain are blocked, starving nerve cells of much-needed oxygen. Many of the same risk factors that promote heart disease, such as high blood pressure and high cholesterol, can contribute to higher risk of stroke as well. “Our study is really the first study that looks at the dietary habits of people who live in and out of the stroke belt,” says Nahab. (More on Time.com: Want to Eat Less? Imagine Eating More)

In this part of the U.S., the odds of people eating the federally recommended two servings of fish a week in non-fried form are 17% lower than in other areas of the country. People in the stroke belt are also 32% more likely to be consuming two or more servings of fried fish each week than other Americans.

Nahab, a neurologist, had an interest in explaining why stroke-belt residents are 20% more likely to have a stroke than those living elsewhere in the U.S. Intrigued by

government nutrition statistics showing that African Americans, who have the highest stroke rates in that region, were eating more than two servings of fish each week, he decided to tease apart exactly what people in that part of the country were eating. It turns out that most of the fish being consumed was fried, which negated its potential stroke-preventing benefits on several levels. First, as studies by researchers in Spain have found, the act of frying fish can cause fatty fish such as salmon, which is rich in healthy omega-3 fatty acids, to lose its beneficial oils; those oils get replaced with the often unhealthier oil in which the fish is fried. In addition, the types of fish that are normally fried, such as cod and other white fish, tend to be less dense in omega-3 fats. (More on Time.com: Weight Watchers' New Points: Zero for Most Fruits and Veggies)

“What we hope to highlight with our study is that it's not just about having fish, but about how you prepare that fish,” says Nahab. “And it's not about any kind of fish whatsoever, but having certain fish species that have more omega-3 fats, so if you're going to have fish, it's better to have fish like salmon, herring and mackerel that are much higher in omega-3 fats.”

Studies have already shown that consuming more omega-3 fats, whether from pelagic creatures or in supplement form, can lower the risk of heart attack, but the data is less conclusive when it comes to protecting against stroke. Nahab is planning to follow up this study by looking at stroke patients who take regular supplements of fish oil, to see if their risk of a recurrent stroke is any lower than among those who don't add pills of omega-3 fats to their nutritional regimen.

Until then, the current study suggests that it's not enough to simply eat fish, but to make sure that it's cooked any way but fried. That may not be so easy to do in the South, but it could potentially shrink the girth of the stroke belt.

Diet&Fitness

Want to Eat Less? Imagine Eating More

Imagine you could eat less, simply by thinking about eating! A new study published in Science finds just that: people who imagined themselves repeatedly indulging in sweet or salty treats ended up eating less of the actual foods than people who didn't visualize eating the same foods or thought about them only fleetingly.

The study is based on the principle of habituation — that repeated exposure to a stimulus reduces people's response to it. It explains why the 10th bite of pumpkin pie isn't as desirable as the first. And why chronic alcoholics need more alcohol to feel drunk. \"People habituate to a wide range of stimuli, from the brightness of a light to their income,\" the study's authors write. (More on Time.com: 5 Ways to Get Oatmeal in Your Diet, Deliciously)

What the authors wondered, however, is why, when it comes to food, does the

imagination usually have the opposite effect — the mere notion of a piece of pie tends to whet the appetite, rather than suppressing it. \"If you look at the literature on imagination and eating, thinking about [a specific food] leads people to desire it more,\" says lead author Carey Morewedge, assistant professor of social and decision sciences at Carnegie Mellon University. \"But when you eat a lot of a food, you desire it less. What's the difference between these two experiences?\"

The key may lie in the repetition. For the study, Morewedge and colleagues conducted five different experiments with 51 participants in each. In the first experiment, people were divided into three groups and asked to imagine performing 33 consecutive tasks: inserting 30 quarters into a laundry machine, then eating three M&Ms; inserting three quarters into a laundry machine, then eating 30 M&Ms; or inserting 33 quarters into a laundry machine. Then, all groups were given a real bowl of M&Ms from which they were allowed to sample freely.

The researchers found that the people who imagined eating 30 M&Ms ate about half as much candy in real life, compared with the other two groups. There was no difference in actual consumption between those who imagined eating three M&Ms or no M&Ms. (More on Time.com: Mind Over Matter: Can Zen Meditation Help You Forget About Pain?)

It doesn't take much imagination to conceive that these findings could aid the

development of real-world behavioral techniques for dieters — and anyone else dealing with craving — who need help fighting the urge for more. Conversely, the findings could be applied to help people reduce phobic-responses to fear-inducing stimuli like, say, spiders. \"I think this is a very nice study, an impressive demonstration that shows the power of imagery, the power of imagination,\" says Kent Berridge, professor of psychology

and neuroscience at the University of Michigan-Ann Arbor, who was not involved with the research.

Researchers repeated the M&M experiment, this time combining visualizations of eating either M&Ms or cheddar cheese cubes. The goal was to test whether the imaginary eating resulted in habituation to specific foods or to a more general feeling of \"fullness\" that resulted in less consumption. As expected, people who imagined eating 30 cheese cubes ate less actual cheese than those imagining eating three, when presented with the real food. But people who imagined eating either three or 30 M&Ms showed no difference in later cheddar-cheese consumption.

This might help explain why you can be sure you couldn't eat another bite of Thanksgiving turkey — but still have plenty of room for pumpkin pie. (More on Time.com: Special Report: Overcoming Obesity)

In yet another iteration of the experiment, people were asked to think about either eating M&Ms or moving an equal amount of the candies one-by-one into a bowl. In this case, researchers found, the more people imagined moving M&Ms (30 times versus three), the more M&Ms they ate in real life. But in the imagined-eating group, the more people

visualized consuming the candy, the less they ate later. \"You have to be careful not to just think about the taste and smell, and what the food looks like,\" says Morewedge,

explaining that this kind of \"priming\" can increase desire for it. \"You have to think about actually chewing biting and swallowing food repeatedly for the effect to work.\"

Of course, for dieters or others who battle cravings, this presents a dilemma. Once the thought of a food has triggered immediate desire, it can be hard to think your way out of it. \"There's a danger if you just think of the food and the flavor, it will prime you and make you want it more,\" Berridge agrees.

In drug recovery programs, this is why addicts are told to avoid \"people, places and

things\" that might remind them of drugs and set off an urge to use. To quash the craving once it's set in, however, addiction experts advise \"thinking it through\" — that is, considering the negative consequences, not just the momentary high, associated with drug use. Perhaps, based on the new study, recovery treatment could include asking addicts to think about the details of drug-taking over and over in a repetitive loop; but whether that technique could habituate people to drugs as well as to food remains to be studied. (More on Time.com: Top 10 Most Dangerous Foods)

Morewedge is now seeking funding for a similar study to test the power of imagination over nicotine cravings in smokers. He and his colleagues are also currently running a variation of the original research, comparing participants with various levels of hunger to see how that affects the results.

Morewedge's research also sheds light on the way desire works and how the brain

distinguishes between \"liking\" and \"wanting\" a food — or any experience, thing or person.

In a final experiment, participants were asked to rate how much they liked cheddar

cheese before and after imagining eating three or 33 cheese cubes; they were also asked to play a computer game in which they could click on an image of a cheese cube to earn cheese. Again, people who had imagined eating more cheese clicked less for real cheese, showing that they wanted less of it. However, their ratings of how much they liked cheddar cheese remained the same, before and after.

Berridge notes that in the real world when people eat foods to the point of not wanting it anymore, their liking for the food tends to decline a bit as well. \"Where people are loaded with actual food, it suppresses both wanting and liking but wanting goes down further,\" he says. \"It's striking in this case that you can lower wanting at all just by imagining food.\" (More on Time.com: Overeating: Is It an Addiction?)

In addiction as well, wanting escalates out of proportion to liking: it's not that the drug or food experience becomes more likeable or feels better and better; instead, desire and craving skyrocket. Ultimately, people find themselves intensely wanting an experience that no longer feels overwhelmingly pleasurable — in fact, it simply feels normal or even sometimes negative. By figuring out exactly how the brain processes these different strands of pleasure and desire, craving may one day be conquered.

Meanwhile, you can try imagining eating Christmas candies and desserts over and over and over, until it feels about as desirable as another rendition of \"Feliz Navidad\" — and perhaps spare your waistline this holiday season.

Baby Getting Heavy? The Culprit May Be in the Bottle

There are many contributors to childhood weight gain — diet, inactivity, genes — but a study released on Dec. 27 in Pediatrics identifies another potential cause: certain types of baby formula.

Researchers from the Monell Chemical Senses Center recruited 56 mothers with new infants to test two types of infant formula. The women, who had already decided to feed their children formula, were split into two groups: For seven months, starting when the babies were two weeks old, 32 of the babies got traditional formula made from cow's milk — the most popular kind available; 24 received a \"hypoallergenic\" formula called protein hydrolysate formula (PHF), which contains predigested proteins that are easier on infants' digestive tracts. (More on Time.com: How Your Dad's Diet Affects Your Weight)

All the infants were regularly weighed and measured, and were also videotaped while feeding. Early on, researchers found that the traditional formula-fed group was gaining more weight more quickly than the PHF group; the babies getting cow's-milk formula had significantly higher weights per length by 2.5 months. After just 3.5 months, researchers

found that the cow's-milk formula group also weighed significantly more for their age, compared with PHF-fed babies, who weighed on average the same as breast-fed infants. What's more, the cow's-milk formula group remained heavier throughout the study, even though all the infants began eating solid foods at about the same time. It's not clear why cow's-milk formula may contribute to increased weight, but the researchers speculate that the type and amount of protein in PHF may make babies feel fuller faster, or that babies dislike the taste of PHF and eat less. The Los Angeles Times reported:

[Researchers] speculate that the free amino acids in the pre-digested formula did a better job of stimulating receptors in the mouth and gut that signal to the brain that the stomach is full and it's time to stop eating. Though babies in both groups spent about the same amount of time eating at each feeding (between 11 and 12 minutes), the babies on the PHF formula drank less during that time before pushing the bottle away.

\"Because dietary and nutritional programming can have long-term consequences in terms of later development of obesity, diabetes, and other diseases, it is imperative that we learn more about the long-term consequences of the early growth differences caused by environmental triggers, such as those associated with infant formulas, and how and why they differ from breast-feeding, which is the optimal mode of feeding,\" the researchers wrote.

Healthcare Reform

U.S. issues rules for health insurance rate review

WASHINGTON | Tue Dec 21, 2010 8:50am EST

Dec 21 (Reuters) - U.S. health officials on Tuesday proposed new rules for health insurance companies to undergo government review of their price increases to decide whether premium hikes are \"unreasonable.\"

The draft rule, called for under the healthcare law passed earlier this year, will require insurers with price increases of 10 percent or more in 2011 to submit data justifying the higher rates for states or, in some cases the federal government, to assess.

Category: Policy & Industry Health Care Under the Golden Arches: Cheap But Faulty

There's a central maxim to health insurance pricing: If it seems too good to be true, it is. Health insurance is basically standardized gambling. Insurers set premiums based on how much risk is posed by those who enroll in their plans. Profit margins are generally small and fixed — about 3% to 6%. So next time you hear about a health insurance plan offering deep discounts, keep this in mind: There are only a few variables that can push the price of health insurance down. (More on Time.com: Maybe It's Not Such a Good Idea to Marry a Doctor...)

* A huge number of people enrolled in a single plan, diffusing risk * A very healthy and/or young group of people enrolled in a plan * Skimpy coverage

The last factor explains how McDonald's can offer its part-time hourly employees the chance to buy “health insurance” for just $13.09 per week. The fast food chain is under scrutiny for this coverage thanks to a waiver it recently received from the Department of Health and Human Services (HHS).

McDonald's, along with scores of other organizations that offer these so-called “mini med plans,” were temporarily exempted from a new Affordable Care Act rule that bans

insurers from severely limiting how much they will pay annually to cover medical costs. HHS justified these exemptions, which affect more than 1 million Americans, by basically saying mini med plans would go out of business under the new regulation. The

exemptions are temporary and besides, said HHS, skimpy coverage is better than no coverage. But is it?

Insurers that that aren't exempted can set annual limits no lower than $750,000 in 2011. The $13.09 McDonald's plan, in contrast, will only pay out a maximum of $2,000 in benefits per year. Appearing on Wednesday before a Senate committee that is

investigating mini med plans, Richard Floersch, the chief human resources office for McDonald's, said the coverage — while minimal — was an affordable option for workers. (More on Time.com: \"Family Only\" Hospital Visitation Rules Get Scrapped)

A person enrolled in this plan would pay $680.68 per year in premiums and be subject to a $150 deductible before the plan would pay charges for hospital stays or emergency room visits. So at best, a person enrolled in this plan who breaks a bone or who gets cancer will enjoy a $1,169.32 discount on whatever care they need. For someone who spends any time in a hospital — stays can easily exceed $5,000 per day — $1,169.32 is a drop in the bucket. Still, for these folks the plan may indeed be better than nothing. Yet, at Wednesday's mini med hearing in the Senate, Floersch, of McDonald's, said 90% of the company's workers with these plans never hit their annual limits. These folks

presumably use the coverage mainly for routine check ups and generic prescriptions drugs, which require copayments of only $20 and $5, respectively, under the plan. But these people would, in many cases, be better off financially if they didn't shell out for mini med plans and simply paid full price for their checkups and generic drugs. In most cases, the 90% of people who don't hit their limits are paying out more in premiums than they are getting in benefits. This is how insurers make money. (More on Time.com: Family Health History: 'Best Kept Secret' in Care)

The McDonald's $2,000 annual limit plan is small compared to some other severely restricted coverage. As I wrote in a story earlier this year:

Cinergy Health charged families $479 per month for its Preferred 1000 plan, which covered $100 for one emergency-room visit per year per person and $1,000 per day of hospitalization for up to 30 days. (The average cost of an ER visit is more than $500; a single day in the hospital can easily cost more than $5,000.) Coverage for doctor visits was pretty decent — up to $70 per visit for up to five visits per year, a key selling point. But even if a family of four maxed out this particular benefit, it would have received only $1,400 in payouts after paying nearly $6,000 a year in premiums.

See, there are no deals. Under traditional health insurance plans, as with mini med plans, most people pay more in than they get out, and this helps cover the costs for people who experience catastrophic illness or injury. But with the McDonald's plans, someone with a horrible or even routine health event isn't protected from massive financial drain, which is usually the point of what we think of as “insurance.”