Wednesday, October 05, 2011

The Morning Drill: October 5, 2011

A collection of dentistry and health related links/comments for your day.

Children Destined to Be Obese Can Be Identified by Age 3.5
A prospective analysis of body mass index (BMI) in 1957 children from ages 5 months to 8 years reveals that an "atypically elevated BMI trajectory" that leads to obesity is identifiable by age 3.5 years.

The study, by Laura E. Pryor, MSc, from the National Institute of Health and Medical Research (INSERM) in Paris, France, and colleagues and reported in the October issue of the Archives of Pediatric and Adolescent Medicine, tracked a subset of the Quebec Longitudinal Study of Child Development.

Three groups of weight gain trajectories clearly emerged: low to stable (54.5%), moderate (41%), and high-rising (4.5%). Plotting age against BMI produces a chart in which the first and second curves run parallel to each other on the x-axis, while the high-rising trajectory veers sharply upward at 3.5 years.
Calif. Medicaid Cuts Open Supreme Court Term
The ability of providers to sue state healthcare authorities over Medicaid cuts was the focus of the Supreme Court's first morning of its new term on Monday.

The case the justices heard challenges several laws passed by the California legislature ordering cuts of up to 10% in reimbursements to providers who participate in Medi-Cal, the state's Medicaid plan. A number of providers in California filed suit against California's Department of Health Care Services seeking preliminary injunctions against the rate cut.

A federal district court denied the injunction, and the providers then took their case to the Ninth Circuit Court of Appeals, which ruled in their favor. The California state government appealed that decision to the U.S. Supreme Court.

But rather than determining whether state officials can cut Medicaid rates to keep their state budgets in check, the justices on Monday focused on whether people or groups can sue a state over the state's perceived noncompliance with federal law.

Federal Medicaid law states that any state accepting federal Medicaid money must set payments for providers that are "consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available ... to the general population."

The healthcare providers in the case -- which is actually three cases consolidated into one -- argue that California set Medicaid reimbursement rates so low that it would endanger the Medicaid program and therefore violate federal law.

Doctors' groups, former Department of Health and Human Services officials, and others who sided with the California providers argued in briefs that doctors and Medicaid recipients should be able to sue their state over adopting policies that would cut payment and potentially harm patients.
An Addiction Vaccine, Tantalizingly Close
Imagine a vaccine against smoking: People trying to quit would light up a cigarette and feel nothing. Or a vaccine against cocaine, one that would prevent addicts from enjoying the drug’s high.

Though neither is imminent, both are on the drawing board, as are vaccines to combat other addictions. While scientists have historically focused their vaccination efforts on diseases like polio, smallpox and diphtheria — with great success — they are now at work on shots that could one day release people from the grip of substance abuse.

“We view this as an alternative or better way for some people,” said Dr. Kim D. Janda, a professor at the Scripps Research Institute who has made this his life’s work. “Just like with nicotine patches and the gum, all those things are just systems to get people off the drugs.”

Dr. Janda, a gruff-talking chemist, has been trying for more than 25 years to create such a vaccine. Like shots against disease, these vaccines would work by spurring the immune system to produce antibodies that would shut down the narcotic before it could take root in the body, or in the brain.

Unlike preventive vaccines — like the familiar ones for mumps, measles and so on — this type of injection would be administered after someone had already succumbed to an addictive drug. For instance, cocaine addicts who had been vaccinated with one of Dr. Janda’s formulations before they snorted cocaine reported feeling like they’d used “dirty coke,” he said. “They felt like they were wasting their money.”

It’s a novel use for vaccines that has placed Dr. Janda, who is 54, in the vanguard of addiction treatment. Because addiction is now thought to cause physical changes in the brain, doctors increasingly advocate medical solutions to America’s drug problem, leading to renewed interest in his work.
Top 5 Unnecessary Health-care Costs
What did the researchers say was the No. 1 most over-used activity by primary care physicians? Prescribing a brand-name cholesterol-lowering drug without trying a less expensive generic first, according to the research posted on-line by the Archives of Internal Medicine.

Doctors’ prescribing a brand-name statin, without first  checking to see if a lower-priced generic drug would cut a patient’s cholesterol sufficiently, results in $5.8 billion in excess health-care spending, according to the research letter published Oct. 1.

The authors found $6.76 billion in what they said was non-recommended health-care spending after analyzing surveys of patient visits to certain primary care doctors’ offices and hospital outpatient departments in 2009.

Other practices deemed inappropriate by the authors: bone density scans for women ages 40 to 64 years, costing $527.4 million; ordering CT Scans or MRI’s for lower back pain, amounting to $175.4 million; and prescribing antibiotics to children with sore throats caused by a virus, worth $116.3 million.
Enjoy your morning!

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