Americans spent $33.9 billion out-of-pocket on complementary and alternative medicine (CAM) over the previous 12 months, according to a 2007 government survey(1). CAM is a group of diverse medical and health care systems, practices, and products such as herbal supplements, meditation, chiropractic, and acupuncture that are not generally considered to be part of conventional medicine.

CAM accounts for approximately 1.5 percent of total health care expenditures ($2.2 trillion(2)) and 11.2 percent of total out-of-pocket expenditures (conventional out-of-pocket: $286.6 billion(2) and CAM out-of-pocket: $33.9 billion(1)) on health care in the United States.

Approximately 38 percent of adults use some form of CAM for health and wellness or to treat a variety of diseases and conditions, according to data from the 2007 National Health Interview Survey (NHIS)(3). The CAM component of the NHIS was developed by the National Institutes of Health’s (NIH) National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics (NCHS) part of the Centers for Disease Control and Prevention. The data provide estimates of the cost of CAM use, the frequency of visits made to CAM practitioners, and frequency of purchases of self-care CAM therapies.

“With so many Americans using and spending money on CAM therapies, it is extremely important to know whether the products and practices they use are safe and effective,” said Josephine P. Briggs, M.D., director of NCCAM. “This underscores the importance of conducting rigorous research and providing evidence-based information on CAM so that health care providers and the public can make well-informed decisions.”

Of the $33.9 billion spent on CAM out-of-pocket, an estimated $22.0 billion was spent on self-care costs — CAM products, classes, and materials — with the majority going to the purchase of nonvitamin, nonmineral, natural products ($14.8 billion) such as fish oil, glucosamine and Echinacea. U.S. adults also spent approximately $11.9 billion on an estimated 354.2 million visits to CAM practitioners such as acupuncturists, chiropractors, massage therapists, etc.

To put these figures in context, the $14.8 billion spent on nonvitamin, nonmineral, natural products is equivalent to approximately one-third of total out-of-pocket spending on prescription drugs, and the $11.9 billion spent on CAM practitioner visits is equivalent to approximately one-quarter of total out-of-pocket spending on physician visits.

“These data indicate that the U.S. public makes millions of visits to CAM providers each year and spends billions of dollars for these services, as well as for self-care forms of CAM,” said Richard L. Nahin, Ph.D., MPH, acting director of NCCAM’s Division of Extramural Research and lead author of the cost of complementary and alternative medicine analysis. “While these expenditures represent just a small fraction of total health care spending in the United States, they constitute a substantial part of out-of-pocket health care costs.”

Inclusion and development of the 2007 NHIS supplement was supported, in part, by seven NIH components: NCCAM; National Heart, Lung, and Blood Institute; National Institute of Allergy and Infectious Diseases; National Institute of Mental Health; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; Office of Dietary Supplements; and Office of Behavioral and Social Sciences Research.

The National Center for Health Statistics (NCHS) is a component of the Centers for Disease Control and Prevention (CDC). NCHS’s mission is to provide statistical information that will guide actions and policies to improve the health of the American people. The CDC protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations. The complete data set can be found under “Questionnaires, Datasets, and Documentation” at www.cdc.gov/nchs/nhis.htm.

The National Center for Complementary and Alternative Medicine’s (NCCAM) mission is to explore complementary and alternative medical practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals. For additional information, call NCCAM’s Clearinghouse toll free at 1-888-644-6226, or visit the NCCAM Web site at nccam.nih.gov.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov

NOTES:

(1) Nahin, RL, Barnes PM, Stussman BJ, and Bloom B. Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007. National health statistics reports; no 18. Hyattsville, MD: National Center for Health Statistics. 2009.

(2) Office of the Actuary, Centers for Medicare and Medicaid Services, National Health Expenditure Data for 2007. U.S. Department of Health and Human Services. Available at: http://www.cms.hhs.gov/NationalHealthExpendData/02_NationalHealthAccountsHisto rical.asp#TopOfPage. Accessed June 25, 2009.

(3) Barnes PM, Bloom B, Nahin RL. Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007. National health statistics reports; no 12. Hyattsville, MD: National Center for Health Statistics. 2008.

Source: National Center for Complementary and Alternative Medicine, National Institutes of Health


Findings May Potentially Lead to New Approach to Stroke Treatment

When minimally invasive endovascular (through the vessel) therapy made its debut two decades ago, stroke care underwent a major shift as the “window of treatment” for patients suffering a stroke was expanded to eight hours within symptom onset, rather than the standard three-hour window required by the FDA-approved intravenous tPA therapy. Now, a new retrospective, multi-center study shows that endovascular therapy beyond the eight-hour window restored blood flow in the brain in approximately 74 percent of patients suffering ischemic (caused by a clot) stroke. Presented today at the Society of NeuroInterventional Surgery (SNIS) 6th Annual Meeting in Boca Raton, FL, the data suggests that this treatment is safe and potentially leads to improved outcomes for a select number of late-presenting patients, including those who awake with stroke symptoms.

According to lead author Raul Nogueira, M.D., Assistant in Neurology and Radiology at Massachusetts General Hospital — Harvard Medical School, presentation beyond eight hours of symptom onset has traditionally been the single most important factor in excluding patients from stroke treatment. Thus, continued Nogueira, when brain imaging studies revealed that a significant number of late-presenting stroke patients showed evidence of salvageable brain tissue in the area of the stroke, it was an important avenue to pursue. This meant that endovascular therapy (performed by neurointerventional specialists who use drugs or mechanical devices inserted through a catheter or narrow tube that is threaded up through the vessels directly to the problem site to dispel the clot) could potentially be utilized successfully in these patients.

“As we considered the possibilities, it became an exciting proposition to pursue our hypothesis,” said Nogueira. “Traditionally, these patients had been deemed untreatable. But if the therapeutic window could be expanded, these findings could make a significant impact on the future of stroke treatment.”

The study included a consecutive case series of 237 patients whose first angiography (a diagnostic test that infuses the blood vessels with dye in order to clearly visualize the vessel structures) confirming a clot in the brain was performed later than eight hours from the last time the patient was seen well. All patients were identified from prospectively acquire databases at 10 high volume academic stroke centers across the United States.

Of the 237 study participants, 49 percent were males and 51 percent were females, with a mean (or average) age of 64 years and whose mean time from last seen well to t reatment was 15 hours. On the standard National Institute of Health Stroke Scale (NIHSS) — a test that uses baseline data to determine severity of a stroke and projected outcome — participants registered a mean score of 15 (any score over 10 is associated with a serious stroke). Various endovascular treatments were used, including: clot-dissolving drugs in 46 percent of the cases; the MERCI Retriever, a clot-removal device, in 62 percent of cases; and other mechanical instruments, including the recently FDA-approved Penumbra Device, in 36 percent of cases.

Beyond the immediate results that showed an overwhelming success in restoring blood flow, follow-up at 90 days in 198 patients indicate that 93 (47 percent) patients registered good outcomes (meaning patients could be functionally independent) and 123 (62 percent) patients reflected acceptable outcomes. Approximately nine percent suffered a symptomatic brain hemorrhage and the overall mortality rate was 22 percent. When analyzing what factors were most closely associated with favorable outcomes, successful restoration of blood flow, younger age, lower stroke severity (as indicated by the NIHSS), and male gender were identified.

According to Nogueira, the study serves as preliminary data for DAWN, a prospective randomized trial designed to assess the benefit of this approach as compared to standard medical therapy. “We look forward to exploring this preliminary data more in-depth in order to bring more clarity to the treatment of late-presenting stroke patients. The possibilities are exciting, as these findings could very well mean that thousands of patients who would not have been previous candidates for treatment could benefit from therapies that could restore their quality of life.”

Stroke is the third leading cause of death in the United States, Canada, Europe and Japan. According to the American Stroke Association, approximately 800,000 Americans each year suffer a new or recurrent stroke. Americans will pay close to $68.9 billion in 2009 for stroke-related medical costs and disability.

Source: Society of NeuroInterventional Surgery


As we age, brown spots and splotchy skin are all too often a fact of life. But for people with darker skin, changes in pigmentation can occur without warning at any age and can be very difficult to treat. Fortunately, dermatologists can help people with skin of color diagnose and treat bothersome pigmentation problems.

At the American Academy of Dermatology’s Summer Academy Meeting 2009 in Boston, dermatologist Jonith Y. Breadon, M.D., FAAD, co-chair of Dermasurgery at John H. Stroger, Jr. Hospital of Cook County in Chicago, discussed pigmentation problems that occur more frequently in darker-skinned patients and how early diagnosis is key to stopping the progression of these skin conditions.

“Even though people with skin of color have less moles and experience less premature aging from the sun than lighter-skinned individuals, in some ways their darker pigmentation makes their skin more vulnerable to other skin problems,” said Dr. Breadon. “While these skin discolorations can be stubborn, there are treatments that offer noticeable improvement.”

Hyperpigmentation

One of the most common pigmentation problems in darker-skinned individuals is hyperpigmentation (or the darkening of the skin). Usually the result of some type of inflammation or injury to the skin, such as a cut, burn or scrape, hyperpigmentation produces darkened areas of the skin that can last months or years. Even healed acne lesions can leave permanent dark spots in darker-skinned people that, in some cases, can be more distressing than the original acne.

Dr. Breadon noted that treatments for hyperpigmentation are based on whether or not the dark areas are confined to the surface of the skin or if they have penetrated to the deeper layers of the skin. For superficial dark spots, a prescription topical medication consisting of hydroquinone, retinoic acid and mild hydrocortisone can be effective in fading skin discoloration. Deeper dark areas require an in-office surgical procedure, such as dermabrasion, chemical peels, or microdermabrasion with an infusion of hydroquinone solution. In patients with lighter skin, intense pulsed light (IPL) or one of the pigmented lasers could be considered.

“Patients with any type of hyperpigmentation problem need to use a sunscreen with a high sun protection factor (SPF) regularly – the higher SPF the better,” said Dr. Breadon. “There is no cure for this condition, so even when patients experience clearing, it can come back. For most patients, I usually recommend a three-month topical regimen then long-term maintenance with a sunscreen.”

Melasma

Often referred to as the “mask of pregnancy,” melasma is a skin condition marked by brown patches on areas such as the face, neck and arms that most often affects dark-skinned people and women in particular. Many dermatologists have long believed that there may be a hormonal component to melasma, and a recently published study found that there were an increased number of estrogen receptors in areas where patients developed melasma.

For this reason, Dr. Breadon advises patients with melasma to consider stopping oral contraceptives and hormone replacement therapy due to the large amount of estrogens in these medications. Regular sunscreen use is vital to protect the skin from further hyperpigmentation.

With melasma, the skin can be affected in three different ways: on the epidermis (superficial layer), in the dermis (deep layer) or a mixture of both the epidermis and dermis. Dermatologists use a light device known as the Woods lamp, which shows skin diseases as specific colors, to determine how deep melasma has penetrated the skin.

For superficial melasma, the triple cream combination of hydroquinone, retinoic acid and mild hydrocortisone with regular sunscreen use can be effective, with clearance occurring in about three months for most patients. Dr. Breadon noted that cases where melasma has penetrated the dermis are very difficult to treat and the combination triple cream medication will not be effective in these patients. However, some patients may experience improvement with microdermabrasion, dermabrasion, chemical peels or lasers. In cases where both the epidermis and the dermis are involved, the triple cream medication may offer some improvement for some patients.

“Melasma is hard to define, as it can occur in women during or after pregnancy or in women who have never been pregnant or used oral contraceptives,” said Dr. Breadon. “While lasers can be effective, there are risks of further hyperpigmentation and results vary greatly from person to person. Dermatologists can help patients decide the best course of treatment, depending on the severity of the condition.”

Lichen Planus

Lichen planus is a common inflammatory disease of the skin and the mouth that is characterized by a rash of round, or oval, violet-colored lesions. While lichen planus can affect people of all races and genders, it is more pronounced in people with darker skin since, as the lesions heal, the affected skin can develop very dark, leopard-looking spots.

When caught early, steroid injections are used to reduce the inflammation thereby minimizing hyperpigmentation. However, if the condition progresses before it can be treated and dark spots appear, Dr. Breadon explained that the triple cream topical medication, mild or systemic steroids, or lasers can be used with varying degrees of success to try to lighten the darkened areas of the skin.

“Detecting lichen planus early can make all the difference between spots that heal without hyperpigmentation and spots that are extremely pronounced and do not fade on their own,” said Dr. Breadon. “That’s why it is critical that people who experience an unexplained rash see their dermatologist immediately for proper diagnosis and treatment.

Ashy Dermatosis

Another skin condition that affects people of color, and especially African-Americans, is ashy dermatosis. While the cause of ashy dermatosis is unknown, it usually starts as a flat, dark grayish-brown rash that appears bi-laterally (or on both sides of body, such as both arms or both legs).

Ashy dermatosis closely resembles a condition known as fixed drug eruption, which causes the same type of pigmentation problem and is the result of an allergy to a food, medication or workplace trigger. For example, one of Dr. Breadon’s patients with this type of rash noticed a flare when she would consume a particular sugar substitute – which was eventually identified as the trigger.

“Based on my evaluation of numerous cases of ashy dermatosis and fixed drug eruption, my theory is that these two conditions are actually one in the same,” said Dr. Breadon. “That’s why I think it is so important to identify the trigger, as this can help alleviate the rash and prevent its spread. I encourage my patients to keep a food diary or a list of any medications or items with which they come into contact to see if we can identify the source of the problem.”

Dr. Breadon noted that ashy dermatosis and fixed drug eruption can be very difficult to treat. A compound lotion of salicylic acid, a mid-potency steroid and hydroquinone can offer gradual clearing. Regular use of sunscreen with a high SPF also is highly recommended to avoid further hyperpigmentation.

“It is important for people with darker skin to be aware of any changes in their skin and to see a dermatologist at the first sign of anything unusual,” said Dr. Breadon. “Dermatologists not only can diagnose and provide the best treatment options for a particular pigmentation problem, but also can rule out a serious condition, such as skin cancer.”

Source: American Academy of Dermatology


Diabetes gene raises odds of lower birth weight

  • Author: Health Informer
  • Filed under: Health News
  • Date: Jul 30,2009

Pediatric researchers have found that a gene previously shown to be involved in the development of type 2 diabetes also predisposes children to having a lower birth weight. The finding sheds light on a possible genetic influence on how prenatal events may set the stage for developing diabetes in later childhood or adulthood.

Researchers from The Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine published the study July 10 in the online version of the journal Diabetes.

“It’s a bit unusual to find a gene linked to both prenatal events and to a disease that occurs later in life,” said study leader Struan F.A. Grant, Ph.D., a researcher at the Center for Applied Genomics of The Children’s Hospital of Philadelphia. “This gene variant carries a double whammy, in raising the risk of both lower birth weight and the development of type 2 diabetes in later life.”

Type 2 diabetes occurs either when the pancreas produces too little insulin or when the body cannot efficiently use the insulin that is produced. Formerly called adult-onset diabetes and still most common in adults, type 2 diabetes has been increasing sharply among children.

Grant and study co-leader Hakon Hakonarson, Ph.D., director of the Center for Applied Genomics at Children’s Hospital, investigated 20 gene locations previously reported to be associated with type 2 diabetes. Drawing on a cohort of some 5,700 Caucasian children in an ongoing genome-wide association study of childhood obesity at Children’s Hospital, the researchers compared birth weights with the occurrence of the 20 gene variants.

They found that one of the gene variants, called CDKAL1, had a strong association with lower birth weight — a finding that supports the so-called fetal insulin hypothesis. Previous studies by European diabetes researchers, said Grant, had suggested that CDKAL1 was implicated in both lower birth weight and type 2 diabetes, and the current study, using a large sample size, reinforced that association.

Under the fetal insulin hypothesis, a slight underproduction of insulin, an important fetal growth factor, during the prenatal period may cause a baby to be born smaller. Low birth weight is already known to increase the risk of disease later in life, and the fetal insulin hypothesis proposes that the same gene that causes lower birth weight also increases the risk of developing type 2 diabetes.

“The mechanisms by which CDKAL1 may act are not well understood, but it is believed to reduce insulin secretion, and that underproduction contributes to type 2 diabetes,” said Grant. He added that further research may investigate biological pathways on which the gene functions, and may also study whether it may influence the risk of developing other diseases in later life.

The National Institutes of Health, the Cotswold Foundation and The Children’s Hospital of Philadelphia supported this study. Grant and Hakonarson, and their co-authors, are from both The Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine.

Source: The Children’s Hospital of Philadelphia


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