The FDA recently approved two new drugs that quickly and effectively lower LDL cholesterol levels. This exciting development is tempered by the very high cost of these drugs. These costs can even trickle down to others on the same insurance plan as people taking these new drugs. Several politicians and institutions have spoken out against these high costs, but it is unlikely that the prices will be lowered anytime soon. For now, these drugs should be reserved only for those whose other efforts to reduce LDL have been unsuccessful.
There are several good reasons to keep ticks off your body. One is that they are creepy and suck your blood. Others are the 14 diseases they are known to transmit. A report published online this week in the Annals of Internal Medicine describes the newest tick-borne disease in North America, which is caused by a bacterium known as Borrelia miyamotoi. This spiral-shaped bacterium is related to the one that causes Lyme disease. Like Lyme disease, Borrelia miyamotoi disease is spread by small, hard-bodied deer ticks. Infection with Borrelia miyamotoi often causes a recurring fever, as well as headache, muscle aches, and chills. It does not usually cause the “bull’s eye” rash seen in some people with Lyme disease. According to the Annals report, nearly one-quarter of people diagnosed with Borrelia miyamotoi disease are so sick they need to be hospitalized. The best therapy so far is the oral antibiotic doxycycline. Experts aren’t sure how common Borrelia miyamotoi disease is because it isn’t on doctors’ radar screens, and because some people who develop it never see a doctor.
Over the past decade, a barrage of reports linking low vitamin D levels to cancer, heart disease, diabetes, and a host of other ills led many doctors to routinely test vitamin D levels in their healthy patients. But there is no good reason to do that, according to a new recommendation from the U.S. Preventive Services Task Force (USPSTF) published in this week’s Annals of Internal Medicine. The task force concluded that it isn’t helpful for most people to know their vitamin D level, and that even if you have a “low” vitamin D level there’s little evidence that taking a vitamin D supplement will do most people any good.
Last spring, an advisory panel for the Center for Medicare and Medicaid Services (CMS) recommended that Medicare not cover low-dose CT scans for smokers or former smokers. These scans can double the proportion of lung cancers found at an early stage, while they are still treatable. Yesterday, CMS announced that it would cover the cost of these scans for people between the ages of 55 and 74 who smoke, or who quit within the last 15 years, and who have a smoking history of 30 pack-years. (That means a pack a day for 30 years, two packs a day for 15 years, etc.) The new Medicare plan would cover scans for an estimated 4 million older Americans, at a cost estimated to be more than $9 billion over five years. In a wise addition, Medicare will require smokers to get counseling on quitting or the importance of staying smoke-free before having the annual scan.
The best test for finding hidden lung cancer in smokers is a low-dose CT scan. Its use has been endorsed by the U.S. Preventive Services Task Force (USPSTF), an independent panel that makes recommendations for screening tests. Most insurers follow the recommendations of the task force, and pay for those services. But some opposition to this by Medicare may mean that the test isn’t covered for some of the people who could benefit from it the most. A new report in the New England Journal of Medicine showed that the cost of adding one good year to a person’s life through CT screening is around $80,000. Tests or procedures that cost less than $100,000 per year added are considered cost effective. The analysis identified two groups for whom screening is the most cost-effective—current smokers and people ages 60-74. People with private insurance will have low-dose CT scans covered. But those with Medicare may not, thanks to the decision of a Medicare advisory committee. The CMS is expected to publish a draft of its decision within the next few days and come to a final decision in early 2015.
Getting a flu shot can help ward off the flu. It also works to prevent pneumonia, a leading cause of hospitalization (about one million a year) and death (about 50,000) in the United States. Pneumonia can be especially dangerous in young children and older people. For these groups, as well as others who face a high risk of pneumonia, two different vaccines can help prevent pneumonia caused by the bacterium known as Streptococcus pneumoniae. One, called PPSV23 or Pneumovax, is derived from 23 different types of pneumococcal bacteria. A newer vaccine, called PCV13, features parts of 13 different pneumococcal bacteria linked to a protein that helps the vaccine work better. PCV13 is recommended for all children younger than 5 years old, all adults 65 years or older, and anyone age 6 or older with risk factors for pneumonia. PPSV23 is recommended for all adults 65 years or older and anyone age 2 years through 64 years are at high risk of pneumonia.
A new report in JAMA Neurology offers yet another reminder why keeping your blood pressure in the healthy range for as long as you can is a good life strategy. Researchers with the long-term Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study found that memory and thinking skills declined significantly more over the course of a 20-year study in middle-aged people with high blood pressure than it did in those with healthy blood pressure. Interestingly, those who had normal blood pressure in midlife but who developed high blood pressure in their late 60s, 70s, and 80s didn’t have similar declines as those who developed high blood pressure earlier. The main take-home lesson from this study? The longer you live with normal blood pressure, the less likely you are to have memory and reasoning problems when you’re older.
The handshake is an important way that many people communicate nonverbally. It’s a standard gesture when we say hello, goodbye, and make an agreement. We’ve been doing it for millennia. But hands carry germs that can spread infections to others. And some of these infections can be very serious, including those that can’t be killed by standard antibiotics. Is it time to consider changing the tradition of shaking hands? Two researchers from Aberystwyth University in Wales make the case that handshaking exchanges a lot more germs than a modern alternative, the fist bump. In a nifty experiment, they showed that shaking hands transmitted 2 times more bacteria than high fives, and 10 times more bacteria than bumping fists. Their results are published in the August 2014 issue of the American Journal of Infection Control.
A sugar-laden diet boosts the chances of dying of heart disease even among people who aren’t overweight. So says a major study published online this week in JAMA Internal Medicine. Over the course of the 15-year study, individuals who took in 25% or more of their daily calories as sugar were more than twice as likely to die from heart disease as those whose diets included less than 10% added sugar. Overall, the odds of dying from heart disease rose in tandem with the percentage of sugar in the diet—and that was true regardless of a person’s age, sex, physical activity level, and body-mass index (a measure of weight). Sugar-sweetened beverages such as sodas, energy drinks, and sports drinks are by far the biggest sources of added sugar in the average American’s diet. They account for more than one-third of the added sugar we consume as a nation. Other important sources include cookies, cakes, pastries, and similar treats; fruit drinks; ice cream, frozen yogurt and the like; candy; and ready-to-eat cereals.
On a Saturday morning 50 years ago tomorrow, then Surgeon General Luther Terry made a bold announcement to a roomful of reporters: cigarette smoking causes lung cancer and probably heart disease, and the government should do something about it. Terry, himself a longtime smoker, spoke at a press conference unveiling Smoking and Health: Report of the Advisory Committee of the Surgeon General of the Public Health Service. That press conference was held on a Saturday in part to minimize the report’s effect on the stock market. The 1964 Surgeon General’s report, and others that followed, have had a profoundly positive effect on the health of Americans, despite the tobacco industry’s concerted and continuing efforts to promote smoking. By one new estimate, the decline in smoking triggered by the 1964 report and others that followed prevented more than 8 million premature deaths, half of them among people under age 65. But we still have a long way to go. Some 42 million Americans still smoke, and tobacco use accounts for millions of deaths each year around the world.