Insurance Industry Report Faults High Fees for Out-of-Network Care

Insurance Industry Report Faults High Fees for Out-of-Network Care

Michael Nagle for The New York Times

Angel Gonzalez, 36, faced huge bills after emergency gallbladder surgery, despite having good insurance coverage. “I was on the hook for more than I made in a year.”

Just over a year ago, Angel Gonzalez, 36, awoke with searing chest pain at 2 a.m. A friend drove him to the closest emergency room.

Though he was living on $ 18,000 a year as a graduate student, Mr. Gonzalez had good insurance and the hospital, St. Charles in Port Jefferson, N.Y., was in his network. But the surgeon who came in to remove Mr. Gonzalez’s gallbladder that Sunday night was not.

He billed Mr. Gonzalez $ 30,000, and an assistant billed an additional $ 30,000. Mr. Gonzalez’s policy covered out-of-network providers, but at a rate it considered appropriate: $ 2,000. “I was on the hook for more than I made in a year,” Mr. Gonzalez said.

A health insurance industry report to be released on Friday highlights the exorbitant fees charged by some doctors to out-of-network patients like Mr. Gonzalez. The report, by America’s Health Insurance Plans, or AHIP, contrasts some of the highest bills charged by non-network providers in 30 states with Medicare rates for the same services. Some of the charges, the insurers assert, are 30, 40 or nearly 100 times greater than Medicare rates.

Insurers hope to spotlight a vexing problem that they say the Affordable Care Act does little to address. “When you’re out of network, it’s a blank check,” said Karen Ignagni, president and chief executive of AHIP. “The consumer is vulnerable to ‘anything goes.’ ”

“Unless we deal with cost, we won’t have affordability,” she added. “And unless we have affordability, we won’t have people participating” under the Affordable Care Act.

Among the fees on the report’s list are a $ 6,205 outpatient office visit to a doctor in Massachusetts for which Medicare would have paid $ 152; a $ 12,000 bill for examining a tissue specimen in New York for which Medicare would have paid $ 128; and a $ 48,983 surgeon’s fee for a total hip replacement in New Jersey that Medicare would have reimbursed at $ 1,543. Many of the highest billers were in New York, Texas, Florida and New Jersey.

Elisabeth R. Benjamin, co-founder of the Health Care for All New York coalition, who is often at odds with the insurance industry, said that “is one area we totally agree on.” She continued, “Out-of-network billing is just out of control.”

Even when out-of-network fees are compared with average commercial insurance reimbursements, which are usually greater than Medicare, she said, “It’s pretty outrageous.”

Doctors say the report is skewed because it focuses on a few dozen cases of overcharging that are not representative of their billing. In response to the insurers’ report, the American Medical Association noted on Thursday that a recent analysis found that doctors’ services account for just 16 percent of health care costs.

“There are outliers in every profession, in every business,” said Dr. Andrew Y. Kleinman, a plastic surgeon who is vice president of the Medical Society of the State of New York.

Dr. Kleinman also noted that insurers had effectively shifted the costs of out-of-network care onto patients by changing reimbursement formulas. Instead of the rates commercial insurers usually pay doctors, insurers increasingly are basing their out-of-network payments on Medicare rates, usually far lower.

A growing number of high-end, flexible health plans offer policies that cover outside providers at, for example, 140 percent of Medicare. “They’re selling you an insurance product you can’t use,” Dr. Kleinman said. “You’re buying an insurance policy where the out-of-network benefit is worthless.”

The industry’s own report suggests that using Medicare rates as a benchmark will lead to patients’ picking up much more of the cost for out-of-network care, whether they carefully select a specialist or, as in the case of Mr. Gonzalez and many others, have no choice in the matter.

Had Mr. Gonzalez been 65 or older, Medicare would have paid only $ 958 for the surgery. The average commercial price is $ 12,292, according to FAIR Health, an independent nonprofit group that tracks information on health care costs.

But Mr. Gonzalez’s health plan, United Healthcare, determined the fee should be $ 1,273, of which the company paid $ 838. Mr. Gonzalez filed appeals, which were rejected. He then contacted Community Health Advocates at the Community Service Society of New York for help, and the group’s caseworkers negotiated with the surgeon on his behalf.

After months of wrangling, the surgeon agreed to accept a significantly reduced payment: $ 340.

Consumer advocates and health insurance executives are calling for greater transparency in health care pricing, including upfront disclosure of prices of medical procedures and services.

“The health care industry can give you an estimate, just like any other industry,” said Carrie H. Colla, an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice, noting that the Dartmouth-Hitchcock Medical Center has a patient price estimator online.  

“It’s just not current practice right now,” Dr. Colla said. “Sometimes a doctor won’t even know. The patient really has to push for it.”

Well: A Doctor's Struggle With Numbers

Well: A Doctor's Struggle With Numbers

My youngest child has been struggling with numbers.

This all started around the time of his 4th birthday, in mid-November. He knew he was getting older and asked a lot of questions about babies, who were “too little to have a number,” being less than 1 year old. Then, on the day of his birthday, he wanted to know when he was turning 4.

I told him that today was his birthday, that he turned 4 today.

“But when do I turn 4?” He had recently learned to emphasize certain words in an effort to assist his dim parents in getting his questions answered.

I told him at 8 in the morning, the time he was born.

“No, no, when do I turn 4?”

I looked at him helplessly, wondering whether he was expecting some pivotal moment when he would suddenly gain five inches in height. He decided that the anointed time occurred later that day, after he received his presents .

A week later, his mother and I went for a car ride with her parents, both in their mid-70s. In a rare quiet moment amid the usual barrage of instructions on how to navigate the rural western Pennsylvania roads, our son spoke up.

“When is Pappy going to die?”

The adults fell over themselves responding, trying to both reassure him and ourselves, as if the faster and louder we answered his question, the more we would negate it: A lot of years. Not for a long, long time. We hope he never does.

This satisfied him for the moment, but much like his father, he broods about these types of important topics. A couple of hours later, back at the house, he asked as if in mid-thought: “But, what is the last number?”

I repeated his question, stalling.

“Yes, what is the last number? What’s my last number?” he asked. His mother and I glanced at each other, in a quick game of chicken to see who would answer first.< /p>

“We don’t know, honey,” I finally said. He looked up at my wife, who nodded in agreement.

My son’s words came back to me the following Monday when I saw my first patient, a man in his 70s whose leukemia didn’t get worse on chemotherapy, but unfortunately also didn’t get better. We had run out of options, aside from supportive care.

“How long does he have?”

My patient’s son asked the question that was on everyone’s mind, and when he did, the wave of emotion that washed across the room was almost palpable. My patient’s daughter crossed her legs, and his wife started to cry. So did my patient, though he tried to hide it, glancing up at the fluorescent ceiling lights of the clinic room. Guys in his generation, I’ve found, don’t like to appear weak in front of their family.

I turned to my patient and asked him if he wanted me to talk about this, about his prognosis. My first responsibility in this type of situation is always to my patient and what he wants to hear. Some people want to know specifics, down to the half-month of predicted survival; others want no information at all, as if hearing a number will seal their fate.

“Sure, I guess so,” he answered. He did want to know, but he didn’t want to know.

Oncologists are notoriously bad at predicting survival, and none of us wants to be known as “the doctor who told me I would be dead by now,” the doctor who made a prediction of imminent demise, sending a family into a terrifying tailspin of goodbyes, only to be proven wrong and subsequently mocked for years to come. One of my patients, upon being told by another doctor that she had two months to live, held Christmas in April so she could spend one last holiday with her grandchildren. She survived to see two more Christmases.

At the same time, we need to be truthful and give guidance to people who want time to prepare, time to write wills and pay off debts, to say go odbyes and to leave instructions, to tie up the loose ends of a life now heavy with meaning.

We try to provide hope, but not false hope.

So we give ranges, starting with the best estimate of survival, because my patients have told me they shut down after they hear the worst estimate. We talk about setting goals, about maximizing quality of life, because we don’t have much leverage with quantity of life. We emphasize spending as much time as possible with family and friends, and as little time as possible with people wearing white coats. We tell them we’re not going to give up if they don’t give up.

But the truth is, we don’t know.

---

Dr. Mikkael Sekeres is director of the leukemia program at the Cleveland Clinic.

Well: Waiting for Alzheimer's to Begin

Well: Waiting for Alzheimer's to Begin

My gray matter might be waning. Then again, it might not be. But I swear that I can feel memories â€" as I’m making them â€" slide off a neuron and into a tangle of plaque. I steel myself for those moments to come when I won’t remember what just went into my head.

I’m not losing track of my car keys, which is pretty standard in aging minds. Nor have I ever forgotten to turn off the oven after use, common in menopausal women. I can always find my car in the parking lot, although lots of “normal” folk can’t.

Rather, I suddenly can’t remember the name of someone with whom I’ve worked for years. I cover by saying “sir” or “madam” like the Southerner I am, even though I live in Vermont and grown people here don’t use such terms. Better to think I’m quirky than losing my faculties. Sometimes I’ll send myself an e-mail to-do reminder and then, seconds later, find myself thri lled to see a new entry pop into my inbox. Oops, it’s from me. Worse yet, a massage therapist kicked me out of her practice for missing three appointments. I didn’t recall making any of them. There must another Nancy.

Am I losing track of me?

Equally worrisome are the memories increasingly coming to the fore. Magically, these random recollections manage to circumnavigate my imagined build-up of beta-amyloid en route to delivering vivid images of my father’s first steps down his path of forgetting. He was the same age I am now, which is 46.

“How old are you?” I recall him asking me back then. Some years later, he began calling me every Dec. 28 to say, “Happy birthday,” instead of on the correct date, Dec. 27. The 28th had been his grandmother’s birthday.

The chasms were small at first. Explainable. Dismissible. When he crossed the street without looking both ways, we chalked it up to his well-cultivated, absent-minded professor persona. But the chasms grew into sinkholes, and eventually quicksand. When we took him to get new pants one day, he kept trying on the same ones he wore to the store.

“I like these slacks,” he’d say, over and over again, as he repeatedly pulled his pair up and down.

My dad died of Alzheimer’s last April at age 73 â€" the same age at which his father succumbed to the same disease. My dad ended up choosing neurology as his profession after witnessing the very beginning of his own dad’s forgetting.

Decades later, grandfather’s atrophied brain found its way into a jar on my father’s office desk. Was it meant to be an ever-present reminder of Alzheimer’s effect? Or was it a crystal ball sent to warn of genetic fate? My father the doctor never said, nor did he ever mention, that it was his father’s gray matter floating in that pool of formaldehyde.

Using the jarred brain as a teaching tool, my dad showed my 8-year-old self the difference between frontal and temporal lobes. He also pointed out how brains with Alzheimer’s disease become smaller, and how wide grooves develop in the cerebral cortex. But only after his death â€" and my mother’s confession about whose brain occupied that jar â€" did I figure out that my father was quite literally demonstrating how this disease runs through our heads.

Has my forgetting begun?

I called my dad’s neurologist. To find out if I was in the earliest stages of Alzheimer’s, he would have to look for proteins in my blood or spinal fluid and employ expensive neuroimaging tests. If he found any indication of onset, the only option would be experimental trials.

But documented confirmation of a diseased brain would break my still hopeful heart. I’d walk around with the scarlet letter “A” etched on the inside of my forehead â€" obstructing how I view every situation instead of the intermittent clouding I currently experience.

“You’re still grievi ng your father,” the doctor said at the end of our call. “Sadness and depression affect the memory, too. Let’s wait and see.”

It certainly didn’t help matters that two people at my father’s funeral made some insensitive remarks.

“Nancy, you must be scared to death.”

“Is it hard knowing the same thing probably will happen to you?”

Maybe the real question is what to do when the forgetting begins. My dad started taking 70 supplements a day in hopes of saving his mind. He begged me to kill him if he wound up like his father. He retired from his practice and spent all day in a chair doing puzzles. He stopped making new memories in an all-out effort to preserve the ones he already had.

Maybe his approach wasn’t the answer.

Just before his death â€" his brain a fraction of its former self â€" my father managed to offer up a final lesson. I was visiting him in the memory-care center when he got a strange look on his face. I figured it was gas. But then his eyes lit up and a big grin overtook him, and he looked right at me and said, “Funny how things turn out.”

An unforgettable moment?

I can only hope.

---

Nancy Stearns Bercaw is a writer in Vermont. Her book, “Brain in a Jar: A Daughter’s Journey Through Her Father’s Memory,” will be published in April 2013 by Broadstone.

During Trial, New Details Emerge on DuPuy Hip

During Trial, New Details Emerge on DuPuy Hip

When Johnson & Johnson announced the appointment in 2011 of an executive to head the troubled orthopedics division whose badly flawed artificial hip had been recalled, the company billed the move as a fresh start.

But that same executive, it turns out, had supervised the implant’s introduction in the United States and had been told by a top company consultant three years before the device was recalled that it was faulty.

In addition, the executive also held a senior marketing position at a time when Johnson & Johnson decided not to tell officials outside the United States that American regulators had refused to allow sale of a version of the artificial hip in this country.

The details about the involvement of the executive, Andrew Ekdahl, with the all-metal hip implant emerged Wednesday in Los Angeles Superior Court during the trial of a patient lawsuit against the DePuy Orthopaedics division of Johnson & Johnson. More than 10,000 lawsuits have been filed against DePuy in connection with the device â€" the Articular Surface Replacement, or A.S.R. â€" and the Los Angeles case is the first to go to trial.

The information about the depth of Mr. Ekdahl’s involvement with the implant may raise questions about DePuy’s ability to put the A.S.R. episode behind it.

Asked in an e-mail why the company had promoted Mr. Ekdahl, a DePuy spokeswoman, Lorie Gawreluk, said the company “seeks the most accomplished and competent people for the job.”

On Wednesday, portions of Mr. Ekdahl’s videotaped testimony were shown to jurors in the Los Angeles case. Other top DePuy marketing executives who played roles in the A.S.R. development are expected to testify in coming days. Mr. Ekdahl, when pressed in the taped questioning on whether DePuy had recalled the A.S.R. because it was unsafe, repeatedly responded that the company had recalled it “because it did not meet the clinical standards we wanted in the marketplace.”

Before the device’s recall in mid-2010, Mr. Ekdahl and those executives all publicly asserted that the device was performing extremely well. But internal documents that have become public as a result of litigation conflict with such statements.

In late 2008, for example, a surgeon who served as one of DePuy’s top consultants told Mr. Ekdahl and two other DePuy marketing officials that he was concerned about the cup component of the A.S.R. and believed it should be “redesigned.” At the time, DePuy was aggressively promoting the device in the United States as a breakthrough and it was being implanted into thousands of patients.

“My thoughts would be that DePuy should at least de-emphasize the A.S.R. cup while the clinical results are studied,” that consultant, Dr. William Griffin, wrote.

A spokesman for Dr. Griffin said he was not available for comment.

The A.S.R., whose cup and ball components were both made of metal, was first sold by DePuy in 2003 outside the United States for use in an alternative hip replacement procedure called resurfacing. Two years later, DePuy started selling another version of the A.S.R. for use here in standard hip replacement that used the same cup component as the resurfacing device. Only the standard A.S.R. was sold in the United States; both versions were sold outside the country.

Before the device recall in mid-2010, about 93,000 patients worldwide received an A.S.R., about a third of them in this country. Internal DePuy projections estimate that it will fail in 40 percent of those patients within five years; a rate eight times higher than for many other hip devices.

Mr. Ekdahl testified via tape Wednesday that he had been placed in charge of the 2005 introduction of the standard version of the A.S.R. in this country. Within three years, he and other DePuy executives were receiving reports that the device was failing prematurely at higher than expected rates, apparently because of problems related to the cup’s design, documents disclosed during the trial indicate.

Along with other DePuy executives, he also participated in a meeting that resulted in a proposal to redesign the A.S.R. cup. But that plan was dropped, apparently because sales of the implant had not justified the expense, DePuy documents indicate.

In the face of growing complaints from surgeons about the A.S.R., DePuy officials maintained that the problems were related to how surgeons were implanting the cup, not from any design flaw. But in early 2009, a DePuy executive wrote to Mr. Ekdahl and other marketing officials that the early failures of the A.S.R. resurfacing device and the A.S.R. traditional implant, known as the XL, were most likely design-related.

“The issue seen with A.S.R. and XL today, over five years post-launch, are most likely linked to the inherent design of the product and that is something we should recognize,” that executive, Raphael Pascaud wrote in March 2009.

Last year, The New York Times reported that DePuy executives decided in 2009 to phase out the A.S.R. and sell existing inventories weeks after the Food and Drug Administration asked the company for more safety data about the implant.

The F.D.A. also told the company at that time that it was rejecting its efforts to sell the resurfacing version of the device in the United States because of concerns about “high concentration of metal ions” in the blood of patients who received it.

DePuy never disclosed the F.D.A. ruling to regulators in other countries where it was still marketing the resurfacing version of the implant.

During a part of that period, Mr. Ekdahl was overseeing sales in Europe and other regions for DePuy. When The Times article appeared last year, he issued a statement, saying that any implication that the F.D.A. had determined there were safety issues with the A.S.R. was “simply untrue.” “This was purely a business decision,” Mr. Ekdahl stated at that time.

This article has been revised to reflect the following correction:

Correction: January 30, 2013

An earlier version of this article, in the summary, described the start of the DePuy trial incorrectly. It began last week, not this week.

SciTimes Update: Recent Developments in Health and Science News

SciTimes Update: Recent Developments in Health and Science News

Charles A. Nelson Lab, University of Minnesota

Studying the infant brain. From the book:  "Raising America: Experts, Parents and a Century of Advice About Children" by Ann Hulbert.

Wednesday in Science, babies who know what’s on your mind, a sinkhole in China, coral reefs in crisis and a soldier who can now talk with his hands. Check out these and other headlines from around the Web.

Baby Mind Readers: Even babies as young as 1 ½ can guess what other people are thinking, LiveScience.com reports. Previously, scientists thought this ability to understand other people’s perspectives emerged much later in children.

Time Wasters: An explosion in technology aimed at helping people manage their time and tasks may actually be making it harder, reports The Wall Street Journal. Many people choose something that doesn’t fit the way they think and work, or they jump from one tool to another, wasting time and energy.

More Housework, Less Sex: Married men who spend more time doing traditionally female chores, like cooking, cleaning and shopping, report having less sex than husbands who don’t do as much, reports The Houston Chronicle. Conversely, men who did more manly chores, such as yard work, paying bills and auto repairs, reported having more sex.

Roman Tag Artists: A facelift of the Colosseum in Rome that began last fall has revealed centuries of graffiti, National Geographic reports.

Sinkhole Swallows Building: An enormous sinkhole opened up under a building complex in China’s southern city of Guangzhou Tuesday, swallowing five shops and one building. Watch the video from The Christian Science Monitor.

Sandwiched Generation: More middle-aged adults are caring for both children and aging parents, reports USA Today. About 15 percent of American adults in their 40s and 50s provided financial support to both an aging parent and a child in 2012, according to a survey of 2,511 adults from the Pew Social and Demographic Trends Project.

Misleading Trials: A rare peek into drug company documents reveals troubling differences between publicly available information and materials the company holds close to its chest, reports ScienceNews.org. In comparing public and private descriptions of drug trials conducted by the pharmaceutical giant Pfizer, researchers discovered discrepancies,including changes in the number of study participants and inconsistent definitions of protocols and analyses.

Reuters

A diver swam past a healthy colony of Caribbean elkhorn coral near Molasses Reef, Florida, in 2009.

Coral in Crisis: Coral reefs are producing less calcium carbonate and growth rates have slowed dramatically, reports Science News.

Severe Flu Cases Among Chinese: A genetic variant commonly found in Chinese people may help explain why some got seriously ill with swine flu, reports The Boston Globe. The discovery could help pinpoint why flu viruses hit some populations particularly hard and change how they are treated.

Video by AssociatedPress

Double-Arm Transplant Recipient: Feels Amazing

Double-Arm Transplant Soldier Speaks: Brendan Marrocco, a soldier who lost all four limbs in Iraq and then received a double-arm transplant said he hated living without arms. “Not having arms takes so much away from you. Even your personality, you know. You talk with your hands. You do everything with your hands, and when you don’t have that, you’re kind of lost for a while,” the 26-year-old New Yorker told reporters Tuesday at Johns Hopkins Hospital, reports The Associated Press.

Phys Ed: Helmets for Ski and Snowboard Safety

Phys Ed: Helmets for Ski and Snowboard Safety

Recently, researchers from the department of sport science at the University of Innsbruck in Austria stood on the slopes at a local ski resort and trained a radar gun on a group of about 500 skiers and snowboarders, each of whom had completed a lengthy personality questionnaire about whether he or she tended to be cautious or a risk taker.

The researchers had asked their volunteers to wear their normal ski gear and schuss or ride down the slopes at their preferred speed. Although they hadn’t informed the volunteers, their primary aim was to determine whether wearing a helmet increased people’s willingness to take risks, in which case helmets could actually decrease safety on the slopes.

What they found was reassuring.

To many of us who hit the slopes with, in my case, literal regularity â€" I’m an ungainly novice snowboar der â€" the value of wearing a helmet can seem self-evident. They protect your head from severe injury. During the Big Air finals at the Winter X Games in Aspen, Colo., this past weekend, for instance, 23-year-old Icelandic snowboarder Halldor Helgason over-rotated on a triple back flip, landed head-first on the snow, and was briefly knocked unconscious. But like the other competitors he was wearing a helmet, and didn’t fracture his skull.

Indeed, studies have concluded that helmets reduce the risk of a serious head injury by as much as 60 percent. But a surprising number of safety experts and snowsport enthusiasts remain unconvinced that helmets reduce overall injury risk.

Why? A telling 2009 survey of ski patrollers from across the country found that 77 percent did not wear helmets because they worried that the headgear could reduce their peripheral vision, hearing and response times, making them slowe r and clumsier. In addition, many worried that if they wore helmets, less-adept skiers and snowboarders might do likewise, feel invulnerable and engage in riskier behavior on the slopes.

In the past several years, a number of researchers have attempted to resolve these concerns, for or against helmets. And in almost all instances, helmets have proved their value.

In the Innsbruck speed experiment, the researchers found that people whom the questionnaires showed to be risk takers skied and rode faster than those who were by nature cautious. No surprise.

But wearing a helmet did not increase people’s speed, as would be expected if the headgear encouraged risk taking. Cautious people were slower than risk-takers, whether they wore helmets or not; and risk-takers were fast, whether their heads were helmeted or bare.

Interestingly, the skiers and riders who were the most likely, in general, to don a helmet were the most expert, the men and women with the most talent and hours on the slopes. Experience seemed to have taught them the value of a helmet.

Off of the slopes, other new studies have brought skiers and snowboarders into the lab to test their reaction times and vision with and without helmets. Peripheral vision and response times are a serious safety concern in a sport where skiers and riders rapidly converge from multiple directions.

But when researchers asked snowboarders and skiers to wear caps, helmets, goggles or various combinations of each for a 2011 study and then had them sit before a computer screen and press a button when certain images popped up, they found that volunteers’ peripheral vision and reaction times were virtually unchanged when they wore a helmet, compared with wearing a hat. Goggles slightly reduced peripheral vision and increased response times. But helmets had no significant effect.

Even when researchers added music, testing snowboarders and skiers wearing Bluetooth-audio equipped helmets, response times did not increase significantly from when they wore wool caps.

So why do up to 40 percent of skiers and snowboarders still avoid helmets?

“The biggest reason, I think, is that many people never expect to fall,” says Dr. Adil H. Haider, a trauma surgeon and associate professor of surgery at Johns Hopkins University in Baltimore and co-author of a major new review of studies related to winter helmet use. “That attitude is especially common in people, like me, who are comfortable on blue runs but maybe not on blacks, and even more so in beginners.”

But a study published last spring detailing snowboarding injuries over the course of 18 seasons at a Vermont ski resort found that the riders at greatest risk of hurting themselves were female beginners. I sympathize.

The takeaway from the growing body of science about ski helmets is in fact unequivocal, Dr. Haider said. “Helmets are safe. They don’t seem to increase risk taking. And they protect against serious, even fatal head injuries.”

The Eastern Association for the Surgery of Trauma, of which Dr. Haider is a member, has issued a recommendation that “all recreational skiers and snowboarders should wear safety helmets,” making them the first medical group to go on record advocating universal helmet use.

Perhaps even more persuasive, Dr. Haider has given helmets to all of his family members and colleagues who ski or ride. “As a trauma surgeon, I know how difficult it is to fix a brain,” he said. “So everyone I care about wears a helmet.”

Transplant Recipient Describes Arms as 'Amazing'

Transplant Recipient Describes Arms as 'Amazing'

Published January 30, 2013

A U.S. soldier who lost all four limbs in Iraq was released from a hospital near Washington Tuesday after a rare double arm transplant.[[ TAKE VIDEO ]]Twenty-six-year-old Brendan Marrocco told reporters it is "amazing" to have arms again after losing them to a roadside bomb in 2009. He is the first U.S. soldier from the Iraq and Afghanistan wars to survive losing all four limbs.

Well: Baths Offer Babies Protection

Well: Baths Offer Babies Protection

Critically ill children are usually bathed more for comfort than for any medical reason. But a new study has found that a bath with an antibacterial soap can reduce the risk for bacteremia, a sometimes fatal infection of the blood.

For the study, performed in two intensive care units in each of five hospitals, the staff of one unit bathed children with ordinary soap and water, while in the other staff used cloths with chlorhexidine, a widely used antiseptic. Then the units switched procedures for the following six months. More than 4,000 children were hospitalized for at least two days in all the units combined.

The report, published online on Friday in The Lancet, found a 36 percent reduction in the incidence of bacteremia in the children bathed with chlorhexidine.

“We’ve taken a substance easily available and something we’re already doing â€" giving baths â€" and put them together to show it reduces infection,” said the lead author, Dr. Aaron M. Milstone, an assistant professor of pediatrics at Johns Hopkins. “It’s not novel, and it’s not sexy. But it works.”

Well: Ask Well: Long-Term Use of Nicotine Gum

Well: Ask Well: Long-Term Use of Nicotine Gum

In small doses, like those contained in the gum, nicotine is generally considered safe. But it does have stimulant properties that can raise blood pressure, increase heart rate and constrict blood vessels. One large report from 2010 found that compared to people given a placebo, those who used nicotine replacement therapies had a higher risk of heart palpitations and chest pains.

That’s one reason that nicotine gum should, ideally, be used for no more than four to six months, said Lauren Indorf, a nurse practitioner with the Cleveland Clinic’s Tobacco Treatment Center. Yet up to 10 percent of people use it for longer periods, in some cases for a decade or more she said.

Some research has raised speculation that long-term use of nicotine might also raise the risk of cancer, though it has mostly involved laboratory and animal research, and there have not been any long-term randomized studies specifically addressing this question in people. One recent report that reviewed the evidence on nicotine replacement therapy and cancer concluded that, “the risk, if any, seems small compared with continued smoking.”

Ultimately, the biggest problem with using nicotine gum for long periods is that the longer you stay on it, the longer you remain dependent on nicotine, and thus the greater your odds of a smoking relapse, said Ms. Indorf. “What if the gum is not available one day?” she said. “Your body is still relying on nicotine.”

If you find yourself using it for longer than six months, it may be time to consider switching to sugar-free gum or even another replacement therapy, like the patch or nasal spray.

“Getting peo ple on a different regimen helps them break the gum habit and can help taper them off nicotine,” Ms. Indorf said.

Double-arm transplant soldier 'excited for the future'

Double-arm transplant soldier 'excited for the future'

It was an exciting day for a 26-year-old veteran, the first soldier to survive after losing all four limbs in the Iraq War. On Tuesday, Brendan Marrocco wheeled himself into a news conference to show off his newly transplanted arms following his surgery last month at Johns Hopkins Hospital.

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Marrocco received his new arms in a 13-hour operation that involved 16 surgeons on December 18 at Johns Hopkins Hospital in Baltimore.

"I hated not having arms," Marrocco said during the news conference. "I was alright with not having legs. Not having arms takes so much away from you. Even your personality. You talk with your hands. You do everything with your hands, basically. And when you don’t have that you’re kind of lost for a while."

Marrocco received his two new arms from a deceased donor, becoming one of only seven people in the United States who have undergone successful double-arm transplants.

“It's given me a lot of hope for the future. I feel like I’m getting a second chance to start over after I got hurt,” Marrocco said. “I’m excited for the future.”

His transplants involved the connection of bones, blood vessels, muscles, tendons, nerves and skin on both arms, and was the most extensive and complicated limb transplant procedure so far performed in the U.S., according to a hospital statement.

Doctors say it will take years for Marrocco to fully recover, but as he brushed the hair from his forehead with his left arm at the news conference, it appeared that he may get there far faster than predicted.

The main limiting factor in recovery is the slow growth of nerves, said the surgical team’s leader, Dr. W.P. Andrew Lee, plastic surgery chief at the Johns Hopkins Hospital.

Dr. Jamie Shores agreed.

“We expect it will take two to three years to see what that final function will be,” said Shores, the hospital's clinical director of hand transplantation. "The nerves make the muscles work as well as giving sensation.”

As the strength in his new arms improves, Marrocco said he is looking forward to swimming and driving. He conceded he probably won't be playing soccer, a sport he loved in high school.

NBC News

To explain how much recovery Marrocco can expect, Lee pointed to the results from another patient who had a similar surgery three years ago.

“He was showing me how he was now able to tie shoe laces with his transplanted hands,” Lee said of the previous patient. “Also, in addition to being able to tie his shoes, he sent us a video of him using chopsticks with his transplanted hand.”

Marrocco was in high spirits as he answered questions about how he’d be spending the rest of his life.

“I’ve got the job I always wanted, doing nothing,” he said with a smile. “I guess I’ll just be a drain on society.”

In reality, Marrocco will be spending his days in physical therapy. “He’ll be doing therapy to make his hands work six hours a day,” Shores said. “There’s no amount of surgery we can do to make something work if the patients aren’t going to put an incredible amount of effort into this afterwards. He isn’t just sitting a home playing video games. It’s a full time job. That’s why we picked him. He’s demonstrated how hard he’s willing to work. He’s got that fighting spirit.”

Wearing a T-shirt bearing the slogan, "Keep Calm and Chive On" (a reference to a comedy news website), Marrocco joked, “I think video games can be great therapy.”

During the news conference, Marrocco offered a message for other amputee veterans of the wars in Afghanistan and Iraq, saying they should "be stubborn" and not give up hope.

"Life always gets better and you're still alive," he said. "There's a lot of people who will say you can't do something. Just do it anyway. Work your ass off. You can do it."

Related:

Texas mom gets go-ahead for historic double-arm transplant

Double hand transplant recipient wants to feel grandkids' faces

Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Personal Health: Keeping Blood Pressure in Check

Personal Health: Keeping Blood Pressure in Check

Since the start of the 21st century, Americans have made great progress in controlling high blood pressure, though it remains a leading cause of heart attacks, strokes, congestive heart failure and kidney disease.

Now 48 percent of the more than 76 million adults with hypertension have it under control, up from 29 percent in 2000.

But that means more than half, including many receiving treatment, have blood pressure that remains too high to be healthy. (A normal blood pressure is lower than 120 over 80.) With a plethora of drugs available to normalize blood pressure, why are so many people still at increased risk of disease, disability and premature death? Hypertension experts offer a few common, and correctable, reasons:

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Jane Brody speaks about hyperten sion.

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¶ About 20 percent of affected adults don’t know they have high blood pressure, perhaps because they never or rarely see a doctor who checks their pressure.

¶ Of the 80 percent who are aware of their condition, some don’t appreciate how serious it can be and fail to get treated, even when their doctors say they should.

¶ Some who have been treated develop bothersome side effects, causing them to abandon therapy or to use it haphazardly.

¶ Many others do little to change lifestyle factors, li ke obesity, lack of exercise and a high-salt diet, that can make hypertension harder to control.

Dr. Samuel J. Mann, a hypertension specialist and professor of clinical medicine at Weill-Cornell Medical College, adds another factor that may be the most important. Of the 71 percent of people with hypertension who are currently being treated, too many are taking the wrong drugs or the wrong dosages of the right ones.

Dr. Mann, author of “Hypertension and You: Old Drugs, New Drugs, and the Right Drugs for Your High Blood Pressure,” says that doctors should take into account the underlying causes of each patient’s blood pressure problem and the side effects that may prompt patients to abandon therapy. He has found that when treatment is tailored to the individual, nearly all cases of high blood pressure can be brought and kept under control with available drugs.

Plus, he said in an interview, it can be done with minimal, if any, side effects and at a reas onable cost.

“For most people, no new drugs need to be developed,” Dr. Mann said. “What we need, in terms of medication, is already out there. We just need to use it better.”

But many doctors who are generalists do not understand the “intricacies and nuances” of the dozens of available medications to determine which is appropriate to a certain patient.

“Prescribing the same medication to patient after patient just does not cut it,” Dr. Mann wrote in his book.

The trick to prescribing the best treatment for each patient is to first determine which of three mechanisms, or combination of mechanisms, is responsible for a patient’s hypertension, he said.

¶ Salt-sensitive hypertension, more common in older people and African-Americans, responds well to diuretics and calcium channel blockers.

¶ Hypertension driven by the kidney hormone renin responds best to ACE inhibitors and angiotensin receptor blockers, as well as direct r enin inhibitors and beta-blockers.

¶ Neurogenic hypertension is a product of the sympathetic nervous system and is best treated with beta-blockers, alpha-blockers and drugs like clonidine.

According to Dr. Mann, neurogenic hypertension results from repressed emotions. He has found that many patients with it suffered trauma early in life or abuse. They seem calm and content on the surface but continually suppress their distress, he said.

One of Dr. Mann’s patients had had high blood pressure since her late 20s that remained well-controlled by the three drugs her family doctor prescribed. Then in her 40s, periodic checks showed it was often too high. When taking more of the prescribed medication did not result in lasting control, she sought Dr. Mann’s help.

After a thorough work-up, he said she had a textbook case of neurogenic hypertension, was taking too much medication and needed different drugs. Her condition soon became far better managed, wit h side effects she could easily tolerate, and she no longer feared she would die young of a heart attack or stroke.

But most patients should not have to consult a specialist. They can be well-treated by an internist or family physician who approaches the condition systematically, Dr. Mann said. Patients should be started on low doses of one or more drugs, including a diuretic; the dosage or number of drugs can be slowly increased as needed to achieve a normal pressure.

Specialists, he said, are most useful for treating the 10 percent to 15 percent of patients with so-called resistant hypertension that remains uncontrolled despite treatment with three drugs, including a diuretic, and for those whose treatment is effective but causing distressing side effects.

Hypertension sometimes fails to respond to routine care, he noted, because it results from an underlying medical problem that needs to be addressed.

“Some patients are on a lot of blood pressure drugs â€" four or five â€" who probably don’t need so many, and if they do, the question is why,” Dr. Mann said.

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How to Measure Your Blood Pressure

Mistaken readings, which can occur in doctors’ offices as well as at home, can result in misdiagnosis of hypertension and improper treatment. Dr. Samuel J. Mann, of Weill Cornell Medical College, suggests these guidelines to reduce the risk of errors:

¶ Use an automatic monitor rather than a manual one, and check the accuracy of your home monitor at the doctor’s office.

¶ Use a monitor with an arm cuff, not a wrist or finger cuff, and use a large cuff if you have a large arm.

¶ Sit quietly for a few minutes, without talking, after putting on the cuff and before checking your pre ssure.

¶ Check your pressure in one arm only, and take three readings (not more) one or two minutes apart.

¶ Measure your blood pressure no more than twice a week unless you have severe hypertension or are changing medications.

¶ Check your pressure at random, ordinary times of the day, not just when you think it is high.

Lumpectomy May Be Safer Than Mastectomy

Lumpectomy May Be Safer Than Mastectomy

Lumpectomy procedures may be a healthier option for those with early stages of breast cancers, says a new study from researchers at Duke Cancer Institute in Durham, N.C. For the study Dr. Shelley Hwang and her team reviewed the health records from over 112,000 women in the early stages of breast cancer between 1990 and 2004.

They found that the women who underwent a lumpectomy were 13 less likely to die from breast cancer and 19 percent less likely to die of any cause then women who underwent mastectomy procedures.

"Lumpectomy is just as effective if not more effective than mastectomy. There are lots of women who think the more [treatment] they do, the better they will do. This refutes that," says Hwang.

"We wanted to look at early stage disease, and those patients typically don't get radiation aft er mastectomy," she said. "The group that benefited the most -- who had the biggest difference in breast cancer survival -- were those women over 50 with estrogen-receptor positive disease," Hwang adds.

by RTT Staff Writer

For comments and feedback: editorial@rttnews.com

Health News

Swine flu infected 1 in 5, death rate low, study shows

Swine flu infected 1 in 5, death rate low, study shows

By Kate Kelland

LONDON | Fri Jan 25, 2013 11:41am EST

LONDON (Reuters) - At least one in five people worldwide were infected with swine flu during the first year of the 2009-2010 H1N1 pandemic, an international research group said on Friday, but the death rate was just 0.02 percent.

The results echo other studies that found children were hit harder by the H1N1 strain, which swept around the world, than they are by regular seasonal flu outbreaks and that people over 65 were less vulnerable.

More accurate early surveillance is needed to plan for and respond to future pandemics, scientists said, in the wake of the international research led by the World Health Organization (WHO) and Imperial College London.

"Knowing the proportion of the population infected in different age groups and the proportion of those infected who died will help public health decision-makers plan for ... pandemics," said the WHO's Anthony Mounts who helped lead the study.

The information could be used to assess severity and develop mathematical models to predict how flu outbreaks spread and what effect different interventions, such as school closures, vaccination or preventative treatment, might have, he said.

The study, which used data from 19 countries, collated results from more than 24 studies involving some 90,000 blood samples collected before, during and after the pandemic.

The results, published in the journal Influenza and Other Respiratory Viruses, showed 20 to 27 percent of people studied were infected during the first year of the pandemic.

Because infection rates were likely to have been similar in countries where data were not available, this means as many as a quarter of the world's people may have been infected, the researchers said.

The WHO declared H1N1 swine flu a pandemic in June 2009 when laboratories had identified cases in 74 countries. By November 2009 it had started to peter out but the WHO did not declare the epidemic at an end until August 2010.

While this study did not set out to look at death rates, the researchers said they had used previously published and still-in-progress death rate estimates to calculate the proportion of people infected who died from the pandemic virus.

Based on an estimate of around 200,000 deaths, they said the case fatality ratio was probably less than 0.02 percent.

The WHO's official data show 18,500 people were reported killed by the H1N1 flu. But a study published in The Lancet last year said the actual death toll may have been up to 15 times higher at more than 280,000.

Maria Van Kerkhove of Imperial College London, who worked on the study, said it would improve understanding of the H1N1 pandemic's impact and fuel efforts to improve prediction of future pandemics.

"It puts it into context and gives us a fuller picture," she said in a telephone interview. "That's incredibly important because we know this will happen again and there is a lot of effort being put into trying to prepare now...for the next one."

(Reporting by Kate Kelland, editing by Robert Woodward)

Brain Aging Linked to Sleep-Related Memory Decline

Brain Aging Linked to Sleep-Related Memory Decline

For decades scientists have known that the ability to remember newly learned information declines with age, but it was not clear why. A new study may provide part of the answer.

The report, posted online on Sunday by the journal Nature Neuroscience, suggests that structural brain changes occurring naturally over time interfere with sleep quality, which in turn blunts the ability to store memories for the long term.

Previous research had found that the prefrontal cortex, the brain region behind the forehead, tends to lose volume with age, and that part of this region helps sustain quality sleep, which is critical to consolidating new memories. But the new experiment, led by scientists at the University of California, Berkeley, is the first to link structural changes directly with sleep-related memory problems.

The findings suggest that one way to slow memory decline in aging adults is to improve sleep, specifically the so-called slow-wave phase, which constitutes about a quarter of a normal night’s slumber.

Doctors cannot reverse structural changes that occur with age any more than they can turn back time. But at least two groups are experimenting with electrical stimulation as a way to improve deep sleep in older people. By placing electrodes on the scalp, scientists can run a low current across the prefrontal area, essentially mimicking the shape of clean, high-quality slow waves.

The result: improved memory, at least in some studies. “There are also a number of other ways you can improve sleep, including exercise,” said Ken Paller, a professor of psychology and director of the cognitive neuroscience program at Northwestern, who was not involved in the research.

Dr. Paller said that a whole array of changes occurred across the brain during aging and that sleep was only one factor affecting memory function.

But Dr. Paller said that the study told “a convincing story, I think: that atrophy is related to slow-wave sleep, which we know is related to memory performance. So it’s a contributing factor.”

In the study, a research team in California took brain images from 19 people of retirement age and 18 in their early 20s. It found that a brain area called the medial prefrontal cortex, roughly behind the middle of the forehead, was about a third smaller on average in the older group than in the younger one â€" a difference due to natural atrophy over time, previous research suggests.

Before bedtime, the team had the two groups study a long list of words paired with nonsense syllables, like “action-siblis” and “arm-reconver.” The team used such nonwords because one type of memory that declines with age is for new, previously unseen information.

After training on the pairs for half an hour or so, the participants took a test on some of them. The young group outscored the older group by about 25 percent.

Then everyone went to bed â€" and bigger differences emerged. For one, the older group got only about a quarter of the amount of high-quality slow-wave sleep that the younger group did, as measured by the shape and consistency of electrical waves on an electroencephalogram machine, or EEG. It is thought that the brain moves memories from temporary to longer-term storage during this deep sleep.

On a second test, given in the morning, the younger group outscored the older group by about 55 percent. The estimated amount of atrophy in each person roughly predicted the difference between his or her morning and evening scores, the study found. Even seniors who were very sharp at night showed declines after sleeping.

“The analysis showed that the differences were due not to changes in capacity for memories, but to differences in sleep quality,” said Bryce A. Mander, a postdoctoral fellow at Berkeley, and the lead author of the study. His co-authors included researchers from the California Pacific Medical Center in San Francisco; the University of California, San Diego; and the Lawrence Berkeley National Laboratory.

The findings do not imply that medial prefrontal atrophy is the only age-related change causing memory problems, said Matthew P. Walker, a professor of psychology and neuroscience at Berkeley, and a co-author of the study.

“But these things are interrelated,” Dr. Walker said. “Essentially, with time, the less and less tissue you have in this prefrontal area, the less and less quality deep wave sleep you get, the less and less you remember of content that you just learned.”

The Bad Habit You Must Break by Age 44

The Bad Habit You Must Break by Age 44

Put it out.

Hey young smokers, here’s your mulligan: People who quit smoking by age 44 tend to live nearly as long as those who never smoked, reports a study in the New England Journal of Medicine.

Researchers from the University of Toronto analyzed health and smoking records collected from more than 200,000 Americans, then compared the lifespans of smokers to non-smokers. One of the study findings was predictable: Those who never smoke live a decade longer, on average, than lifetime smokers.

But for those who quitâ€"even well into middle ageâ€"the study results are encouraging: Men and women who smoke their last butt before turning 44 die just 1 year earlier, on average, than those who never smoke, the research shows. Also good news: Those who quit by age 54 die just 4 years youngerâ€"a lot better than the decade lost among lifetime smokers.

But don’t think of this as your green light to smoke into your 40s, says study author Prabhat Jha, M.D., Ph.D., a professor of public health at the University of Toronto. Jha says men who quit by 40 are still 20 percent more likely to die in a given year than those who never smoke. Why? Increased risk for heart disease, cancer, stroke, and the dozen other life-threatening health risks research has linked to cigs, Jha explains.

Having a hard time breaking the habit? Download Quitpal (free for IOS), a new app from the National Cancer Institute. Among other features, it helps you track the money you’re saving and connects you with social media networks so friends can help you stay on track. It will even send you encouraging texts, which can double your likelihood of quitting, according to a study in The Lancet.

If you liked this story, you’ll love these:

• The Easiest Way to Quit Smoking
• The Craziest Reason to Eat Vegetables
• 7 Muscle-Building Mistakes to Avoid

F.D.A. Panel Recommends Restrictions on Hydrocodone Products Like Vicodin

F.D.A. Panel Recommends Restrictions on Hydrocodone Products Like Vicodin

Trying to stem the scourge of prescription drug abuse, an advisory panel of experts to the Food and Drug Administration voted on Friday to toughen the restrictions on painkillers like Vicodin that contain hydrocodone, the most widely prescribed drugs in the country. 

The recommendation, which the drug agency is likely to follow, would limit access to the drugs by making them harder to prescribe, a major policy change that advocates said could help ease the growing problem of addiction to painkillers, which exploded in the late 1990s and continues to strike hard in communities from Appalachia and the Midwest to New England. 

But at 19 to 10, the vote was far from unanimous, with some opponents expressing skepticism that the change would do much to combat abuse. Oxycodone, another highly abused painkiller and the main ingredient in OxyContin, has been in the more restrictive category since it first came on the market, they pointed out in testimony at a public hearing. They also said the change could create unfair obstacles for patients in chronic pain. 

 Painkillers now take the lives of more Americans than heroin and cocaine combined, and since 2008, drug-induced deaths have outstripped those from traffic accidents. Prescription drugs account for about three-quarters of all drug overdose deaths in the United States, with the number of deaths from painkillers quadrupling since 1999, according to federal data.

The change would have sweeping consequences for doctors, pharmacists and patients. Refills without a new prescription would be forbidden, as would faxed prescriptions and those called in by phone. Only written prescriptions from a doctor would be allowed. Distributors would be required to store the drugs in special vaults.

The vote comes after similar legislation in Congress failed last year, after aggressive lobbying by pharmacists and drugstores.

“This is the federal government saying, ‘We need to tighten the reins on this drug,’ ” said Scott R. Drab, associate professor of pharmacy and therapeutics at the University of Pittsburgh’s School of Pharmacy. “Pulling in the rope is a way to rein in abuse, and, consequently, addiction.”

But at the panel’s two-day hearing at F.D.A. headquarters in Silver Spring, Md., many spoke against the change, including advocates for nursing home patients, who said frail residents with chronic pain would have to make the trip to a doctor’s office. The change would also ban nurse practitioners and physician assistants from prescribing the drugs, making it harder for people in underserved rural areas.

Panelists also cautioned that the change would produce a whack-a-mole effect, pushing up abuse of other drugs, like heroin, which has declined in recent years.

“Many of us are concerned that the more stringent controls will eventually lead to different problems, which may be worse,” said Dr. John Mendelson, a senior scientist at the Addiction and Pharmacology Research Laboratory at the California Pacific Medical Center Research Institute in San Francisco.

The F.D.A. convened the panel, made up of scientists, pain doctors and other experts, after a request by the Drug Enforcement Administration, which contends that the drugs are among the most frequently abused painkillers and should be more tightly controlled.

If the F.D.A. accepts the panel’s recommendation, it will be sent to officials at the Department of Health and Human Services, who will make the final determination. The F.D.A. denied a similar request by the D.E.A. in 2008, but the law enforcement agency requested that the F.D.A. reconsider its position in light of new research and data.

While hydrocodone products are the most widely prescribed painkillers, they make up a minority of deaths, because there is less medication in each tablet than some of the other more restricted drugs, like extended-release oxycodone products, said Dr. Nathaniel Katz, assistant professor of anesthesia at Tufts University School of Medicine in Boston. Oxycodone and methadone products account for about two-thirds of drug overdose deaths, he said, despite accounting for only a fraction of hydrocodone prescriptions.

The importance of Friday’s vote was more symbolic, he said, a message to doctors that they will need to think twice before prescribing hydrocodone, and to patients that the days of “unbridled access” are coming to an end. The tide has been turning against easy opioid prescriptions, as the medical system and federal regulators slowly make adjustments to reduce the potential for abuse.

“It will help shape thinking,” said Dr. Katz, whose clinical research company, Analgesic Solutions, is trying to develop other treatments for pain. “It’s an important marker in the progressively more conservative swing of the pendulum in opioid prescribing.”

He cautioned that patients who need the medications for pain should not suffer inappropriate barriers to access because of the change, a concern that the dissenters shared.  Medical professionals battling the prescription drug abuse epidemic applauded the change.

“This may be the single most important intervention undertaken at the federal level to bring the epidemic under control,” said Dr. Andrew Kolodny, chairman of psychiatry at Maimonides Medical Center in New York and president of Physicians for Responsible Opioid Prescribing, a New York-based advocacy group. “This is about correcting a mistake made 40 years ago that’s had disastrous consequences.”

Testimony at the hearing included emotional appeals from parents who had lost their children to painkiller addiction. Senator Joe Manchin III, a Democrat from West Virginia, a state that has been hit hard by the prescription drug epidemic, pleaded for tougher restrictions.

“When I go back to West Virginia, I hear how easy it is for anybody to get their hands on hydrocodone drugs,” Mr. Manchin said. “For under-age children, these drugs are easier to get than beer or cigarettes.”

Diner’s Journal Blog: PepsiCo Will Halt Use of Additive in Gatorade

Diner’s Journal Blog: PepsiCo Will Halt Use of Additive in Gatorade

PepsiCo announced on Friday that it would no longer use an ingredient in Gatorade after consumers complained.

The ingredient, brominated vegetable oil, which was used in citrus versions of the sports drink to prevent the flavorings from separating, was the object of a petition started on Change.org by Sarah Kavanagh, a 15-year-old from Hattiesburg, Miss., who became concerned about the ingredient after reading about it online. Studies have suggested there are possible side effects, including neurological disorders and altered thyroid hormones.

The petition attracted more than 200,000 signatures, and this week, Ms. Kavanagh was in New York City to tape a segment for “The Dr. Oz Show.” She visited The New York Times on Wednesday and while there said, “I just don’t understand why they can’t use something else instead of B.V.O.”

“I was in algebra class and one of my friends kicked me and said, ‘Have you seen this on Twitter?’ ” Ms. Kavanagh said in a phone interview on Friday evening. “I asked the teacher if I could slip out to the bathroom, and I called my mom and said, ‘Mom, we won.’ ”

Molly Carter, a spokeswoman for Gatorade, said the company had been testing alternatives to the chemical for roughly a year “due to customer feedback.” She said Gatorade initially was not going to make an announcement, “since we don’t find a health and safety risk with B.V.O.”

Because of the petition, though, Ms. Carter said the company had changed its mind, and an unidentified executive there gave Bever age Digest, a trade publication, the news for its Jan. 25 issue.

Previously, a spokesman for PepsiCo had said in an e-mail, “We appreciate Sarah as a fan of Gatorade, and her concern has been heard.”

Brominated vegetable oil will be replaced by sucrose acetate isobutyrate, an emulsifier that is “generally recognized as safe” as a food additive by the Food and Drug Administration. The new ingredient will be added to orange, citrus cooler and lemonade Gatorade, as well Gatorade X-Factor orange, Gatorade Xtremo citrus cooler and a powdered form of the drink called “glacier freeze.”

Ms. Carter said consumers would start seeing the new ingredient over the next few months as existing supplies of Gatorade sell out and are replaced.

Health advocates applauded the company’s move. “Kudos to PepsiCo for doing the responsible thing on its own and not waiting for the F.D.A. to force it to,” said Michael Jacobson, executive director of the Center for Science in the Public Interest.

Mr. Jacobson has championed the removal of brominated vegetable oil from foods and beverages for the last several decades, but the F.D.A. has left it in a sort of limbo, citing budgetary constraints that it says keep it from going through the process needed to formally ban the chemical or declare it safe once and for all.

Brominated vegetable oil is banned as a food ingredient in Japan and the European Union. About 10 percent of drinks sold in the United States contain it, including Mountain Dew, which is also made by PepsiCo; some flavors of Powerade and Fresca from Coca-Cola; and Squirt and Sunkist Peach Soda, made by the Dr Pepper Snapple Group.

PepsiCo said it had no plans to remove the ingredient from Mountain Dew and Diet Mountain Dew, both of which generate more than $ 1 billion in annual sales.

Heather White, executive director at the Environmental Working Group, said of PepsiCo’s decision, “We can only hope that other companies will follow suit.” She added, “We need to overhaul how F.D.A. keeps up with the latest science on food additives to better protect public health.”

Ms. Kavanagh agreed. “I’ve been thinking about ways to take this to the next level, and I’m thinking about taking it to the F.D.A. and asking them why they aren’t doing something about it,” she said. “I’m not sure yet, but I think that’s where I’d like to go with this.”

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This post has been revised to reflect the following correction:

Correction: January 26, 2013

An earlier version of this article misspelled the surname of the 15-year-old who started a petition on Change.org to end the use of brominated vegetable oil in Gatorade. She is Sarah Kavanagh, not Kavanaugh.

A version of this article appeared in print on 01/26/2013, on page B1 of the NewYork edition with the headline: PepsiCo Will Halt Additive Use In Gatorade.

FDA Panel Recommends More Restrictions on Vicodin and Other Hydrocodone ... - About

FDA Panel Recommends More Restrictions on Vicodin and Other Hydrocodone ... - About

On Friday, January 25, 2013, an advisory panel to the U.S. Food and Drug Administration voted 19 to 10 to recommend moving hydrocodone combination drugs, such as Vicodin, Lortab, and Norco to the schedule II category of controlled substances. If the FDA follows the panel's recommendation and moves hydrocodone combination drugs from their current schedule III to schedule II, prescribing practices would be more restricted. Many arthritis patients use hydrocodone combination drugs to manage their pain.

Drugs and other substances that are considered controlled substances under the Controlled Substances Act are divided into 5 schedules. Classification is based on whether a drug or substance has a currently accepted medical use in treatment in the U.S., its abuse potential, and the likelihood of causing dependence when abused. Here is a closer look at the 5 schedules.

The move from schedule III to II would disallow prescribing hydrocodone combination drugs for up to a 6-month period. Doctors would no longer be able to call in or fax a prescription for these drugs. Schedule II drugs require a written prescription for no more than a 3-month supply.

Those fighting to prevent prescription drug abuse and the fatal consequences that result from opioid abuse sit on one side of this issue. It has become an epidemic and a problem we as a society must recognize and address. Yet, there is the other side of the issue which cannot be ignored -- appropriate access to opioid medications for people living with chronic pain conditions, such as arthritis. If, implemented, will the schedule change for hydrocodone combination drugs and corresponding restrictions produce an unneccessary burden for people who need the drugs to function in their daily lives? Would the change cause doctors to shy away from prescribing the drugs, creating problems with access for people who live with chronic pain? Are the needs of chronic pain patients being overlooked or sacrificed because fighting prescription drug abuse has become a more urgent battle? Or, is the proposal simply justifiable? What do you think? Sound off.

Related Articles:

• Vicodin - What You Should Know
• Facts About Analgesics (Painkillers)
• Drug Safety Is Partly the Patient's Responsibility
• Study: Addiction to Narcotic Painkillers Prescribed for Chronic Pain Is Not Common

Follow Me:

Facebook | Twitter | Message Board | Newsletter

_{Photo by David Sucsy (iStockphoto)}

FDA Panel Recommends More Restrictions on Vicodin and Other Hydrocodone ... - About

FDA Panel Recommends More Restrictions on Vicodin and Other Hydrocodone ... - About

On Friday, January 25, 2013, an advisory panel to the U.S. Food and Drug Administration voted 19 to 10 to recommend moving hydrocodone combination drugs, such as Vicodin, Lortab, and Norco to the schedule II category of controlled substances. If the FDA follows the panel's recommendation and moves hydrocodone combination drugs from their current schedule III to schedule II, prescribing practices would be more restricted. Many arthritis patients use hydrocodone combination drugs to manage their pain.

Drugs and other substances that are considered controlled substances under the Controlled Substances Act are divided into 5 schedules. Classification is based on whether a drug or substance has a currently accepted medical use in treatment in the U.S., its abuse potential, and the likelihood of causing dependence when abused. Here is a closer look at the 5 schedules.

The move from schedule III to II would disallow prescribing hydrocodone combination drugs for up to a 6-month period. Doctors would no longer be able to call in or fax a prescription for these drugs. Schedule II drugs require a written prescription for no more than a 3-month supply.

Those fighting to prevent prescription drug abuse and the fatal consequences that result from opioid abuse sit on one side of this issue. It has become an epidemic and a problem we as a society must recognize and address. Yet, there is the other side of the issue which cannot be ignored -- appropriate access to opioid medications for people living with chronic pain conditions, such as arthritis. If, implemented, will the schedule change for hydrocodone combination drugs and corresponding restrictions produce an unneccessary burden for people who need the drugs to function in their daily lives? Would the change cause doctors to shy away from prescribing the drugs, creating problems with access for people who live with chronic pain? Are the needs of chronic pain patients being overlooked or sacrificed because fighting prescription drug abuse has become a more urgent battle? Or, is the proposal simply justifiable? What do you think? Sound off.

Related Articles:

• Vicodin - What You Should Know
• Facts About Analgesics (Painkillers)
• Drug Safety Is Partly the Patient's Responsibility
• Study: Addiction to Narcotic Painkillers Prescribed for Chronic Pain Is Not Common

Follow Me:

Facebook | Twitter | Message Board | Newsletter

_{Photo by David Sucsy (iStockphoto)}

FDA Panel Recommends More Restrictions on Vicodin and Other Hydrocodone ... - About

FDA Panel Recommends More Restrictions on Vicodin and Other Hydrocodone ... - About

On Friday, January 25, 2013, an advisory panel to the U.S. Food and Drug Administration voted 19 to 10 to recommend moving hydrocodone combination drugs, such as Vicodin, Lortab, and Norco to the schedule II category of controlled substances. If the FDA follows the panel's recommendation and moves hydrocodone combination drugs from their current schedule III to schedule II, prescribing practices would be more restricted. Many arthritis patients use hydrocodone combination drugs to manage their pain.

Drugs and other substances that are considered controlled substances under the Controlled Substances Act are divided into 5 schedules. Classification is based on whether a drug or substance has a currently accepted medical use in treatment in the U.S., its abuse potential, and the likelihood of causing dependence when abused. Here is a closer look at the 5 schedules.

The move from schedule III to II would disallow prescribing hydrocodone combination drugs for up to a 6-month period. Doctors would no longer be able to call in or fax a prescription for these drugs. Schedule II drugs require a written prescription for no more than a 3-month supply.

Those fighting to prevent prescription drug abuse and the fatal consequences that result from opioid abuse sit on one side of this issue. It has become an epidemic and a problem we as a society must recognize and address. Yet, there is the other side of the issue which cannot be ignored -- appropriate access to opioid medications for people living with chronic pain conditions, such as arthritis. If, implemented, will the schedule change for hydrocodone combination drugs and corresponding restrictions produce an unneccessary burden for people who need the drugs to function in their daily lives? Would the change cause doctors to shy away from prescribing the drugs, creating problems with access for people who live with chronic pain? Are the needs of chronic pain patients being overlooked or sacrificed because fighting prescription drug abuse has become a more urgent battle? Or, is the proposal simply justifiable? What do you think? Sound off.

Related Articles:

• Vicodin - What You Should Know
• Facts About Analgesics (Painkillers)
• Drug Safety Is Partly the Patient's Responsibility
• Study: Addiction to Narcotic Painkillers Prescribed for Chronic Pain Is Not Common

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Religious Groups and Employers Battle Contraception Mandate

Religious Groups and Employers Battle Contraception Mandate

Shawn Thew/European Pressphoto Agency

President Obama, with his health secretary, Kathleen Sebelius, offering a compromise on the contraception mandate last year.

In a flood of lawsuits, Roman Catholics, evangelicals and Mennonites are challenging a provision in the new health care law that requires employers to cover birth control in employee health plans â€" a high-stakes clash between religious freedom and health care access that appears headed to the Supreme Court.

In recent months, federal courts have seen dozens of lawsuits brought not only by religious institutions like Catholic dioceses but also by private employers ranging from a pizza mogul to produce transporters who say the government is forcing them to violate core tenets of their faith. Some have been turned away by judges convinced that access to contraception is a vital health need and a compelling state interest. Others have been told that their beliefs appear to outweigh any state interest and that they may hold off complying with the law until their cases have been judged. New suits are filed nearly weekly.

“This is highly likely to end up at the Supreme Court,” said Douglas Laycock, a law professor at the University of Virginia and one of the country’s top scholars on church-state conflicts. “There are so many cases, and we are already getting strong disagreements among the circuit courts.”

President Obama’s health care law, known as the Affordable Care Act, was the most fought-over piece of legislation in his first term and was the focus of a highly contentious Supreme Court decision last year that found it to be constitutional.

But a provision requiring the full coverage of contraception remains a matter of fierce controversy. The law says that companies must fully cover all “contraceptive methods and sterilization procedures” approved by the Food and Drug Administration, including “morning-after pills” and intrauterine devices whose effects some contend are akin to abortion.

As applied by the Health and Human Services Department, the law offers an exemption for “religious employers,” meaning those who meet a four-part test: that their purpose is to inculcate religious values, that they primarily employ and serve people who share their religious tenets, and that they are nonprofit groups under federal tax law.

But many institutions, including religious schools and colleges, do not meet those criteria because they employ and teach members of other religions and have a broader purpose than inculcating religious values.

“We represent a Catholic college founded by Benedictine monks,” said Kyle Duncan, general counsel of the Becket Fund for Religious Liberty, which has brought a number of the cases to court. “They don’t qualify as a house of worship and don’t turn away people in hiring or as students because they are not Catholic.”

In that case, involving Belmont Abbey College in North Carolina, a federal appeals court panel in Washington told the college last month that it could hold off on complying with the law while the federal government works on a promised exemption for religiously-affiliated institutions. The court told the government that it wanted an update by mid-February.

Defenders of the provision say employers may not be permitted to impose their views on employees, especially when something so central as health care is concerned.

“Ninety-nine percent of women use contraceptives at some time in their lives,” said Judy Waxman, a vice president of the National Women’s Law Center, which filed a brief supporting the government in one of the cases. “There is a strong and legitimate government interest because it affects the health of women and babies.”

She added, referring to the Centers for Disease Control and Prevention, “Contraception was declared by the C.D.C. to be one of the 10 greatest public health achievements of the 20th century.”

Officials at the Justice Department and the Health and Human Services Department declined to comment, saying the cases were pending.

A compromise for religious institutions may be worked out. The government hopes that by placing the burden on insurance companies rather than on the organizations, the objections will be overcome. Even more challenging cases involve private companies run by people who reject all or many forms of contraception.

The Alliance Defending Freedom â€" like Becket, a conservative group â€" has brought a case on behalf of Hercules Industries, a company in Denver that makes sheet metal products. It was granted an injunction by a judge in Colorado who said the religious values of the family owners were infringed by the law.

“Two-thirds of the cases have had injunctions against Obamacare, and most are headed to courts of appeals,” said Matt Bowman, senior legal counsel for the alliance. “It is clear that a substantial number of these cases will vindicate religious freedom over Obamacare. But it seems likely that the Supreme Court will ultimately resolve the dispute.”

The timing of these cases remains in flux. Half a dozen will probably be argued by this summer, perhaps in time for inclusion on the Supreme Court’s docket next term. So far, two- and three-judge panels on four federal appeals courts have weighed in, granting some injunctions while denying others.

One of the biggest cases involves Hobby Lobby, which started as a picture framing shop in an Oklahoma City garage with $ 600 and is now one of the country’s largest arts and crafts retailers, with more than 500 stores in 41 states.

David Green, the company’s founder, is an evangelical Christian who says he runs his company on biblical principles, including closing on Sunday so employees can be with their families, paying nearly double the minimum wage and providing employees with comprehensive health insurance.

Mr. Green does not object to covering contraception but considers morning-after pills to be abortion-inducing and therefore wrong.

“Our family is now being forced to choose between following the laws of the land that we love or maintaining the religious beliefs that have made our business successful and have supported our family and thousands of our employees and their families,” Mr. Green said in a statement. “We simply cannot abandon our religious beliefs to comply with this mandate.”

The United States Court of Appeals for the 10th Circuit last month turned down his family’s request for a preliminary injunction, but the company has found a legal way to delay compliance for some months.