Care at top hospitals is NOT INCLUDED in Obamacare, report reveals

  • Insurers selling cover on the new exchanges will not offer access to cancer centers, Memorial Sloan Kettering in Manhattan and MD Anderson Cancer Center in Houston
  • Access to Cedars-Sinai in Los Angeles, one of the top research and teaching hospitals, may also be limited

By  Daily Mail Reporter

PUBLISHED: 01:53 EST, 9 December 2013 |  UPDATED: 03:13 EST, 9 December 2013

People buying insurance plans through Obamacare’s online exchanges may not have full access to some of the nation’s top hospitals, it has been claimed.

In a bid to cut costs, insurers selling cover on the new exchanges in states including New York, Texas and California will not offer patients access to two renowned cancer centers – Memorial Sloan Kettering in Manhattan and MD Anderson Cancer Center in Houston, according to The Financial Times. Continue reading “Care at top hospitals is NOT INCLUDED in Obamacare, report reveals”

Study suggests link between regular aspirin use, increased risk of age-related macular degeneration: 3.7% vs 9.3%

Contact: Jie Jin Wang, Ph.D. jiejin.wang@sydney.edu.au JAMA and Archives Journals

CHICAGO – Regular aspirin use appears to be associated with an increased risk of neovascular age-related macular degeneration (AMD), which is a leading cause of blindness in older people, and it appears to be independent of a history of cardiovascular disease and smoking, according to a report published Online First by JAMA Internal Medicine, a JAMA Network publication.

Aspirin is one of the most widely used medications in the world and is commonly used in the prevention of cardiovascular disease, such as myocardial infarction (heart attack) and ischemic stroke. While a recent study suggested that regular aspirin use was associated with AMD, particularly the more visually devastating neovascular (wet) form, other studies have reported inconsistent findings. Smoking is also a preventable risk factor for AMD, the authors write in the study background.

Gerald Liew, Ph.D., of the University of Sydney, Australia, and colleagues examined whether regular aspirin use (defined as once or more per week in the past year) was associated with a higher risk of developing AMD by conducting a prospective analysis of data from an Australian study that included four examinations during a 15-year period. Of 2,389 participants, 257 individuals (10.8 percent) were regular aspirin users.

After the 15-year follow-up, 63 individuals (24.5 percent) developed incident neovascular AMD, according to the results.

“The cumulative incidence of neovascular AMD among nonregular aspirin users was 0.8 percent at five years, 1.6 percent at 10 years, and 3.7 percent at 15 years; among regular aspirin users, the cumulative incidence was 1.9 percent at five years, 7 percent at 10 years and 9.3 percent at 15 years, respectively,” the authors note. “Regular aspirin use was significantly associated with an increased incidence of neovascular AMD.”

The authors note that any decision concerning whether to stop aspirin therapy is “complex and needs to be individualized.”

“Currently, there is insufficient evidence to recommend changing clinical practice, except perhaps in patients with strong risk factors for neovascular AMD (e.g., existing late AMD in the fellow eye) in whom it may be appropriate to raise the potentially small risk of incident neovascular AMD with long-term aspirin therapy,” the authors conclude.

(JAMA Intern Med. Published online January 21, 2013. doi:10.1001/jamainternmed.2013.1583.)

Editor’s Note: This study was supported by project grants from the National Health & Medical Research Council Australia. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Commentary: Relationship of Aspirin Use with Age-Related Macular Degeneration

In an invited commentary, Sanjay Kaul, M.D., and George A. Diamond, M.D., of Cedars-Sinai Medical Center, Los Angeles, write: “This study has important strengths and limitations. It provides evidence from the largest prospective cohort with more than five years of longitudinal evaluation reported to date using objective and standardized ascertainment of AMD.”

“The key limitation is the nonrandomized design of the study with its potential for residual (unmeasured or unobserved) confounding that cannot be mitigated by multivariate logistic regression or propensity score analysis,” the authors continue.

“From a purely science-of-medicine perspective, the strength of evidence is not sufficiently robust to be clinically directive. These findings are, at best, hypothesis-generating that should await validation in prospective randomized studies before guiding clinical practice or patient behavior,” the authors conclude. “However, from an art-of-medicine perspective, based on the limited amount of available evidence, there are some courses of action available to the thoughtful clinician. In the absence of definitive evidence regarding whether limiting aspirin exposure mitigates AMD risk, one obvious course of action is to maintain the status quo.”

(JAMA Intern Med. Published online January 21, 2013. doi:10.1001/jamainternmed.2013.2530.)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

###

To contact Jie Jin Wang, Ph.D., email jiejin.wang@sydney.edu.au. To contact commentary author Sanjay Kaul, M.D., email sanjay.kaul@cshs.org.

Vitamin B3 ( NIacin ) may offer new tool in fight against ‘superbugs’ – increased by 1,000 times the ability of immune cells to kill staph bacteria

Contact: Adrian Gombart adrian.gombart@oregonstate.edu 541-737-8018 Oregon State University

CORVALLIS, Ore. – A new study suggests that nicotinamide, more commonly known as vitamin B3, may be able to combat some of the antibiotic-resistance staph infections that are increasingly common around the world, have killed thousands and can pose a significant threat to public health.

The research found that high doses of this vitamin increased by 1,000 times the ability of immune cells to kill staph bacteria. The work was done both in laboratory animals and with human blood.

The findings were published today in the Journal of Clinical Investigation by researchers from Cedars-Sinai Medical Center, the Linus Pauling Institute at Oregon State University, UCLA, and other institutions. The research was supported by several grants from the National Institutes of Health.

The work may offer a new avenue of attack against the growing number of “superbugs.”

“This is potentially very significant, although we still need to do human studies,” said Adrian Gombart, an associate professor in OSU’s Linus Pauling Institute. “Antibiotics are wonder drugs, but they face increasing problems with resistance by various types of bacteria, especially Staphylococcus aureus.

“This could give us a new way to treat staph infections that can be deadly, and might be used in combination with current antibiotics,” Gombart said. “It’s a way to tap into the power of the innate immune system and stimulate it to provide a more powerful and natural immune response.”

The scientists found that clinical doses of nicotinamide increased the numbers and efficacy of “neutrophils,” a specialized type of white blood cell that can kill and eat harmful bacteria.

The nicotinamide was given at megadose, or therapeutic levels, far beyond what any normal diet would provide – but nonetheless in amounts that have already been used safely in humans, as a drug, for other medical purposes.

However, there is no evidence yet that normal diets or conventional-strength supplements of vitamin B3 would have any beneficial effect in preventing or treating bacterial infection, Gombart said, and people should not start taking high doses of the vitamin.

Gombart has been studying some of these issues for more than a decade, and discovered 10 years ago a human genetic mutation that makes people more vulnerable to bacterial infections. In continued work on the genetic underpinnings of this problem, researchers found that nicotinamide had the ability to “turn on” certain antimicrobial genes that greatly increase the ability of immune cells to kill bacteria.

One of the most common and serious of the staph infections, called methicillin-resistant S. aureus, or MRSA, was part of this study. It can cause serious and life-threatening illness, and researchers say the widespread use of antibiotics has helped increase the emergence and spread of this bacterial pathogen.

Dr. George Liu, an infectious disease expert at Cedars-Sinai and co-senior author on the study, said that “this vitamin is surprisingly effective in fighting off and protecting against one of today’s most concerning public health threats.” Such approaches could help reduce dependence on antibiotics, he said.

Co-first authors Pierre Kyme and Nils Thoennissen found that when used in human blood, clinical doses of vitamin B3 appeared to wipe out the staph infection in only a few hours.

Serious staph infections, such as those caused by MRSA, are increasingly prevalent in hospitals and nursing homes, but are also on the rise in prisons, the military, among athletes, and in other settings where many people come into close contact