You Are What You Eat

I, like most people, do not have the world’s best eating habits. I think in part that is because it is very hard to make food for one person. There are plenty of cookbooks for two people but not nearly enough for one. In addition, it is hard to make something and realize that you are going to spend all week eating the same food. And of course, with all this you also have to determine what is healthy enough to eat. Relying on food nutrition labels will only give you a so-so understanding of what you are consuming.

Nutrition Labels

I think that most people can probably agree that our current nutrition labels are less than helpful. Portion sizes on these tend to not reflect the way most people consume. Who really eats only 3 Oreos in a sitting? And not only are the portions misleading, but nutrition labels often contain a lot of confusing, scientific terms and leave you wondering what you are truly consuming, how good it is for you, and how much you should actually be consuming (possibly none). Earlier this year, the FDA proposed a new nutrition label that, in theory, is more in line with American eating habits.

However, nutrition labels still hide a lot of information about food. According to Dr. David Kessler, the commissioner of the FDA, “although the numbers can look good, the product may not be real food and have no nutritional value.” But, at the very least the revisions require companies to list out the different types of sugar and provides a more accurate portion sized based on America’s eating habits.

One key challenge is that the measurements used are often hard to reconcile. You might be shocked to learn that a 20 ounce coke has 16 teaspoons of sugar. Eating pancakes for breakfast involves less sugar than that. In addition, since ingredients are listed separately it is hard to determine what is naturally in the product versus what was added during the processing of your food.

Juices are one of the worst offenders because most claim to be 100% juice but for many filtered water is listed as the main ingredient. Can something be 100% juice if you first ingredient is water?

Don’t Leave it All to the Label

For all of us who wish to know what we are consuming and how healthy the item is there is now a great resource. Environmental Working Group built a Food Score database. The site contains information on more than 80,000 items sold in groceries stores. The site offers details of ingredients, nutritional information, and how processed the food items are.

The site assigns food products a score from 1 to 10, with 1 being the best. The score is based on how nutritious it is, how many ingredients are in it, and an estimated how processed it is. The rating also includes information about whether the food product is organic, how the animals were raised, whether antibiotics were used, and if the food was exposed to dangerous environmental factors like pesticides. The site also tells you if it gluten-free, whether it potentially contains genetically modified ingredients, and how it stacks up to the competition. While the site isn’t perfect, it’s a great place to look if you want to better understand what you’re eating.

The Food Score database has also done broad analysis of trends found in different foods. They found that 60% of the products on the database contain added sugar. Shockingly, 90% of granola bars contain added sugar while 100% of stuffing mixes contain added sugar. And processed meats such as bologna and salami also contain added sugar.

Eating Right is Hard, But Worth it

Eating well is hard. The best choice is obviously to cook your own meals with foods that you have meticulously researched. Unfortunately, it is often hard to find the motivation and time to do so. But the new nutrition labels are a start, and for those who want to look deeper sites like the Food Database make it easier for us to make healthy choices. While finding and choosing the healthy option is sometimes inconvenient, it’s a smart choice.

But What If There Isn’t A Generic Drug?

Stuck in the medicine aisle, wracked with indecision about which cold medication to buy? Although we complain about having too many options we have when choosing OTC medicine, having options is really a great thing. Tylenol might work for one person while Advil is better for another. And, of course, generic options keep costs down. But some pharmaceutical companies actively work to prevent options from being made available, to the detriment of the consumer.

Case Study: Asthma Medication

Ever wonder why your asthma inhaler looks different from time to time but yet the medicine is the same? Asthma medication is one of the best examples of pharmaceutical companies preventing generic drugs from entering the market. These companies are allowed to patent the inhaler model, so even though the medication in the inhaler hasn’t changed in roughly twenty years, the patent remains because they changed the inhaler shape. This successfully prevents generic inhalers from being introduced in the market. Pulmicort uses this technique setting the retail cost of their inhalers at $175. For reference, consider that in Britain patients receive the same medicine for free and the pharmacist only pays $20 for it.

But this patent trolling is limited to only brand name drug companies prevent competition right? Unfortunately, it looks like a Teva, a generic drug manufacturer, is using this same technique.

Teva Pharmaceutical and Copaxone

Teva Pharmaceutical is the world’s largest maker of generic drugs. They have been publically critical of brand name companies that try to block a generic drug from being produced. However, when it comes to Copaxone, a brand name drug that Teva Pharmaceutical manufactures, they sing a different tune.

Teva Pharmaceutical produces Copaxone, a drug used to reduce the frequency of multiple sclerosis (MS) attacks. Last year the drug had global sales of $4.3 billion, with $3.2 billion coming from the United States. Copaxone has been available for 17 years and is considered one of the best-selling treatments for MS. Over the last decade, MS drugs have almost quadrupled in price, raising the list price for Copaxone to $60,000 a year. According to Dr. John R. Corboy, co-director of the Rocky Mountain Multiple Sclerosis Center at the University of Colorado “the price would go up 10, 20, 30 percent at a time.” Luckily for patients, the patent for Copaxone is set to expire in late May. But Teva is fighting to prevent a generic drug from driving down prices.

In an attempt to protect the patent, Teva Pharmaceutical opened a lawsuit and in late March the U.S. Supreme Court agreed to hear the case. Teva has submitted multiple petitions to the Food and Drug Administration arguing that since Copaxone has such a complex makeup it is almost impossible to create a generic drug that is the same as the original.

In addition to pursuing a case in the court system, Teva Pharmaceutical has tried to find other methods to prevent losing their competitive edge. Currently, patients who use Copaxone must inject themselves every day with the drug, which of course is inconvenient for patients. Teva has created a more concentrated form of Copaxone that patients only need to inject three times a week. Although this is easier for patients, the new form of Copaxone is registered under a different patent, meaning the generic option is still years away. Unfortunately for patients, once they switch to new version of Copaxone, returning to the old one to purchase the cheaper generic option will be difficult.

It should be noted that the new Copaxone is cheaper than the older version. The new concentrated version is $4,641 a month compared to the older version which was $5,060. However, it is highly possible that a generic would be priced much lower than $4,641 a month.

A Generic Copaxone Alternative

Momenta Pharmaceuticals, and Natco Pharma have both submitted a generic version of the older Copaxone to the F.D.A. Both of these groups claim that their drug is just as viable and are confident that the F.D.A. will approve their drug; unless of course Teva gains the ability to expand its patent. Insurances companies want the generic drug to enter the market as well, as it will significantly drop their costs. Excellus BlueCross BlueShield in upstate New York is fighting back against Teva Pharmaceutical’s attempt to switch patients from the daily dose to the concentrated version. They are requiring that the switch be medically necessary and not just for convenience. They are hoping to outlast Teva so that they can switch their patients to a cheaper generic version.

What’s Best for the Patient?

It sounds like Teva Pharmaceutical losing their case is the best option – this means generic drugs will be introduced into the market reducing the cost for patients. But there’s another problem – the U.S. Supreme Court case Mutual Pharmaceutical Co v. Bartlett and in PLIVA Inc. v. Mensing ruled that a patient did not have the right to sue a generic drug company for any side effects that might occur, but are not listed on the label. If a patient suffers unlisted side effects from a brand name drug, they can successfully sue. If the generic drug is really as dangerous as Teva Pharmaceutical claims, than how many patients will experience severe side effects and be left with NO options simply because their insurance company forced them to take a generic drug?

Stand Up, Move, Trust Me: You Will Live Longer

A while ago, I wrote a blog about the dangers of cutting school recess because it made it harder for kids to focus in class. A couple of studies found that exercising helps children remember and retain information better. However these benefits aren’t limited to children – exercise is good for adults as well. Not only will exercising help adults focus (like it does with children and students) but it can help you live longer even if your other risk factors are high.

Framingham Heart Study

The Framingham Heart Study, which began in 1948, tracked 5,200 adults living in Framingham and monitored their health and lifestyle. The study found that high blood pressure, cholesterol levels, obesity, age, gender, and smoking all influenced whether a person would develop a cardiovascular disease. This information was compiled to create the Framingham Risk score, which calculates the chance of an individual having a heart attack within the next 10 years. Low numbers are better than higher numbers. A women who has 9 points or less on the scale has less than a 1% chance, while for men it is 4 points. However, the Framingham score excluded one key factor: physical activity.

New Study: How Much Does Exercise Help?

Because most old studied did not factor in the effect of exercise, a new study was conducted to determine the relationship between exercise and an individual’s risk of cardiac disease. Researchers at Curtin University in Perth, Australia used data from 6,662 Australian men and women over the past 15 years. These volunteers (ages to 30 to 55 at the study’s beginning) submitted to cholesterol and blood pressure testing, waist circumference measurements, and a questionnaire about exercise. The questionnaire asked how many minutes they exercised, and whether the exercised had been easy or hard.

The researchers used these numbers to determine each volunteer’s Framingham Risk Score at the time of the initial study. They divided the group into three categories based on the frequency and intensity of the exercise. The highest category included people who had high Framingham score, the middle group had medium Framingham scores, and the last group had low Framingham scores. They then checked the names of the volunteers against the national death registry in Australia which list somebody’s cause of death, if known. In the intervening 15 years, 211 of the men and women had died of heart disease. Most of those who had died had high Framingham Risk Scores and had large waistlines. But in addition, those in the lowest category (those with low Framingham scores) had about twice the risk of dying from heart disease compare to those in the middle category. In addition, the lowest category was 6 more times likely to die than those in the highest category

Exercise did not help as much as a healthy cholesterol, blood pressure, and weight did, but still helped reduce people’s risk of dying from heart disease. The study found that, “someone with a high Framingham score who exercised had less risk of dying than someone with a similar score who did not.” The study found that those who walked often and at a respectable pace were more likely to be alive 15 years later than those who did little to no physical activity.

I Know Exercising is Good, But (Insert Excuse here)

Everyone knows exercise is good for you, but few people act on this knowledge. Finding time and motivation to exercise is hard. I suggest finding a friend that helps motivate you to exercise. I personally work out with a co-worker of mine during my lunch break. Also buying a dog helps you exercise as walking the dog is good for the dog and for you.

If you do not have a co-worker or cannot get a pet, I suggest trying to join a class. If you only have a couple of minutes, doing a few squats is one of the most effective exercises you can do in a short period of time.

Regardless of what you pick it should be something you like to help ensure you stick to it. And exercise can not only help you live longer and lose weight; it will help you focus more at work. When in the office, stand up, walk around and move a little bit; it will at least allow you to rest your eyes from staring at a computer screen all day. And hey, you might meet somebody new.

Skipping Sleep is NOT a Solution

Americans often complained about lack of sleep. While the United States may not be the worst offender when it comes to trading sleep for work, we definitely work long hours to our own detriment. As job pressures rise, especially in the current economic situation, many people feel they cannot say no when asked to put in extra work. Roughly 41 million people in the United States get six or fewer hours of sleep a night. Research shows that people should be averaging 7 to 8 hours a sleep a night.

In an earlier blog, I talked about the health ramifications of not getting enough sleep. Consistently being deprived of sleep makes you as impaired as when you are drunk. In addition, the University Of Pittsburgh School Of Medicine and a Japanese study that found a correlation between sleep deprivation and health. This included an increase of risk of cancer, cardiovascular diseases, and strokes, among many others. But there are even more potential costs tied up in too few z’s.

Sleep Helps Fight Depression

Recently on the Freakonomics podcast, Stephen D. Levitt and Stephen J. Dubner discussed the fact that there are more suicides a year in the United States than homicides. In 2009, there were 36,500 suicides and 16,500 homicides. The reasons that people commit suicide are very complicated but one of the main assumed reasons is depression.

Depression affects approximately 18 million Americans every year. More than half of all Americans who have depression also suffer from insomnia. For years, doctors have considered poor sleep to be a side effect of depression. However, a pilot study at Stanford in 2008 found evidence that insomnia can precede depression and in fact the relationship is bidirectional. In addition, several studies suggest that developing insomnia doubles a person chances of becoming depressed.

After the pilot study, the National Institute of Mental Health financed additional studies, one of which took place at Ryerson University in Toronto. The team at Ryerson found that curing insomnia in people with depression could double their chance of a full recovery. The study used an insomnia treatment that focused on talk therapy instead of drugs. The study found that 87% of patients who resolved their insomnia in four biweekly talk therapy sessions saw their depression symptoms disband after eight weeks of treatment. This was true for patients regardless of whether they were using an antidepressant drug or were part of the placebo group.

This study relied on a therapy called cognitive behavior therapy for insomnia (CBT-I). The therapist advises people to stick to a regular wake up time, get out of bed during waking periods, avoid reading, eating, or watching TV in bed, and to not nap during the day. It is designed to help people who feel they have to do something in order to get to sleep. Admittedly, the study was small with only 66 patients, but the results are promising.

It’s worth noting that not only will curing insomnia help people fight depression, it is also significantly cheaper for patients than anti-depression drugs. This means it may be a more cost-effective way to help the U.S. decrease its suicide rate. But there may be even more benefits from a better night’s sleep, that have to do with your risk of developing Alzheimer’s disease.

Sleep Can Help Me NOT get Alzheimer’s?!

A new study from Maiken Nedergaard, a neurosurgeon at the University of Rochester, found that when mice are asleep the cleanup system of the brain – which flushes out toxic waste produced by cells – goes into overdrive. Not only does that part of the brain function faster, but the cells even shrink in size to make it easier to clean out the system. One of the products that the brain gets rid of during this time is beta-amyloid proteins, which can clump and form the plaques found in Alzheimer’s patients. Rats deprived of sleep die within a week.

Nedergaard found that the glymphatic system drains waste from the brain. It does this by, “circulating cerebrospinal fluid throughout the brain tissue and flushing any resulting waste into the bloodstream, which then carries it to the liver for detoxification.” To study the effects of sleep they tagged the fluid with a fluorescent dye. During sleep the fluid increased the space between cells by 60% which allows the flow and speed to increase. However, when the mouse was awake, flow in the glymphatic system was limited. The study also found that harmful beta-amyloid protein can be purged from a sleeping brain twice as fast.

Nedergaard is working on an MRI diagnostic test for the glymphatic system and hopes that it might be possible to create a drug that could force the brain to clean out the system. While still is still a few years away, there are some ways you can improve your sleep in the short term.

Can I Track My Sleep?

Tracking your sleep will allow you to know how much sleep you are actually getting and how well you are sleeping. There are currently many apps and tools that you can use to track your sleep. Although they are not always the most reliable they are still pretty decent in determining approximately how much sleep you are or are not getting. Currently Fitbit, Sleepbot, Sleep Cycle, Jawbone UP, Aura sleep system, Beddit, SleepRate, and Basis track how well people are sleeping. They work in various different ways, some of them worn on the wrist, some are placed under the bed sheet, and some use cognitive behavior therapy. Even though none of these devices are perfect it would still be beneficial to get a more accurate reading of how much sleep you are getting. You might not be getting as much as you think.

Trade Offs

There are always trade-offs and the best laid plans frequently don’t work out as hopped, but when contemplating one more chapter in your book or another episode of your favorite show, you might want to opt for a bit more sleep instead. Your brain will thank you!

Faster is Better Right?

For years American society has functioned under the mentality that doing things quickly is the goal. If you do your work fast then it must be good and you must be smart. But faster doesn’t always mean better. We have forgotten the age old story of the Tortoise and the Hare – speed does not guarantee success. A recent study on angioplasty offers an excellent case study in this attitude.

Acute Heart Attacks

The common consensus among hospitals and doctors is that rapid treatment of an acute heart attack increases the likelihood of a patient’s survival. The preferred procedure for patient’s having a heart attack is an angioplasty, a process that uses tiny balloons and stents (wire-mesh cylinders) to open up blockages in the arteries connected to the heart. The period of time between the patient’s arrival and the inflation of the balloons is known as “door to balloon” (D2B). The standard goal is for D2B to take no more than 90 minutes. Hospitals strive to lower the number as much as possible which results in a current average time of about 67 minutes.

But a shorter D2B time may not actually improve patient mortality rates.

The D2B Time Study

A team of experts, headed by Daniel S. Menees M.D., recently published a paper called Door-to-Balloon Time and Mortality among Patients Undergoing Primary PCI in The New England Journal of Medicine (PCI is Primary Percutaneous Coronary Intervention). The study used historical data from the CathPCI Registry of the National Cardiovascular Data Registry (NCDR), which collects data from more than 1,400 hospitals across the U.S. This studied examined the correlation between in-hospital mortality and D2B time for July 2005 through June 2009; this was ideal because during this time there was a national effort to reduce Door to Balloon time.

The study consisted of 95,007 patients. The average age of the patient was 60.8 with 20% of the patients being female. Out of the 95,007 patients 61% had hypertension, 59.2% had dyslipidemia, and 43.3% were current smokers. To control for D2B time, the study excluded patients who had been transferred from other facilities, patients who were undergoing non-emergency PCI, and patients who had D2B that were longer than 3 hours.

The study found that the median door-to-balloon time decreased each year. In 2005-2006 the average time was 83 minutes but fell to 67 minutes by 2008-2009. However the mortality rate was not significantly affected. The unadjusted (before taking out variables for the NCDR model and the patients that were excluded from the study) in-hospital mortality started at 4.8% in 2005 and in 2009 it was only at 4.7%. The unadjusted mortality rate was lower for patients who had a D2B time of 90 minutes or less (3.7%) versus those who had a longer than 90 minute time period (7.3%). However, the unadjusted mortality rate for patients who had a door-to-balloon time of 90 minutes or less remained constant at around 3.7% for the time of the study. This can be seen in the chart below. As long as the D2B time is less than 90 minutes there does not seem to be any improvement.

Why Isn’t a Shorter D2B Time Better?

There could be multiple reasons why decreasing Door-To-Balloon time does not seem to result in a decrease in mortality. One of which is that a retrospective study cannot provide truly meaningful insight because of its observational nature. It is also possible that currently cardiology has reached its limit. There is no way to account for how long a patient might have waited before going to a hospital. And of course sometimes angioplasties are not effective and it does not matter how long it took to inflate the balloon.

However, it should be clear that a D2B time longer than 90 minutes did have an impact on mortality rate. The study only found that there is little improvement with a D2B of less than 90 minutes. So it does not seem to matter if a patient has a D2B of 54 minutes versus 89 minutes. Regardless of external factors, this study should at least have us question the mentality that speed is our focus metric. Speed is not everything and does not guarantee better care or healthier patients.

Private or Corporate: Doctors Make the Choice

There are many advantages to starting or working at a private practice in the medical profession. Running a private practice allows you to set your own schedule, take vacations when you want (within reason), and focus on the type of care you are most interested in. However, like with all entrepreneurial endeavors, there are certain risks involved. There is no guarantee that your practice will be successful and profitable. And success depends on more than your medical skills. Medical school doesn’t offer opportunities to learn finance, accounting, economics, and other business skills that are beneficial for running a medical practice. Although working for a hospital might not provide as much flexibility, it does potentially provide more stability. The choice ultimately comes down to what is best for you.

The Numbers

According to the American Medical Association, 60% of family doctors and pediatricians, 50% of surgeons, and 25% of surgical subspecialists work for hospitals and corporations. 64% of the jobs filled in 2013 by Merritt Hawkins, a leading physician placement firm, were with hospitals; this figure rose dramatically from 2004, when only 11% of jobs filled were for hospitals. Merritt Hawkins expects this number to rise to 75% in the next two year; anticipating that close to 75% of new medical jobs will be with corporations and not small entrepreneurs.

Trade Offs for Doctors

Employed physicians income is partly based on how much revenue for the hospital they can generate. around $200,000 in primary care, $575,000 in cardiology, and $663,000 in neurosurgery. Dr. Cathleen London, who has practiced family medicine for 13 years outside of Boston, recently took a salary job in Manhattan. Although it is a pay cut, she said she was losing business and ground in her private practice. By joining a hospital, doctors no longer have to worry about the challenges of running an independent group, like paying malpractice premiums or finding health insurance for themselves and their staff.

The tradeoff is that doctors take a pay cut to gain stability and other additional benefits, but lose the flexibility and benefits of being their own boss.

How Does this Affect Patients?

You might think it would be cheaper for a patient if the doctor is located at the hospital.   And sometimes this is true, as can be seen in the Kaiser System (California) and Intermountain Healthcare (Utah). However the increased number of providers working for hospitals may not be better for patients.

For patients, working with hospital-based providers makes it easier for patients to find different types of doctors in one location. It also has the potential to simplify communication amongst different types of doctors which could enhance the overall patient’s care. If doctors can more easily communicate with each other, then less critical details are lost in the patient shuffle. However, there are some serious disadvantages to this happening as well. Some hospitals encourage doctors to run tests and procedures that may not benefit the patient to drive revenue. As a result, some insurance companies have pushed back by only paying an all-inclusive payment for each patient regardless of how many test or procedures are performed. Patients face a narrowing choice of physician options as big conglomerates take over and combine with other hospitals and doctors.

How Can Doctors Reduce the Risks of Private Practice?

While private practices carry more risk for providers than working for a hospital, there are ways to mitigate the danger. One of the easiest ways to simplify the challenge of managing a private practice is to apply technological solutions to reduce the amount of work required of an administrator. Another way to make working for or managing a private practice easier is to hire a practice management company to oversee the business side of your practice.

MediMobile offers a complete practice management solution, from our mobile charge capture tool to our office management to our medical billing. We have helped practices, hospitals and individual providers earn more and reduce administrative busywork. If you want to learn more about our solution, request a free practice revenue consultation!

Conclusion

These risk are not new. Entrepreneurs in general always face the risk of unpredictability and instability; that is part of being in business for oneself. There are always tradeoffs. Whether what is best for the doctors is also what is best for the patients remains to be seen.

X-Men vs Magneto: The Benefits of Mutation

In an earlier blog, I discussed DNA mapping. DNA mapping involves the analysis of an individual’s genome. This can be used to identify genetic mutations. While ‘mutation’ sounds ominous, just like in the X-Men comics, it is not always a bad thing.

No Type 2 Diabetes For Me

A new study, which analyzed the genomes of 150,000 people, found that a rare mutation protects some people from getting Type 2 diabetes. This mutation even protects people who are statistically more prone to acquiring Type 2, such as individuals who are overweight.

The mutation destroys a gene used by the pancreas cells. People with this mutation produce more insulin than those who do not, and have lower blood glucose levels throughout their lives. The mutation reduces the risk of acquiring Type 2 Diabetes by two-thirds.

The Study

Four years ago, Pfizer and a group of geneticists from academia began to search for a genetic mutation that protected against diabetes. They started with populations in Finland and Sweden where 28,000 people had already been part of a study. They focused on individuals who were statistical anomalies.

The most interesting findings from this study focused on the relationship (or lack thereof) between risk factors and actually having diabetes. They found that a group of 352 people had Type 2 diabetes even though they were technically at low risk for the disease. These individuals’ average age was 50, they were physically fit, and they did not smoke. The study also identified a group of 406 people whose average age was above 80 and had high risk indicators; including smoking, obesity, and drinking. Despite their high statistical risk, this group did not have the disease. Out of these 406 people, 2 of them had a mutation that destroyed a copy of the ZnT8 gene. In mice destroying the ZnT8 gene causes Type 2 Diabetes; however, it seems in humans that the opposite happens. Since 2 people out of 406 is not statistically significant, they decided to expand their study.

The group expanded their study to include 18,000 people in Sweden of varying characteristics (age, body weight, and whether they had diabetes or not). Out of these 18,000 people they found 31 people who seemed to be protected from Type 2 Diabetes and that also had a genetic mutation which destroyed the ZnT8 gene.

To get a larger data set, the group contacted deCODE Genetics, a company with access to the genetic and medical history of the population of Iceland. They found that 39 people out of 5,440 had the mutation and did not have diabetes, while 9 out of 3,727 diabetes patients had the mutation.

Finally, they mapped 13,000 additional people and again found a correlation between the mutation and a lower risk of Type 2 Diabetes.

What Does This Mean for Diabetes?

The hope is that this research will allow drug companies to make a drug that mimics the mutation’s effect. However, according to Timothy Rolph, a Pfizer vice president, it could be 10 to 20 years before a drug is ready to enter the market. Luckily, no bad side effects of the mutation have been found so far. If a drug can be made that replicates or uses this mutation, this could be a major breakthrough in fighting Type 2 Diabetes.

But The Label Doesn’t Match! – FDA Update

For years I have put little faith in nutrition labels.  The portion size tends not to reflect what I am actually consuming and it can be difficult to figure out what exactly I am eating.  Who really eats only 3 Oreos in a sitting?  Not only are the portions misleading, nutrition labels often contain a lot of confusing, scientific terms (that basically mean sugar) and leave you wondering what you are truly eating, how good it is for you, and how much you should actually be consuming (possibly none).

Current Nutrition Labels

In the early 1990s, the federal government required food labels to include nutritional information.  The labels were based on nutrition data from the 1970s and the 1980s.  Portion size was significantly different and smaller in the 1970s and the 1980s than it is today.  Recently, the FDA decided that the nutrition labels need to be overhauled and updated to reflect the modern diet.

Our New Nutrition Label

The FDA revealed the new label on February 26, 2014.  The label changes will look like –

 

The change will include a separate line for sugars and added sugars.  This will allow consumers to understand what sugar is inherently in the food, say from fruit or other natural sources, verses what has been added.  The hope is also that the new label will be easier for the consumer to determine if the food is good for them.

The new label also focuses on calories, making it easier to figure out how many calories are in a single serving.  In addition, it makes the serving size line bigger and easier to identify.  Some products will also be required to list serving size and package quantity separately.

Since serving size has grown, products will now reflect what people are actually consuming.  For example, a twenty ounce bottle of soda will be counted as 1 serving instead of the 2.5 it is labeled as now.  Ice cream carton size will be raised from ½ a cup to 1 cup.  This will hopefully force consumers and food companies to be more conscious of what they consume and what they put in the food, since it will now be easier to hold them accountable.

When Will These Changes Take Effect?

The new label is open to public comment for 90 days.  After the 90 days concludes, the food industry will have two years to transition to the new labels.  For more information on the nutritional label change or to make a comment about the label you can go here.  How much this will help Americans fight obesity remains to be seen.  However, it will be nice to get a more accurate understanding of what we are consuming.

If You Could Know: Would You Want To?

When my sister was a kid and found out that my parents were going to have another child, she begged my mother to have a boy.  My mom use to tell her she didn’t know what they would get but that all she could hope for was for a healthy child.  Unfortunately for my sister, my parents had a girl (me) and my sister was stuck with a sister and not a brother.  I promise that we get along.

Today, it is pretty easy to determine the gender of an unborn child. This means that, for better or for worse, the surprise for most people is gone (which is kind of sad in my opinion).  Science, for better or for worse, continues to push boundaries and move forward. So what if you could take science one step further and not only figure out if the unborn child was a boy or girl, but their DNA?  What if you could find potential medical problems in an unborn child?  What would you do if you knew your potential child had a severe medical condition?  Do you know?  Do you want to know what you would decide?

A New Way to Sequence DNA

In 2012, researchers and scientists at the University of Washington mapped the DNA of a fetus to determine its genetic sequence.  To accomplish this, scientists used a blood sample from pregnant women and a saliva specimen from the father.  They then used high-speed DNA sequencing as well as statistical and computational acrobatics to calculate the DNA sequence of the fetus.  The map is approximately 98% accurate, which is quite an achievement.

This is not the first means of DNA testing a fetus, but this type of testing is less risky and easier.  Currently, DNA sequences of fetuses are conducted by acquiring fetal cells from placental tissue. This is an invasive procedure and carries a risk of inducing a miscarriage. And not only is this procedure safer, it’s also faster. The first test used a blood sample taken 18.5 weeks into the pregnancy, but this technique could be used in the first trimester.

The technique applies a discovery made in the 1990s that a women’s blood plasma can contain fragments of DNA from the fetus.  Even before its use to roadmap a fetus’ DNA, this discovery was used to test for gender, paternity, and Down Syndrome. But the recent innovation allows doctors to detect Mendelian disorders, including cystic fibrosis, Tay-Sachs disease, and Marfan syndrome.  These disorders are all caused by a mutation in a single gene.

Mutations in fetus can be inherited from a parent or occur spontaneous. Predicting spontaneous mutations is much more difficult than predicting those inherited from parents.  In 2010, Dr. Lo at the Chinese University of Hong Kong showed that reconstructing a fetal genome was possible. However, his team relied on an invasive procedure to gain a sample and still could not test for spontaneous mutations. The team at the University of Washington managed to detect 39 of 44 spontaneous mutations, although with a fair amount of false positives.  According to Dr. Beaudet, chairman of molecular and human genetics at the Baylor College of Medicine in Houston, spontaneous mutations account for 10% of mental retardation and other learning disability cases.

The test still has a long way to go, as it still needs to weed out its abundance of false positives. They currently provide a fair amount of ambiguous genetic information because it is hard to narrow down what the fetus inherited from the mother. But it represents a big step in understanding fetal health.

Grants

The National Institutes of Health has awarded $5 million to four pilot programs intended to study genome sequencing before it becomes widespread.  One of the goals is to narrow down information that is relevant.  Currently this procedure offers parents multiple findings that might or might not indicate the presence of an actual condition.  In addition, it can be difficult to determine if a mutation is “bad” or can cause a disease or disorder.  Interpreting genes still remains a challenge.  Some mutations in DNA cause diseases and disorders but not all do.  Currently all a DNA mapping could tell you is what the DNA of the fetus looks like and what mutations have occurred.  Drawing conclusions from a genetic DNA map has a long way to go.  The pilot programs also hope to answer the question of should we genetically map fetus’ DNA, and is there value in doing so?

Gattaca: Can I Pick Certain Characteristics?

DNA mapping is not the same as picking the characteristics of fetuses.  Medical research and science is still far away from that reality. The mapping is important because it helps determine the genetic sequence of the fetus and the potential changes and mutations in the DNA.  But it does not explain what these mutations and changes to the DNA mean. Will we someday be able to select traits for the fetus?  I honestly don’t know, but it is a possibility.  A better question might be, is it right to do so? The movie Gattaca would like to convince you that DNA and traits are not everything.

Ethical, Moral, Legal Implications

As you can imagine, the concept of DNA mapping leads to ethical, moral, and legal questions.  The ramifications of the potential in DNA mapping are unpredictable. This will open the debate on a lot of hot topic issues.  As the research expands the legality and ethical dilemma will catch up.  At the end of the day though, you will have to ask yourself -Will you use DNA sequencing?  And, depending on the results, what will you do with this information?

An Update on the Federal Health Insurance Marketplace

In 2010 the United States Congress passed the Affordable Health Care Act.  Since it was written into law, the ACA has struggled against political and structural problems.  Recently, the federal health insurance marketplace www.healthcare.gov was rolled out and prematurely, meaning that the site had a lot of problems.  This led to a lot of frustrated consumers, voters, and politicians.  This begs the question, how hard is it to build a website?

I can tell you from personal experience (with much simpler projects than www.healthcare.gov) that building websites is more complicated than one would think.  That’s why the United States government contracted out the construction of the site. Our government established a 292 million dollar contract with the CGI Group to build the health insurance marketplace (although it is estimated that the total cost of building the website was closer to 500 million).

Why the CGI Group?

The CGI Group is a Canadian consultant company.  At the time the United States signed a contract with the CGI Group, they were working on eHealth Ontario. eHealth Ontario is an electronic diabetes registry for Ontario, Canada.  The contract was later canceled when CGI failed to meet deadlines.  CGI also created the Connect for Health Colorado which is running smoothly.  When the contract was established, the CGI Group seemed like a more than a reasonable choice.

What is the Federal Health Insurance Marketplace?

While you’ve no-doubt heard of the website in the past few months, here’s a quick refresher. The healthcare.gov website was created to educate citizens about their new insurance options and allow them to purchase health insurance.  The site includes plans and rates from across the country, not just a specific state.   This means that the marketplace must offer plans that are applicable, available, and useable in every state.

A Plethora of Problems

As everyone knows the website did not have a smooth launch.  Among the many issues, some of the most prevalent were problems accessing the site, issues that prevented enrolling, important information that was missing, and a wide variety of technical problems.  These issues are being addressed slowly and painfully.  Because of all the problems, the United States government decided to not renew its contract with CGI Group.

The New HealthCare.gov Website

The US Government has signed a new, 12-month contract with Accenture, one of the world’s largest consulting firms.  Accenture’s resume includes some impressive, completed projects, including California’s new health-insurance exchange.  Accenture also finished an online human-services eligibility project for Iowa in 2012.  The system was nearly 20 years old and Accenture updated it in less than a year.  The company will also overhaul the technology behind the Ohio Medicaid program.  Hopefully with their superior experience, Accenture will be able to create a better HealthCare.gov.  For the sake of everyone who is waiting for the site, I hope so.