Thursday, October 18, 2012

Friday, September 28, 2012

Beyond Obamacare

A very strong argument in favor of Anabolic Medicine sm.

From the New York Times

September 16, 2012

Beyond Obamacare

By STEVEN RATTNER

WE need death panels.

Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget.

But in the pantheon of toxic issues — the famous “third rails” of American politics — none stands taller than overtly acknowledging that elderly Americans are not entitled to every conceivable medical procedure or pharmaceutical.

Most notably, President Obama’s estimable Affordable Care Act regrettably includes severe restrictions on any reduction in Medicare services or increase in fees to beneficiaries. In 2009, Sarah Palin’s rant about death panels even forced elimination from the bill of a provision to offer end-of-life consultations.

Now, three years on, the Republican vice-presidential nominee, Paul D. Ryan, has offered his latest ambitious plan for addressing the Medicare problem. But like Mr. Obama’s, it holds limited promise for containing the program’s escalating costs within sensible boundaries.

The Obama and Ryan plans are not without common ground; both propose an identical formula for capping the growth in Medicare spending per beneficiary. And both dip into the same toolbox (particularly lower payments to providers) to achieve a reduction of nearly $1 trillion in Medicare expenditures over the next decade from projected levels.

That’s where the agreement ends. Mr. Ryan believes that meeting the goal over the long term requires introducing more competition into Medicare through vouchers to purchase private insurance.

But Ryan’s approach was rendered toothless when the issue’s brutal politics forced him to retreat from his initial tough plan to simply cap the growth in government spending on Medicare and stick the inevitable overage onto beneficiaries. Under his revised plan, private insurers would be required to offer the same level of benefits as traditional Medicare, meaning that any savings would have to come from unidentified efficiencies (the ever-popular “waste, fraud and abuse”).

If the cap was breached — as it almost certainly would eventually be — Mr. Ryan blithely says, “Congress would be required to intervene.” Fat chance; Congress regularly does the opposite when it rolls back caps on payments to doctors and hospitals.

Meanwhile, Mr. Obama’s hopes for sustained cost containment are pinned on a to-be-determined mix of squeezing reimbursements, embracing a selection of the creative ideas that have spewed forth from health care policy wonks and scouring the globe for innovations.

To Mr. Obama’s credit, his plan has more teeth than Mr. Ryan’s; if his Independent Payment Advisory Board comes up with savings, Congress must accept either them or vote for an equivalent package. The problem is, the advisory board can’t propose reducing benefits (a k a rationing) or raising fees (another form of rationing), without which the spending target looms impossibly large.

That’s the view of the bipartisan Medicare trustees, whose 2012 report stated: “Actual future Medicare expenditures are likely to exceed the intermediate projections shown in this report, possibly by quite large amounts.”

To be sure, health care cost increases have moderated, in part because of the recession and in part because Medicare has been tightening its reimbursements. But those thumbscrews can’t be tightened forever; Medicare reimbursement rates are already well below those of private providers.

Let’s not forget that with the elderly population growing rapidly, even if cost increases for each beneficiary can be contained, Medicare would still claim a rising share of the American economy.

Medicare needs to take a cue from Willie Sutton, who reportedly said he robbed banks because that’s where the money was. The big money in Medicare is not to be found in Mr. Ryan’s competition or Mr. Obama’s innovation, but in reducing the cost of treating people in the last year of life, which consumes more than a quarter of the program’s budget.

No one wants to lose an aging parent. And with price out of the equation, it’s natural for patients and their families to try every treatment, regardless of expense or efficacy. But that imposes an enormous societal cost that few other nations have been willing to bear. Many countries whose health care systems are regularly extolled — including Canada, Australia and New Zealand — have systems for rationing care.

Take Britain, which provides universal coverage with spending at proportionately almost half of American levels. Its National Institute for Health and Clinical Excellence uses a complex quality-adjusted life year system to put an explicit value (up to about $48,000 per year) on a treatment’s ability to extend life.

At the least, the Independent Payment Advisory Board should be allowed to offer changes in services and costs. We may shrink from such stomach-wrenching choices, but they are inescapable.

Steven Rattner, a contributing opinion writer, was a counselor to the Treasury secretary in the Obama administration.

Friday, September 7, 2012

With Medicaid, Long-Term Care of Elderly Looms as a Rising Cost

Medicaid has long conjured up images of inner-city clinics jammed with poor families. Its far less-visible role is as the only safety net for millions of middle-class people whose needs for long-term care, at home or in a nursing home, outlast their resources.

With baby boomers and their parents living longer than ever, few families can count on their own money to go the distance. So while Medicare has drawn more attention in the election campaign, seniors and their families may have even more at stake in the future of Medicaid changes — those proposed, and others already under way.

Though former President Bill Clinton overstated in his convention speech on Wednesday how much Medicaid spends on the elderly in nursing homes — they account for well under a third, not nearly two-thirds, of spending — Medicaid spends more than five times as much on each senior in long-term care as it does on each poor child, and even more per person on the disabled in long-term care.

Seniors like Rena Lull, 92, who spent the last of her life savings on $250-a-day nursing home care near Cooperstown, N.Y., last year, will face uncharted territory if Republicans carry out their plan to replace Medicaid with block grants that cut spending by a third over a decade. The move would let states change minimum eligibility, standards of care, and federal rules that now protect adult children from being billed for their parents’ Medicaid care.

Now, like a vast majority of the nation’s 1.8 million nursing home residents, Mrs. Lull, a retired schoolteacher with dementia, counts on Medicaid to cover most of her bill. But her daughter Rena, 66, also a retired schoolteacher with a lifetime of savings, no longer knows what she can count on in her own old age.

“I get choked up thinking about this,” she said, recalling how her widowed mother had depleted $300,000 on five years of care in the community and one year in the Otsego Manor nursing home, before qualifying for Medicaid. “I’m so scared about what’s going to happen to me.”

The presidential election may decide Medicaid’s future. But many states faced with rising Medicaid costs and budget deficits are already trying to cut the cost of long-term care by profoundly changing Medicaid coverage, through the use of federal waivers.

Waivers sought or obtained by 26 states, including New York, California, Illinois and Texas, would affect some three million people, most of them eligible for both Medicaid and Medicare. Plans vary, but typically they try to cut costs by giving private managed-care organizations a fixed sum for a lifetime of care, from doctor and hospital visits to help at home to nursing home placement, with the expectation that more care will take place in less expensive home or community settings.

Over all, 31.5 percent of Medicaid’s $400 billion in shared federal and state spending goes to long-term care for the elderly and the disabled. That ranges from less than 8 percent in Hawaii, where nursing home use is low, to more than 60 percent in North Dakota...

Wednesday, September 5, 2012

The Benefits of Middle-Age Fitness

Americans are living longer, with our average life expectancy now surpassing 78 years, up from less than 74 years in 1980. But we are not necessarily living better. The incidence of a variety of chronic diseases, like diabetes, cancer and heart disease, has also been growing dramatically, particularly among people who are not yet elderly.

The convergence of those two developments has led to what some researchers have identified as a “lengthening of morbidity.” That means we are spending more years living with chronic disease and ill health — not the outcome that most of us would hope for from a prolonged life span.

But a notable new study published last week in Archives of Internal Medicine suggests that a little advance planning could change that prospect. Being or becoming fit in middle age, the study found, even if you haven’t previously bothered with exercise, appears to reshape the landscape of aging...

Tuesday, September 4, 2012

Development of hepatocellular carcinoma associated with anabolic androgenic steroid abuse in a young bodybuilder: a case report.

Introduction. Many different etiological factors are involved in the development of hepatocellular carcinoma (HCC). We report the case of HCC in a 37-year-old male professional bodybuilder with extensive anabolic androgenic (AAS) steroid abuse. Case Presentation. Because of increasing epigastric and abdominal pain, abdominal ultrasound was performed in a 37-year-old male professional bodybuilder. A hyperechoic lesion in the liver was detected in segment VI. The magnetic resonance imaging showed hepatomegaly and confirmed the lesion, which showed features of a hepatocellular adenoma (HCA). Laboratory values were inconspicuous. After laparoscopic segmentectomy the histological examination revealed HCC. Conclusion. While the development of HCA in the liver by chronic intake of AAS is well known, little is known about the association with HCC. The presented case may indicate aetiological association of chronic intake of AAS and the development of HCC.

Age-related changes of skeletal muscles: physiology, pathology and regeneration.

This review provides a short presentation of the aging-related changes of human skeletal muscles. The aging process is associated with the loss of skeletal muscle mass (sarcopenia) and strength. This results from fibre atrophy and apoptosis, decreased regeneration capacity, mitochondrial dysfunction, gradual reduction of the number of spinal cord motor neurons, and local and systemic metabolic and hormonal alterations. The latter involve age-related decrease of the expression and activity of some mitochondrial and cytoplasmic enzymes, triacylglycerols and lipofuscin accumulation inside muscle fibres, increased proteolytic activity, insulin resistance and decreased serum growth hormone and IGF-1 concentrations. Aging of the skeletal muscles is also associated with a decreased number of satellite cells and their proliferative activity. The age-related reduction of skeletal muscle mass and function may be partially prevented by dietary restriction and systematic physical exercises.

Determinants of Bone Microarchitecture and Mechanical Properties in Obese Men.

Context:Recent studies have suggested that obesity in men is associated with increased fracture risk. Obesity in men is also associated with dysregulation of the GH/IGF-I and gonadal steroid axes, important regulators of bone homeostasis.Objective:The aim of the study was to investigate body composition and endocrine determinants of bone microarchitecture and mechanical properties in obese men.Design and Setting:We conducted a cross-sectional study at a clinical research center.Participants:Thirty-five obese men (mean age, 33.8 ± 6.4 yr; mean body mass index, 36.5 ± 5.8 kg/m(2)) participated in the study.Outcome Measures:Distal radius microarchitecture and mechanical properties were measured by three-dimensional high-resolution peripheral quantitative computed tomography and microfinite element analysis; body composition by computed tomography; bone marrow fat by proton magnetic resonance spectroscopy; total and free estradiol and testosterone; IGF-I; peak glucagon-stimulated GH; 25-hydroxyvitamin D.Results:Men with high visceral adipose tissue (VAT) had impaired mechanical properties compared to men with low VAT (P < 0.05), despite comparable body mass index. VAT was inversely associated and thigh muscle was positively associated with mechanical properties (P < 0.05). Bone marrow fat was inversely associated with cortical parameters (P ≤ 0.02). Free estradiol was positively associated with total density (P = 0.05). Free testosterone was positively associated with trabecular thickness and inversely with trabecular number (P ≤ 0.05). Peak stimulated GH was positively associated with trabecular thickness, as was IGF-I with cortical area (P ≤ 0.04).Conclusion:VAT and bone marrow fat are negative predictors and muscle mass is a positive predictor of microarchitecture and mechanical properties in obese men. Testosterone, estradiol, and GH are positive determinants of trabecular microarchitecture, and IGF-I is a positive determinant of cortical microarchitecture. This supports the notion that VAT is detrimental to bone and that decreased GH and testosterone, characteristic of male obesity, may exert deleterious effects on microarchitecture, whereas higher estradiol may be protective.

Saturday, July 7, 2012

New Numbers on Elder Care

Friday, June 8, 2012

Endogenous Sex Hormones and C-reactive protein in Healthy Chinese Men.

Safer sex as the bolder choice: testosterone is positively correlated with safer sex behaviorally relevant attitudes in young men.

Men's health: sexual dysfunction, physical, and psychological health--is there a link?

Testosterone as potential effective therapy in treatment of obesity in men with testosterone deficiency: a review.

Acute testosterone deprivation reduces insulin sensitivity in men.

Endogenous testosterone levels are associated with assessments of unfavourable health information.

Men's health in primary care: an emerging paradigm of sexual function and cardiometabolic risk.

Testosterone and sex hormone-binding globulin have significant association with metabolic syndrome in Taiwanese men.

Combination of low free testosterone and low vitamin D predicts mortality in older men referred for coronary angiography.

Sexual function in men with metabolic syndrome.

The effect of testosterone supplementation on depression symptoms in hypogonadal men from the Testim Registry in the US (TRiUS).

One-year efficacy and safety study of a 1.62% testosterone gel in hypogonadal men: results of a 182-day open-label extension of a 6-month double-blind study.

Low free testosterone predicts mortality from cardiovascular disease but not other causes: the Health in Men Study.

Testosterone pellet implants and migraine headaches: a pilot study.

Salivary testosterone: associations with depression, anxiety disorders, and antidepressant use in a large cohort study.

Hypertension, dyslipidemia and overweight are related to lower testosterone levels in a cohort of men undergoing prostate biopsy.

Improved prediction of all-cause mortality by a combination of serum total testosterone and insulin-like growth factor I in adult men.

Testosterone therapy decreases subcutaneous fat and adiponectin in aging men.

Obesity, body composition, and prostate cancer.

Occurrence of erectile dysfunction, testosterone deficiency syndrome and metabolic syndrome in patients with abdominal obesity. Where is a sufficient level of testosterone?

Association of testosterone levels with endothelial function in men: results from a population-based study.

Influence of baseline serum testosterone on changes in body composition in response to testosterone therapy.

The Comparison of the Aging Male Symptoms (AMS) Scale and Androgen Deficiency in the Aging Male (ADAM) Questionnaire to Detect Androgen Deficiency in Middle-Aged Men.

Thursday, May 31, 2012

Tuesday, May 29, 2012

Long-Term Bisphosphonates May Be OK for Select Patients

Testosterone Treatment Helps Obese Older Males Lose Weight, Other Health Gains Too

Early Menopause May Predict Osteoporosis, Fractures, Death

Calcium Supplements Linked to Heart Attack Risk

Bisphosphonates May Increase Risk for Uveitis and Scleritis

Testosterone May Help Heart Failure Patients, Studies

Burgeoning Cost of Alzheimer's Disease Unsustainable

Anti-Obesity Drug Now In Clinical Trials May Cause Rapid Bone Loss

Bisphosphonates Increase Contralateral Atypical Fracture Risk

Men at Higher Risk for Mild Cognitive Impairment

Depression drugs ‘causing falls’

Factors That Predict Walking Difficulty In Elderly

Most Medicare Demo Projects Fail to Raise Quality, Cut Costs

2 Inch Loss In Height Could Signal Fracture Risk And Death In Older Women

Brain power can decline from age 45: study

Women on Bisphosphonate Therapy May Need Screening Radiography

Growth Hormone Increases Bone Formation In Obese Women

UK elderly's human rights 'being breached': study

Panel’s Advice on Prostate Test Sets Up Battle

U.S. Panel Says No to Prostate Screening for Healthy Men

Hip Fracture Increases 1-Year Mortality Rate in Elderly Women

Standard of Living, Income Drops With COPD

Highest Testosterone Levels Equal Lowest Risk for CV Events

Oral Steroids Linked To Severe Vitamin D Deficiency In Nationwide Study

For older women, year following hip fracture can be especially deadly

FDA Committee to Review Osteoporosis Drug Safety

Increased Muscle Mass Associated With Reduced Risk for Insulin Resistance

Soy No Help for Bone Loss, Hot Flashes

Raise Your Muscle Mass And Reduce Your Type 2 Diabetes Risk

FDA Studying Link Between Bisphosphonates, Esophageal Cancer

Aging boomers strain cities built for the young

Study Of Strength Training For Seniors Finds Increased Muscle Strength, Reduced Muscular Atrophy

Diet Appears to Modulate Alzheimer's Biomarker

Monday, May 28, 2012

High Calcium Intake No Better for Bone Health

Elderly care costs could treble says OECD

Sunday, May 27, 2012

Calcium Supplements Appear To Raise Heart Attack And Cardiovascular Event Risk

Prevalence of Frailty Increases Throughout Adulthood

Older Workers Take Longer to Recover from Injuries

In Hypertension, Strong Men Live Longer

Frailty: Not Just in the Aged Any More

Calcium Supplements and CV Events: New Data, More Debate

Winning Linked To Higher Testosterone Levels

Hormonal And Molecular Responses To Exercise Differ By Age

Routine Osteoporosis Screening Recommended For All Women Over Age 65

Coffee May Help Protect Against Diabetes

Falls as Serious for Elderly as Stroke, Heart Attack: Experts

Walking Speed and Survival Connected

With Alzheimer’s Patients Growing in Number, Congress Endorses a National Plan

Study Finds Strength Training For Seniors Provides Cognitive Function, Economic Benefits

Anabolic steroids after total knee arthroplasty. A double blinded prospective pilot study

Following the Money, Doctors Ration Care

Excess Premenopausal Visceral Fat a Risk Factor for Osteoporosis

Drug Suits Raise Questions for Doctors, and Juries

Omega-3 pills fail to work in Alzheimer's patients

Low testosterone a problem in cancer: study

Low Testosterone Levels Linked to Alzheimer's Disease in Older Men

Flexing Their Muscles Helps Kidney Disease Patients Live Longer, Study Finds

US FDA warns of thigh fractures with bone drugs

World's pensioners headed for global care crunch

Testosterone and Metabolic Syndrome: A Meta-Analysis Study

New Report Finds Stronger Link Between Osteoporosis Drugs and Thigh Fractures

Dementia cost 'to top 1% of GDP'

Link between bone drugs and oesophageal cancer

With Muscle-Building Treatment, Mice Live Longer Even As Tumors Grow

Beta-Amyloid Further Implicated in Mental Decline

What prevents falls after strokes? Study: Not much

Calcium supplements may raise risk of heart attack

Calcium pills 'increase' risk of heart attack

Fall-Prevention Program Fails

Osteoporosis Screenings Done too Frequently in U.S.?

Low Testosterone May Signal Frailty in Elderly Men

Preliminary Draft Guidance Recommends New Osteoporosis Treatment For Women At Increased Risk Of Fractures

CODHy: Testosterone Improves Metabolic Syndrome

"Doc Fix" Delaying Medicare Pay Cuts Is Law Until November 30

As You Age, Better Health Means Better Sex

Is ageing a disease?

Alzheimer's costs to soar without effective drugs

Testosterone boosts skepticism

Shortage of Nurses Means Death After Hip Fracture

New Guidance on Hormone Therapy Issued

Height Loss in Older Women May Signal Vertebral Fracture

Height Loss in Older Women May Signal Vertebral Fracture

Erectile Dysfunction and Increased Dangers of Cardiovascular Disease

Low testosterone tied to frailty in older men

Mortality Rate in Older Adults Persistently Increased 5- to 8-Fold After Hip Fracture

Mortality Rate in Older Adults Persistently Increased 5- to 8-Fold After Hip Fracture

Fosamax: Is Long Term Use of Bone Strengthening Drug Linked to Fractures?

Welcome. This is the official blog of The Anabolic Clinic, SC. Here we will post information about anabolic substances that may be of interest to you. Some of it will be from the professional literature. Some of it will be from the lay press. For additional information, follow the links to the sources.