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Friday, November 22, 2013

Let's Go Nuts!

This has been the buzz of the health-related mainstream media this week.
Increased nut consumption has been associated with a reduced risk of major chronic diseases, including cardiovascular disease and type2 diabetes mellitus. However, the association between nut consumption and mortality remains unclear.

We examined the association between nut consumption and subsequent total and cause-specific mortality among 76,464 women in the Nurses’ Health Study (1980–2010) and 42,498 men in the Health Professionals Follow-up Study (1986–2010). Participants with a history of cancer, heart disease, or stroke were excluded. Nut consumption was assessed at baseline and updated every 2 to 4 years.

During 3,038,853 person-years of follow-up, 16,200 women and 11,229 men died. Nut consumption was inversely associated with total mortality among both women and men, after adjustment for other known or suspected risk factors. The pooled multivariate hazard ratios for death among participants who ate nuts, as compared with those who did not, were 0.93 (95% confidence interval [CI], 0.90 to 0.96) for the consumption of nuts less than once per week, 0.89 (95% CI, 0.86 to 0.93) for once per week, 0.87 (95% CI, 0.83 to 0.90) for two to four times per week, 0.85 (95% CI, 0.79 to 0.91) for five or six times per week, and 0.80 (95% CI, 0.73 to 0.86) for seven or more times per week (P< LT 0.001 for trend). Significant inverse associations were also observed between nut consumption and deaths due to cancer, heart disease, and respiratory disease.
In two large, independent cohorts of nurses and other health professionals, the frequency of nut consumption was inversely associated with total and cause-specific mortality, independently of other predictors of death. (Funded by the National Institutes of Health and the International Tree Nut Council Nutrition Research and Education Foundation.)
Full paper PDF here. The paper closes with this:
In conclusion, our analysis of samples from these two prospective cohort studies showed significant inverse associations of nut consumption with total and cause-specific mortality. Nonetheless, epidemiologic observations establish associations, not causality, and not all findings from observational studies have been confirmed in controlled, randomized clinical trials.
Pretty interesting. I love nuts. Routinely sprinkle chopped-up nuts in my salads, and eat them as snack foods. But, re "association vs causation," are healthier people per se more likely to have a habitual taste for nuts (or myriad other foods thought to be beneficent)?

Just checked over at They've not chimed in on this yet. Their current post is "Do vitamins prevent cancer and heart disease?"


From THCB today

This guy is a lawyer.
Another Law Raising the Cost of Health Care

While there has been much focus lately on the ways in which ObamaCare is chilling the growth of private business, we should not overlook the continuing deleterious effects of the one surviving relic of HillaryCare, the Health Insurance Portability and Accountability Act (HIPAA). Quietly, September 23 came and went as the compliance effective date for a new rule, expanding the reach of HIPAA, and likely driving many smaller players out of the health care industry...
My response in the comments:
“Spearheaded by then First Lady Clinton, HIPAA was established in 1996 to improve privacy of personal health information”

HIPAA 1996 was an INSURANCE REFORM bill and law, not a “privacy” law. The “Kennedy-Kassebaum” bill. You could call it “ObamaCare Precursor, v1.0″
According to respected medical economist (and former Hill policy operative) J.D. Kleinke, “PHI privacy” was an 11th hour tossed-in faceless bargaining chip. Only 13 of the 167 pages of the law refer to it. I have my yellow-highlighted, sticky-noted, red-penned copy.
(See Subtitle F “Administrative Simplification”).

Washington Post, James K. Glassman, Tuesday, April 23, 1996

“…New, stricter laws will be needed to correct the deficiencies, and probably more after that. Inevitably, Americans will arrive at the destination they rejected when Bill and Hillary Clinton proposed it: government-controlled health care.

“…At its heart, the bill does two things that seem worth doing. First, it makes insurance policies more “portable” by requiring insurers to issue you a policy if you lose or leave your job. Second, it prevents insurers from denying you a policy if you have a pre-existing medical condition…”

“Both of these measures seem humane and sensible. Unfortunately, they are also expensive. For example, if an insurer does not have the right to reject — or delay for a long time — coverage of someone who has a disease that’s costly to treat, then the insurer will have to raise premiums.

The bill sponsored by Sen. Ted Kennedy (D-Mass.) and Sen. Nancy Kassebaum (R-Kan.) does not cap premiums — which is why so many Republicans support it. But caps will come because the outcry over higher rates will be deafening, and politicians will be forced to respond. That’s what makes this bill so insidious and its “modesty” so illusory.

Just take a look at what’s happened in the state of Washington. The state’s program, says an article on the front page of the Wall Street Journal, “contains many provisions — broader public access to insurance rolls, portability and short waiting period for people with pre-existing heath problems — that mark the health-care bills that congressional reformers are pushing.”
The article continues: “But three years into Washington state’s program, rates for its 400,000 individual policyholders are soaring, in some cases to triple their former level. . . . More than 30 insurers have notified the state they no longer want to do business here.”
The Washington state program is broader than Kennedy-Kassebaum, but the effects are likely to be similar. What Congress wants to do is to force insurers to insure sick people. When that happens, everyone else will have to pay more in premiums. And when that happens, the healthiest people (mainly the young) will decide they don’t need insurance at these prices, so they’ll drop out of the system. And when that happens, premiums will increase even more sharply for those who are left, because the healthy people who subsidized the sick people will be gone…”

Sound familiar? Groundhog Day, anyone?

Search the article for the word “privacy.” You won’t find it.


Oh, 2014 CEHRT, Where Art Thou? 

39 days to the onset of calendar year Stage 2, Year one of the Meaningful Use program. Below, inpatient setting complete certified products to date.

Nine vendors, nominally 15 products (and, looks like perhaps one overcount -- MEDITECH v5.66; I simply scraped the data off the CHPL and dropped 'em into Excel).

There are 240 "modular" certs on the inpatient side. And, 194 modules and 57 complete products on the ambulatory side (comprising 26 vendors).

2011 certs to date, by way of partial contrast, total 1,831 outpatient and 72 inpatient "complete" products.

A little late in the day, are we not?

More to come...

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