November 15, 2010

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November 15, 2010

  1. 1. November 15, 2010 Should you be snuggling with your cellphone? The legal departments of cellphone manufacturers slip a warning about holding the phone against your head or body into the fine print of the little slip that you toss aside when unpacking your phone. Apple, for example, doesn’t want iPhones to come closer than 5/8 of an inch; Research In Motion, BlackBerry’s manufacturer, is still more cautious: keep a distance of about an inch. The warnings may be missed by an awful lot of customers. The United States has 292 million wireless numbers in use, approaching one for every adult and child, according to C.T.I.A. - The Wireless Association, the cellphone industry’s primary trade group. It says that as of June, about a quarter of domestic households were wireless-only. If health issues arise from ordinary use of this hardware, it would affect not just many customers but also a huge industry. Our voice calls — we chat on our cellphones 2.26 trillion minutes annually, according to the C.T.I.A. — generate $109 billion for the wireless carriers. The cellphone instructions-cum-warnings were brought to attention by Devra Davis, an epidemiologist who has worked for the University of Pittsburgh and has published a book about cellphone radiation, “Disconnect.” Her book surveys the scientific investigations about the cellphone radiation and concludes that the question is not yet settled. Brain cancer is a concern that Davis takes up. Over all, there has not been a general increase in its incidence since cellphones arrived. But the average masks an increase in brain cancer in the 20-to-29 age group and a drop for the older population. “Most cancers have multiple causes,” she says, but she points to laboratory research that suggests mechanisms by which low-energy radiation could damage cells in ways that could possibly lead to cancer. Children are more vulnerable to radiation than adults, Davis and other scientists point out. Radiation that penetrates only two inches into the brain of an adult will reach much deeper into the brains of children because their skulls are thinner and their brains contain more absorptive fluid. No field studies have been completed to date on cellphone radiation and children, she says. Henry Lai, a research professor in the bioengineering department at the University of Washington, began laboratory radiation studies in 1980 and found that rats exposed to radiofrequency radiation had damaged brain DNA. He maintains a database that holds 400 scientific papers on possible biological effects of radiation from wireless communication. He found that 28 percent of studies with cellphone industry funding showed some sort of effect, while 67 percent of studies without such funding did so. The unit of measurement for radiofrequency exposure is called the specific absorption rate, or SAR. The Federal Communications Commission mandates that the SAR produced by phones be no more than 1.6 watts per kilogram. One study listed by Lai found effects like loss of memory in rats exposed to SAR values in the range of 0.0006 to 0.06 watts per kilogram. The city of San Francisco passed an ordinance this year that requires cellphone retailers to post SARs prominently. This angered the C.T.I.A., which announced that it would no longer schedule trade shows in the city. The association maintains that all F.C.C.-approved phones are perfectly safe. John Walls, the association’s vice president for public affairs, said: “What science tells us is, ‘If the sign on the highway says safe clearance is 12 feet,’ it doesn’t matter if your vehicle is 4 feet, 6 feet or 10 feet tall; you’re going to pass through safely. The same theory applies to SAR values and wireless devices.” The association has set up a separate Web site, cellphonehealthfacts.com. Four attractive young people are seen on the home page, each with a cellphone pressed against the ear — and all four are beaming as they listen. By this visual evidence, cellphone use seems to be correlated with elation, not cancer. The largest study of cellphone use and brain cancer has been the Interphone International Case-Control Study, in which researchers in 13 developed countries (but not the U.S.) participated. It interviewed brain cancer patients, 30 to 59 years old, from 2000 to 2004, then cobbled together a control group of people who had not regularly used a cellphone.
  2. 2. The study concluded that using a cellphone seemed to decrease the risk of brain tumors, which the authors acknowledged was “implausible” and a product of the study’s methodological shortcomings. The authors included some disturbing data in an appendix available only online. http://ije.oxfordjournals.org/content/suppl/2010/05/06/dyq079.DC1/Interphone_Appendix2.pdf These showed that subjects who used a cellphone 10 or more years doubled the risk of developing brain gliomas, a type of tumor. The 737 minutes that we talk on cellphones monthly, on average, according to the C.T.I.A., makes today’s typical user indistinguishable from the heavy user of 10 years ago. Davis recommends keeping a phone out of close proximity to the head or body, by using wired headsets or the phone’s speaker. Children should text rather than call, she said, and pregnant women should keep phones away from the abdomen. The F.C.C. concurs about the best way to avoid exposure. It is not by choosing a phone with a marginally lower SAR, it says, but rather by holding the cellphone “away from the head or body.” But Davis, citing unsettling findings from research in Israel, France, Sweden and Finland, said, “I do think I’m looking at an epidemic in slow motion.” Visit the New York Times for the article. http://www.nytimes.com/2010/11/14/business/14digi.html?_r=1&ref=health Doctors brace for possible big Medicare pay cuts Breast cancer surgeon Kathryn Wagner has posted a warning in her waiting room about a different sort of risk to patients' health: She'll stop taking new Medicare cases if Congress allows looming cuts in doctors' pay to go through. The scheduled cuts - the result of a failed system set up years ago to control costs - have raised alarms that real damage to Medicare could result if the lame-duck Congress winds up in a partisan standoff and fails to act by Dec. 1. That's when an initial 23 percent reduction would hit. Neither Democrats nor newly empowered Republicans want the sudden cuts, but there's no consensus on how to stave them off. The debate over high deficits complicates matters, since every penny going to make doctors whole will probably have to come from cuts elsewhere. A reprieve of a few months may be the likeliest outcome. That may not reassure doctors. "My frustration level is at a nine or 10 right now," said Wagner, who practices in San Antonio. "I am exceptionally exhausted with these annual and biannual threats to cut my reimbursement by drastic amounts. As a business person, I can't budget at all because I have no idea how much money is going to come in. Medicine is a business. Private practice is a business." The cuts have nothing to do with President Barack Obama's healthcare overhaul. They're the consequence of a 1990s budget-balancing law whose requirements Congress has routinely postponed. But these cuts don't go away; they come back for a bigger bite. Doctors have muddled through with temporary reprieves for years. This time, medical groups estimate that as many as two-thirds of doctors would stop taking new Medicare patients, throwing the health program for 46 million older and disabled people into turmoil just when the first baby boomers will become eligible. Healthcare for military service members, families and retirees also would be jeopardized because Tricare payments are tied to Medicare's. Former Medicare administrator Gail Wilensky, a leading Republican policy expert, says lawmakers coming back to Washington next week better take note. "We simply cannot let physicians take a 23 percent reduction in payment and think that we are not going to seriously disrupt access for beneficiaries," Wilensky said. Yet there's no agreement among lawmakers and the Obama administration on how long a reprieve to grant or whether the cost - about $1 billion per month - should be added to the deficit or paid for with spending reductions elsewhere. The last reprieve, in June, was paid for after a struggle to come up with offsets acceptable to Democrats and Republicans. The deadline for congressional action expired, plunging Medicare's claims system into confusion for weeks. There's widespread recognition that the way Medicare pays doctors is flawed because it rewards sheer volume of services, not quality results. But there's no agreement on a better way. So in the 1990s lawmakers devised a formula for cuts as an automatic braking system to keep Medicare humming along at a sustainable growth rate. Except every time costs went up, they hit the override button. Repealing the formula now would cost more than $280 billion over 10 years. The American Medical Association is calling for a 13-month reprieve that would give Congress time to work on a new payment system; the administration supports that approach. The AMA and Obama would settle for adding the cost to the deficit. Most Republicans and many conservative Democrats want it paid for.
  3. 3. Last summer, when Congress missed the deadline for an extension, Wagner had to tap her line of credit to pay the salaries of her nurses and office staff. Medicare is only a fraction of her practice, but the cancer surgeon said private insurance companies also held up payments waiting to see what would happen. "I didn't get a check in the mail for almost a month," she said. As a doctor, she recognizes there could be grave consequences if she follows through on not taking new Medicare patients. Older women are more likely to have malignant disease than younger patients. "Those are cancers that are waiting at the door," Wagner said. She would continue to see established patients. But she's getting closer and closer to the breaking point with Medicare. (Associated Press) Visit the Washington Post for the article. http://www.washingtonpost.com/wp-dyn/content/article/2010/11/12/AR2010111202811.html UN appeals for $164M to combat Haiti cholera The United Nations asked for $164 million Friday to fight the cholera outbreak in Haiti that has already claimed 724 lives and is expected to continue spreading for up to a year. It was an appeal primarily to donor nations, but also to international and regional organizations. The funds will be used by U.N. and non-governmental organizations to bring in additional doctors, medicines and water-purification equipment to treat up to 200,000 people who could show cholera symptoms ranging from mild diarrhea to severe dehydration, the global body said. "We absolutely need this money as soon as possible," said Elisabeth Byrs, a spokeswoman for the U.N. humanitarian office. She told reporters in Geneva that the funds need to be provided quickly "otherwise all our efforts can be outrun by the epidemic." At least 11,125 cases of cholera have been confirmed in five of Haiti's 10 districts since the outbreak began last month. Ten deaths and 278 cases have occurred in the capital Port-au-Prince. The World Health Organization said Friday that the epidemic isn't likely to end soon. "The projections of 200,000 cases over the next six to twelve months shows the amplitude of what could be expected," said WHO spokesman Gregory Hartl. He noted that the current fatality rate of 6.5 percent is far higher than it should be. "No one alive in Haiti has experienced cholera before, so it's a population which is very susceptible to the bacteria," Hartl said. "Once it is in water systems it transmits very easily, and it transmits among people who are often asymptomatic." The cause of the outbreak in Haiti is still unknown. The country hadn't seen cholera cases for decades before last month. (Associated Press) Visit the Detroit Free Press for the article. http://www.freep.com/article/20101113/NEWS07/11130341/1001/news/UN-seeks-164M-to-fight- cholera Tests show lead levels vary in reusable grocery bags TAMPA - Grocery chain Winn-Dixie sells a reusable grocery bag with two sturdy handles, pictures of cute baby faces and enough toxic lead to alarm health experts. The bag contains enough lead that Hillsborough County could consider the bag hazardous if thrown out with household trash, according to independent laboratory tests commissioned by The Tampa Tribune. It's not just Winn-Dixie. Tribune tests also showed some Publix reusable bags had lead levels that exceed federal limits for paint and exceeded rules coming soon for children's toys. Though the bags comply with other limits, Publix, in a cautionary move, asked its bag suppliers to lower lead content in bags. That decision came after officials were told the results of the Tribune tests. This presents a dilemma for shoppers who avoid paper or plastic for environmental reasons. Lead is linked to learning disabilities in children and fertility problems in adults. The answer for shoppers appears to be: Not all bags are created equal, the lab tests showed. The more elaborate the illustrations on the bags, the more likely they contained toxins. Yellow and green paint on bags is a common carrier of lead. Some health advocates say there is no safe level for lead, calling it a toxin at any level. Florida has no clear regulation focused on lead in bags, so lab officials and health advocates point to a conflicting series of government rules regarding consumer products. Currently, the U.S. Consumer Product Safety Commission allows 300 parts per million of lead in children's products. In August, that level will fall to 100. And any paint on consumer products can contain no more than 90 parts per million. In the first round of tests, the Baby Faces bag from Winn-Dixie showed the highest levels of lead, 121 parts per million, and showed 117 in the second. A bag from Publix with a University of South Florida theme approached the 100 parts per million threshold, with a level of 87 parts per million in the first tests, and showed 194 parts per million in a second test — the highest result of any bag in Tribune tests. The differences between the two tests likely came from different production runs at the manufacturer, said Hugh Rodrigues, owner of Thornton Laboratories, which tested 13 bags for the Tribune. The lead appears to be in a form that is not easily extracted or leached,
  4. 4. Rodrigues said. It is not in a form that would rub off on food simply by touching the bag, like wet paint, he said, but over time, bags wear down and paint can flake off and threads can fray, releasing the lead. Environmental Protection Agency rules require that any product with a lead content higher than 100 parts per million should technically undergo further testing before landfills accept them for disposal, he said. Publix officials stress that their bags are not toys or paint, and thus comply with current federal rules. But after reviewing the Tribune test results last week, Publix officials said they took action. "We have already contacted the supplier of this bag and asked them to look at reducing the lead content, even though it is within government safety standards," said spokeswoman Shannon Patten. "We would never knowingly carry something in our stores that wasn't in compliance with government regulations, and we work hard every day to bring safe, high-quality products to our customers." Shoppers have been switching to reusable totes, avoiding plastic bags to help the environment and lessen the nation's dependence on oil used to make the plastic. Some states want to ban inexpensive plastic bags or impose a tax to discourage their use. Reusable bags seemed the natural solution. Publix has sold 13 million reusable bags, saving an estimated 1 million plastic bags a day. This summer, an independent group tested bags from the upscale Wegmans grocery company and found some contained lead at 799 parts per million, well beyond levels that health officials consider problematic. Wegmans commissioned its own tests, which also found lead, and immediately stopped selling two styles of bags, one with a green pea design and one with a holiday illustration. (No other designs were affected.) Wegmans posted signs in stores telling customers the bags were safe to use, but should be returned to the store before disposal. Reusable bags don't list lead as an ingredient in the material. All the bags tested by the Tribune were made in China. A tag on the USF bag from Publix says to hand wash separately and line dry. By contrast, a nylon bag sold by Target with almost no illustrations had almost undetectable levels of lead. Also, the simplest bags from Sweetbay, Walmart and Publix contained little lead. Visit the Tampa Tribune for the article. http://www2.tbo.com/content/2010/nov/14/140842/lead-taints-reusable-bags/news-metro/ APIC response to JAMA article, “Quality of Traditional Surveillance for Public Reporting of Nosocomial Bloodstream Infection Rates” APIC - The Association for Professionals in Infection Control and Epidemiology shares the concern expressed in the recent Journal of the American Medical Association (JAMA) study entitled, “Quality of Traditional Surveillance for Public Reporting of Nosocomial Bloodstream Infection Rates,” by Michael Lin, MD, MPH, and colleagues. The study, published in the November 10 issue of JAMA, found significant variation among medical centers regarding surveillance of bloodstream infections and concludes that such variations “may complicate inter- institutional comparisons of publicly reported central line-associated BSI (bloodstream infection) rates.” While this was a well-designed investigation, there are some aspects that stimulate follow-up questions. For example, is the computerized algorithm used to detect central line-associated bloodstream infections able to discern whether the infection could be attributed to another source, e.g., a urinary tract infection? This is something that infection preventionists are trained to ferret out and may account for some of the variances observed in the study. Another challenge is ruling out contaminants from true infections, which may also account for some of the variation. The findings of the recent JAMA study are consistent with a separate study published in APIC’s American Journal of Infection Control (AJIC) by Matthew Niedner, MD. The AJIC author writes, “With increased mandatory public reporting of catheter-associated bloodstream infections and the insurance ramifications of such never events, the inter-institutional variability introduced by surveillance techniques warrants further scrutiny – both to improve public health through accurate measurement, but also to reduce the possibility of gaming the system or being punitive to centers exercising diligence.” The inconsistencies identified in these studies reflect the challenges inherent in healthcare-associated infection (HAI) surveillance. Even when supported by the Centers for Disease Control and Prevention’s (CDC’s) standard infection criteria and definitions, as available via the National Healthcare Safety Network (NHSN), complex medical cases often require in-depth analysis and case-by-case review to determine if the infection meets the CDC definition criteria. Inconsistencies in data review may reflect the differences used in case finding and HAI identification. Facilities performing greater surveillance would likely report a higher HAI rate due to a more precise measurement system. However, inconsistencies may also indicate incomplete or inaccurate surveillance efforts or different ways of applying the same surveillance criteria. Therefore, the detection of inconsistencies in HAI data reinforces the increasingly urgent need for data validation. APIC, a champion of public HAI reporting, strongly supports validation of data which must include both internal and external review of infection data. This will help to ensure that infection rates accurately support both the comparisons among facilities, as well as informed decision making by consumers. Fortunately, funding provided by the American Recovery and Reinvestment Act of 2009 is currently supporting data validation
  5. 5. studies in several states – some of these include direct engagement of APIC. These projects will help direct future efforts to assure accuracy and comparability in state and national HAI statistics. APIC does not support sole reliance on other sources of data, such as administrative or claims, as these are even less precise than surveillance data collected by trained infection preventionists. Under no circumstances should the recent JAMA study be used to support use of claims or administrative data over surveillance data. Meanwhile, hospital administrators can best ensure accurate HAI rates by building a robust infection prevention infrastructure. The optimum infrastructure will likely necessitate a combination of electronic surveillance technology with appropriate staffing for infection preventionists and other personnel well-qualified to manage its use in complex and often challenging clinical situations. Engagement by leadership is essential to the success of all infection prevention programs to ensure the most accurate information for the public, as well as to provide optimal patient care. APIC has developed a Program Evaluation Tool to assist its members and their affiliates with identification of adequate infrastructure to assure a properly resourced infection prevention program. In addition, APIC, through its scientific journal AJIC, publishes case studies to improve the application of NHSN criteria for its members. It is imperative that all infection prevention stakeholders work together to determine the true incidence of HAIs in order to reward good performance and allow consumers to make informed choices about their healthcare. Visit APIC for more information. http://www.apic.org/Content/NavigationMenu/GovernmentAdvocacy/PublicPolicyLibrary/ID_of_HAIs_US_Hospitals_1010.pdf Diabetes has reached epidemic proportions in India, says expert Diabetes has reached epidemic proportions in the country and is increasing with 'tsunamic' speed, a top expert of the Aligarh Muslim University (AMU) said Saturday. “More than 75 percent of heart attack patients are either diabetic or undiagnosed. A vast majority of patients undergoing renal dialysis and transplants have diabetes as the underlying cause,” said Prof. Jamal Ahmad, director, Centre of Diabetes and Endocrinology, J.N. Medical College, AMU. He said India had 50 million diabetes patients, and more than 95 percent of the population suffers from some form of the disease. “Early diagnoses and optimal management can significantly decrease the mortality associated with this dreaded disease,” he said. Visit here for the article. http://news.in.msn.com/national/article.aspx?cp-documentid=4574115
  6. 6. studies in several states – some of these include direct engagement of APIC. These projects will help direct future efforts to assure accuracy and comparability in state and national HAI statistics. APIC does not support sole reliance on other sources of data, such as administrative or claims, as these are even less precise than surveillance data collected by trained infection preventionists. Under no circumstances should the recent JAMA study be used to support use of claims or administrative data over surveillance data. Meanwhile, hospital administrators can best ensure accurate HAI rates by building a robust infection prevention infrastructure. The optimum infrastructure will likely necessitate a combination of electronic surveillance technology with appropriate staffing for infection preventionists and other personnel well-qualified to manage its use in complex and often challenging clinical situations. Engagement by leadership is essential to the success of all infection prevention programs to ensure the most accurate information for the public, as well as to provide optimal patient care. APIC has developed a Program Evaluation Tool to assist its members and their affiliates with identification of adequate infrastructure to assure a properly resourced infection prevention program. In addition, APIC, through its scientific journal AJIC, publishes case studies to improve the application of NHSN criteria for its members. It is imperative that all infection prevention stakeholders work together to determine the true incidence of HAIs in order to reward good performance and allow consumers to make informed choices about their healthcare. Visit APIC for more information. http://www.apic.org/Content/NavigationMenu/GovernmentAdvocacy/PublicPolicyLibrary/ID_of_HAIs_US_Hospitals_1010.pdf Diabetes has reached epidemic proportions in India, says expert Diabetes has reached epidemic proportions in the country and is increasing with 'tsunamic' speed, a top expert of the Aligarh Muslim University (AMU) said Saturday. “More than 75 percent of heart attack patients are either diabetic or undiagnosed. A vast majority of patients undergoing renal dialysis and transplants have diabetes as the underlying cause,” said Prof. Jamal Ahmad, director, Centre of Diabetes and Endocrinology, J.N. Medical College, AMU. He said India had 50 million diabetes patients, and more than 95 percent of the population suffers from some form of the disease. “Early diagnoses and optimal management can significantly decrease the mortality associated with this dreaded disease,” he said. Visit here for the article. http://news.in.msn.com/national/article.aspx?cp-documentid=4574115

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