Risk Calculator for Cholesterol Appears Flawed nytimes.com/2013/11/18/hea…, see more
Mostrando las entradas con la etiqueta New York Times. Mostrar todas las entradas
Mostrando las entradas con la etiqueta New York Times. Mostrar todas las entradas
19 noviembre, 2013
Risk calculator for Cholesterol
Risk Calculator for Cholesterol Appears Flawed nytimes.com/2013/11/18/hea…, see more
02 julio, 2013
Women Hit Hard in Rising Toll From Painkiller Overdoses
Source: New York Times 7-2-2013
Prescription painkiller addiction has long been seen as mainly a man’s
problem, but a new analysis of federal data released Tuesday shows that
in recent years the death rate has risen far faster among women.
Fatal overdoses from prescription pain pills increased fivefold among
women from 1999 to 2010, the most recent year for which the federal
government has final data. The rate among men tripled over the same
period, according to the analysis, which was conducted by the Centers for Disease Control and Prevention.
More women die from drug overdoses than from cervical cancer or car
accidents. Four times as many died over the last decade from drug
overdoses than from homicides. And while the absolute number of overdose
deaths is still higher for men, women are catching up.
The rising rate of overdoses among women is what Dr. Thomas R. Frieden,
the director of the C.D.C., called “a sleeper problem.” Even medical
professionals who work in the field expressed surprise, he said.
“It’s a big problem among women,” Dr. Frieden said. “It’s underrecognized.”
Experts offered medical theories for the rise. Women have smaller body
mass than men, so the gap between a therapeutic dose and a dangerous
dose is narrower. Some studies have found that women are more likely to
have chronic pain. Other patterns in women are not well understood. For
example, they are more likely to be given higher doses of painkillers,
and more likely than men to use them for a long time.
Women addicts interviewed for this article said they believed that it
had to do with the changing nature of American society. The rise of the
single-parent household has thrust immense responsibility on women, who
are both the primary breadwinner and parent. Some said they craved the
numbness that drugs bring as a response to feeling overwhelmed by life’s
responsibilities. Others said highs brought feelings of prettiness,
strength and productiveness.
The rate among women for all drug overdose deaths — not just those from
painkillers — was highest for those ages 45 to 54, the C.D.C. analysis
found. In 2010, 15,323 women died of drug overdoses, compared with
23,006 men. Among men and women, the highest death rate was among Native
Americans and whites.
19 mayo, 2013
Cancer Risks for BRCA1 and BRCA2 Mutation Carriers: Results From Prospective Analysis of EMBRACE
Source: http://jnci.oxfordjournals.org/content/early/2013/04/26/jnci.djt095
Cancer Risks for BRCA1 and BRCA2 Mutation Carriers: Results From Prospective Analysis of EMBRACE
- Nasim Mavaddat,
- Susan Peock,
- Debra Frost,
- Steve Ellis,
- Radka Platte,
- Elena Fineberg,
- D. Gareth Evans,
- Louise Izatt,
- Rosalind A. Eeles,
- Julian Adlard,
- Rosemarie Davidson,
- Diana Eccles,
- Trevor Cole,
- Jackie Cook,
- Carole Brewer,
- Marc Tischkowitz,
- Fiona Douglas,
- Shirley Hodgson,
- Lisa Walker,
- Mary E. Porteous,
- Patrick J. Morrison,
- Lucy E. Side,
- M. John Kennedy,
- Catherine Houghton,
- Alan Donaldson,
- Mark T. Rogers,
- Huw Dorkins,
- Zosia Miedzybrodzka,
- Helen Gregory,
- Jacqueline Eason,
- Julian Barwell,
- Emma McCann,
- Alex Murray,
- Antonis C. Antoniou,
- Douglas F. Easton,
- on behalf of EMBRACE
+ Author Affiliations
- Correspondence to: Nasim Mavaddat, MBBS, PhD, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK (e-mail: nasim@srl.cam.ac.uk).
- Received July 24, 2012.
- Revision received March 20, 2013.
- Accepted March 22, 2013.
Abstract
Background Reliable estimates of cancer risk are critical for guiding management of BRCA1 and BRCA2
mutation carriers. The aims of this study were to derive penetrance
estimates for breast cancer, ovarian cancer, and contralateral
breast cancer in a prospective series of
mutation carriers and to assess how these risks are modified by common
breast cancer
susceptibility alleles.
Methods Prospective cancer risks were estimated using a cohort of 978 BRCA1 and 909 BRCA2
carriers from the United Kingdom. Nine hundred eighty-eight women had
no breast or ovarian cancer diagnosis at baseline,
1509 women were unaffected by ovarian cancer,
and 651 had been diagnosed with unilateral breast cancer. Cumulative
risks were
obtained using Kaplan–Meier estimates.
Associations between cancer risk and covariables of interest were
evaluated using Cox
regression. All statistical tests were
two-sided.
Results The average cumulative risks by age 70 years for BRCA1 carriers were estimated to be 60% (95% confidence interval [CI] = 44% to 75%) for breast cancer, 59% (95% CI = 43% to 76%)
for ovarian cancer, and 83% (95% CI = 69% to 94%) for contralateral breast cancer. For BRCA2 carriers, the corresponding risks were 55% (95% CI = 41% to 70%) for breast cancer, 16.5% (95% CI = 7.5% to 34%) for ovarian
cancer, and 62% (95% CI = 44% to 79.5%) for contralateral breast cancer. BRCA2
carriers in the highest tertile of risk, defined by the joint genotype
distribution of seven single nucleotide polymorphisms
associated with breast cancer risk, were at
statistically significantly higher risk of developing breast cancer than
those
in the lowest tertile (hazard ratio = 4.1, 95%
CI = 1.2 to 14.5; P = .02).
Management of hereditary breast and ovarian cancer syndrome and patients with BRCA mutations
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| Ovarian and breast cancer patients in a pedigree chart of a family (Photo credit: Wikipedia) |
Read More
15 mayo, 2013
La doble mastectomía de Angelina Jolie impulsa las acciones del fabricante de pruebas genéticas Myriad Genetics
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| Angelina Jolie at the premiere of Alexander in Cologne. Español: Angelina Jolie en el estreno de Alejandro Magno en Colonia. Français : Angelina Jolie à la première du film Alexandre à Cologne. Italiano: Angelina Jolie alla prima del film Alexander a Colonia. Português: Angelina Jolie na estréia do filme Alexandre Magno em Colônia. (Photo credit: Wikipedia) |
Via: Martin Cañas
el Economista, 14/05/2013Las acciones del fabricante de pruebas genéticas Myriad Genetics llegaron a dispararse hasta un 4 por ciento después de que la actriz Angelina Jolie detallase su decisión de someterse a una mastectomía doble. La decisión se produjo tras las pruebas que mostraban que es portadora del gen BRCA, que potencia el cáncer de mama.
Jolie detalló su decisión en un artículo de opinión publicado en The New York Times donde dijo tener "un gen defectuoso", el BRCA1, que aumenta bruscamente el riesgo de desarrollar cáncer de mama y cáncer de ovario. Jolie, cuya madre murió de cáncer de mama, dijo que eligió someterse a esta cirugía agresiva para reducir el riesgo de padecer cáncer de mama.
Myriad Genetics es la compañía encargada de hacer la prueba predictiva del cáncer de mama y ovario hereditarios que contienen los genes BRCA1 y BCRA2. Las acciones de esta compañía se han revalorizado más de un 19 por ciento desde que comenzase el año.
En un comunicado, un portavoz de Myriad animó a los pacientes a hablar con sus proveedores de atención médica acerca del riesgo hereditario de cáncer. "Creemos firmemente el uso apropiado de muchas de nuestras pruebas de diagnóstico puede ayudar a reducir las enfermedades, hospitalizaciones y otras intervenciones costosas, y potencialmente reducir los costes de atención médica", aseguró.
El portavoz explicó que bajo la Ley de Cuidado de Salud Asequible, popularmente conocido como Obamacare, las pruebas genéticas BRACA serán totalmente cubiertas. Así, los pacientes de riesgo no serán responsable de los copagos para la detección del cáncer. Es decir, aquellos que están en riesgo podrían librarse de pagar una prueba cuyo coste asciende a los 3.000 dólares.
Si bien la eficacia de esta prueba está más que probada, la patente de Myriad sobre los genes BRCA es el centro de atención de un caso que debate el Supremo de EEUU, donde se cuestiona si se puede patentar un gen. El caso está siendo seguido de cerca por la industria de biotecnología y el sector farmacéutico.
Myriad tiene los derechos exclusivos de mas de dos docenas de patentes en todo el mundo sobre los genes BRCA. La compañía patentó su descubrimiento después de aislar los genes en la década de 1990 y desarrollar una prueba para generar un marcador genético. El fabricante sostiene que el aislamiento de las moléculas llevado a cabo, y su aplicación, son comparables al desarrollo de un nuevo producto químico ya que el gen por sí mismo no detecta el cáncer.
05 mayo, 2013
Why Patients Don’t Report Medical Errors
Are we talking only about Medicare in USA ? Seems to be genocide.
I was recently browsing through the nearly 200 stories we’ve compiled with our Patient Harm Questionnaire,
when I was reminded again of a troubling truth. Many of the people who
suffer harm while undergoing medical care do not file formal complaints
with regulators. The reasons are numerous: They’re often traumatized,
disabled, unaware they’ve been a victim of a medical error or don’t
understand the bureaucracy.
That’s a problem for those individual patients and for the rest of us. There are many places to complain: a state licensing agency; a professional licensing board that monitors doctors or nurses; the Joint Commission, which accredits hospitals or a Medicare Quality Improvement Organization. But if there are no complaints, there are no independent investigations, and that means no outside accountability for providers who may have made mistakes, and no public inspection reports that documents the case -- assuming an agency makes reports public, which is not always the case. It’s a collective problem because patient safety flaws that remain hidden, if they are not corrected, may be repeated.
We have staggering estimates of the number of people harmed while undergoing medical treatment. A review of medical records by the U.S. Health and Human Services Department’s inspector general found that in a single month one in seven Medicare patients was harmed in the hospital, or roughly 134,000 people. “An estimated 1.5 percent of Medicare beneficiaries experienced an event that contributed to their deaths,” the IG found, “which projects to 15,000 patients in a single month.”
But there’s no central system in place to tally and track these events. There’s no way to know when and where patients are being harmed or to tell if the problem is worse in one place than another.
It’s not like keeping track of patient harm is a new idea. More than a decade ago the Institute of Medicine’s landmark “To Err Is Human” report called for a national system to capture cases of serious harm to patients or death. The report said accurate reporting provides accountability and knowledge that leads to learning. That’s information that could save lives.
“You really can’t improve what you don’t measure,” said Dr. Julia Hallisy, president of the Empowered Patient Coalition. “How do you know where to focus your improvement efforts if you haven’t measured what’s happening in the first place?”
Efforts at the state level appear to be falling short, according to federal inspectors. In many states, hospital are required by law to file a report every time a patient suffers unexpected harm -- often called “sentinel” or “adverse” events. But a July report by the HHS inspector general’s office found that only 12 percent of harmful events identified by the office even met state requirements for reporting them. Compounding the problem: Hospitals themselves only reported 1 percent of the harmful events.
We found something similar when I was a reporter in Las Vegas. We used hospital billing records to identify 3,689 cases of patient harm at the city’s hospitals in a two-year period. Each of those cases would fit the state’s definition of a “sentinel event,” meaning the hospitals were required by law to report them. Yet in the same time period they reported to the state only 402 sentinel events.
The federal Agency for Healthcare Research and Quality is now accepting public comment about a proposed program to encourage consumers to complain about harm suffered while undergoing medical care. The goals include collecting information in a common format, developing prototype methods for gathering information on the phone and Internet and creating a follow-up questionnaire for medical providers. Patients will be asked what happened, who was involved and for permission to follow up with the providers involved in the event.
I recently referred the 1,000 members of the ProPublica Patient Harm Facebook Group to a story about the proposal in The New York Times. Many members of the group have suffered harm firsthand and filed complaints, so the article created lively discussion:
That’s a problem for those individual patients and for the rest of us. There are many places to complain: a state licensing agency; a professional licensing board that monitors doctors or nurses; the Joint Commission, which accredits hospitals or a Medicare Quality Improvement Organization. But if there are no complaints, there are no independent investigations, and that means no outside accountability for providers who may have made mistakes, and no public inspection reports that documents the case -- assuming an agency makes reports public, which is not always the case. It’s a collective problem because patient safety flaws that remain hidden, if they are not corrected, may be repeated.
We have staggering estimates of the number of people harmed while undergoing medical treatment. A review of medical records by the U.S. Health and Human Services Department’s inspector general found that in a single month one in seven Medicare patients was harmed in the hospital, or roughly 134,000 people. “An estimated 1.5 percent of Medicare beneficiaries experienced an event that contributed to their deaths,” the IG found, “which projects to 15,000 patients in a single month.”
But there’s no central system in place to tally and track these events. There’s no way to know when and where patients are being harmed or to tell if the problem is worse in one place than another.
It’s not like keeping track of patient harm is a new idea. More than a decade ago the Institute of Medicine’s landmark “To Err Is Human” report called for a national system to capture cases of serious harm to patients or death. The report said accurate reporting provides accountability and knowledge that leads to learning. That’s information that could save lives.
“You really can’t improve what you don’t measure,” said Dr. Julia Hallisy, president of the Empowered Patient Coalition. “How do you know where to focus your improvement efforts if you haven’t measured what’s happening in the first place?”
Efforts at the state level appear to be falling short, according to federal inspectors. In many states, hospital are required by law to file a report every time a patient suffers unexpected harm -- often called “sentinel” or “adverse” events. But a July report by the HHS inspector general’s office found that only 12 percent of harmful events identified by the office even met state requirements for reporting them. Compounding the problem: Hospitals themselves only reported 1 percent of the harmful events.
We found something similar when I was a reporter in Las Vegas. We used hospital billing records to identify 3,689 cases of patient harm at the city’s hospitals in a two-year period. Each of those cases would fit the state’s definition of a “sentinel event,” meaning the hospitals were required by law to report them. Yet in the same time period they reported to the state only 402 sentinel events.
The federal Agency for Healthcare Research and Quality is now accepting public comment about a proposed program to encourage consumers to complain about harm suffered while undergoing medical care. The goals include collecting information in a common format, developing prototype methods for gathering information on the phone and Internet and creating a follow-up questionnaire for medical providers. Patients will be asked what happened, who was involved and for permission to follow up with the providers involved in the event.
I recently referred the 1,000 members of the ProPublica Patient Harm Facebook Group to a story about the proposal in The New York Times. Many members of the group have suffered harm firsthand and filed complaints, so the article created lively discussion:
- Robin Karr said that based on her experience, she’s skeptical about reporting harm directly to the government “but not without hope” about the proposed program.
- Debra Van Putten said she knows many people who have filed complaints about harm they suffered, but little came of their efforts. Patients want more than mere acknowledgement, she said. They want accountability for whoever is responsible.
- Martha Deed said there are so many barriers to a patient reporting harm -- emotional trauma and physical disabilities, feeling intimidated by providers, social pressure not to complain -- that a passive questionnaire is unlikely to elicit responses. Instead, the patient harm information should be gathered in a way that’s standardized, she said, like the national survey that’s administered to recently discharged hospital patients that has results publicly reported on Hospital Compare.
That’s food for thought for those developing the program. Official public comment is due Nov. 9 and can be sent to Doris Lefkowitz, the AHRQ reports clearance officer: doris.lefkowitz@AHRQ.hhs.gov.
We’d also love to hear your comments. How do those of you who work in the medical field feel about this type of reporting system? Patients, what do you think about it? And what would you recommend as characteristics that would be essential to such a program?
04 noviembre, 2012
Sicko / Недъзи
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| Official photographic portrait of US President Barack Obama (born 4 August 1961; assumed office 20 January 2009) (Photo credit: Wikipedia) |
In 4 days USA will vote again between Democrats and Republicans.....the old division which doesn't mean nothing because you have Congresists and Senators who think the same no matter which is the Party on the "Administration" ( good word administration because the real power is in Goldman Sachs but not in Presidents).
Obama promised a new Health Care Reform.............nothing happpens for real.....now the cost has increased in USA..........more money doesnt mean more health....is Obama a real change ? In my opinion, this election is only about when another war will begin.........3 days with Roomey, 3 months with Obama ? Nothing changes.......God Bless the USA Impery.
Many years ago Michael Moore show us this movie......just time to think in America.......( Im also American.......I live in South America). Don't worry.......Obama will prevail......Sicko.....another love story of the capitalism in health care sistems.
Oказва се че американската мечта не е това което милиони а може би милиарди хора по света мислят, и че Америка далеч не е мястото където бих искал да живея. Майкъл Мур ми го доказа с този филм. Гледайте го!!!
Един потресаващ филм на режисьора Майкъл Мур, които съвсем скоро излезе по кината и бързо завладя публиката. "Sicko" (Недъзи) влезе в тройката на най-печелившите и успешни документални филми в момента. Лентата представя всички недъзи и порочни неща в некачественото и потресаващо американско здравеопазване. След като гледате този филм няма да посмеете да се оплаквате от българското здравеопазване!
Obama promised a new Health Care Reform.............nothing happpens for real.....now the cost has increased in USA..........more money doesnt mean more health....is Obama a real change ? In my opinion, this election is only about when another war will begin.........3 days with Roomey, 3 months with Obama ? Nothing changes.......God Bless the USA Impery.
Many years ago Michael Moore show us this movie......just time to think in America.......( Im also American.......I live in South America). Don't worry.......Obama will prevail......Sicko.....another love story of the capitalism in health care sistems.
Oказва се че американската мечта не е това което милиони а може би милиарди хора по света мислят, и че Америка далеч не е мястото където бих искал да живея. Майкъл Мур ми го доказа с този филм. Гледайте го!!!
Един потресаващ филм на режисьора Майкъл Мур, които съвсем скоро излезе по кината и бързо завладя публиката. "Sicko" (Недъзи) влезе в тройката на най-печелившите и успешни документални филми в момента. Лентата представя всички недъзи и порочни неща в некачественото и потресаващо американско здравеопазване. След като гледате този филм няма да посмеете да се оплаквате от българското здравеопазване!
Translated to Russian
15 mayo, 2012
Overload information and marketing
Making Choices in the Age of Information Overload
Illustrations by Grant Snider
By ADAM DAVIDSON
Published: May 15, 2012, New York Times.
Recently my wife and I went on an epic hunt to uncover everything possible about baby formula. We scoured more Web sites than I’d like to admit to and learned about all the options: powder, liquid, milk-based, soy, D.H.A.- and A.R.A.-fortified. (I’m still not clear on what A.R.A. is, exactly.) Then we learned that none of it actually matters. Since the Infant Formula Act of 1980, the F.D.A. makes sure that all formula is pretty much the same, no matter which one you buy.
Despite knowing this, I still insist on paying twice as much for Enfamil, which its maker claims is “scientifically designed.” (Aren’t they all?) I splurge because Mead Johnson is a 107-year-old company that has been promoting a single baby-formula brand for more than 50 years. I figure that it’s less likely to squander its name by skirting the rules or engaging in shoddy manufacturing than a company with less to lose. This peace of mind costs me about $7 per day.
Economists have a name for these cues that companies employ to convey their hidden strength: signaling. We see various forms of it everywhere, from the wristwatches of wealthy bankers to the nuclear arsenals of developing countries. Technology companies keep massive financial reserves to show potential competitors that they won’t back down in a fight. Why do people pay so much, in dollars and sweat, to go to a top-tier college? It might offer a superior education, but it definitely shows future employers that they are smart and willing to work hard. (Though it can also suggest that the student comes from a wealthy background. That, for some, is an even more powerful signal.) Sixty years ago, Edmund Hillary and Tenzing Norgay signaled their perseverance by climbing Mount Everest. Now, for upward of $60,000, relative amateurs can achieve the same thing, albeit with the help of state-of-the-art breathing equipment, climbing gear and a team of Sherpas.
Signaling is also often associated with consumer goods. In many ways, it was useful. How does anyone really know that they’ve picked the right baby formula, soda or car? They don’t, and manufacturers know that. That’s why our economy is filled with highly promoted branding campaigns that, however superficial or annoying, can be enormously helpful guides. In 1982, Coca-Cola demonstrated its market power with a star-studded commercial, featuring Bob Hope and Joe Namath, to introduce Diet Coke. Pepsi recently paid a fortune to hire Nicki Minaj as a spokeswoman. Even for consumers who don’t listen to her music or trust her expertise in the carbonated-beverage sector, the mere act of paying for a pop-star endorser sends a subconscious signal that their product is so successful that, well, they can afford Nicki Minaj. It also signals that the company is too heavily invested to turn out a shoddy product. For many, that’s a reason to choose the soda over the generic stuff.
In a way, the Minaj endorsement surprised me. I had assumed that kind of signaling was destined to be a relic of the pre-Internet age — a time when people couldn’t pull up an objective review on their phones while perusing the soda aisle. According to some economists, however, signaling seems to be increasing throughout our economy. Why are we listening to signals when we can do the research ourselves?
The Internet is, among other things, a massive, chaotic marketplace. Too much information, it turns out, is a lot like no information. “If we researched every single purchase, we wouldn’t have time to make any purchases,” says Anna Kirmani, a marketing professor at the University of Maryland. “I have better things to do with my time.”
Signaling can be a shorthand to identify whom you want to buy from. That’s why we may need it now more than ever. Hemant Bhargava, a business professor at the University of California, Davis, told me that he has been thinking about signaling as he decorates his new home. Though he is looking for good deals, he still worries about vendors outside the major brands. Bhargava recently found one chandelier for $750 on Amazon and $650 on a cheaper site. He went with Amazon. “The lower price, it bothered me,” he said, indicating that he saw the discount as a signal that the company was willing to cut every cost imaginable. He ended up paying an extra $100 for some peace of mind.
Is it better to live in an economy where there’s so much chaos that we spend more to ensure our chandelier shows up unbroken or our baby formula isn’t tainted? “Oh, definitely,” Bhargava says. Sure, there’s certainly a lot of wasteful signaling, but Bhargava says that the crucial difference is that now we can each choose, purchase by purchase, moment by moment, whether we want to research a product or just trust some signal instead. After all, the chances are good that somebody else has already done the hard work of researching any product we’re interested in. “If there is a critical-enough mass of informed buyers, that is sufficient” to pressure manufacturers to make better-quality goods, Bhargava says. “That group of informed consumers creates a force. It doesn’t have to be everybody.”
According to classical theories, signaling thrives when consumers don’t have access to reliable information. But signaling actually works far better in an information-rich society than in a poor one. Port-au-Prince, Haiti, for example, is filled with numerous beautiful commuter buses that are painted with all sorts of bright, bold images — of naked women, Catholic saints, voodoo symbols, soccer players, musicians. Maintaining these paint jobs is enormously expensive. The buses need to be taken out of commission for at least a couple of weeks, and the painters demand hundreds of dollars, often more than a year’s wages in Haiti.
Yet bus owners feel the need to get a fresh paint job once or twice each year because few people will pay to ride an unpainted bus. The extravagant decorations suggest that an owner cares about his business — that he spends money maintaining his engines, tires and brakes (no small matter in a country with steep mountains and lousy roads). My hunch, however, is that many owners, short of cash, are likely to invest in a visible new paint job over invisible brake maintenance. With no external authority — government inspectors or consumer-watchdogs or online consumer forums — there’s no way to know if the signal is accurate.
The information-rich world is obviously better for consumers, but Bhargava says that it still offers considerable advantages for producers too, as demonstrated by my baby formula and his chandelier. While online competition generally drives down commodity prices, consumers have proved willing to pay more for their favorite specialty products. And there are many of them. Back when brand signaling tended to travel through broad channels like TV ads or the sides of buses, companies narrowed their offerings. They tended toward a few bland, least-common-denominator goods, like watery beer and one kind of minty toothpaste. The Internet and advances in manufacturing now allow for a much wider range of products aimed at narrower consumer interests. I might pay more for a craft beer and a bar of deluxe chocolate, but I’ll be happier than when I was saving money buying Bud Light and a waxy Hershey’s bar.
Signals, of course, can be misleading, and excessive Internet research often leads to confusion. The psychologist Barry Schwartz says he believes that many of us suffer from the paradox of choice — the more options we have, the less happy we might be. I’m not convinced it’s that simple. I feel more shopping anxiety now than I did when I just bought whatever my brand loyalty told me. But I also know I don’t have to worry about so many other purchases that I used to fret about. I just discovered that Amazon users seem to really hate Crest Pro-Health Clean Mint toothpaste. I’ll buy the better-rated one, but I do hope those ratings force Crest to reformulate or kill the one nobody likes. And I bet they will.
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