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U.S. Health Policy Idea Gets Rave Reviews From Canadians : Shots …

The Centers for Medicare and Medicaid Services — and its controversial center for innovation — is part of the U.S. Department of Health and Human Services, and has its headquarters outside D.C., in Woodlawn, Md.

Jay Mallin/Bloomberg via Getty Images

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Jay Mallin/Bloomberg via Getty Images

The Centers for Medicare and Medicaid Services — and its controversial center for innovation — is part of the U.S. Department of Health and Human Services, and has its headquarters outside D.C., in Woodlawn, Md.

Jay Mallin/Bloomberg via Getty Images

Ask people in Canada what they make of U.S. health care, and the answer typically falls between bewilderment and outrage.

Canada, after all, prides itself on a health system that guarantees government insurance for everyone. And many Canadians find it baffling that there’s anybody in the United States who can’t afford a visit to the doctor.

So even as Canadians throw shade at the American hodgepodge of public plans, private insurance, deductibles and copays, they hold in high esteem a little-known Affordable Care Act initiative: the federal Center for Medicare Medicaid Innovation.

Obamacare's Test Kitchen For Payment Experiments Faces An Uncertain Future

CMMI was a hot topic on a reporter’s recent visit to Toronto to study the single-payer health care system.

Wonky as it seems, the center’s mission — testing innovations to hold down health care costs while increasing quality — is drawing praise from many policy analysts. Researchers and clinicians talk about its potential to foster experimentation and how it has led the United States to think creatively about payment and reimbursement models.

“It is gaining traction in many circles here,” says Dr. Robert Reid, who researches health care quality at the University of Toronto.

Thanks to the ACA, the center for innovation is equipped with $10 billion each decade and sponsors on-the-ground experiments with doctors, health systems and payers. The idea is to devise and implement payment approaches for health care services that reward quality and efficiency, rather than the number of procedures performed.

“There have been some good efforts — they have tried more things than we have,” agrees Dr. Kaveh Shojania, an internist at same university who studies health care quality and safety.

Still, despite the praise emanating from north of the border, the U.S. program doesn’t get the same love on the homefront. Since taking office, President Donald Trump has moved to roll back the center’s reach.

Canada has its own reasons for seeing potential in this sort of systemic test kitchen.

Hospitals Worry Repeal Of Obamacare Would Jeopardize Innovations In Care

Health care’s growing price tag — and a payment system that doesn’t always reward keeping people healthy — is not just an American problem. The vast majority of Canadian doctors are paid through what Americans call the “fee-for-service” model. And Canadian policymakers are also looking for strategies to curb health care costs — which are a big part of federal and provincial budgets in Canada, too.

“The whole world is confronting the same issue, which is, ‘How do you pay and incentivize doctors to keep people out of the hospital and keep them healthy?’ ” says Dr. Ezekiel Emanuel, a former adviser to President Barack Obama, who pushed for the center’s initial development.

“Different places are looking at how to break out of that system, because everyone knows its perversions,” Emanuel says. “This is one place where … we are in the world among the most innovative groups.”

Emanuel says he’s not surprised to hear of the center’s appeal in Canada. He has received similar feedback from health ministers in Belgium and France, he says.

Even so, U.S. critics say CMMI’s work is a waste of money or a federal overreach.

And, so far, the Trump administration has taken steps to reduce by half the size of one high-profile Obama administration project that bundles payments for hip and knee replacements. Under the bundling program, the hospitals performing those are paid a set amount, rather than for individual services. The administration has also canceled other scheduled “bundling” projects that target payment for cardiac care and other joint replacements.

Seema Verma, Trump’s administrator of the Centers for Medicare and Medicaid Services, wrote in The Wall Street Journal in September that the innovation center was going to begin moving “in a new direction.”

A federal document recently issued by CMS suggests that the center for innovation will now emphasize cutting health care costs through strategies like market competition, eliminating fraud and helping consumers actually shop for care. It also says the innovation center will favor smaller-scale projects.

At least for now, it’s hard to interpret exactly what this means, says Jack Hoadley, a health policy analyst at Georgetown University who has previously worked at the Department of Health and Human Services.

Limiting CMMI’s footprint in the U.S. would be problematic, Emanuel says.

Meanwhile, the center’s influence in Canada, seems to be growing.

“We definitely looked to it as a model as something we can do. Like look, this happened, and why can’t we do the same thing here?” says Dr. Tara Kiran, a Toronto-based primary care doctor who also researches health care quality.

The nonprofit health newsroom Kaiser Health News is an editorially independent part of the Kaiser Family Foundation. Shefali Luthra covers health care for KHN. She’s on Twitter @shefalil.

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Health giant Sutter destroyed evidence in crucial antitrust case over high prices, judge says

Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge.

In a ruling this week, San Francisco County Superior Court Judge Curtis E.A. Karnow said Sutter destroyed documents “knowing that the evidence was relevant to antitrust issues. … There is no good explanation for the specific and unusual destruction here.”

Karnow cited an internal email by a Sutter employee who said she was “running and hiding” after ordering the records destroyed in 2015. “The most generous interpretation to Sutter is that it was grossly reckless,” the judge wrote in his 12-page ruling.

Sutter, which has 24 hospitals and nearly $12 billion in annual revenue, said the destruction was a regrettable mistake.

Madison Latino Health Fair to offer free screenings and information Saturday

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What States Can Learn From One Another on Health Care


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Some have made large improvements in certain areas. What have they done to get better?

Syrian twins during a ceremony to celebrate the success rates of maternal and infant health after the 5,000th birth at a refugee camp in the Jordanian city of Mafraq in 2016. The U.S. has one of the highest infant mortality rates among wealthy nations, although some states are showing a lot of progress.CreditMuhammad Hamed/Reuters


Nov. 16, 2017

We know that where you live matters: There are huge disparities in health and costs across the country.

The uninsured rate in Texas is six times higher than in Massachusetts. You’re four times more likely to be readmitted to the hospital in Maryland or New Jersey than in Hawaii. One-third of low-income adults in Texas forgo medical care because of cost, but only 9 percent in Vermont do. Alaska spends twice as much on health care per person as Utah does.

If all states were to improve to the level of top performers, we’d see gains across the country: 20 million more people insured and 14 million fewer skipping care because of cost; 12 million more adults screened for cancer and 500,000 more children vaccinated; 124,000 fewer hospital readmissions and 90,000 fewer premature deaths.

How can we get there? Although it’s important to learn from states at the top, it’s perhaps more instructive to see what states with large improvements are doing, or have done, to get better.

Health care is perhaps the area most consistently recognized as ripe for state-based policy innovation, in keeping with the ideal of states as laboratories of democracy. Nearly all recent health reform proposals, especially from Republicans, focus on granting states greater flexibility to design and manage their health systems.

Seema Verma, the director of the Centers for Medicare and Medicaid Services, has promised to give states an “unprecedented level of flexibility” to devise their Medicaid programs, including the option to impose work requirements. Senators Lamar Alexander and Patty Murray have put forth a plan to make it easier for states to get federal waivers to reshape their health systems.

There are good reasons to pursue such a strategy. States have markedly different populations with varying needs, resources and cultures — and systems that work well in one state may not work well in another. But what do we know about how states use health policy freedom?

Stabilizing Marketplaces and Lowering Premiums

One fundamental challenge in the Obamacare insurance marketplaces is that a few very sick patients can increase premiums for everyone, especially in states with small individual markets. To address this problem, Alaska applied for a Section 1332 waiver to expand its reinsurance program, which brings in federal funds to cover costs for people with particularly expensive conditions.

Alaska thus “reinsures” its insurers for high-cost patients, and prevents those costs from being passed on to healthier people. Because premiums don’t rise as steeply, the federal government pays out less in premium subsidies — keeping the program deficit-neutral. The waiver is expected to lower premiums by 20 percent in 2018, and insure nearly 1,500 additional Alaskans.

Minnesota recently received a similar waiver, and several other states are exploring their own reinsurance programs.

Tackling Health Care Prices

Prices for health care services vary widely across the United States with little relation to quality. The price of an M.R.I., for example, is 12 times higher in the most expensive markets than in the least expensive ones, and can vary by a factor of nine even within the same area.

In 2011, the California Public Employees’ Retirement System (Calpers) changed how it paid for common procedures, a move that drastically reduced prices and saved the state millions. Before the initiative, prices for knee and hip replacements ranged from $15,000 to $100,000 with no difference in quality. That’s when Calpers introduced reference pricing — meaning it set an upper limit on how much it would pay for a given procedure, and patients would pay the rest.

For example, Calpers would pay up to $30,000 for knee or hip surgery at 41 acceptable-quality hospitals, defined by measures like infection and readmission rates. Patients could still go wherever they wanted, but would have to cover the additional cost of a high-priced hospital.

The results were impressive. Referrals to lower-priced hospitals increased by nearly 20 percent. The average price of the procedures dropped to about $26,000 from $35,000 — driven primarily by hospitals not initially included, and hoping to compete. There was no change in how well patients did or how much they paid out of pocket. California saved $5.5 million on knee and hip operations in the first two years. It also saved $7 million on colonoscopies, $1.3 million on cataract operations, and $2.3 million on arthroscopies. Prices fell by about 20 percent for each procedure.

Reducing Infant Mortality

The United States has one of the highest infant mortality rates among wealthy nations — and does worse than even many poorer countries like Cuba and Belarus. Mississippi’s infant mortality rate puts it on par with Botswana and Bahrain. The infant mortality rate in the U.S. is nearly three times higher than in Finland or Japan.

Georgia, which recently had one of the highest infant mortality rates in the country, has had perhaps the largest improvement in the past decade. The state has taken a three-pronged approach to the problem.

First, it began a Safe to Sleep campaign to educate parents and health care providers about putting babies on their backs to sleep, in a separate bed, free of loose bedding or soft objects. The Department of Public Health developed “hot-spot” maps to focus the campaign on six areas with the highest infant mortality.

Second, based on research suggesting that short intervals between births lead to poorer outcomes, Georgia introduced a program to expand access to long-acting reversible contraception (LARC). The state received a Medicaid waiver so it could be reimbursed for LARC insertion immediately after births in the hospital, overcoming a major barrier to broader LARC use among low-income women.

Finally, Georgia aimed to reduce early elective deliveries, which increase the risk of feeding, breathing and developmental problems, by changing its reimbursement policy so that non-medically necessary inductions and cesarean sections before 39 weeks of gestation would no longer be covered.

Back to Basics

There’s much to learn from state-level innovations, but there are also general principles that apply across states. High-performing states have competitive and accessible insurance markets; strategies for data-sharing and health information technology expansion; more value-based purchasing; greater emphasis on primary care; and strong partnerships with community organizations. They also expand Medicaid.

It’s also important to note that many state-level policy changes do not require federal approval, and that states don’t always use their flexibility to improve population health. Proposals that allow states to weaken protections for those with pre-existing conditions, for example, could harm patients and their ability to access care.

Greater flexibility for states is an opportunity, not a solution. The enormous variation in quality, costs and access across the nation should remind us that experiments succeed and experiments fail. Having laboratories is probably a good thing. But it depends on what they cook up.

Dhruv Khullar, M.D., M.P.P., is a physician at NewYork-Presbyterian Hospital and a researcher at the Weill Cornell Department of Healthcare Policy and Research. Follow him on Twitter: @DhruvKhullar.


Giles Price/Institute, for The New York Times

The U.S. battle against ISIS is killing far more Iraqi civilians than acknowledged. Survivors may never learn why they were targeted. This is the story of one man who did.

Republicans held a news conference on Capitol Hill after the House of Representatives passed a tax reform bill.
Al Drago for The New York Times

Our tax burden could increase by tens of thousands of dollars, based on money we don’t even make.

President Trump visited Capitol Hill to speak to House Republicans before the vote.
Al Drago for The New York Times

Eric Thayer for The New York Times

Michelle Goldberg

It’s not necessarily fair to him. But it’s what needs to happen now.

Senator Al Franken, Democrat of Minnesota, during a Judiciary committee hearing last month.
Al Drago for The New York Times
Sarah Silverman in a clip from her show, “I Love You, America,” on which she discussed Louis C.K.

On her Hulu series, “I Love You, America,” Ms. Silverman addressed the sexual misconduct of Louis C.K., who has been a longtime friend and colleague.


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Opinion: We’ve lost one of the clearest voices on health care, Uwe Reinhardt

All journalists have a list of experts they can call to explain complicated theories and policies, but few if any could explain things as clearly and with such distinct humor as Uwe Reinhardt.

When news broke this week of Reinhardt’s death at the age of 80, it quickly reminded us of just how important and valuable Uwe had been to so many over the years. Friends and colleagues began tweeting memories of how Reinhardt had helped them, and how Uwe (pronounced OO-va) tried to change the thinking and conversation around health care in this country.

For many years, Reinhardt was an occasional guest on our program (and a number of others). And when I (or my colleagues) brought Reinhardt on as part of a panel on the show, it meant we were going for the big guns, intellectually. We called him when we needed a thinker to weigh in on the health care conundrums of the time; someone who was pressing for a higher aspiration for the country, yet was sober enough to understand its political and economic realities, and resolute enough to leave cynicism at the door.

Uwe, who wrote prolifically and served as an advisor to many government agencies, seemed to be all of that and more.

I was not especially close to Uwe, but our experiences at the program over the years march right in sync with the high praise you read elsewhere, including in these tributes. He would make the case for a fairer system that would cover more of the uninsured. He’d extol the virtues of the German system where he had grown up. He spent a considerable amount of his time breaking down why American prices were so high for health care and highlighted the lack of transparency around them.

All the while, he was extraordinarily patient and generous with his time. I think it’s safe to say this professor from the Woodrow Wilson School at Princeton University enjoyed teaching to journalists, too. Hospital readmissions? Sure, Uwe could break that down for you — or, lay out the folly, as he saw it, of the employer-based insurance system in America and its origins. All the while, he would punctuate a point with dry and sometimes acerbic humor.

Uwe Reinhardt spent a considerable amount of his time breaking down why American prices were so high for health care and highlighted the lack of transparency around them.  Photo courtesy of Princeton University, Office of Communications, Brian Wilson.

Uwe Reinhardt spent a considerable amount of his time breaking down why American prices were so high for health care and highlighted the lack of transparency around them. Photo courtesy of Princeton University, Office of Communications, Brian Wilson.

His opinions and commentary were not limited to health care. During the Iraq and Afghanistan wars, he spoke eloquently and wrote passionately about the small percentage of Americans fully appreciating the burdens of the military on those who served and their families. He was among them; his son, a Marine, was wounded in Iraq. In this op-ed in the Washington Post in 2005, he wrote about why, he thought, “the general public is so noticeably indifferent to the plight of our troops and their families.”

Several writers, experts and leaders have described Uwe as a powerful voice who served as a kind of conscience about how the American health care system operated, who it left behind and what it could strive to be. He articulated those views elegantly during the debate over “Hillarycare” in the early 1990s. And in an era before “Obamacare” became a much-debated reality and example of our polarized politics, Reinhardt never lost sight of his hopes and goals, or his gentle and civil tone.

We were grateful that he brought his insights to our viewers, too.

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Middle-Class Families Confront Soaring Health Insurance Costs …

And even though he does not need an assistant for his work as a developer of mobile apps, Ian Dixon, 38, said he might hire an employee just so he could buy health insurance as a small business, at a cost far below what he and his family would have to pay on their own.

“If one word captures all this, it’s ‘helpless,”’ Mr. Dixon said. “There’s rage and anger and all that stuff in there, too. Any reasonable person would agree that this should not be happening. And there’s no one to go talk to about it. There’s no hope that this is going to get fixed.”


Sara Stovall said she might try to reduce her hours and income, so her family could qualify for subsidies on offer to poorer families to help pay for premiums.

Matt Eich for The New York Times

The situation here in Charlottesville is an extreme example of a pattern that can be seen in other places around the country. The Affordable Care Act is working fairly well for people who receive subsidies in the form of tax credits, said Doug Gray, the executive director of the Virginia Association of Health Plans, which represents insurers. But for many others, especially many middle-class families, he said, “the premium is outrageous, and it’s unaffordable.”

Congress’s repeated efforts to repeal President Barack Obama’s signature health law have rattled insurance markets. Actions by President Trump and his administration have added still more uncertainty. Now, Senate Republicans have attached a provision to their $1.5 trillion tax cut that would repeal the health law’s mandate that most Americans have health insurance or pay a penalty.

All of those actions — along with flaws in the law itself — are having real-world impact.

“We share their pain,” Michael M. Dudley, the president and chief executive of Optima Health, said of his Virginia customers now shopping for policies on the health law’s online exchange. “The rate increases are very high. We can’t minimize that because it’s a fact.”

The Dixon family, which includes two girls ages 1 and 3, has been paying $988 a month this year for insurance provided by Anthem Blue Cross and Blue Shield. But Anthem plans will not be available in Charlottesville next year. The company told customers that uncertainty in the insurance market “does not provide the clarity and confidence we need to offer affordable coverage to our members.”

The online federal marketplace,, recommended another plan for Mr. Dixon in 2018. The new plan, offered by Optima Health, has premiums of $3,158 a month — about $37,900 a year — and an annual deductible of $9,200.


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Alternatively, Mr. Dixon could pick a lower-cost plan offered by Optima with premiums of about $2,500 a month, or $30,000 a year. But the deductible would be much higher. The Dixons would need to spend $14,400 a year for certain health care services before Optima would begin to pay.

The Stovalls are facing similar mathematics.

“Our premiums will triple to $3,000 a month, with a $12,000 deductible, and that is far, far out of reach for us,” Ms. Stovall said after researching the options for her family of four on “We are not asking for free health insurance. All we want is a reasonable chance to buy it.”


Mr. Dixon credited the Affordable Care Act with encouraging him to work for himself as a mobile app developer.

Matt Eich for The New York Times

Subsidies are available to help low- and moderate-income people pay premiums, but no financial assistance is available to a family of four with annual income over $98,400.

Optima, a division of Sentara Healthcare, invited customers to share their personal stories on its Facebook page, and they obliged, with a fusillade of plaintive and sardonic comments.

Bill Stanford, who works for a floor-covering business in Virginia Beach, said, “Optima Health Care just raised my premium from an absurd $1,767 a month to an obscene $2820.09 per month,” which is more than the mortgage payments on his home for a family of four.

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“At an average of $60 per visit,” Mr. Stanford said, “I could visit the doctor’s office 45 times a month for the premium that I’m paying. I think we will probably drop our insurance and get a gap policy.” Such short-term insurance is meant to fill temporary gaps, but typically does not cover maternity care or treatment for pre-existing medical conditions.

Mr. Dudley said in an interview that Optima, a Virginia company, felt an obligation to continue serving Virginians when larger national insurers were pulling back. But, he said, Optima is affected by the same factors destabilizing insurance markets elsewhere. These include President Trump’s decision to terminate certain federal subsidies paid to insurers and doubts about the future of the requirement for most Americans to have insurance — the individual mandate, which would be eliminated by the Senate Republicans’ tax bill.

And in the Charlottesville area, Mr. Dudley said, costs are high because many people receive care from an expensive academic medical center at the University of Virginia.

Carolyn L. Engelhard, director of the health policy program at the university’s School of Medicine, acknowledged that teaching hospitals often charged more. But another factor, she said, is that Virginia has not regulated insurance rates as aggressively as some other states.

Did You Sign up For Insurance Under the Affordable Care Act? Share Your Experience.

The Times would like to hear from Americans who are signing up for insurance under the Affordable Care Act.

Consumers are feeling the effects.

“Obamacare helped me,” Ms. Griffith said. “I had a pre-existing condition, could not get insurance and had to pay cash, nearly $30,000, for the birth of my first baby in 2010. For my second pregnancy in 2015, I was covered by Obamacare, and that was a huge financial relief.”


Continue reading the main story

But the costs for next year, she said, are mind-boggling.

She and her husband, both self-employed, expect to pay premiums of $32,000 a year for the cheapest Optima plan available to their family in 2018. That is two and a half times what they now pay Anthem. And the annual deductible, $14,400, will be four times as high.

“I have no choice,” Ms. Griffith said. “I agree that we need to make changes in the Affordable Care Act, but we don’t have time to start over from scratch. We are suffering now.”

Jill A. Hanken, a health lawyer at the Virginia Poverty Law Center, said, “People who qualify for premium tax credits are finding very affordable plans with low premiums, and those consumers are quite pleased.” But she added: “For people who don’t qualify for tax credits, the cost of plans has truly skyrocketed. They can’t afford or don’t want to pay the high premiums.”

When the Affordable Care Act was adopted in 2010, Democrats like Nancy Pelosi, who was then the House speaker, said the law would make it easier for people to switch jobs or start their own businesses because they would not have to worry about losing health insurance.

“We see it as an entrepreneurial bill,” Ms. Pelosi said, “a bill that says to someone, if you want to be creative and be a musician or whatever, you can leave your work, focus on your talent, your skill, your passion, your aspirations because you will have health care.”

And for a few years, Mr. Dixon said, that idea was appealing. “I would not be an entrepreneur if it were not for Obamacare,” he said.

With soaring premiums, that option is less attractive.

“When I saw the insurance prices for 2018, my initial instinct was to try and go back to my previous employer,” Mr. Dixon said. “But that would just smell of desperation.”

Continue reading the main story

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Health IQ raises $34.6 million for life insurance for healthy people

People who work out and eat healthily shouldn’t have to pay as much for life insurance.

That’s the concept behind Health IQ, a startup that’s been making headway in the “insureTech” category.

Venture capitalists have been betting that insurance is ready for change and Health IQ has convinced investors to put another $34.6 million in the startup for its Series C. Andreessen Horowitz is leading the round with participation from Charles River Ventures, First Round Capital, Foundation Capital and others.

Munjal Shah, co-founder and CEO of Health IQ, said that said he was inspired to start the business after encountering a health issue, right after he sold his last startup, Riya, to Google.

It started out as an online health quiz and after a million people took the test, Shah believed that he had “accidentally built the largest new mortality table in 100 years of life insurance.”

Now that quiz, which has questions about diet and exercise, is used to determine whether someone should get a discount on their policy.

Health IQ provides life insurance with a 4% discount for people who pass the quiz. Users are eligible for another 4% discount if they meet certain thresholds like running an eight-minute mile.

And he says that because it’s based on healthy lifestyle instead of family history, for some people it could save them another 25% to what they would be paying elsewhere.

“Those who have taken responsibility should get a special rate,” said Shah.

Health IQ is paid a commission by insurance carriers every time it sells someone a policy.

Shah said he would like to move beyond life insurance and expand to health insurance, but he laments that the current U.S. system doesn’t allow for healthy people to pay a lower rate.

He hopes that will change someday and that he can execute on a concept that he believes promotes “meritocracy.”

Health IQ has raised $81 million since it was founded in 2014.

Featured Image: Ascent Xmedia/Getty Images

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Coffee-Rich, Plant-Based Diets May Be Best For Heart Health

Coffee drinkers probably don’t need any additional data to support their habit, but a new study presented at the American Heart Association meeting brings some happy news anyway: It finds that each additional cup of coffee a person drinks is associated with a measurable reduction in heart risk. Also presented at the conference this week, a plant-based diet seems to be best for the heart, compared to various alternatives.

Neither of these studies offers any great revelations—earlier research has certainly revealed the same connections—but they do offer some more evidence and more specifics. And perhaps more reason for coffee-drinkers and veggie lovers alike to feel good about their routines.


The first study looked at data from the Framingham Heart Study, which has been following participants for decades, tracking their lifestyle habits and health outcomes. Using machine learning to analyze the data, the team found that coffee was strongly associated with heart health: for each additional cup of coffee consumed per week, the risk of heart failure dropped by 7%, and the risk of stroke by 8%. The benefit seemed to extend up to a whopping six cups per day, which was the most people in the study tended to drink. For those of us who drink multiple cups per day, this is great news.

The other study, on dietary habits and heart health, used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, which has been tracking people middle-aged and older over time. The researchers also looked for correlations, this time between five different types of diet and heart health. The plant-based diet, which consisted largely of leafy vegetables, fruits, beans and fish, sounds a lot like the Mediterranean diet. There was also the “convenience diet,” made up of red meats, pasta, fast foods and fries. The “sweets diet” was carb- and sugar-heavy. The “Southern diet” consisted was heavy on fried foods, organ meats, processed foods, eggs, and sugar-sweetened drinks. Finally, the “alcohol/salads diet” was marked by consumption of leafy vegetables, salad dressings, butter, wine and liquor.

The plant-based diet was linked to a reduction in risk for heart failure (up to 42%), compared to those which consisted of the fewest vegetables. Unsurprisingly, the other types weren’t associated with any heart benefits.

For coffee, it’s likely the antioxidants that may account for much of the heart benefit. As for a plant-based diet, aside from the rich antioxidants, vitamins and minerals, the fiber and healthy fats may add to the benefit.

Keep in mind these were both presentations at a conference, so haven’t been peer-reviewed or published in a journal. They’re also just correlations, and although potentially confounding variables were accounted for, it’s possible that there’s more to the story than what we see here. But because both findings agree strongly with previous research, it’s probably OK to take them as more evidence for a plant-based and coffee-rich lifestyle.

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Could The U.S. Pursue A Public Health Response To Gun Violence …

More than 30,000 people a year are killed by gun violence, including 50 killed near the Los Vegas strip last month where this makeshift memorial stands.

Drew Angerer/Getty Images

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Drew Angerer/Getty Images

More than 30,000 people a year are killed by gun violence, including 50 killed near the Los Vegas strip last month where this makeshift memorial stands.

Drew Angerer/Getty Images

When U.S. officials feared an outbreak of the Zika virus last year, the Department of Health and Human Services and state officials kicked into high gear.

They tested mosquitoes neighborhood by neighborhood in Miami and other hot Gulf Coast communities where the virus was likely to flourish. They launched outreach campaigns to encourage people to use bug spray. And they pushed the development of a vaccine.

“The response was swift,” says former Surgeon General Vivek Murthy, and was even faster during the Ebola outbreak a year earlier.

But last month when 50 people died and more than 400 were injured in Las Vegas, and weeks later another 26 died in Texas of the same cause, public health officials have had almost no role.

Texas Shooter's History Raises Questions About Mental Health And Mass Murder

That’s because the victims in Las Vegas and Texas were killed with guns. And over the last three decades, Congress has made it clear that they don’t want the public health community looking too hard into the causes of the violence.

“If you look at the number of people who have died or been injured from gun violence, that dwarfs the number of people who have been affected by Zika or Ebola. There’s absolutely no comparison,” Murthy says.

More than 30,000 people are killed with guns in the U.S. every year. That’s more than die of AIDS, and about the same number as die in car crashes or from liver disease. But unlike AIDS or car crashes, the government doesn’t treat gun injuries or deaths as a public health threat.

Murthy and other public health experts say it should.

Funding For Research On Gun Violence Compared To Other Leading Causes Of Death

Funding represents the total funding awarded over the years 2004 to 2015. Dollar amounts have not been corrected for the year in which they were reported. (Note: Funding and mortality rate values are plotted on a logarithmic scale.)

funding chart

Source: JAMA

“It should be no different than the approach we take to cancer, heart disease or diabetes,” he says.

But such an approach would have to start essentially from scratch. The government spends only about $22 million a year on research into gun violence — a tiny fraction of what it spends on other major health threats.

That’s because of Congress. Back in 1997, lawmakers added a provision in the bill that funds the Centers for Disease Control and Prevention barring the agency from doing anything that would “advocate or promote gun control.” At the same time, they cut CDC’s budget by the exact amount it had been spending in gun violence research up until then.

So government research into the causes of gun deaths virtually stopped.

The issue comes up routinely after mass shootings. Two years ago, after a young man killed nine people in a church in South Carolina, a reporter asked former Republican House Speaker John Boehner about the CDC restrictions.

“The CDC is there to look at diseases that need to be dealt with to protect the public health. I’m sorry but a gun is not a disease,” he said at the time.

After the most recent shootings, Democrats in Congress have called for more restrictions on guns while Republicans, including President Trump, say the problem is mental health.

Gun Violence: How The U.S. Compares With Other Countries

But neither conclusion is backed by research, says Dr. Georges Benjamin, the executive director of the American Public Health Association.

“When a new disease, particularly an infectious disease, enters the community … we have a mechanism to anticipate it, track it, get our arms around it,” he says. “We do that when he have measles, mumps, chicken pox, zika. But firearm-related death and disability, we don’t.”

That kind of prior knowledge could lead to policies that reduce the toll of gun injuries without cutting off access to them.

“Firearms are a tool, and … a consumer product. And unlike other consumer products, we’re not working hard to make that consumer product safer,” he says.

Take cars for example. Benjamin points to the combination of safety features — airbags and seat belts — and safety policies like requiring licensing and banning drunk driving — that have made cars less lethal, while ensuring they’re still available.

A similar strategy with guns could lead to some laws or regulations that make them safer.

That could involve barring large ammunition clips to limit the number of shots a person could take, or requiring trigger locks that open by fingerprint, allowing only the gun owner to fire a weapon.

“We could think about where firearms ought not to be,” he says. “Alcohol and firearms and people who might get a little rowdy probably are not a good combination. There are solutions to that.”

Creating more shooting ranges may be a good idea so gun owners have a safe place to use their weapons, he says.

Today, Benjamin says, there is no data to show whether people are safer in communities with more or fewer guns.

Something has to change, because up until now, “We have done everything we can to ensure that this epidemic of death and disability from firearms is only going to get worse,” he says.

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Indulgent grandparents ‘bad for children’s health’

Grandmother and grandchildrenImage copyright

Indulgent grandparents may be having an adverse impact on their grandchildren’s health, say researchers.

The University of Glasgow study, published in PLOS One journal, suggests grandparents are often inclined to treat and overfeed children.

The study also found some were smoking in front of their grandchildren and not giving them sufficient exercise.

Lucy Peake, of the charity Grandparents Plus, said grandparents needed to be “better recognised and supported”.

“Grandparents want the best for their grandchildren, and the more they’re informed and enabled to play a positive role in their grandchildren’s lives the better things will be,” said Ms Peake.

  • Children with obesity ‘need NHS help’
  • Parents ‘may be overfeeding infants’

The researchers looked at 56 studies with data from 18 countries, including the UK, US, China and Japan.

The report focused on the potential influence of grandparents who were significant – but not primary – caregivers in a child’s early years.

The review considered three key areas of influence:

  • diet and weight
  • physical activity
  • smoking

Image copyright
Getty Images

In terms of both diet and weight, the report concluded that grandparents’ behaviour had an adverse effect.

Grandparents were characterised by parents as “indulgent” and “misinformed”, and accused of using food as an emotional tool.

Many studies found they were inclined to feed grandchildren high-sugar or high-fat foods – often in the guise of a treat.

Parents felt unable to interfere because they were reliant on grandparents helping them out.

The study also found that grandchildren were perceived to be getting too little exercise while under the care of their grandparents.

Physical activity levels appeared to be related to whether grandparents were active themselves, or whether there was appropriate space where children could be active.

Some grandparents actively promoted exercise by taking grandchildren to sporting events or the park.

But where grandparents were sedentary, children were likely to be too.


Smoking around the children, even when they had been asked not to, became an area of conflict between grandparents and parents.

Conversely, in certain cases, the birth of a grandchild became a catalyst to a grandparent giving up smoking – or changing their habits.

Lead researcher Dr Stephanie Chambers said: “From the studies we looked at, it appears that parents often find it difficult to discuss the issues of passive smoking and over-treating grandchildren.

“While the results of this review are clear that behaviour such as exposure to smoking and regularly treating children increases cancer risks as children grow into adulthood, it is also clear from the evidence that these risks are unintentional.

“Given that many parents now rely on grandparents for care, the mixed messages about health that children might be getting is perhaps an important discussion that needs to be had.”

According to Grandparents Plus, grandparents are “the largest provider of informal childcare” in the UK.

The charity’s chief executive, Ms Peake, said: “We know that children benefit enormously from having close relationships with their grandparents right through childhood into adolescence.

“What this study shows is that the role they’re playing in children’s lives needs to be better recognised and supported.

“We’d like to see more focus on ensuring that information available to parents about children’s health reaches grandparents too.”

Prof Linda Bauld, from Cancer Research UK, which part-funded the study, said: “With both smoking and obesity being the two biggest preventable causes of cancer in the UK, it’s important for the whole family to work together.

“If healthy habits begin early in life, it’s much easier to continue them as an adult.”

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